All international codes of research ethics and virtually all national legislation and regulation in the field of research involving human subjects project an attitude of protectionism. Written with the aim of avoiding a repetition of atrocities like those committed by the Nazi physician-researchers, calamities like the thalidomide experience, or ethical violations like those of the Tuskegee syphilis study, their dominant concerns are the protection of individuals from injury and from exploitation. In recent years, however, society's perception of clinical research (...) has shifted dramatically. Now, largely as a consequence of the efforts of the AIDS activists, clinical research is widely perceived as benign and beneficial. Although this shift in attitude has resulted in some important improvements in research policies and practices, this new perception is just as wrong-headed as was the earlier excessive protectionism. It is necessary to maintain a balanced perspective; our policies should encourage the conduct of ethical research while maintaining the vigilance necessary to safeguard the rights and welfare of the subjects. (shrink)

Records the papers and commentaries, with an edited discussion, presented at an international consultation convened by the Council for International Organizations of Medical Sciences (CIOMS) to guide revision of the CIOMS International Ethical Guidelines for Biomedical Research Involving Human Subjects. The Guidelines, first issued in 1982 and then revised in 1993, are being updated and expanded to address a number of new and especially challenging ethical issues. These include issues raised by international collaborative trials of drugs in developing countries, (...) especially expensive drugs, and the use of placebo controls in randomized clinical trials. Others arise from the complexity of research in human genetics, including stem-cell research, and in reproductive biology. Throughout, particular attention is given to the difficult questions that arose during the heated debate over trials in developing countries, of short-duration zidovudine (AZT) therapy to reduce perinatal transmission of HIV. The International Ethical Guidelines for Biomedical Research Involving Human Subjects set out a code of research ethics that is widely used by ethical review committees and other bodies responsible for reviewing and overseeing the ethical design of studies and conduct of research. The revision of the Guidelines is being coordinated by CIOMS, in collaboration with WHO. The consultation centered on seven specially commissioned papers, authored by international experts that explore some of the more difficult issues in depth. Each is followed by an invited commentary, often expressing opposing views, and a summary of the issues or conclusions that emerged during the subsequent debate. The first paper, on justice in international research, deals with the question of whether proposals for research to be conducted in a developing country should make provision for future access of the population involved to the interventions under investigation. Also considered are questions that arise when research uses populations in developing countries to investigate interventions that will be of exclusive benefit to the industrialized world. Case studies of recent drug trials and their research protocols are discussed to illustrate circumstances in which use of populations in developing countries is justified or constitutes exploitation. Ethical challenges of the randomized controlled trial are considered in the second paper, which includes a discussion on the equitable distribution of benefits and risks, the use of placebo for controls, and the obligation to ensure that the participation of controls does not compromise their medical care or endanger their health. A paper on informed consent in international health research considers how cultural factors influence communication and language in the informed-consent process and respect for privacy and confidentiality in the research. Subsequent papers address issues in genetics research and reproductive biology, including the moral status of fetuses and the use of embryos in research, and examine the contribution which international human rights instruments can make in the application of the general principles of ethics to research involving human subjects. The final paper gives an overview of capacity building and the role of communities in international biomedical research. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:A Theory of International Bioethics: Multiculturalism, Postmodernism, and the Bankruptcy of Fundamentalism 1Robert Baker (bio)AbstractThis first of two articles analyzing the justifiability of international bioethical codes and of cross-cultural moral judgments reviews “moral fundamentalism,” the theory that cross-cultural moral judgments and international bioethical codes are justified by certain “basic” or “fundamental” moral principles that are universally accepted in all cultures and eras. Initially propounded by the judges at the (...) 1947 Nuremberg Tribunal, moral fundamentalism has become the received justification of international bioethics, and of cross-temporal and cross-cultural moral judgments. Yet today we are said to live in a multicultural and postmodern world. This article assesses the challenges that multiculturalism and postmodernism pose to fundamentalism and concludes that these challenges render the position philosophically untenable, thereby undermining the received conception of the foundations of international bioethics. The second article, which follows, offers an alternative model—a model of negotiated moral order—as a viable justification for international bioethics and for transcultural and transtemporal moral judgments.Man in the Twentieth Century can not be circumscribed by the standards of any single culture.American Anthropological Association (1948) in a statement officially denouncing the 1948 United Nation’s Declaration of Human Rights.Recently... so-called “liberal” medicine has revived the old rights of a clinic understood in terms of a special contract, a tacit pact made between one man and another. This patient gaze has even been attributed the power of assuming [a role in clinical decision making].Miracles are not so easy to come by....Michel Foucault (1975, p. 5) [End Page 201]An Overview of the AnalysisInternational bioethics originated in the trauma of the Holocaust, specifically, in the 1946–1947 Nuremberg “Doctors Trial” when a tribunal of three American judges convicted Nazi medical researchers of “crimes against humanity.” In justifying their judgment, the Nuremberg Tribunal cited 10 principles for morally permissible research, which, they claimed, were based on “fundamental” principles that civilized societies “all agree” upon and accept as the foundations of their “moral, ethical, and legal” norms. Foremost among the principles was one stating that morally permissible human experiments require the informed voluntary consent of the subject. The Nuremberg judgment soon became associated with the ideal of human rights declared in the 1948 United Nations Charter. These two ideas—fundamental principles of morality and human rights—have been linked in all major formulations of international bioethics promulgated in the past 50 years, including the Council of Europe’s 1997 Convention for the Protection of Human Rights and Dignity of the Human Being with Regard to the Application of Biology and Biomedicine (Council of Europe 1997; Dommel and Alexander 1997). In this paper, I explore the received justification for international bioethics—the idea that it is grounded in fundamental principles accepted in all societies—tracing it from its initial, almost off-hand, promulgation by the Nuremberg Tribunal, through its more thoughtful development by such bioethicists as Ruth Macklin, to its more complex use by the President’s Advisory Committee on Human Radiation Experiments.After a brief review of the evolution of the received justification, I discuss the viability of this justification in the face of the critique implicit in two important intellectual movements: multiculturalism and postmodernism. In the international context, multiculturalism asserts the claim that there are no common moral principles shared by all cultures. Postmodernism asserts a similar claim against all universal standards, moral and nonmoral. In the 1990s, bioethicists have attempted to respond to these claims in various ways. These responses are documented, analyzed, and then shown to be “bankrupt,” in the sense that they undercut the most important objective of moral fundamentalism: the justification of transcultural moral judgments, such as the condemnation of the Nazi doctors.A second article, which follows the present one in the same issue of the Kennedy Institute of Ethics Journal, revisits the contractarian tradition [End Page 202] of Hobbes and Locke, as it has been reinterpreted by David Gauthier (1986), John Rawls (1971, 1993), and Robert Nozick (1974), to develop the idea of negotiated moral order as the basis of international bioethics. When conceptualized as a negotiated moral order, international bioethics can accept the genuine insights... (shrink)

Patient decision aids enable patients to be better informed about the potential benefits and harms of their healthcare options. Certification of patient decision aids at the national level in the United States is a critical step towards responsible governance—primarily as a quality measure that increases patients’ safety, as mandated in the U.S. Patient Protection and Affordable Care Act (PPACA). Certification would provide a verification process to identify conflicts of interest that may otherwise bias the scientific evidence presented in decision (...) aids. Certification also benefits clinicians who may otherwise face malpractice claims based on harm to patients caused by possible reliance on patient decision aids that are inaccurate, incomplete, or presented in a manner that biases the patient’s decision. Existing work by the International Patient Decision Aid Standards Collaboration could guide the establishment of a certification process within the U.S. This article argues for national certification of patient decision aids and discusses how that may be achieved. (shrink)

First published in 1982. Routledge is an imprint of Taylor & Francis, an informa company.

