Elements of Moral Experience in Clinical Ethics Training and Practice: Sharing Stories with Strangers is a philosophical and professional memoir of the education, training, and professional development of becoming a clinical ethics consultant. Utilizing a phenomenological and narrative lens, this book offers a fresh and energizing window into the field of healthcare ethics by pairing compelling clinical narratives of what it is like to do clinical ethics consultation with clear reflections and accessible introductions to key philosophical, professional, and humanistic roots (...) for responsible practice. (shrink)

Open-uterine surgery to repair spina bifida, or ‘fetal surgery of open neural tube defects,’ has generated questions throughout its history—and continues to do so in a variety of contexts. As clinical ethics consultants who worked (Mark J. Bliton) and trained (Virginia L. Bartlett) at Vanderbilt University—where the first successful cases of open-uterine repair of spina bifida were carried out—we lived with these questions for nearly two decades. We worked with clinicians as they were developing and offering the procedure, (...) with researchers in refining and studying the procedure, and with pregnant women and their partners as they considered whether to undergo the procedure. From this experience in the early studies at Vanderbilt, we learned that pregnant women and their partners approach the clinical uncertainty of such a risky procedure with a curious and unique combination of practicality, self-reflection, fear, and overwhelming hope. These early experiences were a major contributing factor to the inclusion of an ethics-focused interview in the informed consent process for the Management of Myelomeningocele Study (MOMS) trial study design. (shrink)

Bruno and Arora (2018) present a range of important ethical issues emerging from the development of procedures for uterine transplant (UT). They approach those issues by drawing on parallels to oth...

Despite increased attention to the question of how best to evaluate clinical ethics consultations and emphasis on external evaluation, there has been little sustained focus on how we, as clinicians, make sense of and learn from our own experiences in the midst of any one consultation. Questions of how we evaluate the request for, unfolding of, and conclusion of any specific ethics consultation are often overlooked, along with the underlying question of whether it is possible to give an accurate account (...) of clinical ethics consultants’ experience as experienced by ethics consultants. Before the challenge of submitting one’s accounts or case reports for review and evaluation from others, there is an underlying challenge of understanding and evaluating our own accounts. To highlight this crucial and deeply challenging dimension of actual clinical ethics practice, we present an account of a complex consultation, explicitly constructed to engage the reader in the unfolding experience of the consultant by emphasizing the multiple perspectives unfolding within the consultant’s experience. Written in script format, the three perspectives presented—prototypical clinically descriptive account; didactically reflective and self-evidentiary account often seen in journal presentations; highly self-critical reflective account emphasizing uncertainties inherent to clinical ethics practice—reflect different manners for responding to the ways actual clinical involvement in ethics consultation practice accentuates and refocuses the question of how to understand and evaluate our own work, as well as that of our colleagues. (shrink)

Against the background assumptions that knowing what clinical ethics consultation represents to those with whom ethics consultants work most closely is a necessary component for being responsible in the practice of ethics consultation, and the complexities of soliciting and understanding colleague evaluations require another inherent responsibility for the methods by which ethics consultations are evaluated, in this article we report our experience soliciting, analyzing, and trying to understand retrospective evaluations of our Clinical Ethics Consultation Service. These evaluations were collected through (...) a quality assessment effort at our institution. Drawing from the qualitative elements of our survey instrument, we describe unexpected variations among the requests for ethics consultation and the retrospective reports from those colleagues making the requests. Focusing on just one aspect – the reason for request – raised several core questions about how we should evaluate those retrospective reports, what could be learned from the differences that we were now encountering, and what we could learn about the process of evaluating our practices. Working through these questions, we suggest several issues to consider in ongoing efforts to describe and evaluate clinical ethics consultation: the role of time and memory in evaluating retrospective evaluations, the importance of attending to the language of moral shift or disruption with which our colleagues describe their experiences, and how to understand the role of ethics consultation in creating ‘moral space’ for colleagues to process their moral experiences. (shrink)

Volume 19, Issue 10, October 2019, Page 43-46.

