Artificial devices that functionally replace internal organs are likely to be more common in the future. They are becoming more and more technologically feasible, increases in chronic diseases that can compromise various organs are anticipated, and donor organs will remain necessarily limited. More people in the future may have bodies that are partly nonorganic. How might artificial organs affect how we experience and conceptualize our bodies and how we understand the relation of the body to the experiencing, acting subject, or (...) self? Here, I focus on artificial heart devices (AHDs), including total artificial hearts (TAHs) and ventricular assist devices (VADs). While other devices, such as pacemakers and implantable cardiac defibrillators, assist the heart, I focus on devices that replace rather than assist organic function. AHDs, I argue, may have two opposing effects. On the one hand, having an AHD could alter experience, seemingly confirming that selves are shaped by the specifics of embodiment. On the other hand, AHDs are likely to encourage people to regard bodies as machines that are separable from the self. AHDs thus both confirm and undermine a body-self dualism. People with these devices may come to regard their bodies as machinelike even while having an artificial part alters their subjective experience. (shrink)

Nurses and ethicists worry that the implementation of care at a distance or telecare will impoverish patient care by taking out ‘the heart’ of the clinical work. This means that telecare is feared to induce the neglect of patients, and to possibly hinder the development of a personal relation between nurse and patient. This study aims to analyse whether these worries are warranted by analysing Dutch care practices using telemonitoring in care for chronic patients in the Netherlands. How do clinical (...) practices of nursing change when telecare devices are introduced and what this means for notions and norms of good nursing? The paper concludes that at this point the practices studied do not warrant the fear of negligence and compromised relations. Quite the contrary; in the practices studied, telecare lead to more frequent and more specialised contacts between nurses and patients. The paper concludes by reflecting on the ethical implications of these changes. (shrink)

Compromises are arrived at when, in spite of the efforts of those participating to mediate and defend their position in a rationally acceptable manner, each remains with his judgment while, at the same time, a decision must be made without further delay. What this means is that the parties agree to an option about which they are not, in their heart of hearts, entirely convinced. This article examines the notion of moral compromise, concentrating thereby on the case of political (...) praxis. It asks whether, in view of the complexity and multiplicity of morally relevant decisions encountered in a pluralist society, it is at all realistic to expect much else from political institutions than what Rawls dismissively refers to as a modus vivendi and whether a conception of justice that is true or reasonable only given the reasonable pluralism of comprehensive doctrines is still a conception of justice, and not simply a compromise between the contending doctrines. (shrink)

While procurement of organs from donors who are not "brain dead" does not appear to pose insurmountable moral obstacles, the social practice may raise questions of conflict of interest. Non-heart-beating organ donation opens the door for pressure on patients or families to forgo possibly beneficial treatment to provide organs to save others. The combined effects of non-heart-beating donation and organ shortages at major transplant centers brought about by the 1991 United Network for Organ Sharing (UNOS) local-use organ allocation policy created (...) potential conflicts, including the fact that candidates for organs become potential donors far more frequently than previously. Hospitals with a major emphasis on transplantation have economic and academic interests that may have been hurt by the relative organ shortage. Some may view non-heart-beating organ donation as a way to restore weakened programs and thus unconsciously compromise recognition of problems associated with non-heart-beating donation. (shrink)

In the preceding commentary, Campbell and Weber raise two valid and important issues concerning non-heart-beating organ donation (NHBOD). First, because the procedure links withdrawal of life support and the potential for subsequent organ donation, the desire for organs may create a situation in which care of the dying individual has relatively less importance and the dying may receive suboptimal care. Second, even if concerns about care of the dying were dealt with adequately, there will not be enough non-heart-beating donors to (...) significantly decrease the organ shortage that exists, making the procedure not worth the risk. We agree that attention to the important details of caring for the dying are, and must be, the primary concern of all health care workers caring for those individuals. Ensuring the patients' comfort, dignity, and autonomy, and providing for family and social support are the mainstays of this care. All policies for NHBOD should clearly support and mandate these concepts. Regarding the second concern, we agree that NHBOD is currently rare; however, evidence is increasing that this type of donation has great potential. Continued growth of the practice in this country will depend largely on public acceptance, which we believe will be directly influenced by whether the public perceives that care of the dying is not compromised by this procedure. (shrink)

This paper uncovers a distinctively social type of injustice that lies in the kinds of wrongs we can do to each other specifically as social beings. In this paper, social injustice is not principally about unfair distributions of socio-economic goods among citizens. Instead, it is about the ways we can violate each other’s fundamental rights to lead socially integrated lives in close proximity and relationship with other people. This paper homes in on a particular type of social injustice, which we (...) can call social contribution injustice. The paper identifies two distinct forms of social contribution injustice. The first form involves compromising a person’s social resources so as to deny her adequate scope to contribute socially. The second form involves unjustly misvaluing a person as a social contributor, usually by not taking her seriously as a social contributor. (shrink)

Bioethics is not a field for the faint-hearted. Life and death decisions are both at stake and everything in between. Increasingly, before-life decisions are being taken as well and this issue comm...

Procurement of organs from non-heart-beating cadaver donors raises concerns. Standards for optimal patient care during withdrawal of life-sustaining therapy are evolving and continue to be debated and studied. Consensus on specific procedures and methods has not been attained, however, and protocols for the procurement of organs from patients following the withdrawal of life-sustaining therapies may compromise the evolving standards and harm the patient and the attendant family. In addition, there is little evidence to suggest that such protocols will significantly increase (...) the number of organs procured. "Non-heart-beating cadaver" protocols that do not give comprehensive attention to optimal patient/family care at the time of withdrawal of life-sustaining therapy ought not to be endorsed. (shrink)

Questioning the usual judgements of political ethics, Ruth W. Grant argues that hypocrisy can actually be constructive while strictly principled behavior can be destructive. _Hypocrisy and Integrity_ offers a new conceptual framework that clarifies the differences between idealism and fanaticism while it uncovers the moral limits of compromise. "Exciting and provocative.... Grant's work is to be highly recommended, offering a fresh reading of Rousseau and Machiavelli as well as presenting a penetrating analysis of hypocrisy and integrity."—Ronald J. Terchek, _American Political (...) Science Review_ "A great refreshment.... With liberalism's best interests at heart, Grant seeks to make available a better understanding of the limits of reason in politics."—Peter Berkowitz, _New Republic_. (shrink)

In this essay, the directors of an NEH Institute on “Medicine, Literature, and Culture” consider the lessons they learned by bringing humanities scholars to a teaching hospital for a month-long institute that mingled seminar discussions, outside speakers and clinical observations. In an exchange of letters, they discuss the productive tensions inherent in approaching medicine from multiple perspectives, and they argue the case for a broader conception of medical humanities that incorporates the methodologies of cultural studies.

In this book I address the widely debated topic of the legitimacy of democratic decisions showing that the traditional concept of the legitimacy of political authority developed by liberal theories involves dilemmatic outcomes. In order to solve this intrinsic tension of the liberal model of legitimacy, I argue that the legitimacy of political decisions must be granted with a two steps strategy that involves both ideal and non-ideal analysis. Starting from the models developed by John Rawls and Gerald Gaus, I (...) build up my own paradigm, claiming that, pace Rawls, it is not possible to do away with an epistemic analysis of the actual circumstances of justification. I look at the epistemology of disagreement literature in order to build up an epistemic and procedural framework in which it could be shown that disagreement is not a practical obstacle that prevents participants from agreeing on virtually correct solutions; rather, it is exactly in virtue of the fact of disagreement that democracy is the best method for collective decisions. The heart of this proposal is that given certain epistemic circumstances (i.e. pervasive disagreement due to an opaque appraisal of evidence), it is possible to argue that participants within a collective decision-making setting should refer to each other as epistemic peers. This normative request inherits its value from a shared understanding of persons as being on an equal footing and capable of reasoning powers. This reading of political equality implies two related features of peerhood. One is the proceduralist tenet that equality is a non-instrumental value that should be expressed by the fact that any voice, in the political arena, should be given equal weight. The second is the idea that, assumed the fact of pluralism, citizens should be ready to share both practical and epistemic authority while publicly debating over evaluative matters. In the second part of the book I argue that democratic procedures of decision-making, in order to actually respect members of society as equal peers, and in the attempt to solve the dilemmatic outcomes of public reason models of legitimacy, should look at political agreements achieved through compromise rather than consensus. In fact, an overly idealized approach to collective-choice procedures may lose track of actual decision-making processes (lack of guidance). Moreover, seeking consensus, through the establishment of deliberative standards that some individuals or groups have less opportunities than others to fulfil may engender exclusion and inequality (lack of inclusion). Accordingly, I suggest that deliberative constraints should be loosened to include partisan and interested claims and to pursue principled compromises rather than consensual agreement. According to the model of legitimacy I defend, a normative account of democracy cannot rely on standards that could be only applied in an ideal context, otherwise this attempt will be doomed to fail in two ways: 1) delegitimizing actual democratic decision-making processes and 2) undermining the actual possibility to implement decisions reached through deliberation in real contexts. (shrink)

