Controlled human malaria infection (CHMI) studies involve the deliberate infection of healthy volunteers with malaria parasites under controlled conditions to study immune responses and/or test drug or vaccine efficacy. An empirical ethics study was embedded in a CHMI study at a Kenyan research programme to explore stakeholders’ perceptions and experiences of deliberate infection and moral implications of these. Data for this qualitative study were collected through focus group discussions, in‐depth interviews and non‐participant observation. Sixty‐nine participants (...) were involved, including CHMI study volunteers, community representatives and research staff. Data were managed using QSR Nvivo 10 and analysed using an inductive‐deductive approach, guided by ethics literature. CHMI volunteers had reasonable understanding of the study procedures. Decisions to join were influenced by study incentives, trust in the research institution, their assessment of associated burdens and motivation to support malaria vaccine development. However, deliberate malaria infection was a highly unusual research strategy for volunteers, community representatives and some study staff. Volunteers’ experiences of physical, emotional and social burdens or harms were often greater than anticipated initially, and fluctuated over time, related to specific procedures and events. Although unlikely to deter volunteers' participation in similar studies in furture, we argue that the dissonance between level of understanding of the burdens involved and actual experiences are morally relevant in relation to community engagement, informed consent processes, and ongoing support for volunteers and research staff. We further argue that ethics oversight of CHMI studies should take account of these issues in deciding whether consent, engagement and the balance of benefits and harms are reasonable in a given context. (shrink)

Global fatalities related to COVID-19 are expected to be high in 2020–2021. Developing and delivering a vaccine may be the most likely way to end the pandemic. If it were possible to shorten this development time by weeks or months, this may have a significant effect on reducing deaths. Phase II and phase III trials could take less long to conduct if they used human challenge methods—that is, deliberately infecting participants with COVID-19 following inoculation. This article analyses arguments for and (...) against such methods and provides suggested broad guidelines for regulators, researchers and ethics committees when considering these matters. It concludes that it may be possible to maintain current ethical standards yet still permit human challenge trials in a context where delay is critical. The implications are that regulators and researchers need to work together now to design robust but short trials and streamline ethics approval processes so that they are in place when applications for trials are made. (shrink)

Here we identify approximately 40,000 healthy human volunteers who were intentionally exposed to infectious pathogens in clinical research studies dating from late World War II to the early 2000s. Microbial challenge experiments continue today under contemporary human subject research requirements. In fact, we estimated 4,000 additional volunteers who were experimentally infected between 2010 and the present day. We examine the risks and benefits of these experiments and present areas for improvement in protections of participants with respect to safety. These are (...) the absence of maximum limits to risk and the potential for institutional review boards to include questionable benefits to subjects and society when weighing the risks and benefits of research protocols. The lack of a duty of medical care by physician–investigators to research subjects is likewise of concern. The transparency of microbial challenge experiments and the safety concerns raised in this work may stimulate further dialogue on the risks to participants of human experimentation. (shrink)

In controlled human infection (CHI) studies, investigators deliberately infect healthy individuals with pathogens in order to study mechanisms of disease or obtain preliminary efficacy data on investigational vaccines and medicines. CHI studies offer a fast and cost‐effective way of generating new scientific insights, prioritizing investigational products for clinical testing, and reducing the risk that large numbers of people are exposed to ineffective or harmful substances in research or in practice. Yet depending on the pathogen, CHI studies can involve significant (...) risks or burdens for participants, pose risks to individuals or communities not involved in the research, and lead to public controversy. It is therefore essential to ensure that the risks of CHI studies are justified by their social value—that is, their potential to generate benefits for society—and that public trust can be maintained. In this paper, we aim to clarify how research sponsors, research ethics committees and other reviewers should judge the social value of CHI studies. We develop a list of relevant considerations for making social value judgments based on the standard view of social value. We then use this list to discuss the example of potentially conducting dengue virus CHI studies in endemic settings. We argue that dengue virus CHI studies in endemic settings would fall on the higher end of the spectrum of social value, mostly because of their potential to redirect all fields of future dengue research. Drawing on this discussion, we derive several general recommendations for how reviewers should judge the social value of CHI studies. (shrink)

BackgroundHuman infection studies (HIS) are valuable in vaccine development. Deliberate infection, however, creates challenging questions, particularly in low and middle-income countries (LMICs) where HIS are new and ethical challenges may be heightened. Consultation with stakeholders is needed to support contextually appropriate and acceptable study design. We examined stakeholder perceptions about the acceptability and ethics of HIS in Malawi, to inform decisions about planned pneumococcal challenge research and wider understanding of HIS ethics in LMICs.MethodsWe conducted 6 deliberative focus (...) groups and 15 follow-up interviews with research staff, medical students, and community representatives from rural and urban Blantyre. We also conducted 5 key informant interviews with clinicians, ethics committee members, and district health government officials.ResultsStakeholders perceived HIS research to have potential population health benefits, but they also had concerns, particularly related to the safety of volunteers and negative community reactions. Acceptability depended on a range of conditions related to procedures for voluntary and informed consent, inclusion criteria, medical care or support, compensation, regulation, and robust community engagement. These conditions largely mirror those in existing guidelines for HIS and biomedical research in LMICs. Stakeholder perceptions pointed to potential tensions, for example, balancing equity, safety, and relevance in inclusion criteria.ConclusionsOur findings suggest HIS research could be acceptable in Malawi, provided certain conditions are in place. Ongoing assessment of participant experiences and stakeholder perceptions will be required to strengthen HIS research during development and roll-out. (shrink)

Controlled human infection (CHI) studies involve the deliberate exposure of healthy research participants to infectious agents to study early disease processes and evaluate interventions under controlled conditions with high efficiency. Although CHI studies expose participants to the risk of infection, they are designed to offer investigators unique advantages for studying the pathogenesis of infectious diseases and testing potential vaccines or treatments in humans. One of the central challenges facing investigators involves the fair selection of research subjects to (...) participate in CHI studies. While there is widespread agreement that investigators have a duty to select research participants fairly, this principle also yields conflicting ethical imperatives, for example requiring investigators to both exclude potential participants with co‐morbidities since they face increased risks, but also to include them in order to ensure generalizability. In this paper we defend an account of fair subject selection that is tailored to the context of CHI studies. We identify the considerations of fairness that bear directly on selecting participants for CHI studies and provide investigators and members of IRBs and RECs with a principled way to navigate the conflicting imperatives to which these considerations give rise. (shrink)

In controlled human infection studies (CHIs), participants are deliberately exposed to infectious agents in order to better understand the mechanism of infection or disease and test therapies or vaccines. While most CHIs have been conducted in high‐income countries, CHIs have recently been expanding into low‐ and middle‐income countries (LMICs). One potential ethical concern about this expansion is the challenge of obtaining the voluntary informed consent of participants, especially those who may not be literate or have limited education. In (...) some CHIs in LMICs, researchers have attempted to address this potential concern by limiting access to literate or educated populations. In this paper, we argue that this practice is unjustified, as it does not increase the chances of obtaining valid informed consent and therefore unfairly excludes illiterate populations and populations with lower education. Instead, we recommend that investigators improve the informed consent process by drawing on existing data on obtaining informed consent in these populations and interventions aimed at improving their understanding. Based on a literature review, we provide concrete suggestions for how to follow this recommendation and ensure that populations with lower literacy or education are given a fair opportunity to protect their rights and interests in the informed consent process. (shrink)

Risks and benefit evaluation for controlled human infection studies, where healthy volunteers are deliberately exposed to infectious agents to evaluate vaccine efficacy, should be explicit, systematic, thorough, and non‐arbitrary. Decision analysis promotes these qualities using four steps: (1) determining explicit criteria and measures for evaluation, (2) identifying alternatives to the study, (3) defining the models used to estimate the measures for each alternative, and (4) running the models to produce the estimates and compare the alternatives. In this paper, we (...) describe how decision analysis might be applied by funders and regulators, as well as by others contemplating the use of novel controlled human infection studies for vaccine development and evaluation. (shrink)

It is a popular view thatpractical deliberation excludes foreknowledge of one's choice. Wolfgang Spohn and Isaac Levi have argued that not even a purely probabilistic self-predictionis available to thedeliberator, if one takes subjective probabilities to be conceptually linked to betting rates. It makes no sense to have a betting rate for an option, for one's willingness to bet on the option depends on the net gain from the bet, in combination with the option's antecedent utility, rather than on the offered (...) odds. And even apart from this consideration, assigning probabilities to the options among which one is choosing is futile since such probabilities could be of no possible use in choice. The paper subjects these arguments to critical examination and suggests that, appearances notwithstanding, practical deliberation need not crowd outself-prediction. (shrink)

Antibiotic resistance is one of the most pressing public health problems humanity faces. Research into new classes of antibiotics and new kinds of treatments – including risky experimental treatments such as phage therapy and vaccines – is an important part of improving our ability to treat infectious diseases. In order to aid this research, we will argue that we should permit researchers to pay people any amount of money to compensate for the risks of participating in clinical trials, including ‘challenge (...) studies’ that involve deliberately infecting patients. We think that standard worries about paying for participation in risky research are reducible to concerns that can be addressed with the right screening mechanisms. (shrink)

AbstractDuring the Covid-19 pandemic, ethicists and researchers proposed human challenge studies as a way to speed development of a vaccine that could prevent disease and end the global public health crisis. The risks to healthy volunteers of being deliberately infected with a deadly and novel pathogen were not low, but the benefits could have been immense. This essay is a history of the three major efforts to set up a challenge model and run challenge studies in 2020 and 2021. The (...) pharmaceutical company Johnson and Johnson, the National Institutes of Health in the United States, and a private-public partnership of industry, university, and government partners in Britain all undertook preparations. The United Kingdom’s consortium began their Human Challenge Programme in March of 2021.Beyond documenting each effort, the essay puts these scientific and ethical debates in dialogue with the social, epidemiological, and institutional conditions of the pandemic as well as the commercial, intellectual, and political systems in which medical research and Covid-19 challenge studies operated. It shows how different institutions understood risk, benefit, and social value depending on their specific contexts. Ultimately the example of Covid-19 challenge studies highlights the constructedness of such assessments and reveals the utility of deconstructing them retrospectively so as to better understand the interplay of medical research and research ethics with larger social systems and historical contexts. (shrink)

The Tuskegee Syphilis Study is surrounded by illuminating misconceptions—myths that cannot be blithely dismissed because they actually provide some insight into the significance of the study. One of those is that the men were deliberately infected with syphilis; another is that they obtained no treatment for the disease. Some other errors are alleged in two recent articles about the study, but these articles themselves create their own fictions.

The infection rates of COVID-19 have been exponential in some countries despite the imposition of infectious disease control measures such as lockdowns and physical distancing, which form one of the basic principles of public health and infectious disease control. There have been significant problems with leaders and citizenry deliberately ignoring and not complying with such measures and which have directly resulted in sudden rises in infection numbers. Here, I show the nature and extent of the widespread problem and (...) argue that the problem is in large part due to our modern society characterised by liberal individualism. I apply the philosophy proposed by philosopher Alasdair MacIntrye to show that one key underlying cause of the non-compliant behaviour of citizenry is due to modern liberal individualism that has deprived the modern nation state of the opportunities and authority for it to teach or to dictate what is the common good of the society as a whole to individuals in its community. This is the first time MacIntyre’s philosophy has been applied to public health, and this paper demonstrates the need for ethics education to counter-balance liberal individualism in order to contain and to prevent another pandemic and public health crisis in modern society. (shrink)

The U.S. National Institute of Allergies and Infectious Diseases and the National Institute of Mental Health have a new research priority: inclusion of terminally ill persons living with HIV in HIV cure-related research. For example, the Last Gift is a clinical research study at the University of California San Diego for PLWHIV who have a terminal illness, with a prognosis of less than 6 months. As end-of-life HIV cure research is relatively new, the scientific community has a timely opportunity to (...) examine the related ethical challenges. Following an extensive review of the EOL and HIV cure research ethics literature, combined with deliberation from various stakeholders and our experience with the Last Gift study to date, we outline considerations to ensure that such research with terminally ill PLWHIV remains ethical, focusing on five topics: 1) protecting autonomy through informed consent, 2) avoiding exploitation and fostering altruism, 3) maintaining a favorable benefits/risks balance, 4) safeguarding against vulnerability through patient-participant centeredness, and 5) ensuring the acceptance of next-of-kin/loved ones and community stakeholders. EOL HIV cure-related research can be performed ethically and effectively by anticipating key issues that may arise. While not unique to the fields of EOL or HIV cure-related research, the considerations highlighted can help us support a new research approach. We must honor the lives of PLWHIV whose involvement in research can provide the knowledge needed to achieve the dream of making HIV infection curable. (shrink)

In our everyday lives, we confront a host of moral issues. Once we have deliberated and formed judgments about what is right or wrong, good or bad, these judgments tend to have a marked hold on us. Although in the end, we do not always behave as we think we ought, our moral judgments typically motivate us, at least to some degree, to act in accordance with them. When philosophers talk about moral motivation, this is the basic phenomenon they seek (...) to understand. Moral motivation is an instance of a more general phenomenon—what we might call normative motivation—for our other normative judgments also typically have some motivating force. When we make the normative judgment that something is good for us, or that we have a reason to act in a particular way, or that a specific course of action is the rational course, we also tend to be moved. Many philosophers have regarded the motivating force of normative judgments as the key feature that marks them as normative, thereby distinguishing them from the many other judgments we make. In contrast to our normative judgments, our mathematical and empirical judgments, for example, seem to have no intrinsic connection to motivation and action. The belief that an antibiotic will cure a specific infection may move an individual to take the antibiotic, if she also believes that she has the infection, and if she either desires to be cured or judges that she ought to treat the infection for her own good. All on its own, however, an empirical belief like this one appears to carry with it no particular motivational impact; a person can judge that an antibiotic will most effectively cure a specific infection without being moved one way or another. (shrink)

This special theme brings together reflections and deliberations regarding the design, implementation, and development of data governance. By addressing “social data governance” as the keyword of the special theme, we aim to further the discussion on a contextual understanding of both the governing foundations and effects of data, dataism, and datafication in different societies. Such a discussion reminds us to pay particular attention to—and thus account for—the social dynamics that underpin and contextualize the design, operation, and promotion of quantified governing (...) mechanisms in which information on social behaviors is collected, datafied, manipulated, and represented. Essentially, the social dynamics of data governance have existed for a long time and in many forms, ranging from credit bureaus’ scrutiny, evaluation, and labeling of their customers to internet-enabled massive data collection and scoring systems used by governments, and to automated contact tracing techniques as a centerpiece of dataveillance and infection control amid the COVID-19 pandemic. Nevertheless, scholarly work from a wide range of disciplines like law, mathematics, and business and with diverse geographical foci has not yet been comparatively and reflectively articulated. Being rich and diverse, the special theme advances such a requisite understanding of the status and relevance of social dynamics of data governance mechanisms based on a wide range of empirical cases around the globe. To scrutinize the social dynamics helps illuminate and contrast divergent manifestations of data governance and their underlying mechanisms. (shrink)

To counter the pandemic caused by severe acute respiratory syndrome coronavirus 2, some have proposed accelerating SARS-CoV-2 vaccine development through controlled human infection trials. These trials would involve the deliberate exposure of relatively few young, healthy volunteers to SARS-CoV-2. We defend this proposal against the charge that there is still too much uncertainty surrounding the risks of COVID-19 to responsibly run such a trial.

