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

Some health care organizations allow physicians to withhold cardiopulmonary resuscitation from a patient, despite patient or surrogate requests that it be provided, when they believe it will be more harmful than beneficial. Such cases usually involve patients with terminal diagnoses whose medical teams argue that aggressive treatments are medically inappropriate or likely to be harmful. Although there is state-to-state variability and a considerable judicial gray area about the conditions and mechanisms for refusals to perform CPR, medical teams typically follow a (...) set of clearly defined procedures for these decisions. The procedures are based on the principle of nonmaleficence and typically include consultation with hospital ethics committees, reflecting the guidelines of relevant professional associations. Ethical debates about when CPR can and should be limited tend to rely more on discussions of theory, principles, and case studies than systematic empirical study of the situations in which such limitations are applied. Sociologists of bioethics call for empirical study, arguing that what ethicists and health professionals believe they are doing when they draft policies or invoke principles does not always mirror what is happening on the ground. In this article, we begin the task of modeling the empirical analyses sociologists call for, focusing on a cohort at Massachusetts General Hospital. We inductively analyzed ethics committee notes and medical records of nineteen patients whose surrogates did not accept the decision to withhold CPR. (shrink)

In 2015, the major critical care societies issued guidelines outlining a procedural approach to resolving intractable conflict between healthcare professionals and surrogates over life-sustaining treatments (LST). We report our experience with a resolving conflict procedure. This was a retrospective, single-centre cohort study of ethics consultations involving intractable conflict over LST. The resolving conflict process was initiated eleven times for ten patients over 2,015 ethics consultations from 2000 to 2020. In all cases, the ethics committee recommended withdrawal of the contested LST. (...) In seven cases, the patient died or was transferred or a legal injunction was obtained before completion of the process. In the four cases in which LST was withdrawn, the time from ethics consultation to withdrawal of LST was 24.8 ± 12.2 days. Healthcare provider and surrogate were often distressed during the process, sometimes resulting in escalation of conflict and legal action. In some cases, however, surrogates appeared relieved that they did not have to make the final decision regarding LST. Challenges regarding implementation included the time needed for process completion and limited usefulness in emergent situations. Although it is feasible to implement a due process approach to conflict over LST, there are factors that limit the procedure’s usefulness. (shrink)

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

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

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

A growing body of research has demonstrated significant heterogeneity of hospital ethics committee (HEC) size, membership and training requirements, length of appointment, institutional support, clinical and policy roles, and predictors of self identified success. Because these studies have focused on HECs at a single point in time, however, little is known about how the composition of HECs changes over time and what impact these changes have on committee utilization. The current study presents 20 years of data on the evolution of (...) the Massachusetts General Hospital HEC. Between 1993 and 2012, the average number of committee members per year was 38 ± 3 and the average length of membership was 4.8 ± 0.4 years. During that time, the committee performed 934 consults, averaging 47 ± 3 per year. Attendance rates fell from 61.5 to 23.8 % over the study period and were inversely correlated with the total number of members. Between 1993 and 2012, the committee saw substantial growth in the diversity of the professional backgrounds of its members. Multivariate analysis, however, suggests that substantial changes in committee composition did not impact its utilization and that other factors are more likely to explain fluctuations in consultation volume. (shrink)

The reign of paper files would seem to be over once files are reduced to the status of icons on computer screens, but Vismann's book, which examines the impact of the file on Western institutions throughout history, shows how the creation of order in medieval and early modern administrations makes its returns in computer architecture.

This paper explores one organisation’s journey into non-financial reporting, initially motivated by a crisis in public confidence that threatened the organisation’s legitimacy to the present with the organisation embracing integrated reporting. The organisation’s journey is framed through a legitimation lens and is illustrated by aligning internal reflections with external outputs guided by predominant paradigms of good practice, such as the GRI guidelines and more recently integrated reporting 〈IR〉. We find that the organisation’s relationship with external guidelines has evolved from pragmatic (...) adoption as a means of seeking external legitimation to the present position where those that prepare external reports are informed by the organisation’s strategic positioning and not constrained by the promulgation of voluntary guidelines. From the case study, we suggest that the International Integrated Reporting Council may face two hurdles: First, organisations may define social norms based on a broader definition of stakeholders than the definition currently published by the IIRC. The second hurdle is to convince report preparers that adopting integrated reporting 〈IR〉 will positively impact on capital flows. (shrink)