The woman at the heart of Pearl Jam’s “Better Man” (Vitalogy, 1994) is trapped. She has committed herself to a relationship that makes her miserable, but she sees no viable alternative to staying in it. She mourns a past self who might have been able to leave and dreams of a dierent way things might be, but remains unable to move on. It is tempting to view her with a mixture of pity and frustration (reecting some of the personal circumstances (...) -- Eddie Vedder’s mother’s second marriage -- informing its composition). As a moral being, she appears to be hopelessly compromised by her situation, even as she is also doing her best to survive under conditions designed to undermine her autonomy and keep her trapped (as abusive relationships do). The song is not so much critical of her choice to stay as it is confused by and resigned to it. -/- What keeps a person where she so clearly does not want to be? -/- The song itself was, at least early in its recorded life for Pearl Jam, similarly compromised. Vedder appears to have thought of it as too “accessible”, too much of a pop hit for the kind of musical vision he had in mind either for Vs. (for which it had originally been intended) or for Vitalogy; by this point in the band’s career, he was ever more actively resisting success, accessibility, and everything that went with the version of rock star life imposed collectively on the band and on him as an individual. The form that resistance took was an exercise of artistic and other forms of control, sometimes exercised in ways that were destructive or damaging (to the band and its internal relationships, its fame or success, its image, its artistic identity, etc.). -/- What keeps an artist or a band where they so clearly do not want to be? In this chapter, I oer a loose exploration of some possible philosophical approaches to answering the question of what keeps us where we are, like it or not, worked out in parallel through the lyrics of “Better Man” and the circumstances of the song’s eventual arrival Vitalogy. My main interest is in examining the ethical dimensions of the question itself -- what, if anything, are we morally required or expected to do under compromised or compromising conditions? My main suggestion is that answering the question might require of us a messier, more ambivalent, and perhaps more compassionate notion of moral agency, inspired by Simone Weil’s work on affliction. (shrink)

How the new conspiracists are undermining democracy—and what can be done about it Conspiracy theories are as old as politics. But conspiracists today have introduced something new—conspiracy without theory. And the new conspiracism has moved from the fringes to the heart of government with the election of Donald Trump. In A Lot of People Are Saying, Russell Muirhead and Nancy Rosenblum show how the new conspiracism differs from classic conspiracy theory, why so few officials speak truth to conspiracy, and what (...) needs to be done to resist it. Classic conspiracy theory insists that things are not what they seem and gathers evidence—especially facts ominously withheld by official sources—to tease out secret machinations. The new conspiracism is different. There is no demand for evidence, no dots revealed to form a pattern, no close examination of shadowy plotters. Dispensing with the burden of explanation, the new conspiracism imposes its own reality through repetition and bare assertion. The new conspiracism targets democratic foundations—political parties and knowledge-producing institutions. It makes it more difficult to argue, persuade, negotiate, compromise, and even to disagree. Ultimately, it delegitimates democracy. Filled with vivid examples, A Lot of People Are Saying diagnoses a defining and disorienting feature of today's politics and offers a guide to responding to the threat. (shrink)

This paper makes the case that environmental education needs to be taken up as a moral education to the extent that we see the connection between harm and destruction in the environment and harm and destruction within human individuals and their relationship, and proceeds to show this connection by introducing the key notion of human alienation and its psychological factors of wounding, dissociation or split, self and other oppression and exploitation, all of which result in compromised moral agency. To (...) this end, the paper further makes the case that we need to replace the culture of alienation with a culture of healing and reclamation of fundamental humanity manifest as compassion and wisdom, and presents an ideal of moral agency that would emerge when all parts and dimensions of one’s being—body–mind–heart–energetics—are aligned, attuned and integrated, having healed from the body–mind split, mind–heart split, body–spirit split and mind–matter split. Concepts and imagery borrowed from Asian philosophies, such as Buddhism and Daoism, are offered as illustrative resources for the project of reclaiming uncompromised moral agency and its manifestation through compassion and wisdom. These concepts include hungry ghosts, bodhicitta, sunyata and wu-wei. (shrink)

This paper has two goals. The first goal is to show that the structuralists’ claims about dependence are more significant to their view than is generally recognized. I argue that these dependence claims play an essential role in the most interesting and plausible characterization of this brand of structuralism. The second goal is to defend a compromise view concerning the dependence relations that obtain between mathematical objects. Two extreme views have tended to dominate the debate, namely the view that all (...) mathematical objects depend on the structures to which they belong and the view that none do. I present counterexamples to each of these extreme views. I defend instead a compromise view according to which the structuralists are right about many kinds of mathematical objects (roughly, the algebraic ones), whereas the anti-structuralists are right about others (in particular, the sets). I end with some remarks about how to understand the crucial notion of dependence, which despite being at the heart of the debate is rarely examined in any detail. (shrink)

The possibility that industry is exerting an undue influence on the culture of medicine has profound implications for the profession's public health mission. Policy analysts, investigative journalists, researchers, and clinicians have questioned whether academic-industry relationships have had a corrupting effect on evidence-based medicine. Psychiatry has been at the heart of this epistemic and ethical crisis in medicine. This article examines how commercial entities, such as pharmaceutical companies, influence psychiatric taxonomy and treatment guidelines. Using the conceptual framework of institutional corruption, we (...) show that organized psychiatry's dependence on drug firms has led to a distortion of science. We describe the current dependency corruption and argue that transparency alone is not a solution. We conclude by taking the position that the corruption of the evidence base in diagnostic and practice guidelines has compromised the informed consent process, and we suggest strategies to address this problem. (shrink)

Can we expect our scientific theories to make up a unified structure, or do they form a kind of “patchwork” whose pieces remain independent from each other? Does the proliferation of sometimes-incompatible representations of the same phenomenon compromise the ability of science to deliver reliable knowledge? Is there a single correct way to classify things that science should try to discover, or is taxonomic pluralism here to stay? These questions are at the heart of philosophical debate on the unity or (...) plurality of science, one of the most central issues in philosophy of science today. This book offers a critical overview and a new structure of this debate. It focuses on the methodological, epistemic, and metaphysical commitments of various philosophical attitudes surrounding monism and pluralism, and offers novel perspectives and pluralist theses on scientific methods and objects, reductionism, plurality of representations, natural kinds, and scientific classifications. (shrink)

Addressing fatigue is useful in a variety of scenarios and activities. Fatigue has recently been studied from a psychophysiological standpoint. As a result, the expression and impact of peripheral and central fatigue has been evaluated. Driving is one occupation where tiredness has disastrous consequences. BAlert is a smartphone app that approaches exhaustion with psychophysiological measures. More specifically, it evaluates the level of fatigue via heart rate variability data and the cognitive compromise via Stroop effect. The goal of this study is (...) to determine if there are gender differences in fatigue levels among professional drivers using the BAlert app. Statistically significant differences were found in the number of hours awake, in different parameters of HRV, in the level of stress, as well as in the cognitive response evaluated through the app. The results are discussed and their implications for the management of work fatigue are presented. (shrink)

According to luck egalitarianism, it is not unfair when people are disadvantaged by choices they are responsible for. This implies that those who are disadvantaged by choices that prevent disadvantage to others are not eligible for compensation. This is counterintuitive. We argue that the problem such cases pose for luck egalitarianism reveals an important distinction between responsibility for creating disadvantage and responsibility for distributing disadvantage which has hitherto been overlooked. We develop and defend a version of luck egalitarianism which only (...) holds people responsible for creating disadvantage. This revision enables luck egalitarianism to offer compensation to those who are disadvantaged by preventing disadvantage to others, like dependent caretakers, without compromising the responsibility–sensitivity at the heart of luck egalitarianism. (shrink)

According to luck egalitarianism, it is not unfair when people are disadvantaged by choices they are responsible for. This implies that those who are disadvantaged by choices that prevent disadvantage to others are not eligible for compensation. This is counterintuitive. We argue that the problem such cases pose for luck egalitarianism reveals an important distinction between responsibility for creating disadvantage and responsibility for distributing disadvantage which has hitherto been overlooked. We develop and defend a version of luck egalitarianism which only (...) holds people responsible for creating disadvantage. This revision enables luck egalitarianism to offer compensation to those who are disadvantaged by preventing disadvantage to others, like dependent caretakers, without compromising the responsibility–sensitivity at the heart of luck egalitarianism. (shrink)

