Savulescu and colleagues have provided interesting insights into how the UK public view the ‘best interests’ of children like Charlie Gard. But is best interests the right standard for evaluating these types of cases? In the USA, both clinical decisions and legal judgments tend to follow the ‘harm principle’, which holds that parental choices for their children should prevail unless their decisions subject the child to avoidable harm. The case of Charlie Gard, and others like it, show how the USA (...) and the UK have strikingly different approaches for making decisions about the treatment of severely disabled children. (shrink)

Stolorow and his collaborators' post-Cartesian psychoanalytic perspective – intersubjective-systems theory – is a phenomenological contextualism that illuminates worlds of emotional experience as they take form within relational contexts. After outlining the evolution and basic ideas of this framework, Stolorow shows both how post-Cartesian psychoanalysis finds enrichment and philosophical support in Heidegger's analysis of human existence, and how Heidegger's existential philosophy, in turn, can be enriched and expanded by an encounter with post-Cartesian psychoanalysis. In doing so, he creates an important psychological (...) bridge between post-Cartesian psychoanalysis and existential philosophy in the phenomenology of emotional trauma. (shrink)

The concept of brain death was recently described as being “at once well settled and persistently unresolved.” Every day, in the United States and around the world, physicians diagnose patients as brain dead, and then proceed to transplant organs from these patients into others in need. Yet as well settled as this practice has become, brain death continues to be the focus of controversy, with two journals in bioethics dedicating major sections to the topic within the last two years.By way (...) of background, the Uniform Determination of Death Act states that “[a]n individual who has sustained either: irreversible cessation of circulatory and respiratory functions, or irreversible cessation of all functions of the entire brain, including the brain stem, is dead. A determination of death must be made in accordance with accepted medical standards.” In other words, death can be defined by either cardiorespiratory or neurological criteria, with “brain death” representing the loss of all brain function. This standard, or closely related variants, has become the accepted approach throughout the United States and in many parts of the world. (shrink)

The language we use over the course of conversation changes as we establish common ground and learn what our partner finds meaningful. Here we draw upon recent advances in natural language processing to provide a finer‐grained characterization of the dynamics of this learning process. We release an open corpus (>15,000 utterances) of extended dyadic interactions in a classic repeated reference game task where pairs of participants had to coordinate on how to refer to initially difficult‐to‐describe tangram stimuli. We find that (...) different pairs discover a wide variety of idiosyncratic but efficient and stable solutions to the problem of reference. Furthermore, these conventions are shaped by the communicative context: words that are more discriminative in the initial context (i.e., that are used for one target more than others) are more likely to persist through the final repetition. Finally, we find systematic structure in how a speaker's referring expressions become more efficient over time: Syntactic units drop out in clusters following positive feedback from the listener, eventually leaving short labels containing open‐class parts of speech. These findings provide a higher resolution look at the quantitative dynamics of ad hoc convention formation and support further development of computational models of learning in communication. (shrink)

This special report is published in commemoration of the fiftieth anniversary of the “Report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death,” a landmark document that proposed a new way to define death, with implications that advanced the field of organ transplantation. This remarkable success notwithstanding, the concept has raised lasting questions about what it means to be dead. Is death defined in terms of the biological failure of the organism to (...) maintain integrated functioning? Can death be declared on the basis of severe neurological injury even when biological functions remain intact? Is death essentially a social construct that can be defined in different ways, based on human judgment? These issues, and more, are discussed and debated in this report by leading experts in the field, many of whom have been engaged with this topic for decades. (shrink)

