Hastings Center Report, Volume 52, Issue 2, Page 21-31, March‐April 2022.

This is the second paper in a two-part series describing subject and family perspectives from the CENTURY-S (CENtral Thalamic Deep Brain Stimulation for the Treatment of Traumatic Brain InjURY-Safety) first-in-human invasive neurological device trial to achieve cognitive restoration in moderate to severe traumatic brain injury (msTBI). To participate, subjects were independently assessed to formally establish decision-making capacity to provide voluntary informed consent. Here, we report on post-operative interviews conducted after a successful trial of thalamic stimulation. All five msTBI subjects met (...) a pre-selected primary endpoint of at least a 10% improvement in completion time on Trail-Making-Test Part B, a marker of executive function. We describe narrative responses of subjects and family members, refracted against that success. Interviews following surgery and the stimulation trial revealed the challenge of adaptation to improvements in cognitive function and emotional regulation as well as altered (and restored) relationships and family dynamics. These improvements exposed barriers to social reintegration made relevant by recoveries once thought inconceivable. The study’s success sparked concerns about post-trial access to implanted devices, financing of device maintenance, battery replacement, and on-going care. Most subjects and families identified the need for supportive counseling to adapt to the new trajectory of their lives. (shrink)

ABSTRACT:Daniel Callahan died on July 16, 2019, just short of his 89th birthday. In the years since, we have seen the overturning of abortion rights, a concern central to his scholarship and musings about the place of religion in American civic life. Callahan’s journey from lay Catholic journalist and commentator at Commonweal to a co-founder of the Hastings Center, during his decade of doubt, is especially relevant today as America revisits established precedent governing a woman’s right to choose. His life-long (...) struggle with faith and the secularization of bioethics is a story worth telling, as it may foster dialogue across a divide between religious and laical thinkers that has fractured our political discourse. We recall Callahan’s misgivings about the marginalization of religious perspectives in public life; he sought not the denial of complexity nor of difference in views, but rather the importance of free and honest debate around deeply held beliefs, contextualized in the realities of the contemporary world. Callahan’s ambivalence about his faith remains a part of the fabric of American life, a story that Callahan chronicled to our collective benefit for over a half-century. (shrink)

BackgroundRadiotherapy is an essential component of cancer treatment, yet many countries do not have adequate capacity to serve all patients who would benefit from it. Allocation systems are needed to guide patient prioritization for radiotherapy in resource-limited contexts. These systems should be informed by allocation principles deemed relevant to stakeholders. This study explores the ethical dilemmas and views of decision-makers engaged in real-world prioritization of scarce radiotherapy resources at a cancer center in Rwanda in order to identify relevant principles.MethodsSemi-structured interviews (...) were conducted with a purposive sample of 22 oncology clinicians, program leaders, and clinical advisors. Interviews explored the factors considered by decision-makers when prioritizing patients for radiotherapy. The framework method of thematic analysis was used to characterize these factors. Bioethical analysis was then applied to determine their underlying normative principles.ResultsParticipants considered both clinical and non-clinical factors relevant to patient prioritization for radiotherapy. They widely agreed that disease curability should be the primary overarching driver of prioritization, with the goal of saving the most lives. However, they described tension between curability and competing factors including age, palliative benefit, and waiting time. They were divided about the role that non-clinical factors such as social value should play, and agreed that poverty should not be a barrier.ConclusionsMultiple competing principles create tension with the agreed upon overarching goal of maximizing lives saved, including another utilitarian approach of maximizing life-years saved as well as non-utilitarian principles, such as egalitarianism, prioritarianism, and deontology. Clinical guidelines for patient prioritization for radiotherapy can combine multiple principles into a single allocation system to a significant extent. However, conflicting views about the role that social factors should play, and the dynamic nature of resource availability, highlight the need for ongoing work to evaluate and refine priority setting systems based on stakeholder views. (shrink)