The principle of the child's right to an open future was first proposed by the legal philosopher Joel Feinberg and developed further by bioethicist Dena Davis. The principle holds that children possess a unique class of rights called rights in trust—rights that they cannot yet exercise, but which they will be able to exercise when they reach maturity. Parents should not, therefore, take actions that permanently foreclose on or pre-empt the future options of their children, but leave them the (...) greatest possible scope for exercising personal life choices in adulthood. Davis particularly applies the principle to genetic counselling, arguing that parents should not take deliberate steps to create physically abnormal children, and to religion, arguing that while parents are entitled to bring their children up in accordance with their own values, they are not entitled to inflict physical or mental harm, neither by omission nor commission. In this paper, I aim to elucidate the open future principle, and consider whether it is applicable to non-therapeutic circumcision of boys, whether performed for cultural/religious or for prophylactic/health reasons. I argue that the principle is highly applicable to non-therapeutic circumcision, and conclude that non-therapeutic circumcision would be a violation of the child's right to an open future, and thus objectionable from both an ethical and a human rights perspective. (shrink)

The last half century has been characterized by a growth in the regulation of clinical research nationally and internationally. Each area of research on human subjects has been the subject of a vast academic literature and extensive public policy debate, from issues of informed consent to that of regulatory structures. Professor Bernard Dickens has provided an outstanding contribution to this debate internationally through his many innovative and incisive papers in this area. This paper provides an English lawyer’s perspective upon the (...) increasing regulation of clinical research practices and asks – does regulation equate with effective rights protection? From Nuremberg onwards, there has been concern to ensure that research practices are ethical and in accordance with legal principles. So, for example, there have been statements such as the Declaration of Helsinki, which was initially produced in 1964. In the European context in particular, notably influential statements have been the European Convention on Human Rights, which has been followed by the Council of Europe Convention on Human Rights and Biomedicine and, more recently, a Draft Additional Protocol on medical research. (shrink)

The last half century has been characterized by a growth in the regulation of clinical research nationally and internationally. Each area of research on human subjects has been the subject of a vast academic literature and extensive public policy debate, from issues of informed consent to that of regulatory structures. Professor Bernard Dickens has provided an outstanding contribution to this debate internationally through his many innovative and incisive papers in this area. This paper provides an English lawyer’s perspective upon the (...) increasing regulation of clinical research practices and asks – does regulation equate with effective rights protection? From Nuremberg onwards, there has been concern to ensure that research practices are ethical and in accordance with legal principles. So, for example, there have been statements such as the Declaration of Helsinki, which was initially produced in 1964. In the European context in particular, notably influential statements have been the European Convention on Human Rights, which has been followed by the Council of Europe Convention on Human Rights and Biomedicine and, more recently, a Draft Additional Protocol on medical research. (shrink)

International Rules brings together exemplary works from the most prominent approaches to international rules of International Law and International Relations disciplines. Included are chapters on Natural Law, Legal Positivism, Classical Realism, the New Haven School, Institutionalism, Structural Realism, the New Stream, and Feminist Voices. Each of the eight chapters begins with a brief overview, offers a representative work or works, and concludes with a selected bibliography. From Hugo Grotius to David Kennedy, from George Kennan to Robert Keohane, the (...) featured authors provide valuable insights into their common subject: international rules. Despite divergent methods and objectives, they address fundamentally the same questions: What is the nature of such rules? What is their purpose? How do they originate? What role, if any, do they play in politics? Framing the selections assembled are two original chapter-length essays. The first chapter of this volume assesses the prospects for interdisciplinary collaboration; the final one suggests a direction for future research. (shrink)

Now in its Eighth Edition, UNDERSTANDING ARGUMENTS: AN INTRODUCTION TO INFORMAL LOGIC, 8th Edition. has proven itself to be an exceptional guide to understanding and constructing arguments in the context of students' academic studies as well as their subsequent professional careers. Its tried and true strengths include multiple approaches to the analysis of arguments; a thorough grounding on the uses of language in everyday discourse; and chapters in the latter half of the book that apply abstract concepts to concrete (...) class='Hi'>legal, moral, and scientific issues. Important Notice: Media content referenced within the product description or the product text may not be available in the ebook version. (shrink)

The expanded use of genetic testing raises key ethical and policy questions about possible benefits and harms for those receiving disease‐risk information. As predictive testing for Huntington’s was initiated in a clinical setting, survey research posing hypothetical test scenarios suggested that the vast majority of at‐risk relatives wanted to know whether they carried a disease‐causing mutation. However, only a small minority ultimately availed themselves of this opportunity. Many at‐risk individuals concluded that a positive test result would be too psychologically overwhelming. (...) A substantial literature suggests that individuals are often more resilient than anticipated in coping with many different health‐related stresses. Much of my own work in the field has been through the Risk Evaluation & Education for Alzheimer’s Disease study (REVEAL), a series of randomized clinical trials assessing the impact of genetic susceptibility testing on asymptomatic individuals at risk for Alzheimer’s disease. Our experience in developing and implementing four successive, multisite trials provides some potentially useful lessons for the field. More people will be asking for their personal genetic information. Better understanding will help us decide when access is appropriate and how best to disclose results in a manner that supports adjustment to test findings and promotes use of genetic information to improve human health. (shrink)

The American Psychological Association's (APA's) as well as other professional organizations' (e.g., American Psychiatric Association) removal of homosexuality as a mental disorder represented a paradigmatic shift in thinking about exual orientation. Since then, APA (2000) disseminated guidelines for working with lesbian, gay, and bisexual (LGB) clients, and a variety of scholars and researchers alike have advocated affirmative therapeutic interventions with LGB individuals. Despite these efforts, the controversy over treating individuals with LGB orientations using nonaffirmative techniques continues. In this discussion, the (...) limited evidence regarding the efficacy and effects of conversion therapy is surveyed, particularly in the context of empirically supported treatment criteria summarized by Division 12 (clinical psychology) of the APA. Authors then consider the resulting ethical considerations in performing conversion therapy and propose alternative uses of affirmative therapy on the basis of ethical standards defined by APA. Finally, options for treating LGB individuals who are coming to terms with their sexual orientations are discussed. (shrink)

Modern scientific theories of emotional behavior, almost without exception, trace their origin to Charles Darwin, and his publications On the Origin of Species (1859) and The Expression of the Emotions in Man and Animals (1872). The most famous evolutionary dilemma Darwin acknowledged as a challenge to his theory of natural selection was the incomplete sub Cambrian fossil record. However, Darwin struggled with two other rarely referenced theoretical and scientific dilemmas that confounded his theories about emotional behavior. These included (1) the (...) origin of social instincts (e.g., altruism, empathy, reciprocity and cooperation) and the reasons for their conservation in evolution and (2) the peripheral control of heart rate vis-a-vis emotional behavior outside of consciousness. Darwin acknowledged that social instincts are critical to the survival of some species, but had difficulty aligning them with his theory of natural selection in humans. Darwin eventually proposed that heart rate and emotions are controlled via one’s intellect and cortical mechanisms, and that instinctive behavior is genetically-programmed and inherited. Despite ongoing efforts, these two theoretical dilemmas are debated to this day. Simple testable hypotheses have yet to emerge for the biological mechanisms underlying instinctive behavior or the way heart rate is controlled in infants. In this paper, we review attempts to resolve ¬these issues over the past 160 years. We posit that research and theories that supported Darwin’s individualistic brain-centric and genetic model have become an “orthodox” Western view of emotional behavior, one that produced the prevailing behavioral construct of attachment as developed by John Bowlby. We trace research and theories that challenged this orthodoxy at various times, and show how these challenges were repeatedly overlooked, rejected, or misinterpreted. We review two new testable theories, emotional connection theory and calming cycle theory, which we argue resolve the two dilemmas We show emerging scientific evidence from physiology and a wide variety of other fields, as well from clinical trials among prematurely born infants, that supports the two theories. Clinical implications of the new theories and possible new ways to assess risk and intervene in emotional, behavioral and developmental disorders are discussed. (shrink)

Disasters overwhelm resources and threaten the safety and functioning of communities. Mental health and community needs after catastrophic disasters can be substantial, however the effects of traumatic events are not exclusively bad with many people showing individual resilience and some reporting growth. Sustaining the social fabric of the community and facilitating recovery following disaster depends on leadership=s knowledge of a community=s resilience and vulnerabilities as well as an understanding of the distress, disorder, and health risk behavioral responses. A coordinated systems (...) approach across medical care, public health, and emergency response system is necessary to meet the mental health care needs of a disaster region. (shrink)

With the publication of two books and a series of articles in the late 1960s and 1970s, E. D. Hirsch Jr. established himself as a major voice in the debates about interpretation and literary criticism. Against the mainstream, he proposed and defended an “objectivist” hermeneutics. His voice has remained alive in the debates as the proponent of objectivity in interpretation. As the title of his major book on hermeneutics, Validity in Interpretation (1976), suggests, Hirsch's primary concern is the validation of (...) an interpretation. According to Hirsch, validation is one of two sides of the interpretive process. The first step of any interpretation is guessing at its meaning. Hirsch's genial guess was Schleiermacher's divination. In the course of his discussion of genre, to clarify his view of interpretation, Hirsch mentions Emilio Betti's classification of three types of interpretation: re‐cognitive (historical and literary), presentational (dramatic and musical), and normative (legal and religious). (shrink)

In a brief summary of a poll conducted by the Carnegie Council, Myers outlines the American public's views on issues ranging from foreign policy/peace issues to economic security, defense, and human rights.

