Biobanks act as the custodians for the access to and responsible use of human biological samples and related data that have been generously donated by individuals to serve the public interest and scientific advances in the health research realm. Risk assessment has become a daily practice for biobanks and has been discussed from different perspectives. This paper aims to provide a literature review on risk assessment in order to put together a comprehensive typology of diverse risks biobanks could potentially face. (...) Methodologically set as a typology, the conceptual approach used in this paper is based on the interdisciplinary analysis of scientific literature, the relevant ethical and legal instruments and practices in biobanking to identify how risks are assessed, considered and mitigated. Through an interdisciplinary mapping exercise, we have produced a typology of potential risks in biobanking, taking into consideration the perspectives of different stakeholders, such as institutional actors and publics, including participants and representative organizations. With this approach, we have identified the following risk types: economic, infrastructural, institutional, research community risks and participant’s risks. The paper concludes by highlighting the necessity of an adaptive risk governance as an integral part of good governance in biobanking. In this regard, it contributes to sustainability in biobanking by assisting in the design of relevant risk management practices, where they are not already in place or require an update. The typology is intended to be useful from the early stages of establishing such a complex and multileveled biomedical infrastructure as well as to provide a catalogue of risks for improving the risk management practices already in place. (shrink)

This contribution includes three selected works from an exhibition on _Cyborg Encounters_. These works deal with hybrid connections of human and non-human species that (might) emerge as a result of enhancement technologies and bio-technological developments. They offer not only an artistic exploration of contemporary but also futuristic aspects of the subject. Followed by an introduction by Melike Şahinol, _Critically Endangered Artwork_ (by Ayşe Melis Okay) highlights Turkey’s ongoing problems of food poverty and the amount of decreasing agricultural lands. It (...) displays seeds of a promising endemic plant to mitigate these problems using the seeds of the _Thermopsis Turcica_, a herbaceous perennial endemic plant. _Ecomasculinist Pregnancy_ (by Burak Taşdizen and Charles John McKinnon Bell) follows the design fiction methodology and illustrates a future scenario through a patient’s diary and the medical letters he receives during his pregnancy with an extinct sea-lion. _Polluted Homes_ (by Beyza Dilem Topdal) is a fictional art installation consisting of polychaete species evolved in time under the ecological circumstances prevalent in the Bosphorus and the Sea of Marmara today. These works show, that manufacturing life has consequences, not only for the human body and its physical appearance, but also, for example, for gender orders, the social structure of society, and even the environment, and thus for (re)shaping (non)living matter and their environments. This Art-Science Collection intends to provide an impetus for debate about the extent to which cyborg encounters should be taken seriously. (shrink)

Biobanks’ activity is based not only on securing the technology of collecting and storing human biospecimen, but also on preparing formal documentation that will enable its safe use for scientific research. In that context, the issue of informed consent, the reporting of incidental findings and the use of Transfer Agreements remain a vast challenge. This paper aims to offer first–hand tangible solutions on those issues in the context of collaborative and transnational biobanking research. It presents a four‐step checklist aiming to (...) facilitate researchers on their compliance with applicable legal and ethical guidelines, when designing their studies, when recruiting participants, when handling samples and data, and when communicating research results and incidental findings. Although the paper reflects the outcomes of the H2020 B3Africa project and examines the transfers from and to the EU as a case study, it presents a global checklist that can be used beyond the EU. (shrink)

The purpose of this study was to determine the opinions and expectations of patients and nurses about privacy during a hospital admission for surgery. The study explored what enables and maintains privacy from the perspective of Turkish surgical patients and nurses. The study included 102 adult patients having surgery and 47 nurses caring for them. Data were collected via semistructured questionnaire by face-to-face interviews. The results showed that patients were mostly satisfied by the respect shown to their privacy by the (...) nurses but were less confident of the confidentiality of their personal data. It was found that patients have expectations regarding nursing approaches and attitudes about acknowledging and respecting patient autonomy and confidentiality. It is remarkable that while nurses focused on the physical dimension of privacy, patients focused on informational and psychosocial dimensions of privacy, as well as its physical dimension. (shrink)

Deixis is the thing referred to by linguistic units outside the text or the discourse. The act of demonstrating or indicating the elements of a state through gestures or linguistic units is called deixis. Deictic is the name given to the linguistic elements such as pronouns, demonstrative nouns and adverbs which refer to the personal, spatial or temporal aspects of a speech act and which are, therefore, all directly related to the context surrounding its act of communication. Since the references (...) of the deixis expressions can only be identified within the context of actual communication, the subject is considered as a part of the pragmatics. This study aims to analyse the demonstrative nouns used in Qur’anic verses within the context of deixis and types of deixis, which are research areas of pragmatics, and to identify the types of deixis used in Qur’an. This study also aims to provide insight about how to present the references of demonstrative nouns especially in Qur’anic translations to be understood correctly by the readers. This is because the translations of Qur’an are presented in written form and the references of the deictic units are not expressed clearly in some of them. In this case, it is assumed that the reader might have difficulty understanding the meanings of the deixis such as “this, to this, these”. This study, firstly by studying deixis and types of deixis from the modern linguistics and pragmatics resources, aims to form a conceptual framework. After the first chapter, upon which the main problem of the study will be built, is completed, the demonstrative nouns are analysed in terms of their structural and referential aspects within balâg̲h̲a and tafsîr sources, classical Arabic language nahw sources being in the first place. After the obtained data is analysed, by associating the demonstrative nouns in Qur’anic verses to types of deixis, anaphora and cataphora, their references are determined. In this direction, firstly the demonstrative nouns in Qur’an will be identified and the type of deixis is tried to be explained by providing one example for each one of the demonstrative nouns in terms of their referential variety. For this purpose, this study highlights the demonstrative nouns which cannot be directly understood but only can be identified by checking the context. That is, the demonstrative nouns which take adjectives or which are adjectives themselves will not be included in the scope. The references of these nouns existing in the verses will be specifically analysed within the classical tafsîr works. This study is significant as it reveals the references of the demonstrative nouns by analysing the types of deixis in order to understand Qur’an more accurately. Though there are various studies regarding the demonstrative nouns, there are no studies found analysing the references of these nouns according to their types of deixis. With this study, it is understood that classical tafsîrs mention the deixis, types of deixis, and the references anaphora and cataphora for demonstrative nouns. As the demonstrative nouns, which are deictic elements, are used to point to all types of living and non-living creatures, they are considered as indefinite things. It is understood that for the other interpreters, the vagueness can only be eliminated by taking pragmatic factors such as the speaker, listener and the context of communication into consideration. 20 types of demonstrative nouns were used for a total of 1047 times in 89 different surahs. These demonstrative nouns are as following: “ذا، هذا، هذان، هاتين، هؤلاء، ذلك، ذانك، ذلكما، ذلكم، تلك، ذلكن، هذه، أولئك، أولئكم، أولاء، كذلك، كذلكم، هاهنا هنالك، ثم”. The fact that demonstrative nouns are used so often in Qur’an prove that these nouns are quite important in understanding the Qur’an. This study addresses the verses with demonstrative nouns in terms of types of deixis, as part of pragmatics, by referring to classical tafsîr and linguistic sources. It has been determined that demonstrative nouns in Qur’an make personal, spatial or temporal references, discourse deixis, anaphora and cataphora, however they do not perform as social deixis. It has been concluded that identifying the references of demonstrative nouns is quite important in understanding and interpreting Qur’an correctly. It is also understood that the methods to determine the references of demonstrative nouns by the sources used in the study have pragmatic characteristics. It is observed that the references of the demonstrative nouns are not presented in certain Qur’an translations. In this context, it has been concluded that stating the references of these nouns in written form for the translation of Qur’an into different languages is vital for these references to be understood correctly. It has also been concluded that it is a requirement in terms of pragmatics to take the references of the deictic elements mentioned especially in the primary sources into consideration. (shrink)