Jahi McMath's case has raised challenging uncertainties about one of the most profound existential questions that we can ask: how do we know whether someone is alive or dead? The case is striking in at least two ways. First, how can it be that a person diagnosed as dead by qualified physicians continued to live, at least in a biological sense, more than four years after a death certificate was issued? Second, the diagnosis of brain death has been considered irreversible; (...) in fact, there has never been a case of a person correctly diagnosed as brain‐dead who improved to the point that the person no longer fulfilled the diagnostic criteria. If the neurologist Alan Shewmon is correct that, prior to her cardiac arrest in June 2018, McMath no longer met the criteria for brain death and was actually in a minimally conscious state, this case could have momentous implications for how we think about this diagnosis going forward. In this essay, I will offer a hypothesis that could, perhaps, explain both these aspects of the case. The hypothesis is based on differences in how we distinguish between biological and legal categories. The law tends to prefer to draw bright‐line distinctions between categories, whereas biological categories tend to fall along a spectrum, without sharp distinctions. (shrink)

Historically, the practice of medicine has been a physically intimate endeavor. Physicians have used their hands to palpate and reveal the secrets hidden within the body. Smelling the breath for the ketosis of diabetes or tasting the skin for the saltiness of cystic fibrosis were among the physician's essential practices. Today, perhaps the most defining characteristic of a brilliant clinician is the ability to synthesize many images—from electrocardiograms, ultrasounds, CT scans, and so forth—into a coherent picture that can guide our (...) diagnosis and treatment. Yet this is rapidly becoming a Sisyphean task. Just as we are about to drown in a deluge of data, AI is throwing us a life preserver, to save not only our patients but ourselves. But where will AI take us? (shrink)

This essay joins Wilhelm Dilthey’s conception of the metaphysical impulse as a flight from the tragedy of human finitude with Ludwig Wittgenstein’s understanding of how language bewitches intelligence. We contend that there are features of the phenomenology of language that play a constitutive and pervasive role in the formation of metaphysical illusion.

In this essay, it is argued that naturalism of an even moderate sort speaks strongly against a certain widely held thesis about the human mental (and cognitive) architecture: that it is divided into two distinct levels, the personal and the subpersonal, about the former of which we gain knowledge in a manner that effectively insulates such knowledge from the results of scientific research. -/- An empirically motivated alternative is proposed, according to which the architecture is, so to speak, flattened from (...) above. On this flattened view, although the states and processes typically associated with the personal level likely appear in our best models of the production of human behavior, they appear alongside states and processes normally associated with the subpersonal level. Moreover, the success of such models depends nowise on a levels-based distinction between the various causal contributors. It is argued that the flattened view has methodological implications of significant import. (shrink)

When faced with the complexity of an intersubjective system, in which one is oneself implicated, an epistemic humility that recognizes and respects the finitude of knowing is essential.

Herodotus gives a lengthy description of the important council of the Greek allies which took place at Samos after Mycale in 479, but Thucydides fails to mention it. This is likely not because of succinctness in his treatment of the period. Throughout the Pentecontaetia, Thucydides presents the events which led to the Peloponnesian War in a somewhat indirect and passive way in order to attribute its causality to historical forces of deeper import. His desire to accentuate the role of Athenian (...) growth and Spartan fear of that growth in making the war inevitable commended the omission of events which by their nature might focus attention instead on the deliberate policy choices of the protagonists. Thucydides’ decision to omit other key events during the Pentecontaetia may stem from the same motivation. (shrink)

The psychiatric diagnostic system, as exemplified by the DSM, is a pseudo-scientific framework for diagnosing sick Cartesian isolated minds. As such, it completely overlooks the exquisite context sensitivity and radical context dependence of human emotional life and of all forms of emotional disturbance. In Descartes’s vision, the mind is a “thinking thing,” ontologically decontextualized, fundamentally separated from its world. Heidegger’s existential phenomenology mended this Cartesian subject-object split, unveiling our Being as always already contextualized, a Being-in-the-world. Here I offer a critique (...) of studies in “phenomenological psychopathology” that presuppose the validity of the psychiatric diagnostic system and leave it unchallenged. In this vein, I contend that all emotional disturbances are constituted in an indissoluble context of human interrelatedness. Specifically, I claim that all emotional disturbances, including those objectified by the DSM, take form in relational contexts of severe emotional trauma. There are no psychiatric entities, only devastating contexts. Additionally, I show that Heidegger’s analyses of Angst, world-collapse, uncanniness, and thrownness into Being-toward-death provide extraordinary philosophical tools for grasping the existential significance of such contexts of emotional trauma. Applying Heidegger’s concept of authenticity, I suggest that emotional health entails an ease of passage—i.e., an absence of dissociation—between the world of trauma and the world of everydayness. (shrink)