The principles Vico offers for his science indicate that his conception of his science is flawed and inconsistent. But this does not mean his conception of explanation is inadequate and inconsistent. Vico's method of science contains three different perspectives which can be called the providential, institutional, and ideational perspectives. Vico does distinguish between description and explanation and the providential perspective involves the former. Explanations of the world of nations are made by looking at institutions and ideas. The institutional perspective aims (...) at knowledge of what is true of things while the ideational perspective studies human thoughts. They are associated with the disciplines of philosophy and philology. These disciplines do complement each other; they are both concerned with ideas and institutions. The complementary workings of these perspectives in producing explanations can be understood in terms of a Vichian explanatory circle. (shrink)

This is a much-needed development from the first edition that provides an update on the theory and research on love by world-renowned scientific experts. It explores love from a diverse range of standpoints: social-psychological, evolutionary, neuropsychological, clinical, cultural, and even political. It considers questions such as: how men and women differ in their love, what makes us susceptible to jealousy and envy in relationships, how love differs across various cultures? As the neuropsychological basis of love is examined, this study showcases (...) what attracts people to one another, why love has developed the way it has over time, and what evolutionary purpose it serves. It also analyses why and when love relationships both succeed and fail, which means readers will be rewarded with a better understanding of their own relationships and those of others, as well as what can be done to build a lasting, loving relationship. (shrink)

A good pragmatist's constitutional theory is inseparable from the legal disputes out of which it arises. John Paul Stevens's theory, that of deciding individual cases well instead of applying constitutional principles in the abstract to cases by category, thus lends itself to being studied in its natural, factual habitat—in his own words, case by case. That's what this book does. In Chapter 1 Sickels distills Stevens's thoughts about law and appellate judging from his early writings and his opinions on (...) the federal appeals court and, from 1975 to the present, on the U.S. Supreme Court. Stevens shows a concern for facts and consequences, for balancing, for deference to other decision makers unless they have been careless, for avoidance of undue complexity in judge-made law, and for drawing the line between clarity and oversimplification in legal rules. The next three chapters describe the application of Stevens's pragmatism to areas of constitutional law to which the Court and he especially have devoted most attention in recent years: First Amendment guarantees of freedom of expression and religion, the procedural guarantees of the Bill of Rights and the Fourteenth Amendment, and the equal protection of the laws. In each area, Stevens's special contributions are described. The concluding chapter places Stevens's judging in the contexts of the ongoing debate about the legitimacy of balancing, the ways of other moderates on the Court, and the voting records of the other members of the Court as a whole. Unique to this work is a meaningful introduction to the term moderate when applied to a Supreme Court justice, a definition based on careful analysis of the interplay of general rules and specific, case-by-case context. As such it is the very essence of Stevens's own way of judging and thus enables analysis of the work of a pragmatist on his own terms rather than through the distortions of a conflicting theory of law. John Paul Stevens is recognized as a jurist of unusual ability and one adheres to no ideological camp. While it is one thing to know he is neither rigid liberal nor a conservative, this book goes beyond the "neither nor" to accomplish the more difficult goal of defining what he is. This study is intended for scholars and students of the Supreme Court, the Constitution, the courts, and the American political process. Lawyers working before the Supreme Court, informed generalists, and courtwatchers generally, whether liberal, conservative, or neutral, will find much of interest here. (shrink)

A handbook of best practices for newspaper journalists, for students and teachers of journalism, and for the publics they serve. The handbook examines some of the concerns readers have expressed about newspapers and provides a list of best practices used in many of the nation's newspapers to address those criticisms.

The devotion of a full article in the Paris Agreement to loss and damage was a major breakthrough for the world’s most vulnerable nations seeing to gain support for climate impacts beyond what can be adapted to. But how will loss and damage be paid for, and who will pay it? Will ethics be part of this decision? Here we ask what are the possible means of raising predictable and adequate levels of funding to address loss and damage? Utilizing a (...) framework developed by Marco Grasso, we argue that making the ethical connections between addressing climate impacts and finance mechanisms could significantly enhance their likelihood of being adopted. We briefly review insurance mechanisms and catastrophe bonds, and then move on to six “innovative finance” approaches to funding loss and damage. We utilize six criteria in assessing them: adequacy, predictability, technical feasibility, fairness, and indirect effects, and whether each has a clear link to loss and damage. Several mechanisms for gathering funds emerged as most promising. Three of the six financial mechanisms we reviewed to raise funding involved airline transport: clearly, there is a huge opportunity to tax this sector in one form or another, in recognition of airline emissions’ role in creating losses and damages in vulnerable nations from sea level rise, droughts, floods or hurricanes. Funding loss and damage response is a contentious issue that will get only more unwieldy if Parties’ conceptions of loss and damage are at odds: a common definition of loss and damage needs to be agreed upon under the UNFCCC. Most immediately, to meet any equity criteria, wealthy countries should do more to support the premiums of those who cannot afford insurance. (shrink)

European portraits of the great Asian states, China, India, and Persia, remained remarkably constant from the establishment of the Chinese silk trade in the first century B.C. until the religious and mercantile expeditions to the Orient prominent in the late Middle Ages. For more than a millenium, the Eastern empires had been classified by Europeans as stable despotisms – stationary societies governed by custom and tradition and devoid of economic, political, or cultural dynamism. Only during the Enlightenment did the proper (...) interpretation of the merits of ‘Oriental despotism’ become a matter of controversy. To some Enlightenment figures, the paternalistic despotisms of Asia appeared to be superior to the nations of Europe ethically and in the quality of their political, legal, and educational institutions. Many social philosophers of the period agreed that the example afforded by Asia could contribute much to the rejuvenation of European society they hoped to effect. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:EPILOGUE Robert J. Daly, SJ. Boston College April 2002 Iwill arrange my comments under four headings: (1) what we had hoped to accomplish; (2) what we actually did accomplish; (3) what we may have learned from this; (4) what this might now enable us to do in thefuture. This epilogueisbeingwritten in April, 2002,twenty-twomonths after the conference. To draw what good we can from this delay, writing at this (...) distance allows me to summarize and draw conclusions with, perhaps, a bit more balance. On the other hand, my listening again to the audio record in the course ofpreparing this publication has enabled me to relive something of the original experience. (1)As I indicated in the introduction, we had unrealistically hoped that, by the time ofthe conference, the five presenters, and perhaps also the twoprincipals inthe "Girard-Lonergan Conversation," wouldhavealready exchanged with each other not just first drafts, but even second drafts of their papers, and that the conference itself would then be invited to join a conversation that was already well under way. As it turned out, I couldn't muster the organizational skills and resources needed to achieve this. But reflecting after the fact, I can see that so carefully detailed a preparation might have been counterproductive. Carrying out our original plan might have been at the cost ofimposing more ofa Western analytic pattern on our discussion ofother traditions, and of!thus smothering from the outset some of the insight that did occur. We had also hoped that the opening "Girard-Lonergan Conversation" would provide an analytic resource for the rest of the meeting. But that did not happen to any great extent. (2)The proximate preparation for this conference began with a draft version ofmy paper being sent to the other major presenters. I opened with 194Robert J. Daly, SJ. a series of brief sketches of salient points in the often unhappy but also occasionally felicitous history ofChristianity on this theme ofviolence and institution. Then, after emphasizing the importance of distinguishing between the normative and the descriptive, I tried to make some sense, both rational and theological, of all this data, especially by reflecting on the influences and consequences ofthe belief in hell, on the one hand, and the hope of universal salvation, on the other. The next major religious theme was Judaism. Reuven Kimelman provided a detailed—and, for some, overwhelming—glimpse of the way the talmudic traditions deal with the theme of war and its restrictions. This highly text-oriented and interpretation-of-texts driven presentation seemed to many, at first, to be irrelevant to mimetic theory and to the need to be confronting actual violence. But, in the course of Sandor Goodhart's response, and in the course ofthe at times spirited discussion that followed, we began to understand that how one interprets texts and traditions, and how these are played off against each other, is indeed fundamental to the way Jews typically try to deal with the practical challenges of violence. Qamar-ul Huda's presentation on IsIamfocused stronglyonthe way the spiritual teachings of Islam—i.e., islam as a religion rather than Islam as a political or national institution—foster peace. The initial reaction was somewhat similarto the reaction to Kimelman's paper: disappointment that Huda was not talking more directly about contemporary Muslim extremist violence. But here, too, the discussion enabled us to catch a glimpse both of the inner spiritual resources of Islam, and of the limitations ofthe range of concerns that Westerners typically bring to the table. Francis Clooney, in his presentation ofHinduism, strongly emphasized the great variety in Hinduism, stressing that one cannot speak ofHinduism as such. Much of this variety comes from the several millennia of Hindu history, and from the complex relationships to Buddhism and Jainism which, themselves, are important parts of Hindu history, and also from the fact that only recently have Hindus, after centuries of Moslem or Colonial domination, once again returned to positions of political and military power. Finally, Christopher Ives's presentation on Buddhism, in a way similar to my presentation on Christianity, but more extensively or more consequently, pointed out the various ways in which Buddhism has been politically and... (shrink)