In their “social contextual view” of emotional mimicry, authors Hess and Fischer (2022) put forward emotional mimicry as a social regulator, considering it a social act, bound to certain affiliative contexts or goals. In this commentary, we argue that the core function of mimicry is to ease predicting conspecifics’ behaviours and the environment, and that as a consequence, this often smoothens social interactions. Accordingly, we make three main points. First, we argue that there is no good reason to believe that (...) the mimicry of negative expressions is fundamentally different than the mimicry of positive or ambiguous or autonomic expressions. Second, we give examples of empirical evidence that mimicry is not always a social act. Third, we show that mimicry has primary benefits for the mimicker. As such, we will briefly summarise and elaborate on the relevant findings in these respects, and propose a comparative, multi-method and ecologically valid approach which can explain the multifaceted character of the phenomenon. (shrink)

While there are legal regulations prohibiting smoking in indoor areas in Turkey, there is none for outdoor areas. Many non-smokers are exposed to environmental tobacco smoking against their will in Turkey. Numerous research efforts have documented the fact that environmental tobacco smoke poses risks to human health because it pollutes the environment by releasing dangerous chemicals into the air that non-smokers breathe. This means that tobacco smoking poses risks to a safe environment and people’s lives. People have a right to (...) the environment, as guaranteed by the Turkish Constitution. Since Stockholm Declaration, many countries have recognized that people have a right to a safe environment or that a safe environment is essential to the enjoyment of human rights, including Turkey. However, how non-smokers perceive of the impacts of environmental tobacco smoke on the enjoyment of the right to the environment enshrined within the Turkish legal system has not been studied to date. Accordingly, this research aims to explore how issues relating to environmental tobacco smoke can be approached from an environmental human rights perspective. To achieve this purpose, a qualitative case study was conducted in Istanbul. The results of this analysis show that non-smokers do not enjoy the right to the clean environment guaranteed by the Turkish Constitution due to the ETS. (shrink)

Background: Informed consent involves patients being informed, in detail, of information relating to diagnosis, treatment, care and prognosis that relates to him or her. It also involves the patient explicitly demonstrating an understanding of the information and a decision to accept or decline the intervention. Nurses in particular experience problems regarding informed consent. Research question and design: This descriptive study was designed to determine nurse knowledge and practices regarding their roles and responsibilities for informed consent in Turkey. The research was (...) performed using 92 nurses who work at the surgical clinics. Data collection form was prepared by the researchers with assistance from the literature, and the data were evaluated by the SPSS 12.0 data analysis program. Ethical consideration: This study was approved by the Medicine and Health Sciences Research and Ethics Committee of the university. Written consent was received from the nurses. Findings: Among the nurses who participated in this study, 39.1% indicated that they were responsible for obtaining informed consent. It was also found that 90.2% of the nurses informed patients before providing nursing interventions and 32.6% of the nurses obtained consent from patients, and 90.0% of the nurses who indicated that they obtain patient consent only obtain verbal consent. Among all of the nurses, 21.7% agreed that informed consent needs to be obtained in order to protect the medical staff legally. Discussion: It is argued that a lack of official procedures at hospitals regarding informed consent and insufficient information being provided to healthcare providers has caused problems regarding informed consent. Conclusion: The nurses in this study lacked information regarding their role in obtaining informed consent from patients and they often performed incomplete and/or incorrect practices within the framework of their required role. It is believed that an increased level of education along with the creation of official policies and procedures would contribute towards solving these problems. (shrink)

I recently told my uncle that I thought I had come up with a way of showing that a mother who saw her child about to be stung by a wasp should try to intervene. I’d been working on this for several months. My uncle did not look very impressed. To be fair, it doesn’t sound like a very impressive result. Surely it is just utterly obviously that mothers should protect their children from wasps? So why had this taken me (...) months of work? I am trying to come up with a moderate account of maternal duties. Maternal duties pick out what a mother is morally required to do for her children. In doing so, I’ve discovered that it is harder than it might at first appear to come up with a moderate account of maternal duties that recognises ‘obvious’ duties like the duty not to let your child be stung by a wasp. I’ve also found that in the context of maternal duties, even more than in other contexts, we need be cautious before we accept our judgments about what seems obvious. Yet, it is absolutely vital to come up with a good moderate account of maternal duties – because doing so is necessary to protect vulnerable women and children. (shrink)

In this chapter, I argue that it is impossible to trust the Big Tech companies, in an ethically important sense of trust. The argument is not that these companies are untrustworthy. Rather, I argue that the power to hold the trustee accountable is a necessary component of this sense of trust, and, because these companies are so powerful, they are immune to our attempts, as individuals or nation-states, to hold them to account. It is, therefore, literally impossible to trust Big (...) Tech. After introducing the accounts of trust and power that I deploy, I argue that Big Tech companies have four kinds of power that render them unaccountable: fiscal power, political power, data power, and cognitive power. I conclude by reflecting on recent calls to break up the Big Tech firms, suggesting a new antitrust test in the light of my arguments. (shrink)

After giving the name “burnout” to the experience of being overworked and undervalued and the physician and patient suffering that comes from it, many clinicians have sought to elucidate further wh...

Though Bloom makes a good case that learning content-word meanings requires no task-specific apparatus, he does not seriously address problems inherent in learning the meanings of functional items. Evidence from creole languages suggests that the latter process presupposes at least some task-specific mechanisms, perhaps including a list of the limited number of semantic distinctions that can be expressed via functional items, as well as default systems that may operate in cases of impoverished input.

