In this view from 2007–2009, the ethical challenges facing a potential global effort to control infectious disease are explored; they provide sobering insight into the challenges of later decades. Despite the devastating pandemic of HIV/AIDS that erupted in the early 1980s, despite the failure to eradicate polio and the emergence of resistant forms of tuberculosis that came into focus in the 1990s, and despite newly emerging diseases like Severe Acute Respiratory Syndrome (SARS) in 2003 and the fearsome prospect of human-to-human (...) avian flu, it is nevertheless a time of some excitement over prospects for effective control of much of infectious disease. Funded by national and international governmental and nongovernmental organizations (NGOs), private foundations, and even popular entertainers, large-scale new efforts are under way to address global killers like AIDS, tuberculosis, and malaria, among others. This “marvelous momentum” can be seen as part of a continuing effort from the time of Jenner onward. Extrapolating from this, we explore the notion of a “comprehensive global effort for the eradication, elimination or control of infectious disease”, with particular attention to the ethical issues that arise. This is to “think big” about disease-control efforts that are now often done in piecemeal ways. This chapter identifies five tracks along which such efforts need to be pursued: (1) national and international organizations and the development of collective will; (2) epidemiological and health care infrastructure; (3) scientific development; (4) religious, social, and cultural considerations; (5) legal and social protections for individuals and groups. Each of these poses significant ethical issues which, we argue, should be viewed in a comprehensive way, to ensure that practice, research, and policy in each of these areas understands the person with communicable infectious disease as both victim and (potential) vector. (shrink)

ABSTRACT In this article, we first document the virtually complete absence of infectious disease examples and concerns at the time bioethics emerged as a field. We then argue that this oversight was not benign by considering two central issues in the field, informed consent and distributive justice, and showing how they might have been framed differently had infectiousness been at the forefront of concern. The solution to this omission might be to apply standard approaches in liberal bioethics, such as autonomy (...) and the harm principle, to infectious examples. We argue that this is insufficient, however. Taking infectious disease into account requires understanding the patient as victim and as vector. Infectiousness reminds us that as autonomous agents we are both embodied and vulnerable in our relationships with others. We conclude by applying this reunderstanding of agency to the examples of informed consent and distributive justice in health care. (shrink)

This paper examines the characteristics of infectious diseases that raise special medical and social ethical issues, and explores ways of integrating both current bioethical and classical public health ethics concerns. Many of the ethical issues raised by infectious diseases are related to these diseases' powerful ability to engender fear in individuals and panic in populations. We address the association of some infectious diseases with high morbidity and mortality rates, the sense that infectious diseases are caused by invasion or attack on (...) humans by foreign micro-organisms, the acute onset and rapid course of many infectious diseases, and, in particular, the communicability of infectious diseases. The individual fear and community panic associated with infectious diseases often leads to rapid, emotionally driven decision making about public health policies needed to protect the community that may be in conflict with current bioethical principles regarding the care of individual patients. The discussion includes recent examples where dialogue between public health practitioners and medical-ethicists has helped resolve ethical issues that require us to consider the infected patient as both a victim with individual needs and rights and as a potential vector of disease that is of concern to the community. (shrink)

ABSTRACT In this article, we first document the virtually complete absence of infectious disease examples and concerns at the time bioethics emerged as a field. We then argue that this oversight was not benign by considering two central issues in the field, informed consent and distributive justice, and showing how they might have been framed differently had infectiousness been at the forefront of concern. The solution to this omission might be to apply standard approaches in liberal bioethics, such as autonomy (...) and the harm principle, to infectious examples. We argue that this is insufficient, however. Taking infectious disease into account requires understanding the patient as victim and as vector. Infectiousness reminds us that as autonomous agents we are both embodied and vulnerable in our relationships with others. We conclude by applying this reunderstanding of agency to the examples of informed consent and distributive justice in health care. (shrink)