The ubiquity of inner awareness thesis states that all conscious states of normal adult humans are characterised by an inner awareness of that very state. UIA-Backers support this thesis while UIA-Skeptics reject it. At the heart of their dispute is a recalcitrant phenomenological disagreement. UIA-Backers claim that phenomenological investigation reveals ‘peripheral inner awareness’ to be a constant presence in their non-introspective experiences. UIA-Skeptics deny that their non-introspective experiences are characterised by inner awareness, and maintain that inner awareness is only gained (...) when they explicitly introspect. Each camp has put forward a range of arguments designed to resolve this dispute, but I argue that none of these arguments has genuine dialectical purchase. This leads me to develop a compromise position that trades on the contribution that affordances can make to our phenomenology. According to the Affordance Model of inner awareness, all conscious states of normal adult humans are characterised by an affordance of introspectability. In line with the UIA-Skeptic, non-introspective experiences are not characterised by inner awareness. But against the traditional UIASkeptic, non-introspective experiences are characterised by an awareness of the opportunity for introspection. On this view, our capacity to gain inner awareness of our current experience is a ubiquitous feature of our phenomenology. I show how the Affordance Model respects the driving phenomenological intuitions of both the UIA-Backers and the traditional UIA-Skeptics, and suggest that it is able to explain why neither camp achieves an accurate description of how inner awareness figures in their phenomenology. (shrink)

The moral and political philosophy of pluralism has become increasingly influential. To pluralists, when values genuinely conflict we should aim to strike an appropriate balance or trade-off between them, though this means accepting that compromise will be inevitable. Politics, as a result, appears as a thoroughly tragic affair. Drawing on a "hermeneutical" conception of interpretation, the author develops an original account of practical reasoning, one which assumes that, though making compromises in the face of conflicts is indeed often unavoidable, there (...) are times when reconciliation, as distinct from compromise, is feasible. For this to be so, however, citizens must strive to converse--and not just negotiate--with each other, thus fulfilling the good that is at the heart of their shared political community. This is the central message of the patriotic alternative to pluralist politics that the author defends here. (shrink)

In visually cataloging the endearing and enigmatic ways in which the built environment takes shape, 'Best Practices' proposes a new way of thinking about neighbourhoods, housing developments, streetscapes, and storefronts, not so much as places defined by building codes, dimensions, or geographic features, but as assemblages of ad hoc interventions and incidental ephemera. Drawing on the history of architecture, media theory, cultural anthropology, and urban studies, 'Best Practices' pairs photographic documentation with extensive captions and citations to define a territory within (...) the margins between the sanctioned and unsanctioned, the regulated and unregulated, the tasteful and tacky, the novel and the nonsense. While not necessarily in opposition of those mechanisms, Best Practices asserts that interest, knowledge, and meaning are more often generated on the lines that divide such categories. This book advocates for a more thorough consideration of the unauthorised remodels, slap-dash handiwork, haphazard paint jobs, half-hearted do-it-yourself projects, cracked facades, contradictions, compromises, and coincidences. (shrink)

When The Ad Hoc Committee of Harvard Medical School to Examine the Definition of Brain Death began meeting in 1967, I was a graduate student, with committee member Ralph Potter and committee chair Henry Beecher as my mentors. The question of when to stop life support on a severely compromised patient was not clearly differentiated from the question of when someone was dead. A serious clinical problem arose when physicians realized that a patient's condition was hopeless but life support (...) perpetuated body function. Thus, the committee stated that its first purpose was to deal with the burdens on patients and families as well as on hospitals and on patients needing hospital beds occupied by comatose patients. They intuited the strategy of “defining” these patients as dead, thus legitimating treatment stoppage. They noted that this would also serve a second purpose. Although the dead donor rule had not yet been clearly articulated, they claimed that defining patients as dead would also address controversy over obtaining organs for transplant.My mentors’ discussions related to my interest in the intersection between questions primarily of medical fact (When has a human brain irreversibly ceased functioning?) and nonmedical questions of social policy (Should we treat individuals with dead brains and beating hearts as dead humans?). It quickly became clear that most committee members did not appreciate the interplay of these questions. (shrink)

Parvalbumins (PVs) are acidic, intracellular Ca2+‐binding proteins of low molecular weight. They are associated with several Ca2+‐mediated cellular activities and physiological processes. It has been suggested that PV might function as a “Ca2+ shuttle” transporting Ca2+ from troponin‐C (TnC) to the sarcoplasmic reticulum (SR) Ca2+ pump during muscle relaxation. Thus, PV may contribute to the performance of rapid, phasic movements by accelerating the contraction–relaxation cycle of fast‐twitch muscle fibers. Interestingly, PVs promote the generation of power stroke in fish by speeding (...) up the rate of relaxation and thus provide impetus to attain maximal sustainable speeds. However, immunological monitoring of diverse tissues demonstrated that PVs are also present in non‐muscle cells. The axoplasmic transport and various intracellular secretory mechanisms including the endocrine secretions seem to be controlled by the Ca2+ regulation machinery. Any defect in the Ca2+ handling apparatus may cause several clinical problems; for instance, PV deficiency alters the neuronal activity, a key mechanism leading to epileptic seizures. Moreover, atypical relaxation of the heart results in diastolic dysfunction, which is a major cause of heart failure predominantly among the aged people. PV may offer a unique potential to correct defective relaxation in energetically compromised failing hearts through PV gene transfer. Consequently, PV gene transfer may present a new therapeutic approach to correct cellular disturbances in Ca2+ signaling pathways of diseased organs. Hence, PVs appear to be amazingly useful candidate proteins regulating a variety of cellular functions through action on Ca2+ flux management. (shrink)

In 2003, the pharmaceutical company Biovail received a spate of negative publicity around a program for its heart medication Cardizem LA. For a three-month period Biovail paid US doctors US$1000 (and their office managers US$150) for patient data when at least 11 of their patients renewed a prescription to Cardizem. Doctors who signed up for the trial but who did not keep 11 patients on the drug received US$250 for participation. According to Biovail, this was a research trial, meeting US (...) federal regulations for research trials – the consulting firm that had designed the trial had guaranteed that it would meet US criteria. The trial was expected to provide data that would help ‘in designing future clinical trial programs’, according to Biovail’s vice-president of finance. In addition, the results would eventually be published. However, the program was originally presented as a marketing campaign, and was being handled by Biovail’s sales department and sales force. According to ethicists who commented on the case, a US$1000 payment to doctors was unusually high for a post-marketing research trial, and a US$150 payment to office managers was thought to raise novel ethical conflicts. Cardizem is a drug intended for long-term use, so paying doctors to get patients started on a course of treatment could lead to substantial profits from these prescriptions. In line with this, immediate comments from professional ethicists and representatives of medical associations focused on questions about whether the Biovail campaign amounted to paying doctors to prescribe specific drugs. And that is a concern for the obvious reason that it has the potential to compromise doctors’ decisions about best care. Payments for prescriptions place doctors in ethically difficult situations: Peter Singer, a medical ethicist, says ‘There is clearly the potential for [physicians’] conflict of interest’ (Toronto Globe and Mail, 2003). Physicians’ decision-making is the most common locus of discussion in medical ethics.. (shrink)

The author presents a history of the attempts to find the final "theory of everything," gives a forceful argument that one can never be found, and a warning that the compromises necessary to produce a final theory may well undermine the rules of doing good science. At the heart of the story is the rise of the particle physicists and their attempts to reach far out into the cosmos for a unifying theory. Unable to subject their findings and theories to (...) experimental scrutiny, they have moved into a world governed entirely by mathematical and highly speculative theories, none of which can be empirically verified. "Does physics then become a branch of aesthetics?" Lindley asks. For an opposing viewpoint, see Stephen Weinberg's Dreams of a Final Theory. Annotation copyright by Book News, Inc., Portland, OR. (shrink)

Of late, resistance has become a central notion in political theory, standing at the heart of attempts to respond to the dilemmas of contemporary times. However, many accounts tend to ascribe to an idealised, heroic view. In this view, resistance represents a clearcut action against injustice and stems from individuals’ conscious choice and their unwavering ethical commitment to the cause. Some liberal scholars, most notably Candice Delmas and Jason Brennan, have argued that citizens of democratic societies have a moral duty (...) to resist state-sanctioned injustice. This resistance occurs either through ‘principled – civil or uncivil – disobedience’ or through ‘defensive actions’. While acknowledging that pervasive injustice can compromise our cognitive and moral capacities, however, their articulation of our political obligation to resist refrains from a sustained examination of the moral dilemmas, uncertainties and risks that arise when fighting systemic oppression. (shrink)