Since the concept of the living wills emerged nearly 50 years ago, there have been practical challenges in translating the concept of an advance directive into documents that are clinically useful across various healthcare settings and among different patient populations and cultures. Especially, challenging has been the reliance in most ADs on pre-selected “choices” about specific interventions which either revolve around broad themes or whether or not to utilize particular interventions, both of which about most laypersons know little and, more (...) importantly, lacking context, prove to be of limited meaningfulness. Moreover, whether by foundational frame, decade-long misunderstanding in medicine and bioethics, or different societal customs, these ADs present decision-making responsibility for initiating, continuing, or withdrawing medical interventions as a patient responsibility—creating a burden for which most patients are unprepared—and hence reducing healthcare providers’ responsibility to mere technical application or customer service. At our institution, significant efforts have focused on embracing the unique and complementary responsibilities of patients and physicians for enabling appropriate plans of care. This includes re-structuring our AD form to more accurately represent patient’s values as the frame within which physicians are responsible for determining appropriate care. Rather than specifying interventions, the AD makes patients responsible for specifying what matters to them as well as what they value in terms of function, interaction, and level of acceptable burden, thus providing clear goals for clinicians to pursue—or when goals are not reachable by available medical interventions, to acknowledge and allow for logical shifts to what may be achieved, including, in end of life contexts, care focused on respect and dignity. (shrink)

“If philosophy is essentially this activity of questioning and responding, that is, dialogue…” ∼ R.M. Zaner (The Way of Phenomenology)“Not to philosophize is to philosophize still.” E. Lévinas (“Go...

Clinical ethics consultants (CECs) work in complex environments ripe with multiple types of expectations. Significantly, some are due to the perspectives of professional colleagues and the patients and families with whom CECs consult and concern how CECs can, do, or should function, thus adding to the moral complexity faced by CECs in those particular circumstances. We outline six such common expectations: Ethics Police, Ethics Equalizer, Ethics Superhero, Ethics Expediter, Ethics Healer or Ameliorator, and, finally, Ethics Expert. Framed by examples of (...) requests for ethics consultation that illustrate each kind, along with brief descriptions, we argue that while these expectations ought to be resisted for clear and practical reasons, they also create opportunities for CECs to articulate, educate, and ultimately be responsible to the professional demands of clinical ethics work. Recognizing, acknowledging, and at times resisting those expectations thus become key activities and responsibilities in the performance of ethics consultation. (shrink)

Furthermore, adults with decision-making capacity, including pregnant women, can currently accept interventions with moderate net risks for themselves in other settings (e.g., open f...

The paper begins by acknowledging that weakened systematic precision in phenomenology has made its application in philosophy of science obscure and ineffective. The defining aspirations of early transcendental phenomenology are, however, believed to be important ones. A path is therefore explored that attempts to show how certain recent developments in the logic of self-reference fulfill in a clear and more rigorous fashion in the context of philosophy of science certain of the early hopes of phenomenologists. The resulting dual approach is (...) applied to several problems in the philosophy of science: on the one hand, to proposed rejections of scientific objectivity, to the doctrine of radical meaning variance, and to the Quine-Duhem thesis, and or. the other, to an analysis of hidden variable theory in quantum mechanics. (shrink)

The Pathology of Man is the first comprehensive study of the psychology and epistemology of human evil, long urged by leading psychiatrists and psychologists, including Freud, Jung, Menninger, Fromm, and Peck. The book breaks new ground by offering a clear, empirically based, and theoretically sound understanding of human evil as a widespread, real, non-metaphorical pathology. With deliberate and thorough scholarship the author proposes a new framework-relative theory of disease and justifies the provocative thesis that human evil should be classified as (...) a pathology which is not a deviation from an accepted norm, but rather is a normal state. This break with tradition provides the necessary psychological foundation for the familiar concept of the banality of human evil, a foundation which in the past it has lacked. (shrink)