This paper examines the characteristics of infectious diseases that raise special medical and social ethical issues, and explores ways of integrating both current bioethical and classical public health ethics concerns. Many of the ethical issues raised by infectious diseases are related to these diseases’ powerful ability to engender fear in individuals and panic in populations. We address the association of some infectious diseases with high morbidity and mortality rates, the sense that infectious diseases are caused by invasion or attack on (...) humans by foreign micro‐organisms, the acute onset and rapid course of many infectious diseases, and, in particular, the communicability of infectious diseases. The individual fear and community panic associated with infectious diseases often leads to rapid, emotionally driven decision making about public health policies needed to protect the community that may be in conflict with current bioethical principles regarding the care of individual patients. The discussion includes recent examples where dialogue between public health practitioners and medical‐ethicists has helped resolve ethical issues that require us to consider the infected patient as both a victim with individual needs and rights and as a potential vector of disease that is of concern to the community. (shrink)

Syndromic surveillance uses new ways of gathering data to identify possible disease outbreaks. Because syndromic surveillance can be implemented to detect patterns before diseases are even identified, it poses novel problems for informed consent, patient privacy and confidentiality, and risks of stigmatization. This paper analyzes these ethical issues from the viewpoint of the patient as victim and vector. It concludes by pointing out that the new International Health Regulations fail to take full account of the ethical challenges raised by syndromic (...) surveillance. (shrink)

Since testing for HIV infection became possible in 1985, testing of pregnant women has been conducted primarily on a voluntary, ‘opt-in’ basis. Faden, Geller and Powers, Bayer, Wilfert, and McKenna, among others, have suggested that with the development of more reliable testing and more effective therapy to reduce maternal-fetal transmission, testing should become either routine with ‘opt-out’ provisions or mandatory. We ask, in the light of the new rapid tests for HIV, such as OraQuick, and the development of antiretroviral treatment (...) that can reduce maternal-fetal transmission rates to <2%, whether that time is now. Illustrating our argument with cases from the United States (US), Kenya, Peru, and an undocumented Mexican worker in the US, we show that when testing is accompanied by assured multi-drug therapy for the mother, the argument for opt-out or mandatory testing for HIV in pregnancy is strong, but that it is problematic where testing is accompanied by adverse events such as spousal abuse or by inadequate intrapartum or follow-up treatment. The difference is not a ‘double standard’, but reflects the presence of conflicts between the health interests of the mother and the fetus – conflicts that would be abrogated by the assurance of adequate, continuing multi-drug therapy. In light of these conflicts, where they still occur, careful processes of informed consent are appropriate, rather than opt-out or mandatory testing. (shrink)

The prelims comprise: Seeing Infectious Disease as Central The Birth of Bioethics Amid the Decline of Infectious Disease The Shifting Concerns of Public Health Bioethics and Public Health: How the Twain Didn't Meet The Case of HIV Bridging the Gap: Seeing Bioethics in Terms of the Patient as Victim and Vector An Ordinary Example Summing Up: Autonomous Agency in the Context of Infectious Disease Notes.

1 Evidence-based policy requires researchers to provide the answers to ecological questions that are of interest to policy makers. To find out what those questions are in the UK, representatives from 28 organizations involved in policy, together with scientists from 10 academic institutions, were asked to generate a list of questions from their organizations. 2 During a 2-day workshop the initial list of 1003 questions generated from consulting at least 654 policy makers and academics was used as a basis for (...) generating a short list of 100 questions of significant policy relevance. Short-listing was decided on the basis of the preferences of the representatives from the policy-led organizations. 3 The areas covered included most major issues of environmental concern in the UK, including agriculture, marine fisheries, climate change, ecosystem function and land management. 4 The most striking outcome was the preference for general questions rather than narrow ones. The reason is that policy is driven by broad issues rather than specific ones. In contrast, scientists are frequently best equipped to answer specific questions. This means that it may be necessary to extract the underpinning specific question before researchers can proceed. 5 Synthesis and applications. Greater communication between policy makers and scientists is required in order to ensure that applied ecologists are dealing with issues in a way that can feed into policy. It is particularly important that applied ecologists emphasize the generic value of their work wherever possible. (shrink)

Preparing the Next Generation of Oral Historians is an invaluable resource to educators seeking to bring history alive for students at all levels. Filled with insightful reflections on teaching oral history, it offers practical suggestions for educators seeking to create curricula, engage students, gather community support, and meet educational standards. By the close of the book, readers will be able to successfully incorporate oral history projects in their own classrooms.