''In a democracy, should everyone - absolutely everyone - get a vote? Does it really matter if tigers become extinct? Why does murder carry a heavier penalty than attempted murder? If you don't like the socks your grandma gives you for Christmas, should you tell her so? This entertaining introduction to ethics will bring you face to face with some tough moral choices. It presents you with 101 imaginative scenarios - sometimes amusing, sometimes tragic and sometimes uncomfortably realistic - which (...) will force you to re-examine your most cherished assumptions about right and wrong. Including: the torturer with a conscience; the lady who can prevent enormous suffering for the price of a latte; and the man who is handy with his fists but not a killer, surely." -- Back cover. (shrink)

This article demonstrates the ‘patterning’ of the ways discourse markers such as okay, right and yeah are used in academic lectures by native speaker lecturers. It presents an analysis of a) what the lecturers thought they would say and b) what they actually say in comparison to what the lecturers actually do say. In other words, it focuses on the differences between expectations of what would be said and speech, that is, what is actually said.The data comprise verbatim lecture (...) transcriptions of four native speaker lecturers of different disciplines, analysed using a discourse analytical approach. The findings and discussions exhibit the reasons for the differences between the ‘anticipated’ and ‘real’ meanings of the use of these discourse markers.They also reflect upon the significance of non-verbal features in determining the actual functions of these markers. In short, this article highlights the reality use of okay, right and yeah as interactive conversational markers in academic lectures. (shrink)

Recently, the view that anger is bad, even wrong, to feel and express has gained popularity. Philosophers like Martha Nussbaum and Derk Pereboom posit that anger is fundamentally tied to a desire for retribution, which they argue is immoral, counterproductive, and irrational. Thus, they argue, we should try our best to stop ourselves from feeling and expressing anger whenever it arises. I argue that anger is not inherently retributive, and that feeling and expressing anger are sometimes the most adaptive response (...) to unfairness in one’s environment. I draw on robust psychological literature to characterize the dangers of overregulating anger in terms of the practical, psychological, and humanitarian costs associated with not feeling and expressing anger. In the appropriate contexts, anger is crucial to prepare people to communicate disapproval, motivate necessary confrontation, and change wrongdoers’ harmful behaviors. Thus, the functions of anger are not focused on getting even for past events, but rather on protecting individuals from future harm. Importantly, the overregulation of anger is likely to cause the most harm to individuals and communities that experience routine unfairness, thereby reinforcing social injustices. By adopting a functionalist perspective of emotions, we can shift our focus away from policing experiences of anger and toward enhancing its functional qualities through thoughtful reflection on the sources of people’s anger and resolutions for that anger. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Things Are NOT OkayLynne HillardThree doctors, each with good intentions, led us to believe that everything would be all right for our son Ben. In the fall of 2008, Ben presented with two documented seizures. We first saw a doctor from our pediatrician’s office. He told us not to worry since the basic neurological physical exam showed nothing, but recommended that we see a pediatric neurologist. He gave us (...) a list of recommended doctors, and upon leaving the examining room the doctor then said, “Don’t worry. It’s not a brain tumor.”We arranged a meeting with one of the pediatric neurologists who had been practicing for a long time and had worked in one of the well–respected children’s hospitals before going into private practice. She was attentive and kind and spent a couple hours with us as we went over Ben’s medical history. She examined Ben and found nothing unusual, in fact per her notes, “his neurological examination is better than normal.” She said that she would order an EEG and a brain MRI because he had two witnessed seizures. She asked us to look into family history to see if there was anyone with a history of seizures in either one of our families. Upon leaving she said not to worry that it was probably something that he would out grow.After looking into family history, I found out that my older brother had had a couple of seizures when he was about twelve. He was put on phenobarbital. He eventually outgrew the seizures. Armed with this information I felt certain that Ben’s issues were hereditary. It was right before Christmas 2008, so I delayed on getting the EEG and brain MRI until January of that new year. The results of the EEG were unremarkable. The following week was the MRI. The day after the MRI, the receptionist at the neurologist’s office called. She requested that we come in the next day and asked that Ben not come to the appointment.“I am sorry to tell you, but Ben has a brain tumor.” What? I couldn’t even concentrate on what the doctor was saying. Ben’s tumor was located in the right temporal lobe and extensively involved the right amygdala and right hippocampus.I remember feeling completely overwhelmed with the process of choosing the individual who would ultimately perform brain surgery on our son. My husband and I interviewed three surgeons within a few weeks. On March 20 of 2009 Ben underwent surgery. The neurosurgeon was able to remove about 75 percent of the tumor. Two days after surgery Ben was released from the hospital. I remember that surreal feeling. My son had just had brain surgery and now we were going home with a list of medications and a schedule for administering the medications. I felt inept, unprepared, and yet relieved that my son had made it through; he could talk, he could move all his limbs and everything appeared to be normal. The only distinguishing feature that anything had happened was the six–inch scare on the side of his head.The pathology report said it was a DNET tumor (Dysembryoplastic Neuroepithelial Tumor), one that should not re–grow or cause any further problems. I remember the audible sigh of relief that came out of my mouth. I remember the neurosurgeon’s words: “Ben will grow up to be a fi ne young man, and you will dance with him at his wedding.” I wanted to be happy, like I had won the lottery, but I had this feeling that there must be something more to this, it couldn’t be this easy.In his second year at preschool Ben’s behavior problems became more obvious. When Ben became overwhelmed he would just sit down and not budge. Even when the director of the preschool asked us if there were any problems that were the result of his anti–seizure medication or his surgery, we said “no” because we were told “all should be good.” But all along there was that nagging feeling that not all was good in Ben’s world. [End Page 11]In... (shrink)

A dearth of clinical research involving children has resulted in off-licence and sometimes inappropriate medications being prescribed to the paediatric population. In this environment, recent years have seen the introduction of a raft of regulation aimed at increasing the involvement of children in clinical trials research and generating evidence-based medicinal preparations for their use. However, this regulation pays scant attention to the autonomy of competent minors. In particular, it makes no provision for the ability of competent minors to consent to (...) participate in medical research and is therefore at odds with best ethical practice. This article explores the tensions between law and ethics in relation to clinical research involving minors and concludes that greater respect should be given to the autonomy of those minors who are competent to decide for themselves. (shrink)

As an answer to the title question, some stories you can operate on and then get something good. I explain why I find a story about a tiger attack good, because of this reason, “courageously” presenting what I take to be something good. In the appendix, I present an attempt to clarify a distinction.

Many of the most important social institutions—e.g., law and language—are thought to be normative in some sense. And philosophers have been puzzled by how this normativity can be explained in terms of the social, descriptive states of affairs that presumably constitute them. This paper attempts to solve this sort of puzzle by considering a simpler and less contentious normative social practice: table manners. Once we are clear on the exact sense in which a practice is normative, we see that some (...) practices can be normative in an interesting and non-trivial sense, but also explicable with merely descriptive resources. In addition to arguing that it is possible to explain normative practices with descriptive resources, this paper presents and defends just such an explanation—an account of the nature of table manners that appeals only to descriptive states of affairs. (shrink)

_Taking Picture Books Seriously: What can we learn about philosophy through children's books?_ This warm and charming volume casts a spell on adult readers as it unveils the surprisingly profound philosophical wisdom contained in children's picture books, from Dr Seuss's _Sneetches_ to William Steig's _Shrek!_. With a light touch and good humor, Wartenberg discusses the philosophical ideas in these classic stories, and provides parents with a practical starting point for discussing philosophical issues with their children. Accessible and multi-layered, it answers (...) questions like, Is it okay for adults to deceive kids? What's the difference between saying the Mona Lisa is a great painting and vanilla is your favorite flavor? Each chapter includes illustrations commissioned especially for this book. (shrink)

