By 20 October 2021, the U.S. Food and Drug Administration (FDA) had amended its Emergency Use Authorizations for immunocompetent adults who previously received the Pfizer-BioNTech, Moderna, or Johnson & Johnson COVID-19 vaccines. For the 2-dose Pfizer-BioNTech and Moderna vaccines, the FDA permitted a single booster dose for adults aged 65 years or older and adults aged 18 to 64 years at high-risk for severe COVID-19 or at high risk for occupational or institutional COVID-19 exposure. For the single-dose Johnson & Johnson (...) vaccine, the FDA permitted a single booster dose for all adults aged 18 or older. These eligibility schemes were endorsed by the Centers for Disease Control and Prevention shortly after FDA approval. (shrink)

Can strikes by resident doctors training to become consultants in Indian public-sector teaching hospitals be ethical? These hospitals were established for the medical care of the very poor in a country where health insurance and a national health service are nonexistent. In such a situation, the paralysis of tertiary healthcare centers by striking doctors runs contrary to the raison d'être of the profession. It also violates the first dictum of medicine: Primum,nonnocere. And although there is some discussion in the Western (...) literature on strikes by doctors, authorities in India are silent on the subject. (shrink)

This unique volume is a comprehensive,well-illustrated study of the organization of the white matter pathways of the brain. Schmahmann and Pandya have analyzed and synthesized the corticocortical and corticosubcortical connections of the major areas of the cerebral cortex of the rhesus monkey. The result is a detailed understanding of the constituents of the cerebral white matter and the organization of the fiber tracts. The findings from the 36 cases studied are presented on a single template brain, facilitating comparison of (...) the locations of the different fiber pathways. The summary diagrams provide a comprehensive atlas of the cerebral white matter. The text is enriched by close attention to functional aspects of the anatomical observations. The clinical relevance of the pathways is addressed throughout the text and a chapter is devoted to human white matter diseases. The introductory account gives a detailed historical background. Translations of seminal original observations by early investigators are presented, and when these are considered in the light of the authors' new observations, many longstanding conflicts and debates are resolved. This scholarly book is an important addition to systems and cognitive neuroscience that will be of lasting value to neurobiologists, anatomists, neurologists, neurosurgeons, neuroradiologists, psychiatrists, psychologists, and to their students and trainees. (shrink)

Contributed research papers presented at National Seminar jointly organized by Somanth Sanskrit University, Veraval and Sanskrit Sahitya Akadami at Gandhinagar on February 21-22, 2022.

As ethics consultants on a busy consult service in a large urban setting, we would approach this case by gathering more information and context. This involves clarifying the clinical facts, underst...

_Disaster Psychiatry: Intervening When Nightmares Come True_ captures the state of disaster psychiatry in the aftermath of the terrorist attacks of September 11, 2001. This emergent psychiatric specialty, which is increasingly separated from trauma and grief psychiatry on one hand and military psychiatry on the other, provides psychotherapeutic assistance to victims during, and in the weeks and months following, major disasters. As such, disaster psychiatrists must operate in the widely varying locales in which natural and man-made disasters occur, and they (...) must establish their role among the chaotic array of organizations involved in direct disaster response. Editors Anand Pandya and Craig Katz have captured the challenge and promise of disaster psychiatry through first-person narratives. We hear from psychiatrists who have encountered disasters at various stages of their career and in widely varying social, political, and personal contexts. Accounts of psychiatric involvement with adults and children during and after 9/11 have understandable pride of place in this collection. But they are balanced by richly informative narratives about other domestic and international disasters. Fraught with the drama attendant to the events they describe, these essays delineate the dizzying array of challenges that confront the disaster psychiatrist. They range from the intense emotional responses that are part of the aftermath of any disaster, to the need to legitimize a psychiatric presence within diverse cultural and medical contexts, to the subtle task of providing therapeutic boundaries at a time when all rules seem to be suspended. Special attention is given to the daunting task of working with children whose parents' are disaster victims. What emerges from these testimonies is compelling documentation of skilled and compassionate psychiatrists at the outer limits of their specialty, pursuing their calling into uncharted realms of therapeutic engagement. (shrink)