In the behavioral literature on human movement, a distinction is made between the learning of parameters and the learning of new movement forms or topologies. Whereas the target articles by Thach, Smith, and Houk et al. provide evidence for cerebellar involvement in parametrization learning and adaptation, the evidence in favor of its involvement in the generation of new movement patterns is less straightforward. A case is made for focusing more attention on the latter issue in the future. This would (...) directly help to bridge the gap between current neurophysiological approaches to the role of the cerebellum and the behavioral expressions of human motor learning, [HOUK et al.; SMITH; THACH]. (shrink)

Keith Thomas: Gerald Edward Aylmer, 1926-2000 Adrian Hollis: William Spencer Barrett, 1914-2001 Bruce Williams: Charles Frederick Carter, 1919-2002 Malcolm Mackintosh: John Erickson, 1929-2002 J. H .R. Davis: Raymond William Firth, 1901-2002 F. M. L. Thompson: Hrothgar John Habakkuk, 1915-2002 A. W. Price: Richard Mervyn Hare, 1919-2002 Hugh Lloyd-Jones: Geoffrey Stephen Kirk, 1921-2003 Michael Lapidge and Peter Matthews: Vivien Anne Law, 1954-2002 Ann Moss: John Lough, 1913-2000 Terence Cave: Ian Dalrymple McFarlane, 1915-2002 Ludwig Paul: David Neil MacKenzie, 1926-2001 Peter Birks: (...) John Kieran Barry Moylan Nicholas, 1919-2002 Jonathan Shepard: Dimitri Dimitrievich Obolensky, 1918-2001 David Cannadine: John Harold Plumb, 1911-2001 Daniel Waley: Nicolai Rubinstein, 1911-2002 Ian Wood: John Michael Wallace-Hadrill, 1916-1985 R. G. M. Nisbet: William Smith Watt, 1913-2002 G. W. Bernard: Richard Bruce Wernham, 1906-1999. (shrink)

To what extent do people attribute meanings to “nonsense” words? How general is such attribution of meaning? We used a set of words lacking conventional meanings to elicit drawings of made‐up creatures. Separate groups of participants rated the nonsense words and the drawings on several semantic dimensions and selected what name best corresponded to each creature. Despite lacking conventional meanings, “nonsense” words elicited a high level of consistency in the produced drawings. Meaning attributions made to nonsense words corresponded with meaning (...) attributions made by separate people to drawings that were inspired by the name. Naïve participants were able to recover the name that inspired the drawing with greater‐than‐chance accuracy. These results suggest that people make liberal and consistent use of non‐arbitrary relationships between forms and meanings.Open Research Badges This article has been awarded Open Materials and Open Data badges. All materials and data are publicly accessible via the Open Science Framework at https://osf.io/8juyc/. Learn more about the Open Practices badges from the Center for Open Science: https://osf.io/tvyxz/wiki. (shrink)

