In lieu of an abstract, here is a brief excerpt of the content:Surprised DivideAnonymous OneAnonymous OneNot long after our daughter was born, my wife and I were expecting a son. We were busy new parents, so her pregnancy with our second child went by quickly and without a lot of the fuss that a first pregnancy brings. To our surprise, our son was born a few weeks early but aside from a little jaundice he was a happy, healthy baby.My parents (...) were caring for our daughter while we were at the hospital. After my son's birth, we were excited for them to bring our daughter up to the hospital to visit her new baby brother. The hospital photographer came by and took photos of our two kids together and photos of our son swaddled and sleeping soundly in a basket. Other family members stopped by to meet the new baby as well. It was a happy time.Little did we know that a couple of hours later we would be faced with a communication breakdown. My wife and I usually pride ourselves on how well we are able to communicate and plan our future.I grew up heavily Catholic, attending parochial schools through high school graduation. Meanwhile, my wife's family are Unitarian Universalists. You could not have two more polar opposite religions! We are used to having different points of view. We have always talked through many of life's choices and have both had to make compromises in order to have a successful relationship. It was on that happy day of my son's birth that we discovered we forgot to discuss one important topic.As our family was gathered in my wife's hospital room, joyfully celebrating the newest addition, the doctor entered the room to check on my wife and said it was time to do the circumcision if we wanted.Without hesitation, I responded in the affirmative, then the doctor and I looked over at my wife, who was staring at us with saddened, conflicted eyes. I was confused. Didn't she want the same thing for our son that I did? Surprisingly we never discussed this decision, at least not that I remember. I don't recall her ever telling me she was against it.My wife stated that she wasn't prepared to make a decision because she didn't know what our son would want and she was worried about him experiencing pain. She worked hard for 9 months to grow this baby boy, and he was so little. I understood her anguish in the thought of letting someone alter his tiny body.I am circumcised myself. My background provided me guidance and an expectation that this would be happening, so it was a nonissue for me. I never considered a scenario in which my son would not be circumcised. In truth, it felt ridiculous to even contemplate not circumcising him. My words of reassurance that it would be fine and my explanation to my wife that this was just one of the many decisions we would need to make for him and our other child did little to settle her.It was clear that no one (including me) had discussed this with my wife prior to this point, which was unfortunate. The doctor described the process and tried to reassure my wife that it was a safe and minor procedure. This still left my wife in a conflicted state. The other men in my family there visiting at the time chimed in to reassure my wife that this is what our son would want. She reluctantly agreed to the circumcision, giving in to peer pressure I suppose. I'm confident that an alliance of circumcised men telling her that our son would also want to be circumcised is what swayed her. Frankly, I'm glad they happened to be there when the doctor stopped by to help back up my position.But while our son was out of the room undergoing his procedure, my wife remained conflicted and saddened. We were both surprised at each other's response. My opinion on this was coming from the position of expectation and tradition, while she was worried about not knowing... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Parenting Children With Autism Spectrum Disorders Through the Transition to AdulthoodAnonymous One, Anonymous Two, Lorri Centineo, Anonymous Three, Virginia Clapp, Catherine Cornell, Nancy Coughlin, David McDonald, Mark Osteen, Laura Shumaker, Julie Van der Poel, Anonymous FourMy Son's Life with Autistic Spectrum DisorderAnonymous OneThis is the story of how my son, David, has tried to become independent. David is now 25–years–old. His immediate family is his dad, (...) a brother (age 22) and myself (his mother). He was diagnosed with an autism spectrum disorder (ASD) when he was 13. We looked up all the information and decided not to make a big deal of it. Looking back, he displayed all the classic signs of a high functioning autistic disorder. Would he have been diagnosed with the new DSM 5 guidelines? He probably would have. His life would be much, much different if he had been diagnosed at an early age.I'll start with David at age 13 when he was able to harness his big interest in computer science into a career for himself. He was expelled from middle school for threatening some kid that had been picking on him all year. He had a meltdown and wasn't able to communicate his side of the story and that was it.During the summer of that year he took classes in computer engineering (Microsoft) and became an engineer when he was 13. At that time it was quite an accomplishment because he was the youngest person in the United States to do so at such a young age. (By the way, the administration of the school that expelled him sent him a congratulatory card when he was written up in the paper).His father and uncle are in business running a computer company so David had a ready–made job waiting for him when he graduated from high school and was able to keep it during difficult times. David finished high school (mainstreamed special education as emotionally disturbed) and he also received another engineering certification (Cisco).I have to mention here that I truly did not understand what it was like for my son until one day when he was in high school, as I was lecturing him again for some stupid reason, he said, "You don't know how hard it is for me to not sit in a corner and rock every day." Think about that. ASD individuals get up and keep going every day when they know they are going to be misunderstood and picked on. They all deserve a medal for bravery.David became really upset that he had never had a date and that girls were not even interested in talking to him. He started cutting himself and shaving his head. That got him some attention from the stoner group. He had someone to sit with at lunch anyhow. Parents, I think it's better to have no friends than the wrong friends. They introduced him to drugs.We did not mention any trouble David was having to any relatives. We had lived 800 miles from our families in a very unspoiled part of northern America. In hindsight this was not good either. [End Page 151]Another thing, and I think every parent will agree with this—teachers, school staff, health care industry staff, doctors and every one that comes into contact with an ASD individual—take the time to get to know them. It may be difficult and some may appear non–caring and rude. You must overlook this and look to the person underneath. They are great people. They have been through stuff and it means so much to them. Like I said—parents, you know this. Please remember it when times get tough.During David's senior year he started work release so he could start earning money to buy a car and move out as soon as he turned 18. Things were made easy for David since the company was owned by his father and his uncle and I worked there also. David enjoyed the work but had the occasional meltdown and had difficulties fitting in with other employees. He wasn't able to communicate... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:My Story:Evolving ObesitiesAnonymous OneI am a 66–year–old Caucasian woman. I have always had, either in perception or fact, a “weight problem.” In my childhood and early teens when my weight was within the normal range, I felt fat and was always trying to lose weight. After gaining weight in college, I had a weight problem in body as well as mind. Weight concerns have consumed much of my energy (...) over the years. I have spent most of my life evolving toward a healthy way to manage my weight.Act 1: Obesity as MetaphorI can’t remember ever not feeling fat. Growing up I felt humiliated and shamed by my body, even though I was not overweight, just bigger than my peers, with a pear shape and heavy legs, thighs, and ankles. In high school my BMI, although not used at the time as a measuring tool, was 22.8. Yet despite these facts, I was made to feel fat.In my family being overweight was tantamount to sin. My father and sister were tall and skinny; my mother was petite and shapely. I took after another genetic code—the dumpy ones with knocked knees—the grotesque branch of the family tree. Hand–me–downs from my sister were supposed to fit me, but we were too different, and the difference was not celebrated.Other things were at play, a perfect storm of conditions that contributed to my feelings of worthlessness. I really shouldn’t have been born. The earth should have opened up and swallowed me. Of course I was not conscious of reasons for these feelings at the time. That awareness came later. But these feelings of loss, grief, terror, and terrible wrongness were the context of my struggles over the years.I developed a pattern of binge eating, which satisfied two contradictory impulses: my need to nurture myself combined with my desire to punish myself. The intensity of a binge–eating episode was also an avenue for rage. I was young so the extra calories didn’t result in weight gain, but the behavior had begun to take root.Stepping on the scale was like the final judgment. The scale did not measure weight; it measured value. I would see the number, as would the person weighing me, and my failure, as a person, would be evident. My secret shame would become public. I would be declared guilty for the worthless grub that was me.Nothing else mattered: that I was an A student; that I was kind and compassionate; that I had friends. These facts had no bearing. All that counted was the number on the scale. That number sent a shudder of condemnation down to my very soul. That number threatened to hurl me into a bottomless abyss from which I could not escape.I avoided being weighed. I was a very obedient youth, with an exaggerated respect for authority drilled into me by my father. The one time I ever cut class was in high school. I skipped health class where I had heard we would be weighed.The situations when I could not avoid being weighed confirmed my worst fears. Before one gym class we were publicly weighed in [End Page 96] assembly–line fashion. As I stepped off the scale my gym teacher yelled out “Diet” for all to hear. Doctors who knew nothing about me, to whom I had been sent for various required physicals, told me to lose weight.In the mysterious and internally logical way that the mind works, my weight became a metaphor for all that was reprehensible in me. With no comprehension of why I was so unhappy, it was easy for me to fixate on my weight. It was too horrible to contemplate that I was the problem. The problem with me was my size, my body.As I look back now, I am angry that because of its shape, this perfectly wonderful body was judged as wrong, and that there was no compassionate voice loud enough to contradict this message. But at the time I felt no anger. To feel anger over being made to feel bad requires self–respect... