In his story entitled "Toenails," the surgeon Richard Selzer (1982) warns readers that total immersion in medicine is wrongheaded. Rather, to ensure their own health, doctors should discover other passions that permit them periodically to disconnect from medical practice. Selzer's surgeon character devotes his Wednesday afternoons to the public library, where he joins "a subculture of elderly men and women who gather … to read or sleep beneath the world's newspapers" (p. 69). Among these often eccentric personages is Neckerchief, an (...) arthritic man in his 80s who suffers from severe foot pain. His toenails, never trimmed because of his inability to reach them, have grown so long that they curve beneath his toes and .. (shrink)

Poems and Commentaries by Amit Majmudar, Kelly Sievers, Bonnie Salomon, David Watts, Paul Boor, and Beth Lown.Jack Coulehan, Editor.

Ten years ago there was little talk about adding “professionalism” to the medical curriculum. Educators seemed to believe that professionalism was like the studs of a building—the occupants assume them to be present, supporting and defining the space in which they live or work, but no one talks much about them. Similarly, educators assumed that professional values would just “happen,” as trainees spent years working with mentors and role models, as had presumably been the case in the past. To continue (...) the metaphor, when educators did discuss ethics and values, they tended to focus more on external building codes than on the nature of construction materials. Building codes are designed to ensure the public's safety by establishing procedures and standards. Likewise, the “new” bioethics of autonomy and informed consent that entered the medical curriculum in the 1970s and 1980s was oriented primarily toward protecting human rights by codification. In fact, educators explicitly warned students against acting on their personal or professional values in a misguided way—that is, in the absence of adequate ethical constraints, a type of behavior that came to be labeled, pejoratively, as paternalism. (shrink)

Hope helps alleviate suffering. In the case of terminal illness, recent experience in palliative medicine has taught physicians that hope is durable and often thrives even in the face of imminent death. In this article, I examine the perspectives of philosophers, theologians, psychologists, clinicians, neuroscientists, and poets, and provide a series of observations, connections, and gestures about hope, particularly about what I call “deep hope.” I end with some proposals about how such hope can be sustained and enhanced at the (...) end of life. Studies of terminally ill patients have revealed clusters of personal and situational factors associated with enhancement or suppression of hope at the end of life. Interpersonal connectedness, attainable goals, spiritual beliefs and practices, personal attributes of determination, courage, and serenity, lightheartedness, uplifting memories, and affirmation of personal worth enhance hope, while uncontrollable pain and discomfort, abandonment and isolation, and devaluation of personhood suppress hope. I suggest that most of these factors can be modulated by good medical care, utilizing basic interpersonal techniques that demonstrate kindness, humanity, and respect. (shrink)

Robert Coles' sentiment characterizes well the moral tenor of medical education today. Indeed, medical educators are frequently “seized by spasms of genuine moral awareness,” as they try to cope with the massive social and economic problems that face medical schools and teaching hospitals. The perception among educators that we currently fail to adequately teach several core aspects of doctoring, including professional values and behavior, constitutes one such spasm. In this case, the proposed remedy has generated considerable enthusiasm, but whether the (...) “core competencies” curriculum will make a difference, or simply “accommodate to the prevailing rhythms of the world we inhabit,” remains to be seen. (shrink)

This paper argues that evidential decision theory is incompatible with options having objective values. If options have objective values, then it should always be rationally permissible for an agent to choose an option if they are certain that the option uniquely maximizes objective value. But, as we show, if options have objective values and evidential decision theory is true, then it is not always rationally permissible for an agent to choose an option if they are certain that the option uniquely (...) maximizes objective value. (shrink)