The concept of governmentality has a textual and philosophical basis as well as being concerned with what might be called the practices of government. This article discusses and develops the governmentality argument with respect to the guru-led movements. It outlines the basics of Michel Foucault’s concept of governmentality, its analytical frame, the fact that governmentality moves beyond only the practices of the state and its nuances in a neoliberal frame of reference, drawing on Zygmunt Bauman and others. It then discusses (...) the governmentality of guru-led movements through: (1) the political acts and powers of the gurus; (2) the supplementary and complementary efforts to aid the state by the guru-led movements; (3) instances of resistance and taking on the state, and (4) the flipside of governmentality, which manifests as hegemony, Hindutva politics and Hindu nationalism. Through the governmentality argument, aspects of the surveillance, discipline, control, interactivity and competition of the guru-led movements emerge. What is discussed is a post-disciplinary model of governance which devolves power downwards from crumbling state institutions to new agencies of control, in this case, the gurus and their institutions. This devolution, however, is not without its tensions and the article also argues that guru governmentality betrays traces of hybridity and non-linearity. (shrink)

I have reviewed briefly persons who have influenced me during my years as a student of medicine and to date. I have been blessed in my teachers and owe everything I am to them. The chief lessons they taught me were integrity, sincerity, the need to keep learning and practice ethically keeping the welfare of the patient in mind all the time. Above all, they taught me to observe the Golden Rule**.

The importance of Levinas’ notions of sensibility and subjectivity are evident in the revision of phenomenological method by current phenomenologists such as Jean-Luc Marion and Michel Henry. The criticisms of key tenants of classical phenomenology, intentionality and reduction, are of a particular note. However, there are problems with Levinas’ characterization of subjectivity as essentially sensible. In “Totality and Infinity” and “Otherwise than Being”, Levinas criticizes and recasts a traditional notion of subjectivity, particularly the notion of the subject as the first (...) and foremost rational subject. The subject in Levinas’ works is characterized more by its sensibility and affectedness than by its capacity to reason or affect its world. Levinas ties rationality to economy and suggests an alternative notion of reason that leads to his analysis of the ethical relation as the face-to-face encounter. The ‘origin’ of the social relation is located not in our capacity to know but rather in a sensibility that is diametrically opposed to the reason understood as economy. I argue that the opposition in Levinas’ thought between reason and sensibility is problematic and essentially leads to a self-conflicted subject. In fact, it would seem that violence characterizes the subject’s self-relation and, thus, is also inscribed at the base of the social relation. Rather than overcoming a problematic tendency to dualistic thought in philosophy Levinas merely reverses traditional hierarchies of reason/emotion, subject/object and self/other. (shrink)

In this paper I have examined the Saibaba phenomenon which originated in India and now has a global influence. Through fieldwork, I build on the life and works of three faith teachers (gurus) who have contributed to the Sai movement to forward my thesis that sociality and hence tangible social service is an important means to gain legitimacy, social standing and as a response to late modernity. I begin by giving an overview of the Sai phenomena and its peculiarities in (...) terms of syncretism, bricolage and aspects of global proliferation. I then discuss how sociality is a strategy for this genre of faith movement and its implications. Finally I propose that sociality has become a metaphor of Sai sacrality. (shrink)

This article is based on field work with the Vivekananda Kendra in Kanyakumari, India. The Vivekananda Kendra is a Hindu spiritual organization founded in 1972, based on principles promoted by Swami Vivekananda. The organization’s members translate Vivekananda’s Vedanta and Yoga ideals into national reconstruction. The efforts of Eknath Ranade as the key transmitter of Vivekananda’s ideals, the way he effectively wove austerity, renunciation, and service to realize them, and the Kendra’s strategy of social service and its effects are discussed. In (...) particular, the Kendra’s social service is analyzed on the basis of its social consciousness, its views on social issues and gender, its Hindu nationalist stance, and its relationship with the establishment and the global political economy. This critical discourse highlights the Kendra’s emphasis on Vedantic socialism as opposed to traditional socialism. The lenses by which the Kendra views society are gendered and ethnonationalist. It deals with matters of justice, equity, and state relations from a benevolent patriarchal vantage point. (shrink)