In view of scholarly work that has explored the socio-psycho significance of national performativity, the body and the “other,” this article critically analyses newspaper representations of the Canadian-born British tennis player Greg Rusedski. Drawing on Lacanian interpretations of the body, it illustrates how Rusedski’s media framing centered on a particular feature of his body—his “smile.” In doing so, we detail how Rusedski’s “post-imperial” Otherness—conceived as a form of “extimacy” (extimité)—complicated any clear delineation between “us” and “them,” positing instead a (...) dialectical understanding of the splits, voids and contradictions that underscore the national “us.”. (shrink)

The American Medical Association enacted its Code of Ethics in 1847, the first such national codification. In this volume, a distinguished group of experts from the fields of medicine, bioethics, and history of medicine reflect on the development of medical ethics in the United States, using historical analyses as a springboard for discussions of the problems of the present, including what the editors call "a sense of moral crisis precipitated by the shift from a system of fee-for-service medicine to (...) a system of fee-for-system medicine, better known as 'managed care.'" The authors begin with a look at how the medical profession began to consider ethical issues in the 1800s and subsequent developments in the 1900s. They then address the sociological, historical, ethical, and legal aspects of the practice of medicine. Later chapters discuss current and future challenges to medical ethics and professional values. Appendixes display various versions of the AMA's Code of Ethics as it has evolved over time. Contributors: George J. Annas, J.D., M.P.H., Arthur Isak Applbaum, Ph.D., Robert B. Baker, Ph.D., Chester R. Burns, M.D., Ph.D., Arthur L. Caplan, Ph.D., Alexander Morgan Capron, J.D., Christine K. Cassel, M.D., Linda L. Emanuel, M.D., Ph.D., Eliot L. Freidson, Ph.D., Albert R. Jonsen, Ph.D., Stephen R. Latham, J.D., Ph.D., Susan E. Lederer, Ph.D., Florencia Luna, Ph.D., Edmund D. Pellegrino, M.D., Charles E. Rosenberg, Ph.D., Mark Siegler, M.D., Rosemary A. Stevens, Ph.D., Robert M. Tenery, Jr., M.D., Robert M. Veatch, Ph.D., John Harley Warner, Ph.D., Paul Root Wolpe, Ph.D. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:A Theory of International Bioethics: The Negotiable and the Non-NegotiableRobert Baker (bio)AbstractThe preceding article in this issue of the Kennedy Institute of Ethics Journal presents the argument that “moral fundamentalism,” the position that international bioethics rests on “basic” or “fundamental” moral principles that are universally accepted in all eras and cultures, collapses under a variety of multicultural and postmodern critiques. The present article looks to the contractarian tradition of (...) Hobbes and Locke—as reinterpreted by David Gauthier, Robert Nozick, and John Rawls—for an alternative justification for international bioethics. Drawing on the central themes of this tradition, it is argued that international bioethics can be rationally reconstructed as a negotiated moral order that respects culturally and individually defined areas of nonnegotiability. Further, the theory of a negotiated moral order is consistent with traditional ideals about human rights, is flexible enough to absorb the genuine insights of multiculturalism and postmodernism, and yet is strong enough to justify transcultural and transtemporal moral judgments, including the condemnation of the Nazi doctors at Nuremberg. This theory also is consistent with the history of the ethics of human subjects experimentation and offers insights into current controversies such as the controversy over changing the consent rule for experiments in emergency medicine and the controversy over exempting certain clinical trials of inexpensive treatments for preventing the perinatal transmission of AIDS from the ethical standards of the sponsoring country.The Preamble to the Council of Europe’s (1997) Convention on Human Rights and Biomedicine, the most recently ratified code of international bioethics, is noteworthy because it never mentions “principles,” the concept most frequently cited by the fundamentalists as basic to international bioethics. Instead it stresses rights, a concept that has been utterly ignored by the fundamentalist theorists of international bioethics. The Preamble exemplifies a conception of international [End Page 233] bioethics as an ethics of covenants and conventions grounded in human rights. In the full text of the Preamble, the term “rights” appears eight times and the expressions “convention” and “covenant” are used six times; the term “principle” does not appear at all. In this essay, I develop a theoretical framework for international bioethics based on conventions, covenants, and areas of “nonnegotiability”—a concept that serves as a functional analogue to the traditional notion of “human rights.” I also shall argue that, unlike the theory of basic principles central to moral fundamentalism, the theory of negotiated morality appears immune to the multicultural and postmodern critiques of international bioethics that were analyzed in the preceding article in this issue of the Kennedy Institute of Ethics Journal (Baker 1998).Negotiated Moral Order: A Model for International BioethicsReconsidering ContractarianismThe linkage of “conventions” and “covenants” with human rights that is evident in the Council of Europe’s Convention on Human Rights and Biomedicine traces back directly to the moral and political theories of Thomas Hobbes and John Locke. Such philosophers as David Gauthier (1986), Robert Nozick (1974), and John Rawls (1971, 1993) recently have reinvigorated this classic contractarian line of analysis. In this section, I shall reconsider classical contractarian theory from a perspective informed by these more recent analyses.The most riveting feature of all forms of contractarian theory is the metaphor of the contract itself, particularly the legitimating role it accords to assent. Because contractarians look to the assent of those who would be bound by a moral norm as ultimately the sole source of a norm’s legitimacy, the most important corollary of contractarian moral theory is that moral norms are illegitimate insofar as agents either in principle could not, hypothetically would not, or actually will not rationally assent to be bound by them. Contractarians also argue that because legal norms are legitimated by acceptance of the authority of those who promulgate them, the authority of such norms is bounded by the actual or hypothetical assent of the governed. These features of contractarian analysis generate the correlative concepts of human rights and civil rights.Less often remarked, but nonetheless integral to the metaphor of the social contract, is the contractarian recognition that the interests of the [End Page 234] parties who contract to form civil society are naturally in conflict (or, as Hobbes put... (shrink)