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Second GuessingAnonymous OneThis is difficult for me to write because I have tremendous respect for every doctor that has been involved in my son’s care. I firmly believe that they chose and administered the highest level of care that they assessed as appropriate; that they cared for him both personally and professionally as if he were their own child; and that he was in the care of acknowledged giants (...) in their fields. I write this knowing that I will share this narrative with these doctors, in order that they can better understand the decisions I was faced with and the guilt I must live with feeling that I may not have made the best possible informed choice for my son, because of this trust and relationship.Let me describe my oncologist. I say “my” instead of my son’s whose doctor he really is, because he is mine too in every sense of the word. He cares passionately about his work and about my son specifically; he engenders my trust because he is compassionate, brilliant, and available to me for concerns both great and small. His accomplishments have saved lives and will continue to impact his field. He became the narrow bridge I walk, that is the only thing between me and dangerous water and rocks waiting below; the balancing bar on the tightrope that is the only thing that stands to keep me from falling into the abyss and breaking my neck. And this made it difficult for me to disagree with him and seek a second opinion. Because his unspoken words were, “Don’t you trust me that I will do the best for your child?” and I could not answer then what I would answer now, “Nobody is infallible and sometimes we may miss something that someone else can see despite how much we know or care.”It is ironic, I think, that sometimes a layperson, because of her limited knowledge, can see more clearly where a professional may not.My son was diagnosed at age six with Grade II ependymoma in 2006. He was treated with surgery, a complete resection, and then 33 rounds of conformal radiation. He recurred in 2012, and was diagnosed with anaplastic ependymoma Grade III. He had another surgery, with the same surgeons, who pronounced it another successful total resection. This is where my story begins.The MRI taken the next day showed a sliver of something there. My oncologist, much sought after for his diagnostic abilities in reading MRI’s showed slight concern that it may be residual tumor, but both the surgeons and the MRI report came back negative, identifying the sliver as inflammation. Six [End Page 9] weeks later, 3 days before we were scheduled to leave out of town to receive proton beam radiation, I insisted on another MRI. The sliver was enlarged from the post–op MRI. My oncologist said it was tumor; one surgeon said it was inflammation and the other surgeon abstained from speculation. The MRI report stated it appeared to be recurrent tumor.Now here was my dilemma as a parent. The prognosis today of radiation on residual tumor for ependymomas is very bad, especially with a residual tumor of his size. On the other hand, my oncologist felt that going in for surgery with no guarantee of a total resection anyway, was incurring a risk of damage to my child that may impact severely on his quality of life.My oncologist felt that for many medical reasons, inherent risks of surgery, uncertainty about status of the scan reading, quality versus quantity of life, and—I think—an understandably pessimistic view of the possibility of cure for recurrent anaplastic grade III ependymoma, he was against another surgery, and opted to continue with radiation with the tumor as is.I am part of two support groups on line, one for parents of children with any type of brain tumor and the other specific for ependymoma parents. The clinical and anecdotal knowledge of these groups as a whole is phenomenal because, unfortunately, we have parents who have experienced and researched almost everything about this illness, in all its stages. When I was faced... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:What Power Do I Have? A Nursing Student’s Concerns Lead to a Passion for EthicsAnonymous OneThe day began like many in our ten–week rotation, around the large table in the brightly lit ICCU nurses’ station. Report, which was given by the night charge nurse, included information on all the patients on the unit. Since I had cared for A. G. the previous day, I was eager to know how (...) she had spent the night. She had a debilitating neuro–muscular disease known as myasthenia gravis. Placed on the ventilator days before, it was reported that she was likely to be dependent on the machine for life. In the late 1970’s there were very few facilities that accepted ventilator dependent patients. She might be with us for a long time.When I entered her room for the first time, I saw a frail older woman with kind eyes and a warm smile. She was breathing with the help of the ventilator through her tracheostomy tube. I learned through her chart that she had no known family. On the day I took care of her, no one came to see her and she had no visitors the previous evening. She lived in a local long–term care facility and was brought to the hospital after she developed respiratory distress. A. G. was unable to move in the bed due to her condition and required frequent suctioning along with turning and repositioning for comfort.Despite her weakness, A. G. was able to communicate silently by mouthing the words for what she wanted and by nodding and shaking her head. I found her to be quite skilled in non–verbal [End Page 93] communication since it took minimal effort to understand what she wanted, but the activity tired her easily. I had just completed A. G.’s morning care when her physician came in to examine her. After completing his assessment, he stopped and leaned in closely to speak with her. He began asking a number of questions about whether she wanted to spend the rest of her life in this way, on a ventilator. She shook her head. Continuing the line of questioning in different ways, she responded to him. I wondered why he was asking these questions. After seeing her response, the physician asked me to get 30 mg of morphine from the narcotics cabinet. Although I didn’t understand the implication of the request, I complied.While I was retrieving the medication from the narcotics cabinet, the charge nurse came to tell me I was being reassigned to a new admission. When I asked why, she told me she couldn’t discuss it, but asked me to please do what she said. I left her standing there, wondering what was going on. After assisting with the new admission, I went back to see A.G.; her door was closed. When I opened the door, the ventilator tubing hung over the side of the machine. Looking down at the bed, I was shocked to find A.G. had been disconnected. She was dead. In a state of disbelief and panic, I sought out the charge nurse to find out what happened. It was clear that I was not to know. I asked her a number of questions but she adeptly changed the subject and redirected me to other activities. By then it was lunchtime and my instructor had left the unit. I asked to be excused and went to seek her out.When I told my instructor what happened, a look of doubt came over her face. “You think Doctor M. killed your patient? That would never happen.” Although I tried to tell her the story, she too, dismissed me, telling me my story didn’t make sense. I was distraught. An overwhelming sense of dread came over me and I began to cry. She encouraged me to go home, which I did.Happily, I had the weekend to recover before returning to clinical. I never found out what happened to A. G. and neither my instructor nor the charge nurse ever spoke to me about my experience. In fact, it seemed no one believed my story... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Narrative SymposiumPersonal Narratives Experiences of Psychiatric HospitalizationV. Barnard, J. Carson, Eugene Doe, Robin Driben, Anonymous One, Anonymous Two, Charles Kelley, Michael Kerins, D. Millman, Anonymous Three, Viesia Novosielski, Ben Zion, and Anonymous Four• Dreaming: A Recovery Story• The Intervention of the Demon• Bent but Not Broken• Tortured Souls Do Not Rest• Homesick• A Professional Patient No More• My Spiritual Journey• Personal Account of Psychiatric Hospitalization• (...) Psychiatric Hospitalization Story• As Ice Is to Water• The Power Of Human-To-Human Contact• Dignity• HospitalizationCopyright © 2011 The Johns Hopkins University Press... (shrink)

