The facilitation of tight regulatory frameworks necessary to ensure that new drugs are safe and effective have yet to be effectively applied within the paediatric population. Utilization of unlicensed and off-label drugs in children results in a variety of problems ranging from inefficacy, adverse reactions and in some cases death. This ethically questionable behaviour has led the European government to legally force pharmaceutical companies to propose paediatric applications and carry out clinical studies at early stages of drug development. (...) The new European Paediatric Regulation implemented in 2007 opens a new era of paediatric drug development and will offer the opportunity to vastly improve children's health. However, this brighter outlook for the paediatric community might encourage potentially unethical behaviour in a pharmaceutical industry that finds itself in economically unstable times. The article records the gradual evolution of the US Paediatric Exclusivity Plan and the underlying principle of the newly introduced European Paediatric Regulation. It discusses some of the potential drawbacks and detrimental consequences of implementing the new European regulation, and the prospects of avoiding these by critically evaluating the difficulties experienced by the US. (shrink)

There have been a number of challenges to the Simple View—the view that an intention to A is necessary if an agent is to A intentionally. Michael Bratman’s celebrated video game case has convinced many that the view is false. This article presents a novel objection to Bratman’s case. It is argued, first, that the Simple View is not undermined by the case, and second, that the real import of the case is that it raises the question of how we (...) can rationally intend mutually exclusive ends. I offer a solution to this puzzle that draws on what I call the Self-Evaluation aspect of intention. (shrink)

Respiratory illness continues to be a leading cause of paediatric morbidity and mortality in Indonesia. The Indonesian government is moving towards a more managed care-based approach as it reforms its health care system following the 1997 financial crisis. In order to better design contractual relationships between the payor and different providers, there needs to be a better understanding of the patterns and predictors of health services utilization for respiratory illness. This study uses the Indonesia Demographic and Health Survey to (...) study the determinants of private, public and non-formal provider utilization for respiratory illness. Multinomial logistic regression models for predicting use were constructed using the Andersen Behavioural Model as the conceptual framework. The findings indicate that age, household size, maternal education, religion, the asset index, location and illness severity play a role in determining use of private, public or non-formal providers. The results indicate that from a policy perspective, the Indonesian government needs be inclusive rather than exclusive in the choice of providers that are contracted by the managed care plans, in order to safeguard the health of the under-five population. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Prepping for the Day You Hope Never Arrives:Facing RecurrenceTerra TrevorMy 14–year–old son was eight years past diagnosis of a brain tumor. Gone were the pristine sick days when his white hooded sweatshirt stayed spotlessly clean for weeks at a time. Each time he left a muddy footprint on the kitchen floor I rejoiced; it felt so good to have a healthy kid again. However, my son was a survivor (...) of an anaplastic ependymoma, grade IV, brain tumor, and although I wanted to be out of the woods, I knew we were not. I’d climbed out of the space where medical problems were fi led in my mind, yet I kept the door open because statics showed that the type of brain tumor he had, frequently recurred.Still, I was determined to keep our lives as ordinary as possible. But for a brain tumor family this meant staying connected to sources of support. Parent programs, patient and sibling support groups [End Page 27] and camps, and we remained connected to hospital resources. Most of all we needed to have fun as a family, and we attended the cancer survivor picnics and parties our hospital hosted, where the doctors served as volunteers, grilling hamburgers and dishing up ice cream for the guest of honor patients.My husband and I felt confident that as long as we worked as a team with our doctors and stayed connected to resources offered, we would find a way to meet any challenges that might surface.In the end ultimately what saved us was this mosaic of support provided to us over the years from a multitude of good people and organizations offering help when we needed it most. And I had the opportunity to learn to accept help, which it turns out, is far harder than offering to help.Shortly after my son Jay celebrated his 8th year as a brain tumor survivor, I watched him open the medicine cabinet and reach for the bottle of Advil, for the second time in a row that day. “Do you have a headache again?” I asked. He shrugged his shoulders, then hiccupped hard, and ducked his head in the toilet and threw up. Tears welled in his eyes. I sank into the deep, silent panic that made me calm.Our primary care physician called in an authorization for an MRI. Jay hid his fear behind a mask of quiet strength. It was ten days before his fifteenth birthday.While we waited for the MRI appointment, that week Jay was elected student of the month, and he got a lead part in the school play. My idyll of family hood continued until the MRI confirmed my worst fear—the tumor was back, and this time its fingers spread into the brainstem.We had to decide on a plan of treatment. Surgery was scheduled. When Jay was admitted to the hospital and I requested that he be placed in the pediatric ward, an environment he was familiar with, they agreed. Although Jay was a teenager, the recurrence caused him to revert emotionally back to a younger age. It was as if he was seven–years–old again, reliving his first brain tumor experience, and he kept his childhood security item—a small teddy bear with him, tucked under the hospital covers, like he had with the first diagnosis.Luck held. With surgery most of the tumor was resected and symptoms disappeared. Three days later, on Thanksgiving, he was feeling well enough to be excited about the Thanksgiving dinner our hospital provided us. A table and chairs were brought in, along with a feast of good food. The nurses gave Jay lavish attention, they laughed at the corny jokes he told, and made us feel like special company.Within a week Jay was out of the hospital, recovering well. But what to do about the remaining brain tumor slivers that were inoperable? He had already received his lifetime dose of whole brain radiation, and chemotherapy available offered little hope of curing a recurrent tumor. But there was a small chance that stereotactic radiation might stall tumor growth. We set up a consultation.We had... (shrink)

