This essay will argue for the centrality of empathy in the doctor-patient relationship — as a core of ethically sound, responsible therapeutics. By empathy, I intend an explicitly hermeneutic practice, informed by a reflexive understanding of patient and self. After providing an overview of the history of the concept of empathy in clinical medicine, I discuss current definitions and the use of Balint groups in residency training as a way to develop empathic competence in novice physicians.

Professor Solmsen's interpretation is orthodox; his comprehensive account builds on recent more specialized studies, including his own, and those of Jaeger, Ross, and Cherniss. If in some ways the book contains no large surprises, it nevertheless makes a major contribution by its treatment of Plato. The author has skillfully disengaged Plato's observations about nature from the customary ethical, epistemic, or, as the case may be, metaphysical contexts. He demonstrates that Plato was toward the end of his career a (...) class='Hi'>more serious investigator of physical phenomena than is commonly supposed. Moreover, at almost every turn he finds Platonic precedents for Aristotle's thinking in this field. He does not detract from Aristotle's originality, but illumines it, and Plato's as well. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Discourses of Jewish Identity in Twentieth-Century FranceEllen S. FineDiscourses of Jewish Identity in Twentieth-Century France, edited by Alan Astro; Yale French Studies 265pp. New Haven: Yale University Press, 1994, $17.00.Ever since France became the first European country to grant Jews equal rights as citizens with the enactment of the Declaration of the Rights of Man in 1791, the question of identity has been a central preoccupation of French (...) Jews. Their emancipation brought about assimilation to the universalist principles of the French Republic and led them to detach themselves from their own traditions, generating conflicting emotions about what it meant for a Jew to be French. The topic of French-Jewish identity has been reflected upon by writers ranging from Sartre, Memmi, and Misrahi to Levinas and Finkielkraut, none of whose discourses are included in this volume but whose ideas are discussed in Seth Wolitz’s pertinent article, “Imagining the Jew in France: From 1945 to the Present.”Divided into two main sections, “Literary Texts” and “Cultural Contexts,” this collection contains articles written by authors not familiar to English speaking readers. They are excellently translated, mainly by the editor, Alan Astro. In his introductory essay, Astro notes that his aim is to portray the cultural and ethnic diversity of French Jews of different origins and to show their part in the formation of Jewish identity. The focus is on how French Jews feel about their own identity, and not on how others see them.The first section, “Literary Texts,” represents a variety of genres, generally fiction. Over half of the thirteen texts date from the 1970s to the present, and are mostly personal narratives, anecdotal in nature. The tone often conveys “a certain humor or self-irony,” described by Rachel Ertel in her essay, “A Minority Literature” (in the second section) as identifiable traits of a Jewish work.With no logical sequence to the presentation of the texts, a multiplicity of perspectives is clearly the objective. For example, Bernard Frank, whose ancestors have lived in France since the Revolution, feels “as French as anyone else,” yet recognizes that Jews are different, “because they’ve been made to be different.” Wolf Wieviorka in 1936 exalts his “noble pedigree,” being a naturalized French citizen; he was later murdered by the Nazis.North African Jews who emigrated to Paris in the 1950s and early 1960s, studied sociologically by Michel Abitbol, are portrayed in Gil Ben Aych’s novel, The Chant of Being (Algerian), and in Paula Jacques’s novel, Aunt Carlotta’s Legacy (Egyptian). Jews of Eastern European descent are depicted in the short stories by Cyrille Fleischman, one of which recounts how a Sorbonne professor of sixteenth-century French literature renounces his eminent career and like his father, opens up a delicatessen in the Jewish quarter of the Marais, thus returning to his roots. Henri Raczymow returns imaginatively to a pre-war Poland in Tales of Exile and Forgetfulness, recreating in French the intonations of Yiddish, the language of his grandparents who died in the Holocaust. In an [End Page 378] outstanding essay, “Memory Shot Through With Holes,” Raczymow articulates urgent questions posed by the second generation: “By what right could I speak, I who was not a victim, survivor or witness?”If the first section is multicultural, the second, “Cultural Contexts,” is interdisciplinary. Annette Wieviorka (granddaughter of Wolf Wieviorka) studies accounts by survivors, revealing the impact of Vichy’s imposing a Jewish identity on its citizens. Wieviorka also evokes the importance of the Six-Day War which compelled assimilated French Jews to proclaim their Jewish allegiance, a pivotal event transforming their sense of identity.Other significant contributions are Gérard Haddad’s exploration of the importance of Judaism in the life and work of Jacques Lacan, an outsider who seemed more concerned with Jewish identity than his fellow psychoanalysts. Ora Avni analyzes Patrick Modiano’s repudiation of his Jewish patrimony in his seminal novel, La Place de l’étoile. Elizabeth de Fontenay comments on how the quant-à-soi (“keeping to oneself”), the reserve characteristic of the French, becomes the quant-à-nous (“ourselves”) for the French Jew who is linked to a community beyond the... (shrink)

Confidentiality is a cornerstone of the physician-patient relationship. Breaches of confidentiality in the context of genetic testing are of particular concern for a number of reasons. First, genetic testing reveals information not only about a particular patient, but also about his or her family members. Second,genetic testing can label healthy people as “at risk,” subjecting them to possible stigmatization or discrimination by third parties. Third, as genetic testing becomes more widespread and is incorporated into primary care, breaches of confidentiality (...) might inadvertently occur more frequently because primary care providers may not be trained to understand the uniqueness of genetic information. Until now, genetic services have been provided primarily by medical geneticists and genetic counselors. However, with the proliferation of new genetic presymptomatic and carrier tests, primary care physicians are going to become increasingly involved in genetic testing. Currently, little is known about physicians’ attitudes toward disclosure of confidential genetic information to third parties. (shrink)

Confidentiality is a cornerstone of the physician-patient relationship. Breaches of confidentiality in the context of genetic testing are of particular concern for a number of reasons. First, genetic testing reveals information not only about a particular patient, but also about his or her family members. Second,genetic testing can label healthy people as “at risk,” subjecting them to possible stigmatization or discrimination by third parties. Third, as genetic testing becomes more widespread and is incorporated into primary care, breaches of confidentiality (...) might inadvertently occur more frequently because primary care providers may not be trained to understand the uniqueness of genetic information. Until now, genetic services have been provided primarily by medical geneticists and genetic counselors. However, with the proliferation of new genetic presymptomatic and carrier tests, primary care physicians are going to become increasingly involved in genetic testing. Currently, little is known about physicians’ attitudes toward disclosure of confidential genetic information to third parties. (shrink)

Research indicates that consumers are particularly concerned about the safety of meat. More highly processed meat is perceived as more unsafe than fresh or natural meats, i.e., consumers trust processed meat less. This paper studies the relationship between perceived trust and day-to-day purchase behavior for meat, giving special attention to the degree of meat processing. Controlling for trust in food chain actors and demographic and socio-economic variables, actual meat purchases of Canadian households are linked to answers from a (...) commissioned food attitudes survey completed by the same households. Expenditures for processed and total meat (but not for fresh meat) are significantly different by three levels of trust in the food industry. Consumer with the lowest trust levels consume less (especially of processed meat) compared to those with higher trust levels. However, in a multivariate setting, trust shows no effect on fresh or processed meat purchases with or without demographic and socio-economic control variables, suggesting that the impact of trust on meat purchases is only small. However, the low trusting consumer segment could potentially be a target for marketing strategies focused on reputation and quality to increase sales in this particular group. (shrink)

A 1999–2000 national study of U.S. hospitals raised concerns about ethics consultation (EC) practices and catalyzed improvement efforts. To assess how practices have changed since 2000, we administered a 105-item survey to “best informants” in a stratified random sample of 600 U.S. general hospitals. This primary article details the methods for the entire study, then focuses on the 16 items from the prior study. Compared with 2000, the estimated number of case consultations performed annually rose by 94% to 68,000. The (...) median number of consults per hospital was unchanged at 3, but more than doubled for hospitals with 400+ beds. The level of education of EC practitioners was unchanged, while the percentage of hospitals formally evaluating their ECS decreased from 28.0% to 19.1%. The gap between large, teaching hospitals and small, nonteaching hospitals widened since the prior study. We suggest targeting future improvement efforts to hospitals where needs are not being met by current approaches to EC. (shrink)