Now in a fully corrected edition, one of the true spiritual classics of the twentieth century. Published for the first time with an index and Cardinal Hans Urs von Balthasar’s afterword, this new English publication of Meditations on the Tarot is the landmark edition of one of the most important works of esoteric Christianity. Written anonymously and published posthumously, as was the author’s wish, the intention of this work is for the reader to find a relationship with the author in (...) the spiritual dimensions of existence. The author wanted not to be thought of as a personality who lived from 1900 to 1973, but as a friend who is communicating with us from beyond the boundaries of ordinary life. Using the 22 major arcana of the tarot deck as a means to explore some of humanity’s most penetrating spiritual questions, Meditations on the Tarot has attracted an unprecedented range of praise from across the spiritual spectrum. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Narrative SymposiumPersonal Narratives Experiences of Psychiatric HospitalizationV. Barnard, J. Carson, Eugene Doe, Robin Driben, Anonymous One, Anonymous Two, Charles Kelley, Michael Kerins, D. Millman, Anonymous Three, Viesia Novosielski, Ben Zion, and Anonymous Four• Dreaming: A Recovery Story• The Intervention of the Demon• Bent but Not Broken• Tortured Souls Do Not Rest• Homesick• A Professional Patient No More• My Spiritual Journey• Personal Account of Psychiatric Hospitalization• (...) Psychiatric Hospitalization Story• As Ice Is to Water• The Power Of Human-To-Human Contact• Dignity• HospitalizationCopyright © 2011 The Johns Hopkins University Press... (shrink)