Currently, millions of minors are being inoculated against SARS-CoV-2 in many countries in the world. Ethical concerns about clinical research involving children have barely been addressed in the literature, despite the fact that the paediatric population is particularly vulnerable within this context. Children should be included in the research plans for COVID-19 vaccines. Nevertheless, it is necessary to critically assess to what extent clinical trials are being conducted according to methodological and ethical criteria that allow us to conclude that (...) the results are valid and, in consequence, how far the vaccination plans for children are scientifically justified.The principal aim of this article is to analyse critically the process of clinical research on COVID-19 vaccines involving children, highlighting the ethical concerns that arise, including the need to stratify the results from older adolescents separately for analysis before proceeding, if further research is warranted, in descending age order. The development of COVID-19 vaccines is examined, with a special look at the participation of children throughout their clinical development, including a review of the clinical trials registered in three international databases. We also offer some additional considerations about the inclusion of minors in vaccination plans. Finally, we conclude with some recommendations, with particular emphasis on the following ethical duties: research in children should be carried out only once the relevant research in adults has previously been conducted; issues that concern children’s needs and rights should be specifically addressed; and, therefore, the highest standards of ethical and scientific quality should be met. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Misquotations from RealityAnn Lauterbach (bio)In the girdle of Aphrodite, in the crown, in the body of Helen and her phantom, beauty is superimposed over necessity, cloaking it in deceit. The necessary has a certain splendor, and behind any splendor one senses a metallic coldness, as though of a weapon poised to strike. The real split in Greek consciousness, like all other irreversible steps it took, comes when Plato for (...) the first time affirms, ‘How very different is the nature of the necessary from the nature of the good.’ And he means an immense, an unbridgeable distance—the same distance that made atheists of ‘those who study astronomy and other sciences of the necessary, when they see that what is, is so out of necessity and not out of any plan conceived by some will to accomplish the good.’ The Beautiful, in this scenario, must either be quickly reabsorbed into the Good—as its agent, instrument, and pedagogue—or left up in the air, like a malignant spell (goeteuma) bewitching the mind only to subject it even more helplessly to the fiat of necessity.—Roberto Calasso, The Marriage of Cadmus and Harmonyl. The Stranger’s HandOnce at the circus, when I was young we were strolling around in a throng of clowns and cotton candy, bright sun, I looked up to find that the hand I was holding was that of a stranger.Just before dawn, ejected from sleep, I am unraveled into another condition.The place between these two conditions is complex and difficult, a peculiar suspension between two exclusive frames for which there is no dialogue box. The familiar crosses into the unfamiliar and back again.What separates works of art from the fallible empirical world is not their higher degree of perfection but their ability to actualize themselves in a brilliant and expressive appearance just like fireworks. 1Fireworks! Temporality construed as ephemeral vision.And so: In every work of art something appears that does not exist. 2And so: The question of the truth of art comes into view when a non-existent is seen to rise as if it were real. In terms of its form, art promises what is not real. Objectively, it raises the claim, however obliquely this may come out, that just because something appears, it [End Page 143] must be possible to imbue it with being. The unquenchable longing excited by the beautiful is the longing for the fulfillment of a promise. 3The promise of meaning.One of my students writes, “We deem beautiful that which offers meaning to our meaningless lives.”I failed to draw a map and you followed it perfectly because the word for ‘cannot’ inscribes itself here to define an atmosphere of absolute trust which both fastens and unfastens us. 4Day unblooms into insatiable prerogatives vetoedsustained in their august sudden ramifications as if saying soEvery frame is danger and security. Poems that interest me are poems that show me how to proceed, not where to go or what to look at. They assuage the panic of the Stranger’s Hand by awakening curiosity rather than fear. The poem attests to the mobility of the frame, not to the totality of the picture.Thus the grip of realism has found a picture chosen to cover the space occupied by another picture establishing a flexibility so we are not immobile like a car that spends its night outside a window, but mobile like a spirit. 5* * * but we were not, we are not shadows; as we walk, heel and sole leave our sandal-prints in the sand, though the wounded heel treads lightly and more lightly follow, the purple sandals. 6 [End Page 144]2. The Real ThingA poet too has constantly to ask himself: “but is what I am writing really true?”—and this does not necessarily mean: “Is this how it happens in reality?” 7I do not remember when or why I became interested in looking at the ways in which notions of the truth and notions of the real had become blurred. Perhaps in the slogans of advertising. Perhaps it was the political discourse around the Vietnam... (shrink)

Arguing that a crisis is upon us, the Bush Administration has proposed an energy strategy remarkable in its scope and audacity. While much criticism has been directed towards the plan’s ecological impacts, it also guarantees the continuing collapse of communities tha stand in the way of the full realization of the current energy economy. This situation is best understood reference to evolving notions of environmental justice. Unfortunately, the variety of meanings attributable to environmental justice often times come into conflict (...) when applied to specific cases. Until a way is found to reconcile the idea’s many diverse meanings and to prevent one or another to be used in a specific institutional context to the exclusion of all others, environmental justice will, in a perverse way, be turned into yet another means to disregard society’s most vulnerable members. (shrink)

Paediatric Intensive Care Units (PICU) are complex interdisciplinary environments where challenging, high stakes decisions are frequently encountered. We assert that appropriate decisions are more likely to be made if the decision-making process is comprehensive, reasoned, and grounded in thoughtful deliberation. Strategies to overcome barriers to high quality decision-making including, cognitive and implicit bias, group think, inadequate information gathering, and poor quality deliberation should be incorporated. Several general frameworks for decision-making exist, but specific guidance is scarce. In this paper, we (...) provide specific guidance on collaborative complex decision-making for PICUs. The proposed approach is on principles of procedural justice and pragmatic hermeneutics. The process encompasses set-up/planning, information gathering, question formulation, analysis (perspectives, values, and principles), action plan development, decision documentation, and a review and appeal mechanism. The process can be adapted to suit other clinical contexts. Research evaluating the process, exploring how best to develop education for clinicians, and how to build a culture that values high quality deliberation, is worthwhile. (shrink)

