In lieu of an abstract, here is a brief excerpt of the content:Operating Through HatredAndrew G. Shuman“You’re not cutting my ***ing neck. The cancer is in my ***ing mouth.”While many patient encounters are memorable, Mr. K’s introduction to the head and [End Page 20] neck surgical oncology clinic is indelibly imprinted into the minds of all of the clinicians present on that certain autumn morning. This was, quite simply, a man who resonated hate. He was rude and disruptive. He (...) insisted on an expedited workup “without any waiting.” He questioned the ethnicity and nationality of his care providers. He told me, in no uncertain terms, that he did not appreciate my Jewish heritage—the swastika tattooed on his bicep underscored the point. He bragged about his recent incarceration for armed robbery. While my colleagues and I were tempted to simply refuse to assume his care, Mr. K had a bad problem—his recurrent tongue cancer required a major operation in order to offer him any hope for cure.Mr. K initially received an abbreviated course of radiation at an outside institution, which was limited by his non–compliance. While one might debate the wisdom of this decision in retrospect—in general, surgery is preferred for his type of tumor—the die was already cast. A heroic attempt at surgical salvage was now his only curative option. He previously sought care elsewhere... only to be fired by this original surgeon when Mr. K physically threatened him in the outpatient office during preoperative consultation. [It was the doctor’s fault for insulting him in the first place, Mr. K maintained... and no charges were filed.] We were, indeed, his last resort. Other than his recurrent cancer, Mr. K was robust; he was in his sixth decade, physically fit, and on the whole, fairly healthy. In the classic surgical lexicon, he was a reasonable surgical candidate. But was it reasonable to operate on such a person?I remember thinking, at the time, about our obligation to care for such an individual. Of course, being a medical professional carries with it many obligations, including a judicious assumption of personal risk. And, working in a tertiary care center begets the responsibility to assist referring clinicians in the management of difficult cases. Although professional obligations certainly have their limits, defining their bounds is decidedly more difficult. Paramount is creating an atmosphere of mutual trust and acceptance. Naturally, this was easier said than done in regard to Mr. K.Perhaps against our better judgment, we agreed to operate under the condition that he abide by strict behavioral ground rules, on our terms. We agreed upon the extent of the necessary operation (which indeed involved cutting his ***ing neck, much to his chagrin and reluctant acceptance). Mr. K promised to follow instructions for postoperative care. He assured us that he would not swear or yell (again). And, in the presence of hospital security, who reinforced our institutional policies regarding patient behavior, he guaranteed that he would not be verbally or physically violent or inappropriate, and would not make disparaging comments to other patients or staff. It seemed, at least, that we had an understanding.Needless to say, these rules were broken shortly after he awoke from surgery. I vividly remember being summoned from the OR when he threatened to murder his impressionable and terrified nurse a few days later, who would not acquiesce to his unreasonable demands. From that point onward, hospital security was deployed to his room regularly, and anything resembling a potential weapon was safeguarded. Any semblance of a mutual doctor–patient bond was shattered. At this point, everyone’s goal was simply to get Mr. K home.My visceral reactions to his behavior, while intense, were not unexpected, and fell in line with those of the entire team of clinicians caring for him. His antics brought his healthcare team together in collective unity (and condemnation). However, my surgical colleagues and I also felt somewhat guilty and responsible. While surgeons can choose to assume some degree of inherent personal danger in caring for a violent and angry patient, we also put the safety and soundness of the entire perioperative team in jeopardy, without necessarily seeking their input. But once we had decided to... (shrink)

A thirty-year-old single mother with recurrent, metastatic, treatment-refractory cancer presents to the emergency room with severe difficulty breathing due to an obstructive tumor in her neck, compounded by progressive disease in her lungs and a new pulmonary embolism. She cannot be safely intubated and would require an emergent awake tracheotomy. Even if the airway can be successfully secured surgically, the likelihood that she will be able to be weaned from mechanical ventilation is very low. The surgeon, a young mother too, (...) appreciates the patient's desire for more time with her toddler. But the surgeon knows the significant risk of surgery, the massive responsibility she would accept in trying to get the patient through it, and the emotional toll of an intraoperative death on surgical staff. And she can imagine the second-guessing that will come during the inevitable morbidity and mortality conference if the patient should die in the perioperative window. Yet the surgeon does not want to take the “easy” way out; after all, critically ill patients undergo aggressive resuscitation all the time. What should she do? (shrink)

