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)

“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...

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)

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)

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

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...

Empirical evidence suggests that people naïvely represent time as dynamical (i.e. as containing robust temporal passage). Yet many contemporary B-theorists deny that it seems to us, in perceptual experience, as though time robustly passes. The question then arises as to why we represent time as dynamical if we do not have perceptual experiences which represent time as dynamical. We consider two hypotheses about why this might be: the temporally asperspectival replacement hypothesis and the moving open future hypothesis. We then empirically (...) test the moving open future hypothesis. According to that hypothesis we represent the past as objectively fixed and the future open. And we represent that this objective openness moves as events that were open, become fixed such that in doing so we represent a privileged moving present. We found no evidence for the moving open future hypothesis, which suggests that further investigation of the temporally asperspectival replacement hypothesis is called for. Our results also shed further light on our understanding of the respects in which we represent the future to be open, which, in turn, has implications for our theorising about the open future. (shrink)

While philosophical questions about health and disease have attracted much attention in recent decades, and while opinions are divided on most issues, influential accounts seem to embrace negativism about health, according to which health is the absence of disease. Some subscribe to unrestricted negativism, which claims that negativism applies not only to the concepts of health and disease as used by healthcare professionals but also to the lay concept that underpins everyday thinking. Whether people conceptualize health in this manner has (...) implications for medical care and public health, and so we set out to examine this claim in two studies. Participants were asked to assess and compare the health states of two people presented in two vignettes. We found that both lay people and medical students conceptualize health as something more than the absence of disease. We argue that our findings highlight a need to rethink unrestricted negativism and indicate a need to rethink the way the debate has traditionally focused on disease. (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)

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)

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.

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.

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.

Los gināns son un corpus de literatura religiosa ismailí del sur de Asia. Su temática es muy variada e incluye cuestiones como el amor divino, la cosmología, la meditación, la práctica ritual, la escatología y el comportamiento ético. La palabra ‘ginān’ deriva en última instancia de la raíz sánscrita ‘ŷñāna’ y está relacionada etimológicamente con la palabra griega ‘γνῶσις’, o ‘gnôsis’, que tiene derivados en muchas lenguas. Varios estudiosos han señalado el doble significado del término ‘ginān’ entre los ismailíes, ya (...) que se refiere tanto a su literatura sagrada como a la gnosis. Este estudio exhaustivo explora el significado y el uso de la palabra ‘ginān’ en la propia tradición ginān. Como la mayoría de los gināns se recitan en melodías particulares, este estudio de la tradición ginān se inspira en la organización de la sinfonía tradicional. Al igual que una sinfonía, composición extensa en la música clásica occidental, suele estar dividida en cuatro movimientos, este estudio de la Sinfonía de la Gnosis se compone de cuatro secciones, cada una de las cuales explora diferentes aspectos acerca de cómo se define la tradición ginān. (shrink)

In a relatively little-known interview, conducted by Thomas Bertonneau, Girard remarks that with Heidegger there is an aspect he "would almost call a worship of the old sacred," something that struck him as "pretty scary … sinister." But, almost in the same breath, Girard continues, "And yet there can be no doubt that Heidegger is a genius."1This doubled attitude to Heidegger, where on the one side the German philosopher is basically a hostile relic of the archaic sacred, and on the (...) other he has contributed something of genius to contemporary thought, has not been sufficiently examined among Girardians. The default position seems to be a dismissal on account of the former and an unwillingness to engage in respect... (shrink)

Resumen: Esta exposición intenta comprender las formas culturales de comunicación y fijación mnémica en una narración específica que Davi Kopenawa, chamán Yanomami, expone al antropólogo Bruce Albert, en virtud de los modos de existencia amazónicos, refiriéndose en particular a la intensidad de los espíritus selváticos y a la experiencia chamánica con los mundos espirituales. En el contexto de una extensión vegetal dispersa y sobresaliente, afirmamos una sociabilidad cotidiana en el marco de una “ética respetuosa o amorosa” entre todas las formas (...) de vida, expresada estéticamente en formas significantes y transportadoras de emociones desarrolladas por la cosmología amazónica. Para ello utilizamos las nociones que Aby Warburg emplea en su estudio de la cultura de las imágenes, en tanto curso por el que estas pueden entenderse como organismos vivientes susceptibles a transformación, preservando su propia biología en la trasmisión codificada de la memoria.: This exhibition tries to understand the cultural forms of communication and mnemic fixation in a specific narrative that Davi Kopenawa, Yanomami shaman, exposes to the anthropologist Bruce Albert, by virtue of Amazonian modes of existence, especially referring to the intensity of jungle spirits and experience Shamanic with spiritual worlds. In the context of a dispersed and outstanding plant extension, we affirm a daily sociability within the framework of a “respectful or loving ethic” among all life forms, aesthetically expressed in significant and transporting forms of emotions developed by Amazonian cosmology. For this we use the notions that Aby Warburg uses in his study of the culture of images, as a course by which they can be understood as living organisms susceptible to transformation, preserving their own biology in the coded transmission of memory. (shrink)

This paper develops insights from Foucault and Lyotard to examine the Darfur crisis and the transformative potential of spaces of alterity. We show that Foucault’s quest for an aesthetics of existence is an attempt to found an alternative form of ethics based on wakefulness, sensibility, and suspicion on the part of the subject. In the final part of the paper we link this idea to Lyotard’s sensibility of the sublime. We show how aesthetic sensibility can be transformed in a political (...) sensibility which bears witness to political injustices that result from the incommensurability of different genres of discourse. We illustrate this point using aesthetic representations of Darfur. (shrink)

Elizabeth Anscombe and Anthony Kenny disagree on whether or not it is possible to doubt the existence of one’s own body. Anscombe believes that such doubt makes sense while Kenny argues that it could make sense only if one supposed that he had become a bodyless Cartesian ego. To resolve the issue I explore the knowledge one acquires of himself, and thus the manner in which such knowledge might be weakened into doubt. Siding with Anscombe, I argue that under the (...) conditions of sensory deprivation some very basic questions asked of oneself such as, “Which body?” cannot be answered. Without such answers, one can be uncertain about his own body. Such uncertainty, however, is to be explained by the autonomy of the relevant ‘J-thoughts’ and not because one had become a Cartesian ego. (shrink)

Niedenthal et al. present a model for embodied emotion simulation and expression understanding that spans multiple brain systems. This commentary addresses the potential role of time in this model, and its implications for understanding social dysfunction.