Background: It is stated that the communication and disease experiences of paediatric patients, especially paediatric oncology patients, with healthcare professionals are completely different from those of adults. Objective: The aim of this study was to determine the definitions of a good physician and good nurse provided by elementary school-age oncology patients. Research design: In this qualitative research, data were collected through semi-structured individual interviews. The data were evaluated thorough thematic analysis. Participants and research context: Eighteen children hospitalised due (...) to cancer in paediatric oncology and haematology clinics of a university hospital in Turkey. Ethical considerations: Permission to conduct the study was obtained from the Institution’s Ethics Committee. The objectives of this study were explained to the participants and families, and written consent was obtained from them. Also, participants were assured that necessary measures would be taken to protect their anonymity and confidentiality. Findings: The definitions of children were based on five main themes: interpersonal relationships, virtues, professional responsibility, security and individual characteristics. Conclusion: Children conveyed important messages to health professionals. They emphasised that a good physician and good nurse should communicate well, not only with themselves but also with their family. In addition, children were sensitive about health professionals who played with them and actively participated in the treatment by informing them about the disease. Meeting the expectations of children can be possible by improving the communication skills of physicians and nurses and by adding games and activities to the treatment and care plan. (shrink)

What is the trouble with schools and why should we want to make ‘school trouble’? Schooling is implicated in the making of educational and social exclusions and inequalities as well as the making of particular sorts of students and teachers. For this reason schools are important sites of counter- or radical- politics. In this book, Deborah Youdell brings together theories of counter-politics and radical traditions in education to make sense of the politics of daily life inside schools and explores a (...) range of resources for thinking about and enacting political practices that make ‘school trouble’. The book offers a solid introduction to the much-debated issues of ‘intersectionality’ and the limits of identity politics and the relationship between schooling and the wider policy and political context. It pieces together a series of tools and tactics that might destabilize educational inequalities by unsettling the knowledges, meanings, practices, subjectivities and feelings that are normalized and privileged in the ‘business as usual’ of school life. Engaging with curriculum materials, teachers’ lesson plans and accounts of their pedagogy, and ethnographic observations of school practices, the book investigates a range of empirical examples of critical action in school, from overt political action pursued by educators to day-to-day pedagogic encounters between teachers and students. The book draws on the work of Michel Foucault, Judith Butler, Ernesto Laclau and Chantel Mouffe, and Gilles Deleuze and Felix Guattari to make sense of these practices and identify the political possibilities for educators who refuse to accept the everyday injustices and wide-reaching social inequalities that face us. _School Trouble_ appears at a moment of political and economic flux and uncertainty, and when the policy moves that have promoted markets and private sector involvement in education around the globe have been subject to intense scrutiny and critique. Against this backdrop, renewed attention is being paid to the questions of how politics might be rejuvenated, how societies might be made fair, and what role education might have in pursing this. This book makes an important intervention into this terrain. By exploring a politics of discourse, an anti-identity politics, a politics of feeling, and a politics of becoming, it shows how the education assemblage can be unsettled and education can be re-imagined. The book will be of interest to advanced undergraduate and postgraduate students and scholars in the fields of education, sociology, cultural studies, and social and political science as well as to critical educators looking for new tools for thinking about their practice. (shrink)

Background: Paediatric nurses often face complex situations requiring decisions that sometimes clash with their own values and beliefs, or with the needs of the children they care for and their families. Paediatric nurses often use new technology that changes the way they provide care, but also reduces their direct interaction with the child. This may generate ethical issues, which nurses should be able to address in the full respect of the child. Research question and objectives: The purpose of (...) this review is to describe the main ethical dimensions of paediatric nursing. Our research question was, ‘What are the most common ethical dimensions and competences related to paediatric nursing?’ Research design: A rapid evidence assessment. Method: According to the principles of the rapid evidence assessment, we searched the PubMed, SCOPUS and CINAHL databases for papers published between January 2001 and March 2015. These papers were then independently read by two researchers and analysed according to the inclusion criteria. Ethical considerations: Since this was a rapid evidence assessment, no approval from the ethics committee was required. Findings: Ten papers met our inclusion criteria. Ethical issues in paediatric nursing were grouped into three areas: (a) ethical issues in paediatric care, (b) social responsibility and (c) decision-making process. Conclusion: Few studies investigate the ethical dimensions and aspects of paediatric nursing, and they are mainly qualitative studies conducted in critical care settings based on nurses’ perceptions and experiences. Paediatric nurses require specific educational interventions to help them resolve ethical issues, contribute to the decision-making process and fulfil their role as advocates of a vulnerable population (i.e. sick children and their families). Further research is needed to investigate how paediatric nurses can improve the involvement of children and their families in decision-making processes related to their care plan. (shrink)

For a long time, academic institutes stigmatized activism and dissociated it from academic practice. It was looked down upon and considered to be disruptive and western institutes continued silencing critical thinking and practice, and encouraged what they named 'critical distance'. These practices of exclusion must push us, city inhabitants, to ask: what is the point of excluding activism from academic practice? How can we bridge between theory and activism? How can we decenter city planning? If cities belong to the people, (...) why are public authorities trying to erase the public's print in the urban realm? Who gets to speak and why? In our group as the ‘Radicals’, we discussed the gap between urban theory and practice, while encouraging the audience to reflect on how urban concepts adopt multiple definitions within different geographies and communities. (shrink)

