In response to national trends calling for increasing accountability and an emerging dialogue within bioethics, we describe an effort to credential clinical ethicists at a major academic medical center. This effort is placed within the historical context of prior calls for credentialing and certification and efforts currently underway within organized bioethics to engage this issue. The specific details, and conceptual rationale, behind the New York-Presbyterian Hospital’s graduated credentialing plan are shared as is their evolution and ratification within the context of (...) institutional policy. While other programs will design their credentialing schema consistent with their local context and demographics, the description of one such effort is offered to be instructive to others who want to bring additional standardization to the assessment of the readiness and credentials of those who will engage in the practice of clinical ethics case consultation. (shrink)

Blending social analysis and philosophy, Albert Borgmann maintains that technology creates a controlling pattern in our lives.

The COVID-19 pandemic swept through New York City swiftly and with devastating effect. The crisis put enormous pressure on all hospital services, including the clinical ethics consultation team. This report describes the recent experience of the ethics consultants and Columbia University Irving Medical Center during the COVID-19 surge and compares the case load and characteristics to the corresponding period in 2019. By reporting this experience, we hope to supplement the growing body of COVID-19 scientific literature and provide details of the (...) human toll the virus took on our hospitals and communities. We also aim to highlight the role of the clinical ethics consultant as well as areas of policy and law that may need to be addressed in order to be better prepared for a future public health crisis. (shrink)

The COVID-19 pandemic that struck New York City in the spring of 2020 was a natural experiment for the clinical ethics services of NewYork-Presbyterian (NYP). Two distinct teams at NYP’s flagship academic medical centers—at NYP/ Columbia University Medical Center (Columbia) and NYP/ Weill Cornell Medical Center (Weill Cornell)—were faced with the same pandemic and operated under the same institutional rules. Each campus used time as an heuristic to analyze our collective response. The Columbia team compares consults during the pandemic with (...) the same period during the year prior. The Weill Cornell service describes the phases of the pandemic to depict its temporal evolution and subsequent ethical challenges. Both sites report that the predominant ethical challenges centered around end-of-life decision making, setting goals of care, and medical futility, all complicated by resource allocation questions and the ambiguity of state law under crisis standards of care. The Columbia campus saw a statistically significant increase in ethics consultations provided to Hispanic patients, perhaps reflective of the disproportionate burden of COVID-19 suffered by this demographic. While Weill Cornell and Columbia saw a surge in clinical ethics consultations, the two services assumed a more expansive role than one normally played in institutional life. Serving as intermediaries between frontline clinicians and senior hospital administrators, consultants provided critical intelligence to hospital leadership about the evolution of the pandemic, disseminated information to clinicians, and attended to the moral distress of colleagues who were asked to provide care under truly extraordinary circumstances. The COVID-19 surge in New York City revealed latent capabilities in ethics consultation that may prove useful to the broader clinical ethics community as it responds to the current pandemic and reconceptualizes its potential for future service. (shrink)

Almaatouq et al. argue that an “integrative experiment design” approach can help generating cumulative empirical and theoretical knowledge. Here, we discuss the novelty of their approach and scrutinize its promises and pitfalls. We argue that setting up a “design space” may turn out to be theoretically uninformative, inefficient, and even impossible. Designing truly diagnostic experiments provides a better alternative.

From mid-March through May 2020, New York City was the world’s epicenter of the COVID-19 pandemic, and its hospitals faced an unparalleled surge of patients who were critically ill with the virus. In addition to putting an enormous strain on medical resources, the pandemic presented many ethical issues to emotionally and physically stressed clinicians and hospital administrators. Analyses of the challenges faced by the ethics consultation services of the two campuses of New York Presbyterian Hospital, and how they assisted their (...) clinician and administrative colleagues, is the subject of the following four articles. (shrink)

The major divide in contemporary epistemology is between those who embrace and those who reject a priori knowledge. Albert Casullo provides a systematic treatment of the primary epistemological issues associated with the controversy. By freeing the a priori from traditional assumptions about the nature of knowledge and justification, he offers a novel approach to resolving these issues which assigns a prominent role to empirical evidence. He concludes by arguing that traditional approaches to the a priori, which focus primarily on (...) the concepts of necessity and analyticity, are misguided. (shrink)