Treatment of diseases of the brain by drugs or surgery necessitates an understanding of its structure and functions. The philosophical neurosurgeon soon encounters difficulties when localising the abstract concepts of mind and soul within the tangible 1300-gram organ containing 100 billion neurones. Hippocrates had focused attention on the brain as the seat of the mind. The tabula rasa postulated by Aristotle cannot be localised to a particular part of the brain with the confidence that we can localise spoken speech to (...) Broca's area or the movement of limbs to the contralateral motor cortex. Galen's localisation of imagination, reasoning, judgement and memory in the cerebral ventricles collapsed once it was evident that the functional units-neurones-lay in the parenchyma of the brain. Experiences gained from accidental injuries (Phineas Gage) or temporal lobe resection (William Beecher Scoville); studies on how we see and hear and more recent data from functional magnetic resonance studies have made us aware of the extensive network of neurones in the cerebral hemispheres that subserve the functions of the mind. The soul or atman, credited with the ability to enliven the body, was located by ancient anatomists and philosophers in the lungs or heart, in the pineal gland (Descartes), and generally in the brain. When the deeper parts of the brain came within the reach of neurosurgeons, the brainstem proved exceptionally delicate and vulnerable. The concept of brain death after irreversible damage to it has made all of us aware of 'the cocktail of brain soup and spark' in the brainstem so necessary for life. If there be a soul in each of us, surely, it is enshrined here. (shrink)

Medical practice is based on teaching, learning and examples set by seniors. Past and present practices are briefly analysed. Current trends do not justify optimism. The poor patient is likely to be sidelined as doctors reach out to the rich and powerful in this country and those bringing in American dollars from abroad. While corrective steps are possible, it is unlikely that they will be implemented.

When the COVID-19 surge hit New York City hospitals, the Division of Medical Ethics at Weill Cornell Medical College, and our affiliated ethics consultation services, faced waves of ethical issues sweeping forward with intensity and urgency. In this article, we describe our experience over an eight-week period (16 March through 10 May 2020), and describe three types of services: clinical ethics consultation (CEC); service practice communications/interventions (SPCI); and organizational ethics advisement (OEA). We tell this narrative through the prism of time, (...) describing the evolution of ethical issues and trends as the pandemic unfolded. We delineate three phases: anticipation and preparation, crisis management, and reflection and adjustment. The first phase focused predominantly on ways to address impending resource shortages and to plan for remote ethics consultation, and CECs focused on code status discussions with surrogates. The second phase was characterized by the dramatic convergence of a rapid increase in the number of critically ill patients, a growing scarcity of resources, and the reassignment/ redeployment of staff outside their specialty areas. The third phase was characterized by the recognition that while the worst of the crisis was waning, its medium- and long-term consequences continued to pose immense challenges. We note that there were times during the crisis that serving in the role of clinical ethics consultant created a sense of dis-ease as novel as the coronavirus itself. In retrospect we learned that our activities far exceeded the familiar terrain of clinical ethics consultation and extended into other spheres of organizational life in novel ways that were unanticipated before this pandemic. To that end, we defined and categorized a middle level of ethics consultation, which we have termed service practice communication intervention (SPCI). This is an underappreciated dimension of the work that ethics consult services are capable of in times of crisis. We believe that the pandemic has revealed the many enduring ways that ethics consultation services can more robustly contribute to the ethical life of their institutions moving forward. (shrink)

While it is not explicitly included in capacity assessment tools, “consistency” has come to feature as a central concern when assessing patients’ capacity. In order to determine whether inconsistency indicates incapacity, clinicians must determine the source of the inconsistency with respect to the process or content of a patient’s decision-making. In this paper, we outline common types of inconsistency and analyze them against widely accepted elements of capacity. We explore the question of whether inconsistency necessarily entails a deficiency in a (...) patient’s capacity. While inconsistency may count as _prima_ _facie_ evidence of incapacity—enough evidence to justify a closer look—when making such determinations, it is important for clinicians to slow down, inquire about the reasons underlying the inconsistency and clearly show which of the elements of capacity the patient fails to satisfy. (shrink)

Electronic media present tremendous opportunities for improving the nature of society. I will address how discourse affects society, and how changes in media may improve societal discourse.

While it is not explicitly included in capacity assessment tools, “consistency” has come to feature as a central concern when assessing patients’ capacity. In order to determine whether inconsistency indicates incapacity, clinicians must determine the source of the inconsistency with respect to the process or content of a patient’s decision-making. In this paper, we outline common types of inconsistency and analyze them against widely accepted elements of capacity. We explore the question of whether inconsistency necessarily entails a deficiency in a (...) patient’s capacity. While inconsistency may count as prima facie evidence of incapacity—enough evidence to justify a closer look—when making such determinations, it is important for clinicians to slow down, inquire about the reasons underlying the inconsistency and clearly show which of the elements of capacity the patient fails to satisfy. (shrink)