During the Covid-19 pandemic, a considerable amount of people seem to have been lured into believing in conspiracy theories. These people deliberately disregard expert advice by virologists and physicians concerning social behaviour that is aimed at reducing the number of new infections. Disregarding traditional experts and their advice is just one example of what, in the philosophy of science, is referred to as a crisis of expertise – the phenomenon whereby people seem to have lost their trust in traditional expert (...) advice and are looking for alternatives. In the following paper, the trend to use Internet technology as an epistemic alternative will be analysed in detail by investigating the question of whether the Internet really allows people to become epistemically more autonomous. The focus will be on the epistemic and moral vulnerability of people resorting to new media tools instead of relying on traditional expert opinion. It will be shown that some important presuppositions about the Internet and, in particular, social media tools as alternative ways to collect information and find emotional support in a group of like-minded people cannot be maintained. (shrink)

Genetically engineered (GE) insects, such as the GE OX513A Aedes aegypti mosquitoes, have been designed to suppress their wild-type populations so as to reduce the transmission of vector-borne diseases in humans. Apart from the ecological and epidemiological uncertainties associated with this approach, such biotechnological approaches may be used by individual governments or the global community of nations to avoid addressing the underlying structural, systemic causes of those infections... We discuss here key ethical questions raised by the use of GE mosquitoes, (...) with the aim of fostering discussion between the public, researchers, policy makers, healthcare organizations, and regulatory agencies at the local, national, and international levels. We affect that goal by outlining a procedural approach to decision-making about the use of the “biotechnology” that goes beyond “community engagement.” The protocol we advocate for entails informed deliberations and decision-making at the community level. It is designed to ensure that the voices of the marginalized and vulnerable groups that would be disproportionately affected by the decision are heard during the community-wide discussions. Moreover, we make the case that the values embedded in the risk assessment should be identified so that the community can make an informed decision about the use of GE insects. In addition, we advocate for the involvement of a variety of actors whose responsibility would be to ensure that the community has the opportunity to make an informed decision based on deliberations about the use of the “biotechnology.”. (shrink)

The notion of digital virus covers, in our view, two points: computer viruses that infect our computers and technological solutionism, the unreasonable passion that consists in considering that the solution to all social problems lies in the digital world. Yet the digital world is as vulnerable as the biological world. Moreover, it is dangerous because it pushes us into a digital bondage that undermines democracy. The solution to the crisis is not less democracy, but more democracy. More precisely, we will (...) argue that digital devices do not strengthen democratic communication, they promote a digital connection that hinders deliberation and threatens the very idea of democracy. (shrink)

The COVID-19 pandemic has necessitated rapid research to aid in the understanding of the disease and the development of novel therapeutics. One option is to conduct controlled human infection trials (CHITs). In this article I examine the history of deliberate human infection and CHITs and their utilization prior to the COVID-19 pandemic, key ethical considerations of CHITs in the COVID-19 setting, an analysis of the World Health Organization’s (WHO) Key criteria for the ethical acceptability of COVID-19 human (...) challenge studies, and a review of the two COVID-19 CHITs that have already commenced, their compliance with the WHO criteria and other ethical considerations. (shrink)

This paper examines the case of a recent H5N1virus (avian influenza) outbreak in West Bengal, an eastern state of India, and argues that poorly executed pandemic management may be viewed as a moral lapse. It further argues that pandemic management initiatives are intimately related to the concept of health as a social 'good' and to the moral responsibility of protection from foreseeable social harm from an infectious disease. The initiatives, therefore, have to be guided by special moral obligations towards biorisk (...) reduction, obligations which remain unfulfilled when a public body entrusted with the responsibility fails to manage satisfactorily the prevention and control of the infection. The overall conclusion is that pandemic management has a moral dimension. The gravity of the threat that fatal infectious diseases pose for public health creates special moral obligations for public bodies in pandemic situations. However, the paper views the West Bengal case as a learning opportunity, and considers the lapses cited as challenges that better, more effectively conducted pandemic management can prepare for. It is hoped that this paper will provoke constructive bioethical deliberations, particularly pertinent to the developing world, on how to ensure that the obligations towards health are fulfilled ethically and more effectively. (shrink)

Secondly, as utterances, our performances are also heir to certain other kinds of ill which infect all utterances. And these likewise, although again they might be brought into a more general account, we are deliberately at present excluding. I mean, for example, the following: a performative utterance will be in a peculiar way hollow or void if said by an actor on the stage, or introduced in a poem, or spoken in soliloquy. This applies in a similar manner to any (...) and every utterance — a sea-change in special circumstances. Language in such circumstances is in special ways — intelligibly — used not seriously, but in ways parasitic upon its normal use — ways which fall under the doctrine of the etiolations of language. All this we are excluding from consideration. Our performative utterances, felicitous or not, are to be understood as issued in ordinary circumstances. (shrink)