While philosophical engagement with ideology once necessitated a “critique of critics” and their social context, today the emphasis often lies in analyzing common and unreflective errors – whether espoused by unrepentant racists, conspiracy theorists, or others in the grip of ignorance. Though cases like these might help us understand the prevalence and persistence of modes of thought that strengthen an exploitative social order, an exclusive focus on such unambiguous examples of false consciousness leaves the reflexive character of social critique out (...) of the picture. Since its earliest philosophical treatments, however, ideology was understood not simply as the absence of education, but as a problematic form of consciousness produced and maintained through educational institutions. As a contribution to this tradition, my dissertation explores the relationship between critical social philosophy and the illusions of critics. If ideological delusion designates the tendency to self-deception accompanying any attempt to learn about society from within it, the critique of ideology demands a self-transformative assessment of ourselves, our context, and our forms of life and thought. I develop my account through an historical exploration of programs of social thought in which the educational dimension of criticism was overlooked. In the authors I examine – Karl Popper, Theodor Adorno and Karl Mannheim – I find three influential social philosophies identifying a role for critique as a tool for social transformation, but nonetheless failing in various ways to appreciate the development of their own perspective. In these theoretical programs, critique seems to issue from intellectuals whose process of becoming critical is either of little interest, incapable of being planned, or uncritically endorsed. By implicitly or explicitly excluding the educational development of the critic from the domain of critique, these social philosophies reveal the methodological and substantial obstacles confronting philosophy as the cultivation of critical consciousness today. Attending to this latter project in the writings of a few political educators, I argue in closing that understanding critique as a process of education allows us to better recognize how our own forms of life and institutional conditions work to stabilize the society in which we live. As a process of political struggle, the critique of ideology is not merely a theoretical undertaking, but a practical task in the most basic sense, aiming first and foremost at the self-conscious development of new intellectuals. (shrink)

The Orthodox Church has been given the fullest of truth by the inspiration of the Holy Spirit, truth honored and valued in the communion of the Saints. For men, to grasp divine truth is a progressive process part of a permanent development. Each and every person walks along this path together with other people, without being the same as the others. Every person is offered and understands truth according to their own religious experience and skills to understand. Ultimate truth exists (...) and it has been revealed completely, but the way in which it is grasped varies from one person to another. “This is not a narrowly doctrinal vision of theological truth. However, it is an essentially spiritual vision for worldly reality, one that removes arrogance from authority and opens new ways of approaching believers of other religions. It presupposes magnanimity and charity, faith and hope, tolerance and reconciliation. It opposes forceful conversion and conflinct, imposition and intolerance, aggression and violence”.85 This approach prevents us from assigning to God intentions and plans which are exclusively ours. Thus, whenever we have a dialogue with those of different beliefs and ideologies, we must always start from God’s sacrificial love for all men. (shrink)

Background While prenatal surgery historically was performed exclusively for lethal conditions, today intrauterine surgery is also performed to decrease postnatal disabilities for non-lethal conditions. We sought to describe physicians' attitudes about prenatal surgery for lethal and non-lethal conditions and to elucidate characteristics associated with these attitudes. Methods Survey of 1200 paediatric surgeons, neonatologists and maternal–fetal medicine specialists. Results Of 1176 eligible physicians, 670 responded. In the setting of a lethal condition for which prenatal surgery would likely result in the (...) child surviving with a severe disability, most respondents either disagreed or strongly disagreed that they would recommend the surgery. Male physicians were twice as likely to recommend surgery for the lethal condition, as were physicians who believe that abortion is morally wrong. Older physicians were less likely to recommend surgery. For non-lethal conditions, most respondents agreed that they would recommend prenatal surgery, even if the surgery increases the risk of prematurity or fetal death. Compared with MFMs, surgeons were less likely to recommend such surgery, as were physicians not affiliated with a fetal centre, and physicians who were religious. Conclusion Physician’s attitudes about prenatal surgery relate to physicians’ beliefs about disability as well as demographic, cultural and religious characteristics. Given the variety of views, parents are likely to receive different recommendations from their doctors about the preferable treatment choice. (shrink)

A number of writers, myself included, have recently argued that an “interventionist” treatment of causation of the sort defended in Woodward, 2003 can be used to cast light on so-called “causal exclusion” arguments. This interventionist treatment of causal exclusion has in turn been criticized by other philosophers. This paper responds to these criticisms. It describes an interventionist framework for thinking about causal relationships when supervenience relations are present. I contend that this framework helps us to see that standard arguments for (...) causal exclusion involve mistaken assumptions about what it is appropriate to control for or hold fixed in assessing causal claims. The framework also provides a natural way of capturing the idea that properties that supervene on but that are not identical with realizing properties can be causally efficacious. (shrink)

