Recently a great deal of attention has been paid to conflicts of interest in medical research, and the Institute of Medicine has called for more research into this important area. One research question that has not received sufficient attention concerns the mechanisms of action by which conflicts of interest can result in biased and/or flawed research. What discretion do conflicted researchers have to sway the results one way or the other? We address this issue from the perspective of selective (...) class='Hi'>inertia, or an unnatural selection of research methods based on which are most likely to establish the preferred conclusions, rather than on which are most valid. In many cases it is abundantly clear that a method that is not being used in practice is superior to the one that is being used in practice, at least from the perspective of validity, and that it is only inertia, as opposed to any serious suggestion that the incumbent method is superior, that keeps the inferior procedure in use, to the exclusion of the superior one. By focusing on these flawed research methods we can go beyond statements of potential harm from real conflicts of interest, and can more directly assess actual harm. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Clinical Anecdotes: A Painful Lack of WoundsChristopher Bailey (bio)Keywordsdepression, post-traumatic stress disorder (PTSD), evolution, fight-or-flight, veteran (treatment of)Colin came to me complaining of depression, which started after he got back from Iraq in 2005. Although he had served in the National Guard, he volunteered absolutely nothing about his time in Iraq as we spoke, instead focusing on other factors, like problems at his job and a family history (...) of depression.Colin's depression seemed serious but not severe. He had been functioning fairly well at work and was not suicidal, although his home life had begun to suffer. As the interview proceeded, I myself fell into Colin's blind spot, all but forgetting his tour of duty as I forged ahead with my list of questions. My avoidance was conscious at first, a deliberate reluctance to come across as one more morbidly curious onlooker recklessly inflaming the wounds of war.When Colin complained of irritability, however, and being kept awake by sinister, shadowy “flashes” at night, I knew I had to ask about Iraq. He was probably suffering from post-traumatic stress disorder, I decided, and was thus trying to avoid the very memories that were haunting and hunting him. And for fear of retraumatizing him (if not suffering second-hand trauma myself), I had colluded in his denial.So when I finally got around to asking about Iraq, I fully expected to hear horror stories, half-articulated perhaps, but all the more grisly for the graininess of their images. Instead, Colin surprised me. He had not experienced anything he considered traumatic. No bombs, bloodshed, or shattered bodies. And in fact, he felt like a “wimp” for having been assigned to a noncombat detail where he missed what might have been his last, best chance “to be a hero.”Most of us would consider this a good thing, but in Colin's case, it had left him feeling somehow uninitiated, like he had not done his part or proven his manhood. Contrary to my assumption, it was the lack of trauma that seemed to trigger his depression upon returning from Iraq. In a relatively safe homeland, rife with middle-class comforts and lacking all but metaphorical rites of passage, perhaps we all feel this way at some level.I pointed out to Colin that people have been dying everywhere in Iraq and under all different circumstances, not just combat. From my stateside perspective, just being there is brave. Although I meant to honor him, he seemed to take my offering as more evidence of his failure, reassuring me that nothing he did could ever compare with the unspeakable horrors endured by veterans of Viet Nam and World War II.Now, as a civilian, he questions whether or not he would respond with sufficient ferocity if, say, he had to defend his family against an attacker. Although powerfully built, Colin (to his credit) has never been a brawler or a bully. Nonetheless, [End Page 223] I have no doubt he could do whatever it took to protect his family. What concerns me more is the opposite: That in trying to prove himself, he might unwittingly put himself and his family in harm's way, if not hurt someone who was never really a threat to begin with.With a new family member, I too feel the burden of hypervigilance. But although terrorists, serial killers, and gangs grab headlines, activating our visceral alarm systems, data from the Centers for Disease Control and Prevention suggest that a sedentary lifestyle still exacts a higher death toll among white American men, like Colin and myself. Although the effect of inertia on the body has been discussed extensively, its impact on mental health has received relatively little attention. Maybe for a creature who evolved on the African savannah, competing over territory and trying not to get eaten, the absence of a visceral challenge can be as debilitating as too much of one.Colin seemed receptive to my concerns, which I took to be a good sign. Although insecure men are quick to fear emasculation, Colin did not seem to be the least bit threatened when I suggested a course... (shrink)