Don't tell terrible stories—everyone here has enough of their own. Everyone here has a whole bloody sack of terrible stories, and at the bottom of the sack is a hammer the narrator uses to pound you on the skull the instant you dare not believe your ears. Or to pound you when you do believe. Not long ago I saw a tomboyish girl on Khreshchatyk Street demand money of an elderly woman, threatening to bite her and infect her with syphilis. (...) Don't stroll through Volodymyr Hill Park, don't stroll around the botanical garden, and especially don't stroll on Kontraktova Square. Don't stroll anywhere. Don't go to the pavilion with the Golgotha panorama near St. Alexander's Church. Not even the twelve-meter-tall crucified Christ will save you. Don't go outside when it's dark and people turn into shadows a shade darker than dark. Also don't go where you can be seen from far away. Not to imply that people used to be like a bunch of lilies, but now they stink like a cellar of cabbage.The city, which earlier might have had some fun, is now going crazy. It's like a fish in warm water: it doesn't react to anything, swims slowly like it doesn't care if it swallows a hook or not. The excitement and exaltation pass into oppression, just as our necks have sunk into our shoulders, our shoulders into our lumbars, our lumbars into our nether regions. The holiday turns into a funeral, the parades into explosions, depression into mania. Winter passes into summer, people turn into beasts, the hours into ages, and the ages into hours. It's worth simply walking around the city to see a soldier from an unknown army taking a piss near the opera. Farther on is a row of identical old widows selling ball gowns and candelabra. Then there are the aristocrats and manufacturers who throw so much at the prostitutes that they'll soon be richer than their wives.I returned late through the Kyryliv Wood, not heeding all the warnings that I myself have given here. It really is dangerous—the place is famous for it. There's a madhouse nearby, caves where criminals and the sick can hide out. Also, once upon a time, as they say in fairy tales, the great dragon Zmei Gorynich lived here beside the Puchai River. The stench in these places drives away the most committed misanthropes and even one type of philanthrope—that is, perverts. It sounds dumb, but the stench is cleansing. I don't know where it comes from. After the operating theaters and the rooms with amputees, the stench no longer repelled or attracted me; it just was. And this was a great place to think. As I walked, I considered an incident with our patient.The patient, a respectable individual whose name carries too much weight for me to state it directly, one day began to assault people. He nearly strangled a merchant who he believed asked too much for a beaver coat. He likewise wanted to kill his business partner when he didn't say hello loudly enough. But the worst was, he lost all shame of his own nakedness. At first it was the police who took care of it. When our future patient slipped off his pants and undergarments, he was taken to Kyrylivska, which has had means for dealing with such cases dating back to the day when unhinged Cossacks and composers from Kyiv Mohyla Academy were taken there.During the examination we determined that the patient was experiencing a severe breakdown. His wife added that lately, more than once, he had allowed himself strong words in front of the children and often suffered from ennui. Furthermore, she said, the patient had been undergoing treatment for “the French disease” for some years—which was, obviously, where we needed to start.“Syphilis!” Skorsky spat out the matchstick he was chewing on. He was a specialist on the psychological aspects of diseases related to the venereal. “Tertiary syphilis! When poorly treated, over time ‘the French disease’ can destroy the central nervous system. Hence the patient's chicanery. Such theater!”Skorsky and I had not spoken since the incident at Bilinsky's. Meanwhile, something significant had happened to him. The most boring person on earth, Skorsky had simply caught fire. He said hello and kibitzed. I even heard the doctor got drunk alone in his office, then wandered through the forest. Could he be using narcotic substances?“Cocaine!” was the doctor's second proclamation. It was his favorite treatment for the psychological complications of syphilis. Skorsky himself never took what he called “the universal drug”—good for alcoholism and toothaches, neuroses and morphine dependency—though he had read in an article by a respectable Viennese physician, who used cocaine as a panacea, that it was not addictive. That doctor subsequently recanted, but Skorsky paid no attention. He believed the retraction was made under pressure from pharmacologists who had no incentive to cease production of the medications that cocaine might supplant. Their representatives either paid or threatened the Viennese to repent.As the patient was escorted to his room, he assaulted the orderly, Alevtyna. They tried pulling him off her, but, though he released his fingers from her neck, he buried his teeth in her leg. The poor orderly, who had not until then been attacked by a psychotic, nearly died of fear. Later, panic set in over Skorsky's diagnosis. He told her about the consequences of syphilis: grotesque patterns on one's face due to infection of the skin, mucous membranes, cartilage, and bones. He went on about the devastation to the central nervous system, which they had just observed in real life: “The face starts to look like lace some mangy dogs fought over before rolling in the mud.”Alevtyna, who had not yet regained her faculty of speech, straightened up. Ignoring the slavering male orderlies, she bared her leg to get a better look at the wound. She then ran down the hall and out into the garden, where she fell on the ground to rip up grass and small bunches of daisies. Alevtyna ate them along with the soil in their roots.“Minor hysteria. She needs fifteen milligrams of cocaine.”Skorsky took a snuff box out of his pocket and scooped up some white powder with a toothpick made from a goose feather. He gave the order to close Alevtyna's mouth and one of her nostrils, forcing her to snort the medication.We fretted over her so long that evening fell. I decided to walk down, along the ravine, behind the church.It was unlikely there were any large beasts there, but something was rustling. The pits and mounds, ravines, paths, graves of witches whose living sisters flew in the treetops from time to time, the whispers of the forest spirits, the spirits of the nutcases who died in the hospital, the spirits of the monks from the St. Cyril Monastery, Zmei Gorynich and the bogatyrs who wanted to defeat him. The city would be calmer without this forest. I saw the gaps between the trees and went off in the direction of the tram tracks.As I was coming out of the forest, there was a patch of Amanita muscaria that had been trampled into porridge. A bit farther on, the body of Professor Bilinsky lay killed in the blackberry bushes. The way he was lying it looked as though he had not struggled before death. I quickly examined his body but saw nothing out of the ordinary. There were no wounds, no dirt under the fingernails. Animals had not yet smelled the carrion, but swarms of various insects covered him. Oh, why did I have to find the putrid body?The best thing would be to take the tram to his house to inform his relatives. The doors closed, and I noticed my own calm. This death had not evoked any emotions in me other than a feeling of responsibility, the need to tell the family. But also—some alarm at the thought of who the murderer could be. I knew that it was murder.“Your nose is bleeding.” A woman as round as an onion, carrying two baskets full of strawberries, offered me an ironed and starched handkerchief.“Have I dirtied my shirt?”“No, it's as neat as a pin. It's just your nose that's dirty. Wipe it now before you spray blood on my strawberries.”“No one will see the red on red.”“Ah, but it's salty!”“You know why it's not sweet? We'd drink it like syrup.”“Those with Christ in their heart do not talk that way.”“Are your strawberries expensive?”“Why? What?”“I'm checking to see if you have God in your heart.”“Child, if you knew how I have to work for this berry! I have to weed it a hundred times. In a week, the quitch grass grows as high as a horse. And I water it with water I carry from the stream, it kills my arms... ”“How much are the berries?”“They're not for sale. Anyway, soon money won't mean a thing. Soon all money, all these papers made from the skins of sinners on their satanic presses will be annulled. What matters is how we treat each other.”“So if I try your strawberries for free, my ‘thank you’ will be enough?”“Hands off!” she said and thwacked my fingers.I heard loud laughter behind me—same laughter as from the café near the Continental. There was no one sitting near Alina. (This is what fate looks like, remember.) Without asking, I sat next to her, away from the old lady.“Excuse me, but the night before last didn't you, yes, didn't you intrude on my privacy?” She started right away.“I saw it a little differently. Who was that young man with the mustache who paid me for you?”“Are you checking to see if you can flirt?”The tram stopped. People got on and off.“Are you coming back from the hospital?” she asked. “Don't be shocked. My uncle works there. He's told me all about you.”“An uncle by the name of Skorsky?”(Remember: this is what fate looks like.)“Yes. Skorsky's been strange recently—says things that make me wonder if he hasn't lost his mind. Have you noticed anything?”“I don't know.”“You know perfectly well.”“Where are you going?” I tried to change the subject.“I have to send something to my theater friends in Odesa. By the way, they'll be putting on Oedipus Rex soon in Kyiv—in Ukrainian.”“Greek tragedy in Ukrainian! That's a first.”“Exactly. The troupe is rehearsing now in Odesa. The theater where they will perform this fall is being remodeled.”“Wait. Now I remember where I've seen you before—it was at a performance! Vynnychenko's Black Panther and White Bear, at the Bergonier on Fundukleivska.“The same director is doing the Oedipus. He's my friend.”“He's your friend in what sense?”“Again with that tired subject. By the way, I've been thinking about you.”“And I about you.”“That's good. I was thinking not about you, to be precise, but about that elevator you invited me on.”“Who was that man with you?”“Like a broken record! Even if he had been my fiancé, I'm not bought or inherited. I'm not a brooch or a hundred acres of land, and I'm not a house in Kaniv!... Who was with you when you saw Black Panther?“Ah, so.”“Answer!”“That was my mother. She looks very young. She is coming to Kyiv the day after tomorrow. I can introduce you.”“Oh, this is my stop.”I looked out the window and realized that I had long since passed the stop for Bilinsky's.“Can we see each other again?”“We can. But you have only one chance.”Alina the anarchist wrote something on a scrap of paper and handed it to me.Morning, not morning but a thick porridge (I hate porridge). Dew, thick spit, crushed fruits, urine, all on the sparkling cobblestones. The sun, just barely having made its appearance, is already scorching. The human masses scurry and grumble like poorly digested food inside a stomach.I walked diagonally across St. Sofia's Square, then along the perimeter, then one edge, then again diagonally across. I went underground. The basement café of the Continental Hotel was practically empty. I again asked the server to bring the cloth with the embroidered portrait, but I couldn't remember the musician's last name, only that it ended with -sky. The server said that -sky was currently in the southern cities of Yalta and Odesa. I added that Kurbas, the director, Alina's friend, was also in Odesa, rehearsing Oedipus Rex, and that he'd previously put on Black Panther.I was bored, so I walked along Khreshchatyk and then headed down, calling to mind all the Kyiv churches of Podil: there's Birth of Christ, St. Nicholas on the Shore, Intercession, Pyrohoshcha, Holy Presentation, St. Dymytrii Rostovsky, St. Illia's. And also the Epiphany Brotherhood Monastery, Ascension Convent, and St. Katherine's, all these whipped-cream churches on the waffles of our streets. A few of them reminded me of themselves by appearing suddenly out of nowhere.The smells on Kontraktova Plaza where commerce buzzed were like multicolored light bulbs turning on one after another. Here you could catch the aroma of Balabukha jam, which blended with the next smell, English shoe polish at the Raiskys’ shop. Then the crunchy-smelling cabbage from old women standing in a row like herons and spitting out the shells of sunflower seeds. Farther on, the stench of a good-sized rat that crawled under Mrs. Shevchuk's shop where she sells broadcloth. Oh, she can't scream: no, she'll quietly dig that rat out herself so as to not scare off her clients.I bought a paper and two pairs of underwear. I asked two laughing young chambermaids who were secretly puffing in a grape-filled yard for a smoke. I wandered around Podil until evening when I came across a sawmill near the Dnipro that surprisingly smelled pleasantly of mazut fuel oil. The weather was dry, yet in the middle of the road was an enormous puddle, a deep dark black. A forty-year-old woman in a pale pink dress stood near it. The theatricality of it all provoked me to pose her a question,“Ma'am, what should I do?”But she paid me no attention. I shouted,“What should I do?”“What to do, what to do?” she said in Polish. “Jump in the water and swim so far away that you cannot return.”I quickly crossed a section of the forest. The wind brought a mixture of unpleasant air, like a stinky handkerchief held under one's nose. Passing the trees, I saw light in the spaces between them and exited at the hospital.Outside the windows, two orderlies lay in chairs with their heads thrown back. Two others—fools—ran around the yard in different directions, peering out at... something. The lights on the first floor of the hospital were on, and the staff milled about.“You're just in time!” said Ivan, a tall, young orderly.“For what?”“Your patient ran away! We went into his room and he wasn't there.”“What patient?”“The one who bit Alevtyna,” said Danylo, the other orderly, short and middle-aged.“That's Skorsky's patient, not mine.”I had no intention of helping them. This was all history—like my family, Kyiv, and my previous life. I had no intention of thinking about it. I wanted to go to my office, pack up my field surgery kit, and get out. So what? Their psychotic syphilitic ran away—it happened.Of course, that patient could have something to do with Bilinsky's murder. But that was no longer my problem.“What a strange coincidence!” the doctor on duty said. “Comrade doctor, the other one responsible for this patient was just here.”“And where is he now?”“He took off toward the church to look for the patient.”“Didn't the patient escape earlier?”“Don't know.”“How do you not know? You had better call the police, moron, before he kills someone. And get those sleeping orderlies to look for him.”“They can't... ”“Why not? Should I go wake them?”“They're on morphine.”“And you, I can see, have lost your mind. Go, catch your psycho! If it turns out that he killed Bilinsky—and on your watch—you can't imagine what's in store for you.”I adjusted my homburg and set off in the direction of St. Cyril's, that unwelcoming monolithic cube. I glanced around—what if our escaped syphilitic were to jump out of the bushes and bite or strangle me. I looked around because I wasn't sure of my actions, wasn't sure of my choices. Tripping over a clump of clover, I reached the open doors of the church. I couldn't stop myself from going in.The walls and ceiling were covered with frescoes. There was what used to be an angel rolling up the sky on the southern column of the narthex. But also graffiti: people scratched their names on it so as not to be forgotten—their idea of eternity. Prince Volodymyr the Great compared this activity to the desecration of graves. The vandals paid a fine and were beaten with canes. During the raids of Batu Khan, the church was deserted and cracks appeared all over it. Wild martens and feral dogs sought shelter here; insects swarmed under the ceiling with its red mosaics. Birches grew in its midst. Water seeped in the cracks, the water became ice, the ice widened the cracks, more water seeped in the cracks, becoming more ice that further widened the cracks, the wall split and nearly fell over, and then the wall fell over. Yet the angel is still rolling up the sky... When I reached the exit, I heard a rustling behind me. I turned after I stepped outside: in the depths of the church, like a stick in a pot of tar, stood a man with a large bag thrown over his shoulder and a revolver pointed right at me.“Is that you, Doctor?“Don't move!”“What's... Skorsky, what's with you?”“Don't move, I say!”“What are you doing here?”And finally I understood... Skorsky was himself the psycho! (Really, I had known for a while.)“You are the murderer! I knew it! But—why?”“Shut up.”“It was you. You! The stolen cigarettes, the strange behavior, Bilinsky. If I shout, everybody will come running. They've already called the police!”There was heavy breathing behind me. And then a gun rang out.The city is overgrown with new buildings. They encircle everything that was once on the periphery. Kyiv has become an old lady that can no longer restrain herself in the face of pastries. The city climbs farther. It steps over the swamps, turns the old rivers into a series of lakes; the other bodies of water it drives into canals. The grain that falls from the wild wheat is black. When the sun heats it, the grain melts and trickles into the earth. St. Cyril's stands indestructible. No one spackles the small cracks in its walls with either expensive putty or glues, nor with cheap cement and whitewash. One day a small fox appears in the doorway. It runs inside and along the floor of simple gray tiles. The gods watch from the walls, watch and fall into ruin. The fox runs to the iconostasis. Before it is a time-darkened Virgin Mother and Child in oil on sheets of zinc. The fox runs the metal steps that wind up to the second floor. The fox runs past all the vaults, naves, all the frescoes. A buckthorn seed flies in through a broken window. It will be the first. Soon the buckthorn will grow everywhere. A dumb hare will make its nest in the buckthorn bushes and nightingales will settle in the upper branches to sing until the end of the world. The fox runs between the thick rays that penetrate the windows. It catches one of the rays, squints its eyes, and warms itself in the sun.The shot rang out, but I did not fall. I looked around—and on the church threshold was our syphilis patient bearing a rod. His head lay on the rocks by the doorway.“If only he'd been at the stage of nose deformity! Just imagine: a hole instead of a nose plus a hole from the bullet—like an extra pair of eyes!” Skorsky laughed at the corpse.“We need to call the orderlies.”“They heard the shot. They'll run here on their own. You see, Professor Bilinsky believed it would take two or three years to wrap up this patient's case,” Skorsky told me. “But I took care of it much faster!”“Excuse me, but I'm going crazy in this city. I thought that you were Bilinsky's murderer.”“Just so. Why not? I am Bilinsky's murderer.”“Don't tease. You've changed a lot recently, so... ”“Yes, I've started killing people. You might term such a change significant.”“You have the right to irony.”“I am not being ironic.”“Let's call it sarcasm.”“It's the honest-to-God truth.”“And yes, you have the right to mock me.”“Well then, let's be done. To the horses!”“What horses?”“Alina's waiting!”Alina, her uncle Skorsky, a few others I didn't know, and I rode like the wind that ripped off my homburg and carried it back to Kyiv.“There's a fresco in the choir loft at St. Cyril's where Vrubel painted himself and patients from the hospital as the apostles. When I came across it by accident, I really believed they were saints,” Alina said.“I've never been up there. I've only seen the church from below.”“Remember the way back so you can see it sometime.”“The Puchai River used to flow here. You shouldn't trust the landscape,” Skorsky said, reaching for something, perhaps his bag, just when we left the darkness of the trees and saw the endless steppe ahead of us.We rode all night without stopping. Though no one was chasing us. Though we had nowhere to be. We rode like beasts released from a cage. The promises of the horizon turned what we'd left behind into a cage fit for those from whom freedom had been severed, like an anomaly, at birth.The pre-morning sky looked at first like a sack of turnips—filled with something heavy. But with each verst, the sky became lighter. When it was finally light enough to see clearly, we arrived at a knoll at the foot of a stone wall that from a distance had appeared to be a gigantic piece of halva. The exterior ruins of the castle gave no hint of how it was when all was fine here, when people defended themselves successfully from the nomads’ raids. From far off, the wreckage looked like a natural agglomeration of stones—a rocky elevation, no more: a cluster of cliffs. It would rain a few hundred more times, a few hundred more winds from a few hundred directions would blow on this heap, and it would collapse as though nothing had ever been here.A few stalks of wheat grew from one of the rocks. Someone had probably cast a handful of grain here for some birds that forgot to eat it.“Who could this castle belong to?” I asked Skorsky.“I reckon the Swan Princess,” the doctor rejoined, hoping to sound knowledgeable.From behind one of the piles of gray sandstone emerged a young man in a black reptilian coat and a white papakha as lush, bright, and out of place as a dahlia. His name was Artem. The heat was melting our brains, but he was dressed like that, in rooster fashion, which was popular among the otamans. Artem helped Alina dismount her horse and tried to kiss her on the lips, but she offered him a cheek instead.Had she been racing to see this clown?We entered the yard—the ruins had fashioned an internal space that was more or less protected, at least from strangers’ eyes. It turned out that there were even places where it was possible to hide from the rain, and from there the ruins didn't look half bad.In the center of the court was a table, and on it a wooden bucket with pink gladiolas. How romantic! It all looked like it came from outer space. Where on earth, in the middle of the steppe, far from any village or town, did this table, this simple table, come from? And the gladiolas? The steppe hadn't been plowed in so long that any cultivars would have gone wild, degenerated, dried up completely.A campfire crackled nearby—a little preview of what we would soon do to the houses, villages, and cities. Artem the otaman brought over a cezve from the fire and poured the first portion into a small, copper cup for Alina. He also got out a porcelain cup with images of rosy cherubim—but how...?“Who else would like coffee?”Only Skorsky and I responded. The question excited me, even distracted me from the thought of the kiss I had recently witnessed and the Kyiv I had recently left.“It's obvious who the professors here are; cultured people drink coffee. Are you both doctors?”“Uh-huh.”“For wolves of the steppe, like us, doctors are gold, even more precious than gold. Actually, a Hippocrates like you should eat more, because those in your profession will soon be worth your weight in gold. Work on your figures, both of you.”“Who will take pity on the horses that have to carry us?”“We'll find the horses. And very large doctors can be transported on machine-gun carts. We'll need to seat the otamans near you. Only a fool would shoot at a doctor.”“I think we'll find quite enough fools here.”“With your beard, Doctor, you look like Tsar Nicholas II. But even so you won't be shot. You might even be canonized!”“We've only just arrived and you're going on about executions,” Skorsky grumbled and checked to make sure that he still had his bag.“Apologies, apologies, pardonnez-moi. But you are not merely a doctor. A venereologist! Skorsky, you're a specialist! A venereologist is the most important person in wartime. The most valuable! You are the botanists of war. You can't imagine what varieties of flowers grow here, and these beds have long awaited a proper gardener. Or even just a man with a scythe!”“Bite your tongue,” Alina said. “I don't need to listen to this.”“Yes, yes, of course. Excuse me, my r—. ” He almost said “rose.”We rested all day. We went down to a surprisingly close river overgrown with lilies. We rowed the boats left by fishermen. I talked to Skorsky. He took his bag everywhere, refusing even to swim so he wouldn't have to part with it. I asked him what he had in it, but he said it wasn't my damned business.Alina rowed with the otaman to the middle of the river. They were having a loud discussion. She was waving her hands. The current carried their boat downstream slowly and smoothly. What a nuisance, that current!I tried to meet with Alina one-on-one, but she was avoiding me. In the morning I was confused, by lunch I was sad, and after lunch I got angry.In the evening, I lay on the hot grass and drank another cup (I have no idea where they got such good coffee), which had no effect at all on my sleep. I watched the Perseids. Every year, the Earth passes through the tail of Comet Swift-Tuttle. People can see the meteor shower and make a wish. I wished. I counted forty-seven falling stars. All forty-seven of my wishes were for the same thing.Around the campfire, they were sitting, talking. I saw how he tickled her face with a piece of grass and she brushed him off in annoyance. Then they were screaming at each other. Later they again spoke kindly, after which they again quarreled. My joy grew after each tiny mistake that Artem made. I wanted him to show the worst he was capable of.They were screaming at each other, but all I could hear was beautiful opera singing. The stars fell to the sound of their screaming. The stars blessed my joy.Then this happened: Alina kicked the fire, scattered burnt kindling, and burned some of the grass. Artem grabbed her by the arm, but she broke away from him and ran off to the horses.“Go then! I guarantee you'll get to Katerynoslav and return with your tail between your legs.”“I'm going to Huliai-Pole! To Father Makhno!”I jumped up and ran after her.“Where do you think you're going?” Artem shouted.Really—where was I going? I was going after her: to Huliai-Pole, to Katerynoslav, to Rome, to Washington, to Istanbul, to Montevideo... “Go to sleep,” he said. “Come morning, this coquette will be here, right as rain. We've already been through this show. Tomorrow she'll be right here next to my boot!”... No, she won't.In some sort of shape we entered some town. There were some buildings that were some colors, some trees, some streets, some roads, and some signs. Posts, flustered birds’ nests, echoes, colors, shapes—each of some kind. A wedding procession was coming toward us. If you want to make orange, you need to add yellow to red, and then bam—it's black. If you want to salt the soup, shake in a little, and then bam—two handfuls. You want to say a kind word, and then bam—a punch in the face. I was rocked around like a watermelon on a boat and threw up my breakfast straight into the horse's fluffy mane. Sanko found this hilarious, but I said I'd pulverize him. So Sanko sped ahead.No one knew anything about Alina. The daytime sky was like a poorly washed bowl. The sun was a squashed, rotten apricot. The night sky looked like the sole of a boot to me. The moon was a dirty cheap copper coin that had gotten stuck to the sole. Everything seemed spoiled to me, irrelevant, unnecessary. Without her, this journey was a waste of time.“You'd better stay away from everyone,” Artem said. “You'll infect us with your pining, and pining is worse than the clap.”The wedding procession was before us. The young couple, still utter children, walked so calmly it was as if they didn't see us. As if we were made of a light breeze—our bodies, clothes, our horses and their iron shoes—of the lightest gasses. As if we were visible only to ourselves and the coal-black dog that barked, panting and gasping.The wedding was headed straight for us. We were in the middle of the road, and so were they. We approached each other slowly, a wave going toward a wave. Some ten meters before their indifferent faces, I noticed the color of the bride's eyes. And the coral-colored tulips that fell on the road before her. Round goose eggs on meaty stems, the flowers were falling and falling before her. The bride's eyes were almond shaped.“Hey there,” Artem shouted at me. “Wake up!”I came to and saw the whole village, everyone there, not realizing my group had turned left onto a side street away from the procession. The tulips disappeared—where'd they get tulips in the fall? I was sitting alone on my horse in the middle of the road, and the entire wedding procession came to a stop. I moved to the side, and the throng marched on, cutting off our escape route. We rode a few more meters and came across the synagogue.“You know what, you're right,” said the otaman.“Who is?”“Oleksii is the only one here who's right.”“About what?”Artem turned his horse and raced back. Everyone stood still while he ran his horse into the crowd and began firing his revolver. People scattered in all directions. Artem trotted, cackling like an imbecile. The horse kicked an old guy in the mouth. The man fell, spitting out his gold teeth. We rode up to the commotion and formed ranks, but none of us wanted to join the otaman.The bride stopped in the middle of the street. On both sides were buildings and trees, as well as dust, sky, and sun. She stood still, beautiful, as if nothing had happened. Then she adjusted her garland and walked calmly on.“Well, should we get some sugar now?” Artem laughed, looking at the bride, and off he went toward the sugar factory.It was then I noticed that all of the houses had shutters—fuchsia, blue, ocher—and that all the shutters were closed.We flew toward the dirty building, whistling and shouting. If there had been aesthetes among the otamans, they would certainly have razed the abomination in this field after seizing it. They would have spread soil on top and sown buckwheat. Long live buckwheat!, that wonderful crop. Like hunting dogs hot on the trail, we raced to our defenseless victim, with the baying of hundreds of hounds behind us. The field shook beneath us. We became an artist's canvas, evolving from Realism to Romanticism, Romanticism to Expressionism, Expressionism to Suprematism. If we had been painted in black and white, we would have been splotches (until the ink ran, annihilating all remaining patches of white).Two men stood near the gate—unarmed and undressed, in nothing but their undershirts and boots. Our fervor, our kinship with the elements, our entirety, were all for naught.“Jesus Christ! What bores!” Artem exclaimed. “How boring you are!”“Maybe boring for us, but fireworks for them,” Sanko said, dismounting his horse.“The fear of death engenders creativity,” our otaman—a distinguished philosopher of the early twentieth century, that demonic breed—prophesied.He went on, “Excuse me, but with all due respect, we are not going to search you. Just show us right away where the money is. Why are there so few of you? Don't say there's not much money. I want piles and piles of money! If you don't show it to us, we'll print our own on your skin. Believe me, we will.”We entered the factory grounds. There were no workers, only an enormous mountain of sugar beets that looked like a pile of coal from a distance and a pile of dead rats from up close.“So, did you have a good year?” Artem asked a man in an undershirt.“Not really—too dry.”“Nah, that's fine. You wouldn't have been able to gather most of the harvest this year anyway. There's a fire burning across all of Ukraine, all of Russia. The whole world!”While Artem tossed thoughts like well-chewed sunflower seeds into the crowd, the two men quietly stepped aside and then ran fast ahead to the factory's main hall. The gigantic door slammed shut. The gate was locked behind us! The windows were smashed! The factory roared from inside like a cumbersome machine starting up. Bullets whirred through every window.“Bastards! It's a trap! Quick, after me!”Still on horseback, Artem bounded over to a vast window, low to the ground, and smashed it mercilessly. He broke the frame and jumped inside on his horse. I and a few others followed. We broke into their lair, threw open the doors, and let the other warriors inside.Iron vats of hot sugar were steaming, pipes were clattering; machinery groaned.“Parasites!” Artem gritted his teeth. “I'll get you. I'll get you red sons of bitches. Painted whores!”At the word “painted,” his horse fell to the ground. Lying prone, Artem continued fighting, but the red soldiers wouldn't let him stand. Fighting nearby, I rode over to assist but did not know where to aim. Artem got up, ran forward, and brought his sword down on the head of the closest soldier, all the way to the middle of his skull, to the bridge of his nose. It was like butchering a pig. Artem thrust the sword into the buttock of another who was fleeing and cut off his leg at the bend in the knee.“I'll cut off every last one of your asses! Cut off your asses!” Artem bellowed.A half hour later, the dead were lying, the captured sitting, and the victors doing anything they pleased.“Skorsky, are there a lot of casualties?” I asked the doctor, whose hour it was. I hoped not, because I was too tired to help him.“Just a few. The dead are already dead, and the wounded are not ours.”Though Skorsky rarely asked my help, and though I'd become an ordinary soldier, the doctor in me was still present in the most unpleasant attribute—knowledge. Others saw an eviscerated man, pieces of dusty flesh smeared with clay, soil, sand, and straw. I saw a perfectly formed kidney hanging perfectly from the rest of its body like a child's mitten from its coat. You could try this death on for size. Wear it like a sanbenito of the Inquisition.Artem counted the money and then lay on the floor alongside the gigantic sugar mountain in the middle of the room. From time to time, the crystals rustled as they fell.“I didn't think you'd be such a fighter!” the otaman said without turning toward me. “I thought you'd be healing us. You'd keep to the rear and we'd hide you like a girl. But here you are, in the vanguard, like a lion!”“I got excited,” I told him, choosing not to react to the “girl” part.“’Cause Alina said there was no sense counting on you to fight.”“Really?”“Does that sting?”“Why would it? I'm a doctor—not everyone is. It requires a brain. Unlike waving a sword.”“Yeah, yeah. I gave her gladiolas. We were lying in the boat near that castle, doing all manner of things, and she told me all about you. How you met.”“You were lying in that boat talking about me?”“It was the day before you left Kyiv. You agreed to go with the anarchists so quickly!”“Were you surprised? Doctors make fast decisions.”“But you probably had great prospects. Your parents are rich, right?”“And who are your parents?”“Probably all your relatives fled abroad—bourgeois. Why did you stay?”“What the hell's your point?”“Alina, by the way, died a while ago. Probably.”“Don't jinx her.”“Listen here,” he said, staring at the ceiling. “And listen good. If you have designs on her—dead or alive—it's best you castrate yourself now.”“After you.”“If I want to kill somebody, you know, I just do it.”At last he looked at me. I was lying on the floor nearby and looking in his direction, sweaty and relaxed, my appearance complemented by my disdain for his opinion, his authority, his stupid hat. His everything.Artem raised his arm above his head, stuck a finger in the sugar mountain, and licked it. We both got up. Had I anticipated this turn of events, I would have readied a gift for him. Artem held his revolver. Under my hand I found a knife the workers used for gathering beets: it was a deliberately sharpened arc they sank into the swollen brassicas. I jumped up and quickly stepped around the sugar mountain.Artem's bullet hit a pane and broke the glass.“Not man enough for hand-to-hand?”The otaman shot again.“You should've challenged me to a duel, you romantic!”Encrusted with white crystals, I charged Artem from the sugar mountain. We fell in, and the sugar stuck in our hair, mustaches, nostrils, armpits.The gang ran in to get us apart, then backed off because it had nothing to do with them. By now the sugar mountain had burst its banks. Of the once perfect pyramid, a deformed mound remained.Wounded, Artem fell on the sugar mound, turning the white red.I stood before the gang sugar-coated and holding a bloody hook. The old otaman was drawing his last breath. Blood trickled from the corner of Artem's mouth and streamed from the left side of his breast.“What's the commotion?” Old Roman had just come in.“Be quiet,” the boys told him. And a good thing they did.“You killed him? You killed the otaman!”“Shut your mouth,” the boys told him.“You... ”I slugged Roman's stinky herring mouth. How did that son of a bitch find pickled herring in a sugar factory? My fist was now bigger and stronger than ever before, a steel anvil that could split nails and shatter memorial plaques. The unfortunate man's jaw twisted like an upper millstone that had gone off track from the lower.“Let's get out of here and go to Makhno's camp,” I gave my first order.We galloped so fast the grass burned beneath us. The birds and bugs had no time to fly out of the way; hooves trampled the burrows of rodents who didn't dare crawl out of their holes for a long time after. We raced like no one had ever raced before.The steppe, that sly fox, pretended to be an innocent fool. The steppe said, “I'm like Adam: I don't even know my own name.” But its grass harbored the tracks of thousands of armies and the heels of Herodotus, the crunch of Trypillia vessels, and the smell of Scythian hemp, Roman coins, clay figures of wolf people, the chevrons of Denikin's army, glass from the Chekists’ ruby stars, traces of uranium from flying saucers. I threatened it: “Steppe, show me your layers, or I will burn you, plow you under, flood you.” But it just replied: “I'm like Adam: I don't yet know my name.”I lost geography as if it were a silver coin. It fell out of my pocket and rolled through the feather grass that blanketed the steppe in white foam. The open space ahead was so endless that the whole world might as well have been steppe. If people ended up here from somewhere else, they would conclude they were on another planet. The coin fell and became an argentum, became one with the ring on the hand of the princess who had one green eye and one blue, with the twisted candlestick at the monastery on the other side of the steppe, with melted ingots. It broke down into simpler elements, simpler and simpler yet. The horse carried me spreading the seeds of northern plants to the south, just as southern riders had once brought flowers and weeds to the north. And then I turned back. Just as I had no geography, I had no time. Every night I fell asleep with the thought that the next day I would again race. Through all spacelessness, all timelessness. I exchanged one horse for another, got on a train, on a boat, traversed forty versts on foot—in rain that brought the river up to the road, in heat that overturned cattle. The earth I walked on became mine. Mine was the water in the lakes and springs, clean water, dirty water, enlightened water, contaminated with oil, stinking of algae, of fish that died in wells, stinking of the memory of atrocities, water as clean as broken bread. The water did not become Alina.I was doing this for her: I got the basturma out from under my saddle, sodden with the horse's sweat, sliced the throat of a rich man whose daughter I had danced with at a ball, climbed into a vat of beet juice and took a sugar bath, carried out the expropriation of the savings banks, wiped the sweat from my face with my shirt—and the cloth turned red; I didn't know from what. If it was someone else's blood, I didn't care; if it was my own, even less.We mostly came across Reds. We scraped them up like old red paint on a door in order to repaint the boards black. Black looked better. Red is tasteless, but black has style. Healthy men died before us of myocardial rupture like bunnies found in the nest. The ones whose hearts were sewn of steel wire envied the deceased. Seizing estates, banks, distilleries, and prisons reminded us of gathering in the harvest. If you're too lazy to pick an apple, you can shake the tree; some of the fruit gets bruised when it falls. We seized buildings like we were shaking apple trees. No one picked the fruits, we just shook: shook under the beds, under the tables, behind the curtains. No, there was no picking. We just shook until the red juice spurted from the apples.Near the Khorol River with Father Makhno and me in charge, we captured sixteen machine guns and four cannons, as well as five hundred prisoners who immediately came over to our side. The villagers voluntarily gave us bread and cheese, chickens and kvas. People joined us. The front of the machine-gun cart said “You can't run,” and “You won't catch us” at the back. We took factory after factory. Millions of karbovantsi, thousands of poods of sugar, weapons. We smashed the telephone exchanges and captured the telegraphs. We made alliances with some and then with others. Lenin, Wrangel, Frunze, the Germans, Chinese, Australians, Kaiser Wilhelm II, Cleopatra, Maria Theresa Walburga Amalia Christina. We ran the steppe. There were a hundred thousand of us. There were three hundred thousand of them. There were three hundred thousand of us. There were a million of them. There were two million of them. We were all of humanity. We were so many that we were none.The nobles’ estates were long ago forsaken. In the people's deepest trunks lay silks and guipure laces that were once perhaps used only to cover a table. Five steps from the barn in the direction of the pear tree, some silver candlesticks are buried; there's a plaster figure of an angel in the chicken coop, covered with shit and feathers.I was reluctant to be going to my home, but I didn't see any way out. Fate intended me to be a different being from the one I was before.Here my grandfathers and great-grandfathers were born. Here the ones who caused my grandfathers and great-grandfathers to flee had stopped. When we were still far off I noticed that someone was in the house. It was our men—Skorsky had brought them here, about twenty in all. I asked Sanko, whom I had walked with side by side more than once, where the doctor was now. All the men answered that he was around somewhere, but I didn't see him that evening.In 1918, the spirit of my great-grandfather Stepan, along with my mother and uncle, had gotten into a britzka and scrambled off to Paris, to Napoleon, against whom my great-grandfather had fought with the Cossacks, to whom the Russians promised to return self-rule. Following him in the cart went the soul of Grandpa Oleh, who lost a finger when he cut down the old linden near the house; his second finger was blown off by a cannonball near Balaklava, and later his entire hand was cut off by some Turk. Next went the spirit of my father, also Stepan, who did not take part in any war but died of measles at the age of forty. They all got the hell out of here. First, they went to Kyiv, led by my mother, Tamara Makarivna, in order to collect Uncle's family and me, their son. And their son, it turns out, has now come back to rob his own home (I didn't drive my war buddies away, did I?). It's a shame that I didn't know where the bathtub was, or whatever they bathed me in when I was small. It would have been good to walk through the ranks of anarchists with that basin and tell them all to spit into it.Remembering every room, I carried Alina upstairs to my mother's bedchamber. There was no longer furniture or pictures, only bare walls. The bed and mattress remained, but that was enough. Mother hated noise, so she set up her room far away from the running in the halls and the creaks on the stairs. I adjusted the mattress; in a gap, looking like a stalk of wheat, there lay a gold bracelet that she lost in the haste and that the thieves could not find in the mayhem. I tucked it into my pocket.The place could still be saved. It was strong, built under the leadership of my grandfather, who knew how to do it right. He built a sawmill, a gristmill, a dress factory (today it's probably been ransacked, maybe even by our own men).Alina had a complete, displaced break in her right fibula. We needed water first. I went downstairs—the guys were dragging out the piano like an old cow to the slaughter.“What are you doing with that?”“Taking it out.”“Why?”“What's it to you? We want to have fun.”“Can you play?”“We're not your bourgeois lily-handed bitches.”They couldn't play, but they were famous at destruction. “Noise is the music of the new time,” one of the smarter among them might have said. “But noise is the opposite of music. Just as a rose is the opposite of your ugly mugs,” I'd have responded if there was anyone to say it to. I could also have said that this was a Bosendorfer grand piano, that it was very valuable—but do the guys not deserve such a luxury?“Why are you so boring? We're relaxing.”“Then let me play a little first.”“Go ahead, but fast. One-two.”So I played. As before. My fingers ran up and down the black and white keys, which weren't simply keys of these, the simplest, colors. These were the keys that remembered my fingers specifically—achieved by that slovenly German Katerina, our governess. She knew a bundle of languages, could play the piano, and was interested in the latest scientific discoveries. But she had not an ounce of sympathy for anyone who couldn't master anything on the first try. More than once she hit my pinkie against the black key that remembered every one of its four thousand touches. She would pound it on the key and shout, “Si bémol! Si bémol,” and later bang my fingers and translate, “B flach! B flach!”I played. I could not expose myself, so the only thing I could do was believe in miracles. What if these coarse men saw value in this bit of furniture so unintelligible to them? And what if they didn't destroy it, this emblem of my childhood, my land, my air, which I could protect in no other way? My air. My water.“Shchedryk, shchedryk, shchedrivochka,” one of them who recognized the tune began to sing along.“Look at you.” They did not expect music from me, who had until recently been drinking blood like water.They said, “Again, again!”A group of curious men gathered around me. They were ordinary farmers, thieves, and recidivists, peasants and workers, everyone except for Skorsky. They needed this music as they needed baths. The music cleansed them from the inside, perhaps. They had not heard anything besides the whistle of a bullet, the neighing of a horse, or the knocking of a chisel and the whirring of a saw, amputating limbs, for a long time.But it could not go on long. I did not close the piano lid, just stood and went to fetch water for Alina, leaving the unfinished song for later. The well was to the north—that is, at the “Head.” My father once promised to give me a compass if I could learn to identify the ends of the earth by means of the sun. And to make it easier to remember, I gave each one of them a name: the east where the day begins was “Right” (my right hand), the west “Left,” the north “Head,” and the south “Feet.” Back when I could still do whatever I wanted all day long, I would wake in the morning and say: I'm going to the Feet. The mound was at the Feet, Left had the river, Right had the forest. It was only to the Head that I rarely went, because a village was located there. When the villagers saw me, they would speak in whispers and avoid the master's son.... I wiped her brow and her burning, sunken cheeks. I lay down next to her to feel the heat of her skin.When the fire in Alina calmed slightly, I went out into our orchard. My father had once been given a gift from Japan—a tulip tree that blossomed with yellow-green flowers. It had to have grown in the time that I was away. It would have been fatal had it been cut down. I again took the stairs down into the drawing room and came across nobody—they had all disappeared in search of food or were hidden away in their burrows. In the middle of the hall, like an opened rib cage, was the piano, irreparably shattered.B Flach! B Flach!Translation © Ali Kinsella 2022. (shrink)