Over the past several decades, medical ethics has gained a solid foothold in medical education and is now a required course in most medical schools. Although the field of medical ethics is by nature eclectic, moral philosophy has played a dominant role in defining both the content of what is taught and the methodology for reasoning about ethical dilemmas. Most educators largely rely on the case‐based method for teaching ethics, grounding the ethical reasoning in an amalgam of theories drawn from (...) moral philosophy, including consequentialism, deontology, and principlism.In this article we hope to make a case for augmenting the focus of education in medical ethics. We propose complementing the traditional approach to medical ethics with a more embedded approach, one that has been described by others as “microethics,” the ethics of everyday clinical practice. (shrink)

The author develops the claim that humans characteristically maintain a sense of protectedness by creating various forms of metaphysical illusion, replacing the tragic finitude and transience of human existence with a permanent and eternally changeless reality. One such illusion forms around planet earth itself, transformed into an indestructible metaphysical entity. It has become increasingly difficult, in the face of the ravages of climate change, to maintain the illusion of earth’s indestructibility, and with it, a sense of safety. The author refers (...) to the feelings evoked by the crumbling of metaphysical illusion as Apocalyptic anxiety¬—the dread of the end of human civilization. This Apocalyptic dread needs to be confronted (not evaded) in a comportment of dwelling—with our vulnerable planet and with our vulnerable fellow human beings. (shrink)

This book demonstrates how the authors have experienced the power of phenomenology in their therapeutic work with patients, especially those struggling with horrific trauma; in their encounters with psychological and philosophical theories; and in their efforts to comprehend destructive ideologies and the collective traumas that give rise to them. The Power of Phenomenology presents the trajectory of this work. Each chapter begins with a contribution written by one or both authors, extending the power of phenomenological inquiry to one or more (...) of these diverse contexts. The contributions are followed, one or two at a time, by a dialogue between the authors, illustrating the dialectical process of their long collaboration. The unusual format seeks to bring the phenomenology of their collaborative efforts to life for the reader. (shrink)

For more than four decades, George Atwood and I have been absorbed in rethinking psychoanalysis as a form of phenomenological inquiry. In the course of this work, I repeatedly made the claim that phenomenology led us inexorably to relationality, but until now I did not offer an explanation of this inexorability. In this article, I show that emotional phenomenology and relationality always already form an indissoluble unity, because relationality is constitutive of emotional experience.

(2000). Disability, Geography and Ethics. Philosophy & Geography: Vol. 3, No. 1, pp. 91-97.

The author's phenomenological-contextualist psychoanalytic perspective, characterized as a form of applied philosophy, investigates and illuminates worlds of emotional experience and the constitutive intersubjective contexts in which they take form.

After a brief overview of the author's phenomenological-contextualist psychoanalytic perspective, the paper traces the evolution of the author’s conception of emotional trauma over the course of three decades, as it developed in concert with his efforts to grasp his own traumatized states and his studies of existential philosophy. The author illuminates two of trauma’s essential features: (1) its context-embeddedness—painful or frightening affect becomes traumatic when it cannot find a context of emotional understanding in which it can be held and integrated, (...) and (2) its existential significance—emotional trauma shatters our illusions of safety and plunges us into an authentic Being-toward-death, wherein we must face up to our finitude and the finitude of all those we love. The paper also describes the impact of trauma on the phenomenology of time and the sense of alienation from others that accompanies traumatic temporality. The author contends that the proper therapeutic comportment toward trauma is a form of emotional dwelling. He concludes with a discussion of the implications of all these formulations for the development of an ethics of finitude. (shrink)

This article examines the relationship between totalitarianism and the metaphysical illusions on which it rests. Phenomenological investigation is claimed to loosen the grip of totalitarian ideology by exposing its origins in the “resurrective” illusions that seek to overcome the impact of collective trauma. Phenomenology is thus shown to have emancipatory power.