Suzie loves to talk. A successful mid-thirties businesswoman, she is a self-described social butterfly—which made her diagnosis of tongue cancer even more devastating. She came to the clinic complaining of a lump in her throat, which in most young healthy people turns out to be benign and easily treated. But not for Suzie, who had a very rare salivary tumor arising in the back of her tongue. Its slow growth was both a blessing and a curse; such tumors do not (...) kill people quickly, but they typically require surgery. It would slowly and relentlessly grow until and unless we removed most of her tongue. In head and neck surgery, issues of appearance, identity, function, and communication are the foremost considerations when we decide when, and whether, to operate. As the adage goes, knowing when not to operate is the sine qua non of the wise surgeon. But the inverse is also true. (shrink)

Volume 20, Issue 3, March 2020, Page 35-37.

IntroductionDespite the need for trained physician ethicists, fellowships in clinical ethics are limited and primarily offered to thosewho have completed a graduate degree. The standardization of credentialing for clinical ethics consultants (CECs) and the restructuring of undergraduate medical education allow innovative models to train CECs that can provide an expanded opportunity for formal ethics training at an earlier stage.MethodsAt the University of Michigan Medical School we developed, implemented, and evaluated a pre-doctoral clinical ethics fellowship program from 2017 to 2019 for (...) senior medical students, designed to meet established competencies for CECs. Consultation notes from the beginning and end of the fellowship program were randomly selected for each fellow and independently rated by two faculty ethicists who used the validated Ethics Consultation Quality Assessment Tool (ECQAT).1 Inter rater reliability and trends in scores over time were calculated.ResultsThree students successfully completed the fellowship at the University of Michigan Medical School, conducted at least 50 formal ethics consultations, and spent approximately 40 hours a week on service for a minimum of six months. All students finished the fellowship with teaching and policy development experience, first-authored peer-reviewed manuscripts, and national presentations. The fellows demonstrated improvement in their ECQAT overall holistic rating score; all ended their fellowship with a holistic score of adequate or above. There was 92 percent agreement between raters withrespect to the acceptability of the fellows’ ethics consult notes. Two fellows have taken and passed the Healthcare Ethics Consultant-Certification (HEC-C) exam offered by the American Society for Bioethics and Humanities (ASBH).ConclusionsIntegration of a pre-doctoral fellowship model that meets professional certification standards for clinical ethics consultation creates an opportunity for medical students to become trained CECs early in their career. (shrink)

Volume 20, Issue 7, July 2020, Page 77-80.

Volume 20, Issue 9, September 2020, Page 18-20.

The U.S. federal government provides two tracks for eligible patients to obtain access outside clinical trials to investigational interventions currently under study for potential clinical benefits: the Food and Drug Administration’s expanded access pathway and the pathway created by the more recent Right to Try Act. In this issue of the Hastings Center Report, with a critical focus on patients, industry, and the research enterprise, Kelly Folkers and colleagues frame the inherent challenges that these pathways are meant to solve and (...) have also inadvertently created. But an additional key focus is how the relevant situations should be managed at the bedside and how the system risks both inefficient and inequitable access to options at the institutional level. Although either pathway could be helpful to patients, the challenges of having the pathways coexist are greater than the sum of their parts. Individual clinicians represent the front line of the regulatory and eligibility challenges of expanded access and right to try, making clinical education a critical component of a comprehensive approach to using them well. But it is medical institutions that must take the lead on supporting access to investigational options in the most equitable and effective manner possible. (shrink)