Place mouse over image continent. 2.1 (2012): 36–39. From an ethical and political perspective, people and property can hardly be separated. Indeed, the modern political subject – that is, the individual, the person, the self, the autonomous actor, the rational self-interest maximizer, etc. – has taken shape in and through the elaboration, institutionalization, and enactment of that which rightfully belongs to it. This thread can be traced back perhaps most directly to Locke’s notion that the origin of the political state (...) occurs when people rise above the state of nature by ceding the power to prosecute offenses. The rule of law begins then with a defense of the right to property. People become subjects by adhering to the social contract, which they do by deferring the defense of their own property to the state. In this light, the response of the United States federal government to the financial crisis of 2008 appears to many as a breach of the social contract. The chant “banks got bailed out, we got sold out” states the claim plainly. Why exactly did some subjects (e.g., the banks) have their property defended by the state (i.e., through the variety of programs including TARP, the discount window at the US Federal Reserve, etc.), when other subjects (e.g., homeowners) found themselves without protection of their property rights, forced to default on mortgage debts and face dispossession? Even if the rhetoric about “too big to fail” can be believed, and the collapse of the financial system would lead to negative consequences for people who had little or no connection to the activities that brought it about, such consequences need not call into question the notion that everyone stands equally before the law. To occupy, then, appears as a form of civil disobedience, an intentional, retaliatory breach of the social contract by those who feel that they have lost the support of the state to which they ceded their power as sovereign agents. The visible and the invisible The violation of property rights of people who have recognition, protection and power under the law destabilizes their very status as citizens and tests the limit of democracy. Does the financial system force the dematerialized victimization of individuals? Do people become numbers, or worse still, percentages of unemployed, tranches of defaulted mortgages and foreclosures? Are they perhaps instead disenfranchised prospectively from the privileged position occupied by virtual entities and actors such as those involved in the derivatives markets, always already exiled back into the physical, visible realm? The line of conflict appears to be drawn between invisibility/absence/deferral and visibility/presence/realization. The demonstrators occupy an excess property of those subjects, namely, the banks and financial elite, who did receive recognition and protection under the law. By domesticating this excess property, rendering its invisibility visible within the political economy, the protesters raise a new form of threat to the hegemonic order. To occupy, then, involves a rejection of the order under which the “99%” have been subjected to erasure. The occupation seeks creatively to establish a new means of communication and law for its subjects. In the face of an existing power structure that is increasingly disenfranchising the majority of people while consolidating nodes of power and influence, the “occupation”, or the work of the Occupy movement, involves seizing a space that refuses the rules of the existing, allegedly corrupt sovereign state. This refusal of governance extends even to include a steadfast refusal to articulate a strategy, to formulate a list of demands, to converse with the sovereign power on the grounds of its own conventions, to put forth a leader, to resolve the ambiguity of the movement into a discreet identity, face, or voice. Do these tactics provide a resolution to the problem that was its genesis? Not in such a direct and easily resolved manner, but it remains difficult to imagine a direct and simple resolution to the problematic of the breach of the social contract. The ambiguity of the situation has generated significant interest within the broader populace, though many people sympathetic to the cause appear to be frustrated because the movement has not simply put forward a short list of concrete demands, or even a set of leaders and spokespeople, much less a resolution. And yet, this lack of coherence appears as a resolution of a problem generic to protest movements in the past, where individual leaders can be removed or discredited, and lists of demands can be co-opted by others holding more political power. Meanwhile, the ambiguity has compelled imitations on a global scale, with the Occupy Wall Street participants consciously taking actions that can be replicated by anyone anywhere without significant cost. These actions have taken place not in a peripheral location such as a parking lot in New Jersey, but instead close to the centers of power and governance, adjacent to Wall Street, close to the White House, on college campuses, etc. This spontaneous archipelago of protests becomes an irritant, a negation of the accepted order of protests, but when the protesters themselves move outside of their encampments, they are escorted by the police, constantly monitored and maintained so that a permanent state of paranoid persecution takes hold. To occupy, occupying, occupation – these actions involve a variable degree of danger – are you willing to step into a different space, where the rule of law is unclear and evolving? Are you presenting yourself as a representative of the majority, the 99%? Who has a sense of belonging to the 99%? This previously invisible population becomes a focal point of political power, garners increasing public support, infects the public dialogue. The government recognizes this population by forcing it from the occupied space, removing the element of possession of property. It is at this point of conflict, in the struggle to hold the physical property, where the greatest friction and violence occurs. Scaling the rule of law While occupied, the property calls for a redress of grievances, a restoration of the rule of law. The Occupy movement does not select and put forward individuals or leaders, it puts forward places – the occupied property represents the point of conflict, not the individual. And it is this very property that the government then tries to reclaim. The movement remains faceless, anonymous, uncounted, or rather counted only as a mass, the self-labeled mass of 99%. These spaces are like refugee camps or favelas, but constructed to unite the political life and private life of the protesters. This objective is presented as a tactical necessity, as all other means of protest and communication have failed, leaving only the option of seizing, holding, occupying a property. But to what end, exactly? Can anyone deliberately return to the prior social contract, embrace, affirm, and govern in strict accordance with the earlier relationship to property, following the logic of Locke’s arguments? In this respect, the contemporary crisis indicates a new, transitional phase in the way that property operates, or rather, in the balance between real and virtual value. The roots of the crisis lay in the massive overvaluation of property caused by lax lending practices, as more people were encouraged to borrow more money, which drove up the prices of property. At the same time, these individual properties, these mortgages for homes actual families lived in and worked to support, were bundled into securities that could be bought, sold, and speculated on. The reduction of a physical house or piece of real estate to an almost incalculably small element in an investment vehicle appears as a scaling of the hedge that radically diminishes the value of any individually owned property. Moreover, a number of recently-innovated financial products allow investors to hedge in new ways, to deliberately spread risk around a portfolio in hopes of bringing returns even when the individual mortgage defaults. At the level of the ‘free’ market, these virtual negative valuations are designed to balance the physical positive valuation, though many of the biggest lenders are now being investigated for controlling both sides of this valuation, the positive and the negative, to facilitate both the creation and failure of the investments and to profit from both. The ability to benefit from both the negative and positive value of an investment is a result of a technologically enabled capacity to operate within a complex field. These layered and scaled investment vehicles and the simultaneous negation of their value together represent a commingling of the virtual and physical existence that is both complex and multiple. The valuation of a virtual property has tremendous power to change the valuation of the physical - either injecting it with or depriving it of funds, pumping in or draining life and energy. This situation has roots of its own – the notion of property advanced e.g., throughout the enclosure movement in Britain was, from the outset, an imposition of virtuality (i.e., the concept of law, the institutions associated with ownership, etc.) on the physical reality of land. 1 The difference today is that technological trading platforms combined with innovations within the financial services industry have enabled the reduction of each individual property receiving or losing value in scale to an almost atomic level. In turn, the number of properties held simultaneously and valued as a massive, multiple wholes – i.e., the derivatives market in mortgage-backed securities – is a new phenomenon made possible through the application of similar technologies and institutional structures. And those actors who can trade in these layers of complexity can then profit from the new phase of disassociation of the virtual and the physical – unconcerned with and operating at such a virtual distance from the individual residing physically on a particular piece of real estate that they no longer feel the tug of the physical tying them back to the physical, operating literally as in a video game, in a virtually distanced world. What can or should be done about this situation? Answers lie outside the scope of this current essay, but merit consideration in the near future… NOTE 1) Hernando de Soto has emphasized this dimension by empirically demonstrating its non-existence in many countries in The Mystery of Capital. (shrink)