It is widely accepted in the pharmacy profession that pharmacists have the right to conscientiously refuse to participate in certain practices on grounds of conscience. This is allowed in recognition of differences in moral and religious views and out of respect for moral integrity. However, the “conscience clause” does not necessarily sit easily in a professional code of ethics owing to the potential tensions between a professional’s personal moral integrity and her professional obligations. At the heart of these tensions are (...) philosophical questions about the nature of conscience and integrity.These in turn lead to important practical ethical questions about the adequacy of a conscience clause to protect integrity and patient’s rights and guard against wrongdoing, whether conscientious refusals should be publicly announced in advance and what the acceptable bases of a conscientious refusal might be. Such questions apply not just to the professional, but also to pharmacy students, who may hold conscientious objections to some aspects of their training.It is concluded that the conventional compromise that is commonly in place in the pharmacy profession is a workable but imperfect solution and that better understanding of the concepts and competing obligations may be achieved by learning more about conscientious decision-making by pharmacists in practice. (shrink)

continent. 2.2 (2012): 66–75 ~*~ We’re Doomed. Pessimism is the night-side of thought, a melodrama of the futility of the brain, a poetry written in the graveyard of philosophy. Pessimism is a lyrical failure of philosophical thinking, each attempt at clear and coherent thought, sullen and submerged in the hidden joy of its own futility. The closest pessimism comes to philosophical argument is the droll and laconic “We’ll never make it,” or simply: “We’re doomed.” Every effort doomed to failure, every (...) project doomed to incompletion, every life doomed to be unlived, every thought doomed to be unthought. Pessimism is the lowest form of philosophy, frequently disparaged and dismissed, merely the symptom of a bad attitude. No one ever needs pessimism, in the way that one needs optimism to inspire one to great heights and to pick oneself up, in the way one needs constructive criticism, advice and feedback, inspirational books or a pat on the back. No one needs pessimism, though I like to imagine the idea of a pessimist activism. No one needs pessimism, and yet everyone—without exception—has, at some point in their lives, had to confront pessimism, if not as a philosophy then as a grievance—against one’s self or others, against one’s surroundings or one’s life, against the state of things or the world in general. There is little redemption for pessimism, and no consolation prize. Ultimately, pessimism is weary of everything and of itself. Pessimism is the philosophical form of disenchantment—disenchantment as chanting, a chant, a mantra, a solitary, monophonic voice rendered insignificant by the intimate immensity surrounding it. In pessimism, the first axiom is a long, low, funereal sigh. ~*~ We’re Still Doomed. No one has time for pessimism. After all, there are only so many hours in a day. Whatever our temperament, happy or sad, engaged or disengaged, we know pessimism when we hear it. The pessimist is usually understood as the complainer, forever pointing out what is wrong with the world without ever once offering a solution. But more often than not pessimists are the quietest of philosophers, submerging their own sighs within the lethargy of discontent. What little sound it makes is of interest to no one—“I’ve heard it all before,” “tell me something I don’t know,” sound and fury, signifying nothing. In raising problems without solutions, in posing questions without answers, in retreating to the hermetic, cavernous abode of complaint, pessimism is guilty of that most inexcusable of Occidental crimes—the crime of not pretending it’s for real. Pessimism fails to live up to the most basic tenet of philosophy—the “as if.” Think as if it will be helpful, act as if it will make a difference, speak as if there is something to say, live as if you are not, in fact, being lived by some murmuring non-entity both shadowy and muddied. Had it more self-assurance and better social skills, pessimism would turn its disenchantment into a religion, possibly calling itself The Great Refusal. But there is a negation in pessimism that refuses even such a Refusal, an awareness that, from the start, it has already failed, and that the culmination of all that is, is that all is for naught. Pessimism tries very hard to present itself in the low, sustained tones of a Requiem Mass, or the tectonic rumbling of Tibetan chant. But it frequently lets loose dissonant notes at once plaintive and pathetic. Often, its voice cracks, its weighty words abruptly reduced to mere shards of guttural sound. ~*~ Maybe It’s Not So Bad, After All. If we know pessimism when we hear it, this is because we’ve heard it all before—and we didn’t need to hear it in the first place. Life is hard enough. What you need is a change of attitude, a new outlook, a shift in perspective... a cup of coffee. If we have no ears for pessimism, this is because it is always reducible to something as reliably mutable as a voice. If pessimism is so frequently disparaged, it is because it brings everyone down, determined as it is to view each day as a bad day, if only by virtue of the fact that it is not yet a bad day. For pessimism the world is brimming with negative possibility, the collision of a bad mood with an impassive world. In fact, pessimism is the result of a confusion between the world and a statement about the world, a confusion that also prevents it from fully entering the hallowed halls of philosophy. If pessimism is so often dismissed, this is because it is often impossible to separate a “bad mood” from a philosophical proposition (and do not all philosophies stem from a bad mood?) The very term “pessimism” suggests a school of thought, a movement, even a community. But pessimism always has a membership of one—maybe two. Ideally, of course, it would have a membership of none, with only a scribbled, illegible note left behind by someone long forgotten. But this seems unrealistic, though one can always hope. ~*~ Anatomy of Pessimism. Though it may locate itself at the margins of philosophy, pessimism is as much subject to philosophical analysis as any other form of thought. Pessimism’s lyricism of failure gives it the structure of music. What time is to the music of sorrow, reason is to a philosophy of the worst. Pessimism’s two major keys are moral and metaphysical pessimism, its subjective and objective poles, an attitude towards the world and a claim about the world. For moral pessimism, it is better not to have been born at all; for metaphysical pessimism, this is the worst of all possible worlds. For moral pessimism the problem is the solipsism of human beings, the world made in our own image, a world-for-us. For metaphysical pessimism, the problem is the solipsism of the world, objected and projected as a world-in-itself. Both moral and metaphysical pessimism are compromised philosophically; moral pessimism by its failure to locate the human within a larger context, and metaphysical pessimism by its failure to recognize the complicity in the very claim of realism. This is how pessimism makes its music of the worst, a generalized misanthropy without the anthropos . Pessimism crystallizes around this futility—it is its amor fati , rendered as musical form. ~*~ Melancholy of Anatomy. There is a logic of pessimism that is fundamental to its suspicion of philosophical system. Pessimism involves a statement about a condition . In pessimism each statement boils down to an affirmation or a negation, just as any condition boils down to the best or the worst. With Schopenhauer, that arch-pessimist, the thinker for whom the philosopher and the curmudgeon perfectly overlap, we see a no-saying to the worst, a no-saying that secretly covets a yes-saying (through asceticism, mysticism, quietism), even if this hidden yes-saying is a horizon at the limits of comprehension. With Nietzsche comes the pronouncement of a Dionysian pessimism, a pessimism of strength or joy, a yes-saying to the worst, a yes-saying to this world as it is. And with Cioran yet another variation, futile yet lyrical, a no-saying to the worst, and a further no-saying to the possibility of any other world, in here or out there. With Cioran one approaches, but never reaches, an absolute no-saying, a studied abandonment of pessimism itself. The logic of pessimism moves through three refusals: a no-saying to the worst (refusal of the world-for-us, or Schopenhauer’s tears); a yes-saying to the worst (refusal of the world-in-itself, or Nietzsche’s laughter); and a no-saying to the for-us and the in-itself (a double refusal, or Cioran’s sleep). Crying, laughing, sleeping—what other responses are adequate to a life that is so indifferent? ~*~ Cosmic Pessimism. Both moral and metaphysical pessimism point to another kind, a pessimism that is neither subjective nor objective, neither for-us nor in-itself, and instead a pessimism of the world-without-us. We could call this a cosmic pessimism ... but this sounds too majestic, too full of wonder, too much the bitter aftertaste of the Great Beyond. Words falter. And so do ideas. And so we have a cosmic pessimism, a pessimism that is first and last a pessimism about cosmos , about the necessity and possibility of order. The contours of cosmic pessimism are a drastic scaling-up or scaling-down of the human point of view, the unhuman orientation of deep space and deep time, and all of this shadowed by an impasse, a primordial insignificance, the impossibility of ever adequately accounting for one’s relationship to thought—all that remains of pessimism is the desiderata of affects—agonistic, impassive, defiant, reclusive, filled with sorrow and flailing at that architectonic chess match called philosophy, a flailing that pessimism tries to raise to the level of an art form (though what usually results is slapstick). ~*~ Song of Futility. An ethics of futility pervades pessimism. Futility, however, is different from fatality, and different again from simple failure (though failure is never simple). Failure is a breakage within the heart of relations, a fissure between cause and effect, a fissure hastily covered over by trying and trying again. With failure, there is always plenty of blame to go around; it’s not my fault, it’s a technical difficulty, it’s a miscommunication. For the pessimist, failure is a question of “when,” not “if”—failure as a metaphysical principle. Everything withers and passes into an obscurity blacker than night, everything from the melodramatic decline of a person’s life to the banal flickering moments that constitute each day. Everything that is done undone, everything said or known destined for a kind of stellar oblivion. When scaled up in this way, failure becomes fatality. Fatality is the hermeticism of cause and effect. In fatality, everything you do, whatever you do, always leads to a certain end, and ultimately to the end—though that end, or the means to that end, remain shrouded in obscurity. Nothing you do makes a difference because everything you do makes a difference. Hence the effects of your actions are hidden from you, even as you deceive yourself into thinking that, at last, this time you will outwit the order of things. By having a goal, planning ahead, and thinking things through carefully, we attempt, in a daily Prometheanism, to turn fatality to our advantage, to gain a glimpse of an order that seems buried deeper and deeper in the fabric of the universe. But even fatality has its comforts. The chain of cause and effect may be hidden from us, but that’s just because disorder is the order we don’t yet see; it’s just complex, distributed, and requires advanced mathematics. Fatality still clings to the sufficiency of everything that exists... When fatality relinquishes even this idea, it becomes futility. Futility arises out of the grim suspicion that, behind the shroud of causality we drape over the world, there is only the indifference of what exists or doesn’t exist; whatever you do ultimately leads to no end, an irrevocable chasm between thought and world. Futility transforms the act of thinking into a zero-sum game. ~*~ Song of the Worst. At the center of pessimism lies the term pessimus , “the worst,” a term as relative as it is absolute. The worst is about as bad as it gets, “the worst” as “the best” in disguise, shrouded by the passage of time or the twists and turns of fortune. For the pessimist, “the worst” is the propensity for suffering that gradually occludes each living moment, until it eclipses it entirely, overlapping perfectly in death... which, for the pessimist, is no longer “the worst.” Pessimism is marked by an unwillingness to move beyond “the worst,” something only partially attributable to a lack in motivation. In pessimism “the worst” is the ground that gives way beneath every existent—things could be worse, and , things could be better. “The worst” invariably implies a value judgment, one made based on scant evidence and little experience; in this way, pessimism’s greatest nemesis is its moral orientation. Pessimism’s propositions have all the gravitas of a bad joke. Perhaps this is why the true optimists are the most severe pessimists—they are optimists that have run out of options. They are almost ecstatically inundated by the worst. Such an optimism is the only possible outcome of a prolonged period of suffering, physical or metaphysical, intellectual or spiritual. But does this not also describe all the trials and tribulations of each day—in short, of “life?” It seems that sooner or later we are all doomed to become optimists of this sort (the most depressing of thoughts...) ~*~ Song of Doom. Rather than serving as a cause for despair, gloom and doom are the forms of consolation for any pessimist philosophy. Neither quite affects nor quite concepts, gloom and doom transform pessimism into a mortification of philosophy. Doom is not just the sense that all things will turn out badly, but that all things inevitably come to an end, irrespective of whether or not they really do come to an end. What emerges from doom is a sense of the unhuman as an attractor, a horizon towards which the human is fatally drawn. Doom is humanity given over to unhumanity in an act of crystalline self-abnegation. Gloom is not simply the anxiety that precedes doom. Gloom is literally atmospheric, climate as much as impression, and if people are also gloomy, this is simply the by-product of an anodyne atmosphere that only incidentally involves human