One of the most influential works of this century, The Myth of Sisyphus and Other Essays is a crucial exposition of existentialist thought. Influenced by works such as Don Juan and the novels of Kafka, these essays begin with a meditation on suicide; the question of living or not living in a universe devoid of order or meaning. With lyric eloquence, Albert Camus brilliantly posits a way out of despair, reaffirming the value of personal existence, and the possibility of (...) life lived with dignity and authenticity. (shrink)

Substituted judgement is often used in the absence of advanced directives to guide decision-making when patients lack decisional capacity. We present a remarkable case of family members exercising substituted misjudgement for a 42-year-old man hospitalized with multiorgan failure on life support. Feeling that their loved one would rather die than face severe disability, they elected to withdraw life support. Although this was done, the patient remained alive and recovered enough to clearly indicate his preference for life, even with severe disability. (...) This case suggests that in instances of unusual quality-of-life judgements where the patient's wishes cannot be known with reasonable certainty, families and physicians should be very wary using substituted judgement to refuse life support. Unless there are strong considerations based on the patient's prior statements, actions and values to decline life support, it would seem ethically appropriate to continue treatment, even with substantial disability the likely outcome. (shrink)

Charles Sanders Peirce is generally regarded as the founder of pragmatism, and one of the greatest ever American philosophers. Peirce is also widely known for his work on truth, his foundational work in mathematical logic, and an influential theory of signs, or semiotics. Albert Atkin introduces the full spectrum of Peirce’s thought for those coming to his work for the first time. The book begins with an overview of Peirce’s life and work, considering his early and long-standing interest in (...) logic and science, and highlighting important views on the structure of philosophical thought. Atkin then explains Peirce’s accounts of pragmatism and truth examining important later developments to these theories. He then introduces Peirce’s full accounts of semiotics, examines his foundational work on formal and graphical logic, and introduces Peirce’s account of metaphysics, the least understood aspect of his philosophy. The final chapter considers Peirce’s legacy and influence on the thought of philosophers such as John Dewey and Richard Rorty, as well as highlighting areas where Peirce’s ideas could still provide important insights for contemporary philosophers. Including chapter summaries, suggestions for further reading and a glossary, this invaluable introduction and guide to Peirce’s philosophy is essential reading for those new to his work. (shrink)

America is a wonderful and magnificent country that affords its citizens the broadest freedoms and the greatest prosperity in the world. But it also has its share of warts. It is embroiled in a war that many of its citizens consider unjust and even illegal. It continues to ravage the natural environment and ignore poverty both at home and abroad, and its culture is increasingly driven by materialism and consumerism. But America, for better or for worse, is still a nation (...) that we have built. So why then, asks Albert Borgmann in this most timely and urgent work, are we failing to take responsibility for it? In Real American Ethics , Borgmann asks us to reevaluate our role in the making of American values. Taking his cue from Winston Churchill—who once observed that we shape our buildings, and then our buildings shape us—Borgmann considers the power of our most enduring institutions and the condition of our present moral makeup to propose inspired new ways in which we, as ordinary citizens, can act to improve our country. This, he shows, includes everything from where we choose to live and what we spend our money on to daunting tasks like the reshaping of our cities—habits and actions that can guide us to more accomplished and virtuous lives. Using prose that is easy and direct throughout, Borgmann’s position is grounded neither by conservative nor liberal ideology, but in his understanding that he is a devoted citizen among many. In an age in which the blame game is the only game in town, this patriotic book is an eloquent reminder of the political strength we all wield when we work together. (shrink)

Holding On to Reality is a brilliant history of information, from its inception in the natural world to its role in the transformation of culture to the current Internet mania and is attendant assets and liabilities. Drawing on the history of ideas, the details of information technology, and the boundaries of the human condition, Borgmann illuminates the relationship between things and signs, between reality and information. "[Borgmann] has offered a stunningly clear definition of information in Holding On to Reality.... He (...) leaves room for little argument, unless one wants to pose the now vogue objection: I guess it depends on what you mean by nothing."—Paul Bennett, Wired "A superb anecdotal analysis of information for a hype-addled age."—New Scientist "This insightful and poetic reflection on the changing nature of information is a wonderful antidote to much of the current hype about the 'information revolution.' Borgmann reminds us that whatever the reality of our time, we need 'a balance of signs and things' in our lives."—Margaret Wertheim, LA Weekly. (shrink)

At the core of Presenting the Past is the dramatic and troubling case of a woman who during the course of her analysis began to recall scenes of her own ...