Meeting others abroad and/or online is considered important in the broad field of intercultural communication education (amongst others: international education, minority and migrant education, but also teacher education, language education) to test out one’s learning about interculturality. For several weeks, a group of university students from China and a group of local and international students studying at a Finnish university met regularly online to talk about global educational issues. Using a specific lens of interculturality, which focuses on the discursive co-construction (...) of identities, we explore their initial interactions, how they deal with the uncertainty and potential awkwardness of their very first encounters, before they start working on their educational tasks. Based on the students’ self-disclosure (practices, thoughts, identity construction), and adopting a dialogical discourse analysis, the authors examine their co-construction of interculturality. The results show that the students try to facilitate interculturality while promoting it together more or less successfully. Reasons are discussed. The authors argue that research on the underexplored case of online initial interactions, which represent crucial moments in establishing and negotiating interculturality, could provide important research and pedagogical input for intercultural telecollaboration. (shrink)

We target the ontological and epistemological ramifications of the proposed distinction between Friston and Pearl blankets. We emphasize the need for empirical testing next to computational modeling. A peculiar aspect of the free energy principle (FEP) is its purported support of radically opposed ontologies of the mind. In our view, the objective ontological aspiration itself should be rejected for a pragmatic instrumentalist view.

A collection of answers to the philosophical questions on people's minds-from the big to the personal to the ones you didn't know you needed answered. Based on real-life questions from his Ask a Philosopher series, Ian Olasov offers his answers to questions such as: - Are people innately good or bad? - Is it okay to have a pet fish? - Is it okay to have kids? - Is color subjective? - If humans colonize Mars, who will own (...) the land? - Is ketchup a smoothie? - Is there life after death? - Should I give money to homeless people? Ask a Philosopher shows that there's a way of making philosophy work for each of us, and that philosophy can be both perfectly continuous with everyday life, and also utterly transporting. From questions that we all wrestle with in private to questions that you never thought to ask, Ask a Philosopher will get you thinking. (shrink)

When we start with the wrong question, no matter how good an answer we get, it won’t give us the results we want. Rather than joining the throngs who are asking, When will this economic crisis be over? Jim Wallis says the right question to ask is How will this crisis change us? The worst thing we can do now, Wallis tells us, is to go back to normal. Normal is what got us into this situation. We need a new (...) normal, and this economic crisis is an invitation to discover what that means. Some of the principles Wallis unpacks for our new normal are . . . • Spending money we don’t have for things we don’t need is a bad foundation for an economy or a family. • It’s time to stop keeping up with the Joneses and start making sure the Joneses are okay. • The values of commercials and billboards are not the things we want to teach our children. • Care for the poor is not just a moral duty but is critical for the common good. • A healthy society is a balanced society in which markets, the government, and our communities all play a role. • The operating principle of God’s economy says that there is enough if we share it. • And much, much more . . . In the pages of this book, Wallis provides us with a moral compass for this new economy—one that will guide us on Wall Street, Main Street, and Your Street. Embracing a New Economy Getting back to "the way things were" is not an option. It is time we take our economic uncertainty and use it to find some moral clarity. Too often we have been ruled by the maxims that greed is good, it’s all about me, and I want it now. Those can be challenged only with some of our oldest and best values—enough is enough, we are in it together, and thinking not just for tomorrow but for future generations. Jim Wallis shows that the solution to our problems will be found only as individuals, families, friends, churches, mosques, synagogues, and entire communities wrestle with the question of values together. (shrink)

Philosophers have offered several apparently powerful arguments against the permissibility of eating meat. However, the idea that it is okay to eat meat can seem like a bit of ethical common sense. This paper examines the attempt to adapt one of the most influential philosophical defenses of common sense –G. E. Moore’s case against the skeptic andthe idealist –in support of the omnivore. I first introduce and explain Moore’s argument against the skeptic. I then explain how that argument can (...) be adapted to address two influential philosophical arguments against the omnivore, due to Tom Regan and James Rachels. The adapted Moorean arguments appear strikingly similar to the original. However, I argue that we should not simply assume that all Moorean arguments are created equal. Instead, I propose a set of principled criteria that can be used to test Moorean arguments on a case-by-case basis. Those criteria give the Moorean reason for optimism against the skeptic, but suggest that the Moorean’s case is much weaker against the ethical vegetarian. I conclude that the Moorean omnivore’s argument has potentially uncomfortable implications for all sides in debates about ethical vegetarianism, and illuminates important and neglected questions about the force of philosophical arguments in applied ethics. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:A Changed Life: Becoming True to Who I amJay Kyle PetersenI was born intersex in 1952 in the county hospital of a very small, ultraconservative town in rural Southwestern Minnesota. My biological parents and paternal grandparents raised me on a small family farm nearby. I knew by age four I was a boy. No one told me. There was nothing to decide. I have always known I am male. (...) My parents never discussed my unusual condition with me and died having never accepted me. They denied my true identity and instead chose to give me a girl’s name and raise me as a girl.My paternal grandmother knew I was different. She lived on the farm with us and, as she explained to me later on in life, changed my diapers and helped take care of me as an infant and toddler. She also was a Certified Nurse’s Aide in the pediatric ward of the county hospital where I was born and could see that anatomically I was different from other infants. She remained my lifelong ally and friend until her death in 1993. She and Grandpa provided an oasis in their farmhouse where I felt accepted. I felt relaxed and comfortable in their company, and could just be myself. Grandpa took me fishing. Grandma drove me to 4–H State Fair demonstrations and supported me in the audience for which she had helped prepare me. My grandmother taught me good humor, excellence and how it was okay to make mistakes. Much later, in 1977, she drove four hours alone to Minneapolis in blizzard conditions to be my “concerned family person” during chemical dependency treatment, when my mother and dad refused and she also celebrated with me after my successful completion of the program. I loved her and she loved me and she showed it. With her I found refuge away from the pressure and abuse in our farmhouse.But my grandparents and parents did not show me affection physically. The only touch I felt from my family, except my paternal grandparents, was abusive including certain religious figures outside our family. Farm animals and pets provided warmth, love, acceptance, and companionship. I loved riding around the farm on the back of my pet pig, Lucy. Nature, especially trees, wild weather, and local lakes provided rest for my stretched, weary nerves and stimulation for my imagination. There was something about the vivid and contrasting colors, even the sounds and livingness about it all—rich deep moist greens, clean pure vast open blues, dark warm earth which I laid upon and felt in my hands. These and the soothing sounds of the wind gently moving through tree leaves and corn leaves and the lake water lapping calmly upon sandy shores, as Grandpa cast out his line: all this I found both relaxing and energizing and allowed for me the safety and environment to rest, let go and expand so my natural inclinations to express myself creatively could open up. Otherwise, I had a very lonely, frustrated, painful, humiliating childhood and adolescence filled with mounting anger and a sense of futility because I could not be or express my real male self—including my attraction to girls.The cultural and religious pressure I felt, the increased abuse and social lies I was forced to live with—including being forced to wear girls’ clothing against my will—became unbearable. I sought [End Page 106] refuge in addiction early on—food for comfort, nicotine for mood alteration, alcohol given to me by my dad, and more. I became suicidal, and remained for a long time terribly depressed.The geneticist I have consulted for the last four years says that physicians who examined me prior to my genital surgeries described my genitals as “male structures formed without enough testosterone,” rather than female structures formed in the presence of excess androgen. She told me that the features recorded in my medical records, and that she had observed, indicate androgen exposure in utero along with an inherited genetic condition such that she says my condition began at conception. I was born with XX karyotype and testing for usual causes for androgen excess with someone... (shrink)

