In this article I argue against the claim that “actual entity” and “actual occasion” are synonymous in Whitehead. My examination of these terms will help to illuminate the role of “society” in Whitehead’s philosophy and to prepare the way for a fruitful comparison of process thought and contemporary systems theory in the sciences.

The ‘death’ of German Idealism has been decried innumerable times since its revolutionary inception, whether it be by the 19th-century critique of Western metaphysics, phenomenology, contemporary French philosophy, or analytic philosophy. Yet in the face of two hundred years of sustained, extremely rigorous attempts to leave behind its legacy, German Idealism has resisted its philosophical death sentence. For this exact reason it is timely ask: What remains of German Idealism? In what ways does its fundamental concepts and texts still speak (...) to us? Drawing together new and established voices from scholars in Kant, Fichte, Hegel, and Schelling, this volume offers a fresh look on this time-honoured tradition. It uses myriad of recently developed conceptual tools to present new and challenging theories of its now canonical figures. (shrink)

Traditional Christian belief in the existence of human life after death within a transformed material universe should be capable of rational justification if one chooses carefully the philosophical scheme underlying those claims. One should not have to appeal simply to the power of a loving God to justify one's beliefs. A revision of Whitehead's metaphysical scheme is proposed that allows one to render these classical Christian beliefs at least plausible to a broad range of contemporary thinkers as a consequence of (...) a cosmology based on the principle of universal intersubjectivity and the need for a common ground between opposing subjectivities. (shrink)

Hastings Center Report, Volume 52, Issue 2, Page 21-31, March‐April 2022.

ABSTRACT:Daniel Callahan died on July 16, 2019, just short of his 89th birthday. In the years since, we have seen the overturning of abortion rights, a concern central to his scholarship and musings about the place of religion in American civic life. Callahan’s journey from lay Catholic journalist and commentator at Commonweal to a co-founder of the Hastings Center, during his decade of doubt, is especially relevant today as America revisits established precedent governing a woman’s right to choose. His life-long (...) struggle with faith and the secularization of bioethics is a story worth telling, as it may foster dialogue across a divide between religious and laical thinkers that has fractured our political discourse. We recall Callahan’s misgivings about the marginalization of religious perspectives in public life; he sought not the denial of complexity nor of difference in views, but rather the importance of free and honest debate around deeply held beliefs, contextualized in the realities of the contemporary world. Callahan’s ambivalence about his faith remains a part of the fabric of American life, a story that Callahan chronicled to our collective benefit for over a half-century. (shrink)

Panentheism has become a familiar term in contemporary Christian systematic theology and philosophy, for it is widely believed to be an appropriate way to overcome the alleged dualism found in the classical God-world relationship. But what is meant by the term panentheism, and how does it work so as to avoid becoming still another form of pantheism or cosmic monism? In 2004 Philip Clayton and the late Arthur Peacocke published a set of papers on the topic of panentheism that came (...) from a conference in England on that topic in 2001.1 Yet, while there were certain broad affinities in approach and content among many of the papers, none of them used precisely the same conceptual model for analysis of the concept. As.. (shrink)

Having declared that metaphysics had come to its demise in the technologized sciences, Heidegger tried a new way to reopen the question of being. For Blanchette, that Heidegger never got beyond the analysis of Dasein to such an ambitious project is not merely the result of the distractions of other career requirements at the university or of other entanglements along his life’s path. The problem was that the road he took was a road to nowhere, metaphysically speaking.

This volume is a comprehensive study of the basic questions of philosophy of religion. What is distinctive about its approach is the author’s encyclopedic command of the actual practices of the eleven major world religions now extant.

Parallel to the perennial questions about the adequacy of any human language when used of God are questions about the proper interpretation of any divine self-disclosure in revelation. By the theoretical exploration of the latter in this book, Jorge Gracia also sheds a certain light on the former.

Joseph Bracken examines key writings of process-oriented philosophers like Alfred North Whitehead along with systems-oriented thinkers such as Ludwig von Bertalanffy to create a systems-oriented understanding of the God-world relation that serves as a complement to Pope Francis’s reflections on the environmental crisis.