The intuitive notion of a binary relation on information-bearers, comparingthem with respect to their closeness to the available information, is oftenconstrued in terms of comparing their symmetric difference with, orcompositional similarity to, the available information. This happens forinstance in some treatments of verisimilitude. We expound an abstractmathematical rendering of the relevant data-dependent relation in theframework of Boolean algebras. For every element t of a Boolean algebra B we construct the t-modulated Boolean algebra Btin which the order relation represents `is at (...) most as compatible with t as'' or `is at best as similar to t as''. In the case of Lindenbaum-Tarskialgebras, t expresses the available information, and the compatibilityrelation turns out to be an entwinement of inferential and conjecturalrelations. It is just classical entailment when no information is available(i.e., when t is logically true) and becomes more boldly abductive themore information is available. The rich algebraic structures of a Boolean algebra –- including its Boolean group structures –- play a significant role in this combination of deduction and abduction and also induce cautious anddaring variants of the compatibility relation. Links with the literature onverisimilitude, abduction, and related topics are indicated. (shrink)

First published in 2010, Cornelia Vismann’s article has already attained the status of a classic. In a formulation inspired by linguistic theory, the author argues that the relation between cultural techniques and media can be understood in analogy to grammatical operations. Thus, cultural techniques define the agency of media and execute the procedural rules which the latter set in place. Together, they articulate a critique of subjectivity and sovereignty that proceeds by re-examining the notion of ‘culture’ via its agricultural (...) origins to the current moment when the ‘preservation of cultural techniques’ has entered legal and academic discourse. Ultimately, despite their apparent separation from praxis, cultural techniques continue to proliferate through axes of substitution and displacement. (shrink)

The Mahapuranas embody the received tradition of Hindu mythology. This anthology contains fresh translations of these myths, only a few of which have ever been available in English before, thus providing a rich new portion of Hindu mythology. The book is organized into six chapters. "Origins" contains myths relating to creation, time, and space. "Seers, Kings and Supernaturals" relates tales of rivers, trees, animals, demons, and men, particularly heroes and sages. Myths about the chief gods are dealt with in three (...) separate chapters: "Krsna," "Visnu," and "Siva." The chapter "The Goddess" presents stories of the wives and lovers of the gods, as well as of Kali, the savage battle goddess. In their introductions, the editors provide a historical setting in which to discuss Hindu mythology as well as a full analysis of its basic sources. The many names given the gods and goddesses in the Sanskrit texts have been retained since their multiplicity is an essential part of the richness of the original. The editors have provided a thorough glossary to make these names accessible. (shrink)

Baselitz is one of the most important artists of today. His works can be found in major museums around the world. For over 30 years, photographer Benjamin Katz has been documenting Baselitz at work in different studios. This volume now captures Baselitz's exceptional life at work and at home. Benjamin Katz is famous for his photographic portraits of artists. Among his previous subjects are Gerhard Richter, Joseph Beuys, Sigmar Polke, Rosemarie Trockel, and Martin Kippenberger. Because Katz is friends with most (...) of the artists, he is able to capture them when they are completely at ease. But, as he explains in this book, he prefers to photograph people while they are in the process of doing something. Katz shows Baselitz with paintbrush and hammer, and dog and cigar - the close relationship between the two artists is almost palpable. The photographs are the result of a friendship in an artistic world that they have been sharing for many decades. Cornelia Gockel's essay discusses Katz's unique, new window on the world of Georg Baselitz. (shrink)

Powerful ultrastructural tools are providing new insights into neuronal circuits, revealing a wealth of anatomically‐defined synaptic connections. These wiring diagrams are incomplete, however, because functional connectivity is actively shaped by neuromodulators that modify neuronal dynamics, excitability, and synaptic function. Studies of defined neural circuits in crustaceans, C. elegans, Drosophila, and the vertebrate retina have revealed the ability of modulators and sensory context to reconfigure information processing by changing the composition and activity of functional circuits. Each ultrastructural connectivity map encodes multiple (...) circuits, some of which are active and some of which are latent at any given time. (shrink)

Cornelia Dean draws on her 30 years as a science journalist with the New York Times to expose the flawed reasoning and knowledge gaps that handicap readers when they try to make sense of science. She calls attention to conflicts of interest in research and the price society pays when science journalism declines and funding dries up.--.