This piece, included in the drift special issue of continent. , was created as one step in a thread of inquiry. While each of the contributions to drift stand on their own, the project was an attempt to follow a line of theoretical inquiry as it passed through time and the postal service(s) from October 2012 until May 2013. This issue hosts two threads: between space & place and between intention & attention . The editors recommend that to experience the (...) drifiting thought that attention be paid to the contributions as they entered into conversation one after another. This particular piece is from the BETWEEN INTENTION & ATTENTION thread: Jeremy Fernando, Sitting in the Dock of the bay, watching... * R.H. Jackson, Reading Eyes * Gina Rae Foster, Nyctoleptic Nomadism: The Drift/Swerve of Knowing * Bronwyn Lay, Driftwood * Patricia Reed, Sentences on Drifitng * David Prater, drift: a way * * * * * ‘Kraftledningarna / spända i köldens rike / norr om all musik.’ TOMAS TRANSTRÖMER Attention! You are not dreaming, you are drifting into sleep. You are feeling veeeerrry sleepy now. The curvature of the earth is causing you to shift away from the pinpoint that you circled yesterday on a map, your eyes hazed. That was also a today, in a novel fashion—the today of days long gone, of clouds long transformed into rain, or else snow drifts. That’s okay, you know this: in cathedrals of bone we find arcs that keep us warm. In drift- wood we find the puzzles that madden us all night, Tetris dreaming. In from our past, deriving steam, straight lines, axes, branches, kindling. Attention! Does anyone here speak Spanish? Si? Bueno! Dream with me. Cry out in your sleep. Step fearfully out onto the ice and drift awhile, inside a massive Perspex speech-bubble dream. A massive bubble longing to become detergent. The louvres of a ribcage snapping shut. Awe. Curvature of the earth is a con job: ask a dervish. Hail an imaginary cab in a hail-struck avenue and wait for the popcorn to drop. Stop, drifter! In the pharmacies and in the alleys, popping rocks while money men drift by in stockings, purling and unfurling their ways, their means. Attention, people!ion hurts. Reading too much into things I know nothing about, the niceness of the void or else a philosopher’s mouth sewn shut. I know about that, at least: the madness of seeking asylum in antipodean dreams, drifting for weeks at a time on a boat more abstract than surreal. Oh, fuck Life of Pi! Heaven basks like a warm, square meal but I can’t get there from here. There is no shark travelling at speed X while I zoom at speed Y in the opposite direction. I can’t use a lasso. I no longer have fits. I am no, mad. Too bad. Attention! Ambient doom slash moon. Over! The curvature of a yawn, a dream sewn shut. This skin, that knows my dreams, forgets me. Fruit tingles, wet on the tongue: get me some analogue hits, expressways to frozen, lakeside moon-dream voiceovers. The narrator’s cues infuse the afternoon, the canoes, with nostalgia. Somewhere, out there, we become driftories. We lie down in atoms and the clinamina bore. We fight against our own handwritten lies, type marching letters into files and save. Awe. Fidelity is a kind of surveillance. Current A. Attention! It was never my intention to score cheap points at the expense of polar bears, of driftwood, shores. The cockatoos roar. Their explosive chatter could strip a pine tree raw. Implant in me some destructive grace, to drift. Planetoid lamps all along the turnpike’s busy arcs. Extreme emissions of things. Drift-rings. The target of my gaze, sewn shut. Your eyes rising slower than a star from what you read, condensed into steam, here, north of all music. Driftories, signal fires, smoke: disappear. Go back to sleep now. No, we were never here. (shrink)

Are there limits to what it is morally okay to imagine? More particularly, is imaginatively inhabiting morally suspect perspectives something that is off-limits for truly virtuous people? In this paper, I investigate the surprisingly fraught relation between virtue and a familiar form of imaginative perspective taking I call empathy. I draw out a puzzle about the relation between empathy and virtuousness. First, I present an argument to the effect that empathy with vicious attitudes is not, in fact, something that (...) the fully virtuous person can indulge in. At least one prominent way of thinking about the psychology of the virtuous person excludes the possibility that the virtuous could emotionally apprehend the world in a less than virtuous way, and empathizing with vicious outlooks does seem to run afoul of that restriction. Then, I develop an argument that runs in the contrary direction: virtue in fact requires empathy with vicious outlooks, at least in some situations. There is reason to think that a crucial part of being virtuous is ministering effectively to others’ needs, and there is also reason to think that other people may need to be empathized with, even if their emotional outlooks are at least minorly vicious. Finally, I outline two different solutions to this puzzle. Both solutions hold some promise, but they also bring new challenges in their train. (shrink)

Okay, Professor Turner is not Rodney King. He is not responding to bioethicists and social scientists running amuck, setting automobiles aflame, and pelting each other with rocks and broken bottles. He does not come right out and ask, “Why can't we all just get along?” But in its academic way, Turner's essay is an effort to negotiate a truce in the interdisciplinary squabbles that plague bioethics, a plea to move bioethics beyond the “misleading” and “unhelpful” “demarcation of disciplinary goals” (...) that leads to “dichotomous thinking” and “polemical accusations.”. (shrink)