One of Ludwik Fleck’s ideas about the development of scientific knowledge is that—once a system of interpretation is in place—the process that follows can be characterised as one of inertia: any new evidence comes under a strong pressure to be incorporated into the established frame. This can result in what Fleck called a harmony of illusions when contradictory evidence becomes almost invisible or is incorporated into the established frame only by huge efforts.The paper analyses early explanations of the tuberculin (...) reaction as a case study of Fleck’s argument. For Robert Koch, who had presented tuberculin in 1890, the compound was supposed to be a diagnostic tool and a cure for tuberculosis. His conception of its effect was rather peculiar, but strictly in line with ideas on the pathogenesis of infectious diseases he had developed much earlier. After tuberculin was released in late 1890, whether Koch’s conception was convincing depended on the place that a given observer had in the medical world in late-nineteenth-century Germany. Inside Koch’s group, the status of the tuberculin reaction remained stable and tuberculin retained its value as a diagnostic and curative tool. On the other hand, observers from outside that thought collective, and in particular from clinical medicine, soon pointed to flaws in its conception. These critics developed a rather different picture of tuberculin as a mysterious and dangerous drug. No reconciliation followed and what we find instead in German medicine around the year 1900 is the presence of rather contradictory concepts and practices surrounding Koch’s wonder cure. (shrink)

The daily work of the clinical ethics teacher and clinical ethics consultant falls into the routine of classifying clinical cases by ethical type and proposing ethically justified alternatives for the professionally responsible management of a specific type of case. Settling too far into this routine creates the risk of philosophical inertia, which is not good either for the clinical ethicist or for the field of clinical ethics. The antidote to this philosophical inertia and (...) resultant blinkered vision of clinical ethics is sustained, willing exposure to philosophical provocation. The papers in this clinical ethics issue of the Journal of Medicine and Philosophy provide just such philosophical provocation related to core topics in clinical ethics: the distinction between clinical practice and clinical research; telemedicine, or medicine at a distance; illness narratives; the concept of the placebo effect; and sex reassignment. (shrink)

This article explores some implications of the increasing reliance on clinical trials in contemporary health care, particularly health care payers’ efforts to use them in the so-called fourth hurdle decisions. How do these agencies manage medical uncertainty given the desire to produce clear guidelines for clinicians? Their solutions take account of trials in at least two ways, reflecting broader debates about the meaning of these medical experiments. Trials can be read as either ‘‘proofs of protocol’’—straightforward guides to action with (...) individual drugs in specific populations—or ‘‘proofs of principle’’— where extrapolation is made possible through an appeal to underlying biological mechanisms. These contrasting readings of trials are illustrated with reference to guidelines on heart disease prevention/cholesterol reduction using statins among the elderly in North America and the United Kingdom. Uncertainty in these cases does not lead to inertia but solutions use different fixed points to aid navigation, including both physiological principles and moral values. (shrink)

Research question and aimClinical Ethics Committees (CECs) aim to support healthcare professionals (HPs) and healthcare organizations to deal with the ethical issues of clinical practice. In 2020,...