Photo ID 279661800 © Sidewaypics|Dreamstime.com ABSTRACT Decolonization is complex, vast, and the subject of an ongoing academic debate. While the many efforts to decolonize or dismantle the vestiges of colonialism that remain are laudable, they can also reinforce what they seek to end. For decolonization to be impactful, it must be done with epistemic and cultural humility, requiring decolonial scholars, project leaders, and well-meaning people to be more sensitive to those impacted by colonization and not regularly included in the discourse. (...) INTRODUCTION Decolonization is complex. To successfully achieve decolonization, projects should incorporate the voices of those subjugated or silenced. Including such voices requires sincerely exploring who has been affected by colonialism or neocolonialism and how, as well as cultural sensitivity. In its basic use, decolonization refers to countries under colonial rule gaining independence or freedom from forms of subjugation. Additionally, scholars use the term to refer to efforts to dismantle neocolonialism and vestiges of colonialism. The process includes de-silencing subjugated voices.[1] I use decolonization in the latter way to refer to countries with technical independence. While arguably colonization ended formally with independence from colonizing powers, neocolonialism is the indirect, informal, and sometimes subtle control of the people, their economy, and political life despite formal independence from colonizing authorities. I conceptualize neocolonialism as a system that involves direct and involuntary control of another’s political, economic, or social life, impacting their worldview and ways of encountering the world. Decolonization may target actions, places, or systems like health care or AI to overcome the ills of colonialism and neocolonialism. It also may target knowledge and require rethinking how people develop their knowledge base. For example, if people grew up seeing an outside colonizer as superior, they would need to change their knowledge of superiority. Decolonization may target power, for example, changing who owns and distributes COVID-19 vaccines and who distributors exclude in the distribution of vaccines. Decolonization could require looking at those disempowered in the distribution process. Additionally, decolonization may target autonomy of persons by freeing people, ensuring human and individual rights, and respecting cultural traditions. Decolonization projects that try to de-silence by including the voices of those affected by colonialism and neocolonialism must examine inclusiveness in the context of the culture of the subrogated individuals. Examples of decolonization projects include making datasets inclusive of diverse peoples and places, returning to traditional food and eating practices, making sure hospitals in developing countries are led by locals and respectful of cultural traditions, returning unethically obtained artefacts or objects. Another project would be laying the groundwork for equality in formerly colonized countries to ensure that business ownership, education, and financial success will flow fairly to those previously victimized by colonization. Summarily, there are many strategies for decolonizing. However, it is worth asking whether the strategies have risks that undermine the goal of decolonization. I. Understanding Decolonization Discourses Many fields, from AI to politics, economics, health care, aviation, and academia, discuss decolonization. The content of the discourse on decolonization depends on the region and field discussing it. Rather than just reporting on decolonization, the discussions may be calls to action. For example, decolonization discourses reflect activism for cognitive justice, such as equal consideration of Indian or African knowledge systems in global health discourses.[2] In politics and political science, some scholars frame decolonization as an anti-western, anti-colonial movement by Africans to emancipate Africa/ns from subjugation or shift the continent to postcolonialism and post-neo-colonialism. This framing walls off non-African participants and may undermine their capacity to benefit the conversation.[3] There are other political scientists who actively support decolonization and see it as a field of activism in support of anyone and countries where colonization harmed people and development.[4] The point is that two ways of conceptualizing decolonization in politics and political science are discernible. One conceptualization is less inclusive since it alienates scholars and professionals from Western, high-income, or developed countries. The other is more inclusive. In humanitarian studies, including philosophy, some decolonization articles and conversations are efforts to end the destructive force of colonization. They focus on either the form, such as ecocide, genocide, and many others, or the geographic location, such as Africa, Asia, Latin America, and Oceania.[5] Finally, the feelings one brings into this conversation can adversely impact how one engages in them and who they listen to or are willing to hear from. For example, anger, rage, bitterness, and hatred are emotions that are not uncommon in spaces of decolonization conversations. Decolonization conversations that originate from a place of negativity risk deepening the psychological state of victimhood and prevent people from disrupting constructively or critically engaging in the conversation.[6] II. Understanding Decolonization Strategies Decolonization strategies mainly aim to de-silence victims of domination or subjugation. People have proposed many strategies for decolonizing. These strategies may be informed by what the target is for decolonization. Decolonization can target power relations in global health. For example, during the COVID-19 pandemic, public health organizations noted the power imbalance in vaccine distribution. Decolonization could involve de-silencing those affected by neocolonialism to bring about a more balanced distribution of power and a more fair distribution of the vaccine. By analyzing who was adversely impacted by the distribution and who ought to wield power, those engaged in decolonizing advocated for positive change and equitable power relations. Equally, when being is the target of decolonization, the language of unlearning or relearning and mental decolonization take centre stage in the decolonization discourse. For example, the quest to decolonize colonized minds aims to demythologize African inferiority and Western superiority. Demythologizing African inferiority enables those engaged in the decolonization discourse to cultivate and foster African agency.[7] Finally, when knowledge production is the target of decolonization, scholars use inclusion and cognitive justice. For example, they try to alter the knowledge that underlies global health ethics.[8] “[D]decolonizing researchers aim to respectfully understand and integrate theory from Other(ed) perspectives, while also critically examining the underlying assumptions that inform their Western research framework.”