A new position in the philosophy of mind has recently appeared: the extended mind hypothesis (EMH). Some of its proponents think the EMH, which says that a subject's mental states can extend into the local environment, shows that internalism is false. I argue that this is wrong. The EMH does not refute internalism; in fact, it necessarily does not do so. The popular assumption that the EMH spells trouble for internalists is premised on a bad characterization of the internalist thesis—albeit (...) one that most internalists have adhered to. I show that internalism is entirely compatible with the EMH. This view should prompt us to reconsider the characterization of internalism, and in conclusion I make some brief remarks about how that project might proceed. (shrink)

A study of the psychology of demoralization affecting university faculty in the liberal arts. This form of demoralization is not adequately understood in terms of the concept of career burnout. Instead, demoralization that affects university faculty in the liberal arts requires a broadened understanding of the historical and psychological situation in which these professors find themselves today.

This paper examines a largely unrecognized mental disorder that is essentially a disability of values. It is their daily contact with this pathology that leads many university liberal arts faculty to demoralization. The deeply rooted disparity between the world of the traditional liberal arts scholar and today’s college students is not simply a gulf across which communication is difficult, but rather involves a pathological impairment in the majority of students that stems from an exclusionary focus on work, money, and the (...) acquisition of things. It is argued that this state of mind constitutes a self-disabling mental illness, which for a society becomes pathological ideology, and for the individual takes the form of clinical narcissism. (shrink)

This is a study of the relativity of facts in relation to the frameworks of reference in terms of which those facts are established. In this early paper from 1975, intended for a less technical audience, the author proposes an understanding of facts and their associated frameworks in terms of complementarity. This understanding of facts leads to an integrated yet pluralistic concept of reality. In the Addendum, readers will find a partial listing of related publications by the author that extend (...) the research described in this paper. (shrink)

This article begins by wondering how the writer’s transformation into motherhood affects her practice of reading, writing and research: how maternities are made academic. Specifically, this article is interested in thinking through lactating breasts, as a particularly complex and potentially subversive ‘performance’ of maternity. In addition, this article reframes ‘maternal thinking’ through 1990s theories of embodiment and corporeality, and asks how embodied practices like breastfeeding might be theorized, as well as how ‘embodied theory’ might be practised. In looking at various (...) cultural texts about breasts and breastfeeding, the article is scripted into a series of connective and reflexive scenes around performance, space, language and knowledge, coming to rest in the imaginative project of an epistemology of breasts. It sets reflexive accounts of lived experience alongside theoretical reflections to create a dynamic and thoughtful reading of breasts, entwining personal and public discourses, maternal and academic writing, theorizing and cultural practices. (shrink)

Whether truth, morality, and beauty have an objective basis has been a perennial question for philosophy, ethics, and aesthetics, while for a great many relativists and skeptics it poses a problem without a solution. In this essay, the author proposes an innovative approach that shows how cognitive intelligence, moral intelligence, and aesthetic intelligence provide the basis needed for objective judgments about truth, morality, and beauty.

This paper, published in 2022 in the Social Epistemology Review and Reply Collective (SERRC), offers a philosopher-psychologist’s explanation of our species’ deeply rooted resistance to self-knowledge. The article focuses on limitations that come about when people do not possess a group of cognitive and psychological skills and competencies which the author has called “epistemological intelligence.” ¶¶¶¶¶ The paper develops the idea of “one-way concepts,” concepts that can appropriately and informatively be applied to the human species, but which, due to human (...) species pride and exemptionalism, people often refuse to do.¶¶¶¶¶ When people lack the necessary skills and competences, they become resistant to new ways of thinking which can help our species break free from self-limiting and often self-destructive ways patterns of thought and behavior.¶¶¶¶¶ . (shrink)

An essay that weighs the main factors that lead authors of academic and scientific books to consider conventional publication of their work, with realistic and practical recommendations for these authors so they may avoid the contractual “imprisonment” of their books after the period of initial active sales has passed.