BackgroundWhile previous research has examined various aspects of ethics consultation (EC) in U.S. hospitals, certain EC practices have never been systematically studied.MethodsTo address this gap, we surveyed a random stratified sample of 600 hospitals about aspects of EC that had not been previously explored.ResultsNew findings include: in 26.0% of hospitals, the EC service performs EC for more than one hospital; 72.4% of hospitals performed at least one non-case consultation; in 56% of hospitals, ECs are never requested by patients or (...) families; 59.0% of case consultations involve conflict; the usual practice is to visit the patient in all formal EC cases in 32.5% of hospitals; 56.6% of hospitals do not include a formal meeting in most EC cases; 61.1% of hospitals do not routinely assess ethics consultants’ competencies; and 31.6% of hospitals belong to a bioethics network. We estimate the total number of non-case consultations performed in U.S. hospitals to be approximately one half the number of case consultations; we estimate the total number of ECs performed in U.S. hospitals, including both case and non-case consultations, to be just over 100,000 per year.ConclusionsThese findings expand our current understanding of EC in U.S. hospitals, and raise several concerns that suggest a need for further research. (shrink)

Many new genetic tests are used in clinical practice, and the number of available tests is growing. Two important health policy questions arise as these genetic tests become available. The first question, whether a new test should be made available, has been the focus of much recent discussion. The second question concerns defining the appropriate standards surrounding the use of these tests, including patient selection, education, informed consent, test interpretation and counseling.Genetic tests currently move from the research arena, where strategies (...) are put in place to minimize risks,into the clinical context where the practice of medicine is more variable and the risks to patients less understood. In the research setting, risks can be minimized through safeguards including education, consent, and counseling. The frequency and magnitude of psychosocial and clinical risks canbe assessed. In the clinical setting, however, these safeguards may not be used consistently, creating unknown risksfor patients. (shrink)

Many new genetic tests are used in clinical practice, and the number of available tests is growing. Two important health policy questions arise as these genetic tests become available. The first question, whether a new test should be made available, has been the focus of much recent discussion. The second question concerns defining the appropriate standards surrounding the use of these tests, including patient selection, education, informed consent, test interpretation and counseling.Genetic tests currently move from the research arena, where strategies (...) are put in place to minimize risks,into the clinical context where the practice of medicine is more variable and the risks to patients less understood. In the research setting, risks can be minimized through safeguards including education, consent, and counseling. The frequency and magnitude of psychosocial and clinical risks canbe assessed. In the clinical setting, however, these safeguards may not be used consistently, creating unknown risksfor patients. (shrink)

Context: Although ethics consultation is commonplace in United States (U.S.) hospitals, descriptive data about this health service are lacking. Objective: To describe the prevalence, practitioners, and processes of ethics consultation in U.S. hospitals. Design: A 56-item phone or questionnaire survey of the "best informant" within each hospital. Participants: Random sample of 600 U.S. general hospitals, stratified by bed size. Results: The response rate was 87.4%. Ethics consultation services (ECSs) were found in 81% of all general hospitals in the U.S., and (...) in 100% of hospitals with more than 400 beds. The median number of consults performed by ECSs in the year prior to survey was 3. Most individuals performing ethics consultation were physicians (34%), nurses (31%), social workers (11%), or chaplains (10%). Only 41% had formal supervised training in ethics consultation. Consultation practices varied widely both within and between ECSs. For example, 65% of ECSs always made recommendations, whereas 6% never did. These findings highlight a need to clarify standards for ethics consultation practices. (shrink)

In recent years, a debate concerning the nature of knowing-how has emerged between intellectualists who claim that knowledge-how is reducible to knowledge-that and anti-intellectualists who claim that knowledge-how comprises a unique and irreducible knowledge category. The arguments between these two camps have clustered largely around two issues: intellectualists object to Gilbert Ryle's assertion that knowing-how is a kind of ability, and anti-intellectualists take issue with Jason Stanley and Timothy Williamson's positive, intellectualist account of knowing-how. Like most anti-intellectualists, in this paper (...) I will raise objections to Stanley and Williamson's account of knowing-how and also defend the claim that ability is necessary for knowing-how attributions. Unlike most discussions of knowing-how, however, I will return to more Rylean considerations in order to illustrate that any intellectualist account of knowing-how, not simply Stanley and Williamson's preferred variety, will fail because it will be unable to account for fundamental differences in the knowledge required to instantiate an ability and the knowledge involved in propositional thought. (shrink)

The connection between understanding and explanation has recently been of interest to philosophers. Inglis and Mejía-Ramos (Synthese, 2019) propose that within mathematics, we should accept a functional account of explanation that characterizes explanations as those things that produce understanding. In this paper, I start with the assumption that this view of mathematical explanation is correct and consider what we can consequently learn about mathematical explanation. I argue that this view of explanation suggests that we should shift the question of explanation (...) away from why-questions and towards a “what’s going on here” question. Additionally, I argue that when we recognize the connection between understanding and explanation we naturally see how more than just proof can be explanatory. I expand this point by detailing how definitions and diagrams can be explanatory. In all, we see that when we take seriously the connection between understanding and explanation, we get a better sense of how explanation arises within mathematics. (shrink)

This article focuses on what both psychoanalysis and anthropology have in common: the emphasis on the researcher's own experience. An ethnographic fieldwork will be used to illustrate how a psychoanalytical approach unfolds the material when studying conditions for learning from experience among teachers in two Norwegian junior high schools, and also the strong methodological implications of this approach. The researcher's struggle to remain open is elaborated. Here "openness" is regarded as something more than a principle for research practice. It (...) is a way to relate both to oneself and the other, to emotions as well as actions, to the inner as well as the external world. (shrink)

Over the past seventy-five years, the UN secretary-general has come to occupy a highly visible position in world politics. While the UN Charter describes the post merely as the “chief administrative officer” of the organization, today it is widely recognized that the secretary-general also plays a central role in political matters. What makes the role of the UN secretary-general special? Where does the office's authority come from? As part of the special issue on “The United Nations at Seventy-Five: Looking Back (...) to Look Forward,” this essay looks back at the tenures of previous UN secretaries-general and applies ideas from sociological institutionalism to argue that the UN secretary-general holds the position of a “guardian” of the UN Charter. The UN secretary-general, more than anyone else within the UN system, represents the UN overall. From this flows great responsibilities and challenges, as the UN secretary-general is often expected to step in when other parts of the UN are unable or unwilling to act, and to take the blame when things go wrong. But this special position also endows the office with a substantial degree of authority, which future holders of the office can use to shape policies and mobilize support as the UN seeks to address urgent global challenges. (shrink)

In this discussion, we ponder the discourse about the ‘body of the Divine’ in the Indian tradition. Beginning with the Vedas, we survey the major eras and thinkers of that tradition, considering various notions of the Supreme Divine Being it produced. For each, we ask: is the Divine embodied? If so, then in what way? What is the nature of the body of the Divine, and what is its relationship to human bodies? What is the value of the body of (...) the Divine to the spiritual aspirant? We consider, where relevant, which views are pantheistic and which might be considered panentheistic. Panentheism is connected with discourse on the world as the body of God. It has origins in medieval Christian theology with anticipatory traces in Plato’s Timeaus. Under pantheism, were the world to end—were it to collapse or disappear irreversibly, perhaps, into a huge black hole—then God would disintegrate without a remainder as well; for in this view the Divine Spirit is the universe. The same is not true under panentheism which posits a more complex relationship between the Divine and the world. According to panentheism, God pervades the world—God is in the world—and at the same time, God sustains the world—the world is in God. This allows that God be greater than, transcendent of and independent of the world. In our conclusion we remark on how the views we have surveyed link to, resonate with, or dis-compare with the current—should one say revivified—interest in intellectual quarters with panentheism. (shrink)

This article reconsiders the issue of Luce Irigaray's proximity to Jacques Derrida on the question of woman. I use Derrida's reading of Nietzsche in Spurs: Nietzsche's Styles and Irigaray's reading of Heidegger in L'Oubli de l'air to argue that reading them as supplements to one another is more accurate and more productive for feminism than separating one from the other. I conclude by laying out the benefits for feminism that such a reading would offer.