beings. Gloom is more climatological than psychological, the stuff of dim, hazy, overcast skies, of ruins and overgrown tombs, of a misty, lethargic fog that moves with the same languorousness as our own crouched and sullen listening to a disinterested world. In a sense, gloom is the counterpoint to doom—what futility is to the former, fatality is to the latter. Doom is marked by temporality—all things precariously drawn to their end—whereas gloom is the austerity of stillness, all things sad, static, and suspended, a meandering smoke hovering over cold lichen stones and damp fir trees. If doom is the terror of temporality and death, then gloom is the horror of a hovering stasis that is life. At times I like to imagine that this realization alone is the thread that connects the charnel ground Aghori and the graveyard poets. ~*~ Song of Spite. There is an intolerance in pessimism that knows no bounds. In pessimism spite begins by fixing on a particular object of spite—someone one hardly knows, or someone one knows too well; a spite for this person or a spite for all of humanity; a spectacular or a banal spite; a spite for a noisy neighbor, a yapping dog, a battalion of strollers, the meandering idiot walking in front of you on their smart phone, large loud celebrations, traumatic injustices anywhere in the world regurgitated as media blitz, spite for the self-absorbed and overly performative people talking way too loud at the table next to you, technical difficulties and troubleshooting, the reduction of everything to branding, spite of the refusal to admit one’s own errors, of self-help books, of people who know absolutely everything and make sure to tell you, of all people, all living beings, all things, the world, the spiteful planet, the inanity of existence... Spite is the motor of pessimism because it is so egalitarian, so expansive, it runs amok, stumbling across intuitions that can only half-heartedly be called philosophical. Spite lacks the confidence and the clarity of hatred, but it also lacks the almost cordial judgment of dislike. For the pessimist, the smallest detail can be an indication of a metaphysical futility so vast and funereal that it eclipses pessimism itself—a spite that pessimism carefully places beyond the horizon of intelligibility, like the experience of dusk, or like the phrase, “it is raining jewels and daggers.” ~*~ Song of Sleep. A paraphrase of Schopenhauer: what death is for the organism, sleep is for the individual. Pessimists sleep not because they are depressed, but because for them sleep is a form of ascetic practice. Sleep is the askesis of pessimism. If, while sleeping, we have a bad dream, we abruptly wake up, and suddenly the horrors of the night vanish. There is no reason to think that the same does not happen with the bad dream we call “life.” ~*~ Song of Sorrow. Nietzsche, commenting on pessimism, once castigated Schopenhauer for taking things too lightly. He writes: ...Schopenhauer, though a pessimist, really —played the flute. Every day, after dinner: one should read his biography on that. And incidentally: a pessimist, one who denies God and the world but comes to a stop before morality—who affirms morality and plays the flute... what? Is that really—a pessimist? We know that Schopenhauer did possess a collection of instruments, and we also know that Nietzsche himself composed music. There is no reason to think that either of them would ever banish music from the Republic of philosophy. But Nietzsche’s jibes at Schopenhauer are as much about music as they are about pessimism. For the pessimist who says no to everything and yet finds comfort in music, the no-saying of pessimism can only be a weak way of saying yes—the weightiest statement undercut by the flightiest of replies. The least that Schopenhauer could’ve done is to play the bass. I’m not a big fan of the flute, or, for that matter, wind instruments generally. But what Nietzsche forgets is the role that the flute has historically played in Greek tragedy. In tragedy, the flute ( aulos ) is not an instrument of levity and joy, but of solitude and sorrow. The Greek aulos not only expresses the grief of tragic loss, but it does so in a way that renders weeping and singing inseparable from each other. The classicist Nicole Loraux calls this the mourning voice . Set apart from the more official civic rituals of funerary mourning, the mourning voice of Greek tragedy constantly threatens to dissolve song into wailing, music into moaning, and the voice into a primordial, disarticulate anti-music. The mourning voice delineates all the forms of suffering—tears, weeping, sobbing, wailing, moaning, and the convulsions of thought reduced to an elemental unintelligibility. In the collapsed space between the voice that speaks and the voice that sings, pessimism discovers its mourning voice. Pessimism: the failure of sound and sense, the disarticulation of phone and logos . Have we rescued Schopenhauer from Nietzsche? Probably not. Perhaps Schopenhauer played the flute to remind himself of the real function of the mourning voice—sorrow, sighs, and moaning rendered indistinguishable from music, the crumbling of the human into the unhuman. Failure par excellence of pessimism. ~*~ Song of Nothing. In Buddhist thought, the First Noble Truth of existence is encapsulated in the Pali term dukkha , conventionally translated as “suffering,” “sorrow,” or “misery.” The Buddhist teachings are clear, however, that this is an objective claim, and not simply one point of view among others. Existence is suffering and sorrow—and yet this is not, the teachings tell us, a pessimistic attitude. It is likely that Schopenhauer, reading the Buddhist texts available to him, recognized some filiation with the concept of dukkha . But dukkha is a multi-faceted term. There is, certainly, dukkha in the usual sense of the suffering, strife, and loss associated with living a life. But this is, in turn, dependent on the finitude and temporality of dukkha , existence as determined by impermanence and imperfection. And this ultimately points to the way in which both suffering and finitude are grounded by the paradoxical groundlessness of dukkha as a metaphysical principle—the insubstantiality and the emptiness of all that is. Beyond what is worse to me, beyond a world ordered for the worst, there is the emptiness of dukkha as an impersonal suffering... the tears of the cosmos. In this context, it is easy to see how Schopenhauer’s pessimism attempts to compress all the aspects of dukkha into a nothingness at the core of existence, a Willlessness coursing through the Will. Though one thing for certain is that with Schopenhauer we do not find the “ever-smiling” countenance of Buddhism—or do we? The texts of the Pali Canon also contain lists of the different types of happiness—including the happiness of renunciation and the strange happiness of detachment. But Buddhism considers even the different types of happiness as part of dukkha , in this final sense of nothingness or emptiness. Perhaps Schopenhauer understood Buddhism better than he is usually given credit for. Thus the experiment of Schopenhauer’s philosophy—the point at which a Western pessimus and an Eastern dukkha overlap or exchange glances. Empty sorrow, a lyricism of indifference. The result is a strange, and ultimately untenable, nocturnal form of Buddhism. ~*~ Cioran once called music a “physics of tears.” If this is true, then perhaps metaphysics is its commentary. Or its apology. ~*~ Pessimism would be more mystical were it not for its defeatism. Mysticism is much too proactive for the pessimist, and pessimism too impassive even for the mystic. At the same time, there is something enviable about mysticism—despite its sufferings. There is a sense in which pessimists are really failed mystics. ~*~ You, the Night, and the Music. In a suggestive passage, Schopenhauer once noted that, “music is the melody to which the world is the text." Given Schopenhauer’s view on life—that life is suffering, that human life is absurd, that the nothingness before my birth is equal to the nothingness after my death—given all this, one wonders what kind of music Schopenhauer had in mind when he described music as the melody to which the world is text—was it opera, a Requiem Mass, a madrigal, or perhaps a drinking song? Or something like Eine kleine Nachtmusik , a little night music for the twilight of thought, a sullen nocturne for the night-side of logic, an era of sad wings sung by a solitary banshee. Perhaps the music Schopenhauer had in mind is music eliminated to non-music. A whisper would suffice. Perhaps a sigh of fatigue or resignation, perhaps a moan of despair or sorrow. Perhaps a sound just articulate enough that it could be heard to dissipate. ~*~ Teach me to laugh through tears. ~*~ Pessimism always falls short of being philosophical. My back aches, my knees hurt, I couldn’t sleep last night, I’m stressed-out, and I think I’m finally coming down with something. Pessimism abjures all pretenses towards system—towards the purity of analysis and the dignity of critique. We didn’t really think we could figure it out, did we? It was just passing time, taking a piss, something to do, a bold gesture put forth in all its fragility, according to rules that we have agreed to forget that we made up in the first place. Every thought marked by a shadowy incomprehension that precedes it, and a futility that undermines it. That pessimism speaks, in whatever voice, is the singing testimony to this futility and this incomprehension—take a chance and step outside, lose some sleep and say you tried... ~*~ Is there a music of pessimism? And would such a music be audible? ~*~ The impact of music on a person compels them to put their experience into words. When this fails, the result is a faltering of thought and language that is itself a kind of music. Cioran writes: “Music is everything. God himself is nothing more than an acoustic hallucination.” ~*~ If a thinker like Schopenhauer has any redeeming qualities, it is that he identified the great lie of Western culture—the preference for existence over non-existence. As he notes: “If we knocked on the graves and asked the dead whether they would like to rise again, they would shake their heads.” In Western cultures it is commonly accepted that one celebrates birth and mourns death. But there must be a mistake here. Wouldn’t it make more sense to mourn birth and celebrate death? Strange though, because the mourning of birth would, presumably, last the entirety of that person’s life, so that mourning and living would the be same thing. ~*~ To the musical idea of the harmony of the universe corresponds the philosophical principle of sufficient reason. Like the music of mourning, pessimism gives voice to the inevitable breakdown of word and song. In this way, music is the overtone of thought. ~*~ The Patron Saints of Pessimism. The patron saints of pessimism watch over suffering. Laconic and sullen, the patron saints of pessimism never seem to do a good job at protecting, interceding, or advocating for those who suffer. Perhaps they need us more than we need them. Lest we forget, there do exist patron saints of philosophy, but their stories are not happy ones. There is, for instance, the fourth century Saint Catherine of Alexandria, or Catherine of the Wheel, named after the torture device used on her. A precocious fourteen year old scholar, Catherine was subject to continual persecution. After all forms of torture failed—including the “breaking wheel”—the emperor finally settled for her decapitation, a violent yet appropriate reminder of the protector of philosophers. There are also patron saints of music and musicians, but theirs too are sad stories. In the second century, Saint Cecilia was also subject to persecution and torture. As she knelt to receive the blade that would separate her head from her body, she ardently sang a song to God. It took three attempts before she was fully decapitated, all the while she continued, perhaps miraculously, to sing. Does pessimism not deserve its own patron saints, even if they are unworthy of martyrdom? But in our search, even the most ardent nay-sayers frequently lapse into brief moments of enthusiasm—Pascal’s love of solitude, Leopardi’s love of poetry, Schopenhauer’s love of music, Nietzsche’s love of Schopenhauer, and so on. Should one then focus on individual works of pessimism? We could include Kierkegaard’s trilogy of horror— Sickness Unto Death , The Concept of Dread , and Fear and Trembling —but all these are undermined by their fabricated and unreliable authors. Besides, how can one separate the pessimist from the optimist in works like Unamuno’s The Tragic Sense of Life , Shestov’s Postetas Clavium , or Edgar Saltus’ under-read The Philosophy of Disenchantment ? Even in cases where the entire corpus of an author is pessimistic, the project always seems incomplete—witness Cioran’s trajectory, from his first book, On the Heights of Despair , to the last unpublished notebooks of acrid and taut aphorisms. And this is to say nothing of literary pessimism, from Goethe’s sorrowful Werther, to Dostoevsky’s underground man, to Pessoa’s disquiet scribbler; Baudelaire’s spleen and ennui, the mystical Satanism of Huysmans and Strindberg, the hauntologies of Mário de Sá-Carniero, Izumi Kyoka, H.P. Lovecraft, grumpy old Beckett... even the great pessimist comedians. All that remains are singular, perhaps anomalous statements of pessimism, a litany of quotes and citations crammed into fortune cookies. Patron saints are traditionally named after a locale, either a place of birth or of a mystical experience. Perhaps the better approach is to focus on the places where pessimists were forced to live out their pessimism—Schopenhauer facing an empty Berlin lecture hall, Nietzsche mute and convalescent at the home of his sister, Wittgenstein the relinquished professor and solitary gardener, Cioran grappling with Alzheimer’s in his tiny writing alcove in the Latin Quarter. ~*~ 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. ~*~ If pessimism has any pedagogical value, it is that the failure of pessimism as a philosophy is inextricably tied to the failure of pessimism as voice. I read the following, from Shestov’s The Apotheosis of Groundlessness : When a person is young he writes because it seems to him he has discovered a new almighty truth which he must make haste to impart to forlorn humankind. Later, becoming more modest, he begins to doubt his truths: and then he tries to convince himself. A few more years go by, and he knows he was mistaken all round, so there is no need to convince himself. Nevertheless he continues to write, because he is not fit for any other work, and to be accounted a superfluous person is so horrible. (shrink)