How do otherwise considerate human beings do cruel things and still live in peace with themselves? Drawing on his agentic theory, Dr. Bandura provides a definitive exposition of the psychosocial mechanism by which people selectively disengage their moral self-sanctions from their harmful conduct. They do so by sanctifying their harmful behavior as serving worthy causes; they absolve themselves of blame for the harm they cause by displacement and diffusion of responsibility; they minimize or deny the harmful effects of their actions; (...) and they dehumanize those they maltreat and blame them for bringing the suffering on themselves. Dr. Bandura's theory of moral disengagement is uniquely broad in scope. Theories of morality focus almost exclusively at the individual level. He insightfully extends the disengagement of morality to the social-system level through which large-scale inhumanities are perpetrated...Moral disengagement will transform your thinking about how otherwise considerate people can behave inhumanely and still feel good about themselves." -- Book jacket. (shrink)

E. J. Lowe offers an account of modal knowledge that involves two primary theses. First, the basis of modal knowledge is essential knowledge, and the source of essential knowledge is grasp of essence. Second, all empirical knowledge ultimately depends on some modal knowledge. This article assesses Lowe’s account and defends four conclusions. First, there is a tension in Lowe’s account of grasp of essence; it wavers between an undemanding version, which holds that grasp of essence requires no more than our (...) ordinary understanding of propositions, and a more demanding version, which holds that it requires rational insight into necessary relationships between essences. Second, both versions face serious challenges. Third, Lowe’s account of knowledge of essence does not provide a basis for modal knowledge. Fourth, Lowe’s supporting argument for his second thesis contains two significant gaps and the principles necessary to close the gaps reveal further tensions in his epistemological views. (shrink)

Translated by Anthony Bower With an Introduction by Oliver Todd 'A conscience with style' V.S. Pritchett The Rebel (1951) is Camus's 'attempt to understand the time I live in' and a brilliant essay on the nature of human revolt. Here he makes a daring critique of communism - how it had gone wrong behind the Iron Curtain and the resulting totalitarian regimes. And he questions two events held sacred by the left wing - the French Revolution of 1789 and the (...) Russian Revolution of 1917 - that had resulted, he believed, in the use of terrorism as a political instrument. In this towering intellectual document, Camus argues that hope for the future lies in revolt with revolution - a chance to achieve change without losing our freedom. 'The last French intellectual to take the side of humanity and talk its language... a figure of immense moral stature' Sunday Times Winner of the Nobel Prize for Literature. (shrink)

Albert approaches critical rationalism as an alternative to other philosophical standpoints dominant in Germany: the conceptions of the Frankfurt School, hermeneutical thinking as represented by Gadamer, analytic philosophy, and logical empiricism. The author's purpose is to find a way out of the foundationalism of classical philosophy without falling back on the skeptical views so prevalent in today's philosophical thinking. Originally published in 1985. The Princeton Legacy Library uses the latest print-on-demand technology to again make available previously out-of-print books from (...) the distinguished backlist of Princeton University Press. These editions preserve the original texts of these important books while presenting them in durable paperback and hardcover editions. The goal of the Princeton Legacy Library is to vastly increase access to the rich scholarly heritage found in the thousands of books published by Princeton University Press since its founding in 1905. (shrink)