Advance care planning allows patients to articulate preferences for their medical treatment, lifestyle, and surrogate decision-makers in order to anticipate and mitigate their potential loss of decision-making capacity. Written advance directives are often emphasized in this regard. While these directives contain important information, there are several barriers to consider: veracity and accuracy of surrogate decision-makers in making choices consistent with the substituted judgement standard, state-to-state variability in regulations, literacy issues, lack of access to legal resources, lack of understanding of medical (...) options, and cultural disparities. Given these issues, it is vital to increase the use of patient and healthcare provider conversations as an advance care planning tool and to increase integration of such discourse into advance care planning policy as adjuncts and complements to written advance directives. This paper reviews current legislation about written advance directives and dissects how documentation of spoken interactions might be integrated and considered. We discuss specific institutional policy changes required to facilitate implementation. Finally, we explore the ethical issues surrounding the increased usage and recognition of clinician–patient conversations in advance care planning. (shrink)

The attempt to arrive at some consensus on precisely what qualifies a human as a person represents one of the more persistently debated and widely significant issues in modern biomedical ethics. The attribution of personhood has been and continues to be a powerful tool in moral discourse. Biomedical and bioethical debates about personhood seem especially morally significant in late modernity given the recent trends in biomedical technology. Our attempts to formally articulate universally agreed upon criteria for personhood represent some of (...) the last vestiges of the hope that we can achieve substantial moral agreement in an otherwise morally fragmented world. In this essay, we argue that, from the perspective of certain strands of the Christian tradition, all bioethics grounded in attempts to develop formal, objective criteria by which we may designate a given individual a person are misguided. Criteria centering on the possession of reflective mental capacity, moreover, are for Christians especially problematic. We suggest that there are no morally neutral ways of designating personhood. (shrink)

Malebranche's Theodicy ANDREW G. BLACK LEIBNIZ'S SOLUTION tO the problem of evil, his theodicy, might be regarded as a paradigm of philosophical theology. Its pattern, as with so much of Leibniz's philosophy, is reconciliation of deep metaphysical truth with recalcitrant ap- pearance. Thus, a theodicy is not just any solution to the problem; strictly speaking it is a vindication of divine providence in the face of the challenge posed by apparent imperfections of all kinds in creation.' The preeminence of (...) Leibniz's theodicy as a modern solution to the problem of evil has helped to obscure distinguished contributions from among his contemporaries. Not least among these is that made by Nicolas Malebranche, a philosopher having much in common with Leibniz . ~ Malebranche shows a deep concern for the problem of evil throughout his philosophical writings, though nowhere more so than in his Treatise on Nature and Grace, a a book written in response to the Jansenist4 challenge to orthodox In addition to an entire and substantial book, the Theodicy , a number of Leibniz's essays contain versions of his theodicy. See, for example, articles 1- 7 of the Discourse on Metaphysics; also "A Vindication of God's Justice Reconciled with his.. (shrink)

This article documents the main developments in the textual history of a short polemical treatise ascribed to Aḥmad Ibn Ḥanbal, al-Radd ʿalā al-zanādiqa wa-l-jahmiyya. In particular, I show that three different, if related, recensions of the text exist in manuscript. Then, drawing on evidence from the text and biobibliographical sources, I show that al-Radd only emerged over several centuries. The idea for the text finds its roots in the earlist elaborations of Hanbali theology, perhaps even in the notebooks of Ibn (...) Ḥanbal himself. The first recension of the text, however, only emerged after the mid-fourth/tenth century in Baghdad. Another recension appears at the beginning of the sixth/twelfth century, perhaps also in Baghdad. These recensions were combined to form a third recension no later than the eighth/fourteenth century, and it is the third recension that became the basis for most print editions of the work. (shrink)

Name der Zeitschrift: Klio Jahrgang: 97 Heft: 1 Seiten: 157-175.