The classical utilitarian legacy of Jeremy Bentham, J. S. Mill, James Mill, and Henry Sidgwick has often been charged with both theoretical and practical complicity in the growth of British imperialism and the emerging racialist discourse of the nineteenth century. But there has been little scholarly work devoted to bringing together the conflicting interpretive perspectives on this legacy and its complex evolution with respect to orientalism and imperialism. This volume, with contributions by leading scholars in the field, represents the first (...) attempt to survey the full range of current scholarly controversy on how the classical utilitarians conceived of 'race' and the part it played in their ethical and political programs, particularly with respect to such issues as slavery and the governance of India. The book both advances our understanding of the history of utilitarianism and imperialism and promotes the scholarly debate, clarifying the major points at issue between those sympathetic to the utilitarian legacy and those critical of it. (shrink)

ABSTRACTIn ‘Universals’, Ramsey declares that we do not, and cannot, know the forms of atomic propositions. A year later, in a symposium with Braithwaite and Joseph, he announces a change of mind: atomic propositions may, after all, be discoverable by analysis. It is clear from the 1926 paper that Ramsey intends this to be a revision of the 1925 claim. Puzzlingly, however, Ramsey does not mention analysis in 1925. My task in this article is to provide a justification for (...) that change of mind. My argument consists of two parts. I first show what relation holds between the negative 1925 assertion and the more positive 1926 assertion which allows us to read the latter claim as a retraction of the former, as Ramsey appears to have intended it. Then I shall argue that the retraction of the 1925 claim is forced upon Ramsey by reflection on the fact that three theses, all of which he held in or around the relevant period, are, rather surprisingly, revealed to be inconsistent. (shrink)

Patient narratives from two investigational deep brain stimulation trials for traumatic brain injury and obsessive‐compulsive disorder reveal that injury and illness rob individuals of personal identity and that neuromodulation can restore it. The early success of these interventions makes a compelling case for continued post‐trial access to these technologies. Given the centrality of personal identity to respect for persons, a failure to provide continued access can be understood to represent a metaphorical identity theft. Such a loss recapitulates the pain of (...) an individual's initial injury or illness and becomes especially tragic because it could be prevented by robust policy. A failure to fulfill this normative obligation constitutes a breach of disability law, which would view post‐trial access as a means to achieve social reintegration through this neurotechnological accommodation. (shrink)

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

This is the second paper in a two-part series describing subject and family perspectives from the CENTURY-S (CENtral Thalamic Deep Brain Stimulation for the Treatment of Traumatic Brain InjURY-Safety) first-in-human invasive neurological device trial to achieve cognitive restoration in moderate to severe traumatic brain injury (msTBI). To participate, subjects were independently assessed to formally establish decision-making capacity to provide voluntary informed consent. Here, we report on post-operative interviews conducted after a successful trial of thalamic stimulation. All five msTBI subjects met (...) a pre-selected primary endpoint of at least a 10% improvement in completion time on Trail-Making-Test Part B, a marker of executive function. We describe narrative responses of subjects and family members, refracted against that success. Interviews following surgery and the stimulation trial revealed the challenge of adaptation to improvements in cognitive function and emotional regulation as well as altered (and restored) relationships and family dynamics. These improvements exposed barriers to social reintegration made relevant by recoveries once thought inconceivable. The study’s success sparked concerns about post-trial access to implanted devices, financing of device maintenance, battery replacement, and on-going care. Most subjects and families identified the need for supportive counseling to adapt to the new trajectory of their lives. (shrink)

This is the first article in a two-part series describing subject and family perspectives from the central thalamic deep brain stimulation for the treatment of traumatic brain injury using the Medtronic PC + S first-in-human invasive neurological device trial to achieve cognitive restoration in moderate to severe traumatic brain injury, with subjects who were deemed capable of providing voluntary informed consent. In this article, we report on interviews conducted prior to surgery wherein we asked participants about their experiences recovering from (...) brain injury and their perspectives on study enrollment and participation. We asked how risks and benefits were weighed, what their expectations and fears were, and how decisions were reached about trial participation. We found that informed consent and enrollment decisions are fraught. Subjects and families were often split, with subjects more focused on putative benefits and families concerned about incremental risk. Both subjects and families viewed brain injury as disruptive to personal identity and relationships. As decisions were made about study enrollment, families struggled with recognizing the re-emergent agency of subjects and ceding decision-making authority to subjects who had previously been dependent upon them for protection and guidance. Subjects and family members reported a hope for the relief of cognitive disabilities, improved quality of life, normalization of interpersonal interactions, and a return to work or school as reasons for study participation, along with altruism and a desire to advance science. Despite these aspirations, both subjects and families appreciated the risks of the intervention and did not suffer from a therapeutic misconception. A second essay to be published in the next issue of Cambridge Quarterly of Healthcare Ethics—Clinical Neuroethics will describe interviews conducted after surgery, the effects of cognitive restoration for subjects, families, and challenges presented to the social structures they will call upon to support them through recovery. This subsequent article will be available online prior to its formal publication in October 2023. (shrink)