[9] One common strategy that scholars use in decolonization is inclusion. It is worth asking, does including people who have been subrogated foster decolonization? Whether that is effective depends on whether included people are more heard or whether the strategies to include them create new forms of silencing. III. Inclusion and the Quest to Decolonize Evaluating how effective inclusion is in the quest to de-silence subjugated voices is important. First, inclusive strategies are not neutral. They are epistemically situated. This situatedness constrains meaning-making in different ways: how and what questions are asked, how social roles are constructed, organized or assigned, and who is admitted to the room where these conversations occur.[10] Inclusion strategies may reinforce (unchallenged) assumptions. For example, to address prejudices and stereotypes in global health images, Arsenii Alenichev and his colleagues[11] successfully inverted “one stereotypical global health image” by prompting a generative AI to produce “an image of a traditional Indian or African healer healing a White Child.” Although there were some problems with the image of the White child, this innovation is a significant, useful effort to de-embed or strip global health images of problematic pictures that mythologize White superiority and Black inferiority. Yet it is possible that using categories like traditional Indian or African reinforces unchallenged assumptions, raising key questions regarding how language and words create new stereotypes. It is common to define traditional as non-conventional, unorthodox, and informal. Yet studies continue to reveal that non-scientifically appraised healing approaches in India or Africa are not only effective but also real, meaningful, fundamental, and primary care-seeking behaviours in many communities in these regions.[12] Suppose inclusive strategies are not un-situated. These conversations may be had within the structures, language, and spaces built by or connected to colonialism. The spaces, language, places, and structures in which these conversations occur can limit who can participate and how they participate. Importantly, some conditions are not conducive to participation as equals. The allocated time for the discussion could also constrain how individuals express themselves. It is unclear who is ultimately heard. Furthermore, epistemic situatedness of inclusion can impact decolonization conversations when participants are beneficiaries of, products of, and trained by structures and systems they seek to dismantle. To enhance the decolonization project and its goals, a pressing task is to unveil and question how the circumstances may inhibit activism. If the vestiges of colonialism continue to structure the decolonization discourse invisibly, the vestiges may undermine decolonization. For example, a public health discussion that includes white Western doctors and Western pharmaceutical executives in Africa may have many local Africans at the table but could still effectively devalue their input based on built-in assumptions and biases that are vestiges of colonialism. Second, exclusion and inclusion are also not binary. Individuals may experience exclusion, even while included (the phenomenon called internal exclusion). In other words, inclusion can fail to be substantial or become a means of enhancing optics, “a way of (un)consciously weakening the radical claims being pursued.”[13] For example, in South Africa, many institutions have made significant efforts to diversify their faculties due to the promulgation of the Employment Equity Act 55.[14] The act requires South African institutions to implement employment equity that redresses the history of harmful discrimination in the country. The act further requires transforming departments and institutional administrations. Although many recognize and support the need to transform departments in South Africa, the rhetoric of transformation departs sharply from the lived experiences.[15] This misalignment between the plan and practice is evident in the underrepresentation of black people and females in senior management teams, professorships in many universities and health departments, and positions of power in some South African institutions. Those selected in the transformation of the departments have also complained of being overworked. The burden of extra work undermines their ability to develop agency and voice in the space they now occupy or fulfil key requirements that have implications for their career trajectory.[16] This is called the minority tax. Notably, "the minority tax… is the burden of extra responsibilities [placed] on faculty of colour to achieve diversity and inclusion and contributes to attrition and impedes academic promotion."[17] One challenge for decolonializing projects will be for decolonial scholars and those selected for decolonization objectives to have the humility to decline invitations, requests, roles, and platforms for which they are either unqualified or lack the capacity to fulfil. At its heart, decolonization strategies must empower those included rather than weaken them. Finally, inclusion can lead to a phenomenon known as elite capture.[18] Elite capture occurs when socially advantaged individuals in a group monopolize or exploit activism to their own benefit at the expense of the larger, struggling group. Elite capture weakens decolonization efforts from within, revealing that those likely to benefit from global inclusive efforts are those who fulfil globally constructed standards, those “already present in the room.” There is no better strategy to weaken decolonial movements than weakening the project from within by strategically positioning individuals who share physical properties with the victims of exclusion and silencing but intellectually, behaviourally, psychologically, and emotionally share more common ground with the colonizer. Such insiders may be unaware they are furthering neocolonial conditions rather than decolonizing. In relation to decolonization, particularly in global health, elite capture reveals that those whose voices are loudest in the room are not necessarily those more impacted by colonialism. They may benefit more from reinforcing colonialism. Opportunism weakens meaningful activism from within, preventing good initiatives and strategies from having their intended impact or taking substantive root.[19] This paper cannot do justice to elite capture, but it is worth noting its negative impacts. IV. Improving the Impact of Decolonization To end neo-colonialism, it is important to understand how it manifests and what to do at each level. Beyond the academic discourse, many tangible efforts exist to decolonize through de-silencing. Examples of these efforts include the ME2 movement that seeks to centre the concerns and experiences of sexually abused or harassed victims in the public discourse. At the funding level, many grant-awarding agencies like Wellcome Trust have dedicated huge budgets to studies that help them understand how they may have perpetrated colonialism or neocolonialism and what they can do differently going forward.