This book is a collection of riddles in Arabic divided into two main sections, one part on spiritual themes, the other on morals. The book was intended to develop the mind and character of young people.

In lieu of an abstract, here is a brief excerpt of the content:Not the End We Planned ForAnonymous FourIn 1997, my four–year–old daughter was diagnosed with a high–risk medulablastoma. She underwent the current treatment program at that time. She suffered multiple complications from the treatment and developed seizures, which caused her to lose her sight and 80% of her hearing. These all contributed to her manifesting many behavioral issues, making her a danger to herself and others. Also during this time, (...) she developed large amounts of brain atrophy from the maximum radiation dose she had been given. In August of 2010, Emily was still deteriorating, her seizures were uncontrollable, and her quality of life was extremely poor. A meeting to discuss how to care for my child if an acute crisis presented was held. The meeting included her parents, oncologist, endocrinologist, pediatric neurologist, social worker and the head of medical ethics. We discussed what course of action would be best for her nothing could be done to reverse her condition or prevent further deterioration. A POLST is a physician order for life sustaining treatment and is appropriate if the doctor feel that the patient has a good chance of death in the next year. The purpose of this document is to have a plan in place in case the patient has a life threatening crises. We chose to put a POLST in place with specific instructions not to intubate. This was a hard decision to make for a parent, but we all felt it was the best choice for her.A few months after the POLST was entered, in November, 2010, I came home from the store and my daughter’s caregivers told me she had complained of a headache different from her usual headaches. They gave her Tylenol with codeine and she went to bed about 4 p.m. When I checked her later she seemed fi ne, merely sleeping her headache off. We [End Page 30] decided to let her sleep some more. Around 8 p.m the caregivers came and got me because they could not wake her up to go to the bathroom, which was her normal routine. I immediately went to try and wake her up but could not. I ran my thumb up the bottom of her foot and there was no reflex response. I yelled for her father that we needed to immediately go to the hospital.We took her to the ER at the local hospital that treated her close to the house. We told them we did know what was happening with her but that there was a POLST in place in her chart. They started lines, a nasogastric tube, and sent her for a CT, which showed massive amounts of blood in her brain. I repeated again to the ER staff and physician that there was a POLST in place but no one acknowledged my statement. I asked for a different physician, one that would respect the POLST, and was told there was no one else nor was there a neurosurgeon available. The attending physician insisted she be intubated in order to be transferred to a partner hospital (more than 20 minutes away) where there was a neurosurgeon on duty. I asked him to please call her oncologist at which point he yelled at me that, “he was not calling anyone else and that she needed to be intubated and transferred to the other hospital.” By this time, four hours had passed and I knew she had not gotten any medication for pain, so I told the physician to go ahead and transfer her since I knew the hospital we were at would not admit her for palliative care. She was then intubated, in violation of the POLST, and transferred to the other hospital where the neurosurgeon there told us what we already feared: That she had experienced a massive bleed in her brain. We requested she be extubated and be given palliative care to make her comfortable until she passed away.It is tragic that our daughter’s last hours involved aggressive medical treatment. As parents we hoped to avoid any additional suffering for our child, we did everything we knew to do to insure aggressive... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Down the Medical Rabbit HoleAnonymous ThreeEditors’ Note: This woman’s child was treated for an astrocytoma at 8–years–old. The surgery included tumor resection and placement of a ventricular peritoneal shunt, which manages the flow, drainage and pressure of cerebral spinal fluid (CSF ) throughout the brain and spinal column.Am I aliveWhat’s this pain I feelAching insideMaking me kneelDown to the groundSubmissiveLike I’ve been sentTo Hell–AnonymousI am making a time capsule (...) of words. If I don’t write these words now, how will I remember? It is for her. She will need these words to know who she is.They took her at the lowest point, when she was barfing and admitting she needed to be in the emergency room (ER). And they stripped her of the ability to use her words to defend herself.“There’s really no reason for you to be here. The x–ray of your shunt tubing looks fine. The CT of your head looks fine. You should think about going home.” I start to speak, but she is speaking so I wait to hear what she will say.“I was worried since my side hurts so bad that maybe it was my appendix and I didn’t want it to burst and then have the infection go up my shunt, I know someone that that happened to, and then my head was exploding and I threw–up.”“That’s when we have to come in to the ER “ I say. “We’ve done this before. We wait until the last possible moment before coming. You’ve seen us here for almost 12 hours now, but we waited more than 24 hours before coming and she was just like this the whole time.”“One of the only things we can see that might be wrong is that we think she might be constipated.”“I try to stay on top of it, ”My 20-year-old says. “I’ve been taking more pain killers lately because my head is always killing me and I push myself to make it to class. But I take stuff to make it easier for me so I don’t get constipated. Last Wednesday during class my head was exploding and I had to vomit. I don’t think my shunt is broken. But...”I interrupt, which is my job, because they are not hearing her, still she gives me hated looks, “She spends two days in bed laying basically flat so she can spend one day or even a few hours vertical the next day. This has been progressing for a while. Last May she had surgery for a CSF leak in her spine. But the headaches are different this time.”“We really think you should consider going home, the tests we’ve done look good.”This is the part that always happens, the part where I say you go into the twilight zone or down Alice’s rabbit hole. In May I had to demand that she have the right to sit up, pain free in the hospital for two hours before leaving. And that is how they admitted her, Mother wants her to sit upright.Here we are again 15 days before Christmas back in the ER—they, meaning the white coats, disbelieving us.She broke then, like a piece of a falling statue, an arm or a leg or part of a shoulder busting off. “I can’t go on like this, my head is exploding and I push myself so hard just to walk across campus [End Page 18] and when I’m sitting in class I know I shouldn’t be there, it’s just so hard. I had a surgery in April last year to replace my shunt and I never really bounced back, and then they found the cyst in my back and the leak and after that surgery I just couldn’t get any energy and my head still hurt.”They don’t know that she never tells anyone any of this.“I know you don’t see anything on her scans,” I say. They always look fine... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Difficult Road to Deciding on CircumcisionAnonymous TwoAnonymous TwoWhen I got my results back from my noninvasive prenatal testing, NIPT and found out I was going to have a little boy, one of my first thoughts was, "I don't want to circumcise him," which sounds silly because I just found out the gender of my baby and my first thought is about his genitalia. The idea of growing and (...) carrying this perfect little baby for nine months and then hurting him was unthinkable to me. I simply did not want to hurt him. The idea of it made me feel sick. Anytime the subject came up, I would protectively put my hand over my belly. And I do admit there were a lot of times I wished I was having a girl so I didn't have to deal with the circumcision debate.There was a lot of conversation between myself and my husband about it. My husband was adamant about getting it done. He referred to uncircumcised penises as "snake penises" and said our son will be made fun of for being different. He said it would be easier for him to clean and when he's old, he won't have to worry about infection. I would counter with, "well what if he falls in love with a girl from a culture that doesn't circumcise? She will think his penis is weird." The more we talked about it, the more ridiculous it felt thinking that far in advance and all these hypothetical situations he might get in over his penis. My parents wanted it done for religious reasons, but that wasn't a factor for me. My mom kept saying it's in the Bible and it needs to be done. My boss is Jewish and she joked that I could just convert to Judaism and the choice would be taken away from me so I didn't have to stress over it. Everything I read on my mommy groups and sites like Reddit called male circumcision child abuse and stated how barbaric it was. Terms like "genital mutilation" were thrown around a lot, and I didn't want to be part of a group that was seemingly looked down upon by so many.I spent my