BackgroundDuring the COVID-19 outbreak in 2020, national governments took restrictive measures, such as a visitors ban, prohibition of group activities and quarantine, to protect nursing home residents against infections. As ‘safety’ prevailed, residents and close relatives had no choice but to accept the restrictions. Their perspectives are relevant because the policies had a major impact on them, but they were excluded from the policy decisions. In this study we looked into the moral attitudes of residents, close relatives and volunteers regarding (...) the restrictions in retrospect, and what moral lessons they considered important.MethodsWe conducted 30 semi-structured interviews with residents and close relatives and one focus group meeting with volunteers working in nursing homes. Data were transcribed verbatim and analyzed inductively. Subsequently, three Socratic dialogue meetings with residents, close relatives and volunteers were organized in which first analysis outcomes were discussed and dialogues were fostered into moral lessons for future pandemics. Outcomes were combined with moral theory following an empirical bioethics design. ResultsCritical perspectives regarding the COVID-19 restrictions grew in time. Various moral values were compromised and steered moral lessons for our future. The participants recognized three moral lessons as most important. First, constructing tailored (well-balanced) solutions in practice is desirable. Second, proper recognition is needed for the caring role that close relatives fulfill in practice. Third, a responsive power distribution should be in place that includes all stakeholder perspectives who are affected by the restrictions. DiscussionComparing the results with moral theory strengthens the plea for inclusion of all stakeholder groups in decision-making processes. To further concretize the moral lessons, tailored solutions can be realized with the use of moral case deliberations. Proper recognition includes actions addressing moral repair and including counter-stories in the debate. Responsive power distribution starts with providing clear and trustworthy information and including all perspectives. (shrink)