What is right with this “comic” of Euripides's timeless and irreplaceable drama, The Trojan Women, is what was always right about a play that is relentlessly relevant. Carson's translation, spare and clear, distills the language of the original but keeps what is important, including some mouth-puckeringly wry lines. There is barbed wit and heartbreaking lullaby, sometimes coinciding on one page. Thus, the chorus comments, “Troy, you made a bad deal: / ten thousand men for a single coracle of cunt appeal.” (...) In the middle of the same page, the Greek herald Talthybius addresses Hector and Andromache's infant son Astyanax, whom he has come to carry off so that the baby can be thrown from the battlements: “Come along, little mushroom, / little rootlet, little sip, little milk fly, little asterisk, little welkin, / little silhouette, little sugar bubble—/ let go of your mother. / She's broken.” Then lower down on the same page: “It's time for your infinite leap / as decreed by the vote of men. / Take him. / The man to transact things like this / is one who doesn't know pity.”What is wrong with this new rendering is Bruno's awkward, amateurish drawings. Yes, the chorus are all animals, as are all the main characters except mad Cassandra (a partial exception might be made for Menelaus, who is some kind of machine); but Bruno is no Art Spiegelman, and this is no Maus. Spiegelman's cats, pigs, and mice make perfect sense and are elegantly and clearly depicted; they add resonance to the story without raising further questions. In this Trojan Women, it makes sense that Hecuba is an old bitch or Helen a svelte fox in high heels. Poseidon, a wave: okay. But Talthybius, a colossal raven? Athena, “a big pair of overalls, carrying an owl mask in one hand”? Andromache, “a poplar tree with trunk split and roots dragging out the back of the cart”? The infant Astyanax whom Andromache cradles in one Ent-like arm looks more like a cocoon or a hornet's nest or a hypertrophied oak gall than anything else. Menelaus, when he arrives, is “some sort of gear box, clutch or coupling mechanism, once sleek, not this year's model.” These surreal leaps might well work on the stage or screen, but the need to explain them in the text shows how uncomfortably they fit into the story. Carson's explanations, of course, constitute her only significant departures from Euripides.We do not need Bruno's drawings; Carson's pared-down text might work quite well on its own. But even grant the hypothetical that these drawings are an organic and crucial part of this version's vision, then the drawings should not need to be explained. Less would be more. What this version of the classic drama gains in succinctness it loses in tonal clarity—having said which, I would still like to try it out on my students, who might help me to change my mind. Does this retelling of the story remain heartrending and cruel, suffused with irony, sharpened by flashes of wit? Yes. Was it worth the experiment of turning the tragedy into a comic? Sure. Is this uneasy mix of verbal mastery and wobbly draftsmanship the ultimate version of The Trojan Women? Nope. (shrink)

When we read, we do not fixate on each word! How does that work? By deep theory those sorts of decisions must be the result of complex decisions involving the specific “word,” the linguistic context in which it appears, and visual information. But is reading really all that difficult? After all, simple heuristics models of reading seem to do sort of okay by only considering the additive effects of word and context. Entropy measures do well at predicting word “skipping” (...) and suggest that “word frequency” may play the dominant role in the “decision” to skip or not skip! (shrink)

Should I break my promise? -- Should I tell people his secret? -- Can I cancel my plans with my friend? -- Why won't he trust me with his toy? -- Why didn't they believe me? -- Is it okay if I keep Maddie's shirt? -- Is it honest to stuff everything under Mary's bed? -- Should I tell my teacher the truth? -- Should I look at his paper and copy him? -- Activity.

Dialogue has its origins in joint activities, which it serves to coordinate. Joint activities, in turn, usually emerge in hierarchically nested projects and subprojects. We propose that participants use dialogue to coordinate two kinds of transitions in these joint projects: vertical transitions, or entering and exiting joint projects; and horizontal transitions, or continuing within joint projects. The participants help signal these transitions with project markers, words such as uh-huh, m-hm, yeah, okay, or all right. These words have been studied (...) mainly as signals of listener feedback (back-channel signals) or turn-taking devices (acknowledgment tokens). We present evidence from several types of well-defined tasks that they are also part of a system of contrasts specialized for navigating joint projects. Uh-huh, m-hm and yeah are used for horizontal transitions, and okay and all right for vertical transitions. (shrink)

Academic cheating, a common and consequential form of dishonesty, has puzzled moral psychologists and educators for decades. The present research examined a new theoretical approach to the perceptions, evaluations, and motivations that shape students’ decisions to cheat. We tested key predictions of this approach by systematically examining students’ accounts of their own cheating. In two studies, we interviewed undergraduates in psychology (n = 68) and engineering (n = 123) classes about their past experiences with plagiarism or other cheating. Interviews assessed (...) students’ perceptions of whether they were cheating, their evaluations of whether their actions were okay, and their motivations for doing what they did. Most students did not initially recognize their acts as cheating. While students generally thought cheating was wrong, they often judged the exceptional cases in which they cheated to be acceptable, citing concerns such as assignment goals and task feasibility. The findings suggest that perceptions, evaluations, and competing motivations play a key role in students’ decisions to cheat. (shrink)

Daly, Brendan About a month before my ordination as a priest on 7 May 1977, my diocesan bishop asked me to come and see him at his office. He said after my ordination I was going to be appointed to Mairehau parish as an assistant priest. Two weeks later I was making my pre-ordination retreat and the bishop arrived to see me. He was embarrassed and said 'We have a problem. One parish priest won't take the assistant priest that I (...) want to give him, and another assistant priest won't go where he is appointed, so the end result is that you are now going to Addington parish. Is that okay?' I replied 'Yes.' Both parishes were in Christchurch city, and I did not know either parish priest personally, so it really did not matter at all. However, two weeks later at my ordination ceremony, it came time for the promise of obedience. I knelt down before the bishop who asked me did 'I promise him and his successors obedience and respect.' At the same time as he said this I was conscious of the thought going through my mind, 'what does it all mean anyway?'. (shrink)

This article sets out a framework for distinguishing three kinds of norms governing past sexual (mis)conduct and our responses to it: wrongfulness norms, excusability norms, and accountability norms. The framework provides conceptual tools for making sense of (and understanding the limits of) three distinct responses commonly offered by those accused of past sexual misconduct: “But that used to be okay!” “But everybody used to think that was okay!” and “But that was so long ago!”.

In lieu of an abstract, here is a brief excerpt of the content:The Truth in WritingAmandaAn excerpt from my journal during a dark period in my life reads:I am a survivor of sexual mutilation, of coerced gender roles, and of perpetual lies all in the name of normalization. Sometimes I have a hard time even thinking about the true extent of what all happened. It’s like my mind doesn’t have that type of scope, like when I think about the word (...) “eternity.”I wrote this after combing through old medical records, reading comments like “her introitus has healed nicely and looks normal, but my exam suggests that her vagina is shortened,” and “reduction clitoroplasty... removal of testes.” The records go on to say that my “external genitalia is quite satisfactory,” and “on perineal exam, her neovaginal orifice is quite compliant and easily accepts my second and third digits.”My journal continues:I chose this fake hole when I was a teenager because I didn’t know there was another option. I was told from day one to be a female, to be heteronormative, to act like all the other girls, and the only way I could fully accomplish this is by looking the part. A fake hole would be necessary, I thought, to go along with the rest of the lies. Sometimes I think about how the doctors told me to lie about my surgeries and my scars. Sometimes I wonder what my parents would have told the world if I had died during one of surgeries. Maybe they would have said “we were just trying to make her fuckable.”My strength is growing from the stories and experiences I write and share. My journal started about four years ago, when I was in my early 20s, near the beginning of medical school. My initial purpose in writing the journal was to help sort through my feelings and experiences related to a newly discovered sexuality and a changing gender identity. Medical school was thousands of miles away from my previous life, my family, and my friends. Away from my old social network, I was free to self–discover on my own terms. In the first journal entry, I lay out reasons why I decided to get in contact with a therapist, something I had not done previously. Some of the reasons were fairly standard reasons one seeks out a therapist, such as moving away from home. But the fundamental reasons I sought out a therapist, and why I chose to journal, had to do with exploring feelings after my first sexual encounter with a woman, and then [End Page 98] accepting my intersexuality. My relationship with that therapist did not last, but the journaling did.In the beginning of the journal, I write:I am from a small, religious, white, non–diverse, family oriented suburb of Milwaukee. I was raised to be the picture–perfect daughter in a household that did not talk about feelings, sex, cultural or religious differences, etc. My brother and I also never talked about personal issues (and still don’t), which is quite remarkable since we are twins, and have grown up doing most everything together, from sharing birthday parties, to being locker buddies... [When my mother told me about having Androgen Insensitivity Syndrome (AIS)] knowing this little fact about my body kept me wanting to become as perfectly female in all ways possible.Growing up without being able to talk about having AIS was stifling to say the least. Closing communication implied great shame, and with the shame came even greater repression. My skate-boarding, baseball card collecting, and model car building interests disappeared after learning about my AIS, which I believe was when I was 12 years old, but I cannot remember exactly. Granted, it’s tough to say whether my interests just changed as I grew older, but I do remember having a fear of portraying any masculine tendencies that other girls in my town weren’t displaying (for example, playing soccer was okay, but I had to shave my legs). I also had crafted some pretty good covers for my AIS, including stories about when I first had my (fake) period, or how I acted fearful about a... (shrink)