This chapter reviews fundamental ethical controversy surrounding the ongoing effort to revise the Uniform Determination of Death Act in the United States. Instead of focusing on the process of the revision itself, the chapter explores the underlying ethical debate over brain death that has been ongoing for many decades and finally culminated in this revision. Three issues are focused: the requirement for consent and personal exemptions before applying brain death for the diagnosis of death; redefining the areas of the brain (...) that have ceased to function in the definition of brain death; and codifying the American Academy of Neurology as the authority to issue the standards of the diagnosis of brain death. The chapter concludes that allowing the personal choice of death determination gives a pragmatic compromise to the disputed definition and practice of diagnosing brain death. So long as all risks and imperfections of the diagnosis are accepted through the consenting process, there is nothing ethically objectionable to continuing the current practice of diagnosing brain death as a successful tool to facilitate heart-beating organ donation without violating the dead-donor rule. By contrast, precluding personal choice and imposing legal restrictions to consent and exemptions would further erode public trust. (shrink)

The kind of phenomenology that can be useful to theology will be a hermeneutical phenomenology, one that takes us beyond the Cartesian/Husserlian ideal of presuppositionless intuition. It will also be a phenomenology of inverse intentionality, one in which the constituting subject is constituted by the look and the voice of another. In light of these suggestions, the phenomenology of Jean-Luc Marion is defended against three critiques, namely that it compromises the boundary between phenomenology and theology, that the theology it serves (...) is a bad one to boot, and that it has an inadequate account of the subject. At the heart of this defense is Marion's clear distinction between phenomenology as a description of possible experience, and theology as the claim that a certain kind of experience, namely revelation or epiphany, is not merely actual but veridical. Phenomenology says, If revelation occurs it will be in the form of a saturated phenomenon. Theology says, for example, the burning bush was an epiphany, or Jesus Christ is a revelation. The attentive reader should have no trouble distinguishing Marion's phenomenological analyses, which should be persuasive to believer and unbeliever alike, from his theological claims. Marion's account of the subject falls under the heading of inverse intentionality, and there are hints that vision is aufgehoben in the voice. The seer is first of all the one seen, but above all the one addressed, called forth into response-able being. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:My Gratifying Testimonial of My Extended Warranties of LifeDanette RaginMy name is Danette Ragin. I am a 2-time kidney recipient who has been diagnosed with ESRD (End Stage Renal Disease). Both transplants were performed in Baltimore, Maryland. I am also a 3-time Donor Family Member and the proud Mom of a living donor.I received the first kidney from a deceased donor on June 22, 2008. The donor was traveling (...) thru Maryland with her family on vacation and experienced heart complications. My second kidney was donated to me by my youngest daughter Angel on December 20. 2016. I am thankful to God for both of my extended warranties. I’d like to share a little about my journey with you.Around the year 2002, I started seeing my PCP (Primary Care Physician) for terrible migraine headaches, which on occasions lasted for weeks. After several tests, she expressed her concerns. I had been spilling protein in my urine and my kidney function was showing some abnormalities. My PCP sent me to see a neurologist after several failed attempts to gain some type of reprieve from the nerve-racking headaches. My nephrologist confirmed my PCP’s diagnosis, and I had visits with the nephrologist every 6 months until they noticed a substantial change.“Ah, Mrs. Ragin, you’re in the beginning stage of End Stage Renal Disease”. Boom! (That hit me like a ton of bricks.) “Umm, you mean I have kidney failure! No! Not me. I’ve worked in dialysis. That can’t happen to me!”Of course, I was in complete denial. Both my PCP and nephrologist were very supportive mentally, physically, emotionally, and even spiritually. This information was so devastatingly painful that I started working harder and longer. I turned into a Superwoman with my family, work, and church. I was trying to drown out the fact that my health was being compromised, refusing to believe this could happen to me. I started to slow down in my daily functions, my appetite decreased, and I lost weight as a result. I thought that my weight loss was bringing my “Sexy Back,” only to realize that I am not exempt from sickness. My nephrologist assured me of a possible solution. He advised me to have my name placed on the waitlist of one of the transplant centers in Maryland.In October 2006, I had surgery to have an A/V fistula placed in my left arm to prepare for possible dialysis treatments in the future. In January 2007, I went to be evaluated for a kidney transplant. I was given 6 weeks to complete all required tests to secure a place on the transplant waiting list. Determination allowed me to complete all tests within 2 weeks.In April 2007, I was approved to be placed on the transplant list. In October, I had a PDC (Peritoneal Dialysis Catheter) placed in my abdomen so that I could dialyze myself at home. I loved it but it didn’t love me. It was removed in January 2008. Right afterward, I received my first unsuccessful call to be transplanted. (The kidneys were cystic and could not be used.) “Bummer.” I also received another call in April 2008 (Easter Sunday). Those kidneys were [End Page 134] at another hospital in Maryland, so if the waiting patient at their facility refused the kidney, I would be next in line. The patient accepted the donation. It wasn’t my turn yet.In the meantime, I had already started hemo-dialysis in mid-March 2008. On Saturday, June 21, 2008, while enjoying the weekend with my family, I received a call around 2:30 p.m. My youngest daughter and I were out shopping. We were in a crowded store that was going out of business, and I felt my phone vibrate. I noticed a slightly familiar number. I stepped out of the store to retrieve the call.“Mrs Ragin...Me: Yes.“Danette Ragin...Me: Yes.“We are calling from the University with an organ offer for you!”I told them they had me at the sight of the first few digits of the phone number they were calling from!In June... (shrink)