After decades of marginalization in the secularized twentieth-century academy, moral education has enjoyed a recent resurgence in American higher education, with the establishment of more than 100 ethics centers and programs on campuses across the country. Yet the idea that the university has a civic responsibility to teach its undergraduate students ethics and morality has been met with skepticism, suspicion, and even outright rejection from both inside and outside the academy. In this collection, renowned scholars of philosophy, politics, and religion (...) debate the role of ethics in the university, investigating whether universities should proactively cultivate morality and ethics, what teaching ethics entails, and what moral education should accomplish. The essays quickly open up to broader questions regarding the very purpose of a university education in modern society. Editors Elizabeth Kiss and J. Peter Euben survey the history of ethics in higher education, then engage with provocative recent writings by Stanley Fish in which he argues that universities should not be involved in moral education. Stanley Hauerwas responds, offering a theological perspective on the university’s purpose. Contributors look at the place of politics in moral education; suggest that increasingly diverse, multicultural student bodies are resources for the teaching of ethics; and show how the debate over civic education in public grade-schools provides valuable lessons for higher education. Others reflect on the virtues and character traits that a moral education should foster in students—such as honesty, tolerance, and integrity—and the ways that ethical training formally and informally happens on campuses today, from the classroom to the basketball court. _Debating Moral Education_ is a critical contribution to the ongoing discussion of the role and evolution of ethics education in the modern liberal arts university. _Contributors_. Lawrence Blum, Romand Coles, J. Peter Euben, Stanley Fish, Michael Allen Gillespie, Ruth W. Grant, Stanley Hauerwas, David A. Hoekema, Elizabeth Kiss, Patchen Markell, Susan Jane McWilliams, Wilson Carey McWilliams, J. Donald Moon, James Bernard Murphy, Noah Pickus, Julie A. Reuben, George Shulman, Elizabeth V. Spelman. (shrink)

Information can be public among a group. Whether or not information is public matters, for example, for accounts of interdependent rational choice, of communication, and of joint intention. A standard analysis of public information identifies it with (some variant of) common belief. The latter notion is stipulatively defined as an infinite conjunction: for p to be commonly believed is for it to believed by all members of a group, for all members to believe that all members believe it, and so (...) forth. This analysis is often presupposed without much argument in philosophy. Theoretical entrenchment or intuitions about cases might give some traction on the question, but give little insight about why the identification holds, if it does. The strategy of this paper is to characterize a practical-normative role for information being public, and show that the only things that play that role are (variants of) common belief as stipulatively characterized. In more detail: a functional role for “taking a proposition for granted” in non-isolated decision making is characterized. I then present some minimal conditions under which such an attitude is correctly held. The key assumption links this attitude to beliefs about what is public. From minimal a priori principles, we can argue that a proposition being public among a group entails common commitment to believe among that group. Later sections explore partial converses to this result, the factivity of publicity and publicity from the perspective of outsiders to the group, and objections to the aprioricity of the result deriving from a posteriori existential presuppositions. (shrink)

In order to make Mukund Lath’s thoughts on music and identity accessible to a broader audience, and to call attention to links between Hindustānī musical theory and classical Indian philosophical notions, Lath’s paper “Identity Through Necessary Change: Thinking About ‘Rāga-Bhāva,’ Concepts and Characters” is being republished here with an introduction by David Shulman and explanatory notes. Mukund Lath argues that identity is usually understood as something that remains the same despite change. His endeavor is to explore an alternative to (...) this convention. The case study for Lath’s philosophical exploration is rāga music, i.e. Hindustānī classical music. He argues that the identity of the rāga is maintained not despite change, but owing to the necessary change in every execution of “the same” rāga. But how are we to even start thinking about a notion of identity that embraces rather than rejects change, a notion of identity that is based on and is rooted in change, not in stability or perpetuity? Lath explores this alternative and its consequences for the notion of identity at large. (shrink)

Longtermists have argued that humanity should significantly increase its efforts to prevent catastrophes like nuclear wars, pandemics, and AI disasters. But one prominent longtermist argument overshoots this conclusion: the argument also implies that humanity should reduce the risk of existential catastrophe even at extreme cost to the present generation. This overshoot means that democratic governments cannot use the longtermist argument to guide their catastrophe policy. In this paper, we show that the case for preventing catastrophe does not depend on longtermism. (...) Standard cost-benefit analysis implies that governments should spend much more on reducing catastrophic risk. We argue that a government catastrophe policy guided by cost-benefit analysis should be the goal of longtermists in the political sphere. This policy would be democratically acceptable, and it would reduce existential risk by almost as much as a strong longtermist policy. (shrink)