Unlike other states, California retained a large proportion of the child care centers that had been established during World War II. In 1946, the California state government allocated state funds for child care in response to a vigorous child care campaign. The campaign, which was, in large part, a working mothers movement, was a “transformed maternalist” movement. It used maternalist rhetoric to defend state-subsidized child care that was criticized by more traditional maternalists. Using resource mobilization theory, I explain the (...) relatively high degree of political mobilization on the child care issue in California in terms of the greater availability of co-optable social resources, which California's relatively large wartime child care program provided, and the existence of movement entrepreneurs willing to mobilize these latent resources. Child care advocates were successful because they operated within a relatively favorable political opportunity structure since they did not have to contend with a strained state treasury or a mobilized countermovement and were able to garner the support of a wide variety of women's and social organizations and an influential social reformer. (shrink)

Traditional courtship norms delineate distinct gendered behaviors for men and women based on the model of a dominant, breadwinning male and a passive, dependent female. Previous research shows, however, that as women have increased their access to earned income, there has been a rising ideological and behavioral commitment to egalitarian relationships. Drawing on in-depth interviews with 38 college-educated women, this article explores how women negotiate these seemingly contradictory beliefs in order to understand how and why gendered courtship conventions persist even (...) as heterosexual romantic relationships become more egalitarian. My findings show that while the women reference essentialist beliefs about men’s “nature” to explain their commitment to courtship conventions, they draw on narratives of choice, individualism, and personal autonomy to assert that the symbolic gendering of courtship will not interfere with their desire for an egalitarian marriage. However, women’s behaviors and narratives reinforce notions of gender difference, potentially providing support for other forms of gender inequality. (shrink)

Regional planning for improved agricultural capacity to supply produce, legumes, and whole grains has the potential to improve population health as well as the local food economy. This case study of Waterloo Region (WR), Canada, had two objectives. First, we estimate the quantity of locally grown vegetables, fruits, legumes, and whole grains needed to help meet the Region of Waterloo population’s optimal nutritional requirements currently and in 2026. Secondly, we estimate how much of these healthy food requirements for the WR (...) population could realistically be produced through local agriculture by the year 2026. Results show that a shift of approximately 10% of currently cropped hectares to the production of key nutritious foods would be both agriculturally feasible and nutritionally significant to the growing population. We supplement our findings with some agronomic considerations and community-level strategies that would inform and support such change. The methodology of this study could be applied to other regions: more such analyses would create a broader picture of the diverse qualitative and quantitative agricultural shifts that could synchronize optimal land use with dietary recommendations, thus informing coordinated policy and planning. (shrink)

The practical difficulties that trouble any effort to discuss “pluralism” in American literary studies can be glimpsed in the following exchange. In a 1980 interview in the Literary Review of Edinburgh, Ken Newton put this question to Derrida:It might be argued that deconstruction inevitably leads to pluralist interpretation and ultimately to the view that any interpretation is as good as any other. Do you believe this and how do you select some interpretations as being better than others?Derrida replied:I am not (...) a pluralist and I would never say that every interpretation is equal but I do not select. The interpretations select themselves. I am a Nietzschean in that sense. You know that Nietzsche insisted on the fact that the principle of differentiation was in itself selective. The eternal return of the same was not repetition, it was a selection of the more powerful forces. So I would say that some are more powerful than others. The hierarchy is between forces and not between true and false.1­­The irony of Newton’s identification of pluralism with the very interpretive irresponsibility that it accuses others—Derrida foremost among them—of embracing is certainly not lost on those critics who call themselves pluralists; it comes as no surprise to them that Derrida declines to join their company. Nevertheless, the breezy gloss of pluralism as “the view that any interpretation is as good as any other” is bound to seem plausible to the large numbers of readers for whom the word denotes a generalized tolerance the refusal of dogmatism. That Derrida should be called upon to dissociate himself from pluralism is in fact symptomatic of the profound confusion surrounding the term. At present, the pervasiveness of such loose talk compels pluralists to defend themselves regularly against this kind of misinterpretation. Thus, the colloquial reading of pluralism that construes it as mere relativism, the absence of principled constraints, is frequently acknowledged, if only to be rejected. Even Bruch Erlich must emphasize that pluralism does not want “a totally free critical market, for that involves the proliferation of a hundred flowers, what Booth dismissively terms ‘chaotic warfare.’ ”2 1. James Kearn and Ken Newton, “An Interview with Jacques Derrida,” Literary Review 14 , p.21.2. Bruce Erlich, “Amphibolies: On the Critical Self-Contradictions of ‘Pluralism,’ ” this volume, p. 527; all further references to this essay will be included in the text. Ellen Rooney teaches English and women’s studies at Brown University. She is currently at work on a study entitled Seductive Reasoning: Pluralism and the Problematic of General Persuasion. (shrink)

BackgroundDespite its ubiquity in academic research, the phrase ‘ethical challenge(s)’ appears to lack an agreed definition. A lack of a definition risks introducing confusion or avoidable bias. Conceptual clarity is a key component of research, both theoretical and empirical. Using a rapid review methodology, we sought to review definitions of ‘ethical challenge(s)’ and closely related terms as used in current healthcare research literature.MethodsRapid review to identify peer-reviewed reports examining ‘ethical challenge(s)’ in any context, extracting data on definitions of ‘ethical challenge(s)’ (...) in use, and synonymous use of closely related terms in the general manuscript text. Data were analysed using content analysis. Four databases (MEDLINE, Philosopher’s Index, EMBASE, CINAHL) were searched from April 2016 to April 2021.Results393 records were screened, with 72 studies eligible and included: 53 empirical studies, 17 structured reviews and 2 review protocols. 12/72 (17%) contained an explicit definition of ‘ethical challenge(s), two of which were shared, resulting in 11 unique definitions. Within these 11 definitions, four approaches were identified: definition through concepts; reference to moral conflict, moral uncertainty or difficult choices; definition by participants; and challenges linked to emotional or moral distress. Each definition contained one or more of these approaches, but none contained all four. 68/72 (94%) included studies used terms closely related to synonymously refer to ‘ethical challenge(s)’ within their manuscript text, with 32 different terms identified and between one and eight different terms mentioned per study.ConclusionsOnly 12/72 studies contained an explicit definition of ‘ethical challenge(s)’, with significant variety in scope and complexity. This variation risks confusion and biasing data analysis and results, reducing confidence in research findings. Further work on establishing acceptable definitional content is needed to inform future bioethics research. (shrink)

This article reconsiders the issue of Luce Irigaray's proximity to Jacques Derrida on the question of woman. I use Derrida's reading of Nietzsche in Spurs: Nietzsche's Styles (1979) and Irigaray's reading of Heidegger in L'Oubli de l'air (1983) to argue that reading them as supplements to one another is more accurate and more productive for feminism than separating one from the other. I conclude by laying out the benefits for feminism that such a reading would offer.

Systematic study of the intersection of ethics consultation services and solid organ transplants and recipients can identify and illustrate ethical issues that arise in the clinical care of these patients, including challenges beyond resource allocation. This was a single-centre, retrospective cohort study of all adult ethics consultations between January 1, 2007, and December 31, 2017, at a large academic medical centre in the north-eastern United States. Of the 880 ethics consultations, sixty (6.8 per cent ) involved solid organ transplant, thirty-nine (...) (65.0 per cent) for candidates and twenty-one (35.0 per cent ) for recipients. Ethics consultations were requested for 4.3 per cent of heart, 4.9 per cent of lung, 0.3 per cent of liver, and 0.3 per cent of kidney transplant recipients over the study period. Nurses were more likely to request ethics consultations for recipients than physicians (80.0 per cent vs 20.0 per cent, p = 0.006). The most common reason for consultation among transplant candidates was discussion about intensity of treatment or goals of care after the patient was not or was no longer a transplant candidate. The most common reason for ethics consultation among transplant recipients was disagreement between transplant providers and patients/families/non-transplant healthcare professionals over the appropriate intensity of treatment for recipients. Very few consultations involved questions about appropriate resource allocation. Ethics consultants involved in these cases most often navigated communication challenges between transplant and non-transplant healthcare professionals and patients and families. (shrink)

In this article the author argues that men and boys have been historically and structurally rendered an invisible group of victims in international human rights and policy responses towards conflict-related sexual violence stemming from the United Nations. The apparent female-focused approach of instruments on sexual violence is criticized followed by a discussion – through analysis and interviews with legal scholars and champions for the recognition of male survivors’ experiences – of the first ‘emergence’ of male victims in these instruments and (...) key actors involved in this process. The existing serious dichotomy between visible and invisible victims is prominently based on their ‘gender identity’ and leads to structural discrimination of male victims of rape or other forms of sexual violence. To overcome this situation and develop more inclusive instruments, a reconceptualization is needed of the meaning and use of words like ‘gender’ and ‘gender-based violence’. Additionally, a more intersectional approach to sexual violence should be adopted, understanding that victims have a multitude of identities such as ethnicity or religious affiliation that make them particularly vulnerable to suffering. (shrink)