In this eloquent guide to the meanings of the postmodern era, Albert Borgmann charts the options before us as we seek alternatives to the joyless and artificial culture of consumption. Borgmann connects the fundamental ideas driving his understanding of society's ills to every sphere of contemporary social life, and goes beyond the language of postmodern discourse to offer a powerfully articulated vision of what this new era, at its best, has in store. "[This] thoughtful book is the first remotely (...) realistic map out of the post modern labyrinth."—Joseph Coates, _The Chicago Tribune_ "Rather astoundingly large-minded vision of the nature of humanity, civilization and science."—_Kirkus Reviews_. (shrink)

Peirce's Sign Theory, or Semiotic, is an account of signification, representation, reference and meaning. Although sign theories have a long history, Peirce's accounts are distinctive and innovative for their breadth and complexity, and for capturing the importance of interpretation to signification. For Peirce, developing a thoroughgoing theory of signs was a central philosophical and intellectual preoccupation. The importance of semiotic for Peirce is wide ranging. As he himself said, “[…] it has never been in my power to study anything,—mathematics, ethics, (...) metaphysics, gravitation, thermodynamics, optics, chemistry, comparative anatomy, astronomy, psychology, phonetics, economics, the history of science, whist, men and women, wine, metrology, except as a study of semiotic”. (SS 1977, 85–6). Peirce also treated sign theory as central to his work on logic, as the medium for inquiry and the process of scientific discovery, and even as one possible means for 'proving' his pragmatism. Its importance in Peirce's philosophy, then, cannot be underestimated. -/- Across the course of his intellectual life, Peirce continually returned to and developed his ideas about signs and semiotic and there are three broadly delineable accounts: a concise Early Account from the 1860s; a complete and relatively neat Interim Account developed through the 1880s and 1890s and presented in 1903; and his speculative, rambling, and incomplete Final Account developed between 1906 and 1910. The following entry examines these three accounts, and traces the changes that led Peirce to develop earlier accounts and generate new, more complex, sign theories. However, despite these changes, Peirce's ideas on the basic structure of signs and signification remain largely uniform throughout his developments. Consequently, it is useful to begin with an account of the basic structure of signs according to Peirce. (shrink)

Geraud de Cordemoy, 1600-1684 -- Clerselier, 1614-1684, and Rohault, 1620-1675 -- Louis de la Chambre, 1594-1669 -- Samuel Sorbière, 1615-1670 -- Louis de la Forge and the critique of substantial forms -- Cartesian doctrine and the animal soul -- Clauberg and the development of occasionalism -- Some historical steps towards parallelism -- Cartesian refutations of Spinoza -- Matter and scientific efficiency -- Man, Thomistic and Cartesian.

Although the index is one of the best known features of Peirce's theory of signs there is little appreciation of Peirce's theory of the index amongst contemporary philosophers of language. Amongst Peirce scholars, the value placed on Peirce's account is greater, but is largely based on Thomas Goudge's paper, "Peirce's Index" (Goudge, 1965). Despite marking a crucial milestone in our comprehension of Peirce's theory, our understanding of indices and indexical reference has grown markedly over the last forty years. Time has (...) now come, then, to develop the work that Goudge began and to provide a full analysis of Peirce's account that makes its value to the philosophy of language clear. I undertake this enterprise here. (shrink)

This research explores the experiences of UK NHS healthcare professionals working with asylum applicants housed in contingency accommodation during the COVID-19 pandemic. Using a critical understanding of the concept of moral resilience as a theoretical framework, we explore how the difficult circumstances in which they worked were navigated, and the extent to which moral suffering led to moral transformation. Ten staff from a general practice participated in semistructured interviews. Encountering the harms endured by people seeking asylum prior to arrival in (...) the UK and through the UK’s ‘Hostile Environment’ caused healthcare staff moral suffering. They responded to this in several ways, including: (1) feeling grateful for their own fortunes; (2) defining the limitations of their professional obligations; (3) focusing on the rewards of work and (4) going above and beyond usual care. Although moral resilience is reflected in much of the data, some participants described how the work caused ideological transformations and motivated challenges to systems of oppression. We show how current moral resilience theory fails to capture these transformative political and social responses, warning of how, instead, it might encourage healthcare staff to maintain the status quo. We caution against the widespread endorsement of current formulations of moral resilience in contemporary social and political climates, where the hostile and austere systems causing suffering are the result of ideological political decisions. Future work should instead focus on enabling working conditions to support, and developing theory to capture, collective resistance. (shrink)