Whether intentional suppression of an unpleasant or unwanted memory reduces the ability to recall that memory subsequently is a contested issue in contemporary memory research. Building on findings that similar processes are recruited when individuals remember the past and imagine the future, we measured the effects of thought suppression on memory for imagined future scenarios. Thought suppression reduced the ability to recall emotionally negative scenarios, but not those that were emotionally positive. This finding suggests that intentionally avoiding thoughts about emotionally (...) negative episodes may inhibit representations of those memories, progressively reducing their availability to recall. (shrink)

The first learning game to be developed to help students to develop and hone skills in constructing proofs in both the propositional and first-order predicate calculi. It comprises an autotelic (self-motivating) learning approach to assist students in developing skills and strategies of proof in the propositional and predicate calculus. The text of VALIDITY consists of a general introduction that describes earlier studies made of autotelic learning games, paying particular attention to work done at the Law School of Yale University, called (...) the ALL Project (Accelerated Learning of Logic). Following the introduction, the game of VALIDITY is described, first with reference to the propositional calculus, and then in connection with the first-order predicate calculus with identity. Sections in the text are devoted to discussions of the various rules of derivation employed in both calculi. Three appendices follow the main text; these provide a catalogue of sequents and theorems that have been proved for the propositional calculus and for the predicate calculus, and include suggestions for the classroom use of VALIDITY in university-level courses in mathematical logic. (shrink)

Girardian anthropology tells us that the birth of human meaning and its signs are the result of a primitive catastrophe. But if these origins are exposed by the biblical record it is because another, transformative semiosis has opened in human existence. Girard’s seminal remarks on the Greek logos and the logos of John, endorsing Heidegger’s divorce of the two, demonstrate this claim and its source in the nonviolence of the gospel logos. In effect, there is a second catastrophe, one embedded (...) in the bible and reaching its full exposition in the cross, generating a new semiosis in humanity. The transformation may be measured by viewing the original semiosis in a Kantian frame, as a transcendental a priori structured by violence. The second catastrophe generates an equivalent new a priori of nonviolence. The work of Charles Peirce illustrates both the way in which interpretants (of signs) open us progressively to new meanings, and how this process may ultimately be conditioned by love. The catastrophe of the gospel, therefore, works both on the dramatic individual level, with Paul of the New Testament as the great example, but also in slow‑motion over semiotic history, changing the meaning of existence from violence to nonviolence. (shrink)

This is Vol. I in French. Vol. II in English is available separately from this website. -/- The principal objective of the work is to construct an analytically precise methodology which can serve to identify, eliminate, and avoid a certain widespread conceptual fault or misconstruction, called a "projective misconstruction" or "projection" by the author. -/- It is argued that this variety of error in our thinking (i) infects a great number of our everyday, scientific, and philosophical concepts, claims, and theories, (...) (ii) has largely been undetected, and (iii), when remedied, leads to a less controversial and more rigorous elucidation of the transcendental preconditions of human knowledge than has traditionally been possible. -/- The dissertation identifies, perhaps for the first time, a projective variety of self-referential inconsistency, and proposes an innovative, self-reflexive approach to transcendental argument in a logical and phenomenological context. The strength of the approach lies, it is claimed, in the fact that a rejection of the approach is possible only on pain of self-referential inconsistency. The argument is developed in the following stages: -/- A general introduction identifies the central theme of the work, defines the scope of applicability of the results reached, and sketches the direction of the studies that follow. The preliminary discussion culminates in a recognition of the need for a critique of impure reason. -/- The body of the work is divided into two parts: Section I seeks to develop a methodology, on a purely formal basis, which is, on the one hand, capable of being used to study the transcendental foundations of the special sciences, including its own proper transcendental foundation. On the other hand, the methodology proposed is intended as a diagnostic and therapeutic tool for dealing with projective uses of concepts. -/- The approach initiates an analysis of concepts from a perspective which views knowledge as coordination. Section I describes formal structures that possess the status of preconditions in such a coordinative account of knowledge. Special attention is given to the preconditions of identifying reference to logical particulars. The first section attempts, then, to provide a self-referential, transcendental methodology which is essentially revisionary in that it is motivated by a concern for conceptual error-elimination. -/- Phenomenology, considered in its unique capacity as a self-referential, transcendental discipline, is of special relevance to the study. Section II accordingly examines a group of concepts which come into question in connection with the central theme of phenomenological constitution. The "de-projective methodology" developed in Section I is applied to these concepts that have a foundational importance in transcendental phenomenology. A translation is, in effect, proposed from the language of consciousness to a language in which preconditions of referring are investigated. The result achieved is the elimination of self-defeating, projective concepts from a rigorous, phenomenological study of the constitutive foundations of science. -/- The dissertation was presented in a two volume, double-language format for the convenience of French and English researchers. Each volume contains an analytical index. (shrink)