In 1997, a court in Cyprus jailed Pavlos Georgiou for fifteen months for knowingly infecting a British woman, Janet Pink, with HIV-1 through unprotected sexual intercourse. Pink met Georgiou in January 1994 whilst on holiday. She discovered that she had contracted the virus from him in October 1994 but continued the relationship until July 1996 when she developed AIDS. She returned to the UK for treatment and reported Georgiou to the Cypriot authorities.1There have been a number of legal cases involving (...) deliberate transmission of HIV, but most have involved forced exposure to infected bodily fluids for example, rape or biting, and have been dealt with using the existing legislation for rape or assault. While it is often difficult to prove responsibility for transmission in cases of forced exposure to HIV, it is even more contentious in cases like those of Janet Pink where an individual has consented to sex but claims that he/she was not forewarned of his/herpartner's HIV-positive status. At present there is no specific criminal offence of having unprotected sexual intercourse without disclosing one's HIV-positive status but a prosecution could possibly be brought under any one of a number of existing offences.2 Perhaps a change of policy needs to be considered. The Home Office has issued a consultation document which outlines a proposal that will allow the criminalisation of intentional transmission of diseases, like HIV, that are likely to cause serious harm. This revised legislation would cover all other potentially fatal diseases but seems primarily to be targeted at HIV transmission. Should transmission of HIV through consensual sex, without the HIV-positive status of the individual being disclosed, be an offence? This question, and that of whether there is a moral obligation to disclose a positive HIV status prior to having a sexual relationship is the subject of this paper. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:February 19, 2011 (11:48 am) E:\CPBR\RUSSJOUR\TYPE3002\russell 30,2 040 red.wpd Reviews 179 THE EARLY “IRON CURTAIN” Michael D. Stevenson Schulich School of Business, York U. / Russell Research Centre, McMaster U. Toronto, on m3j 1p3 / Hamilton, on l8s 4l6, Canada [email protected] Patrick Wright. Iron Curtain: from Stage to Cold War. Oxford: Oxford U. P., 2007. Pp. xvii, 488. isbn 978-0-19-923150-8. £18.99 (hb); £12.99 (pb). In his famous Westminster College (...) address on 5 March 1946 in Fulton, Missouri, Winston Churchill Wred one of the opening salvos of the Cold War by proclaiming that from “Stettin in the Baltic to Trieste in the Adriatic an iron curtain” had been lowered across Europe. Patrick Wright’s intriguing and provocative book does not examine the phrase “iron curtain” in its popular Cold War context. Instead, he maintains that many characteristics of this metaphor, “including the pronounced sense of theatricality it would bring to international politics, were inherited from the period before the Second World War” (p. 18). Wright divides Iron Curtain into two primary chronological sections, the Wrst covering the period from 1914 to 1920. An iron curtain originally referred to the steel safety screen that descended in English theatres, beginning in the lateeighteenth century, to separate the audience from the often catastrophic Wres that broke out on the stage. The phrase entered the lexicon of international relations in January 1915 when British author and paciWst Violet Page (writing under the pseudonym Vernon Lee) published an article lamenting that “War’s cruelties and recriminations, War’s monstrous iron curtain” (p. 80) had alienated European nations such as England and Germany sharing a common cultural heritage. But the barrier quickly moved east in the aftermath of the 1917 Russian Revolution and “took the form not just of exaggerated political rhetoric, but of an economic blockade enforced by naval power” (p. 171), as the Allies sought to contain the infection of Bolshevism. Wright devotes most attention in this section to documenting the 1920 visit to Russia by the British delegation jointly sponsored by the Trades Union Congress and the Labour Party, which sought to penetrate the dense fog of Allied anti-Bolshevik propaganda and validate the delegation members’ own preconceived views about the nascent socialist utopia in Russia. British delegates witnessed images both of progress carefully stagemanaged by their hosts and of terrible economic dislocation and poverty caused by the Allied blockade and the civil war, which allowed the majority of them to return home to lavish praise on the Soviet experiment that would, in their minds, inevitably fulWl its potential once the Bolshevik government became stable. February 19, 2011 (11:48 am) E:\CPBR\RUSSJOUR\TYPE3002\russell 30,2 040 red.wpd 180 Reviews 1 “The Future of Europe”, European AVairsz 1, no. 1 (April 1949): 3. The second section of Wright’s book examines Western reports of life behind the iron curtain between 1920 and 1939. Here, the author focuses heavily on the theatrical nature of Soviet attempts to create modern-day Potemkin villages that werez—zwith a limited number of exceptionsz—zaccepted as reality by an endless parade of left-wing visitors. A second British Trades Union Congress delegation in 1924, for example, received a dramatically embellished picture of Soviet economic progress that included a train journey past a long-abandoned factory belching smoke created by burning wet straw frantically provided by Russian peasants; the resulting report of the delegation “repeatedly collapsed into the most abject conformity with the Soviet view of reality” (p. 245). The most tragic examples of Western visitors’ blindness to the truth occurred during the 1930s famine deliberately induced by Stalin, and Wright exposes a wide cast of characters who adopted a blinkered view of conditions in the ussr. Among intellectuals, Wright documents the 1931 visit of George Bernard Shaw, who cavalierly dismissed reports of widespread food shortages while dining sumptuously in Moscow’s Hotel Metropole. Among journalists, Wright develops the case of Walter Duranty, the New York Timesz correspondent who knuckled under to demands of Soviet censors to produce sanitized accounts denying or ignoring the famine in order to protect his privileged place in that... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:To Cut or Not to Cut?That is the QuestionTracy WilsonWhat is circumcision? In simple terms, it is the removal or excision of the foreskin of the penis. Seems so simple, right? In some families, it is that simple. In other families, it is a religious exercise. I am a doctorally-prepared Family Nurse Practitioner and started my nursing career in the NICU. I have seen my fair share of circumcisions. (...) As a nurse, our role was to prep the room with whichever instrument the OB/GYNS preferred and then soothe the baby. Some OB/GYNS prescribed Sucrose, which is ultimately sugar water, for the babies to have while undergoing circumcision, while others wouldn't prescribe anything. What I learned in the NICU and by watching circumcisions being performed was that the doctor's preference determined the pain management protocol. Some doctors cared more about pain control, some cared [End Page 85] about presentation and ensuring the foreskin was cut properly, and some were just old school and had their preferences. I wanted to comfort the baby and make his world as comfortable as possible.Watching circumcisions being performed, I never formed an opinion about them. I really looked at circumcision like any other procedure. However, I did see some parents really toil over the decisions, especially fathers who did not want to "see their son tortured or mutilated like that" as one told me once. I didn't quite understand the comparison to mutilation, but I understood why he did not want his son to go through the procedure. It wasn't until years later that I understood the gravity of the decision when I became pregnant with our son and knew immediately it was a boy. Call it a mother's intuition, but I just knew. To circumcise my son was never a decision I had to deliberate very long because it was something I was accustomed to in my family. It wasn't until one of my relatives got married and had her first son that I became aware that this would ever be a weighty decision for someone in my family.I took it for granted all those years before working in the NICU because circumcision was superficial to me. I realized that it's not just a piece of foreskin to many people. For some circumcision is done for religious reasons, for others making the choice to circumcise is about sameness, or hygiene. For my extended family member, it happened to be about sameness. She didn't want her sons to look different from their dad. Since potty training was mostly going to be taught by their father, they wanted their sons to look like him. Many NICU parents told me they wanted their sons to look like their fathers, so this notion was familiar to me. After my extended family member explained why sameness mattered, I understood the reasons why some parents felt this way.There are other stories like this which we pondered upon when we got pregnant with our son, and I really began to reflect on whether we should circumcise or not. Then two additional frames of thoughts arose; one, I ensured that my husband and I jointly made the decision together, but I really leaned on him for his opinion because he was a male and most of the male teaching would come from him. Second, we considered if the decision to circumcise should come from him once he became an adult. His father and I discussed whether he should have a choice regarding being circumcised. He may have chosen a different decision than us and we didn't want to take away his right to choose. However, waiting to have a circumcision as an adult comes with its own sets of challenges, including the possibility of infection, increased pain, missed work, edema, etc. So, ultimately, we made the decision to go ahead with the circumcision.In our case, our pediatrician performed the circumcision. I asked him explicitly which instrument he used because I had my preference, and I was not going to allow my son to be circumcised by a healthcare professional that did not use my... (shrink)