Corporate transgression is a well-known phenomenon in today's business world. Some corporations are involved in violations of law and moral rules that produce organizational practices and products that take a toll on the public. Social cognitive theory of moral agency provides a conceptual framework for analyzing how otherwise pro-social managers adopt socially injurious corporate practices. This is achieved through selective disengagement of moral self-sanctions from transgressive conduct. This article documents moral disengagement practices in four famous cases of corporate transgressions and (...) discusses some implications for business ethics on how to counteract organizational use of moral disengagement strategies. (shrink)

"Race" is so highly charged and loaded a concept it often hampers critical thinking about racial practice and policy. A philosophical approach allows us to isolate and analyse the key questions: What is race? Can we do without race? What is racism and why is it wrong? What should our policies on race and racism be? The Philosophy of Race presents a concise and up-to-date overview of the central philosophical debates about race. It then builds on this philosophical foundation to (...) analyse the sociopolitical questions of racism and race-relevant policy. Throughout, the discussion is illustrated with a wide range of examples: Afro-American 'blackness'; British-Asian racial formation; Aboriginal identity in Australia; the racial grouping of Romany-Gypsies and Jews in Europe; categories of race in Brazil; and the concept of model minorities in the US and UK. (shrink)

This paper examines the view that ordinary particulars are complexes of universals. Russell's attempt to develop such a theory is articulated and defended against some common misinterpretations and unfounded criticisms in Section I. The next two sections address an argument which is standardly cited as the primary problem confronting the theory: (1) it is committed to the necessary truth of the principle of the identity of indiscernibles; (2) the principle is not necessarily true. It is argued in Section II that (...) a proponent of the theory need not accept (1) and an argument against (2) is presented in Section III. The final section attempts to show that Russell's theory ultimately fails because of inadequacies in its treatment of space and time. The paper closes with a suggestion for remedying this difficulty. (shrink)

Some 30 years ago the role of the clinical ethics consultant (CEC) was formalized. At the time, the perception of the role differed between two groups serving in that capacity, clinicians and nonclinicians. Differences in their roles reflected their training and experience.These divergent views were resolved semantically by designating the role of the CEC as “ethics facilitation.” In practice the different perspectives have remained. However, the subsequent published literature on clinical ethics consultation has not adequately reflected the activity of the (...) clinician as a CEC.There have been recurring unanswered calls for the acquisition of empirical data on the nature of the problems that prompt ethics consultation requests and the functions required to address them. The authors introduce a template that provides a means to acquire such data for clinician ethicists. A similar instrument could be constructed to reflect the role of the nonclinician ethicist serving in that capacity. (shrink)

The past twenty-five years have seen a major renewal of interest in the topic of a priori knowledge. In the sixteen essays collected here, which span this entire period, philosopher Albert Casullo documents the complex set of issues motivating the renewed interest, identifies the central epistemological questions, and provides the leading ideas of a unified response to them.

« Qu'est-ce qu'un homme révolté? Un homme qui dit non. Mais s'il refuse, il ne renonce pas : c'est aussi un homme qui dit oui, dès son premier mouvement. »[réf. nécessaire] D'apparence, il existe une limite à la révolte. Cependant, la révolte est un droit. La révolte naît de la perte de patience. Elle est un mouvement et se situe donc dans l'agir. Elle se définit par le « Tout ou Rien », le « Tous ou Personne ». En premier, (...) elle soumet l'idée d'égalité : position d'égal à égal entre le maître et l'esclave. Mais le révolté finit par imposer cette égalité qui se traduit souvent par une inversion des rôles (dialectique hégélienne). Suivant le raisonnement de Scheler, l'homme révolté n'est pas l'homme du ressentiment, c'est-à-dire qu'il ne baigne ni dans la haine ni dans le mépris. La révolte enfante des valeurs. De fait, « pour être, l'homme doit se révolter ». La révolte extirpe l'homme de la solitude puisqu'elle est collective, c'est l'« aventure de tous ». Néanmoins, faire l'expérience de la révolte, c'est faire l'expérience de l'ascèse. Les mythes de Prométhée, d'Achille (avec Patrocle), d'OEdipe et d'Antigone, sont des archétypes de révoltes antiques au même titre que la révolte de Spartacus. La révolte est souvent légitime, elle est l'expression la plus pure de la liberté et semble revêtir le visage de l'espoir. De surcroît, la révolte impose une tension, elle refuse donc formellement le confort de la tyrannie ou de la servitude. Le révolutionnaire a la volonté de « transformer le monde » (Marx) alors que le révolté veut « changer la vie » (Rimbaud). (shrink)