whole pregnancy saying how much I did not want to circumcise my baby. About a week after he was born and we were starting to get settled, my husband started to call around trying to get him an appointment for circumcision. It was unusual to do it this way, as typically it's done when babies are still in the hospital. But the hospital wasn't doing circumcisions because it was elective, and they weren't doing elective procedures because of COVID. At his first doctor's appointment, I talked to our pediatrician about it. She is Indian and told me she didn't circumcise her boys and said that it was very normal in many parts of the world to not do it. I would watch her pull back the skin to check it for fibers and think, "Is it really that bad to keep it? It's just skin." Our pediatrician didn't do it, as she doesn't perform procedures in the office, and she gave us some names of doctors that were supposed to be doing it. My husband called them all and none of them were doing circumcisions either. Finally, my husband found a doctor, but he was booked out for almost a month and a half. With no other option, we made the appointment. I was not thrilled about it, and made my husband do all the calls and arrange it because I did not agree with it.What made me change my mind about circumcising him was I didn't want him to be different. My husband assured me this was the best choice and he was very concerned our son would be bullied for being different. I have a good friend that is a nurse in a long term care facility currently. I called her and asked if it was really that bad for old men to care... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Advocates, Not Problem ParentsAnonymous TwoNothing could have prepared us for the shock of hearing that our son had a brain tumor.Rob* was 13½, an active, healthy eighth grader, when he developed a headache so bad he couldn’t get out of bed in the morning. We saw the pediatrician three times over the next ten days. On the third visit, after ruling out problems at home, stress at school, strep (...) throat and mono, he sent us for an MRI. When the radiology tech handed me the films and told us to drive back to the pediatrician’s office, I knew we were in trouble. Sure enough, after all the other patients had left, our long–time doctor called us into his tiny office, shut the door and fumbled with the films as he pointed to a white spot that he said was a brain tumor.So began the experience that would change the course of our lives. We remember the diagnosis in detail and relive it in slow motion. We recall packing suitcases, driving to the hospital, waiting to be seen in the emergency room, and walking through doors marked “Pediatric Hematology/Oncology” for the first time.We date everything “BC” (Before Cancer) or “AD” (After Diagnosis). We are grateful every day that [End Page 13] our son is alive, but we know he is forever changed. We are changed: Our nuclear family, our extended family, everyone who knew us and supported us at the time was affected. A pediatric cancer diagnosis is a bomb that shatters your world without warning. If you’re lucky, you can pick up a lot of the pieces, maybe even most of them, but the world you re–enter is never the one you inhabited before.Our doctor delivered the diagnosis to Rob and me at the same time. I’ve thought about this many times and perhaps one day will ask him: Why did he choose to do it that way? Was it a conscious decision or just happenstance? Was it kinder, in the long run—like pulling off a band–aid quickly—or terribly risky? What if I had collapsed at the news? I asked to step into the hall to use the phone. In a state of numbness, I called my husband. He knew we had had an MRI a few hours earlier. “Come quickly,” I said. “There’s a mass.”We chose to go to a top-ranked major medical center and were admitted that evening. A couple of days later, the discovery of tumor markers in Rob’s cerebrospinal fluid and blood confirmed a central nervous system mixed germ cell tumor. We were told he would require six cycles of chemotherapy, followed by six weeks of radiation, and possibly second–look surgery and high-dose chemo with stem cell rescue on top of that. We were given a consent form listing a catalogue of short–and long–term side effects, among them the likelihood of infertility. We were urged to start treatment as soon as possible.By sheer coincidence I had just completed a project for a small, nonprofit organization that existed to inform young adult cancer patients about their fertility rights and options. I knew that infertility concerns were usually pushed aside at diagnosis to make way for other priorities, namely the urgency of starting treatment. And that’s exactly the kind of pressure we were facing.But my husband and I were not ready to sign away our son’s fertility in what felt like a no–confidence vote, a capitulation. We needed to believe that he would survive and put this horror behind him, that he would look forward to marriage and starting a family. We were willing to cede nothing to the disease at this early stage of the game. Was this rational, naive or selfish on our part? I don’t know.The medical team seemed surprised when we asked for a delay in treatment in order to collect sperm samples. They warned that our son’s condition could decline suddenly—and that postponing treatment by even several days might be dangerous. However, at our insistence, they agreed to the delay... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Road to RedemptionAnonymous TwoI “am Dr X.* and I am a trained and board certified neonatologist with some years of experience in a high volume NICU with complex pathologies. I have been dismissed from the care of your baby by the fetal surgeon who is not trained in what he’s attempting to do,” that was how I felt when I left the operating room (OR), after performing initial (...) resuscitation on a newborn with congenital diaphragmatic hernia (CDH) with very poor prenatal prognostic indices. CDH is a diaphragm abnormality that allows abdominal organs to move into the chest and restrict lung development. The better part of me knew not to make such a statement and chose not to do so, as this was about the family and a very sick baby, not the professional wrangling of two medical teams or the expression of frustration by a neonatologist who was morally conflicted.I work in a level four Neonatal Intensive Care Unit (NICU) and a very large one by any standard. Staff turnover had been an almost nonexistent issue in previous years because of the very conducive work environment of the NICU. Every team member (physician, nurse, respiratory therapist, pharmacist, etc.) felt like a stakeholder in providing optimal outcomes for the vulnerable neonates in the NICU.As change is the only constant thing in life, the hospital management decided to explore new frontiers and open a center for fetal medicine, with the hope of being a referral center in the region. They brought in a surgeon who came highly recommended for clinical acumen, but not for interpersonal relationship skills (unbeknownst to me). This surgeon, Dr Y., was hired to oversee the fetal center and build it into a center of excellence. Since this had to be a collaborative effort, other specialties (and subspecialties) had to be involved to make this a success. A representative from each of these specialties, including bioethics, was assigned to the fetal center team.The first inkling of a major problem occurred with the very first patient. The team met for the weekly meeting, reviewed the patient’s history and made a tentative plan, which included multidisciplinary counseling. This would require either a joint meeting with the patient or individual consults with the patient at her convenience. The following week at the weekly meeting, Dr Y. informed the group that he had met with the patient and counseled her and she had agreed to an extraordinary procedure for an oral lesion. In my opinion (and that of others), this lesion was not obstructive and could be immediately dealt with at delivery by an Otolaryngologist (ENT) surgeon, without putting the mother at risk for complications arising from the procedure being offered. There was a long discussion about why this was inappropriate [End Page E1] and why further imaging, discussion between the subspecialties and counseling should have been done prior to making this delivery plan. All felt this delivery plan could be remedied prior to delivery. However the surgeon had made plans with the obstetric team (who were at his mercy for financial/ political reasons) to continue with this plan. On the day of delivery, the NICU resuscitation team was called to another operating room instead of the labor and delivery room. I was even more appalled when I realized that the oral lesion was the size of a peanut! I felt like I failed in my obligation of veracity by avoiding the mother’s questions regarding the necessity of the procedure. Every member of my team felt the same and on several occasions I had to reassure concerned nurses that this was an aberrant occurrence that would not repeat itself... so I thought.I informed my departmental chairperson, Dr Z., who had a conversation with the fetal surgeon, Dr. Y., to inform him of my concerns and the effect of Dr. Y.’s actions on my group (physician, nurse practitioner, nurses). This led to being labeled unsupportive of Dr Y.’s goals and caused a less than cordial relationship towards me and the entire NICU group. The next week a picture of Dr Y. and the parents with the baby was on the front page... (shrink)