Evidence suggests that one reason doctors provide certain interventions in assisted reproductive technologies (ART) is because of patient demand. This is particularly the case when it comes to unproven interventions such as ‘add‐ons’ to in vitro fertilisation (IVF) cycles, or providing IVF cycles that are highly unlikely to succeed. Doctors tend to accede to demands for such interventions because patients are willing to do and pay ‘whatever it takes’ to have a baby. However, there is uncertainty as to what moral (...) weight should be placed on patient‐led demands in ART, including whether it is acceptable for such demands to be invoked as a justification for intervention. We address this issue in this paper. We start by elucidating what we mean by ‘patient‐led demand’ and synthesise some of the evidence for this phenomenon. We then argue that a doctor's professional role morality (PRM) yields special responsibilities, particularly in commercialised healthcare settings such as ART, because of the nature of professions as social institutions that are distinct from markets. We argue on this basis that, while there may be reasons (consistent with PRM) for doctors to accede to patient demand, this is not always the case. There is often a gap in justification between acceding to patient‐led demands and providing contested interventions, particularly in commercial settings. As a result, acceding to demand in such settings needs a strong justification to be consistent with PRM. (shrink)

The ethical recruitment of participants with neurological disorders in clinical research requires obtaining initial and ongoing informed consent. The purpose of this study is to characterize barriers faced by research personnel in obtaining informed consent from research participants with neurological disorders and to identify strategies applied by researchers to overcome those barriers. This study was designed as a web-based survey of US researchers with an optional follow-up interview. A subset of participants who completed the survey were selected using a stratified (...) purposeful sampling strategy and invited to participate in an in-depth qualitative interview by phone or video conference. Data were analyzed using a mixed methods approach, including content analysis of survey responses and thematic analysis of interview responses. Over 1 year, 113 survey responses were received from US research personnel directly involved in obtaining informed consent from participants in neurological research. Frequently identified barriers to informed consent included: cognitive and communication impairments (e.g. aphasia), unrealistic expectations of research participants, mistrust of medical research, time constraints, literacy barriers, lack of available social support, and practical or resource-related constraints. Strategies to enhance informed consent included: involving close others to support participant understanding of study-related information, collaborating with more experienced research personnel to facilitate training in obtaining informed consent, encouraging participants to review consent forms in advance of consent discussions, and using printed materials and visual references. Beyond conveying study-related information, researchers included in this study endorsed ethical responsibilities to support deliberation necessary to informed consent in the context of misconceptions about research, unrealistic expectations, limited understanding, mistrust, and/or pressure from close others. Findings highlight the importance of training researchers involved in obtaining informed consent in neurological research to address disease-specific challenges and to support the decision-making processes of potential research participants and their close others. (shrink)

The COVID-19 outbreak has simultaneously increased the need for mental health services and decreased their availability. Brief online self-help interventions that can be completed in a single session could be especially helpful in improving access to care during the crisis. However, little is known about the uptake, acceptability, and perceived utility of these interventions outside of clinical trials in which participants are compensated. Here, we describe the development, deployment, acceptability ratings, and pre–post effects of a single-session intervention, the Common Elements (...) Toolbox, adapted for the COVID-19 crisis to support graduate and professional students. Participants, who were not compensated, were randomly assigned to two of three modules: behavioral activation, cognitive restructuring, and gratitude. Over 1 week, 263 individuals began and 189 individuals completed the intervention. Participants reported that the intervention modules were acceptable, helpful, engaging, applicable to their lives, and could help them manage COVID-related challenges. Participants reported pre- to post-program improvements in secondary control and in the perceived negative impact of the COVID-19 crisis on their quality of life. On average, differences in their perceived ability to handle lifestyle changes resulting from the pandemic were positive, but small and at the level of a non-significant trend. Our results highlight the acceptability and utility of an online intervention for supporting individuals through the COVID-19 crisis. (shrink)

How did meat emerge to become such an important feature in Western society? In both popular and academic literatures, biophysical and political-economic factors are often cited as the reason for meat’s preeminent status. In this paper, we perform a comprehensive investigation of these claims by reviewing the available evidence on the political-economic and biophysical features of meat over the long arc of Western history. We specifically focus on nine critical epochs: the Paleolithic, early to late Neolithic, antiquity, ancient Israel and (...) early Christian societies, medieval Europe, early modern Europe, colonial America, the American frontier, and the modern industrial era. We find that except under conditions of environmental scarcity, the meaning and value of meat cannot be attributed to intrinsic biophysical value or to the political-economic actors who materially benefit from it. Rather, meat’s status reflects the myriad cultural contexts in which it is socially constructed in people’s everyday lives, particularly with respect to religious, gender, communal, racial, national, and class identity. By deconstructing the normalized/naturalized materialist assumptions circling around meat consumption, this paper clears a space for a more nuanced appreciation of the role that culture has played in the legitimation of meat, and by extension, the possibility of change. (shrink)

The foreskin is a complex structure that protects and moisturizes the head of the penis, and, being the most densely innervated and sensitive portion of the penis, is essential to providing the complete sexual response. Circumcision—the removal of this structure—is non-therapeutic, painful, irreversible surgery that also risks serious physical injury, psychological sequelae, and death. Men rarely volunteer for it, and increasingly circumcised men are expressing their resentment about it.Circumcision is usually performed for religious, cultural and personal reasons. Early claims about (...) its medical benefits have been proven false. The American Academy of Pediatrics and the Centers for Disease Prevention and Control have made many scientifically untenable claims promoting circumcision that run counter to the consensus of Western medical organizations.Circumcision violates the cardinal principles of medical ethics, to respect autonomy, to do good, to do no harm, and to be just. Without a clear medical indication, circumcision must be deferred until the child can provide his own fully informed consent.In 2012, a German court held that circumcision constitutes criminal assault. Under existing United States law and international human rights declarations as well, circumcision already violates boys› absolute rights to equal protection, bodily integrity, autonomy, and freedom to choose their own religion. A physician has a legal duty to protect children from unnecessary interventions. Physicians who obtain parental permission through spurious claims or omissions, or rely on the American Academy of Pediatrics' position, also risk liability for misleading parents about circumcision. (shrink)

'The genocide in Rwanda showed us how terrible the consequences of inaction can be in the face of mass murder. But the conflict in Kosovo raised equally important questions about the consequences of action without international consensus and clear legal authority. On the one hand, is it legitimate for a regional organization to use force without a UN mandate? On the other, is it permissible to let gross and systematic violations of human rights, with grave humanitarian consequences, continue unchecked?'. (...) This book is a comprehensive, integrated discussion of 'the dilemma' of humanitarian intervention. Written by leading analysts of international politics, ethics, and law, it seeks, among other things, to identify strategies that may, if not resolve, at least reduce the current tension between human rights and state sovereignty. This volume is an invaluable contribution to the debate on all aspects of this vital global issue. (shrink)

For all of the emphasis on quality improvement—as well as the acknowledged overlap between assessment of the quality of healthcare services and clinical ethics—the quality of clinical ethics consultation has received scant attention, especially in terms of empirical measurement. Recognizing this need, the second edition of Core Competencies for Health Care Ethics Consultation identified four domains of ethics quality: (1) ethicality, (2) stakeholders’ satisfaction, (3) resolution of the presenting conflict/dilemma, and (4) education that translates into knowledge. This study is the (...) first, to our knowledge, to directly measure all of these domains. Here we describe the quality improvement process undertaken at a tertiary care academic medical center, as well as the tools developed to measure the quality of ethics consultation, which include post-consultation satisfaction surveys and weekly case conferences. The information gained through these tools helps to improve not only the process of ethics consultation, but also the measurement and assurance of quality. (shrink)

This second volume arising from the Frontiers in American Philosophy Conference held at Texas A&M University is "festive, celebrating the diversity of thought and influences in American philosophy," say its editors. In these thirty-six essays, there is no attempt to define an American ethos; in fact, the editors conclude that, even pragmatism, identified by Tocqueville as America's defining attribute, should not be described as a national philosophy. It is, as Gerard Deledalle notes in his essay, "the new universal philosophy, (...) because it is the philosophy of experience and democracy that is any nation's `manifest destiny.'" These articles, by thoughtful scholars from North America and several European nations, look forward through the developments presently shaping philosophical inquiry in the United States and backward to the origins and plurality of the American intellectual heritage. Not a parochial or narrow perspective, the focus on American philosophy sharpens the dialogue that clarifies and explicates American thought in the context of a world community. (shrink)