In lieu of an abstract, here is a brief excerpt of the content:Social and Moral Aspects of the WarBertrand Russell and Introduced by Andrew G. BoneAmong nine loose-leaf folders of typed transcriptions of Russell's History of Western Philosophy lectures at the Barnes Foundation1 are two copies of a fourteen-page stenographic record of a political talk he gave there on 2 March 1941.2 The bulk of this significant new accrual to the Russell Archives, bearing as it does on Russell's most (...) successful philosophical work, could stimulate much further research and textual study. But his isolated Barnes lecture, about the politics of American neutrality, Nazi Germany's brutal and expansionist dictatorship, and the causes and possible consequences of the war against it, is also of considerable interest.The transcription reads more like detailed notes than a verbatim account, and there is no evidence that Russell approved this text.3 The stenographer initially recorded Russell in the third person, dispensed with this device before the second [End Page 52] paragraph, but then occasionally returned to it.4 There is also more enumeration of Russell's points than he would have supplied in a prepared script. Even the title may not be his: there is nothing in the text on any social changes wrought by the war. But this title has been retained in the absence of a more plausible alternative in a short report of the speech (quoting sixteen sentences) in the next day's Philadelphia Evening Bulletin.5 Russell's hour-long address on the "Social and Moral Aspects of the War" appears to have been the only occasion when he "laid philosophy aside"6 at the Barnes Foundation. It was delivered on a Sunday to an audience of 160 students (and possibly some invitees, although none are mentioned in the newspaper article), sandwiched between two of his weekly philosophical lectures (on Socrates and Sparta7) in the series scheduled for each Thursday.In opening his case for the United States joining the Allied war effort, Russell challenged the arguments for the "policy of conciliation" which, by his own recent admission in the New York Times,8 he had earlier endorsed. Published two weeks before Russell spoke on a similar topic at the Barnes Foundation, this 2,000-word letter to the editor served as a very detailed and public renunciation of the pacifist viewpoint—neutrality for national governments combined with non-resistance for individuals—which Russell had promoted in Which Way to Peace? (1936) and continued to condone after the Munich Agreement (September 1938) and even the dismemberment of Czechoslovakia (March 1939).Yet Russell the "relative political pacifist"9 also admitted in this most programmatic statement of his prewar position that "In other times and other circumstances, I should be prepared to consider gains and losses, and to concede that war might be worth while" (WWP, pp. 151–2).That moment had obviously arrived and may have done so already when on 15 October 1939 Russell confided to Constance Malleson that his passionate desire for a British victory made a "thorough-going pacifism difficult" (ra Rec. Acq. 596). But six months later he still did "not feel sufficiently sure of the opposite to say anything publicly by way of recantation"—before adding in this letter to Gilbert Murray that "it may come to that" (21 April 1940, ra Rec. Acq. 71g). It clearly did shortly afterwards—when the "phoney war" in Western Europe was dramatically ended by the invasion of France and the [End Page 53] Low Countries. On 13 May Russell asked the editor of the New Statesman and Nation to notify its readers that he had abandoned his once strongly held pacifist convictions.10In his lecture to the Barnes Foundation, Russell turned next to the defence of American non-intervention by Robert M. Hutchins (see n. 16 below)—which he had already critiqued in the New York Times. Although rather precariously situated as a resident alien in the United States, Russell was hardly circumspect about pushing a policy that so sharply divided American opinion.11 He also listed the faults of the League of Nations and the most grievous diplomatic mistakes made since the end of the last war and the fatally... (shrink)