Context: Although ethics consultation is commonplace in United States hospitals, descriptive data about this health service are lacking. Objective: To describe the prevalence, practitioners, and processes of ethics consultation in U.S. hospitals. Design: A 56-item phone or questionnaire survey of the “best informant” within each hospital. Participants: Random sample of 600 U.S. general hospitals, stratified by bed size. Results: The response rate was 87.4%. Ethics consultation services were found in 81% of all general hospitals in the U.S., and in 100% (...) of hospitals with more than 400 beds. The median number of consults performed by ECSs in the year prior to survey was 3. Most individuals performing ethics consultation were physicians, nurses, social workers, or chaplains. Only 41% had formal supervised training in ethics consultation. Consultation practices varied widely both within and between ECSs. For example, 65% of ECSs always made recommendations, whereas 6% never did. These findings highlight a need to clarify standards for ethics consultation practices. (shrink)

Critical care society guidelines recommend that ethics committees mediate intractable conflict over potentially inappropriate treatment, including Do Not Resuscitate status. There are, however, limited data on cases and circumstances in which ethics consultants recommend not offering cardiopulmonary resuscitation despite patient or surrogate requests and whether physicians follow these recommendations. This was a retrospective cohort of all adult patients at a large academic medical center for whom an ethics consult was requested for disagreement over DNR status. Patient demographic predictors of ethics (...) consult outcomes were analyzed. In 42 of the 116 cases, the patient or surrogate agreed to the clinician recommended DNR order following ethics consultation. In 72 of 74 of the remaining cases, ethics consultants recommended not offering CPR. Physicians went on to write a DNR order without patient/surrogate consent in 57 of those cases. There were no significant differences in age, race/ethnicity, country of origin, or functional status between patients where a DNR order was and was not placed without consent. Physicians were more likely to place a DNR order for patients believed to be imminently dying. The median time from DNR order to death was 4 days with a 90-day mortality of 88.2%. In this single-center cohort study, there was no evidence that patient demographic factors affected ethics consultants’ recommendation to withhold CPR despite patient/surrogate requests. Physicians were most likely to place a DNR order without consent for imminently dying patients. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Ethos in Steig’s and Sendak’s Picture Books: The Connected and the Lonely ChildEllen Handler SpitzThere was the child, listening to everything...—Yasunari Kawabata1IntroductionPicture-book characters spring to life in both verbal and visual registers. Moving about the page before our eyes as well as speaking and acting in their respective stories, they often make a long-lasting impact on children. Pictures and words, moreover, may overlap but are never commensurate; like the (...) words and notes of a song, they mean and evoke differently even while being experienced together. This brief essay considers a small selection of works by two distinguished twentieth-century American authors-artists: William Steig (1907–2003) and Maurice Sendak (b. 1928). It argues that, with their artful words and pictures, Steig and Sendak construct very different—even contrasting—visions of childhood. By “ethos” in this context I mean to suggest a vision of what a child is, a sense of what it means both to be a child and to address one. Such visions differ not only through the ages and from one culture and locale to another but also from one author-artist of the same period and locale to another. Invited to speak on Sendak’s and Steig’s respective works at meetings scheduled just a week apart in New York City during the winter of 2007, I found in these paired invitations a fortuitous opportunity to juxtapose several of their works and thereby discover some arresting contrasts and formulate the following readings.2First, a word on the topic of methodology. Nearly one hundred years have elapsed since Freud published his celebrated-cum-notorious foray into psychobiography with Leonardo da Vinci and a Memory of His Childhood,3 wherein shards of circumstantial biographical evidence were laid out in seductive mosaic patterns secured with a grout of ingenious speculation. Despite subsequent decades of critical reflection, Freud’s method soldiers on nonetheless as a modus operandi in the psychological interpretation of art and literature.4 By bracketing a small selection of Steig’s and Sendak’s works here and limiting myself to extracting a tentative underlying ethos from them, I am [End Page 64] taking the position that to write psychologically one need not mention or exploit a creator’s personal life. This essay points gently toward psychological approaches that ask what we can see when we look carefully at the pages of works. What can we find when we share children’s books with children? Why, for example, has Sendak’s Where the Wild Things Are sold over seventeen million copies (and its Amazon rank last time I checked was around 145, which means that only 144 other books in the United States were selling more copies at that particular moment), whereas his later work Outside Over There—a book that apparently figures prominently in his personal life—comes nowhere close?5 While market figures do not correlate flawlessly with children’s actual preferences (adults, not children, are the buyers), I would aver that, in this case, they do reflect the success and beloved status of Where the Wild Things Are, since the figures tally with additional facts: the book continues to appeal in its fifth decade post publication; it is known and has been translated worldwide, dramatized, and set to music6; and its characters have been fashioned into ubiquitous stuffed toys. On the other hand, in my (limited) experience, young children seem to find Outside Over There unsettling, unintelligible, even “creepy” and often have trouble sitting still through a full rendition. Some adults, on the other hand, praise that book as poetic and admire its more complex art. Such discrepancies in reception deserve our attention; they hint at fallow fertile fields lying over the rainbow, far beyond the much-plowed tracts of authorial psychobiography. This essay gestures casually toward those fields.The Connected Child“My dear Deborah,” said Doctor De Soto, “you must have been reading my mind.7Let’s begin with William Steig, who is best known for his New Yorker cartoons. His work for children extends back to 1968,8 however, when he was already a man in his sixties. Setting aside the... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:The Child's Creation of a Pictorial WorldEllen Handler SpitzThe Child'S Creation of a Pictorial World, by Claire Golomb. Mahwah, New Jersey: Erlbaum, 2004, 388 pp.Children's drawings fill us with wonder and delight. They may tend, however, to puzzle us, especially if we seek to comprehend them in terms appropriate to the drawings of mature artists or in terms relevant for other pictorial forms and expressions. Likewise, they may (...) puzzle us if we make the mistake of supposing that they represent in any direct or obvious way the cognitive development of young children or if we see them only as comical, inept efforts at depicting external reality. Children's drawings stimulate many nagging questions, among them the one as to why it should be that a child who knows so much and who is verbally so articulate may be graphically capable of depicting so little.Claire Golomb's work has proven extraordinarily helpful here as a corrective because Golomb, after many years of research and reflection, writes about these youthful creations not as "print-outs" of a child's mind. She sees them, rather, as exemplars of particular visual representational schemata that are generally available to and employed by young children. And although she regards these schemata as universal, she acknowledges that they are clearly subject to a wide range of individual variability. Over all, the value of Golomb's work lies in her extensive, descriptive research. Acknowledging her intellectual debt to her mentor, Rudolph Arnheim, Golomb reminds her readers that representation is never mimesis pure and simple. Representation is never, she tells us, the result of an "intention to copy nature." Therefore, when young children do otherwise, they ought not to be seen as failing. Their drawings ought not to be viewed as unsuccessful attempts to imitate nature or to depict with faithful realism what appears before their eyes. Rather, as Golomb states and attempts to demonstrate throughout the pages of her well-illustrated volume, children employ graphic schemata that develop over time in terms of shape, color, content, and composition. Ever seeking meaning, children create pictorial worlds that, while they have no one-to-one correlation with the perceptual world, are tied to it, importantly, nonetheless.Golomb assiduously describes and illustrates each of her studies so that her readers are treated to a panorama of this "orderly progression," as she puts it, this evolution of children's graphic work. Her book, moreover, is characterized by a certain social scientific aura; that is to say, she proffers statistics and quantifies her data to prove her points. She takes pains to argue, for example, from research conducted in tandem, apparently, with her daughter, that it is extremely difficult to differentiate, prima facie, the drawings of children who have been diagnosed as disturbed from those who are considered normal. Having worked for a couple of years in a residential treatment center for schizophrenic children, I would aver that this claim might be debatable. However, were one to be [End Page 120] able to so differentiate, this might constitute a challenge to Golomb's theory that the representational schemata are, as she puts it, "robust." According to her findings, they remain more or less in tact. Likewise with regard to the issue of cultural variables. Here Golomb argues, gently and respectfully, against positions taken by two other well-known scholars in the field, Brent and Marjory Wilson, who accord a higher priority than she does to cultural differences. According to the Wilsons, children's drawings are importantly influenced by whatever graphic models are made available to them in a given culture. For Golomb, however, these variables, while significant, do not interfere substantially with the universal classifications she proposes. As she writes, "The drawings of young children are as different one from another as fingerprints, yet they can be classified" (357).In general, then, the body of work Golomb offers in this second edition of her first volume published under the same title in 1992 by the University of California Press importantly contributes, as it initially did, to ongoing research in numerous fields, including art education, early childhood studies, art history, developmental psychology, anthropology, and art... (shrink)