Critical ethical questions arise concerning whether studies among adolescents of new behavioral and biomedical HIV preventive interventions such as Pre-Exposure Prophylaxis should obtain parental permission. This paper examines the relevant regulations and ethical guidance concerning waivers of parental permission, and arguments for and against such waivers. Opponents of such waivers may argue that adolescent decision-making is “too immature” and that parents always have rights to decide how to protect their children. Yet requiring parental permission may put adolescents at risk, and/or (...) limit adolescent participation, jeopardizing study findings’ validity. This paper presents recommendations on when researchers and Institutional Review Boards should waive parental permission, and what special protections should be adopted for adolescents who consent for themselves, e.g., assuring adolescent privacy and confidentiality, screening for capacity to consent, and identifying adolescents who are at elevated risk from study participation. We also present a series of specific areas for future research to design tools to help make these assessments, and to inform researcher and IRB decisions. These recommendations can help ensure that research is conducted that can aid adolescents at risk for HIV, while minimizing risks and protecting these individuals' rights as much as possible. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:IntroductionStuart J. Youngner (bio), Laura A. Siminoff (bio), and Renie Schapiro (bio)This issue of the Kennedy Institute of Ethics Journal (KIEJ) centers on a piece of empirical research. The motivation behind the study of Laura Siminoff, Christopher Burant, and Stuart Youngner (2004) was to find out more about what the general public understands and believes about when a person is dead. More specifically, the study tried to determine how (...) members of the public define death, especially their acceptance and interpretation of the medical concept of "brain death," and their attitudes toward the so-called "dead donor rule," an informal but powerful social and legal norm insisting that the taking of organs for transplantation not cause the death of the source of those organs.As the demand for organs increases and the waiting list grows, the United States has explored multiple ways to expand the pool of potential donors. One approach has been to gerrymander (coherently or not) the line between life and death to shift patients who are extremely compromised but traditionally considered to be in the living category into the dead category. In this way, the dead donor rule remains technically intact. This reasoning is explicit in the report of the Harvard Medical School Ad Hoc Committee (1968) that "introduced" "brain death" to the American culture. Since then, other efforts to redraw the line have been proposed and rejected.One alternative to gerrymandering is to consider under what conditions, if any, it is morally acceptable to violate the dead donor rule. Some would argue that this alternative is the more "honest" approach. Rather than sidestepping moral problems by calling people dead, it brings the moral problems to the surface where the necessity of sticking to the rule can be considered on its own merits. However, when the Journal of the American Medical Association printed a position paper that proposed making anencepahlic newborns an exception to the dead donor rule, along with arguments about why this was acceptable, the outcry was so great that the proposal was retracted (AMA 1995).Clearly, our society has identified organ transplantation as a priority, although two papers in this volume (those by Courtney Campbell and by Megan Crowley-Matoka and Robert Arnold) take issue with that prioritization. The fact that the donor pool has remained relatively stable (and inadequate) despite massive efforts [End Page 211] to increase it speaks, at least in part, to the cultural and legal resistance to "new" ways to procure more organs. Voluntarism seems to have peaked. Financial incentives clash with the heavily endorsed notion of the "gift of life" and seem to many to violate the dignity of the human body. Presumed consent or eminent domain, in which the community has a greater claim to a person's organs than that person or his/her family, go against the grain of American individual freedom and the ethos of patient autonomy.Abandoning the dead donor rule generally is regarded as an even tougher sell to the American public and its legislators. The study by Siminoff and colleagues attempts, among other things, to gauge just how tough this sell would be. What the data actually demonstrate is a matter of interpretation, and this issue of the KIEJ is devoted to some of those interpretations. The authors, with the exception of Daniel Hausman, came together for a meeting in Cleveland, Ohio, during which the study's methods and data were presented with time for questions, clarifications, and general discussion. The authors then worked with the editors to generate the papers printed in this volume.The issue begins with a presentation of the study conducted by Siminoff and colleagues. The same paper also appears in the journal Social Science and Medicine, where it includes the conclusions of the authors (Siminoff, Burant, and Youngner 2004). In the current volume, we present only the methodology of and data from the study, allowing a number of distinguished commentators to offer their own conclusions and reflections.The first response comes from Tracy Schmidt, Executive Director of Intermountain Donor Services, one of our nation's organ procurement organizations (OPOs). For years, organ procurement professionals have reported anecdotal stories about families who wished to donate organs of... (shrink)

In contrast to theoretical discussions about potential professional liability of clinical ethicists, this report gives the results of empirical data gathered in a national survey of clinical medical ethicists. The report assesses the types of activities of clinical ethicists, the extent and types of their professional liability coverage, and the influence that concerns about legal liability has on how they function as clinical ethicists. In addition demographic data on age, sex, educational background, etc. are reported. The results show (...) that while nearly one third (28.9%) of the ethicists regularly make recommendations about patient care, only 10.8% of them regularly make entries in the medical record; only approximately half (53.0%) of them are covered by professional liability (malpractice) insurance; and the vast majority (84.3%) of them say that concerns about legal liability do not influence the way they function as clinical ethicists. (shrink)

In the clinical setting, questions of medical ethics raise a host of perplexing problems, often complicated by conflicting perspectives and the need to make immediate decisions. In this volume, bioethicists and physicians provide a nuanced, in-depth approach to the difficult issues involved in bioethics consultation. Addressing the needs of researchers, clinicians, and other health professionals on the front lines of bioethics practice, the contributors focus primarily on practical concerns -- whether ethics consultation is best done by individuals, teams, or committees (...) how an ethics consult service should be structured the need for institutional support and techniques and programs for educating and training staff -- without neglecting more theoretical considerations, such as the importance of character or the viability of organizational ethics. (shrink)

Clinical ethics consultation is largely outside the scope of regulation and oversight, despite its importance. For decades, the bioethics community has been unable to reach a consensus on whether there should be accountability in this work, as there is for other clinical activities that influence the care of patients. The American Society for Bioethics and Humanities, the primary society of bioethicists and scholars in the medical humanities and the organizational home for individuals who perform CEC in the United States, has (...) initiated a two‐step quality attestation process as a means to assess clinical ethics consultants and help identify individuals who are qualified to perform this role. This article describes the process. (shrink)

A revised core curriculum for medical ethics and law in UK medical schools has been published. The General Medical Council requires medical graduates to understand law and ethics and behave in accordance with ethical and legal principles. A parallel policy agenda emphasises accountability, the development of professionalism and patient safety. Given the renewed focus on teaching and learning law alongside medical ethics and the development of professional identity, this survey aimed to identify how medical schools are responding to (...) the preparation of medical students for practice in the future. Questions were asked about the location, content and methods of teaching and assessment of law in undergraduate medical education. Examples of course documentation were requested to illustrate the approaches being taken. A 76% response rate was achieved. Most responding schools integrate law teaching with medical ethics, emphasising both the acquisition of knowledge and its application in a clinical context. Teaching, learning and assessment of law in clinical attachments is much less formalised than that in non-clinical education. Coverage of recommended topic areas varies, raising questions about the degree to which students can embed their knowledge and skills in actual practice. More positively, teaching does not rely on single individuals and clear descriptions were offered for problem-based and small group case-based learning. Further research is required to explore whether there are optimum ways of ensuring that legal knowledge, and skills in its use, form part of the development of professionalism among doctors in training. (shrink)