An exploration of the roots of the contemporary dissatisfaction with the modern Enlightenment. The author argues that the heralded "death of God" has been rapidly followed by the death of reason.

At first sight it may seem as if Imagination can easily be characterized as a continuous process of having images; but this is very soon found to be inadequate and misleading. On the one hand we have a great number of good witnesses who insist that in their best imaginative work they have made use of no images, or of very few; and on the other, everybody makes distinction between flights of fancy, for example, which certainly involve successions of images, (...) and true imagination. Perhaps a better method of approach is found when we examine how the material dealt with in the imaginative process is built together. In the flight of fancy image follows image, and the transition from one to the next seems to be determined by something in the nature of each individual step of the whole chain, or by each individual act of imaging. Thus the train as a whole is very apt, to the outsider, to appear jerky, ill-connected. (shrink)

This article considers the common social act of apologising in the context of professional discipline of lawyers in Australia. It is argued that other social contexts in which an apology occurs, and the meanings generated, inform its use within this legal context. It is from the social meaning that apologies can be used as a legitimate way to gain insights into a person's ethical state of mind in disciplinary hearings. However, there are a range of difficulties, both practical and theoretical, (...) posed in importing a social symbol into a legal context. The article considers issues concerning the process of discipline, the dangers of the act becoming purely instrumental and interpretive difficulties. Finally, the nature of the entry controls applying to lawyers - the 'character test' - is itself contestable. The article argues that, despite this constraint, apologies provide a useful evidential tool to gauge a lawyer's ethical awareness without relying on assumptions about fixed personality traits. Finally, the article argues for a greater emphasis on alternative sanctioning options, such as those which require the lawyer to demonstrate his or her remorse or fulfil a promise over time. It then turns to the question of whether an (ordered) apology should be one of the available sanctions. (shrink)

We live in times of 'apology mania', says Lee Taft, or at least 'national conversation' about the role and meaning of apologies. Roy Brooks talks of an 'age of apology'. Some 10 years after these pronouncements, little has changed. Apologies are ubiquitous and debated in the public and political domain. And they continue to be used and imported into legal jurisdictions. For instance, legislation removes civil liability for saying 'sorry' in certain contexts and may reward apologies in mitigation of sentence.

Angels are the ultimate stranger. They come from another world and have a special place in the art of the Russian Jewish painter Marc Chagall (1887-1985). In My Life (1923) the young Chagall recalls one memorable night in Saint-Petersburg. Drifting into sleep in the corner of a room (all he could afford) he suddenly saw the ceiling open and a winged being, surrounded by light and blue air, hovered above him before disappearing through the ceiling again.

On the surface the concept of self-consciousness would seem to be understandable as consciousness of oneself. It is commonplace to resist this temptation by arguing that the self cannot properly be construed as the object of this form of consciousness. It is the subject. However, in this paper I show that any effort to see the self as the subject of consciousness converts it, willy nilly, into an object.Self-consciousness is not to be understood by determining the logically appropriate role of (...) the self in a univocal kind of consciousness. It differs from ‘ordinary’ consciousness because of the need for it to be unmediated and direct. If, on the one had, one is conscious of something, it is possible for that awareness to be indirect and mediated. On the other hand, if one is self-conscious it is necessary for that awareness to be direct. (shrink)

What was the process by which an antiquity found on the streets of Rome became the subject of a Renaissance engraving? How did engraving preserve the memory of such antiquities as they vanished into the homes of private collectors, were plundered or destroyed? This article focuses on Marcantonio Raimondis Lion Hunt to explore the relationship between ancient sculpture and the medium of print in Raphaels Rome.