These essays in aesthetics by the philosopher Ernst Bloch belong to the tradition of cultural criticism represented by Georg Lukács, Theodor Adorno, and Walter Benjamin. Bloch's fascination with art as a reflection of both social realities and human dreams is evident in them. Whether he is discussing architecture or detective novels, the theme that drives the work is always the same - the striving for "something better," for a "homeland" that is more socially aware, more humane, more just.The book opens (...) with an illuminating discussion between Bloch and Adorno on the meaning of utopia; then follow 12 essays written between 1930 and 1973, on topics as diverse as aesthetic theory, genres such as music, painting, theater, film, opera, poetry, and the novel, and perhaps most important, popular culture in the form of fairy tales, detective stories, and dime novels.Ernst Bloch was a profoundly original and unorthodox philosopher, social theorist, and cultural critic. The MIT Press has previously published his Natural Law and Human Dignity and his magnum opus, The Principle of Hope. The Utopian Function of Art and Literature is included in the series Studies in Contemporary German Social Thought, edited by Thomas McCarthy. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Why Fantasy Matters Too MuchJack Zipes (bio)In September 1997 a fairy-tale princess and a holy saint, Princess Diana and Mother Teresa, died within a few days of each other. Millions of people openly and dramatically expressed their grief and mourning. Their pictures along with many different images of Diana and Mother Teresa were beamed all over the world through television and the Internet. The mass media carried all sorts (...) of stories and acclaimed the two of them as the fairy-tale princess and the saint, so that little was left to the imagination. Fantastic spectacle was all that mattered.We speculate with the fantastic. Fantasy is a celebrity and money-making machine. As a module in our brains, it has the capacity to transform plain junk into gold that glitters. Fantasy mobilizes and instrumentalizes the fantastic to form and celebrate spectacles that exist and have always existed—illusions of social relations of exploitation based on power. Spectacles violate and drain our imaginations by glorifying social relations of power that are made spectacular and involve the magic of fetishism. Generally, the results bring about delusion and acclamation of particular sets of social relations that are commodified, sold, and consumed. We acclaim commodities that we don’t know, products that are not of our own making and that we consume mentally and physically. We reproduce images consciously and unconsciously that are not of our own making. The media and the corporate world occupy our psyches and manipulate our fantasies even when we [End Page 77] dream. Our relations are mediated through fantastic spectacle and through fetish abetted by the latest technology that connects us to each other while also disconnecting us from our minds and feelings. Simultaneously, we seek to project our desires in the form of fantasies onto reality and endeavor to occupy a space in which our most profound wishes and desires can be realized. We seek cognition and recognition. In each instance—in the tension between corporate determination of the fantastic and individual projection of desire—we seem to anchor our understanding of reality in artworks dependent on the fantastic, such as the Bible and fairy tales. Hence, Mother Teresa the saint. Diana the fairy-tale princess.It is through fantasy that we have always sought to make sense of the world, not through reason. Reason matters, but fantasy matters more. Perhaps it has mattered too much, and our reliance on fantasy may wear thin and betray us even while it nourishes us and gives us hope that the world can be a better place. We have imagined gods, the kingdom of a single god, the miraculous feats of divine and semidivine characters, and the commandments that have been established to lead us to the good life, if not paradise. It is through the fictive projections of our imaginations based on personal experience that we have sought to grasp, explain, alter, and comment on reality. This is again why such staples as the Bible and the Grimms fairy tales have become canonical texts: unlike reality, they allegedly open the mysteries of life and reveal ways in which we can maintain ourselves and our integrity in a conflict-ridden world. They compensate for the constant violation of nature and life itself and for the everyday violation of our lives engendered through spectacle. They contest reality and also become conflated with reality.But our fantasy and the fantasies that we conceive have become desperate because they are outstripped by real existing conditions that instrumentalize them at every waking second of our day, and even when we slumber. It is a commonplace today that fiction, especially science fiction and what we label fantasy in the world of art, cannot keep pace with the devastating and disturbing fantastic of real occurrences, or what I call the incredible credibility of the real. When the normal is so fantastically abnormal, what role can fantastic artworks play in our lives? Is the violence that we encounter in our everyday lives so much more fantastic than in literature, film, and the arts that we seek to consume the fantastic like harmless junk food as quick fixes and consolation? Can our joys really and realistically... (shrink)

Economists have always recognised that human endeavours are constrained by our limited and uncertain knowledge, but only recently has an accepted theory of uncertainty and information evolved. This theory has turned out to have surprisingly practical applications: for example in analysing stock market returns, in evaluating accident prevention measures, and in assessing patent and copyright laws. This book presents these intellectual advances in readable form for the first time. It unifies many important but partial results into a satisfying single picture, (...) making it clear how the economics of uncertainty and information generalises and extends standard economic analysis. Part One of the volume covers the economics of uncertainty: how each person adapts to a given fixed state of knowledge by making an optimal choice among the immediate 'terminal' actions available. These choices in turn determine the overall market equilibrium reflecting the social distribution of risk bearing. In Part Two, covering the economics of information, the state of knowledge is no longer held fixed. Instead, individuals can to a greater or lesser extent overcome their ignorance by 'informational' actions. The text also addresses at appropriate points many specific topics such as insurance, the Capital Asset Pricing model, auctions, deterrence of entry, and research and invention. (shrink)