Part I: WHAT IS ETHICS? Plato: Socratic Morality: Crito. Suggestions for Further Reading. Part II: ETHICAL RELATIVISM VERSUS ETHICAL OBJECTIVISM. Herodotus: Custom is King. Thomas Aquinas: Objectivism: Natural Law. Ruth Benedict: A Defense of Ethical Relativism. Louis Pojman: A Critique of Ethical Relativism. Gilbert Harman: Moral Relativism Defended. Alan Gewirth: The Objective Status of Human Rights. Suggestions for Further Reading. Part III: MORALITY, SELF-INTEREST AND FUTURE SELVES. Plato: Why Be Moral? Richard Taylor: On the Socratic Dilemma. David Gauthier: Morality and (...) Advantage. Gregory Kavka: A Reconciliation Project. Derek Parfit: Later Selves and Moral Principles. Bernard Williams: Persons, Character, and Morality. Suggestions for Further Reading. Part IV: VALUE. Jeremy Bentham: Classical Hedonism. Robert Nozick: The Experience Machine. Richard Taylor: Value and the Origin of Right and Wrong. Friedrich Nietzsche: The Transvaluation of Values. Derek Parfit: What Makes Someone’s Life Go Best? Thomas Nagel: Value: The View from Nowhere. Suggestions for Further Reading. Part V: UTILITARIANISM AND CONSEQUENTIALISM. John Stuart Mill: Utilitarianism. J.J.C. Smart: Extreme and Restricted Utilitarianism. Kai Nielsen: Against Moral Conservatism. Bernard Williams: Against Utilitarianism. John Hospers: Rule-Utilitarianism. Robert Nozick: Side Constraints. Peter Singer: Famine, Affluence and Morality. Suggestions for Further Reading. Part VI: KANTIAN AND DEONTOLOGICAL SYSTEMS. Immanuel Kant: Foundation for the Metaphysic of Morals. W. D. Ross: What Makes Right Acts Right? Onora O’Neill: Kantian Formula of the End in Itself and World Hunger. Thomas Nagel: Moral Luck. Philippa Foot: Morality as a System of Hypothetical Imperatives. Judith Jarvis Thomson: Killing, Letting Die, and the Trolley Problem. Suggestions for Further Reading. Part VII: CONTRACTARIAN ETHICAL SYSTEMS. Thomas Hobbes: The Leviathan. David Gauthier: Why Contractarianism? John Rawls: Contractualism: Justice as Fairness. T.M. Scanlon: Contractualism and Utilitarianism. Suggestions for Further Reading. Part VIII: VIRTUE-BASED ETHICAL SYSTEMS. Aristotle: The Ethics of Virtue. Bernard Mayo: Virtue and the Moral Life. William Frankena: A Critique of Virtue-Based Ethics. Walter Schaller: Are Virtues No More than Dispositions to Obey Moral Rules? Alasdair MacIntyre: The Nature of the Virtues. Susan Wolf: Moral Saints. Louis P. Pojman: In Defense of Moral Saints. Suggestions for Further Reading. Part IX: THE FACT/VALUE PROBLEM: METAETHICS IN THE TWENTIETH CENTURY. David Hume: On Reason and the Emotions: The Fact/Value Distinction. G. E. Moore: Non-Naturalism. A. J. Ayer: Emotivism. R. M. Hare: Prescriptivism: The Structure of Ethics and Morals. Geoffrey Warnock: The Object of Morality. Suggestions for Further Reading. Part X: MORAL REALISM AND THE CHALLENGE OF SKEPTICISM. J.L. Mackie: The Subjectivity of Values. Jonathan Harrison: A Critique of Mackie’s Error Theory. Gilbert Harman: Moral Nihilism. Nicholas Sturgeon: Moral Explanations. Bernard Williams: Ethics and the Limits of Philosophy. Bruce Russell: Two Forms of Ethical Skepticism. Michael Smith: A Defense of Moral Realism. Suggestions for Further Reading. Part XI: RELIGION AND ETHICS. Plato: Morality and Religion. Immanuel Kant: God and Immortality as Necessary Postulates of Morality. George Mavrodes: Religious and the Queerness of Morality. Kai Nielson: Ethics Without God. Suggestions for Further Reading. Part XII: CONTEMPORARY CHALLENGES TO CLASSICAL ETHICAL THEORY. Part A. Sociobiology and the Question of Moral Responsibility. Charles Darwin: Ethics and the Descent of Man. E.O.Wilson: Sociobiology and Ethics. Michael Ruse: Evolution and Ethics: The Sociobiological Approach. Elliot Sober: Prospects for an Evolutionary Ethics. J.L. Mackie: The Law of the Jungle, Evolution and Morality. Suggestions for Further Readingon Sociobiology. Part B. The Challenge of Determinism to Moral Responsibility and Desert. Galen Strawson: The Impossibility of Moral Responsibility. Louis Pojman: Free Will, Determinism, and Moral Responsibility:A Response to Galen Strawson. Richard Taylor: A Libertarian Defense of Free Will and Responsibility. Suggestions for Further Reading on Moral Responsibility. Glossary of Ethical Terms. (shrink)