Abstract:This paper examines the historiographic controversies and disagreements surrounding the figure of Septimius Severus and highlighted by Herodian in his Roman History as a means of investigating the development of history writing during and in the aftermath of that emperor's reign. Herodian cites Severus' transition to power and reign as a locus for historical and historiographical controversy and debate, and a comparison of Herodian with other Severan writers allows for an examination of Herodian's competitive relationship with his older historiographic peers (...) and of the innovative aspects of his work that set it apart from others. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Social and Moral Aspects of the WarBertrand Russell and Introduced by Andrew G. BoneAmong nine loose-leaf folders of typed transcriptions of Russell's History of Western Philosophy lectures at the Barnes Foundation1 are two copies of a fourteen-page stenographic record of a political talk he gave there on 2 March 1941.2 The bulk of this significant new accrual to the Russell Archives, bearing as it does on Russell's most (...) successful philosophical work, could stimulate much further research and textual study. But his isolated Barnes lecture, about the politics of American neutrality, Nazi Germany's brutal and expansionist dictatorship, and the causes and possible consequences of the war against it, is also of considerable interest.The transcription reads more like detailed notes than a verbatim account, and there is no evidence that Russell approved this text.3 The stenographer initially recorded Russell in the third person, dispensed with this device before the second [End Page 52] paragraph, but then occasionally returned to it.4 There is also more enumeration of Russell's points than he would have supplied in a prepared script. Even the title may not be his: there is nothing in the text on any social changes wrought by the war. But this title has been retained in the absence of a more plausible alternative in a short report of the speech (quoting sixteen sentences) in the next day's Philadelphia Evening Bulletin.5 Russell's hour-long address on the "Social and Moral Aspects of the War" appears to have been the only occasion when he "laid philosophy aside"6 at the Barnes Foundation. It was delivered on a Sunday to an audience of 160 students (and possibly some invitees, although none are mentioned in the newspaper article), sandwiched between two of his weekly philosophical lectures (on Socrates and Sparta7) in the series scheduled for each Thursday.In opening his case for the United States joining the Allied war effort, Russell challenged the arguments for the "policy of conciliation" which, by his own recent admission in the New York Times,8 he had earlier endorsed. Published two weeks before Russell spoke on a similar topic at the Barnes Foundation, this 2,000-word letter to the editor served as a very detailed and public renunciation of the pacifist viewpoint—neutrality for national governments combined with non-resistance for individuals—which Russell had promoted in Which Way to Peace? (1936) and continued to condone after the Munich Agreement (September 1938) and even the dismemberment of Czechoslovakia (March 1939).Yet Russell the "relative political pacifist"9 also admitted in this most programmatic statement of his prewar position that "In other times and other circumstances, I should be prepared to consider gains and losses, and to concede that war might be worth while" (WWP, pp. 151–2).That moment had obviously arrived and may have done so already when on 15 October 1939 Russell confided to Constance Malleson that his passionate desire for a British victory made a "thorough-going pacifism difficult" (ra Rec. Acq. 596). But six months later he still did "not feel sufficiently sure of the opposite to say anything publicly by way of recantation"—before adding in this letter to Gilbert Murray that "it may come to that" (21 April 1940, ra Rec. Acq. 71g). It clearly did shortly afterwards—when the "phoney war" in Western Europe was dramatically ended by the invasion of France and the [End Page 53] Low Countries. On 13 May Russell asked the editor of the New Statesman and Nation to notify its readers that he had abandoned his once strongly held pacifist convictions.10In his lecture to the Barnes Foundation, Russell turned next to the defence of American non-intervention by Robert M. Hutchins (see n. 16 below)—which he had already critiqued in the New York Times. Although rather precariously situated as a resident alien in the United States, Russell was hardly circumspect about pushing a policy that so sharply divided American opinion.11 He also listed the faults of the League of Nations and the most grievous diplomatic mistakes made since the end of the last war and the fatally... (shrink)

A number of aphorisms in Plutarch’s Laconian Apophthegms contain a similar verbal formulation indicating death in battle. This formulation can be traced back to Thucydides, and was likely descriptive of expected Spartan behavior from the time of Thermopylae. Its employment in the Apophthegms, masking personal and civic shortcomings, reveals both an insistence on maintaining this behavioral directive and the social anxiety surrounding its maintenance.

As he neared 80 Russell was more financially secure than he had been for decades. But to remain so he needed to maintain his prodigious output as a writer, broadcaster and lecturer (see Papers 26, forthcoming). Meanwhile, the breakdown of his third marriage threatened to undermine his much-improved financial position. The monetary concerns addressed in both the text prepared by Russell and the related commentary hint at a lifetime’s scrupulous regard for his personal finances.