The as-structure provided by language, even in the sciences, is always constitutive of experience and never merely designative. “From Saying…it comes to pass that the World is made to appear” (Heidegger 1971 [1957]: 101).

Johan Brännmark's article “Patients as Rights Holders,” in this issue of the Hastings Center Report, squarely identifies some important problems with the way we in clinical practice conceive of our obligations to our patients. As a solution, he helpfully suggests augmenting our focus on autonomy and informed consent with a broader menu of considerations drawn from the literature on human rights. Respect for autonomy is, of course, one of the hallowed principles of bioethics. In our traditional understanding, our patients deserve (...) our respect because they are capable of autonomous choice, and the way we demonstrate our respect is by seeking their informed consent for our care. This model is so deeply ingrained that many of us have difficulty imagining that there could be any other way of thinking about it. But this model has two very serious drawbacks, problems that speak to much of what is wrong with health care today. (shrink)

This book is a history of the crucial developmental years of quantum theory with an emphasis on the literature rather than an overview of this period focusing on personalities or personal stories of the scientists involved. This book instead focuses on how the theoretical discoveries came about, when and where they were published, and how they became accepted as part of the scientific canon.

The process of bringing the visceral, bodily aspect of emotional experience into language plays a vital role in the working through of painful emotional states. Such visceral-linguistic unities are achieved in a dialogue of emotional understanding, and it is in such dialogue that experiences of emotional trauma can be held and transformed into endurable and namable painful feelings. The blues is a wonderful example of such dialogue. In the unifying experience of the blues, songwriter, performers, and listeners are joined in (...) a visceral-linguistic conversation in which universally traumatizing aspects of human existence can be communally held and borne. (shrink)

As a member of the committee that authored the Multiorganization Policy Statement under discussion, I fully endorse the response of Bosslet and my colleagues to the provocative article by Schneiderman, Jecker, and Jonson. In addition, I would like to offer some thoughts about how the different positions reflected here may be at least partially reconciled by considering the different contexts in which the word and the concept of futility may be invoked. The main thrust of the classic paper by Schneiderman, (...) Jecker, and Jonsen, which is that medicine should not offer or perform treatments that are futile, still resonates with many clinicians, including myself. I... (shrink)