Objectives:Over the past two decades, all U.S. states have incorporated alcohol ignition interlock technology into sentencing laws for individuals convicted of driving while intoxicated. This article provides the first 50-state summary of these laws to include changes in the laws over time and their effective dates. This information is critical for policy makers to make informed decisions and for researchers to conduct quantitative evaluation of the laws.Methods:Standard legal research and legislative history techniques were used, including full-text searches in the Westlaw (...) legal database and identification of state session laws. Because ignition interlock device laws often change over time, we identified the date of each law's initial enactment as well as the effective date of each law in its current form.Results:Beginning with California and Washington in 1987, all 50 states have enacted IID laws as a sentencing option for DWI offenders. Initially, most of these laws were discretionary. Today, however, 48 states mandate IID installation for at least some types of DWI offenders to maintain lawful driving privileges. Of these, 27 mandate an IID for all offenders; seven mandate an IID for repeat offenders only; and 21 for some combination of specific groups of DWI offenders, including repeat offenders, offenders with a blood alcohol content above a legislatively-specified level, and aggravated offenders.Conclusion:States have wrestled with a number of IID policy issues, including for whom to mandate IIDs and whether to suspend a license for DWI prior to reinstating driving privileges with or without an IID. By understanding how state interlock laws differ, policy makers and researchers can ultimately better ascertain the impact of these laws. (shrink)

Telling a patient that the outcome of his illness is not good, or even hopeless, requires sensitivity and the ability to communicate with him in the setting of a hospital which is an unnatural environment divorced from family and friends. It is a task which must be taught and learned by doctors and nurses.

The achievements of the textile industry in Roman Britain are often underestimated as a result of the meagreness of our available evidence. The Edict on maximum prices issued by Diocletian in A.D. 301 shows that British capes commanded high prices on the markets of the Empire, and that in the late third century A.D. British rugs were the best in the world. In view of the competition from the traditional centres of rug manufacture in the East, this is an astonishing (...) achievement. (shrink)

The received translation and interpretation of many of the technical terms current in the textile industry of the Roman Empire are inaccurate, because lexicographers have either fought shy of being precise, or have thought that they recognized in the ancient world technical processes which originated at a much later date. The evidence is often equivocal or insufficient, but may still yield details that have been overlooked. The textile expression scutulatus, to take an example, deserves more attention than Blümner has devoted (...) to it. When it refers to the appearance of a garment, Lewis and Short, s.v. scutulatus, translate ‘diamond or lozenge-shaped, checkered’. It seems worth while to attempt a more precise translation, and, if possible, to estimate the significance in context of the goods so designated. (shrink)

If the world itself is metaphysically indeterminate in a specified respect, what follows? In this paper, we develop a theory of metaphysical indeterminacy answering this question.

A cornerstone of Buddhist philosophy, the doctrine of the four noble truths maintains that life is replete with suffering, desire is the cause of suffering, nirvana is the end of suffering, and the way to nirvana is the eightfold noble path. Although the attribution of this seminal doctrine to the historical Buddha is ubiquitous, Rethinking the Buddha demonstrates through a careful examination of early Buddhist texts that he did not envision them in this way. Shulman traces the development of (...) what we now call the four noble truths, which in fact originated as observations to be cultivated during deep meditation. The early texts reveal that other central Buddhist doctrines, such as dependent-origination and selflessness, similarly derived from meditative observations. This book challenges the conventional view that the Buddha's teachings represent universal themes of human existence, allowing for a fresh, compelling explanation of the Buddhist theory of liberation. (shrink)

This essay analyzes Fred Moten’s “antipolitical” romance with the “fugitive black sociality” that he radically opposes to “politics,” defined as inescapably tied to antiblack modernity. By comparing Moten’s argument to other voices in the black radical tradition, and by triangulating Moten with Hannah Arendt and Sheldon Wolin, this essay opens inherited conceptions of the political to risk and reworking but also complicates figurations of fugitivity and resists the antagonism Moten posits between black fugitivity and democratic politics.