Debates over the reality of race often rely on arguments about the connection between race and science—those who deny that race is real argue that there is no significant support from science for our ordinary race concepts; those who affirm that race is real argue that our ordinary race concepts are supported by scientific findings. However, there is arguably a more fundamental concern here: How should we define race concepts in the first place? The reason I claim that this definitional (...) question is more fundamental is that our handling of the underlying definitional problem often determines the scientific support our ordinary race concepts need, and importantly the likelihood of finding such support. In short, the defini- tional question, “How do we define race?” often undercuts the question of whether race is scientifically meaningful. (shrink)

How to mobilize a traumatic national history on behalf of a less fractured polity? How to gain closure over a past that bifurcates the nation and establishes (at least) two national histories — history as told by the victims and by the perpetrators, now to be replaced by a history, as Mark Sanders (2003: 79) describes it, not of `bare facts but, at a crucial level, a history judged, and thus shaped, according to norms of universal human rights'. How to (...) engineer through politics the creation of new national selves, no longer pathologically attached to old and circumscribed forms of identification? These are now the critical questions confronting many elites: the overcoming of traumatic memory through various publicly mandated `technologies of the self'. To heal the nation requires the curing of the self. The politics of social repair understands itself largely through a psychologically inflected vocabulary of regret, apology, and forgiveness — the language of reconciliation. `Social cure', or reconciliation is understood as a process of social healing. In the face of traumatic ruptures in the body politic, in short, governments have sought to repair past wrongs and to heal an emotionally infirmed community. Such politics imply that societies have the capacity to repair themselves, to overcome traumatic pasts, just as an individual possesses the potential to overcome his or her own psychic trauma and fragmentation. But what evidence is there to support the claim that trauma — even for the individual — can be overcome, that history can be overridden, that forgiveness is possible? Psychoanalysis offers the most fully developed systematic body of work embracing a concept of the healing of the self. The article's aim, based upon an empirically derived (case-based) psychoanalysis, is to move toward a more robust theory of self-transformation and political reconciliation in post-traumatic communities. Thus, the article considers contemporary psychoanalytic evidence and asks of it the following questions: How is traumatic experience in the past recovered, and disabled, in the present? Is it necessary through memory to `return to the scene of the crime', in order to move beyond it? What features in the present-day therapeutic setting and in the therapeutic relationship promote healing? The objective is a grounded theory of reconciliation that includes discussion for whole societies of the role of historical recovery in social repair, the relation of the present to the past in self-constitution, and the requisite structure of the present-day reparative community to promote self-transformations. (shrink)

The distinction between a priori knowledge and a posteriori knowledge has come under attack in the recent literature by Philip Kitcher, John Hawthorne, C. S. Jenkins, and Timothy Williamson. Evaluating the attacks requires answering two questions. First, have they hit their target? Second, are they compelling? My goal is to argue that the attacks fail because they miss their target. Since the attacks are directed at a particular concept or distinction, they must accurately locate the target concept or distinction. Accurately (...) locating the target concept or distinction requires correctly articulating that concept or distinction. The attacks miss their target because they fail to correctly articulate the target concept or distinction. I go on to present a different challenge to the a priori-a posteriori distinction. This challenge is not directed at the coherence or significance of the distinction. Its target is the traditional view that all knowledge (or justified belief) is either a priori or a posteriori. (shrink)