Arthur G. Tansley never accepted Frederic E. Clements’ view that succession is a developmental process whose final stage, the climax formation, is determined primarily by regional climate and that all other types of vegetation are some kind of successional stage or arrested successional stage. Tansley was convinced that in a given region a variety of environmental factors could produce different kinds of climax formations. At the heart of their dispute was Clements’ organicist view of succession, i.e., the formation was a (...) complex organism with an ontogeny and phylogeny. As early as 1905, Tansley offered an alternative to Clements’ complex organism, the quasi-organism, but Clements in private and public rejected this compromise. Tansley and other plant ecologists continued to criticize Clements’ theories for the next 20 years, but with no impact on Clements. John Phillips, a South African plant ecologist who was a follower of Clements, published a series of papers in 1934 and 1935 defending Clementsian ecology. These papers were triggered by the publication of a letter by another ecologist working in Africa who claimed that there was a strong correlation between soils and various kinds of climax vegetation, which was contrary to what was predicted by Phillips and Clements. In 1935, Tansley published an attack on Phillips and Clements and their developmental theory of succession. In it, he proposed the concept of the ecosystem as a way to get around Clements’ monoclimax theory by making the physical environment (e.g., soil chemistry, soil texture, soil moisture) as important a factor as climate, plants and other organisms in determining the composition and characteristics of ecological entities, i.e., ecosystems. Tansley’s ecosystem concept quickly replaced Clements’ monoclimax theory as a dominant paradigm in ecology. (shrink)

This essay analyzes one of Germany's former premier research institutions for biomedical research, the Kaiser Wilhelm Institute for Anthropology, Human Heredity and Eugenics (KWIA) as a test case for the way in which politics and human heredity served as resources for each other during the Third Reich. Examining the KWIA from this perspective brings us a step closer to answering the questions at the heart of most recent scholarship concerning the biomedical community under the swastika: (1) How do we explain (...) why the vast majority of German human geneticists and eugenicists were willing to work for the National Socialist state and, at the very least, legitimized its exterminationist racial policy; and (2) what accounts for at least some of Germany's most renowned medically trained professionals' involvement in forms of morally compromised science that wholly transcend the bounds of normal scientific practice? Although a complete answer to this question must await an examination of other German biological research centers, the present study suggests that during the Nazi period the symbiotic relationship between human genetics and politics served to radicalize both. The dynamic between the science of human heredity and Nazi politics changed the research practice of some of the biomedical sciences housed at the KWIA. It also simultaneously made it easier for the Nazi state to carry out its barbaric racial program leading, finally, to the extermination of millions of so-called racial undesirables. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Commandment against the Law Writing and Divine Justice in Walter Benjamin’s “Critique of Violence”Tracy McNulty (bio)Pierre Legendre has shown that the Romano-canonical legal traditions that form the foundations of Western jurisprudence “are founded in a discourse which denies the essential quality of the relation of the body to writing” [“Masters of Law” 110]. It emerges historically as a repudiation of Jewish legalism and Talmud law, where the rite (...) of circumcision encodes the subject’s entry into law as an “allegiance to the absolute Writing,” or the “relationship between the human subject and the logical place of the Other” [110–11; see also “les juifs”]. In this shift, one understanding of writing is displaced by another: the material inscription of the letter, as an incommunicable limit or cut, is supplanted by the fantasy of what Legendre calls a “living writing,” a writing “in the heart” that promotes an ideal of perfect communication in which nothing is lost, in which meaning is lodged in an absolute Other who guarantees all knowledge. In his words, “we belong to a culture in which a mystically alienated human body stands in the place of the absolute book. The state has emerged from this structure.... Its basic characteristics can be set out by means of a fundamental Romano-pontifical maxim: the Emperor carries all the archives in his breast (omnia scrinia habet in pectore suo)” [“Masters of Law” 109].The ultimate theological source of this Roman maxim is Paul’s polemic against the Jewish law in the Epistle to the Romans. Paul’s polemic is structured by a distinction between two orders of law: the “law of God” and the “law of sin.” The first is associated with the intelligible “spirit” of the law, which is “written in the heart,” the second with the prescriptive “letter” of the Jewish law, which compromises or corrupts the first by binding it to a particular representation and consigning it to written form. Paul’s solution is to bypass the law, to bypass representation, and perhaps even language itself. The prescriptive “letter” of the Jewish law must be sublated by the law of the spirit, such that “we serve not under the old written code but in the new life of the Spirit” [Romans 7: 6]. Christ, as the living embodiment of the law of God, upholds the spirit of the law by “fulfilling”––and so rendering obsolete–its written form.The doctrine of Christ as the “living law” sustains what Legendre describes as a “banalisation of writing” [“Masters of Law” 111], a disregard for its material inscription that holds the letter to be nothing more than a placeholder, a flawed or incomplete representation of a meaning or truth that is itself beyond words. At the same time, it makes possible the legal and political fantasy of a living writing, located in a single body understood as the site of interpretive authority. The extraction of a meaning or truth from the intractable letter becomes the ultimate aim of the legal order and the most lofty task of its sovereign interpreter, uniquely charged with animating the dead letter. This notion permeates what Peter Goodrich describes as “the most standard protocols of legal reading,” according to [End Page 34] which “it is not the letter but the spirit that determines the meaning of the law”:The text is composed of dead letters (litera mortua); the rule is no more than a “mute judge,” a sleeping form, requiring the interposition, anima legis, of jurist or judge.... [T]he meaning of the law is internal to its living body, viva vox iuris or lex loquens, its image, interpreter, or legislator. In classical terms it is spelled out by reference to something beyond words: “to know the law is not to know the words of the law, but its force and power.” In a renaissance formulation we are similarly told that “no words, forms, niceties, or propriety of language is of any regard in the Civil Law, in comparison to truth, faithfulness and integrity. For verba menti, non verbis servire debet; words, are made as instruments to serve and express the mind, and not to command it.”[229–30]1... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:“Unduly Iterative Ethical Review?”Franklin G. MillerMadam:Renée C. Fox and Nicholas A. Christakis have written a provocative article, “Perish and Publish: Non-Heart-Beating Organ Donation and Unduly Iterative Ethical Review” (KIEJ, December 1995). The language of their argument and some of the implicit assumptions on which it rests deserve critical scrutiny. They describe the articles presenting and commenting on the University of Pittsburgh protocol as “disquieting” because the display “trial-and-error ethics.” (...) To dismiss “trial-and-error ethics” implies that we antecedently possess all the moral knowledge we need to evaluate and regulate developments in medicine. Should we summarily reject experimentation in ethics, particularly with respect to complex issues involving scientific and technological changes? For if we need to reconsider and possibly revise what counts as moral knowledge, the proposing an experimental approach to the ethics of a novel practice, which is presented publicly and made open to revision, as in the Pittsburgh protocol, may be precisely the best way to proceed.Fox and Christakis resort to invidious insinuation in their criticism of ethicists who have written, and journals that have published, articles about non-heart-beating organ donation. Publication on this issue has given ethicists the opportunity of “adding numerous items to their vitae.” Their appraisal of the vitae-boosting behavior represents an interesting rhetorical specimen: “Although there is nothing inherently dishonorable about this it does create tension between two motives: conviction about the importance of perfecting ethical conduct, on the one hand, and the desire to advance one’s professional career, on the other” (p. 340). I am not sure what the authors mean by “perfecting ethical conduct.” Yet they suggest that a group of reputable scholars, who have taken diverse positions on the ethics of non-heart-beating organ donation, have come perilously close to venality.Finally, in order to avoid further legitimating what they consider to be an ethically objectionable practice, the authors advocate that journals exercise “restraint” in publishing articles about this topic. Perhaps in a future pronouncement they will enlighten us about how enforcing a publication policy that avoids the vice of “unduly iterative ethical review” might work without compromising freedom of discussion. Moral dogmatism and censorship have a long history of association.Franklin G. MillerCenter for Biomedical Ethics University of Virginia Charlottesville, VACopyright © 1996 The Johns Hopkins University Press... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy and Literature 28.2 (2004) 393-405 [Access article in PDF] Decency and Its Discontents Richard Freadman La Trobe University In The Beginning of the Journey, Diana Trilling makes this rather shocking claim about her husband, Lionel: "In the dark recesses of his heart where unhappiness was so often his companion, he was contemptuous of everything in his life that was dedicated to seriousness and responsibility."1 Lionel had been dead (...) almost 20 years when a near blind Diana dictated this comment in her controversial auto/biography in the early 1990s. Of course he was revered for—among other things—precisely his qualities of intellectual "seriousness and responsibility." But Diana argued that Lionel had in effect settled for such sober virtues because for temperamental and other reasons he could not live the life he really craved—the life of a swashbuckling novelist, with all its recklessness, its refusal of compromise, even its moral waywardness. When Hemingway died Lionel wrote in his notebook: "who would suppose how much he haunted me? How much he existed in my mind—as a reproach? He was the only writer of our time I envied" (Beginning, p. 371). Lionel's critical discussions of Hemingway's fiction are judicious and qualified.2 He admired the uncompromising short story writer who was "passionately and aggressively concerned with truth" (SLS, p. 127), but found the work of the self-conscious "legend" (p. 125), writing in the first-person, ponderous and disappointing. It was not the prose that Lionel so wanted to emulate. It was the life; in particular, its power to release and nurture creativity. Diana continues: "It was to decency that Lionel felt he had sacrificed his hope of being a writer of fiction—conscience had not made a coward of him, it had made him a critic" (Beginning, p. 372). [End Page 393]Decency—how often we use the word. How seldom we ask what we mean by it. Usually it functions as a sort of guarantor term, like the caged canary in the coal mine. If the canary lives, the miners are judged to have fair air to breathe; if a person possesses certain qualities, or a society provides certain requisite conditions, we say the person is "decent," or that this is a "decent society." Yet remarkably few virtue ethicists have countenanced the possibility that decency might be counted among the virtues; that it might be the subject of substantive intellectual reflection; that we might investigate its relation to other virtues, its internal structure, its characteristic patterns and possibilities of existential investment. As John Kekes, one of the very few philosophers to have paid the notion serious philosophical attention, says: "Decency is generally admitted to be a good thing, but is not generally supposed to be particularly important."3In this short essay I attempt two linked undertakings: first, to offer a characterization of Decency—the term henceforth accorded a capital "D" to indicate its status as a moral virtue; second, to read aspects of Lionel Trilling's life and work, and Diana's late assessment of him, in the light of Decency, as I understand the term. I "Decent" seems to refer to a "state," a sort of moral condition a person is "in," and to a resultant orientation towards others. The "state" is one of modesty, even humility. The ego doesn't loom large or get in the way. The orientation is one of solicitude towards others. Decent people of this kind genuinely care about, feel for others. Unless they are given good reason to behave otherwise, their disposition towards others tends to be respectful; they bring to most situations an assumption that the other person is worthy, deserves to be taken seriously. Decency of this kind tends to be associated with receptiveness, relatedness, a patient openness to others, though it need not be passive.The word "decent" derives from the Latin, deceré—to become, to be fitting. It's been used in English since about the 1530s. From that period to the early twentieth century "decent" has generally indicated that something is fitting, appropriate, with respect to social rank... (shrink)