Living out of silence, out of a fully functioning, lovingly attentive mind, and not just out of thought, out of a partially functioning mind, is requisite for depth or profundity in living or relating. A fully attentive, truly silent or meditative mind sees that there is real dualism of time and the timeless and that time and the timeless each has its own unique value. The timeless, or real silence, that which alone can make for depth in one's living and (...) relating, can be there only when, in one's awareness, time and all that is related to time, have come to an end. An examination of a wide variety of statements made by writers, both past and present, shows that these understandings are seldom there in contemporary writings, just as they were not there in writings that have come down to us from the past. 'Living beyond the One and the Many' invites readers to consider the possibility that what is presented in it can bring deep meaning to one's way of living in the world"--Publisher's description, back cover. (shrink)

In the years since its twin publication in 2001 and 2003 , Textures of Time has attracted a great deal more attention outside the United States than in the American academy. This, we suggest, is because its ideas and approach are rather at odds with the dominant trends in the area of “postcolonial studies.” In this response to three critical essays that engage with the book—by Rama Mantena, Sheldon Pollock, and Christopher Chekuri—we begin by setting out our principal hypotheses as (...) well as the evidentiary structure of the book, which draws mostly on vernacular materials from South India in the seventeenth and eighteenth centuries. The former includes the claim that South India between roughly 1600 and 1800 possessed considerable and diverse historiographical traditions, though these histories came couched in a variety of genres, rendering them difficult for the uninitiated to recognize at first; the latter requires us to develop the significance of the concepts of “texture” as well as of “subgeneric markers” that help distinguish texts with a historical intention from those that are nonhistorical but have the same generic location. Our response then goes on to discuss why theoretical or sastric texts in India do not themselves explicitly theorize the distinctions we make. Here, we posit a contrast between “embedded” and “explicated” concepts in the “emic” sphere, suggesting that “texture” belongs to the first category. We explicitly distinguish our views from the poststructuralist language adopted by Pollock in his critique of Textures, and the more predictable postcolonial vision of Chekuri. We once more emphasize the need to take the vernacular historiography seriously, and to refine our reading practices, rather than overly depending on normative materials in Sanskrit, or on a prefabricated theoretical schema that derives from a stylized view of the nature of the transformations produced by colonial rule. (shrink)

In the years since its twin publication in 2001 and 2003, Textures of Time has attracted a great deal more attention outside the United States than in the American academy. This, we suggest, is because its ideas and approach are rather at odds with the dominant trends in the area of “postcolonial studies.” In this response to three critical essays that engage with the book—by Rama Mantena, Sheldon Pollock, and Christopher Chekuri—we begin by setting out our principal hypotheses as well (...) as the evidentiary structure of the book, which draws mostly on vernacular materials from South India in the seventeenth and eighteenth centuries. The former includes the claim that South India between roughly 1600 and 1800 possessed considerable and diverse historiographical traditions, though these histories came couched in a variety of genres, rendering them difficult for the uninitiated to recognize at first; the latter requires us to develop the significance of the concepts of “texture” as well as of “subgeneric markers” that help distinguish texts with a historical intention from those that are nonhistorical but have the same generic location. Our response then goes on to discuss why theoretical or sastric texts in India do not themselves explicitly theorize the distinctions we make. Here, we posit a contrast between “embedded” and “explicated” concepts in the “emic” sphere, suggesting that “texture” belongs to the first category. We explicitly distinguish our views from the poststructuralist language adopted by Pollock in his critique of Textures, and the more predictable postcolonial vision of Chekuri. We once more emphasize the need to take the vernacular historiography seriously, and to refine our reading practices, rather than overly depending on normative materials in Sanskrit, or on a prefabricated theoretical schema that derives from a stylized view of the nature of the transformations produced by colonial rule. (shrink)

Many hold that ordinary race-thinking in the USA is committed to the 'one-drop rule', that race is ordinarily represented in terms of essences, and that race is ordinarily represented as a biological (phenotype- and/or ancestry-based, non-social) kind. This study investigated the extent to which ordinary race-thinking subscribes to these commitments. It also investigated the relationship between different conceptions of race and racial attitudes. Participants included 449 USA adults who completed an Internet survey. Unlike previous research, conceptions of race were assessed (...) using concrete vignettes. Results indicate widespread rejection of the one-drop rule, as well as the use of a complex combination of ancestral, phenotypic, and social (and, therefore, non-essentialist) criteria for racial classification. No relationship was found between racial attitudes and essentialism, the one-drop rule, or social race-thinking; however, ancestry-based and phenotype-based classification criteria were associated with racial attitudes. These results suggest a complicated relationship between conceptions of race and racial attitudes. (shrink)