Architecture and Deconstruction Case of Peter Eisenman and Bernard Tschumi -/- Introduction Towards deconstruction in architecture Intensive relations between philosophical deconstruction and architecture, which were present in the late 1980s and early 1990s, belong to the past and therefore may be described from a greater than before distance. Within these relations three basic variations can be distinguished: the first one, in which philosophy of deconstruction deals with architectural terms but does not interfere with real architecture, the second one, in which (...) a collaboration between Jacques Derrida and a group of architects interested in his concepts is commenced, and the third one, in which completed or only designed objects or new concepts of deconstruction created by architects gain their supremacy over philosophy. The following book analyses these three possible ways, first of all with the reference to Peter Eisenman and Bernard Tschumi. -/- Peter Eisenman -/- Misreading… and Other Errors -/- The issue of relations between Peter Eisenman’s work and philosophy of deconstruction may be referred to his activity more than ten years preceding his direct collaboration with Jacques Derrida (in 1985) and organisation of the exhibition Deconstructivist Architecture at Museum of Modern Art in New York (in 1988). As soon as at the stage of designing the first houses (House I-III, 1967-1970), which almost entirely inscribed in formalistic aesthetics of Modernism, the architect analysed the problem of architecture dependence on its assumptions. All his later designs may be treated as consequence of this initial interest in relations between practice and theory, and at the same time as an introduction to manipulations later on led at the level of metaphysics of architecture. Beginning with the issue of presence, considered in comments to House VI (1972), the number of ideas having their analogies in philosophy of deconstruction increased. The text entitled The End of the Classical: The End of the Beginning, The End of the End (1984), in which Eisenman criticised questions of representation in architecture, its delusive strive for truth and comparably unattainable attempts at ultimate definition of elementary rules, should be acclaimed the breaking point. This attitude was extended by numerous strategies disturbing architecture rules defined at metaphysical level in an essay Moving Arrows, Eros, and Other Errors: an Architecture of Absence (1986). The issue of Eisenman’s passage from formalism to deconstruction has already been much discussed in the literature (Rosalind Krauss, Thomas Patin among others), still it should be mentioned that the threads similar to Derrida’s concept included in Eisenman’s writing reveal untranslatability of architecture and philosophy. -/- Choral Works or Separate tricks -/- In 1985-1986 a series of seven disputes between Jacques Derrida and Peter Eisenman took place. The pretext for them were designs concerning Parc de la Villette in Paris. The situation of many months of collaboration between a notable philosopher of the second half of the 20th c. and an architect that already had a huge theoretical oeuvre, ended up with a publication of a large volume entitled Chora L Works and it became at the same time a vast study area for historians of contemporary architecture and philosophers. Derrida’s contribution to concept works were his considerations over the idea of chôra, the properties related to this concept were about to be reflected in shapes of the park. Therefore, Chora L Works became an example of the abilities of contemporary art, both in its capability of translation from philosophical ideas to artistic forms and its resistance to tradition of representing in architecture some phenomena and values originating outside this discipline. In the final period of their collaboration both interlocutors started to polemicise with each other more decidedly, what became a separate part of their thought exchange. The exchange of letters between Derrida and Eisenman at the turn of 1989 ended up the period of their direct contacts, nevertheless, at this time precisely a large group of experts in issues of deconstruction joined the discussion and extended the revealed in the former dispute problems into more than ten years of further considerations and publications. Except for a long text by Jeffrey Kipnis, who had participated in the meetings of the philosopher and the architect, there appeared also comments of researchers of artistic theories (K. Michael Hays, Thomas Patin), philosophers (Andrew Benjamin), and even experts in Greek literature (Maria Theodorou or Ann Bergren). Following these debates a contemporary reflection on architecture has saturated with indeed numerous concepts originating in philosophy of deconstruction. -/- Architecture which imitates mute philosophy -/- The series of Jacques Derrida and Peter Eisenman meetings, which took place in the period of 1985-1987, induced many authors to make comments. Some of them (Jeffrey Kipnis, Ann Bergren, Maria Theodorou) developed the subject of chôra which was introduced to the discussion by Derrida. The problem that was about to be solved was the question of tying up the concept of chôra with architecture, including Eisenman’s architecture and the series of meetings within frames of Chora L Works project. Kipnis on this occasion paid attention to chôra and its character of anachronia which infects any being created within chôra. In other words any event has its counterpart (analogon) in another, earlier event. He demonstrated the similarity of structure of many events and statements from the times of Derrida and Eisenman’s meetings to the almost identical behaviour of figures in Plato’s dialogue Timaeus. The loss of beginning present in this phenomenon was appropriate to both features of chôra and the effects of typical analyses of philosophy of deconstruction. Bergren’s analyses focused on accentuating gender of chôra, which, according to this author, had been neglected hitherto in discussions. She collated chôra descriptions with characteristics of women in myths, early Greek epic and philosophy and she arrived at a conclusion that chôra has features of a single woman and a married one at the same time. And yet Theodorou’s studies showed that in the Homeric epics chôra is not treated as an idea but is related with single things and events. The other part of the comments (represented by Andrew Benjamin and K. Michael Hays’ utterances) concerns Eisenman’s attitude to tradition which was treated as a variety of iteration understood philosophically. Benjamin commenced his considerations at the point of closeness between a definition of tradition and a concept of chôra understood as perpetuation (placement). A problematic issue was for him Eisenman’s complex relation to tradition based on its contest and affirmation at the same time. Overcoming the simple subordination to tradition – according to Benjamin – was based on awareness of the role of repetition in culture not known before. Hays made an attempt to explain the pleasure and torment of repetition with the support of Sigmund Freud and Roland Barthes’ concepts. According to Hays repetitions are attempts of a single being to a certain primal state perceived as free of any tension. In a similar way Rosalind Krauss explained a motif of a grate present in Modernistic art and also exceptionally frequent in Eisenman’s work. -/- Annex Architecture is still writing Balzac novels. Peter Eisenman and literature -/- Architecture’s approach to writing, script or literature, present within Peter Eisenman’s work, is an exceptional phenomenon, furthermore a complex one. The article considers four possible relations. The first one relates to Eisenman’s characteristics as a person extremely gifted with the ability to wordplay, which very ‘play’ reveals skills to create architectural images. In the second approach the attention has been paid to Eisenman’s interests – in the first period of his oeuvre – in linguistic works by Noam Chomsky and his transformational-generative grammar. The third kind of relations applied to overcoming the need for autonomy of architecture (and of modernist aesthetics at the same time) and renew interests in questions of meaning in architecture. The fourth sort of relations occurred when Eisenman started to create reflections of historic or literary narrations in architecture – ‘stone stories’ and architectural fictions of their kind. -/- Bernard Tschumi -/- From perversion to deconstruction In Bernard Tschumi’s writings from the 1970s and 1980s we can find a transposition of important threads of post-structuralist ideas deriving from Georges Bataille, Roland Barthes and Jacques Derrida’s works. The analysis of the architect’s writings also shows roots in Phillippe Sollers, Michel Foucault and Denis Hollier’s works. The analysis of borrowed elements from the beginnings of Tschumi’s theoretical activity may be helpful in explaining the contents of his later writings motre inspired by philosophy of deconstruction. The set of his earliest views was inspired by Marxism, Neo Marxism and French Structuralism, mainly by the writings of Henri Levebre and Guy Debord. From the thought of Levebre Tschumi took interest for city as not only a question of urbanistics but also a political issue. From Debord’s concepts he borrowed a conviction about the role of situational violation for changes in the society structure. Some of these beliefs were preserved in his own concepts of architecture as an event. From this period derived also his will to change conservative elements of social structure not by means of political revolution but of theoretical and creative activity. Tschumi acknowledged that the effective way of the proceedings towards achieving his aims would be accepting the role of both a critical intellectualist and architecture expert who would not hide away his left-wing orientation. The speculations defined by the architect as ‘revolting analyses’ were about to characterise contradictions which tear the society apart, penetrate architecture and constitute the basis of culture. Spreading away of the conscience of false assumptions hidden away in various disciplines could have weakened cohesion of a conservative society and influence the will to change among the elites. This way the beginnings of political revolution were rooted in philosophy of architecture. In 1977 Tschumi published his text entitled The Pleasure of Architecture inspired by Roland Barthes’s The Pleasure of the Text, it also included some concepts derived from Georges Bataille and Jacques Derrida. First of all the author used Barthes’s concept which made an assumption that literary activity is pervaded by the spirit of resistance towards social rules, and Tschudi transferred this remark onto architecture. From the ideas of Bataille, acquainted via Holier’s work, he derived his belief that two concepts of space, a conceptual one (defined as Pyramid) and a sensual one (defined as Labirynth), not losing their distinct features, they join in the concept of experienced space which exceeds contradictions. The exceeding itself was defined as the basic rule of architecture and it was referred to situations in which architecture not only negates social needs, but also disavows its own tradition. Crossing the borders applies not only to political issues or permanent rules of the very discipline but also interfering with other fields (especially literature and film). The fact that architecture is associated with organising events turned Tschumi’s attention to questions of violence that result from upsetting architectural order of a given building by its users and the one hand, and on the other from forcing the users to specific acts imposed by this very order. The analysis of the concepts used by Tschumi in his early writings indicates that they are close to definitions that would occur in his reflection in the following years influenced by philosophy of deconstruction. -/- Approaching deconstruction Tschumi in his theories developed in the 1980s presumed that the current social world had undergone a deep process of decay, and the reaction against which ought to be based on ordering-up actions, and also preserving the main outline of disintegration of the whole and its elements in the state of conflict. The statements concerning the nature of the contemporary to Tschumi social relations were applied by him to the world of architecture, this led him to coming up with designing strategies that took into consideration the destabilised character of conditions in which works of architecture were created. New ways of conduct invented by Tschumi drew their inspiration from literature and research on literature, psychoanalysis, structural linguistics, structuralism and post structuralism, and eventually also deconstruction philosophy. The proposed methods were opposed by their author both to functionalism continuity trends and postmodern architecture. Tschumi’s proposals contradicted any forms of conservatism or traditionalism in political sphere as well as in reference to tendencies in architecture. They were not simple contradictions of social or architectural rules, they intrude them from the inside, weaken or escalate the already existing incongruities, they move the boundaries between the areas. Revolutionary illusions about the possibility of radical changes were replaced with strategies which completed, tainted or test former rules in the series of formal games of permutation and combination. Quite different from avant-garde formalism Tschumi’s games were not about maintaining the autonomy of a given area, but on the contrary – polluting it with other areas’ influences. Tschumi enjoyed demonstrating illusions of architecture concerning simple relations between form and function, or between form and meaning. Making use of Freud, Lacan and Foucault’s research he introduced a category of “madness” into architecture allowing an observation that the recognised norms are nothing but merely ones of many possible principles of behaviour, and their recognised status resulted from unjustified hindering innovativeness which is crucial for architecture. To reborn architecture’s capability of changing Tschumi also made use of Barthes’s discoveries concerning rules of narration and works by writers who applied in their writing knowledge on linguistics. Making a work’s author unclear by various mechanical transformations of its elements was however apparent only, and formal rigours imposed on the process of designing liberated possibilities difficult to obtain in more traditional creative action. Another mode of acting introduced by Tschumi was combining his work of elements deriving from outside architecture; joining space records with notation of motion and events accompanying architectural objects among others. These architectural and extra-architectural elements were not unified, on the contrary their heterogenous and conflictual character was stressed. This is how shock, anxiety and instability, typical for live in great metropolises, infiltrated architecture. Taking some ideas of deconstruction philosophy as a pattern Tschumi also took into critical consideration in his essays traditional in architecture oppositions between form and figuration, or theory and practice. By combining various inspirations he eventually worked out an idea of architectural event, which he understood as a series of actions contesting its own field, redefining its sources, principles and elements. An event, understood in this way, was not so much producing works as rather creating conditions of their production and at the same time designing the society different from a hierarchic one. -/- Park of deconstruction Among numerous philosophical strategies of deconstruction most frequently used was questioning the practice of strong opposition of two reasons. In many cases Bernard Tschumi’s writings just consider functioning of the conflict juxtaposition of the ideas of structure and ornament or theory and practice in history of architecture. Violation of traditional relations between terms of this kind, both old and modern, raised Jacques Derrida’s objections, when he was induced for the first time to co-operate with architects’ milieu. During this long lasting thought exchange the philosopher eventually acknowledged Bernard Tschumi’s arguments for reasoning the encroachment of architecture’s fundamental rules. Deconstruction applied in architecture was not a simple transposition or analogy of practices that had been applied by philosophy of deconstruction. We may even say that considering architectural terms became an important formula of deconstruction. Architecture understood in philosophical way became something beyond the practice and theory of its own discipline, a sort of metaphysics of both philosophy and architecture. The deliberate encroachment of simplicity of dividing architecture into theory and practice, for the first time became a clear aim for Tschumi in his drawings and texts entitled The Manhattan Transcripts. The contents of this series of works was a record of characteristic features of this New York district in such a way that not only objects were the subject of the record but also relations between objects, people and events. The record was about to take into consideration a conflict character of elements of this representation and at the same time to avoid applying to them the rule of mimetism. The record became a form of reflection over the very record by an increased control over the ways of representation. Architecture which was considered in the The Manhattan Transcripts was not directed to fulfill the needs of inhabitation or production, it was rather related with hitherto usually marginalised liminal situations: building ostentatiously big monuments, religious cult, war etc. Architecture operating in these relations focused also the attention on the included in it continuous tendency to overpass its own restrictions, the role of violence as its not recognised factor, or the meaning of excess and shock in its operation. Architecture moving from reason towards madness became even more visible in the design of Parisian Parc de la Villette, whose pavilions were defined as folies (in French it means both small park buildings and follies). The park was supposed to be on the one hand a reflection of traditional society disintegration while on the other it questioned basic rules of producing a work of architecture. The traditional rules of designing, based on ordering up, were replaced with the strategies of dysfunction and dissociation. In Tschumi’s opinion methods of this kind may be equivalent of what Derrida named différance. Instead of aiming at mergence, any diversity, plays or variations were strengthen. Tschumi’s texts, in which he explained his attitude, were completed by Derrida’s extent statement entitled Point de folie – Maintenant l’architecture. Derrida’s article is the most significant of all his statements on architecture as a form of thinking and activity. According to the philosopher, architecture should divide space (in French defined as espacement), what enables both thinking and action – it arranges the space of an event. Tschumi’s buildings, defined as folies, in an essential way destabilise any created order, and at the same time they refresh it. Derrida’s statement suggests that architecture may become both metaphor of an order merging a language or a society but also of inner forces which deconstruct and reconstruct it. Therefore architecture is at the same time a construction, a deconstruction and a reconstruction. Parc de la Villette stands out in this system with its attempt to step beyond the scheme of an easy repetition and its heading for chances of achieving more radical otherness. -/- Conclusion Destruction as construction. Paradoxes of deconstruction in architecture -/- Scepticism about persistence and common importance of fundamental values of human culture evinced in philosophers and writers’ works as early as in Greek antiquity, nevertheless it was not expressed so strongly as in the second half of the 20th century. Especially in Heidegger’s work Being and Time (although originated in 1927, still influential in all later philosophy) the following states were characterised: the state of losing the ground (Abgrund), of being out of sight (Unheimlichkeit) and of being out of dwelling (Un-zuhause-sein) – as the basis of self-confidence of conscious being there (Dasein). The entire criticism of philosophy of home and dwelling draws the inspiration from this early writing of the German philosopher, it combines crisis of basic terms of metaphysics with social conditions which are dictated by living in large metropolis. The crisis of both metaphysical foundation and home appears to be similar to the situation of weakening the relations between a man and his dwelling in extensively expanding cities. Whereas philosophy, as well as many disciplines of social sciences, have diagnosed for a long time the destabilisation of fundamental ideas of Western culture and crucial changes in the ways of dwelling, architecture itself occurred to be “the last fortress of metaphysics” (J. Derrida). Among contemporary architects, Peter Eisenman and Bernard Tschumi were the ones who engaged most decidedly in the issues of critical analysis of architecture foundation and its social role. Both the architects noticed new formulas of contemporary social and individual existence, tremendously different from the entire history, and at the same time they affirmed lack of adequacy of architecture concepts to new situations. Both Eisenman and Tschumi used to describe the existing architecture as a tool for consolidation of highly integrated and hierarchised societies, and also as a discipline extremely uncoincidental with the current character of social life based on ideas of freedom and diversity. The means to transform architecture and make a factor of further social changes out of it, was a concept that accentuated revealing the inner contradictions of this discipline, and considering them in designing strategies. Eisenman’s activity, in regard of what has just been noticed, was focused on questioning the basic rules of traditionally comprehended architecture, especially the rule of purpose. The American architect noticed that the concept of architecture as fulfilment the need of location, hides away the fact that the location has to be constantly reconsidered, and hence it is overtaken by change (dislocation). Therefore new concept of architecture propounded architectural activity to translocate the concept of location – more than before – but also to change its status perpetually. Such comprehended architecture should claim, as its main purpose, the constant revision of this purpose and create itself anew permanently. Even Eisenman’s earliest designs of houses nos. I-IV broke with such values as the sense of safety, closeness and familiarity, and just on the contrary they accentuated senses of strangeness, homelessness and loss of confidence. The contradictions within architecture noticed by Tschumi referred to combination of intellectual and sensual values in architecture, when their non-appropriation was defeated by an additional condition, namely the way of experience based on pleasure of excess, marked by insanity. The features of folly were especially visible in his designs of gardens, where the order of planning was mixed with sensual experience introduced by particular elements (both the ones created by nature, and the buildings defined as folies). Parc de la Villette designed by the French architect in Paris put in question not only the common understanding of purpose in architecture but also the ideas of order and integrity, as its plan was based on the combination of independent layers with records of grids of points, various lines and planes. The architecture that collides inadequate elements with each other was supposed to be a kind of an event with no beginning and no end. The architecture treated as an event became a form of a space weakened articulation that maintains its diversity and lack of accordance of the elements building it up. The analyses of Eisenman and Tschumi’s theoretical writings indicate how much the aims of architecture have actually changed; instead of supporting social persistence, the architecture is rather intensifying contradictions, and instead of providing people with the sense of safety, it sublimes danger. From simple acts of defamiliarisation, increasing the distance to itself and enhancing the role of theory, through discomfort, anxiety, not feeling someone at home, weirdness, excess, shock and violence, architecture reached the edge of stability and uncertainty, only to make an attempt at penetrating what is impossible and unutterable, and recording what cannot become the subject of any records. -/- . (shrink)