As improvements in neuroscience have enabled a better understanding of disorders of consciousness as well as methods to treat them, a hurdle that has become all too prevalent is the denial of coverage for treatment and rehabilitation services. In 2011, a settlement emerged from a Vermont District Court case, Jimmo v. Sebelius, which was brought to stop the use of an “improvement standard” that required tangible progress over an identifiable period of time for Medicare coverage of services. While the use (...) of this standard can have deleterious effects on those with many chronic conditions, it is especially burdensome for those in the minimally conscious state, where improvements are unpredictable and often not manifested through repeatable overt behaviors. Though the focus of this paper is on the challenges of brain injury and the minimally conscious state, which an estimated 100,000 to 200,000 individuals suffer from in the United States, the post-Jimmo arguments presented can and should have a broad impact as envisioned by the plaintiffs who brought the case on behalf of multiple advocacy groups representing patients with a range of chronic care conditions. (shrink)

Objective Although patients exercise greater autonomy than in the past, and shared decision making is promoted as the preferred model for doctor-patient engagement, tensions still exist in clinical practice about the primary locus of decision-making authority for complex, scarce, and resource-intensive medical therapies: patients and their surrogates, or physicians. We assessed physicians’ attitudes toward decisional authority for adult venoarterial extracorporeal membrane oxygenation (VA-ECMO), hypothesizing they would favor a medical locus. Design, Setting, Participants A survey of resident/fellow physicians and internal medicine (...) attendings at an academic medical center, May to August 2013. Measurements We used a 24-item, internet-based survey assessing physician-respondents’ demographic characteristics, knowledge, and attitudes regarding decisional authority for adult VA-ECMO. Qualitative narratives were also collected. Main Results A total of 179 physicians completed the survey (15 percent response rate); 48 percent attendings and 52 percent residents/ fellows. Only 32 percent of the respondents indicated that a surrogate’s consent should be required to discontinue VA-ECMO; 56 percent felt that physicians should have the right to discontinue VA-ECMO over a surrogate’s objection. Those who self-reported as “knowledgeable” about VA-ECMO, compared to those who did not, more frequently replied that there should not be presumed consent for VA-ECMO (47.6 percent versus 33.3 percent, p = 0.007), that physicians should have the right to discontinue VAECMO over a surrogate’s objection (76.2 percent versus 50 percent, p = 0.02) and that, given its cost, the use of VA-ECMO should be restricted (81.0 percent versus 54.4 percent, p = 0.005). Conclusions Surveyed physicians, especially those who self-reported as knowledgeable about VA-ECMO and/or were specialists in pulmonary/ critical care, favored a medical locus of decisional authority for VA-ECMO. VA-ECMO is complex, and the data may (1) reflect physicians’ hesitance to cede authority to presumably less knowledgeable patients and surrogates, (2) stem from a stewardship of resources perspective, and/or (3) point to practical efforts to avoid futility and utility disputes. Whether these results indicate a more widespread reversion to paternalism or a more circumscribed usurping of decisional authority occasioned by VA-ECMO necessitates further study. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Beyond Ratzinger's Republic:Communio's Postliberal TurnSam Zeno Conedera S.J. and Vincent L. Strand S.J.Is the political future of the West a postliberal one? For the past decade, numerous prominent thinkers in America and Europe have been debating this question. Matters that not long ago were merely of historical interest, such as Pope Gelasius I's understanding of the relation between sacral authority and royal power, Thomas Aquinas's thought on monarchy and (...) Robert Bellarmine's theory of the pope's indirect authority in temporal matters are now increasingly studied for their potential answers to contemporary political questions. This development, which would have been nearly unimaginable just a decade earlier, unsurprisingly has been led by Catholics. We say "unsurprisingly" in view of the long pre-modern tradition of Catholic political thought, as well as the Church's long struggle against liberalism during the nineteenth and early twentieth centuries. Some of the current postliberal writers explicitly connect themselves to both of these aspects by using the term "integralist" to describe their position.1 [End Page 889]This "new integralism" represents a radical departure from the mainstream of Catholic political discourse of the last half century, which has largely sought rapprochement with Western liberalism. A group of writers, led by John Courtney Murray, George Weigel, Michael Novak, and Robert George, have held that the American constitutional order is rooted in the natural law tradition, and therefore is basically friendly to Catholic political thought. The Church's role in American life, they say, is upholding the natural law as a public moral philosophy, while embracing the non-establishment clause of the First Amendment as a matter of principle, in accordance with the teachings of the Second Vatican Council. This "Whig Thomism," which for decades represented the predominant outlook of conservative American Catholics, must now face the challenge of a different sort of Thomism represented by the integralists.2While the engagement between Whig Thomists and integralists has received most of the attention from scholars and journalists alike, another postliberal option has emerged in recent years. Its source is a group of Catholic thinkers associated with the Communio theological movement. Their political vision, which has no single name or label, has a complex and subtle relationship with the thought of earlier Communio writers, most of whom shared the Whig Thomist desire for reconciliation with Western liberalism. [End Page 890] The appearance of a Communio postliberalism therefore represents a significant development within this intellectual tradition. The most important representative of the earlier Communio perspective on political questions is Joseph Ratzinger / Pope Benedict XVI, who has recently been lauded as the "most important Catholic thinker of the twentieth century" on matters at the intersection of theology and politics.3In an article titled "Ratzinger's Republic" that appeared in these pages in 2020, we identified a significant tension in his thought about the Church's contribution to political life.4 Exploring Ratzinger's writings on natural law, we demonstrated that two currents are present. In accord with his fundamental theological commitments about nature and grace and about faith and reason, Ratzinger often questioned the effectiveness of arguments from natural law. He claimed that, since reason is historically conditioned, and therefore in the current order marked by sin, reason needs grace and faith to function properly. Yet, on other occasions, Ratzinger strongly endorsed arguments from natural law, highlighting its role as the foundation of a just democratic political order. We traced this ambivalence about natural law back to a dilemma at the heart of Ratzinger's political thought. On the one hand, in accord with his thinking about the relations of nature and grace and faith and reason, Ratzinger argued that the state needs the Church to supply moral values that the state cannot furnish on its own. On the other hand, he believed it belongs to the very nature of the Church to be separate from the state, and he endorsed nonconfessional, religiously pluralistic states.5 In light of these two commitments, Ratzinger argued that the contribution Christians are to make to the state is to supply moral values that were discerned under the influence of grace and divine revelation but... (shrink)