In the place of an introduction to part 5 of the Common Knowledge symposium on forms of quietism, the journal's editor and one of its longtime columnists discuss, in dialogue format, the case of Thomas More. Could he have evaded martyrdom at the hands of Henry VIII and Thomas Cromwell? One discussant argues that More could not have done so without contemptibly abandoning his principles and surrendering fully to despotism. The other discussant disagrees, suggesting that More had to abandon some (...) of his principles one way or the other—in resisting despotism, however quietly, More did serious harm to his wife and daughter, to the European humanist movement, and to the cause of English Catholics. (shrink)

To the extent that acting fairly is in an individual's long-term interest, short-term impulses to cheat present a self-control problem. The only effective solution is to interpret the problem as a variant of repeated prisoner's dilemma, with each choice as a test case predicting future choices. Moral choice appears to be the product of a contract because it comes from self-enforcing intertemporal cooperation.

Most scholars of Islamic intellectual history now agree on the distortedness of the traditional Western portrayal of al-Ġazālī as the defender of Muslim orthodoxy whose Incoherence of the Philosophers was such a powerful critique that it caused the annihilation of philosophical activity in Islamic civilization. Some in fact are coming to the conclusion that al-Ġazālī's importance in the history of Islamic philosophy and theology derives as much from his assiduous incorporation of basic metaphysical ideas into central doctrines of Sunnī kalām (...) , as from his far more celebrated bashing of the falāsifa . What is less well known is that al-Ġazālī's role in the ‘‘philosophizing” of Sunnī theology was not a lonely struggle by a single genius, but part of a broader trend that seems to have begun during Avicenna’s lifetime and that picked up speed in the first and second generations after Avicenna's death in 1037, with the work of al-Ġazālī's teacher, the Aš‘arite al-Gˇuwaynī , as well as of the Māturīdite al-Bazdawī , work that was carried forward by dozens of subsequent members of those two major Sunnī theological schools. It is clear, in fact, that the dividing line between the Sunnī theologians commonly referred to in the later Islamic tradition as mutaqaddimūn , and those referred to as muta’a&hbrevu;h&hbrevu;irūn , lies not with al-Ġazālī but with Avicenna himself, and that the turn in Sunnī kalām was therefore Avicennian, not Ġazālian. (shrink)

The vast majority of gamete donations worldwide are made anonymously, and in some countries, including Spain, France, and Denmark, the anonymity of donors is explicitly protected by law. Nonetheless, a growing number of countries have called into question the morality of such practices and are enacting laws allowing children access to identifying information about their gamete donor. A significant reason for the growing legislative support for nonanonymous gamete donations is the belief that donor‐conceived children have a fundamental moral right to (...) know their genetic origins and that the right should be legally protected. A variety of factors, such as the increasing number of children born by means of gamete donation, advances in genetic science and technology that make it easy to discover the identity of a person's genetic parents, and the widespread belief that genetic information is important for protecting people's health, have made this alleged right quite salient, even leading some to challenge the ethical appropriateness of gamete donation practices altogether. Often, however, this right is assumed rather than explicitly justified. The purpose of this paper is to call into question the ethical justifications that are often thought to ground a right to know one's genetic origins.Proponents of a right to know this information usually argue that such a right protects at least three vital interests: the interest of donor‐conceived people in having strong family relationships, their health interests, and their interest in forming a healthy identity. These different interests might be protected by different aspects of the right to know one's genetic origins: knowing one's mode of conception, accessing medically relevant information, and accessing identifying information about one's genetic parents. I will discuss each of these interests and explore whether and how they might be set back by an individual's lack of access to information about his or her genetic parentage. I will also evaluate whether donor anonymity policies are, as many of their opponents argue, morally impermissible because they fail to protect these important interests. (shrink)

The Corporate Manslaughter and Corporate Homicide Act 2007 establishes the statutory offence of corporate manslaughter, replacing the previous common law corporate liability for manslaughter. Health-care providers are potentially liable. This includes, but is not restricted to, National Health Service bodies. This paper considers the hypothetical liability of the various bodies involved in a well-known case of death arising from medical error, had the Act been in force when it occurred. The discussion illustrates the likelihood of difficulty in establishing liability. This (...) difficulty arises not only from the requirements of the Act but also the involvement of several different bodies in the facts and circumstances of the fatal mistake. There are implications for a National Health Service whose future is likely to include greater fragmentation of service provision, with a greater number of corporate providers. Successful prosecutions for corporate manslaughter are expected to remain rare. (shrink)

A growing number of jurisdictions hold that gamete donors must be identifiable to the children born with their eggs or sperm, on grounds that being able to know about one's genetic origins is a fundamental moral right. But the argument for that belief has not yet been adequately made.