: The love of ruins has generated various epistemes and disciplines: In the sixteenth century it informed philology, in the nineteenth century historiography and criminology. Its status has changed from an allegorical one in the Renaissance to a literal, positivistic one at the beginning of the twentieth century. Johann Gustav Droysen was among the first who reflected the positivistic treatment of ruins systematically. The Prussian historiographer formulated a theory of remains including both written documents and material objects. In the twentieth (...) century the positivistic view lost its appeal for scholars. They began to question the supposed ability of ruins to access the past. The physicality of remains was no longer trusted to guide the process of memory. This disillusion in the power of remains led to a practice of mere tabulation where statistics instead of historical narrative were generated. The contemporary philosopher Giorgio Agamben proposes yet another way of dealing with remains. He liberates ruins from their materialistic shell altogether and takes them consequently in their. (shrink)

The following text provides a conceptual and theoretical introduction to a collection of essays written by members of the multidisciplinary network of scholars, artists and cultural producers named ‘Poetics of Resistance’, which seeks to analyse and encourage discussion of the relationships between creativity, culture and political resistance, in the context of neoliberal globalization. The introduction also provides a critical glossary of a set of loosely interlinking keywords, following Raymond Williams, that mark points of encounter and departure between the approaches of (...) the various authors (not to be confused with the list of keywords used to index each article). Rather than presenting a completed research project, this issue serves as a basis for continuing collaborative research and dialogue in the field, and invites readers to join in the ongoing debate. The contributors to this issue are Paulina Aroch Fugellie, Burghard Baltrusch, Arturo Casas, María do Cebreiro Rábade Villar, Roberto Echavarren, Marcos Giadas Conde, Cornelia Gräbner, Nathalia Jabur, Thomas Muhr and David Wood. (shrink)

The goal of the article is to offer a framework against which relations between gesture and sign can be systematically explored beyond the current literature. It does so by a) reconstructing the history of the discussion in the field of gesture studies, focusing on three leading positions (Kendon, McNeill, Goldin-Meadow); and b) by formulating a position to illustrate how this can be achieved. The paper concludes by emphasizing the need for systematic cross-linguistic research on multimodal use of language in its (...) signed and spoken forms. (shrink)

From the discovery of distant galaxies and black holes to the tiny interstices of the atom, here is the very best on physics and astronomy from the New York Times! The newspaper of record has always prided itself on its award-winning science coverage, and these 125 articles from its archives are the very best, covering more than a century of breakthroughs, setbacks, and mysteries. Selected by former science editor Cornelia Dean, they feature such esteemed and Pulitzer Prize-winning writers as (...) Malcolm W. Browne on teleporting, antimatter atoms, and the physics of traffic jams; James Glanz on string theory; George Johnson on quantum physics; William L. Laurence on Bohr and Einstein; Dennis Overbye on the recent discovery of the Higgs Boson; Walter Sullivan on the colliding beam machine; and more. (shrink)

Inflammatory bowel disease is chronic and incurable. Imperious diarrhea, rectal bleeding, fatigue, and weight loss, the main manifestations, cause a decrease in the quality of the patient’s personal and professional life. The objectives of this study were to identify a possible relationship between early maladaptive schemas and disease activity status using logistic regression, to identify the prevalence of early maladaptive schemes in patients and to propose a psychotherapeutic intervention plan. The following were found in a sample of 46 patients aged (...) 16–76 years. An increase in the domain overvigilance and inhibition score had a significant effect, with an increase of 1.137 CI95% [1.031, 1.254] of the risk of the disease being diagnosed as active. High and very high scores were observed for the emotional deprivation scheme and dependence/incompetence, vulnerability to harm and illness and subjugation schemas. The results show that the proposed model could predict and reconfirm the diagnosis; patients have specific psychotherapeutic needs. The therapeutic goal would be to offer care, empathy and protection, to strengthen self-confidence, to make patients realize that they have the ability to cope, to provide permission, encourage the patient to experiment, and guide the patient to express their anger healthily. The therapy scheme’s intervention could lead to increased long-term disease management capacity and, consequently, reduce costs directly and indirectly caused by this condition. (shrink)

In this short introductory article the origin of this special issue in a Cambridge conference in 2019 is briefly sketched. Moreover, the specific approach which the organizers wanted to highlight is elucidated. Also, a preview is offered of the various contributions to this special issue.

While generally accepted as an interpretive theory, Bull’s emblematic text demonstrates strong structural characteristics. Subsequent attributions move between the interpretive or ‘reflexive’ and t...