This Article explores three theories of humanitarian intervention that appear in, or are inspired by, the writings of Hugo Grotius. One theory asserts that natural law authorizes all states to punish violations of the law of nations, irrespective of where or against whom the violations occur, to preserve the integrity of international law. A second theory, which also appears in Grotius’s writings, proposes that states may intervene as temporary legal guardians for peoples who have suffered intolerable cruelties at the (...) hands of their own state. Each of these theories has fallen out of fashion today based on skepticism about their natural law underpinnings and concerns about how they have facilitated Western colonialism. As an alternative, this Article outlines a third theory that builds upon Grotius’s account of humanitarian intervention as a fiduciary relationship, while updating Grotius’s account for the twenty-first century. According to this new fiduciary theory, when states intervene to protect human rights abroad they exercise an oppressed people’s right of self-defense on their behalf and may use force solely for the people’s benefit. As fiduciaries, intervening states bear obligations to consult with and honor the preferences of the people they seek to protect, and they must respect international human rights governing the use of force within the affected state. By clarifying the respective responsibilities of the Security Council and individual states for humanitarian intervention, the fiduciary theory also lends greater coherency to the international community’s “responsibility to protect” human rights. (shrink)

continent. 2.2 (2012): 76–81 Comments on Eugene Thacker’s “Cosmic Pessimism” Nicola Masciandaro Anything you look forward to will destroy you, as it already has. —Vernon Howard In pessimism, the first axiom is a long, low, funereal sigh. The cosmicity of the sigh resides in its profound negative singularity. Moving via endless auto-releasement, it achieves the remote. “ Oltre la spera che piú larga gira / passa ’l sospiro ch’esce del mio core ” [Beyond the sphere that circles widest / penetrates (...) the sigh that issues from my heart]. 1 The axiomatic sigh of the pessimist is in a way the pure word of philosophy, a thought that thinks without you, speaks where you are not. The live pneumatic form of the soul’s eventual exit from the dead body’s mouth, the sigh restores consciousness to the funeral of being, to the passing away that is existence. Pessimism speaks in piercing aphorisms because first it sighs. “Beyond the sphere passeth the arrow of our sigh. Hafiz! Silence.” 2 … pessimism is guilty of that most inexcusable of Occidental crimes—the crime of not pretending it’s for real. To the pessimist, the ‘real’ world—the world on whose behalf we are expected to wake up in the morning—is a ceaseless index of its own unreality. The pessimist’s day is not an illumined space for the advancement of experience and action, but a permanently and inescapably reflective zone, the vast interior of a mirror where each thing is only insofar as it is, at best, a false image of itself. Within this speculative situation, inside the doubleness of the mirror, pessimism splits into two paths, false and true, one that tries to fix pessimism (establish a relation with the mirror) and decides in favor of the apparent real, and another that totally falls for pessimism (enters the mirror) and communes with the greater reality of the unreal. These two paths are distinguished by their relation to pessimism’s guilt vis-à-vis the world’s reality-project. The first form, that which remains pessimism for the world and puts on a smiling face, stays guilty to itself (i.e. unconscious) and thus turns hypocritical, becoming at once the pessimism of the commoner who really just wants things to be better for himself and the pessimism of the elite who wants to critically refashion reality in his own image. The general form of this worldly, hypocritical pessimism is the impulse to ‘make the world a better place’, which is the global mask under which the world is diurnally made worse. The second form, that which follows pessimism away from the world and ceases to put on a smiling face, refuses guiltiness as itself theessential Occidental mode of pretense and turns honest, becoming at once the intelligent pessimism required of all ordinary action and the radical pessimism necessary for self-knowledge: seeing that no one is capable of doing good. The general form of this universal, honest pessimism is the impulse not to worry, to give up and embrace dereliction, which is the only real way the world is actually improved. Where worldly pessimism is the engine productive of interminably warring secular and sacred religions (good-projects), universal pessimism strives hopelessly for the paradise of a supremely instantiated pessimus: things are getting so bad that there is no longer any time for them to get worse; things are so constantly-instantly worst that this is BEST. Cosmic pessimism is the mode of universal pessimism which can yet discourse with the world, which has not chosen silence and can spread the inconceivably BAD NEWS in an orderly form ( kosmos ) that the world can understand (if it wanted to). … the result of a confusion between the world and a statement about the world. That is what the world is (the result of a confusion between the world and a statement about the world). … a generalized misanthropy without the anthropos. Pessimism crystallizes around this futility—it is its amor fati , rendered as musical form. Pessimism’s love of fate is a blind love, a love of the blindness of being human in a cosmos conceived around the human’s eclipse, a heavy levitation in the contradictory space between the inescapability of its having been and the impossibility of its will-be. Pessimism’s song of futility is a sensible way of loving fate, with a minimum of eros, by means of a kind of matrimonial love of the fatal. As music, pessimism stays open to the irreparable and the inexorable without the binding of affirmation, in the apparent absence of the radical, infinitely surplus will that absolute amor fati seems to require. Crying, laughing, sleeping—what other responses are adequate to a life that is so indifferent? “Unless a man aspires to the impossible, the possible that he achieves will scarcely be worth the trouble of his achieving it. We should aspire to the impossible, to absolute and infinite perfection [….] The apocatastasis is more than a mystical dream: it is a norm of action, it is a beacon for high deeds [….] For true charity is a species of invasion [….] It is not charity to rock and lull our fellow men to sleep in the inertia and heaviness of matter, but rather to arouse them to anguish and torment of spirit.” 3 … the impossibility of ever adequately accounting for one’s relationship to thought. “The paroxysm of interior experience leads you to regions where danger is absolute, because life which self-consciously actualizes its roots in experience can only negate itself [….] There are no arguments [….] On the heights of despair, the passion for the absurd is the only thing that can still throw a demonic light on chaos [….] I live because the mountains do not laugh and the worms do not sing .” 4 It took three attempts before she was fully decapitated, all the while she continued, perhaps miraculously, to sing. According to the earliest account of Cecilia’s martyrdom, the beheading turns out worse. After not severing her head in three strokes, “the cruel executioner left her half dead” (seminecem eam cruentus carnifex dereliquit). 5 Cecilia’s effortlessly powerful endurance of the three strokes—a fitting icon for pessimism as an art of dereliction—demonstrates the “passivity and absence of effort [….] in which divine transcendence is dissolved.” 6 There’s a ghost that grows inside of me, damaged in the making, and there’s a hunt sprung from necessity, elliptical and drowned. Where the moving quiet of our insomnia offers up each thought, there’s a luminous field of grey inertia, and obsidian dreams burnt all the way down. Like words from a pre-waking dream. There is no reason to think that they are not. NOTES 1. Dante Alighieri. Vita Nuova . ed. and trans. Dino S. Cervigni and Edward Vasta. Notre Dame: University of Notre Dame Press. 1995. 41:10. 2. Hafiz of Shiraz. The Divan . trans. H. Wilberforce Clarke. London: Octagon Press. 1974. 10.9. 3. Miguel de Unamuno. The Tragic Sense of Life in Men and Nations . trans. Anthony Kerrigan. Princeton: Princeton University Press. 1972. 305-6. 4. E.M. Cioran. On the Heights of Despair . trans. Ilinca Zarifopol-Johnston. Chicago: University of Chicago Press. 1992. 9-10. 5. Giacomo Laderchi. S. Caeciliae Virg[inis] et Mart[yris] Acta. . . Rome. 1723. 38. 6. Georges Bataille. On Nietzsche . trans. Bruce Boone. London: Continuum. 2004. 135. See Nicola Masciandaro. “ Half Dead: Parsing Cecilia .” A Commentary on Eugene Thacker’s "Cosmic Pessimism" Gary J. Shipley Pessimism is the refusal to seek distraction, the refusal to remodel failure into a platform for further (doomed) possibilities, the refusal of comfort, the acceptance of the sickness of healthy bodies, the cup of life overflowing with cold vomit. If, as Ligotti suggests when discussing Invasion of the Body Snatchers , 1 humans prefer the anxieties of their familiar human lives to the contentment of an alien one, then the pessimist, we could argue, represents some perverted combination of the two, preferring (presuming he has a choice) the defamiliarization of human life to the contentment of its unquestioned mundanity. The quasi-religious state of mind that Wittgenstein would mention on occasion, that of “feeling absolutely safe,” 2 is a state the pessimist could only imagine being approximated by death, or perhaps some annihilative opiate-induced stupor. This Wittgensteinian commingling of certainty and faith looks every bit the futile gesture, a mere rephrasing of collapse or partial collapse. The only certainty open to the pessimist is that of the toxic formula of life itself—a formula known and lacuna-free. Certainty, far from being the gateway to deliverance, becomes the definitive impediment; and the possibility of salvation, as long as it remains, becomes crucially reliant on postulations of ignorance, epistemic gaps, a perennial incompleteness: “the perfect safety of wooed death […] the warm bath of physical dissolution, the universal unknown engulfing the miniscule unknown.” 