In the twenty-first century, 70.6 percent of Americans self-identify as Christians,1 58 percent of them still segregate themselves by race on Sunday mornings, and white Protestants make up the majority of this 58 percent.2 These facts belie the claim, popularized after Barack Obama's 2008 presidential election, that America is living in a postracial society3 And yet, the role played by religion in white people's lived experiences of race, racism, and white class privilege in the United States tends to be neglected (...) by philosophers and religious studies scholars, except perhaps when considering white supremacist groups such as the Ku Klux Klan.4 Contemporary philosophy is secular in a way that generally excludes and... (shrink)

René Girard stands as one of the most fascinating figures in the study of violence and religion. As a thinker, theorist, and theologian, his contribution to literary and cultural theory is indicative of his profound ability to see beyond societal phenomena into the very mechanizations of human existence. Historians, economists, philosophers, psychologists, and even neuroscientists have followed Girard's lead and stepped into the waters of mimetic theory in order to surf the waves of such concepts as desire, imitation, and violence. (...) Yet amid the number of articles, monographs, and anthologies produced by Girard and his colleagues in the Academy, only a few scholars have struck out further into the open seas of... (shrink)

Previous research has suggested that individuals who identify as being more religious request more aggressive medical treatment at end of life. These requests may generate disagreement over life-sustaining treatment (LST). Outside of anecdotal observation, however, the actual role of religion in conflict over LST has been underexplored. Because ethics committees are often consulted to help mediate these conflicts, the ethics consultation experience provides a unique context in which to investigate this question. The purpose of this paper was to examine the (...) ways religion was present in cases involving conflict around LST. Using medical records from ethics consultation cases for conflict over LST in one large academic medical centre, we found that religion can be central to conflict over LST but was also present in two additional ways through (1) religious coping, including a belief in miracles and support from a higher power, and (2) chaplaincy visits. In-hospital mortality was not different between patients with religiously versus non-religiously centred conflict. In our retrospective cohort study, religion played a variety of roles and did not lead to increased treatment intensity or prolong time to death. Ethics consultants and healthcare professionals involved in these cases should be cognisant of the complex ways that religion can manifest in conflict over LST. (shrink)

While a significant literature has appeared discussing theoretical ethical concerns regarding COVID-19, particularly regarding resource prioritization, as well as a number of personal reflections on providing patient care during the early stages of the pandemic, systematic analysis of the actual ethical issues involving patient care during this time is limited. This single-center retrospective cohort mixed methods study of ethics consultations during the first surge of the COVID 19 pandemic in Massachusetts between March 15, 2020 through June 15, 2020 aim to (...) fill this gap. Results indicate that there was no significant difference in the median number of monthly consultation cases during the first COVID-19 surge compared to the same period the year prior and that the characteristics of the ethics consults during the COVID-19 surge and same period the year prior were also similar. Through inductive analysis, we identified four themes related to ethics consults during the first COVID-19 surge including (1) prognostic difficulty for COVID-19 positive patients, (2) challenges related to visitor restrictions, (3) end of life scenarios, and (4) family members who were also positive for COVID-19. Cases were complex and often aligned with multiple themes. These patient case-related sources of ethical issues were managed against the backdrop of intense systemic ethical issues and a near lockdown of daily life. Healthcare ethics consultants can learn from this experience to enhance training to be ready for future disasters. (shrink)

The COVID‐19 pandemic has placed extraordinary stress on frontline healthcare providers as they encounter significant challenges and risks while caring for patients at the bedside. This study used qualitative research methods to explore nurses and respiratory therapists' experiences providing direct care to COVID‐19 patients during the first surge of the pandemic at a large academic medical center in the Northeastern United States. The purpose of this study was to explore their experiences as related to changes in staffing models and to (...) consider needs for additional support. Twenty semi‐structured interviews were conducted with sixteen nurses and four respiratory therapists via Zoom or by telephone. Interviews were transcribed verbatim, identifiers were removed, and data was coded and analyzed thematically. Five major themes characterize providers' experiences: a fear of the unknown, concerns about infection, perceived professional unpreparedness, isolation and alienation, and inescapable stress and distress. This manuscript analyzes the relationship between these themes and the concept of moral distress and finds that some, but not all, of the challenges that providers faced during this time align with previous definitions of the concept. This points to the possibility of broadening the conceptual parameters of moral distress to account for providers' experiences of treating patients with novel illnesses while encountering institutional and clinical challenges. (shrink)

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

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

We describe the structure, operation, and experience of the Massachusetts General Hospital ethics committee, formally called the Edwin H. Cassem Optimum Care Committee, from January 2007 through December 2013. Founded in 1974 as one of the nation’s first hospital ethics committees, this committee has primarily focused on the optimum use of life-sustaining treatments. We outline specific sociodemographic and clinical characteristics of consult patients during this period, demographic differences between the adult inpatient population and patients for whom the ethics committee was (...) consulted, and salient features of the consults themselves. We include three case studies that illustrate important consult themes during this period. Our findings expand knowledge about the structure and workings of hospital ethics committees and illustrate how one ethics committee has developed and utilized policies on end-of-life care. More generally, we model a sociological approach to the study of clinical ethics consultation that could be utilized to contextualize institutional practices over time. (shrink)

In this paper we give a positive answer to Julia Robinson's question whether the definability of + and · from S and ∣ that she proved in the case of positive integers is extendible to arbitrary integers (cf. [JR, p. 102]).