In recent debates about inequality, many have pointed to the predominant position of the finance. This article highlights that structural power, not lobbying resources, are key to explaining variations across countries. It examines finance-government negotiations over national bank rescue schemes during the recent financial crisis. Given the structural power of finance, the variation in bank bailouts across countries cannot be explained by lobbying differences. Instead of observing organized interest intermediation, we can see that disorganization was crucial for the financial industry (...) to get off the hook and let the government carry the burden of stabilizing the economy. Put differently, structural power is strongest when finance remains collectively inactive. In contrast to traditional accounts of the lobbying influence of finance, the comparison highlights that the lack of organization can have crucial redistributive consequences. (shrink)

This article contests the popular assumption that literature is ever less politically relevant. Quite the contrary is the case: literature and literary language becomes increasingly important for the alter-globalization movement and for the notion that ‘another world is possible.’ The work of four authors—Manu Chao, Eduardo Galeano, Subcomandante Marcos, and José Saramago—are comparatively analysed in light of their contribution to an alternative globalism and to an alternative practice of politics. All four authors contribute from different perspectives to the literary articulation (...) of a political project. Their work shares characteristics such as the permeability of genres, the emphasis on the poetical over the narrative, a meandering structure that expresses the search for and step-by-step construction of a cultural and political alternative, and an emphasis on translation and encounter as principles of interaction with difference. (shrink)

Das von Mitgliedern des Historisch-Kulturwissenschaftlichen Forschungszentrums der Universitäten Mainz und Trier sowie des Gutenberg-Museums in Mainz gemeinsam vorbereitete Ausstellungs- und Katalogprojekt veranschaulicht anhand von Beispielen aus unterschiedlichen Forschungsrichtungen die enge Beziehung von Wissen und Raum. Die Resultate interdisziplinärer wissenschaftlicher Arbeit werden so - im wahrsten Sinne des Wortes - veranschaulicht und ihre Aktualität für ein breites Publikum einsichtig gemacht. Die Ausstellung, die vom 30. Oktober 2008 bis zum 29. März 2009 im Gutenberg-Museum in Mainz zu sehen sein wird, vermittelt also (...) nicht nur kunst- und kulturhistorisches Faktenwissen. Vielmehr soll die Ausstellung die bewusste Auseinandersetzung mit Wissen und seiner Verortung fördern. Die Verbindung von Wissen und Raum lässt vielfältige Assoziationen zu. Denkt man zunächst an Schulen und Universitäten, Bibliotheken, Archive und Museen, kommen dann auch noch andere Wissensräume in den Blick: das Internet, unser Schreibtisch, Kirchen, Bücher, Zeitschriften, Filme, Bilder, Landkarten, das menschliche Gehirn. Überall wird Wissen in den unterschiedlichsten Räumen gesammelt, aufbewahrt, geordnet und zugänglich gemacht. (shrink)

In the preliminary work for his Theses On the Concept of History, Walter Benjamin quotes a passage from Henri Focillon’s La vie des formes, using Focillon’s description of classical style for his own notion of the dialectical image. The Essay locates Benjamin’s surprising reception of Focillon in their common interest in a life of forms, not so much in the sense of aesthetic liveliness as defined by Kant, but in its productiveness of other forms. Focillon’s idea of art history is (...) based on the dynamis or potentiality of artistic shapes giving way to ever new figures and forms. This is not only a key to Benjamin’s concepts of Fortleben/Nachleben in the early Essay The Task of the Translator but also to the ‘dialectical image‘ outlined in the Arcades Project. Benjamin, this Essay argues, refers to Focillon’s life of forms to conceptualise disharmonious and sudden changes of form. (shrink)

The first and most important impetus motivating a feminist engagement with the complex of art and aesthetics is – as has been the case in many other realms of social life – the exclusion of women from participation in the respective sphere of activity: the denial of women's entry into formal and institutional education, training, active practice in the profession, and the continuous discrimination and marginalization that women have had to endure even after the end of their formal exclusion. A (...) second stage in the feminist engagement with art and aesthetics is reached when the considerable accomplishments are made visible that women have attained despite all obstacles, although these achievements have so often been overlooked, forgotten, denied, or overtly suppressed. The discovery of the resistance women have always mounted to all hindrances placed in their way, the (re)discovery of “women worthies,” takes place in the fields of art, literary, and music history much in the same way as feminism has begun to dig up the lost memory of women's efforts in the fields of history, science, and so on. (shrink)

In the age of surveillance capitalism, the prevailing business model underlying the use of social media applications (“apps”) foresees the exchange of personal data for the allowance to use an online service. Such a data business model comes with many potential negative side effects ranging from violation of privacy issues to election manipulation. Therefore, it is of utmost importance to think of alternatives to the current data business model. The present study investigated how strong the support would be for a (...) monetary payment model among a sample of 210 participants. Participants were asked about their willingness to pay for social media, if in turn their data would be private and other problems concerning social media use would be tackled. Only one-fifth of participants (21.43%) supported such a model. From the Big Five Personality traits, Agreeableness was positively associated with support of such a model. Finally, data are also provided on how much participants would be willing to pay for social media on a monthly basis. The present study’s findings are of a preliminary nature and will contribute to the start of an important discussion. (shrink)