Medical technology, specialization, and the corporatization of health delivery systems in the late twentieth century have all helped give birth to an unwelcome but unavoidable responsibility for individuals with family or friends—serving as a health care proxy. The responsibility comes without monetary compensation, is often involuntary, and lacks any real guidelines beyond the duty to make life-and-death decisions in circumstances over which the proxy has little control.The parameters of the proxy's job have evolved somewhat awkwardly in statutes and case law, (...) as lawmakers and judges have tried to apply conventional concepts to novel circumstances. This article examines the legal and functional status of the proxy, as well as the strengths and weaknesses of current public policy as reflected by state advance directive and surrogate decision-making laws. The first section of the article provides a historical perspective of our current notions of agency law as relevant to health care proxies. (shrink)

Medical technology, specialization, and the corporatization of health delivery systems in the late twentieth century have all helped give birth to an unwelcome but unavoidable responsibility for individuals with family or friends—serving as a health care proxy. The responsibility comes without monetary compensation, is often involuntary, and lacks any real guidelines beyond the duty to make life-and-death decisions in circumstances over which the proxy has little control.The parameters of the proxy's job have evolved somewhat awkwardly in statutes and case law, (...) as lawmakers and judges have tried to apply conventional concepts to novel circumstances. This article examines the legal and functional status of the proxy, as well as the strengths and weaknesses of current public policy as reflected by state advance directive and surrogate decision-making laws. The first section of the article provides a historical perspective of our current notions of agency law as relevant to health care proxies. (shrink)

Dissipative systems are described by a Hamiltonian, combined with a “dynamical matrix” which generalizes the simplectic form of the equations of motion. Criteria for dissipation are given and the examples of a particle with friction and of the Lotka-Volterra model are presented. Quantization is first introduced by translating generalized Poisson brackets into commutators and anticommutators. Then a generalized Schrödinger equation expressed by a dynamical matrix is constructed and discussed.

Few studies exist which look at psychological factors associated with physician sexual misconduct. In this study, we explore family dysfunction as a possible risk factor associated with physician sexual misconduct. Six hundred thirteen physicians referred to a continuing medical education (CME) course for sexual misconduct were administered the FACES-II survey, a validated and reliable measure of family dynamics. The survey was part of a self-learning activity. We collected data from February 2000 to February 2009. Participants were predominantly white, middle-aged males (...) who represented the full range of medical specialties. Their results were compared against a sample of 177 physicians. The FACES-II is a self-report test that measures family of origin (the family in which one was raised) dynamics on two dimensions (1) flexibility, ranging from too flexible (chaotic) to not flexible enough (rigid) and (2) cohesion ranging from too close (enmeshed) to not close enough (disengaged). The most common family pattern observed among physicians accused of sexual misconduct was rigid flexibility paired with disengaged cohesion, indicative of unhealthy family functioning. This pattern was significantly different than the pattern observed in the comparison group. Physicians who engage in sexual misconduct are more likely to have family of origin dysfunction. Ethics is developmental and learned in one’s family of origin. Family of origin dynamics may be one risk factor predisposing one to ethical violations. These findings have important implications for screening, education, and treatment across the medical education continuum. (shrink)

