Nobel Laureate Kazou Ishiguro’s (2010) novel “Never Let Me Go” follows individuals intentionally bred to donate their organs over multiple years, ultimately dying when the final “vital organs” are...

Berger and Miller argue that contemporary medical education directed toward “cultural competency” fails to address the structural inequities and systemic racism underpinning health dispariti...

This paper argues that Cicero’s critique of Epicureanism in De finibus is motivated by a concern about its degrading effect on the moral sensibility of Rome’s best men. In place of earlier objections to Epicureanism, which centered on its inability to explain or recommend the virtuous conduct of Roman maiores, De finibus focuses on its inability to do so properly and, more prospectively, to assist boni in the work of maintaining the dignity and respectability of Roman civic life. Responding to (...) optimates like Cassius who claimed that Epicureanism was compatible with Roman politics because it treats virtue as being necessary for pleasure, Cicero holds that instrumentalizing virtue in this way is actually a grave corruption of it. Not only do Epicureans debase politics by reducing it to considerations of utility alone: they also introduce deeper forms of civic confusion by distorting and abusing the very idea of honorableness. (shrink)

Who is Lucrezia, the mysterious woman at the center of Machiavelli’s comic play Mandragola? And why is she deemed “fit to govern a kingdom”? This article revisits these questions with attention to Mandragola’s sophisticated, and often irreverent, allusions to Roman source materials. While scholars have long recognized that Mandragola draws on Roman history and drama, its sustained engagement with Lucretian and Ovidian poetry has gone largely unnoticed. In what follows, I trace these allusions and show how Machiavelli uses them to (...) bring into view the fertility of erotic desire. Mandragola is replete with Lucretian phrases and imagery, but a close examination of these references indicates they are made playfully, and even satirically, in the style of Ovid’s Ars amatoria, a didactic elegy on the art of seduction that develops a mixed assessment of Epicurean teachings. Like Ovid, Machiavelli embraces the hedonism that motivates Epicureanism—but without accepting that happiness requires distancing ourselves from illusion. This departure allows both Ovid and Machiavelli to reassess the status of erotic desire. For Lucretius, erotic desire must be handled with extreme caution lest it entangle the mind in ruinous false beliefs and destroy the possibility of theoretical wisdom. Machiavelli, following Ovid, recommends a different course, in which happiness is achieved through the deliberate manipulation of erotic fantasy. For Machiavelli, staging erotic fantasies is an essential part of statecraft. (shrink)

Bioethicists in healthcare institutions have the skills and insights and can and must facilitate and promote measures that address deeply ingrained structural issues that exacerbate health inequity...

In lieu of an abstract, here is a brief excerpt of the content:Consenting for Novel and Dangerous Surgical Procedures with Minimal Supporting EvidenceMichelle J. ClarkeFrank1 was a 19–year–old man referred to me after a workup for back pain led to the discovery of a large, aggressive tumor in his sacrum. The tumor wrapped around the nerves controlling bowel, bladder, and leg function. We performed a needle biopsy and learned that the tumor was an angiosarcoma, an extremely aggressive and usually deadly (...) form of cancer. However, the tumor was unique in that it theoretically could be cured if removed in one piece. But, to do so would necessitate sacrificing the nerves, leaving the patient irreversibly incontinent, lacking sexual function, and confined to a wheelchair.Once we knew the diagnosis, Frank came to the office with his family to discuss treatment options. He appeared terrified and was almost silent through the appointment, deferring most questions to his parents. Due to the speed of tumor growth, we discussed palliative therapy, conventional treatment, and the one–piece or “en bloc” surgery, which was new and unproven for his disease. Based on the remarkable tumor growth we noted during the work–up, with palliative treatment the patient would likely survive for less than six months. Conventional treatment, in which surgery is done to remove part of the tumor while sparing the nerves to bowel and bladder function, was known to have a high rate of recurrence and death. Further, this tumor didn’t respond well to radiation and chemotherapy, so chance of survival was limited, although his life might have been extended for a short period. Thus our conversation turned to the novel “en bloc” procedure.The en bloc procedure offered a hope of long–term survival unlike the other options. However, this came with an enormous cost. The surgery itself would be planned to occur over three days with five separate surgical teams and a very real chance of major complications or death. Nerves to bowel and bladder would be cut, irreversibly leaving the patient without sexual function, and completely incontinent with a urinary catheter and colostomy. Walking was expected to be disrupted or potentially impossible due to the nerve resection. We went to great lengths over the course of many visits to describe the impact of the surgery on the patient’s function, and the impact on his quality of life. To make matters more challenging, as this procedure was so new and the tumor so rare, research did not yet exist to quantify his likelihood of long–term survival.Personally I was very uncomfortable with the situation. From a medical standpoint, the surgery offered was the best distillation of research and professional experience. En bloc surgery offered the best—if not the only—chance for survival in [End Page 5] this young man. Additionally, having treated many spine–injured patients I was aware that many patients with similar deficits led happy and productive lives following an emotional and physical adjustment period. However the surgery was also extreme. I worried that we would not be able to accomplish the goal of a one–piece resection and would accidentally spill some of the tumor, creating all of the deficits but no survival benefit. Frankly, I thought there was a 25% chance that would happen, which was explained to the family preoperatively. Were we overreaching our abilities and making a dying patient’s life worse by proceeding?Second, I was uneasy about the social situation. The patient’s family was very supportive, traveling with him to all appointments and assisting with his care. The patient himself usually deferred all scheduling to his mother, which wasn’t entirely unusual for such a young man. However it was difficult to grasp how much the patient understood of his disease or supported the plan. We attempted to delve more deeply into his thoughts, including without his parents present, but got only short answers, which revealed little. While the family appeared to have accepted the diagnosis and wanted to get to the business of treatment, the patient seemed to me to still carry the shock of his recent cancer diagnosis. Pushed by the rapid tumor growth, we were limited in how long we could wait for... (shrink)

What do modern republics have to fear? Machiavelli's Florentine Republic reconstructs Machiavelli's answer to this question from the perspective of the Florentine Histories, his most probing meditation on the fate of republican politics in the modern age. It argues that his principle goal in narrating the defeat of Florentine republicanism is to debunk the views of leading humanists concerning the overall health of republican politics in modernity and the distinctive challenges that modern republics should expect to face. The Medici family (...) had exposed these vulnerabilities better than anyone else, and Machiavelli reconstructs their political strategy to show how conventional ideas of moral and political virtue are the most potent instruments of princely ambition in a city that wants to be free. (shrink)