This thesis argues for a reconsideration of the social theories of Max Horkheimer and C. Wright Mills in order to increase our understanding of the ideological forces at play in modern society. Despite clear similarities in their work in terms of both subject matter and perspective, the discipline of political science lacks a critical comparison of their writings. I demonstrate that a comprehensive and comparative reading of Horkheimer and Mills can offer a new way to address many issues that remain (...) at the heart of writings on ideology, the production of knowledge, and the culture industry. Instead of simply studying the concept of ideology as it appears in each theorist's writings, I propose to place their views in dialogue with one another. Taken together, Horkheimer and Mills provide an illuminating and dynamic perspective on the current, and often conflicting approaches to the theory of ideology. ;Much of the current literature on ideology reflects fixed positions with little room for compromise. The impasse in the study of ideology revolves around the conceptualization of ideology as either enabling or constraining critical consciousness. A combination of the writings of Horkheimer and Mills can guide social theorists beyond the present impasse towards a reflexive theory of ideology, one that considers its own social and ethical presuppositions and normative values. (shrink)

The present volume honors Rabbi Professor Nehemia Polen, one of those rare scholars whose religious teachings, spiritual writings, and academic scholarship have come together into a sustained project of interpretive imagination and engagement. Without compromising his intellectual integrity, his work brings forth the sacred from the mundane and expands the reach of Torah. He has shown us a path in which narrow scholarship is directly linked to a quest for ever-broadening depth and connectivity. The essays in this collection, from his (...) students, colleagues, and friends, are a testament to his enduring impact on the scholarly community. The contributions explore a range of historical periods and themes, centering upon the fields dear to Polen's heart, but a common thread unites them. Each essay is grounded in deeply engaged textual scholarship casting a glance upon the sources that is at once critical and beneficent. As a whole, they seek to give readers a richer sense of the fabric of Jewish interpretation and theology, from the history of Jewish mysticism, the promise and perils of exegesis, and the contemporary relevance of premodern and early modern texts. (shrink)

Abstract -/- “The Obvious Invisibility of the Relationship Between Technology and Social Values” -/- We all too often assume that technology is the product of objective scientific research. And, we assume that technology’s moral value lies in only the moral character of its user. Yet, in order to objectify technology in a manner that removes it from a moral realm, we rely on the assumption that technology is value neutral, i.e., it is independent of all contexts other than the context (...) in which it is used morally or immorally by someone. However, there is a power to technology. At the very least, technology should be seen as reflecting the values that it rises from: a developmental context. Consequently, we can make the invisible moral realm visible as we investigate the relationship between culture and technology. Pragmatically, we can trace how cultural values inform what counts as a scientific question. When we look at the 1980s epidemiological model for AIDS we see how the presuppositions within a culture frame the type of question asked, i.e. What population do we see AIDS occurring in? This question initially leads scientific research away from actual individual behaviors until a different question is asked that leads the question towards behavioral epidemiological models rather than population models. Secondly, we can make visible the circumstance that depicts that what constitutes a scientific problem has a direct relationship to the types of technologies that are developed. We can more clearly see this circular relationship between culture and technology by looking at clinical research and practice regarding heart disease. Men who were dying of diagnosed heart disease were showing symptoms of problems in large arteries of the heart. Women were also dying of heart disease, but since their large arteries were not overwhelmingly compromised they were not being properly diagnosed until recently. Different technologies and protocol were needed to “see” different symptoms in the smaller vessels of women. Thirdly, I show how the types of technology developed, in turn, can create new values or enhance preexisting values within a culture. DNA research can be used to investigate long, unanswered questions about qualitative dimensions of life in quantitative manners. Yet, long held unanswered questions about a biological basis of race or intelligence are themselves rarely challenged as uninteresting or misguided even when they are tied to prejudicial qualitative assumptions if the chance of a “scientific” answer is possible. When existing technologies or modifications of existing technologies can be used they seem to direct human reactions and behaviors in predictable ways. The technologies themselves may be said to direct culture in ethically valenced manners. (shrink)

Given a strong family history of early heart attacks, the future has always been an iffy proposition. Miraculously, I have bypassed the early off-ramps and find myself approaching 80, stents in place, considering the very real but previously unimaginable possibility of still more. But what kind of more? With dopamine on the wane and no longer supercharged by the push and shove of unbridled ambition and pride, bigger and grander are out of the question. Tired clichés poke through the widening (...) cracks in my thinking to become uninvited bulletins of compromise and consolation. Be grateful. Relax, reminisce, enjoy sunsets, learn the backyard birds’ names, maybe even sing to them, and count blessings. (shrink)