Anonymous argumentation has recently been the focus of public controversy: flash points include the outing of pseudonymous bloggers by newspapers and the launch of an academic journal that expressly permits pseudonymous authorship. However, the controversy is not just a recent one—similar debates took place in the nineteenth century over the then common practice of anonymous journalism. Amongst the arguments advanced by advocates of anonymous argumentation in either era is the contention that it is essential if the widest (...) range of voices are to be heard; amongst the counterarguments of its critics, that it weakens the credibility of individual arguments and irresponsibly cheapens the standard of public discourse. This paper explores some implications of the controversy for the ethics of argumentation in general and virtue theories of argumentation in particular. (shrink)

We will analyze the concept of anonymity, along with cognate notions, and their relation to privacy, with a view to developing an understanding of how we control our identity in public and why such control is important in developing and maintaining our social selves. We will take anonymity to be representative of a suite of techniques of nonidentifiability that persons use to manage and protect their privacy. At the core of these techniques is the aim of being untrackable; this means (...) that others lack the information they would need either to intrude physically upon me or to discover some private facts about me. Anonymity often enough goes together with privacy, but not always. Consider a person walking down a foreign street. It is not a physically private situation but no one there knows who you are. On the other hand, when I cast a postal vote, this act is both private and anonymous. Privacy and anonymity seem to go together because of the way each protects something importantly personal, but their coming apart suggests a difference both in what they mean and in our purposes for securing them. A lot has been written about privacy, and deservedly so; there is reason to think anonymity, and its cognates, important as well. (shrink)

Making use of the liberal concept of civil disobedience, this paper assesses, under which circumstances instances of illegal digital protest—called “hacktivism”—can be justified vis-à-vis the pro tanto political obligation to obey the law. For this, the paper draws on the three main criteria for liberal civil disobedience—publicity, nonviolence, and fidelity to law—and examines how these can be transferred to the realm of the digital. One of the main disanalogies between street and cyberspace protests is the tendency of hacktivists to remain (...) anonymous, which in turn calls into question their fidelity to law (the third criterion). The paper argues that there are functionally equivalent alternatives to what can be called the “acceptance-of-legal-consequences-condition” (ALCC) associated with the fidelity to law. As a result, the ALCC is not a necessary condition for hacktivists to showcase their fidelity to law, thereby resolving the apparent disanalogy. (shrink)

This paper addresses how the anonymity of an assertion affects the epistemological dimension of its production by speakers, and its reception by hearers. After arguing that anonymity does have implications in both respects, I go on to argue that at least some of these implications derive from a warranted diminishment in speakers' and hearers' expectations of one another when there are few mechanisms for enforcing the responsibilities attendant to speech. As a result, I argue, anonymous assertions do not carry (...) the same of the speaker's relevant epistemic authoritativeness that ordinary assertions do. If this is correct, the phenomenon of anonymity provides us with a lesson regarding ordinary assertions: their aptness for engendering belief in others, and so for communicating knowledge, depends in general on the very publicness of the act of assertion itself. (shrink)

In this article, I provide phenomenological reflections on patients’ experiences of undergoing extreme isolation protocols while admitted to Intensive Care Units [ICU] during the first wave of COVID-19. Based on observation studies from within the patient isolation rooms and retrospective, in-depth phenomenological interviews with patients, I characterize this exceptional experience as one of becoming anonymous. To illustrate this, I start by establishing a perspective on embodied existence as constituted on a scale between anonymous embodiment and being enrooted into (...) a personal niche. Against the backdrop of this framework, I illustrate how being admitted to the ICU under strict isolation protocols produced extraordinary experiences of becoming anonymous. Sources of the anonymization were: (1) Mechanical expropriation, pacification and disownership of the visceral-kinaesthetic body; (2) Objectification; (3) Spatial and intercorporeal anonymity (4) Surrealism: the intermingling of objective impressions and dream-like interpretations. Finally, I illustrate how anonymization induced an experience of embodiment as raw materiality, confronting the patient with what Martin Heidegger called the facticity of naked existence. This experience is discussed against Levinas’ critique of Heidegger, while I propose that insights from this exceptional case may substantiate Heidegger’s account. (shrink)

Making use of the liberal concept of civil disobedience, this paper assesses, under which circumstances instances of illegal digital protest—called “hacktivism”—can be justified vis-à-vis the pro tanto political obligation to obey the law. For this, the paper draws on the three main criteria for liberal civil disobedience—publicity, nonviolence, and fidelity to law—and examines how these can be transferred to the realm of the digital. One of the main disanalogies between street and cyberspace protests is the tendency of hacktivists to remain (...) anonymous, which in turn calls into question their fidelity to law (the third criterion). The paper argues that there are functionally equivalent alternatives to what can be called the “acceptance-of-legal-consequences-condition” (ALCC) associated with the fidelity to law. As a result, the ALCC is not a necessary condition for hacktivists to showcase their fidelity to law, thereby resolving the apparent disanalogy. (shrink)

Memes, of the kind found often on the internet, are an increasingly significant medium of expressive activity. I develop a theory of their ontological nature and, in parallel, an analysis of the concept meme. On my view, memes are abstract artifacts made out of norms for production of instances. The norms say things like ‘use a certain image; add text of a certain kind; the text should be delivered in two chunks, one at the top of the image, one at (...) the bottom, etc.’ Instances of these memes are created when users follow these norms and publish the results. The concept meme is analyzed in terms of the notion of memographic practice, a historically situated form of activity within which memes are created and their instances produced and made public. (shrink)

Should anonymous sperm “donation”—a misnomer, since sperm is usually purchased—be permitted? A number of countries, including Sweden, Austria, Germany, Switzerland, the Netherlands, Norway, New Zealand, and several Australian states, have answered no.1 The United Kingdom recently joined this list, instituting a system whereby new sperm (and egg) donors must put information into a registry, and a donor-conceived child “is entitled to request and receive their donor’s name and last known address, once they reach the age of 18.”2 The arguments (...) offered by the legislators in these jurisdictions in favor of these measures, along with the arguments offered by scholarly proponents such as Naomi Cahn, focus on one major .. (shrink)