For decades a debate has played out in the literature about who bioethicists are, what they do, whether they can be considered professionals qua bioethicists, and, if so, what professional responsibilities they are called to uphold. Health care ethics consultants are bioethicists who work in health care settings. They have been seeking guidance documents that speak to their special relationships/duties toward those they serve. By approving a Code of Ethics and Professional Responsibilities for Health Care Ethics Consultants, the American Society (...) for Bioethics and Humanities (ASBH) has moved the professionalization debate forward in a significant way. This first code of ethics focuses on individuals who provide health care ethics consultation (HCEC) in clinical settings. The evolution of the code's development, implications for the field of HCEC and bioethics, and considerations for future directions are presented here. (shrink)

American Academy of Pediatrics (AAP) and American College of Medical Genetics (ACMG) recently provided two recommendations about predictive genetic testing of children. The Clinical Sequencing Exploratory Research Consortium's Pediatrics Working Group compared these recommendations, focusing on operational and ethical issues specific to decision making for children. Content analysis of the statements addresses two issues: (1) how these recommendations characterize and analyze locus of decision making, as well as the risks and benefits of testing, and (2) whether the guidelines conflict (...) or come to different but compatible conclusions because they consider different testing scenarios. These statements differ in ethically significant ways. AAP/ACMG analyzes risks and benefits using best interests of the child and recommends that, absent ameliorative interventions available during childhood, clinicians should generally decline to order testing. Parents authorize focused tests. ACMG analyzes risks and benefits using the interests of the child and other family members and recommends that sequencing results be examined for additional variants that can lead to ameliorative interventions, regardless of age, which laboratories should report to clinicians who should contextualize the results. Parents must accept additional analysis. The ethical arguments in these statements appear to be in tension with each other. (shrink)

Familial determination, replete with its frequent usurping of patient autonomy, propagation of collusion, and circumnavigation of direct patient involvement in their own care deliberations, continues to impact clinical practice in many Asian nations. Suggestions that underpinning this practice, in Confucian-inspired societies, is the adherence of the populace to the familial centric ideas of personhood espoused by Confucian ethics, provide a novel means of understanding and improving patient-centred care at the end of life. Clinical experience in Confucian-inspired Singapore, however, (...) suggests that personhood is conceived in broader terms. This diverging view inspired a study of local conceptions of personhood and scrutiny of the influence of the family upon it. From the data gathered, a culturally appropriate, clinically relevant and ethically sensitive concept of personhood was proposed: the Ring Theory of Personhood that better captures the nuances of local conceptions of personhood. The Ring Theory highlights the fact that, far from being solely dependent upon familial centric ideals, local conceptions of personhood are dynamic, context dependent, evolving ideas delineated by four dimensions. Using the Ring Theory, the nature of familial influences upon the four dimensions of personhood – the Innate, Individual, Relational and Societal – are examined to reveal that, contrary to perceived knowledge, conceptions of personhood within Confucian societies are not the prime reason for the continued presence of this decision-making model but remain present within local thinking and practices as a sociocultural residue and primarily because of inertia in updating ideas. (shrink)

The pandemic creates unprecedented challenges to society and to health care systems around the world. Like all crises, these provide a unique opportunity to rethink the fundamental limiting assumptions and institutional inertia of our established systems. These inertial assumptions have obscured deeply rooted problems in health care and deflected attempts to address them. As hospitals begin to welcome all patients back, they should resist the temptation to go back to business as usual. Instead, they should retain the more deliberative, (...) explicit, and transparent ways of thinking that have informed the development of crisis standards of care. The key lesson to be learned from those exercises in rational deliberation is that justice must be the ethical foundation of all standards of care. Justice demands that hospitals take a safety‐net approach to providing services that prioritizes the most vulnerable segments of society, continue to expand telemedicine in ways that improve access without exacerbating disparities, invest in community‐based care, and fully staff hospitals and clinics on nights and weekends. (shrink)