Satirical news is often characterized as a hybrid genre that consists of three important communicative functions: it is (1) humoristic, (2) informative, and (3) evaluative. The Humoristic Metaphors in Satirical News (HMSN) typology demonstrates that metaphors can be utilized by satirists to express this hybridity by consisting of a combination of one or more of satire’s core communicative functions. Nevertheless, the underlying principles through which metaphors are capable of humorously explaining and/or criticizing current affairs are less clear. To broaden (...) our understanding of how metaphorical humor is used in satirical news to fulfill these functions, we integrate the HMSN typology with the General Theory of Verbal Humor (GTVH). The GTVH assumes that all verbal humor must draw from six interdependent Knowledge Resources (KRs). Through a content analysis of metaphorical humor used across various American satirical news shows, we investigated how these KRs are used to fulfill satire’s core communicative functions across the various metaphorical sub-types of the HSMN typology. We found that: (1) some KRs can help fulfill the communicative function(s) of metaphorical jokes, while (2) some KRs constrain the options available for the expression of certain communicative function(s) or other KRs. (shrink)

A work of art no matter how old and classic is actually, not just potentially, a work of art only when it lives in some individualized experience. . . . It cannot be asserted too strongly that what is not immediate is not aesthetic. Let’s imagine a young professor who receives a poor review of her teaching because she fails, when observed, to complete what she had initially set out to accomplish in the specific class meeting under critique. Assessment, after (...) all, does imply—when taken literally—being judged on what one has set out to do. Why did she fail? Her art history students, mesmerized by Van Gogh’s hypnotic final masterpiece “Crows over Cornfield,” had, after their initial reticence, gradually .. (shrink)

There are countless variations on this theme. The call can come from one of your own physicians who was called by the investigator. Your physician may or may not be well informed on what the reported finding about Disease Y means or how to respond. DNA testing can reveal more than susceptibility to disease. People can learn that they do not have the biological connections — parentage or evidence of ethnic origin — that they thought they did.Colleagues who serve (...) on the Institutional Review Board in my institution tell me that they currently do not permit “cold calls” of the type portrayed in the opening paragraph. Such direct contacts have, however, occurred in the past, with or without the blessing of an IRB. Sharing findings with the individual’s physician, who is then supposed to serve as a learned and wise intermediary, is not without problems either, given that many physicians understand little about complex genetics. Yet the very existence of this project on managing incidental findings in research demonstrates that some people believe that some research findings ought to be available to participants. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Prelude to the Special Issue of the Journal of Aesthetic Education on Children’s LiteratureEllen Handler Spitz, Guest Editor (bio)When Professor Pradeep A. Dhillon, editor of the Journal of Aesthetic Education, suggested to me one day that I might guest edit a special issue of the journal devoted to the topic of children’s literature, my initial reticence was toppled and my sense of resolve buoyed as I began to fantasize (...) with billowing excitement about just how this might be done. First, I dreamt up the image of guest editor as bountiful hostess—setting out delectable dishes in an elegantly appointed banquet before the readers of this journal. That metaphor faded, however, despite Maria Tatar’s eloquent reminder to us in these pages that gastronomy has frequently and salubriously been juxtaposed with reading. I could not help worrying (even though children vociferously protest the logic of this problem) that one cannot have one’s cake and eat it too. Therefore, switching to music, I began to imagine the editor as conductor of a highly select ensemble of musicians, all gifted with glorious well-seasoned voices. They might perform a concert (recorded for posterity, of course) of pieces aimed at an audience of those who care passionately about aesthetics, education, literature, and above all about children, and at those who, perhaps with tenderness, still recall their own childhood reading.But how to accomplish this in practical terms? Well, I reasoned, I would simply invite a group of distinguished senior scholars who, having achieved their reputations in related fields and having written on other subjects as well, have published highly significant works pertaining to children’s literature. Each person would contribute a composition in his or her own voice, and there would be complete freedom, carte blanche, no holds barred—the only constraint being page numbers. Would the results turn out to be harmony or cacophony? Well, I speculated, if each voice were finely tuned, resonant, and clear, whether treble or bass, forte or pianissimo, the outcome—although [End Page 1] unpredictable in terms of specifics—would, unquestionably, be musical. But that, dear reader, is ultimately for you to judge, for you have now heard precisely how this issue came into being and will, we hope, read on. Each author I asked responded to my call with alacrity and, in his or her original style and tone, made my task as conductor a perfect pleasure.We offer you a work in three parts. First, you will encounter two melodious and euphonious pieces, contributed respectively by Marina Warner (“Out of an Old Toy Chest”) and Maria Tatar (“From Bookworms to Enchanted Hunters: Why Children Read”). Here, the overarching themes of children’s play and make believe are set up, analyzed, and explored. Playing and reading are placed side by side, as well as reasons why children love to read and how they are variously exhorted, extolled, and even occasionally excoriated by adults for doing so.Our second movement consists of three apparently unrelated motifs, contributed in turn by Gareth Matthews (“Philosophical Adventures in the Lands of Oz and Ev”), Seth Lerer (“Style and the Mole: Domestic Aesthetics in The Wind in the Willows”), and myself (“Ethos in Steig’s and Sendak’s Picture Books: The Connected and the Lonely Child”). Actually, however, these essays are not unrelated, for each motif arises from a particular mode of interpretation grounded in turn in philosophy, in literary history and theory, and in psychology. The works considered are all by notable writers for children: L. Frank Baum, Kenneth Grahame, William Steig, and Maurice Sendak.For our grand finale, we offer two sonorous, seriously challenging contributions, one by Jack Zipes (“Why Fantasy Matters Too Much”) and the other by Eliza T. Dresang and Bowie Kotrla (“Radical Change Theory and Synergistic Reading for Digital Age Youth”). These works grapple with contemporary matters, with fantasy, with technology, and with “radical change” as these can be discerned in the literature, imagery, and general cultural lives of today’s and even, quite possibly, of tomorrow’s children. Gesturing toward the future even more strikingly, we conclude this work with a flourishing coda in the actual voice of a living child... (shrink)

Inside Out takes people on a journey into terrain not often explored in animated films – the inner workings of the developing 11‐year‐old self. Inside Out takes a girl's emotional development as important, primary, and worthy of attention. Along the way, audiences come to appreciate that even though emotions often feel singular, solitary, and intense, some aspects of emotions are universal and cut across age, gender, and culture. The movie also highlights the social dimension of emotional expressiveness. The directors were (...) originally going to include many more emotions than the five core emotions they depict: joy, sadness, anger, disgust, and fear. The choice to focus on five primary emotions allows people to better appreciate how emotions are central to selfhood and how one's emotions influence his/her memories and self‐understanding. (shrink)

As medical technology has advanced, the question of medical futility has become a topic of intense debate both within the medical community and within society as a whole. However, a unanimous definition thereof is yet to be decided—some commentators are sceptical as to whether an agreement will ever be reached—and this continues to lead to difficulties, tension, and even legal action when a treating physician disagrees with a patient and/or a patient’s family regarding care and treatment options. Although living in (...) a pluralistic society presents one of the major reasons as to why, despite 30 years of intense discussion, no consensus has been made; the issue of medical futility will always be complex as it is, by nature, multifaceted, and numerous elements—including possible risks, evidence of the probability of benefit, the wishes of the patient (and family), professional standards, and cost—interact. Nevertheless, the global medical community has seen the development of two distinctly different approaches to medical futility: one in which the autonomy of patients is of paramount importance in the decision whether or not to pursue a treatment; and one in which beneficence and primum non nocere—first do no harm—are almost entirely the clinician’s prerogative, and whereby he/she has a duty to refuse any treatment for which the potential risks outweigh the potential benefits for the patient. Recently, however, there has been a rejection of this dichotomous view of medical futility and the apparent “power struggle” between physician and patient, and a positive movement towards a more collaborative decision-making process that highlights the necessity of communication, aiming to result in the obtainment of the best possible outcome for each patient as an individual. (shrink)

One fundamental assumption seems to underlie – explicitly or implicitly – every critique of Brenner I have seen: that there can be no such thing as a Marxist theory of competition, the ‘horizontal’ relation among many capitals, that does not presuppose the ‘vertical’ class relation between capital and living labour. To start with the relation between capital and living labour is the only way to establish one's Marxist credentials. In support of that assumption, more than one critic has invoked (...) Marx's comment that competition does not produce or explain capitalist laws of motion but merely executes them, as their visible manifestation in the external movements of individual capitals. Predictably, too, some critics have gleefully turned against Brenner the charge he has famously levelled against other Marxists: that his focus on competition and the market makes him a ‘neo-Smithian’. (shrink)