These ten lectures articulate a distinctive vision of the structure and workings of the human mind, drawing from research on embodied cognition as well as from historically more entrenched approaches to the study of human thought. On the author’s view, multifarious materials co-contribute to the production of virtually all forms of human behavior, rendering implausible the idea that human action is best explained by processes taking place in an autonomous mental arena – those in the conscious mind or occurring at (...) the so-called personal level. Rather, human behavior issues from a widely varied, though nevertheless integrated, collection of states and mechanisms, the integrated nature of which is determined by a form of clustering in the components’ contributions to the production of intelligent behavior. This package of resources, the cognitive system, is the human self. Among its elements, the cognitive system includes a vast number of representations, many subsets of which share their content. On the author’s view, redundancy of content itself constitutes an important explanatory quantity; the greater the extent of content-redundancy among representations that co-contribute to the production of an instance of behavior, the more fluid the behavior. In the course of developing and applying these views, the author addresses questions about the content of mental representations, extended cognition, the value of knowledge, and group minds. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:BOOK REVIEWS 149 temporary, might he an eyeopener to young Thomists who know so little about his work. In the meantime, however, in this English version of The Eyes of Faith a primary source of first importance has come our way. Catholic libraries should definitely have it on hand for philosophers and theologians to consult. Fordham University Bronx, New York GERALD A. McCooL, S.J. The Phuosophy of Thomas Aquinas: (...) Introductory Readings. Edited by CHRISTOPHER MARTIN. New York: Routledge, Chapman & Hall, 1988. Pp. 202. $57.50 (cloth); $18.95 (paper). One has a difficult time finding a wholly satisfactory collection of writings from Thomas Aquinas in a single volume. In different ways, the well-known collections of Mary Clark, Robert Goodwin, Thomas Gilby, Vernon Bourke, and Anton Pegis have their merits, hut they have their defects too-one of which is that they all came out twenty to forty years ago. Christopher Martin has recently produced a new collection of readings, and his selection is much different. Add to this that many of the texts in his work are rare or nonexistent in translation, and one begins to see why it is delightful to see this work appear. Christopher Martin has gathered a number of philosophical texts from Aquinas for those who have already cut their teeth in philosophy. (Hence, the uninitiated to philosophy will find things here hard going.) Texts were selected principally with an eye to interesting those students who are most familiar with philosophy in the analytic tradition. They are often unacquainted with theology and at a loss as to how to sort out Thomas's philosophical claims from his theological claims. The aim was to produce a volume which would help such students read Thomas fruitfully and show them that Thomas has many genuine philosophical insights. To this end, texts were chosen that presupposed no, or a minimal, understanding of theology. Not every side of Thomas's philosophical thought is reflected in this work, hut a number of important sides of it are, and an idea of the breadth of it comes through. The format of this work is something like that of Ralph Mclnerny's recent A First Glance at St. Thomas Aquinas. Each chapter begins with an essay that is closely tied to a Thomistic text or two given at the end of the chapter. In Martin's work, however, the emphasis lies more on the itexts than on the expository essays. Apart from the introduction, the 150 BOOK REVIEWS book is divided into five chapters: Aquinas on Logic; Aquinas on Metaphysics; Aquinas on God; Aquinas on Truth, Knowledge and the Mind; and Aquinas on Ethics. The chapters by design follow the major divisions and order of Anthony Kenny's Aquinas: A Collection of Critical Essays. The essays which begin each chapter and introduce the texts that follow are solid pieces. They make many references to Thomas's depend· ence on Aristotle and to parallels between Thomas's handling of a problem and recent discussions of the same. They also give guidance in reading the Thomistic texts and explain what is difficult in the doctrine found in the texts. Throughout these essays, the influence of Peter Geach's writings is evident (especially God and the Soul and Three Philosophers). At times it is just an example or the choice of a term, and at other times it is something more substantial. Though Martin's essays are quite accurate and helpful, a reader can find things to quibble with. Thomas's distinction, for example, between id a quo nomen imponitur ad significandum and id ad quod nomen imponitur ad significandum does not seem, as Martin suggests, to be Frege's distinction between sense and reference or Kripke's distinction between the reference of a name and the fixing of a reference. Rather, Thomas seems to be distinguishing more the etymology of a name from its meaning. Again, it will not do to say that the principle of individuation for individuals of the same kind is " distinct lumps of matter " and that the lumpiness of matter in turn is responsible for the individuation of forms. The " lumpiness " of matter is itself a formal feature. Thomas's teaching... (shrink)

In an article in JAPA 64/3, Lawrence Friedman addresses a question he takes as his title: “Is There a Usable Heidegger for Psychoanalysts?” I am happy to report that this question has already been answered in my own work with a resounding “Yes”!

The purpose of Plato’s investigation of justice in the ideal polis of the Republic is neither to formulate an abstract conception of justice in itself nor to work out a blueprint for the perfectly just state. Rather, through the contemplation of an ideal social/political order where justice might be found “writ large,” Plato intends to bring about the actualization of justice in the “polity” of the individual soul. It must be kept in mind, of course, that, while possessing a notion (...) of the individual, the Greeks lacked our modern, Cartesian conception of subjectivity, burdened as it is with the existential task of creating and sustaining a meaningful cosmos. But precisely for this reason the ancients had a clearer perspective of the synergistic and mutually determinative dialectic that conjoins the individual and the state, a conjunction grounded in the ethical. This can be seen, Hegel suggests, in terms of the “unwritten and infallible law” that Antigone takes to be the “law of the gods” which “is right because it is what is right,” placing the individual “within the ethical substance; and this substance is thus the essence of self-consciousness.”. (shrink)

The Covid-19 pandemic has led to severe shortages of many essential goods and services, from hand sanitizers and N-95 masks to ICU beds and ventilators. Although rationing is not unprecedented, never before has the American public been faced with the prospect of having to ration medical goods and services on this scale.