Schizophrenia stands as one of the most studied and storied disorders in the history of clinical psychology; however, it remains a nexus of conflicting and competing conceptualizations. Patients endure great stigma, poor treatment outcomes, and condemnatory prognosis. Current conceptualizations suffer from unstable categorical borders, heterogeneity in presentation, outcome and etiology, and holes in etiological models. Taken in aggregate, research and clinical experience indicate that the class of psychopathologies oriented toward schizophrenia are best understood as spectra of phenomenological, cognitive, (...) and behavioral modalities. These apparently taxonomic expressions are rooted in normal human personality traits as described in both psychodynamic and Five Factor personality models, and more accurately represent explicable distress reactions to biopsychosocial stress and trauma. Current categorical approaches are internally hampered by axiomatic bias and systemic inertia rooted in the foundational history of psychological inquiry; however, when such axioms are schematically decentralized, convergent cross-disciplinary evidence outlines a more robust explanatory construct. By reconceptualizing these disorders under a dimensional and cybernetic model, the aforementioned issues of instability and inaccuracy may be resolved, while simultaneously opening avenues for both early detection and intervention, as well as for more targeted and effective treatment approaches. (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)

This book critically assesses arguments for the existence of the God of classical theism, develops an innovative account of objects’ persistence, and defends new arguments against classical theism. The authors engage the following classical theistic proofs: Aquinas’s First Way, Aquinas’s De Ente argument, and Feser’s Aristotelian, Neo-Platonic, Augustinian, Thomistic, and Rationalist proofs. The authors also provide the first systematic treatment of the ‘existential inertia thesis’. By connecting the thesis to relativity theory and recent developments in the philosophy of physics, (...) and by developing a variety of novel existential-inertia-friendly explanations of persistence, they mount a formidable new case against classical theistic proofs. Finally, they defend new arguments against classical theism based on abstract objects and changing divine knowledge. The text appeals to students, researchers, and others interested in classical theistic proofs, the existence and nature of God, and the ultimate explanations of persistence, change, and contingency. (shrink)

This book is about the ethical issues that clinicians encounter as they care for patients and is written to assist those who serve on hospital ethics committees as they deliberate about appropriate action in difficult ethical cases.

To all appearances, the basic building blocks of reality tend to keep existing unless something intervenes to destroy them. In other words, basic things seem to have existential inertia. But why might this be? This paper considers a number of arguments for and against existential inertia. It discusses arguments inspired by Aquinas, Descartes, and Spinoza, as well as considerations deriving from Occam’s Razor, entropy, and certain views about the nature of time and change.

Edward Feser defends the ‘Aristotelian proof’ for the existence of God, which reasons that the only adequate explanation of the existence of change is in terms of an unchangeable, purely actual being. His argument, however, relies on the falsity of the Existential Inertia Thesis, according to which concrete objects tend to persist in existence without requiring an existential sustaining cause. In this article, I first characterize the dialectical context of Feser’s Aristotelian proof, paying special attention to EIT and its (...) rival thesis—the Existential Expiration Thesis. Next, I provide a more precise characterization of EIT, after which I outline two metaphysical accounts of existential inertia. I then develop new lines of reasoning in favor of EIT that appeal to the theoretical virtues of explanatory power and simplicity. Finally, I address the predominant criticisms of EIT in the literature. (shrink)

The “existential inertia” thesis holds that, once in existence, the natural world tends to remain in existence without need of a divine conserving cause. Critics of the doctrine of divine conservation often allege that its defenders have not provided arguments in favor of it and against the rival doctrine of existential inertia. But in fact, when properly understood, the traditional theistic arguments summed up in Aquinas’s Five Ways can themselves be seen to be (or at least to imply) (...) arguments against existential inertia and in favor of divine conservation. Moreover, they are challenging arguments, to which defenders of the existential inertia thesis have yet seriously to respond. (shrink)

The concept of ‘phylogenetic inertia’ is routinely deployed in evolutionary biology as an alternative to natural selection for explaining the persistence of characteristics that appear sub-optimal from an adaptationist perspective. However, in many of these contexts the precise meaning of ‘phylogenetic inertia’ and its relationship to selection are far from clear. After tracing the history of the concept of ‘inertia’ in evolutionary biology, I argue that treating phylogenetic inertia and natural selection as alternative explanations is mistaken (...) because phylogenetic inertia is, from a Darwinian point of view, simply an expected effect of selection. Although Darwin did not discuss ‘phylogenetic inertia,’ he did assert the explanatory priority of selection over descent. An analysis of ‘phylogenetic inertia’ provides a perspective from which to assess Darwin’s view. (shrink)