3 The height of Leibniz’s Panglossian insanity nurtured the idea that our knowing everything—via the universal calculus—could be accurately described a triumph, as opposed to a nightmare in which our every futility is laid bare. Stagnancy and boredom are perhaps two of the greatest ills of Western civilisation, and the most potent pessimism tells you that you’re stuck with both. The most we can hope for, by way of salvation, is to throw open our despair to the unknown. The fact that Schopenhauer’s pessimism stopped short of morality and allowed him to play the flute, as Nietzsche complained, highlights the predicament of a man who despite having adorned nothingness with a smiling face still found himself alive. The demand here is that it be felt: a cross-contamination of intellect and emotion. The safety net of numerous parentheses makes for a failed philosophy, rather than a philosophy of failure. Depressives make bad pessimists, because, unless they choose to die, living will always infect them with necessities of hope, forcing them to find something, anything (all the various “as ifs”) to make existence tolerable. For as Cioran observed, while “[d]epressions pay attention to life, they are the eyes of the devil, poisoned arrows which wound mortally any zest and love of life. Without them we know little, but with them, we cannot live.” 4 And even when cured of our depressions we’ll find ourselves consumed, eaten alive by the hyper-clinical (borderline autistic) mania that replaces them: a predicament captured all too clearly in the microscriptual fictions of Robert Walser, where spectral men and women stifle their depressive madness with protective comas of detail, their failed assimilations buried beneath thick crusts of remote data. Like Beckett’s Malone their stories may have ended, but cruelly their lives have not. Pessimism is an extraneous burden (a purposeless weight) that makes everything else harder to carry, while at the same time scooping it out and making it lighter. If pessimism had a sound it would be the harsh non-noise of tinnitus—the way that every person would hear themselves if they refused their distractions long enough to listen: a lungless scream from the extrasolar nothing of the self. The music of pessimism—if indeed we can imagine such a thing—is the reverberating echo of the world’s last sound, conjectured but never heard, audible only in its being listened for. The one consolation of this hollow paradox of audibility being, that “he will be least afraid of becoming nothing in death who has recognized that he is already nothing now.” 5 The pessimist suffers a derangement of the real, a labyrinthitis at the nucleus of his being: he’s the stumbling ghost relentlessly surprised that others can see him. If Cioran’s refusal is manifested in sleep (when even saying ‘no’ is too much of a commitment), then Pessoa’s resides in the dreams inside that sleep. Pessoa chooses to exploit the fact that he’s being “lived by some murmuring non-entity both shadowy and muddied” 6 by growing more voids to live him. His is a Gnostic breed of sleep, “sleeping as if the universe were a mistake,” 7 a sleep that dreams through Thacker’s cosmic pessimism (“a pessimism of the world-without-us.”, “the unhuman orientation of deep space and deep time” 8 ), through the critical error of there being anything at all when there could be nothing. The metaphysical pessimist is someone who, however well life treats them, still desires to wake from it, as from the poisonous air of a bad dream. Pessimism is a paradox of age, being simultaneously young and old; its youth residing in a refusal to accept the authority of existence (its rich history, its inherent beneficence), a refusal to “get over” the horror of what it sees with its perpetually fresh eyes, and its maturity in the unceremonious disposal of the philosophical playthings (those futile architectures) of adolescence. As Thacker remarks: “Pessimism abjures all pretenses towards system—towards the purity of analysis and the dignity of critique.” 9 A sentiment shared with Pessoa, who duly categorizes those that choose to enact this futile struggle: “The creators of metaphysical systems and of psychological explanations are still in the primary stage of suffering.” 10 If the pessimist has shared a womb with anyone, it’s with the mystic and not the philosopher. As Schopenhauer tells us: “The mystic is opposed to the philosopher by the fact that he begins from within, whereas the philosopher begins from without. […] But nothing of this is communicable except the assertions that we have to accept on his word; consequently he is unable to convince.” 11 The crucial difference between the mystic and the pessimist is not the latter’s impassivity and defeatism, but his unwillingness/inability to contain in any way the spread of his voracious analyticity, his denial of incompleteness, his exhaustive devotion to failure. The truth of our predicament, though heard, is destined to remain unprocessed. Like the revelations of B.S. Johnson’s Haakon (“We rot and there’s nothing that can stop it / Can’t you feel the shaking horror of that?” 12 ) the pessimist’s truths are somehow too obvious to listen to, as if something inside us were saying, “Of course, but haven’t we gotten over that?” Pessimism is simple and ugly, and has no desire to make itself more complex or more attractive. The true moral pessimist knows that the Utilitarian’s accounts will always be in the red. He can see that for all his computational containments, his only honest path is a negative one, and that such a path has but one logical destination: that of wholesale human oblivion. Thacker notes how at the core of pessimism lies the notion of “the worst,” through which death is demoted by the all-pervasive suffering of a life that easily eclipses its threat. And so with doom made preferable to gloom, death begins to glint with promise, “like beauty passing through a nightmare.” 13 But even among pessimists suicide is, for the most part, thought to be an error. Schopenhauer, for instance, regarded suicide a mistake grounded in some fundamentally naïve disappointment or other. Pessoa too thought suicide an onerous escape tactic: “To die is to become completely other. That’s why suicide is a cowardice: it’s to surrender ourselves completely to life.” 14 There is a call here to be accepting of and creative with the puppetry of your being, an insistence that it’s somehow a blunder to attempt to hide in death from the horrors you find inlife. 15 Tied up with this perseverance is the slippery notion of the good death, for maybe, as Blanchot warns, suicide is rarely something we can hope to get right, for the simple reason that “you cannot make of death an object of the will.” 16 “Even in cases where the entire corpus of an author is pessimistic, the project always seems incomplete,” 17 and this is not simply because the project itself belies something yet to be disclosed, but because the project itself is a thing waiting. It waits on a cure it knows will not come, but for which it cannot do anything (as long as it continues to do anything) but wait. NOTES 1. See Thomas Ligotti. The Conspiracy Against the Human Race . New York: Hippocampus Press. 2010. 91. 2. Ludwig Wittgenstein. “A Lecture on Ethics.” Philosophical Review . (74) 1. 1965. 8. 3. Vladimir Nabokov. Pale Fire . New York: Vintage. 1989. 221. 4. E. M. Cioran. The Book of Delusions . trans. Camelia Elias. Hyperion. 5.1. (2010): 75. 5. Arthur Schopenhauer. The World as Will and Representation. vol. 2 . trans. E .F J. Payne. New York: Dover. 1966. 609. 6. Eugene Thacker. “Cosmic Pessimism.” continent. . 2.2 (2012): 67. 7. Fernando Pessoa. The Book of Disquiet . trans. Richard Zenith. London: Penguin. 2002. 35. 8. Eugene Thacker. “Cosmic Pessimism.” continent. . 2.2 (2012): 68. 9. Ibid. 73. 10. Fernando Pessoa. The Book of Disquiet . trans. Richard Zenith. London: Penguin. 2002. 341. 11. Arthur Schopenhauer. The World as Will and Representation. vol. 2 . trans. E .F J. Payne. New York: Dover. 1966. 610-11. 12. B.S Johnson. “You’re Human Like the Rest of Them.” in Jonathan Coe. Like a Fiery Elephant: The Story of B.S. Johnson . London: Picador. 2004. 177. 13. Fernando Pessoa. The Book of Disquiet . trans. Richard Zenith. London: Penguin. 2002. 415. 14. Ibid. 199. 15. “Suicide is, after all, the opposite of the poem.” Anne Sexton. No Evil Star: Selected Essays, Interviews and Prose . ed. Steven Gould Axelrod. Ann Arbor: University of Michigan Press. 1985. 92. 16. Maurice Blanchot. The Space of Literature . trans. Ann Smock. Lincoln: University of Nebraska Press. 1989. 105. 17. Eugene Thacker. “Cosmic Pessimism.” continent. . 2.2 (2012): 75. (shrink)

A sourcebook for developing and facilitating collaborative groups capable of continuously adapting to anticipate the evolving learning needs of students. Based on a theoretical foundation of schools as complex systems in which linear management models are no longer sufficient.