Robert Rupert argues against the view that human cognitive processes comprise elements beyond the boundary of the organism, developing a systems-based conception in place of this extended view. He also argues for a conciliatory understanding of the relation between the computational approach to cognition and the embedded and embodied views.

Kohut’s lasting and most important contribution to psychoanalytic clinical theory was his recognition that the experiencing of selfhood is always constituted, both developmentally and in psychoanalytic treatment, in a context of emotional interrelatedness. The experiencing of selfhood, he realized, or of its collapse, is context-embedded through and through. The theoretical language of self psychology with its noun, “the self,” reifies the experiencing of selfhood and transforms it into a metaphysical entity with thing-like properties, in effect undoing Kohut’s hard-won clinical contextualizations. (...) The language of such decontextualizing objectifications bewitches intelligence in order to evade the tragic dimension of finite human existing. (shrink)

_A moving meditation on recent geopolitical crises, viewed through the lens of ancient and modern tragedy__ “Spare, elegant and poignant.... If there is a single contemporary book that should be pressed into the hands of those who decide issues of war and peace, this is it.”—John Gray, _New Statesman_ “It is tragic that Robert D. Kaplan’s luminous _The Tragic Mind_ is so urgently needed.”—George F. Will_ Some books emerge from a lifetime of hard-won knowledge. Robert D. Kaplan has (...) learned, from a career spent reporting on wars, revolutions, and international politics in Europe, the Middle East, and East Asia, that the essence of geopolitics is tragedy. In _The Tragic Mind_, he employs the works of ancient Greek dramatists, Shakespeare, German philosophers, and the modern classics to explore the central subjects of international politics: order, disorder, rebellion, ambition, loyalty to family and state, violence, and the mistakes of power. The great dilemmas of international politics, he argues, are not posed by good versus evil—a clear and easy choice—but by contests of good versus good, where the choices are often searing, incompatible, and fraught with consequences. A deeply learned and deeply felt meditation on the importance of lived experience in conducting international relations, this is a book for everyone who wants a profound understanding of the tragic politics of our time. (shrink)

In this paper I offer some existential-phenomenological reflections on the interrelationships among the forms of love, loss, and human finitude. I claim that authentic Being-toward-death entails owning up not only to one’s own finitude, but also to the finitude of all those we love. Hence, authentic Being-toward-death always includes Being-toward-loss as a central constituent. Just as, existentially, we are “always dying already,” so too are we always already grieving. Death and loss are existentially equiprimordial. I extend these claims to a (...) discussion of the four forms of love identified by the ancient Greeks, contending that the nature of a loss experience will depend complexly on the forms or dimensions of love that had constituted the lost relationship. I argue that authentic solicitude can be shown to entail one of the constitutive dimensions of deep human bonding, in which we value the alterity of the other as it is manifested in his or her own distinctive affectivity, in particular, in those painful emotional states disclosive of authentic existing. Lastly, I explore the ethical implications of these claims. (shrink)

We seek to change the conversation about brain death by highlighting the distinction between brain death as a biological concept versus brain death as a legal status. The fact that brain death does not cohere with any biologically plausible definition of death has been known for decades. Nevertheless, this fact has not threatened the acceptance of brain death as a legal status that permits individuals to be treated as if they are dead. The similarities between “legally dead” and “legally blind” (...) demonstrate how we may legitimately choose bright-line legal definitions that do not cohere with biological reality. Not only does this distinction bring conceptual coherence to the conversation about brain death, but it has practical implications as well. Once brain death is recognized as a social construction not grounded in biological reality, we create the possibility of changing the social construction in ways that may better serve both organ donors and recipients alike. (shrink)