State law requirements for health care advance directive documents were reviewed in every state and the District of Columbia to determine whether they are consistent and/or flexible enough to permit the utilization by the public of “universal” advance directive forms, specifically a health care power of attorney, that would be valid under every state's advance directive statutes. Such documents would have to overcome the wide variability of state legal formalities for validity. If this could be accomplished, the public would benefit (...) from having a variety of multi-state or truly universal forms available that could be used with confidence in their validity.The review found that a basic, multi-state health care power of attorney appears to be feasible in 41 States and the District of Columbia, compared to 36 states and the District in 2005. Only nine states prevent recognition of a truly universal form. Some barriers were surmountable, including differing agent and witness requirements, execution requirements, and effectiveness triggers. Other barriers were insurmountable, including mandatory forms, mandatory disclosures, and decision-specific language requirements. The strategies identified for overcoming some barriers can be used by lawyers in drafting true multi-state directives. More importantly, states should simplify state advance directive laws to facilitate a more meaningful communication model of advance care planning. (shrink)

Gilead et al.'s approach to human cognition places abstraction and prediction at the heart of “mental travel” under a “representational diversity” perspective that embraces foundational concepts in cognitive science. But, it gives insufficient credit to the possibility that the process of abstraction produces a gradient, and underestimates the importance of a highly influential domain in predictive cognition: language, and related, the emergence of experientially based structure through time.

This article details the results of a national survey conducted in 1999 of statewide laws and protocols providing for the creation and recognition of donot- resuscitate orders effective in nonhospital settings. Applicable primarily to emergency medical services personnel, most of these laws and protocols have been in existence for less than ten years, and there is little current comparative information on them. Such policies are commonly called out-of-hospital or prehospital DNR orders, although one state-Virginia-recently amended its DNR law to establish (...) a durable DNR order applicable to all health care providers and all settings. I will refer to the laws and policies examined here interchangeably as out-of hospital DNR protocols or EMS-DNR protocols. The survey produced a descriptive snapshot of such laws and protocols in effect on a statewide basis as of March 1999. (shrink)

This article details the results of a national survey conducted in 1999 of statewide laws and protocols providing for the creation and recognition of donot- resuscitate orders effective in nonhospital settings. Applicable primarily to emergency medical services personnel, most of these laws and protocols have been in existence for less than ten years, and there is little current comparative information on them. Such policies are commonly called out-of-hospital or prehospital DNR orders, although one state-Virginia-recently amended its DNR law to establish (...) a durable DNR order applicable to all health care providers and all settings. I will refer to the laws and policies examined here interchangeably as out-of hospital DNR protocols or EMS-DNR protocols. The survey produced a descriptive snapshot of such laws and protocols in effect on a statewide basis as of March 1999. (shrink)