Many men who have sex with men (MSM) express feeling marginalized by discourses within public health and sexual health nursing that determine bareback sex is deviant and unsafe. Their resistance to risk‐based discourses can be seen within radical sex practices such as deliberately becoming‐infected with HIV (bug‐chasing) and breeding‐infection (gift‐giving). The metaphors of bug‐chasing and gift‐giving, particularly those spread across global online spaces, can influence the sexual experiences and practices of MSM. A metaphor analysis was conducted of Internet forums (...) discussing HIV chasing and gifting metaphors, and showed a variety of discursive meanings, tactics and effects to the radical sex practice. A radical research approach was used to explore the processes of becoming‐infected and breeding‐infection as determinant steps in the symbolic resistance of risk‐based discourses, as well as the creation of new forms of life and community among MSM. Our analyses demonstrate how the gifting/chasing metaphors express MSM's marginalization as well as their lines of flight from having their practices captured within public health discourses. We hope to offer alternative nursing approaches for thinking through and engaging with transgressive and queer sexual practices. (shrink)

In the fall of 1950, eleven San Francisco residents were admitted to Berkeley Hospital with rare bacterial infections. Nearly thirty years later, a Senate subcommittee hearing revealed that the military deliberately released Serratia marcescens, a known opportunistic pathogen, from a naval ship in San Francisco Bay just days before the outbreak, which resulted in the death of Edward J. Nevin. Over the next twenty years, a court case and numerous investigations uncovered an alarming truth about the United States biological weapons (...) program. Government and military personnel have repeatedly and publicly defended the safety and ethics of the research program, insisting that the released substances were "harmless simulants", and that their activities did not qualify as human experimentation. These claims contradict not only official project reports, but the knowledge of civilian scientists and the experiences of the exposed populations, which document the widely ignored human dimensions of the project. (shrink)

This article draws on the antebellum political thought of Black abolitionists Frederick Douglass and Martin Delany in critically assessing the efficacy of reasonableness in advancing the aims of emancipatory politics in political discourse. I argue, through a reading of Douglass and Delany, that comporting oneself reasonably in the face of oppressive ideology can be counterproductive, if one’s aim is to undermine such ideology and the institutions it supports. Douglass and Delany, I argue, also provide us with a framework for evaluating (...) alternative discursive strategies we might wish to employ in light of the limited value of reasonableness for emancipatory politics. (shrink)

Upon separation of the protein from the nucleic acid component of tobacco mosaic virus by phenol, using a fast and gentle procedure, the nucleic acid is infective in assays on tobacco leaves. A series of qualitative and quantitative control experiments demonstrates that the biological activity cannot depend on residual proteins in the preparation, but is a property of isolated nucleic acid which is thus the genetic material of the virus.

We argue that social deliberation may increase an agent’s confidence and credence under certain circumstances. An agent considers a proposition H and assigns a probability to it. However, she is not fully confident that she herself is reliable in this assignment. She then endorses H during deliberation with another person, expecting him to raise serious objections. To her surprise, however, the other person does not raise any objections to H. How should her attitudes toward H change? It seems plausible that (...) she should increase the credence she assigns to H and, at the same time, increase the reliability she assigns to herself concerning H. A Bayesian model helps us to investigate under what conditions, if any, this is rational. (shrink)

Human infection challenge studies (HCS) involve intentionally infecting research participants with pathogens (or other micro-organisms). There have been recent calls for more HCS to be conducted in low-income and middle-income countries (LMICs), where many relevant diseases are endemic. HCS in general, and HCS in LMICs in particular, raise numerous ethical issues. This paper summarises the findings of a project that explored ethical and regulatory issues related to LMIC HCS via (i) a review of relevant literature and (ii) 45 qualitative (...) interviews with scientists and ethicists. Among other areas of consensus, we found that there was widespread agreement that LMIC HCS can be ethically acceptable, provided that they have a sound scientific rationale, are accepted by local communities and meet usual research ethics requirements. Unresolved issues include those related to (i) acceptable approaches to trade-offs between the scientific aim to produce generalisable results and the protection of participants, (iii) the sharing of benefits with LMIC populations, (iii) the acceptable limits to risks and burdens for participants, (iv) the potential for third-party risk and whether the degree of acceptable third-party risk is different in endemic settings, (v) the conditions under which (if any) it would be appropriate to recruit children for disease-causing HCS, (v) appropriate levels of payment to participants and (vi) appropriate governance of (LMIC) HCS. This paper provides preliminary analyses of these ethical considerations in order to (i) inform scientists and policymakers involved in the planning, conduct and/or governance of LMIC HCS and (ii) highlight areas warranting future research. Insofar as this article focuses on HCS in (endemic) settings where diseases are present and/or widespread, much of the analysis provided is relevant to HCS (in HICs or LMICs) involving pandemic diseases including COVID19. (shrink)

Most philosophers and psychologists assume that habitual acts do not ensue from deliberation, but are direct responses to the circumstances: habit essentially involves a variety of automaticity. My objective in this paper is to show that this view is unduly restrictive. A habit can explain an act in various ways. Pointing to the operation of automaticity is only one of them. I draw attention to the fact that acquired automaticity is one outgrowth of habituation that is relevant to explanation, but (...) not the only one. Habituation shapes our emotional and motivational make up in ways that affect deliberation itself. Hence mentioning a habit might be indispensable in explaining an act which nevertheless ensues from deliberation. The view that habitual acts are direct responses to the circumstances implies an impoverished conception of habit, which fails to do justice to its rich explanatory potential in theoretical and pre-theoretical contexts, as well as to its role in the history of philosophy. (shrink)

Majority cycling and related social choice paradoxes are often thought to threaten the meaningfulness of democracy. But deliberation can prevent majority cycles – not by inducing unanimity, which is unrealistic, but by bringing preferences closer to single-peakedness. We present the first empirical test of this hypothesis, using data from Deliberative Polls. Comparing preferences before and after deliberation, we find increases in proximity to single-peakedness. The increases are greater for lower versus higher salience issues and for individuals who seem to have (...) deliberated more versus less effectively. They are not merely a byproduct of increased substantive agreement. Our results both refine and support the idea that deliberation, by increasing proximity to single-peakedness, provides an escape from the problem of majority cycling. (shrink)

Moral deliberation has been receiving more attention in nursing ethics. Several ethical conversation models have been developed. This article explores the feasibility of the so-called CARE (Considerations, Actions, Reasons, Experiences) model as a framework for moral deliberation in psychiatric nursing practice. This model was used in combination with narrative and dialogical approaches to foster discourse between various stakeholders about coercion in a closed admission clinic in a mental hospital in the Netherlands. The findings demonstrate that the CARE model provides a (...) substantial framework for structuring moral deliberations. Narratives and dialogue are useful tools for broadening issues in conversations, to engage various stakeholders (including patients), and to gain shared understandings. (shrink)

Bohman develops a realistic model of deliberation by gradually introducing and analyzing the major tests facing deliberative democracy: cultural pluralism, social inequalities, social complexity, and community-wide biases and ideologies.

In normative political theory, it is widely accepted that democracy cannot be reduced to voting alone, but that it requires deliberation. In formal social choice theory, by contrast, the study of democracy has focused primarily on the aggregation of individual opinions into collective decisions, typically through voting. While the literature on deliberation has an optimistic flavour, the literature on social choice is more mixed. It is centred around several paradoxes and impossibility results identifying conflicts between different intuitively plausible desiderata. In (...) recent years, there has been a growing dialogue between the two literatures. This paper discusses the connections between them. Important insights are that (i) deliberation can complement aggregation and open up an escape route from some of its negative results; and (ii) the formal models of social choice theory can shed light on some aspects of deliberation, such as the nature of deliberation-induced opinion change. (shrink)

This article considers what can be learned regarding the ethical acceptability of intrusive interventions intended to halt the spread of infectious disease (‘Infection Control’ measures) from existing ethical discussion of intrusive interventions used to prevent criminal conduct (‘Crime Control’ measures). The main body of the article identifies and briefly describes six objections that have been advanced against Crime Control, and considers how these might apply to Infection Control. The final section then draws out some more general lessons from (...) the foregoing analysis for the ethical acceptability of different kinds of Infection Control. (shrink)

An additional compartment of vaccinated individuals is considered in a SIS stochastic epidemic model with infection reintroduction. The quantification of the spread of the disease is modeled by a continuous time Markov chain. A well-known measure of the initial transmission potential is the basic reproduction number $$R_0$$, which determines the herd immunity threshold or the critical proportion of immune individuals required to stop the spread of a disease when a vaccine offers a complete protection. Due to repeated contacts between (...) the typical infective and previously infected individuals, $$R_0$$ overestimates the average number of secondary infections and leads to, perhaps unnecessary, high immunization coverage. Assuming that the vaccine is imperfect, alternative measures to $$R_0$$ are defined in order to study the influence of the initial coverage and vaccine efficacy on the transmission of the epidemic. (shrink)

Deliberation has faced criticism with regard to its application to business, on the basis that it can be misused to disseminate an ideology, divert attention from genuine debates, or strengthen the power of certain people. We suggest that Aristotle’s notion of deliberation can mitigate these ethical risks and help companies strengthen their deliberative practices. A comprehensive perspective based on Aristotelian deliberation reveals the relevance of (a) individual and collective deliberation, promoting a virtuous and meaningful reflection, free from ideological conditioning; (b) (...) deliberation on ends and means that facilitates a transcendental and rooted reflection, thereby avoiding artificial debates; and (c) deliberation that is decisive and cooperative and thus prevents instrumentalization of deliberation by the strongest. We contribute to the discussion of the relationship between business and society by identifying the different steps in the deliberative process and promoting a dynamic perspective on deliberation. (shrink)

Organismic agency is often understood as the capacity to produce goal-directed behavior. This paper proposes a new way of modelling agency, namely as a naturalized deliberation. Deliberative action is not directed towards a particular goal, but involves a process of weighing multiple goals and a choice for a particular combination of these. The underlying causal model is symmetry breaking, where the organism breaks symmetries present in the selective environment. Deliberation is illustrated though the phenomena of mate choice and bacterial chemotaxis.

Deliberation incompatibilism is the view that an agent being rational and deliberating about which of (mutually excluding) actions to perform, is incompatible with her believing that there exist prior conditions that render impossible the performance of either one of these actions. However, the main argument for this view, associated most prominently with Peter van Inwagen, appears to have been widely rejected by contemporary authors on free will. In this paper I argue first that a closer examination of van Inwagen's argument (...) shows that the standard objections are based on a misunderstanding of the notion of ‘deliberation’ presupposed in this argument. Second, I attempt to strengthen the case for deliberation incompatibilism by offering a different argument in its support. (shrink)

Suppose an inquiring group wants to let a certain view stand as the group's view. But there’s a problem: the individuals in that group do not initially all agree with one another about what the correct view is. What should the group do, given that it wants to settle on a single answer, in the face of this kind of intragroup disagreement? Should the group members deliberate and exchange evidence and then take a vote? Or, given the well-known ways (...) that evidence exchange can go wrong, e.g., by exacerbating pre-existing biases, compromising the independence of individual judgments, etc., should the group simply take a vote without deliberating at all? While this question has multiple dimensions to it—including ethical and political dimensions—we approach the question through an epistemological lens. In particular, we investigate to what extent it is epistemically advantageous and disadvantageous that groups whose members disagree over some issue use deliberation in comparison to voting as a way to reach collective agreements. Extant approaches in the literature to this ‘deliberation versus voting’ comparison typically assume there is some univocal answer as to which group strategy is best, epistemically. We think this assumption is mistaken. We approach the deliberation versus voting question from a pluralist perspective, in that we hold that a group’s collective endeavor to solve an internal dispute can be aimed at different, albeit not necessarily incompatible, epistemic goals, namely the goals of truth, evidence, understanding, and epistemic justice. Different answers to our guiding question, we show, correspond with different epistemic goals. We conclude by exploring several ways to mitigate the potential epistemic disadvantages of solving intragroup disagreement by means of deliberation in relation to each epistemic goal. (shrink)