Jean-Numa Ducange’s recent work, La Révolution française et la social-démocratie. Transmissions et usages politiques de l’histoire en Allemagne et Autriche 1889–1934, provides an ambitious and theoretically-sophisticated analysis of the ways in which German and Austrian socialists interpreted the French Revolution from 1889 to the 1930s. Ducange shows how the different strands of Second International socialism interpreted the revolution in their own ways, and shows the impact of the Russian revolutions of 1905 and 1917 on this. His work does not only (...) focus on leading theoreticians such as Karl Kautsky, but also documents very effectively the way in which the readings of the French Revolution were disseminated widely through Social Democracy’s rank-and-file membership. It is a valuable contribution to the literature on the culture of Marxism in Central Europe in this period, as well as a rich addition to the literature on the resonance and uses of the French Revolution: the ‘echoes of the Marseillaise’. (shrink)

At the height of the Sino-Indian border dispute in 1962, Bertrand Russell, as “a lifetime friend of India” (_Unarmed Victory_, p. 88), appealed to Prime Minister Nehru for peace. Yet for the first 75 years of Russell’s life, India had not been an independent, developing state whose non-aligned diplomacy he could (usually) admire, but rather an economically and stra­tegically vital part of the British Empire. Thus Russell’s fraternal bond with India was formed during its protracted struggle against British rule. The (...) central purpose of this article is to reconstruct Russell’s occasionally contorted connection with that historic contest, and it will do so by drawing on a wealth of neglected textual material. More than simply fleshing out a significant but overlooked chapter in Russell’s political life, this assessment of his decades-long association, as participant and observer, with the campaign for Indian independence also strives to capture the complex essence of his thinking on questions of empire generally. (shrink)

At the height of the Sino-Indian border dispute in 1962, Bertrand Russell, as “a lifetime friend of India” (Unarmed Victory, p. 88), appealed to Prime Minister Nehru for peace. Yet for the first 75 years of Russell’s life, India had not been an independent, developing state whose non-aligned diplomacy he could (usually) admire, but rather an economically and stra­tegically vital part of the British Empire. Thus Russell’s fraternal bond with India was formed during its protracted struggle against British rule. The (...) central purpose of this article is to reconstruct Russell’s occasionally contorted connection with that historic contest, and it will do so by drawing on a wealth of neglected textual material. More than simply fleshing out a significant but overlooked chapter in Russell’s political life, this assessment of his decades-long association, as participant and observer, with the campaign for Indian independence also strives to capture the complex essence of his thinking on questions of empire generally. (shrink)

The Soviet Union's successful test of an atomic bomb in 1949 altered Russell's outlook on international politics. But there was a considerable delay between this critical juncture of the Cold War and any perceptible softening of Russell's anti-Communism. Even after a muted optimism about the possibility of improvement in the foreign and domestic policies of the Soviet Union entered Russell's writing, he remained apprehensive about campaigning for peace alongside western Communists and fellow-travellers. He disliked the central thrust of pro-Soviet peace (...) propaganda but regarded ideological diversity as a vital prerequisite for meaningful peace work. Russell also understood that such an approach carried with it a risk that his efforts might be tarnished by association with the Communist-aligned peace movement. His dilemma was eased not by a shift in his own tactics, but by external factors: a crisis within western Communism and the emergence of broadly based movements for peace that could not easily be tainted by their critics as "pro-Soviet". (shrink)

During the First World War Russell frequently complained about unwarranted encroachments by the wartime state on the sphere of individual freedom. He experienced such encroachments very directly. The Defence of the Realm Act (dora) was the legal instrument through which most official reprisals were visited on him—punitive meas­ures arising from his dogged support for conscientious objectors and a negotiated peace. Under this emergency legislation he was twice convicted and had his freedom of movement curbed. This harsh treatment is well known, (...) but the literature on Russell has not yet systematically examined his relationship with this “other DORA”. Using the Russell Archives, his Collected Papers, and government records in the UK’s National Archives, this paper seeks to establish the legal, administrative and political contexts in which he was prosecuted and sanctioned extra-judicially, and where he sometimes benefitted from DORA’s formidable powers being set aside. (shrink)

Charlotte Perkins Gilman was a prominent and effective figure for social change in her prime, yet, despite her prodigious literary output, she had little direct influence on the generations immediately following her. Even before her death, all of her works were out of print. She has been the subject of increasingly widespread attention since her rediscovery, yet, although she was a stalwart advocate for women's rights, many of Gilman's views make hers a problematic revival. That Gilman has a place in (...) the history of feminism is undeniable, but how to situate her, and especially Herland, in relation to contemporary feminist thought remains a matter of debate. Feminist scholars have long been engaged in the question... (shrink)