The term ‘inertia’ is often used to describe a kind of irrational resistance to change in individuals or institutions. Institutions, ideas and power structures appear to become entrenched over time, and may become ineffective or obsolete, even if they once played a legitimate or useful role. In this paper I argue that there is a common set of problems underlying the occurrence of resistance to change in individuals, social structures and the development of knowledge. Resistance to change is not (...) always irrational or problematic; it is also necessary to allow stable personal identities and social structures to survive in a constantly changing world. I offer a historical and theoretical framework for the question of inertia. Finally, I argue that philosophy has often seen its task to be the critique of ossified, inert or obsolete ideas and social structures, but that it has neglected the positive dimension of resistance to change. Normal 0 false false false EN-GB X-NONE X-NONE. (shrink)

Inertia is enshrined in Newton’s first law of motion, a body at rest or in uniform motion remains in that state unless a force is applied to it. Now, consider (1). (1) Pat stopped the car before it hit the tree. Can we conclude from (1) that the car struck the tree? Not without further information such as that supplied in (2). (2) But the bus behind kept going. A post-condition for Pat stopping the car is that the car (...) be at rest. To satisfy a pre-condition for the car hitting the tree (namely, that the car not be at rest), inertia requires that some intervening force act on the car (as hinted, for example, by (2)). In the absence of such a force, (1) would appear to suggest that Pat prevented a collision between car and tree. Exactly what bit of physics are we importing into natural language interpretation here? Oversimplified, Newton’s first law of motion says: no change without force. Identifying force with cause, we come to the slogan no temporality without cause, capturing in a phrase the proposal from Steedman 2000 that.. (shrink)

In this article, I examine Michael Bratman’s account of stability in his planning theory of intention. Future-directed intentions should be stable, or appropriately resistant to change, over time. Bratman claims that the norm of stability governs both intentions and plans. The aim of this article is to critically enrich Bratman’s account of stability by introducing plasticity as an additional norm of planning. I construct plasticity as a kind of stability of intentions which supplements Bratman’s notion of “reasonable stability.” Unlike the (...) latter, plasticity applies mainly to cases in which plan states are abandoned without reconsideration. I focus on the intra-theoretical problems of PTI and elucidate: the distinction between future-directed intentions and plans, the conceptual difference between stability and inertia, which is only implicit in PTI, and the role of the environment of the planner, which has a vestigial role in Bratman’s work. I also defend my incorporation of pl... (shrink)

The best arguments for the 1/3 answer to the Sleeping Beauty problem all require that when Beauty awakes on Monday she should be uncertain what day it is. I argue that this claim should be rejected, thereby clearing the way to accept the 1/2 solution.

Leibniz considered that there are substances in a body, each of which does not solely have a shape and size and can act spontaneously. Although he started to regard bodies as having inherent substantial forces in 1678–79, what exactly led him to suppose this is not obvious. The author aims to articulate Leibniz's most important motivation for "restoring" substantial forms. He first notes that Leibniz considered that every body tends to slow down because of its natural inertia. He then (...) discusses that Leibniz had two arguments to postulate the existence of substantial forms, the first of which is based on his view that God providentially manages the universe in the most efficient way. The second and more interesting argument is based on Leibniz's understanding of science, according to which a scientific explanation of motion should be given in terms of the nature of the body. (shrink)

This article analyzes investors’ portfolio selection problems in a two-period dynamic model of Knightian uncertainty. We account for the existence of portfolio inertia in this two-period framework. Furthermore, by incorporating investors’ updating behavior, we analyze how observing new information in the first period will affect investors’ behavior. By this analysis, we show that observing new information in the first period will expand portfolio inertia in the second period compared with the case in which observing new information has not (...) been gained in the first period if the degree of Knightian uncertainty is sufficiently large. (shrink)