The only contemporary moral problems text to focus directly on the ethics of current, divisive political issues, Ethics, Left and Right features newly commissioned essays on twenty contentious debates, written expressly with undergraduate students in mind. It offers two position pieces on each issue--one left-leaning, one right--followed by a reply from each author, giving you and your students the opportunity to engage in in-depth discussions of serious issues. The essays cover compelling topics including whether we should have an "America First" (...) approach to policy, whether it's okay to have religious tests for immigration, the merits of political correctness, the ethics of voting, whether progressive taxation is legitimate, and what to make of accusations of privilege. Case studies at the end of every main contribution encourage students to examine related problems and/or delve deeper into the current issue. (shrink)

Prominent theories in moral psychology maintain that a core aspect of moral competence is the ability to distinguish moral norms, which derive from universal principles of justice and fairness, from conventional norms, which are contingent on a specific group consensus. The present study investigated the psychological bases of the moral-conventional distinction by manipulating the framing of the test question, the authority’s license, and the historical context. Participants evaluated moral and conventional transgressions by answering an ‘okay for you’ test question (...) (i.e., judging according to their opinion) or an ‘okay in context’ test question (i.e., judging by imagining being a contemporary of the story protagonist). In evaluating moral transgressions that happened in a distant context or with the authority’s license, most of the participants condemned the violations when responding to the ‘okay for you’ test question, but did not do so when responding to the ‘okay in context’ test question. A similar effect of the question framing was found also on scenarios presenting conventional violations suggesting that subtle changes in the framing of the test question can influence people’s evaluations of both moral and conventional prototypical transgressions. We propose that these effects indicate the presence of moral and conventional construals of social actions that are highly flexible and context-sensitive. (shrink)

This paper looks at three ways of addressing probabilism’s implausible requirement of logical omniscience. The first and most common strategy says it’s okay to require an ideally rational person to be logically omniscient. I argue that this view is indefensible on any interpretation of ‘ideally rational’. The second strategy says probabilism should be formulated not in terms of logically possible worlds but in terms of doxastically possible worlds, ways you think the world might be. I argue that, on the (...) interpretation of this approach that lifts the requirement of certainty in all logical truths, the view becomes vacuous, issuing no requirements on rational believers at all. Finally, I develop and endorse a new solution to the problem. This view proposes dynamic norms for reasoning with credences. The solution is based on an old proposal of Ian Hacking’s that says you’re required to be sensitive to logical facts only when you know they are logical facts. (shrink)

Human adults incline toward moral objectivism but may approach things more relativistically if different cultures are involved. In this study, 4-, 6-, and 9-year-old children (N = 136) witnessed two parties who disagreed about moral matters: a normative judge (e.g., judging that it is wrong to do X) and an antinormative judge (e.g., judging that it is okay to do X). We assessed children’s metaethical judgment, that is, whether they judged that only one party (objectivism) or both parties (relativism) (...) could be right. We found that 9-year-olds, but not younger children, were more likely to judge that both parties could be right when a normative ingroup judge disagreed with an antinormative extraterrestrial judge (with different preferences and background) than when the antinormative judge was another ingroup individual. This effect was not found in a comparison case where parties disagreed about the possibility of different physical laws. These findings suggest that although young children often exhibit moral objectivism, by early school age they begin to temper their objectivism with culturally relative metaethical judgments. (shrink)

In the twenty-first century, the debate about life on other worlds is quickly changing from the realm of speculation to the domain of hard science. Within a few years, as a consequence of the rapid discovery by astronomers of planets around other stars, astronomers very likely will have discovered clear evidence of life beyond the Earth. Such a discovery of extraterrestrial life will change everything. Knowing the answer as to whether humanity has company in the universe will trigger one of (...) the greatest intellectual revolutions in history, not the least of which will be a challenge for at least some terrestrial religions. Which religions will handle the discovery of extraterrestrial life with ease and which will struggle to assimilate this new knowledge about our place in the universe? Some religions as currently practiced appear to only be viable on Earth. Other religions could be practiced on distant worlds but nevertheless identify both Earth as a place and humankind as a species of singular spiritual religious importance, while some religions could be practiced equally well anywhere in the universe by any sentient beings. Weintraub guides readers on an invigorating tour of the world's most widely practiced religions. It reveals what, if anything, each religion has to say about the possibility that extraterrestrial life exists and how, or if, a particular religion would work on other planets in distant parts of the universe. (shrink)

Life is pointless. That’s not okay. I show that. I argue that a point is a valued end and that, as agents, it makes sense for us to want our efforts and enterprises to have a point. Valued ends provide justifying reasons for our acts, efforts, and projects. I further argue that ends lie separate from the acts and enterprises for which they provide a point. Since there can be no end external to one’s entire life since one’s life (...) includes all of one’s ends, leading and living one’s life as a whole cannot have a point. Finally, I argue that since we live our lives and structure our living­a­human­life efforts both in parts and as a whole, it is fitting to be sad to recognize that leading and living a life is pointless. My discussion helps make sense of the literature that frequently talks around this topic but often does so vaguely and indirectly. (shrink)