The process of dehumanization, or thinking of others as less than human, is a phenomenon with significant societal implications. According to Haslam's model, two concepts of humanness derive from comparing humans with either animals or machines: individuals may be dehumanized by likening them to either animals or machines, or humanized by emphasizing differences from animals or machines. Recent work in cognitive neuroscience emphasizes understanding cognitive processes in terms of interactions between distributed cortical networks. It has been found that reasoning about (...) internal mental states is associated with activation of the default mode network and deactivation of the task positive network ; whereas reasoning about mechanical processes produces the opposite pattern. We conducted two neuroimaging studies. The first examined the neural bases of dehumanization and its relation to these two brain networks, using images and voice-over social narratives which either implicitly contrasted or implicitly likened humans to either animals or machines. The second study addressed a discrepancy between findings from the first study and prior work on the neural correlates of dehumanization: using a design similar to prior work we examined neural responses to pictures of humans, animals and machines, presented without any social context. In both studies, human and humanizing conditions were associated with relatively high activity in the DMN and relatively low activity in the TPN. However, the non-human and dehumanizing conditions deviated in different ways: they demonstrated more marked changes either in the DMN or in the TPN. Notably, differences between the animal dehumanizing and humanizing conditions were most evident in regions associated with mechanistic reasoning, not in the mentalizing network. Conjunction analysis of contrasts from both paradigms revealed that only one region was consistently more active when participants saw human, a medial parietal region regarded as the central hub of the DMN. These findings provide a neural basis for Haslam's distinction between two types of dehumanization, and suggest that the DMN and TPN play opposing roles in creating a sense of moral concern. (shrink)

This essay, and the special issue it introduces, sets out to reignite ethical interrogations of the theory and practice of Human Resource Management (HRM). To cultivate greater levels of boundary-spanning debate about the ethics of HRM, we develop a framework of four tenors for scholarly work: the ethical-declarative, the ethical-subjunctive, the ethical-ethnographic, the ethical-systemic. Each of these tenors denotes particular grounds for ethical critique and encourages scholars to consider the subjects and objects of their enquiry, the disciplinary scope of their (...) work and the limits to subsequent claims about ethics and HRM. We provisionally locate each of the papers comprising the special issue with regard to one, or more, of these tenors. (shrink)

The existence and unity of a discipline called economics reside in the eye and mind of the beholder. The perception of economics's unity and disciplinarity itself arises in some, but not all, of the different schools of thought that we would loosely categorize as economic. Indeed, as we hope to show, the presumption of unity and disciplinarity—the idea that there is a center or “core” of propositions, procedures, and conclusions or a shared historical “object” of theory and practice—is suggested in (...) the concepts and methods of some schools of economic thought, but is opposed by others. Further, we argue that the portrayal of economics as a discipline with distinct boundaries is often a discursive strategy by one school or another to hegemonize the field of economic discourse. In this way, the issue of the existence of an economics discipline and its principles of unity or dispersion is in part a political question. Its effects are felt in the hiring and firing of economics professors and practitioners, the determination of what comprises an economics curriculum, the determination of what is a legitimate economic argument and what is not, the dispensation of public and private grant monies, and the differential entry into or exclusion from ideological, political, and economic centers of power and decision making.Our view is that no discipline of economics exists. Or, rather, no unified discipline exists. The “discipline” of economics is actually an agonistic and shifting field of fundamentally different and often conflicting discourses. The dispersion and divisions that exist between the schools of thought we discuss here as “economic” may have some regularities. But we do not see closer contiguity of these economic schools when placed on a horizontal scale than, to take just one example, among all of the many different "disciplinary" forms of Marxian thought. That is, in our view, Marxian economic thought shares more concepts, approaches, and methods—may have more discursive regularity—with Marxian literary theory than do Marxian economic thought and neoclassical economic theory. Jack Amariglio is associate professor of economics at Merrimack College and the editor of Rethinking Marxism: A Journal of Economics, Culture, and Society. He is working on a book entitled Modernism and Postmodernism in Economics with Arjo Klamer. Stephen Resnick and Richard Wolff are professors of economics at the University of Massachusetts, Amherst. Their recent coauthored books are Knowledge and Class: A Marxian Critique of Political Economy and Economics: Marxian versus Neoclassical. (shrink)

In “The Bioethics of Environmental Injustice: Ethical, Legal, and Clinical Implications of Unhealthy Environments,” Keisha Ray and Jane Fallis Cooper argue that one aspect of environmental health h...