As the_number of clinical trials continues to grow, there is an increasing need for education and training in the field. The clinical research climate is less forgiving of errors and oversights and therefore requires more knowledge of regulations and requirements. This brand new edition details new laws and regulations in protecting children participating in clinical trials and how a new focus on privacy of individual health information in the United States has changed how medical records are handled. (...) Includes a manual for investigators, research nurses and study coordinators with minimal experience or who are new to clinical research An easy-to-read and open text design using ‘sidebars’ of examples and information boxes related to the main text Includes a list of Frequently Asked Questions and Glossary Duke Clinical Research Institute is the world’s largest academic clinical research organisation and is well known and respected within the clinical research community. (shrink)

Evidentialists say that a necessary condition of sound epistemic reasoning is that our beliefs reflect only our evidence. This thesis arguably conflicts with standard Bayesianism, due to the importance of prior probabilities in the latter. Some evidentialists have responded by modelling belief-states using imprecise probabilities (Joyce 2005). However, Roger White (2010) and Aron Vallinder (2018) argue that this Imprecise Bayesianism is incompatible with evidentialism due to “inertia”, where Imprecise Bayesian agents become stuck in a state of ambivalence towards hypotheses. (...) Additionally, escapes from inertia apparently only create further conflicts with evidentialism. This dilemma gives a reason for evidentialist imprecise probabilists to look for alternatives without inertia. I shall argue that Henry E. Kyburg’s approach offers an evidentialist-friendly imprecise probability theory without inertia, and that its relevant anti-inertia features are independently justified. I also connect the traditional epistemological debates concerning the “ethics of belief” more systematically with formal epistemology than has been hitherto done. (shrink)

I argue that, according to ordinary morality, there is moral inertia, that is, moral pressure to fail to intervene in certain circumstances. Moral inertia is manifested in scenarios with a particular causal structure: deflection scenarios, where a threatening or benefiting process is diverted from a group of people to another. I explain why the deflection structure is essential for moral inertia to be manifested. I argue that there are two different manifestations of moral inertia: strict prohibitions (...) on interventions, and constraints on interventions. Finally, I discuss the connection between moral inertia and the distinction between killing and letting die (or doing and allowing harm). (shrink)

The concept of ‘phylogenetic inertia’ is routinely deployed in evolutionary biology as an alternative to natural selection for explaining the persistence of characteristics that appear sub-optimal from an adaptationist perspective. However, in many of these contexts the precise meaning of ‘phylogenetic inertia’ and its relationship to selection are far from clear. After tracing the history of the concept of ‘inertia’ in evolutionary biology, I argue that treating phylogenetic inertia and natural selection as alternative explanations is mistaken (...) because phylogenetic inertia is, from a Darwinian point of view, simply an expected effect of selection. Although Darwin did not discuss ‘phylogenetic inertia,’ he did assert the explanatory priority of selection over descent. An analysis of ‘phylogenetic inertia’ provides a perspective from which to assess Darwin’s view. (shrink)

Several variant "Newtonian" theories of inertia and gravitation are described, and their scientific usefulness discussed. An examination of these theories is used to throw light on traditional epistemological and metaphysical questions about space and time. Finally these results are examined in the light of the changes induced by the transition from "Newtonian" to general relativistic spacetime.

This book is about the ethical issues that clinicians encounter as they care for patients and is written to assist those who serve on hospital ethics committees as they deliberate about appropriate action in difficult ethical cases.