Walt Disney’s movie, The Pagemaster (1994) begins on a dark and stormy night, with a young boy stumbling into an immense, gothic-styled library for refuge from the rain. Once inside, he is soon carried away by a tumultuous river of coloured paints, transformed into an animated characterization of himself, and thrust into an animated world of literature, where he battles Captain Hook, flees Moby Dick, and participates in other classic tales of adventure, horror, and fantasy. -/- Adults might understand the (...) film as a fanciful description of how they feel when reading a lively book. Although they would probably not imagine themselves tagging along with the animated characters like a 4th musketeer, they might very well claim that they enter a fiction through the viewpoint of one or more of the characters, experiencing, imaginatively, mental images of the sights, sounds, smells, and movements that the character would experience. Under this description, the reader would be forming multi- modal images that would correspond directly to what the literary characters are doing, thinking, and experiencing. When a fictional hero whips out his sword and slashes a rope in half, the reader might form a visual image of the hero’s determined face, an auditory image of the sound of the whizzing sword, and a motor image of an extended arm movement. I call such an imitative participation, by use of mental images in any modality, a simulation. -/- I suggest that this imitative experiencing of a fiction through the production of multi-modal imagery - a simulation - is not the only way in which readers might engage a literary text. In this paper I explore the hypothesis that readers might use their own bodily processes - those of the somato-viscero-motor system (SVM) for a non-imitative activity that I call a reinterpretation and that the reinterpretation might make a distinctive contribution to the reading process. As an example of a simulation and a reinterpretation, take the SVM experience of the reader’s breathing. A simulation would occur if the text describes a character who is taking deep breaths of air and the reader creates a mental image representing the experience of breathing. In this case, the reader’s mental image of breathing would stand for a property of the literary work - the fictional experience of breathing. -/- By contrast to the simulation, a reinterpretation would occur if the text describes a character who is gazing at long, wispy clouds that extend outward from a horizon and the reader uses his own experience of breathing to stand for the visual sense of looking at a long, continuous expanse of filmy white: the reader’s actual breathing would stand for a property of the literary work - the fictional experience of seeing. Breathing is not the same as seeing. This should help clarify the following definition. -/- I hypothesize that a reinterpretation occurs when the reader becomes aware of some component of the SVM system and reinterprets it as a property of the literary work that is not the same as that particular SVM process. The SVM experience is projected into the literary work. (shrink)

This paper suggests that Alfred Schutz’s account of systems of typi­fication together with Sara Ahmed’s account of the proximity of the stranger allows for a different understanding of social integration. The paper proposes to rethink the political and social relationship of the in-group and the stranger, approached through the face-to-face encounter between an integration counselor and an immigrant. The encounter offers a disruption of what is taken for granted by the in-group and functions as a catalyst for a system of (...) reference to appear at all. Through Ahmed’s account on the familiarity and proximity of the stranger, I argue that integration practices are considered to produce, rather than translate, a coherent system of reference for an in-group. The institutionalization of social integration is consequently risking concealing the “unintegratable” stranger rather than offering a solution for the more epistemological dimensions of social exclusion that we find in the experience of sameness and difference. (shrink)

Purpose: to characterize ethics course content, structure, resources, pedagogic methods, and opinions among academic administrators and course directors at U.S. medical schools. Method: An online questionnaire addressed to academic deans and ethics course directors identified by medical school websites was emailed to 157 Association of American Medical Colleges member medical schools in two successive waves in early 2022. Descriptive statistics were utilized to summarize responses. Results: Representatives from 61 (39%) schools responded. Thirty-two (52%) respondents were course directors; 26 (43%) were (...) deans of academic affairs, medical education, or curriculum; and 3 with other roles also completed the survey (5%). All 61 schools reported some form of formal ethics education during the first year of medical school, with most (n = 54, 89%) reporting a formal mandatory introductory course during preclinical education. Schools primarily utilized lecture and small-group teaching methods. Knowledge-based examinations, attendance, and participation were most commonly used for assessment. A large majority regarded ethics as equally or more important than other foundational courses, but fewer (n = 37, 60%) provided faculty training for teaching ethics. Conclusions: Despite a response rate of 39 percent, the authors conclude that medical schools include ethics in their curricula in small-group and lecture formats with heterogeneity regarding content taught. Preclinical curricular redesigns must innovate and implement best practices for ensuring sound delivery of ethics content in future curricula. Additional large-scale research is necessary to determine said best practices. (shrink)

Over the last years, Norway has revised its animal welfare legislation. As of January 1, 2010, the Animal Protection Act of 1974 was replaced by a new Animal Welfare Act. This paper describes the developments in the normative structures from the old to the new act, as well as the main traits of the corresponding implementation and governance system. In the Animal Protection Act, the basic animal ethics principles were to avoid suffering, treat animals well, and consider their natural needs (...) and instincts. In addition, a principle for balancing our duties towards animals with the needs and interests of humans was expressed by the formulation unnecessary suffering. These principles (only with slightly different formulations) are retained in the new act. The novelty of the new act is shown by its explicit intention to promote respect for animals and its recognition of animals’ intrinsic value. Whereas intrinsic value is only given a symbolic function, the notion of respect is intended to have practical consequences. One interpretation of respect for animals is taking the animal’s integrity—and not only welfare—into account. Another is to see the introduction of respect as a call to animal keepers to provide animals with welfare exceeding the minimum requirements. In several respects, the legal system now seems to leave more responsibility to the individual animal keeper—and to citizens in general. I argue that if the authorities really do want to promote respect for animals, they must at the same time initiate activities to achieve this. In my perspective the challenge is to provide adequate measures to achieve in practice the intended respect for animals expressed in the new act. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Border CrossingEllen T. ArmourAs a philosophical theologian deeply formed by a long apprenticeship in continental philosophy, I find more points of entry into Kalpana Seshadri's HumAnimal: Race, Law, Language than I can possibly pass through in the space available to me here. Inevitably, whichever point of entry I take will violate what I take to be a core responsibility of a respondent: to hew closely to the text (...) in question, to trace in one's own words its outline in order to open it up to those who have not had the privilege to devote time and attention (those most valuable of assets for academics, it seems) to the project in question. Such a model of a responsible response itself bespeaks the central problematic of the project: the relationship between speech and silence, language and law, ethics and politics.And so I begin with a de-cision that is, simultaneously, an in-cision; I enter this text through this opening, not that, and in doing so, I relegate to a spectral silence of not-saying what other (in/de)cisions would bring to speech and/or to the invisibility of not-writing what other (in/de)cisions would render legible. In the spirit of a Derridean supplément, I hope to productively open and extend for you, if not precisely retrace, Seshadri's project.HumAnimal: Race, Law, Language (Seshadri 2012) is a brave book in many respects, but particularly in its attempt not just to delineate but to map out certain contested yet liminal spaces. In addition to those I've already mentioned, [End Page 175] let me add those between literature and philosophy, theology and philosophy, work and play, Agamben and Derrida, deconstruction and biopolitics, human and animal. (Any one of these alone would have been plenty for one book.) I take my mark from the site where these last two (or perhaps three) liminal spaces meet. First, allow me to indulge in a bit of intellectual autobiography: I began my career as a Derridean (and may yet end it that way … that remains to be seen), but have in the last few years, taken a decidedly more Foucauldian turn. Reading HumAnimal made me keenly aware of how profound a reorientation I have undergone in the process. And yet I entered into that process of reorientation (perhaps quite naively) sensing that, for all that separated Derrida from Foucault, deconstruction from biopolitics, they were not unconnected (please note the double negative). Thus, I found myself in deep sympathy with Seshadri's project in many ways. Whatever separates projects that foreground the machinations of power (as constitutive of knowledge, and vice versa) as object of analysis and those that foreground language (as constitutive of knowledge, and vice versa) as object of analysis,1 Seshadri's detailed readings suggest they share important points of overlap (which is not to say sameness). To a degree, then, HumAnimal undoes the very delineation between these kinds of projects that I just articulated. To be sure, Seshadri is aided a great deal in this by the fact that Agamben's own work invokes (though not uncritically) both Derridean and Foucauldian antecedents framed largely though not exclusively in and through the relationship between sovereignty and (bare) life.The book's title, HumAnimal: Race, Law, Language, names both the stakes of and framework for Seshadri's incision into this shared but contested space. Her neologism humAnimal marks a boundary integral to sovereignty's exercise, that between human and animal. The subtitle marks the forces at play in sovereignty's construction and its deployment. Race has often figured as the border demarcating those served by the law and those served up by it; those granted access to language and those denied it. Consignment to the nether side of law and language entails as well consignment to the nether side of the human/animal divide. The American practice of chattel slavery serves as one constitutive exemplar of a biopolitical and legal/linguistic regime in HumAnimal, as it will in my comments. But Seshadri seeks out the possibilities for resistance from this nether side; of possibilities opened up by and in silence, the suspension of law, and even... (shrink)