[20] In South Africa, promulgating the Employment Equity Act 55 was a tangible attempt to entrench decolonization concerns in a country's regulatory framework. Yet, these decolonization efforts could fail to be substantive if they do not reflect cultural sensitivity. Two key components of cultural sensitivity are worth highlighting here: epistemic and cultural humility. Epistemic humility is an intellectual virtue described as knowing one’s limitations and the limitations of the learning methods employed. At its simplest, it is the ability to admit when one is wrong. Cultural humility includes genuine attempts to learn about and embrace other cultures. Epistemic and cultural humility are signs of academic excellence and strength. Epistemic and cultural humility seriously acknowledge how the state of our knowledge, cognitive limitations, experiences, and backgrounds, while constraining us, also invite us to listen, learn, grow, and change. The limitations-owing account of epistemic and cultural humility suggests that “a person who is aware of her cognitive limitations and owns them is much better positioned to achieve such epistemic goods as true beliefs and understanding than someone who… simply has insight into the epistemic status of her beliefs.”[21] Epistemic and cultural humility may help prevent decolonization projects that unintentionally reinforce what they seek to dismantle. Epistemic humility calls on decolonizers to defer tasks for which they are not qualified to suitably qualified persons. Beyond this, humility supports brave scholarship that imagines and reimagines how featuring the same voices, faces, and perspectives possibly introduces new forms of domination or silencing. Cultural knowledge can lead to a more intentional way of seeking out the right people or a more diverse group than those frequently featured in decolonization conversations. This would give others more opportunities to navigate these spaces and should do so in ways that are familiar to them. One ought to be more sensitive to those who would ordinarily not be included in these conversations. Unless we radically and boldly reimagine these discussions, we risk alienating those most negatively impacted by neocolonialism. CONCLUSION Decolonization conversations are complex and the subject of academic debate. The strategies employed to decolonize can harm or help the victims of neo-colonialism. Inclusion of previously silenced individuals may not be enough to overcome the vestiges of colonialism, leading to a false inclusion, where those included feel excluded or contribute in ways reflecting their own biases and circumstances. Inclusion of an elite or people who do not truly represent the subjugated can lead to elite capture. For decolonization strategies to be impactful, for example, in the context of global health, project leaders and participants must engage in conversations employing epistemic and cultural humility. In many ways, epistemic and cultural humility can help us demythologize our assumptions of any cultural superiority or cognitive authority, allowing for diverse voices, cultures, and perspectives to emerge without domination. - [1] Caesar Atuire & Olivia Rutazibwa. 2021. An African Reading of the Covid-19 Pandemic and the Stakes of Decolonization. An African Reading of the Covid-19 Pandemic and the Stakes of Decolonization [Online]. Available from: https://law.yale.edu/yls-today/news/african-reading-covid-19-pandemic-and-stakes-decolonization [Accessed July 29, 2021 2021]. [2] Bridget Pratt & Jantina De Vries 2023. Where is knowledge from the Global South? An account of epistemic justice for a global bioethics. Journal of Medical Ethics, medethics-2022-108291. [3] Anye-Nkwenti Nyamnjoh 2023. Is decolonisation Africanisation? The politics of belonging in the truly African university. Social Dynamics, 1-20. [4] Rianna Oelofsen 2015. Decolonisation of the African mind and intellectual landscape. Phronimon, 16, 130-146. [5] Caesar Atuire & Olivia Rutazibwa. 2021. An African Reading of the Covid-19 Pandemic and the Stakes of Decolonization. An African Reading of the Covid-19 Pandemic and the Stakes of Decolonization [Online]. Available from: https://law.yale.edu/yls-today/news/african-reading-covid-19-pandemic-and-stakes-decolonization [Accessed July 29, 2021 2021]. [6] Pedro Alexis Tabensky 2008. The Postcolonial Heart of African Philosophy. South African Journal of Philosophy, 27, 285-295. [7] Nicholas M. Creary 2012. African Intellectuals and Decolonization, Ohio, Ohio University Press. [8] Bridget Pratt & Jantina De Vries 2023. Where is knowledge from the Global South? An account of epistemic justice for a global bioethics. Journal of Medical Ethics, medethics-2022-108291. [9] Vivetha Thambinathan & Elizabeth Anne Kinsella 2021. Decolonizing Methodologies in Qualitative Research: Creating Spaces for Transformative Praxis. International Journal of Qualitative Methods, 20, 16094069211014766. [10] Abimbola Seye 2023. Knowledge from the global South is in the global South. Journal of Medical Ethics, 49, 337. [11] A. Alenichev, P. Kingori & K. P. Grietens 2023. Reflections before the storm: the AI reproduction of biased imagery in global health visuals. Lancet Glob Health. [12] Jonathan K. Burns & Andrew Tomita 2015. Traditional and religious healers in the pathway to care for people with mental disorders in Africa: a systematic review and meta-analysis. Social Psychiatry and Psychiatric Epidemiology, 50, 867-877. [13] Anye-Nkwenti Nyamnjoh & Cornelius Ewuoso 2023. What type of inclusion does epistemic injustice require? Journal of Medical Ethics, jme-2023-109091. [14] 1998. Employment Equity Act. In: GOVERNMENT, S. A. (ed.) 19370. [15] Dina Zoe Belluigi & Gladman Thondhlana 2019. ‘Why mouth all the pieties?’ Black and women academics’ revelations about discourses of ‘transformation’ at an historically white South African university. Higher Education, 78, 947-963. [16] Juliet Ramohai & Khomotso Marumo 2016. Women in Senior Positions in South African Higher Education: A Reflection on Voice and Agency. 231, 135-157. [17] J. Trejo 2020. The burden of service for faculty of color to achieve diversity and inclusion: the minority tax. Mol Biol Cell, 31, 2752-2754. [18] Olufemi Taiwo 2020. Being-in-the-Room Privilege: Elite Capture and Epistemic Deference. The Philosopher, 108, 7. [19] Margarita Kurbatova & Elena Kagan 2016. Opportunism of University Lecturers As a Way to Adaptate the External Control Activities Strengthening. Journal of Institutional Studies, 8, 116-136. [20] Jeremy Farrar. 2022. An update on Wellcome's anti-racist programme. An update on Wellcome's anti-racist programme [Online]. Available from: https://wellcome.org/news/update-wellcomes-anti-racism-programme [Accessed August 10, 2022 2022]. [21] Katherine Dormandy 2018. Does Epistemic Humility Threaten Religious Beliefs? Journal of Psychology and Theology, 46, 292-304. (shrink)