Suppose all of the particles in the universe should happen to come to rest at the same time, in positions so arranged that all of the forces on every particle balance to zero at that time. What would happen next? Or rather, what does Newtonian mechanics say will happen next? Preface Inertia and Stasis 2.1 Stating the Law of Inertia more precisely 2.2 The stasis scenario Indeterministic Examples 3.1 Abstract example 3.2 Second example Non-Lipschitz Forces and Determinism Beyond (...) the Stasis Scenario CiteULike Connotea Del.icio.us What's this? (shrink)

As Harvey Brown emphasizes in his book Physical Relativity, inertial motion in general relativity is best understood as a theorem, and not a postulate. Here I discuss the status of the "conservation condition", which states that the energy-momentum tensor associated with non-interacting matter is covariantly divergence-free, in connection with such theorems. I argue that the conservation condition is best understood as a consequence of the differential equations governing the evolution of matter in general relativity and many other theories. I conclude (...) by discussing what it means to posit a certain spacetime geometry and the relationship between that geometry and the dynamical properties of matter. (shrink)

Change can be difficult to achieve, and system inertia may be considered relevant. There is a tendency for dynamic systems to enter into specific states characterized by stabilizing factors. The present work attempts to define inertia processes and explores these with regard to pro-environmental behaviour and decision-making. Inertia processes can be considered both within an organizational context and from the level of the individual, and may involve a number of psychological processes and aspects of the decision-making process. (...) A few suggestions for research are also presented. (shrink)

There is a complicated relation between social and political inertia – the failure of institutions to respond adequately to social, technological and environmental change – and social acceleration – the tendency of social change to go faster and faster. Social stasis and acceleration are not simply opposed but also causally related. This article contrasts two theories of political and social inertia. Francis Fukuyama argues that political inertia is a result of a cognitive and institutional rigidity which is (...) ultimately grounded in human nature, and that therefore inertia is a feature inherent in political systems. Hartmut Rosa, by contrast, sees inertia as a specifically modern phenomenon, which is the result of the inability of political institutions to cope with the accelerating rate of change in other social systems. It will be argued that a broad approach combining historical, institutional and normative perspectives is needed to explain political inertia. (shrink)

In this paper I try to sort out a tangle of issues regarding time, inertia, proper time and the so-called “clock hypothesis” raised by Harvey Brown's discussion of them in his recent book, Physical Relativity. I attempt to clarify the connection between time and inertia, as well as the deficiencies in Newton's “derivation” of Corollary 5, by giving a group theoretic treatment original with J.-P. Provost. This shows how both the Galilei and Lorentz transformations may be derived from (...) the relativity principle on the basis of certain elementary assumptions regarding time. I then reflect on the implications of this derivation for understanding proper time and the clock hypothesis. (shrink)

In General Relativity (GR), it has been claimed that inertia receives a dynamical explanation. This is in contrast to the situation in other theories, such as Special Relativity, because the geodesic principle of GR can be derived from Einstein’s field equations. The claim can be challenged in different ways, all of which question whether the status of inertia in GR is physically different from its status in previous spacetime theories. In this paper I state the original argument for (...) the claim precisely, discuss the different objections to it and then propose a formulation that avoids the problems the original claim encounters. My conclusion is that one can say meaningfully that inertia is dynamically explained in GR. There are two senses in which the derivation of geodetic motion can be said to provide a (more) dynamical explanation of inertia in GR: it holds for any material test body that is a source of the gravitational field; and it is derivable without assuming inertial structures that are fixed independently of matter. (shrink)

abstract Allen Buchanan argues that conventional applied ethics is impoverished and would be enriched by the addition of social moral epistemology. The aim here is to clarify this argument and to raise questions about whether such an addition is necessary about how such enrichment would work in practice. Two broad problems are identified. First, there are various kinds and sources of epistemic inertia, which act as an obstacle to epistemic change. Religion is one striking example and seems to pose (...) a deep problem for Buchanan's liberal social moral epistemology. Philosophy also exhibits a distinctive kind of epistemic inertia (metaphilosophical beliefs about the impropriety of applying philosophy are hard to shift), but also suffers from epistemic isolationism: (its arguments and conclusions are isolated from practical influence). It is concluded that not only will a liberal social moral epistemology have to overcome a pernicious epistemic inertia with regard to religious belief, but also a different kind of epistemic inertia closer to home. (shrink)