Wright maintains that tradition (including language) plays a fundamental role in the origins and shaping of the monastic world that made a unique Chan mind possible. Through a creative application of the Buddhist idea of dependent origination, Wright has broadened the hermeneutic concept of historicity in that it is more than a linear and causal relationship of contextuality (that is, the person is always a person-in-community, and the text is always a text-in-context). Instead, contextuality refers to a (w)holistic network (...) of associations and re-associations. The word tradition thus becomes an open tradition that is constantly shaped and reshaped, formed and transformed. The meaning of tradition as such is always a trace of that other which is forever absent. In this sense, Wright is quite Derridean. Like Derrida’s deconstruction, Wright’s interpretative endeavor, as part of the tradition of linguistic turn, seems to become separated from the real world of flux and takes on an independent status, that is, the realm of reading, explaining, and understanding (perhaps mis-understanding, sometimes). Wright’s project fits the need of those who have a passion for doing things with words, and those who prefer meditative reading to meditative practice (in a Buddhist sense). Though Wright keeps reminding us that the effort to play language in relation to Chan experience does not imply that Chan enlightenment/mind is in any sense reducible to language; it still remains a question whether his critical philosophical meditations are fully out of the spell of conceptuality of the hermeneutical circle. Wright might say that there is no need to be out of the circle, or there is no such circle in the first place. (shrink)

Objective Although patients exercise greater autonomy than in the past, and shared decision making is promoted as the preferred model for doctor-patient engagement, tensions still exist in clinical practice about the primary locus of decision-making authority for complex, scarce, and resource-intensive medical therapies: patients and their surrogates, or physicians. We assessed physicians’ attitudes toward decisional authority for adult venoarterial extracorporeal membrane oxygenation (VA-ECMO), hypothesizing they would favor a medical locus. Design, Setting, Participants A survey of resident/fellow physicians and internal medicine (...) attendings at an academic medical center, May to August 2013. Measurements We used a 24-item, internet-based survey assessing physician-respondents’ demographic characteristics, knowledge, and attitudes regarding decisional authority for adult VA-ECMO. Qualitative narratives were also collected. Main Results A total of 179 physicians completed the survey (15 percent response rate); 48 percent attendings and 52 percent residents/ fellows. Only 32 percent of the respondents indicated that a surrogate’s consent should be required to discontinue VA-ECMO; 56 percent felt that physicians should have the right to discontinue VA-ECMO over a surrogate’s objection. Those who self-reported as “knowledgeable” about VA-ECMO, compared to those who did not, more frequently replied that there should not be presumed consent for VA-ECMO (47.6 percent versus 33.3 percent, p = 0.007), that physicians should have the right to discontinue VAECMO over a surrogate’s objection (76.2 percent versus 50 percent, p = 0.02) and that, given its cost, the use of VA-ECMO should be restricted (81.0 percent versus 54.4 percent, p = 0.005). Conclusions Surveyed physicians, especially those who self-reported as knowledgeable about VA-ECMO and/or were specialists in pulmonary/ critical care, favored a medical locus of decisional authority for VA-ECMO. VA-ECMO is complex, and the data may (1) reflect physicians’ hesitance to cede authority to presumably less knowledgeable patients and surrogates, (2) stem from a stewardship of resources perspective, and/or (3) point to practical efforts to avoid futility and utility disputes. Whether these results indicate a more widespread reversion to paternalism or a more circumscribed usurping of decisional authority occasioned by VA-ECMO necessitates further study. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Ethos in Steig’s and Sendak’s Picture Books: The Connected and the Lonely ChildEllen Handler SpitzThere was the child, listening to everything...—Yasunari Kawabata1IntroductionPicture-book characters spring to life in both verbal and visual registers. Moving about the page before our eyes as well as speaking and acting in their respective stories, they often make a long-lasting impact on children. Pictures and words, moreover, may overlap but are never commensurate; like the (...) words and notes of a song, they mean and evoke differently even while being experienced together. This brief essay considers a small selection of works by two distinguished twentieth-century American authors-artists: William Steig (1907–2003) and Maurice Sendak (b. 1928). It argues that, with their artful words and pictures, Steig and Sendak construct very different—even contrasting—visions of childhood. By “ethos” in this context I mean to suggest a vision of what a child is, a sense of what it means both to be a child and to address one. Such visions differ not only through the ages and from one culture and locale to another but also from one author-artist of the same period and locale to another. Invited to speak on Sendak’s and Steig’s respective works at meetings scheduled just a week apart in New York City during the winter of 2007, I found in these paired invitations a fortuitous opportunity to juxtapose several of their works and thereby discover some arresting contrasts and formulate the following readings.2First, a word on the topic of methodology. Nearly one hundred years have elapsed since Freud published his celebrated-cum-notorious foray into psychobiography with Leonardo da Vinci and a Memory of His Childhood,3 wherein shards of circumstantial biographical evidence were laid out in seductive mosaic patterns secured with a grout of ingenious speculation. Despite subsequent decades of critical reflection, Freud’s method soldiers on nonetheless as a modus operandi in the psychological interpretation of art and literature.4 By bracketing a small selection of Steig’s and Sendak’s works here and limiting myself to extracting a tentative underlying ethos from them, I am [End Page 64] taking the position that to write psychologically one need not mention or exploit a creator’s personal life. This essay points gently toward psychological approaches that ask what we can see when we look carefully at the pages of works. What can we find when we share children’s books with children? Why, for example, has Sendak’s Where the Wild Things Are sold over seventeen million copies (and its Amazon rank last time I checked was around 145, which means that only 144 other books in the United States were selling more copies at that particular moment), whereas his later work Outside Over There—a book that apparently figures prominently in his personal life—comes nowhere close?5 While market figures do not correlate flawlessly with children’s actual preferences (adults, not children, are the buyers), I would aver that, in this case, they do reflect the success and beloved status of Where the Wild Things Are, since the figures tally with additional facts: the book continues to appeal in its fifth decade post publication; it is known and has been translated worldwide, dramatized, and set to music6; and its characters have been fashioned into ubiquitous stuffed toys. On the other hand, in my (limited) experience, young children seem to find Outside Over There unsettling, unintelligible, even “creepy” and often have trouble sitting still through a full rendition. Some adults, on the other hand, praise that book as poetic and admire its more complex art. Such discrepancies in reception deserve our attention; they hint at fallow fertile fields lying over the rainbow, far beyond the much-plowed tracts of authorial psychobiography. This essay gestures casually toward those fields.The Connected Child“My dear Deborah,” said Doctor De Soto, “you must have been reading my mind.7Let’s begin with William Steig, who is best known for his New Yorker cartoons. His work for children extends back to 1968,8 however, when he was already a man in his sixties. Setting aside the... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:The Pictorial World of the ChildEllen Handler SpitzThe Pictorial World of the Child, by Maureen Cox. Cambridge: Cambridge University Press, 2005, 357 pp., paper.Scholarly, informative, and impartial are adjectives that spring to mind with respect to Maureen Cox's book, The Pictorial World of the Child, a text principally but not exclusively devoted to the subject of children's drawings and to ways in which children seem to understand pictorial (...) representations as well as create them. Because of its clarity and comprehensiveness, this book seems well-suited for classroom use. Effectively organized into a cogent selection of significant subtopics, it summarizes and presents a vast array of contributions by colleagues whose work Cox surely respects and treats in an admirably evenhanded way. Since, as she states at the beginning of her book, a serious scholarly interest in children's pictures has been with us for over a century, her task is prodigious, and she accomplishes it with grace and precision. It is perhaps to her credit that Cox does not argue passionately on one side or another of a host of thorny issues in her field about which many scholars, teachers, and theorists seem to exhibit strong one-sided views. How should art be taught to young children, for example? Should they be given total freedom or required to perform an ordered set of tasks? In every case, Cox offers her readers a panoply of perspectives and invites them to entertain the spectrum of opinion and then decide for themselves or not.The book is written, therefore, as far as I can tell, to promulgate no particular thesis of any kind. It simply is what it purports to be, namely, an overview of the field by someone who has a deep knowledge of it. It informs and educates through its systematic citation of experimental situations, test results, evaluations, neurological research, art historical material, and the like, and, while acknowledging disagreements right and left, it does not enter into philosophical debate. If one were inclined to fault the book at all, one might criticize it for this—that is, for lacking sufficient skepticism and deep questioning. But surely that would be niggardly, for nowhere does Cox state philosophizing to be her purpose in these pages. I would argue, in fact, to the contrary—that Cox underestimates herself when she states as her principal aim merely the furthering of interest in and appreciation of children's drawings (7). To my mind, she goes far beyond that modest goal to enlighten and educate her readers.Let me give some examples of Cox's treatment of controversial topics. It is arguable, for example, as to whether or not young children understand representational duality and can tell the difference between a pictured representation and the object pictured. A broad spectrum of research, claims, and beliefs are citable on both sides here, with the most up-to-date [End Page 110] scholars being persuaded that young children are far more sophisticated than we had previously thought. But conjure up, if you will, on the other side that well-known photograph in which a baby holds a picture of a clock to his ear and tries to hear it ticking. (This image, subtitled "How they read it," was printed on the jacket of Mary Calderone and Edward Steichen's The First Picture Book of 1930, which was reissued by the Frances Mulhall Achilles Library at the Whitney Museum of American Art, New York, in 1991.) After citing numerous sources and experiments, Cox equivocates as follows: "It seems that young children may know the difference between a picture and the real object it represents, but their behaviour is often confusing" (25); to me, this seems exactly right. We simply cannot accept a blanket statement meant to cover all cases, and, as with many or even most of the topics under consideration in this book, there are no definitive answers. Thus, the fact that Cox chooses to present intriguing research but leave the conclusions open seems preferable to joining sides in a spurious debate and one, perforce, with huge cultural and historical contingencies, contingencies to which indeed she pays heed from time to time... (shrink)