Anonymous sperm donation offspring often yearn for information about their biological fathers, and as they come of age that yearning increases in intensity. We first explore will and interest theory regarding this desire to know one’s heritage and argue that both theories lead to a right of the offspring to know. We then turn to the donor contract, look at the inconsistencies between donor ability to eschew parental responsibility compared to other biological fathers, and argue that there should be (...) a procedure similar to adoption procedures, whereby sperm donors take seriously the legal severing of their parental rights and responsibilities. We conclude that the offspring have a right to their genetic heritage and call for caring reproductive technological practices that ensure children of donors this right. (shrink)

The interest in data anonymization is exponentially growing, motivated by the will of the governments to open their data. The main challenge of data anonymization is to find a balance between data utility and the amount of disclosure risk. One of the most known frameworks of data anonymization is k-anonymity, this method assumes that a dataset is anonymous if and only if for each element of the dataset, there exist at least k − 1 elements identical to it. In (...) this paper, we propose two techniques to achieve k-anonymity through microaggregation: k-CMVM and Constrained-CMVM. Both, use topological collaborative clustering to obtain k-anonymous data. The first one determines the k levels automatically and the second defines it by exploration. We also improved the results of these two approaches by using pLVQ2 as a weighted vector quantization method. The four methods proposed were proven to be efficient using two data utility measures, the separability utility and the structural utility. The experimental results have shown a very promising performance. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Anonymous Temporality and Gender:Rereading Merleau-PontyMegan M. BurkeThis Essay Provides a Feminist reading of Merleau-Ponty’s notion of anonymity in order to show that it is a critical resource for a feminist account of gender. For Merleau-Ponty, anonymity is a structure of temporality that is prior to the cogito; it is a time that actualizes the reflective self. It gestures away from ontological commitments rooted in presence and calls attention (...) to how senses inform and actualize one’s reflective experience, which illuminates how it is that certain habits become sedimented or deeply rooted into the structure of one’s lived experience. As such, anonymity provides a useful framework for understanding how and in what ways gender normativity is taken up and resisted in experience. Yet feminist readings of Merleau-Ponty and anonymity are divided. On the one hand, there is a strong criticism of his work in general and anonymity in particular and, on the other hand, there is an effort to recuperate aspects of his project, including anonymity. Four examples can help frame this disparate feminist reception of his work:1. Merleau-Ponty neglects sexual difference. For example, Elizabeth Grosz suggests, “Merleau-Ponty leaves out—indeed, is unable to address—the questions of sexual difference, the question of what kind of human body he is discussing, what kind of perceptual functions, and what kind of sexual desire result from the sexual morphology and particularity of the subject” (Grosz 1994, 10). [End Page 138]2. Anonymity neglects sexual difference. Shannon Sullivan is representative of this point, claiming, “Merleau-Ponty’s notion of the anonymous or impersonal body … leads one to overlook” difference; “Merleau-Ponty fails to realize” difference; “He is wrong” (Sullivan 2001, 71).3. Anonymity illuminates sexual difference. For Silvia Stoller “[W]ith the help of Merleau-Ponty … sexual difference presupposes an anonymous sexuality which underlies gender identifications,” making anonymity important to a phenomenological account of sexual difference (Stoller 2013).4. Merleau-Ponty’s account of embodied subjectivity provides insight into the lived experience of femininity. Feminist analyses of female body comportment, such as those of Iris Marion Young and Sandra Bartky, suggest that gender is a process of sedimentation (Young 1990; Bartky 1990). More specifically, they suggest gender becomes a lived experience through the repetition of particular behaviors and actions such that they become a deeply habituated part of one’s being in the world.While the feminist criticisms of Merleau-Ponty are important insofar as they caution against the acceptance of universal claims about existence, they also overlook anonymity’s relationship to time. Given that Merleau-Ponty’s characterization of anonymity is temporal through and through, this oversight is problematic. Without an account of anonymity as a kind of temporality, we miss the value of anonymity and the further insight that can be drawn from it in relation to gender. In what follows, then, I propose a solution to the disparate reception of his work. I suggest that reading anonymity as a structure of temporality illuminates how gender is taken up in lived experience. And, I suggest that anonymity can provide a strong account of gender normativity when one understands the parallels between sedimentation and anonymity with respect to temporality. By showing the strong connection between sedimentation and anonymous temporality, I suggest that it is ontologically and politically helpful to understand gender as a lived time.In the first section of this paper, I will address the main criticisms of anonymity provided by Shannon Sullivan and Luce Irigaray, while also paying attention to those from Elizabeth Grosz, Judith Butler, and Beata Stawarska. For Sullivan, Grosz, and Butler, Merleau-Ponty’s anonymous body is a neutral body, a body that fails to account for gender differences. Irigaray and Stawarska suggest that anonymity is the mark of patriarchy, making ethical and ontological solipsism fundamental to Merleau-Ponty’s work. In each of these cases, anonymity provides nothing useful for and is, in fact, a detriment to feminist projects.In the second section of this paper, I turn to Stoller’s positive reading of anonymity. For Stoller, anonymity is a political and ethical resource that challenges gender norms because it can allow for transformation in... (shrink)

This essay articulates and defends Aristotle’s argument in Politics 7.4 that there is a rational limit to the size of the political community. Aristotle argues that size can negatively affect the ability of an organized being to attain its proper end. After examining the metaphysical grounds for this principle in both natural beings and artifacts, we defend Aristotle’s extension of the principle to the polis. He argues that the state is in the relevant sense an organism, one whose primary end (...) is to make good reasons available to individuals and promote them as choiceworthy. The size of a polis can affect its ability to perform this function, since growth promotes anonymity among citizens, which in turn frustrates the familiarity between citizens required for the exercise of distributive and restorative justice as well as political prudence. This paper suggests several ways in which Aristotle’s argument, if sound, is important for contemporary issues in moral psychology, Ralwsian political philosophy, and big data analytics. (shrink)