abstract Allen Buchanan argues that conventional applied ethics is impoverished and would be enriched by the addition of social moral epistemology. The aim here is to clarify this argument and to raise questions about whether such an addition is necessary about how such enrichment would work in practice. Two broad problems are identified. First, there are various kinds and sources of epistemic inertia, which act as an obstacle to epistemic change. Religion is one striking example and seems to pose (...) a deep problem for Buchanan's liberal social moral epistemology. Philosophy also exhibits a distinctive kind of epistemic inertia (metaphilosophical beliefs about the impropriety of applying philosophy are hard to shift), but also suffers from epistemic isolationism: (its arguments and conclusions are isolated from practical influence). It is concluded that not only will a liberal social moral epistemology have to overcome a pernicious epistemic inertia with regard to religious belief, but also a different kind of epistemic inertia closer to home. (shrink)

Cellular, or mobile phones are great: they allow people to communicate over long distances whenever and wherever they are, and instantaneously at that when the one called is wearing one too. Having said that, though, it must immediately be added that they, also, have a complex disadvantage, and it is one we are hard pushed to understand. In fact, due to its complexity people simply tend to neglect it, even though everyone in his right mind has had experience with it. (...) Now Walter Benjamin defined aura as “a distance however close it may be”.1) This has standardly been interpreted as a characterisation of an experience of presence, also by Benjamin. This aura supposedly suffered from the rise of photography. Aura can, also, be understood as inertia, the absence of something present. And whether aura is gone or widespread I gladly leave to more speculative-minded thinkers. I submit that we experience a person’s “aura”—her distance however close she may be—when perception tells us the person is present yet our mind realises that she isn’t. I am referring here to the observation had of another person engaged in a cell phone conversation. The inertia of the cell phone caller consists in her incapacity to address those who observe her. I think there is an immoral streak to her selfappointed moral autonomy. In a previous edition of this Dutch-Russian exchange on inertia I argued that our trafficking with facial expressions forms the model with which we’d best understand the workings of art—facial expression is the anthropological foundation of art. My discussion, today, of the cell phone conversation is meant to add to that previous suggestion. (shrink)

Over the past several years Haisch, Rueda, and others have made the claim that the origin of inertial reaction forces can be explained as the interaction of electrically charged elementary particles with the vacuum electromagnetic zero-point field expected on the basis of quantum field theory. After pointing out that this claim, in light of the fact that the inertial masses of the hadrons reside in the electrically chargeless, photon-like gluons that bind their constituent quarks, is untenable, the question of the (...) role of quantum zero-point fields generally in the origin of inertia is explored. It is shown that, although non-gravitational zero-point fields might be the cause of the gravitational properties of normal matter, the action of non-gravitational zero-point fields cannot be the cause of inertial reaction forces. The gravitational origin of inertial reaction forces is then briefly revisited. Recent claims critical of the gravitational origin of inertial reaction forces by Haisch and his collaborators are then shown to be without merit. (shrink)

Any view of equipoise faces perhaps the most radical and far-reaching objections from moral foundations. These objections hold that the equipoise requirement conflates the ethics of medical research and the ethics of clinical medicine. Once this conflation is recognized, this position holds, research can be given a new foundation on the imperative to avoid exploiting research participants. This article argues that what is novel in this critique is not as successful as its proponents claim and that the ultimate success (...) of this approach actually hinges on a version of the objection from utility. Nevertheless, this criticism highlights the limited scope of applicability of the equipoise requirement. The article concludes, therefore, by describing the outlines of what the article calls an ‘integrative approach’ to clinical trials. This approach represents one way in which the normative requirements of equipoise and the non-exploitation approach might be unified under a single, broad framework. (shrink)