BackgroundThe Freedom of Information Act (FOIA) provides access to unreleased government records that can be used to enhance the transparency and integrity of biomedical research. We characterized FOIA requests to Department of Health and Human Services (HHS) agencies, including request outcomes, processing times, backlogs, and costs.MethodsUsing HHS FOIA annual reports, we extracted data on the number of FOIA requests received and processed by HHS agencies between 2008 and 2017, as well as request outcomes. Processing times were reported in three time (...) increments, < 1–20, 21–60, or 61+ days, and trends in backlog status were also described. Information about costs and fees collected were aggregated.ResultsBetween 2008 and 2017, 69.6% of 530,094 HHS FOIA requests were received by the Centers for Medicare and Medicaid Services (CMS), 18.9% by the Food and Drug Administration (FDA), and 11.6% by all other HHS agencies. During this period, CMS processed 374,728 requests, FDA 114,938, and other HHS agencies 61,890. CMS and FDA reduced backlogged requests by 9396 (89.7%) and 4289 (65.3%), respectively, leaving backlogs of 1081 and 2279 requests at the end of 2017. CMS fully or partially granted 60.3% of requests whereas FDA fully or partially granted 72.4%. Of all requests to CMS, 82.0% were considered simple and 18.0% complex; 82.2% of simple requests and 54.9% of complex requests were processed in 20 days, and 5.6% and 29.9% were processed in 61+ days. In contrast, 60.2% of requests to FDA were considered simple and 39.8% complex; 28.8% of simple requests and 9.0% of complex requests were processed in 20 days, and 58.3% and 81.5% were processed in 61+ days. The costs to HHS associated with FOIA requests totaled $446.4 million ($809 per processed request), increasing from $28.1 million ($423 per request) in 2008 to $53.3 million ($1544 per request) in 2017. In total, HHS collected $8.5 million in fees (1.9% of total costs).ConclusionsFOIA is frequently used to obtain information about HHS and its agencies. With growing costs, minimal fees collected, and lengthy processing times, HHS agencies’ FOIA programs might be made more efficient through greater proactive record disclosure. (shrink)

In this article, we propose the Fair Priority Model for COVID-19 vaccine distribution, and emphasize three fundamental values we believe should be considered when distributing a COVID-19 vaccine among countries: Benefiting people and limiting harm, prioritizing the disadvantaged, and equal moral concern for all individuals. The Priority Model addresses these values by focusing on mitigating three types of harms caused by COVID-19: death and permanent organ damage, indirect health consequences, such as health care system strain and stress, as well as (...) economic destruction. It proposes proceeding in three phases: the first addresses premature death, the second long-term health issues and economic harms, and the third aims to contain viral transmission fully and restore pre-pandemic activity. -/- To those who may deem an ethical framework irrelevant because of the belief that many countries will pursue "vaccine nationalism," we argue such a framework still has broad relevance. Reasonable national partiality would permit countries to focus on vaccine distribution within their borders up until the rate of transmission is below 1, at which point there would not be sufficient vaccine-preventable harm to justify retaining a vaccine. When a government reaches the limit of national partiality, it should release vaccines for other countries. -/- We also argue against two other recent proposals. Distributing a vaccine proportional to a country's population mistakenly assumes that equality requires treating differently situated countries identically. Prioritizing countries according to the number of front-line health care workers, the proportion of the population over 65, and the number of people with comorbidities within each country may exacerbate disadvantage and end up giving the vaccine in large part to wealthy nations. (shrink)