Excerpt from The Fundamental Principle of Fichte's Philosophy The purpose of this monograph is to make a careful study of Fichte's conception of the ultimate principle. In his various writings the principle appears under many different names. 'The Ego, ' 'the Idea of the Ego, ' 'the moral world-order, ' 'God, ' 'the Absolute, ' 'Being, ' 'the Light, ' are some of the phrases by which it is most commonly designated. It is not the main purpose of this study (...) to examine tile much discussed question of the relation between the two periods of Fichte's philosophy. But the question is so intimately connected with the problem which I have undertaken that some discussion of it is inevitable. I have tried, however, to keep well within the limits of my theme, and instead of considering the relation between the two periods in all its aspects, have sought merely to determine how far the conception of the fundamental principle which we find in Fichte's later writings differs from that which appears in the earlier ones. The references to Fichte's writings are to the Sammtliche Werke (Berlin, 1845-1846, 8 vols.) and to the Nachgelassene Werke (Bonn, 1834-1835, 3 vols.). References to the Sammtliche Werke are indicated by the letters S. W.; to the Nachgelassene Werke, by the letters N. W. References to the Kritik der remen Vernunft arc indicated by the letters A (for the First Edition) and B (for the Second). All other references to Kant's writings are made to Hartenstein's second edition of the Sammtliche Werke (Leipzig, 1867-1868, 8 vols.) and are indicated by the letter H. About the Publisher Forgotten Books publishes hundreds of thousands of rare and classic books. Find more at www.forgottenbooks.com This book is a reproduction of an important historical work. Forgotten Books uses state-of-the-art technology to digitally reconstruct the work, preserving the original format whilst repairing imperfections present in the aged copy. In rare cases, an imperfection in the original, such as a blemish or missing page, may be replicated in our edition. We do, however, repair the vast majority of imperfections successfully; any imperfections that remain are intentionally left to preserve the state of such historical works.". (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Darwin Meets Literary TheoryEllen DissanayakeEvolution and Literary Theory, by Joseph Carroll; xi & 518 pp. Columbia: University of Missouri Press, 1995, $44.95.In my experience, most literary theorists, even those who participate in conferences called “Literature and Science,” know little about evolution, and don’t want to know. For them, “science” means information theory, chaos or catastrophe theory, fractals, pataphysics, “autopoeisis” or self-organization, emergence, cyborgs, hypertext, virtual signs and other aspects (...) of sci-fi, or techno-politics. (I encountered these subjects at a comparative literature conference I attended in March 1995.) These “scientific” positions are used as trendy metaphors for talking about chance, uncertainty, accident, ideology, and multidimensionality in literary works or in the aims of their authors. In other words, the buzzwords of contemporary science become one more angle from which to view or project another facet onto the glassy, self-reflective edifice of contemporary literary theory, rather than a means from which to shatter it and build again from scratch with more earthy, substantial materials. Joseph Carroll’s book provides the view and the means for this genuinely new and constructive (if initially destructive) possibility.It is ironic that in the present critical climate the very virtues of the book might be seen by some as faults—e.g., the lucid, elegant writing and the erudition and interdisciplinarity of the work as a whole. Carroll [End Page 229] writes clearly, authoritatively, without jargon, and with frequent, delicious wit. His values, aims, explanations, evidence, and criticisms are concisely and plainly stated. This is in marked contrast to the enigmatic and idiosyncratic nature of much recent criticism, and might have the initially disorienting effect of returning to earth and breathing pure oxygen after one has become accustomed to the thin and rarefied atmosphere of remote, icy peaks.Carroll offers wide-ranging and illuminating discussions of standard literary and critical works from both the European and Anglo-American tradition over the past several centuries, and refers to dozens of writers from diverse periods and nationalities. Additionally he enlists, and criticizes where appropriate, ideas from such diverse nonliterary figures as Darwin himself and writers about Darwin, T. H. Huxley, Konrad Lorenz, John Bowlby, Sir John Eccles, the prominent sociobiologists and evolutionary psychologists, S. J. Gould, Richard Lewontin, Derek Bickerton, Piaget, Karl Popper, Thomas Kuhn, Clifford Geertz, H. J. Eysenck, Cardinal Newman, Thorstein Veblen, Trotsky, Raymond Williams, and Richard Rorty, among others.One can be forgiven for wishing to forego an exploration of this demanding array of knowledge argued from the unfamiliar perspective of evolutionary biology. For in order seriously to consider Carroll’s new way of looking at human endeavor (including literature) one must also look critically at what was laboriously mastered during all those years of graduate school and tenure-driven writing for publication. No one wants to be persuaded to give up a view of the world that has been mastered with painstaking diligence. Still less does anyone want to spend time with something that according to conventional academic wisdom is downright wrong-headed. This is really the challenge of Carroll’s book—because such minor matters as the plain unfashionable title, clear writing, impressive erudition, and dated or forgotten thinkers can be overcome if the stakes are high enough.I wish to suggest that the stakes are high enough and that the time is right for this inevitable change of viewpoint. Along with others in diverse fields such as cognitive and developmental psychology, personality theory, neurology, medicine, sociology, political science, epistemology, cultural anthropology, ethics, and linguistics, I find the Darwinian perspective to offer the most comprehensive and viable possibility for an understanding of human behavior and culture, including the arts. Joseph Carroll admirably articulates this position and applies it to literary theory. I invite scholars who think that evolutionary explanations [End Page 230] are erroneous, dangerous, reductionist, simplistic, or irrelevant to read Carroll and deal seriously with his arguments. His book should be the central text for theory classes and seminars, as well as the subject of conferences. Those who would dismiss it should have the courage and curiosity to lay aside their misgivings and have a look. Especially those who are dissatisfied with the surfeit... (shrink)

Focusing on the work of one bioethics commission, the New York State Task Force on Life and the Law, this article explores the role played by moral consensus in public ethics. Task Force members, who were appointed to represent diverse interests in New York State, identified a culturally strong value of individual autonomy as the ethical basis for their work on life-sustaining treatment. This moral consensus permitted the members to unite across their differences and develop public policy recommendations that substantially (...) reformed a highly troubling New York law. However, the principle of autonomy insufficiently guides decisions by caring family members for incompetent adults in cases where little is known of patient preference. A different, more innovative moral vision is required – one that grants a more robust moral authority to the family. While government efforts that rely on moral consensus developed in a broadbased and well-reasoned manner can serve us well, in some cases the consensus will provide inadequate moral guidance. Government bioethical efforts must guard against the limits of moral vision in light of their disproportionate societal power. Keywords: autonomy, consensus, family decisionmaking, government bioethics, incompetent patients, life-sustaining treatment, surrogate decisionmaking CiteULike Connotea Del.icio.us What's this? (shrink)