Mimicry of appearance or of facial, vocal, or gestural expressions emerges frequently among members of different species. When such mimicry directly relates to affective aspects of an interaction, researchers talk about “emotional mimicry”. Emotional mimicry has been amply documented but its functionality is still debated. Why and when do people mimic the expressions of others, who benefits, the mimicker or the mimicked, and how do they benefit? Which processes underlie emotional mimicry? Is it completely automatic and unconscious or can it (...) be deliberate and conscious? The current Theory Section addresses these questions from different theoretical perspectives. The invited article by Hess and Fischer focused on the role of mimicry in social regulation and social bonding. The invited comment by Krets and Akyüz highlights information gathering and prediction in social interaction. The invited comment by Bernhold and Giles emphasizes vocal communication and its role in interpersonal accommodation. In this editorial, I propose the different theoretical perspectives may be integrated by assuming a multilevel appraisal and response generation mechanism. I also suggest that emotional mimicry research may be broadened by including social learning, vocal imitation, interspecies comparisons, and affective computing approaches. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:“We Need to Cut the Neck!”Confronting Psychological and Moral Distress during Emergency Cricothyrotomy1Stephanie CooperEnoughYou didn’t die in the ER, but rather, began your inexorable demise. The last, first, and only words I ever heard you utter was the weak mewl “tight, tight” as the blood pressure cuff constricted your left arm. You were 98–years–old, bed–bound, at the end. Your world was already partitioning itself from us, your brain tunneling (...) down the uneven corridors of consciousness. A concretion of otoliths muffled your hearing, and fatigue burdened your ancient heart.Your name–band encircled your skinny ankle like a bird. Deformed by arthritis, you were caged within yourself, imprisoned by senescence. You could not declare yourself to us. Words disintegrated into moans and your grimace became animal.When you came back from x–ray—hypotensive with multiple neck fractures confirmed—you could speak no more. Your pulse slowed, your blood pressure plummeted. I jammed a gloved finger against your femoral pulse, faint and tired. [End Page E5]“What’s her DNR status?” I gravely asked your nurse.The DNR paperwork for once had arrived with the patient. “No CPR” she said with relief. But then the paperwork went on, forcing me—the waitress of tragedy—to serve up the hash of an impossible menu.As health care providers, we are all often tasked with performing contradictory actions: the pain of IV insertion followed by the morphine push, drilling deeper into broken bone in order to plate it, the inadvertent cracking of ribs during chest compressions. We sometimes must perform violent action in the hope of sustaining and resurrecting life. We are asked to perform the impossible, the contradictory, the painful. And sometimes the actions we must take catalyze an inexorable chain reaction of actions, which can end in death–prolonging and painful interventions that we did not intend.Although our culture may imagine that one can choose one’s meal at the end–of–life fast–food franchise of death, such is not the case. You can’t suddenly decide you’re a vegetarian. You can’t order the cheeseburger without the cheese—and we all are getting the burger, in the end. Ordering the heart–squeezing drugs without the CPR to circulate them, or the antibiotics without the fluid to counter dehydration, is like ordering the burger without the bun. Sometimes the possible choices are not necessarily realistic choices. You get served what you get served, and perhaps we should question the assumption that we have the ability to choose at all.Your DNR form proclaimed no CPR but then said that antibiotics and intubation were okay—the cheeseburger without the cheese. An unfortunate choice for you, me, and the rest of us, as your death menu led to a very unhappy meal.You were comatose. I stuck a tongue blade deep into your desiccated throat. You did not gag. This means I should have intubated you, but morally, I couldn’t. To what end? You were 98 years old, broken, moribund. If you hadn’t suffered multiple neck fractures, or if you were a vibrant elder who had just walked off Mt. Rainier, maybe the story would have been different. But you? I doubted that you truly had a chance of ever feeling joy again. You were somebody’s wife, somebody’s mother. I knew this step would lead to the domino of unstoppable steps. I refused to flog your corpse.I called your daughter Kay on her cell phone, told her that you were in critical condition and that she should come to the ER immediately. But how to begin to tell a daughter her mother is dying, let alone over a cell phone? Gentle but surreal and impersonal, my voice tried to tell your daughter that the interventions you needed would likely kill you. I have seen enough human suffering to know. To me, the choices were clear: death by nature’s irrefutable course, versus a more painful, protracted, and violent death by what we’d do to you.Kay arrived in a wheelchair and scooted up to your bedside. Like all daughters, she wasn’t ready for you... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:How We Keep Caring While Walking Through Our PainOla Ziara and Rachel CoghlanAuthor Dedication. To my dear brother Omar Ziara, a bright doctor, entrepreneur, and community advocate who was killed in an Israeli bombing in November 2023.May your soul rest in peace and may your memory remain alive in our hearts. May your unborn child grow up to become the wonderful man that you were. Forever loved by all.Palestinian-American (...) poet, Suheir Hammad, writes:Occupation means that every day you die, and the world watches in silence. As if your death was nothing, as if you were a stone falling in the earth, water falling over water.And if you face all of this death and indifference and keep your humanity, and your love and your dignity and you refuse to surrender to their terror, then you know something of the courage that is Palestine.I am a doctor from the Gaza Strip in Palestine. I live through acute war and protracted occupation. I work under missiles and through scant resources. I experience risks and dangers and face abominable choices made from nightmares. I know heartbreaking death.As doctors here, we fear, suffer, cry, and grieve alongside our patients and their families. This is my story of how we continue to care.Summer 2014 A Fifty-Two-Day War: How To Stay And How To Keep Them SafeThe huge bombardment strikes close to the hospital, scattering glass and rubble. It brings an abrupt end to my rare, quiet pause for coffee. Are the babies hit? We sprint to the Neonatal Intensive Care Unit, our full attention only on those infants, hastily checking every crib. My thoughts are frenzied. What if the next missile strikes us? Will I be able to rescue them? Will I have time to carry their tiny bodies outside through wreckage and fire? How will I choose who to save, and who to leave behind? Could I choose? Will I even be able to think lucidly, act logically for those babies if the fire consumes us? We stay.Somewhere, a house razed to the ground, a mother and her children dead. This time, our babies are safe.Summer 2014 A Fifty-Two-Day War: How To Cast Off Danger And How To Find ConsolationA missile shatters our neighbour’s roof. I am about to leave home for my evening shift. I check on my shaking mum; she is okay, not hurt at least. I ring the senior doctor. I am sorry. I am coming. I will be a little late. Two further missiles hit, wiping out the next-door building completely. No, do not send an ambulance for me. It is too dangerous. I will come [End Page 153] alone. Trembling through the dust and darkness, I leave on foot to reach those babies. I must compose myself. We are needed there to bring calm, to keep caring.And we gamble our lives to seek distraction and comfort for ourselves. We find solace through unbearable pain in our caring.Winter, Spring, Autumn, Summer, Any Day: How To Question Purpose And How To Feel HelplessIt is an ordinary night shift in ‘quiet’ times. Tonight, all the beds are occupied. All the ventilators are taken, forcing life into small, sick faces. At dawn, the phone call comes. A new baby struggling to breathe is on his way. I call around. No more beds to take him here or anywhere. No more ventilators—here or anywhere. Bring him here. We will care for him.He is in a very bad way. He needs immediate life-saving care. We take turns manually ventilating him, working to the hissing rhythm of the Ambu Bag1—inflating, deflating, inflating. Our arms ache. We keep pumping the bag. Do not stop. The moment when the morning shift arrives is our moment of salvage. We can go home. We have made it through the night without medicines, machines, disposables, or enough manpower, our arms throbbing. We have kept him alive.But he is so fragile, the system is fragile, we are fragile. Dare I even ask—is it worth it? Is it worth a baby surviving the... (shrink)