This book presents a comprehensive examination of Gottfried Leibniz's views on the nature of agents and their actions. Julia Jorati offers a fresh look at controversial topics including Leibniz's doctrines of teleology, the causation of spontaneous changes within substances, divine concurrence, freedom, and contingency, and also discusses widely neglected issues such as his theories of moral responsibility, control, attributability, and compulsion. Rather than focusing exclusively on human agency, she explores the activities of non-rational substances and the differences between distinctive (...) types of actions, showing how the will, appetitions, and teleology are key to Leibniz's discussions of agency. Her book reveals that Leibniz has a nuanced and compelling philosophy of action which has relevance for present-day discussions of agency. It will be of interest to scholars and students of early modern philosophy as well as to metaphysicians and philosophers of action. (shrink)

Twenty-five years after her death, we are still coming to terms with the controversial figure of Hannah Arendt. Interlacing the life and work of this seminal twentieth-century philosopher, Julia Kristeva provides us with an elegant, sophisticated biography brimming with historical and philosophical insight. Centering on the theme of female genius, _Hannah Arendt_ emphasizes three features of the philosopher's work. First, by exploring Arendt's critique of Saint Augustine and her biographical essay on Rahel Varnhagen, Kristeva accentuates Arendt's commitment to recounting (...) lives and narration. Second, Kristeva reflects on Arendt's perspective on Judaism, anti-Semitism, and the "banality of evil." Finally, the biography assesses Arendt's intellectual journey, placing her enthusiasm for observing both social phenomena and political events in the context of her personal life. Drawing on fragments of Arendt's most intimate correspondence with her longtime lover Martin Heidegger and her husband Heinrich Blucher, excerpts from her mother's "Unser Kind" (a diary tracking Hannah's formative years), and passages from Arendt's philosophical writings, Kristeva presents a luminous story. With a thorough thematic index and bibliographical references, _Hannah Arendt_ is a major breakthrough in the understanding of an essential thinker. (shrink)

Although the focus of "Globalizing Democracy and Human Rights" is practical, Gould does not shy away from hard theoretical questions, such as the relentless debate over cultural relativism, and the relationship between terrorism and democracy.

Published in 1982 by CUP (pb. 2009) it discusses the forms of materialism then current, including Davidson, early Rorty, but concentrating on Smart and Armstrong, and arguing that central state materialism fails to give a better 'occurrent' account of conscious states than does behaviourism/functionalism, as Armstrong claims. The book starts with a version of the 'knowledge argument' and ends with a chapter claiming that our conception of matter/the physical is more problematic than our conception of mind.

ABSTRACT:Determining the biological function of phenomenal consciousness appears necessary to explain its origin: evolution by natural selection operates on organisms’ traits based on the biological functions they fulfill. But identifying the function of phenomenal consciousness has proven difficult. Some have proposed that the function of phenomenal consciousness is to facilitate mental processes such as reasoning or learning. But mental processes such as reasoning and learning seem to be possible in the absence of phenomenal consciousness. It is difficult to pinpoint in (...) what way phenomenal consciousness enhances these processes or others like them. In this paper, we explore a possibility that has been neglected to date. Perhaps phenomenal consciousness has no function of its own because it is either a by-product of other traits or a (functionless) accident. If so, then phenomenal consciousness has an evolutionary explanation even though it fulfills no biological function. (shrink)

Silent thinking is often accompanied by subvocal sayings to ourselves, imagery, emotional feelings, and non-sensory experiences such as familiarity, rightness, and confidence that we can go on in certain ways. Phenomenological materials of these kinds, along with our dispositions to give explanations or draw inferences, provide resources that are sufficient to account for our knowledge of what we think, desire, and so on. We do not need to suppose that there is a distinctive, non-imagistic 'what it is like' to think (...) that p, and a different non-imagistic 'what it is like' to think that q. Nor need we suppose that there is a proprietary 'what it is like' to have one propositional attitude type rather than another. (shrink)

Linguist, psychoanalyst, and cultural theorist, Julia Kristeva is one of the most influential and prolific thinkers of our time. Her writings have broken new ground in the study of the self, the mind, and the ways in which we communicate through language. Her work is unique in that it skillfully brings together psychoanalytic theory and clinical practice, literature, linguistics, and philosophy. In her latest book on the powers and limits of psychoanalysis, Kristeva focuses on an intriguing new dilemma. Freud (...) and psychoanalysis taught us that rebellion is what guarantees our independence and our creative abilities. But in our contemporary "entertainment" culture, is rebellion still a viable option? Is it still possible to build and embrace a counterculture? For whom--and against what--and under what forms? Kristeva illustrates the advances and impasses of rebel culture through the experiences of three twentieth-century writers: the existentialist John Paul Sartre, the surrealist Louis Aragon, and the theorist Roland Barthes. For Kristeva the rebellions championed by these figures--especially the political and seemingly dogmatic political commitments of Aragon and Sartre--strike the post-Cold War reader with a mixture of fascination and rejection. These theorists, according to Kristeva, are involved in a revolution against accepted notions of identity--of one's relation to others. Kristeva places their accomplishments in the context of other revolutionary movements in art, literature, and politics. The book also offers an illuminating discussion of Freud's groundbreaking work on rebellion, focusing on the symbolic function of patricide in his _Totem and Taboo_ and discussing his often neglected vision of language, and underscoring its complex connection to the revolutionary drive. (shrink)

Silent thinking is often accompanied by subvocal sayings to ourselves, imagery, emotional feelings, and non-sensory experiences such as familiarity, rightness, and confidence that we can go on in certain ways. Phenomenological materials of these kinds, along with our dispositions to give explanations or draw inferences, provide resources that are sufficient to account for our knowledge of what we think, desire, and so on. We do not need to suppose that there is a distinctive, non-imagistic ‘what it is like’ to think (...) that p, and a different non-imagistic ‘what it is like’ to think that q. Nor need we suppose that there is a proprietary ‘what it is like’ to have one propositional attitude type rather than another. (shrink)