Why, since happiness is so universally sought after, are so many people so miserable? The answer can be found by unpacking the wisdom of two of history's intellectual giants who set out to answer the question that has confounded man from time immemorial: What makes us happy? Aristotle and Thomas Aquinas existed sixteen centuries apart, yet each reached similar understandings about what makes a person happy and what makes him miserable. In these enlightening pages, Dr. Charles Nemeth synthesizes the (...) judgments of history's two greatest thinkers to present for you a life plan that inevitably leads to a happy human existence, whatever your ethnicity, religion, or citizenship. You will explore what it means to be happy and will come to understand the limitations of happiness. You'll learn how to live in accordance with your basic nature so that your inclinations will not conflict with that which makes you flourish. And you'll calibrate your compass so that you will be able to navigate your way into a state of life that makes you truly happy. Moreover, you'll discover why happiness is obtained through action and not mere desire and why wealth and fame do not -- and cannot -- buy happiness. You'll also learn why the body, despite providing avenues for sensory and intellectual pleasure, is incapable of providing true happiness. Strikingly, none of the suggestions in this book have ever been shown to be flawed. These timeless recommendations for a happy life never go out of favor and never change. Instead, they remain a constant, permanent, universal set of criteria on how to achieve a happy existence. You'll also learn: The benefits of moderation, sensibility, and equilibrium The source of ultimate happiness and the means to attain it The formula for fostering contentment -- what to strive for and what to avoid The essence of true goodness, happiness, and beauty Human excellence and different levels of happiness With this Rosetta stone of a book, you will find solutions to fortify your soul and bring you peace. You will be equipped with a new sense of direction, hope, and healing that will guide you closer to lasting happiness. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Nietzsche's Ecce Homo and the Revaluation of All Values: Dionysian Versus Christian Values by Thomas H. BrobjerCharles P. RodgerThomas H. Brobjer. Nietzsche's Ecce Homo and the Revaluation of All Values: Dionysian Versus Christian Values. London: Bloomsbury Academic, 2021. Pp. viii + 210. Hardback, $115.00.It is difficult to review a book so rich in consequences and seemingly sui generis. To categorize it as the work of a "lumper" or (...) "splitter," for example, would only confuse matters. Granted, Brobjer dismisses The Will to Power as the tendentious forgery of Nietzsche's sister. Methodologically, he also appears as a "moderate" splitter who provides a close textual reading and draws on the Nachlass only so far as this serves to elucidate the claims Nietzsche made in his published works. Nonetheless, Brobjer's central hypothesis might, albeit falsely, suggest that he is an old-fashioned lumper, for he holds that Mazzino Montinari was wrong to claim Nietzsche abandoned his plans for a Hauptwerk ("Nietzsches Nachlaß von 1885 bis 1888 oder Textkritik und Wille zur Macht," in Nietzsche Lesen [Berlin: Walter de Gruyter, 1982], 92–119).Granted, Montinari admitted that after abandoning plans for The Will to Power, Nietzsche did, in the fall of 1888, entertain a new plan for a four-volume Hauptwerk titled The Revaluation of All Values. According to these plans, The Antichrist would be its first volume, followed by The Free Spirit, containing a critique of philosophy as a nihilistic movement; The Immoralist, containing a critique of morality and its dangers; and Dionysos Philosophos. Nonetheless, Montinari claimed, these plans also collapsed when, sometime after mid-November 1888, Nietzsche decided to make The Antichrist into the whole of The Revaluation of All Values. Indeed, Montinari's hypothesis was that Nietzsche finally realized, at the last minute, that the work of the past five years and what he had previously regarded as his life task was untenable and, having published everything he could salvage from his failed Hauptwerk project, "Nietzsche's collapse in Turin came when he had literally finished with everything" (12, emphasis in the original). To Brobjer, however, "this claim seems both psychologically improbable and, in regard to Nietzsche's intention to write a Hauptwerk, simply wrong" (12). Yet despite Brobjer having demonstrated in a number of articles published over the past decades that the evidence is not only too thin and ambiguous to sustain Montinari's hypothesis, but that it contradicts his timeline (92–94), scholars continue to treat Montinari's conclusions as established fact, and moreover treat all "discussions and considerations of a magnum opus … as hypothetical and old-fashioned" (12). But if so, why should the present study, wherein Brobjer advances this same thesis, not also fall on deaf ears? The answer is surprising: Ecce Homo.The Druckmanuskript shows that both the final chapter headings and the majority of the final text of Ecce Homo were established prior to mid-November, and, while Nietzsche continued to make additions and alterations to Ecce Homo up until a day before his collapse, his revisions to the completed portions of the text were only "minor" (21). Since, even according to Montinari's timeline, the vast majority of Ecce Homo was thus written at a time when Nietzsche still incontrovertibly intended that The Antichrist would constitute only the first volume of The Revaluation of All Values (47), nothing can possibly speak against examining whether Ecce Homo might retain at least traces of Nietzsche's original plans for his Hauptwerk. To the contrary, a great deal speaks for it. After all, the conventional interpretation of Ecce Homo as a "backward-looking autobiography" (5) has hardly borne fruit; read as a summary of Nietzsche's life and writings, Ecce Homo is so "elliptic, paradoxical, absurd" (48), and so contorted by excessive self-praise and praise for Thus Spoke Zarathustra, that the text is incoherent and unusable for its supposed purpose. Yet Nietzsche explicitly told his publisher that his intention was merely to tell of his life and works "in snatches" (3), and that Ecce Homo was being composed with the "intention to give this work the same form and appearance which that magnum opus [Hauptwerk] will have, to... (shrink)