continent. 1.1 (2011): 60-67. At the beginning of Martin Heidegger’s lecture “Time and Being,” presented to the University of Freiburg in 1962, he cautions against, it would seem, the requirement that philosophy make sense, or be necessarily responsible (Stambaugh, 1972). At that time Heidegger's project focused on thinking as thinking and in order to elucidate his ideas he drew comparisons between his project and two paintings by Paul Klee as well with a poem by Georg Trakl. In front of Klee's (...) Saints from the Window and Death of Fire —though we wouldn’t absolutely understand what we were seeing—he writes, “we should want to stand…a long while.” In a similar manner, of Trakl’s poem “Septet of Death”—although it is likely we are unsure in what we hear—Heidegger states that, “we should want to hear…[it] often.” Heidegger further states that in appreciating these, “we “should abandon any claim that [they] be immediately intelligible” (1). So also we must we approach, Heidegger continues, the realm of theoretical physics, in which the difficult work of Werner Heisenberg, be listened to “without protest” and without “any claim that he be immediately understood.” These works, like his own project, merit the time they take to be originally (mis)understood. But this is not necessarily true for philosophy, Heidegger advises, because, “That thinking is supposed to offer ‘worldly wisdom’ and perhaps even a ‘way to a blessed life’” (1). Philosophy is in the unique position of being both abstract (what do we talk about when we talk?) and at the same moment, useful. There are demands that it make sense, that it be, grounded, immediate, and most importantly, rational. Heidegger draws these comparisons between the works of Klee and Trakl and Heisenberg not to claim that philosophy is totally irresponsible. He does not claim that the poet, the painter, nor the physicist have acted irresponsibly. Rather, he would say, they are rising to the highest levels of intelligibility, though it is perhaps an intelligibility that is commonly unavailable to us. In Trakl’s case, as we shall see, mastery is the end result of difficult words. Instead, Heidegger seems be making pleas: for a period of uninterrupted unintelligibility (pure unintelligibility); and that there is a time (that time is now) when, “thinking is…placed in a position which demands of it reflections that are far removed from any useful, practical wisdom” (1-2). Heidegger argues that philosophy requires a period of time in which, instead of focusing on the practical—or even on the worldly—the discipline draw its “determination” instead from the place of painting and poetry and physics. In doing so, “we should have to abandon any claims to immediate intelligibility” (2). But Heidegger doesn’t offer this as a way out. We still have to turn up, we “still have to listen, because we must think what is inevitable, but preliminary” (2). The point for Heidegger, is not to listen to a series of propositions, but instead to “follow the movement of showing” (2). I. … Maybe we're here only to say: house, bridge, well, gate, jug, olive tree, window— at most: pillar, tower … but to say them, remember, oh, to say them in a way that the things themselves never dreamed of existing so intensely.… Rainer Maria Rilke, “The Ninth Elegy” There is little more fundamental, preliminary, in the world than language. We use language, in the form of speech, constantly, whether we are saying anything or not. “Man speaks,” Heidegger writes, and goes on to describe in his essay “Language” (2001) the constant speaking that we do. “We are always speaking, even when we do not utter a single word aloud, but merely listen or read, and even when we are not particularly speaking or listening but are attending to some work or taking a rest” (187). Speaking is expression, an utterance of something internal. It is a recognition of a world. It is a way of communicating thought and it is an activity that we all do, inevitably. Speaking separates the human from the animal world, and despite advances in primatology that seek to give ‘voice’ to primates and other non-human animals, it can safely be said that our form of communication—what we call speech and know as language—is the most advanced, the most complicated. We use it to present and represent the world around us; through actual utterances (vocalization) or through the written word or through ‘unvoiced thoughts’ and dreams. We use language, but more specifically speech—naming—to transmit moods, thoughts, desires, aversions, and feelings. These expressions, mere utterances, nearly always find a source in words, whether spoken or not. Heidegger writes that this common view of language means “that only speech enables man to be the living being he is as man. It is as the one who speaks that man is—man” (187). Speaking then—utterance—surrounds us constantly, whether in the form of careful thought—in the form of an academic paper, say—or in the half mutterings and forgotten thoughts of a nearly remembered dream. Like scaffolding, the apparatus of speech sustains and explains the world, making, in a sense, the world rational, making it apparent. When we speak, we describe, and in doing so, name the world. We use words, through this process of naming, to interpret and sustain the world we see, and the world we imagine. Like Rilke’s naming of jug, and bridge, and window, and stream, we describe—and inscribe upon—the world through an activity of naming. Are we here, perhaps, to name? Is it possible not to name? Is it possible to regard and to view and to look around without naming what we see? Is it possible to feel—to experience—world without giving utterance to that feeling, that process? Sadness, grief, joy, ecstasy, hunger, thirst. Desk, light, room, pen, book, world. White, black, tomorrow, today. Each of these words is a name given to a thing I see in front of me, or a concept that I imagine (in the case of tomorrow or world). What arises in my mind has already existed. If I imagine it, it is named. The word for ‘tomorrow’ and ‘desk’ and ‘light’ precedes me, and precedes my concept of it. The idea of it is already pre-informed, and I must, in a certain sense, bend my ideas to it. When I imagine a table, I imagine my own table (or I imagine an idea of table) but that imagining must follow certain general rules; while, perhaps, it might not always require four legs and a horizontal surface, it must, at least not be, say, a pool of water, or a pile of excrement. It must have some tableness to it to be a table. It must, with Heidegger, table. Otherwise, speech is reduced to gibberish. For Heidegger however, the discussion of language points to something deeper than its “scientific and analytic” study as a communicative device. Indeed, Heidegger seeks to understand language not in reference to man or woman, not as an utterance of humanity, but in reference to itself. In doing so he abandons the conversation—that is, he casts away the traditional arguments surrounding philosophy of language; that it is a means of expression; that it is a human activity; and that it is somehow a representation of something that is—in order to seek to understand language as language, on its own terms. Heidegger is not a philosopher of language, but a philosopher of world, of being. Despite these “correct ideas” holding sway “over the whole field of the varied scientific perspectives on language…they ignore completely the oldest natural cast of language” (191). What is this “oldest natural cast of language? It is the act of language itself. Language is language and language speaks. “Most often,” Heidegger writes, “and too often, we encounter what is spoken only as the residue of a speaking long past” (195). Speech, as we normally encounter it, is like Echo herself calling out to Narcissus, doomed to repeat what has already been said, a mere remnant of what was once language, a trace left behind in the gathering silence of becoming. In both the essay “Language” and in his three lecture course “The Nature of Language” (1982), Heidegger attempts to unpack the seeming tautology of language as language. In each, he focuses on poetry as a way out, or into, a true discussion of the oldest natural cast of language. Poetry is pure speech. In poetry, language is brought to language and language speaks ( Die Sprach spricht ). In the act of poetry, the act of pure speech, the poet names (on the surface not different from how I name this table, this computer) but in the poet naming, the naming does not “hand out titles,” “apply terms,” but rather the naming is a call, a calling forth of entities that bring them into their own, allow them to take their place purely, without compromise. This calling, Heidegger (2001) states, “here calls into a nearness. But even so the call does not wrest what it calls away from the remoteness, in which it is kept by the calling there. The calling calls into itself and therefor always here and there—here into presence, there into absence” (196). II. Window with falling snow is arrayed, Long tolls the vesper bell, The house is provided well, The table is for many laid. Wandering ones, more than a few, Come to the door on darksome courses. Golden blooms the tree of graces Drawing up the earth’s cool dew. Wanderer quietly steps within; Pain has turned the threshold to stone. There lie, in limpid brightness shown, Upon the table bread and wine. Georg Trakl “A Winter Evening” Heidegger is often given short shrift as an abysmally difficult writer, as one that makes no sense and is needlessly difficult. In doing this though, we forget sometimes his eloquence, his simple beauty in writing. Of the above opening stanza, “Window with falling snow is arrayed/ Long tolls the vesper bell.” he writes (2001), This speaking names the snow that soundlessly strikes the window late in the waning day, while the vesper bell rings. In such a snowfall, everything lasts longer. Therefore the vesper bell, which daily rings for a strictly fixed time, tolls long. The speaking names the winter evening time (197). The speaking names the winter evening time. It is almost impossible to comment on that one line by Heidegger. It is as though it must exist on its own completely, without elucidation—as though in front of it we must stand as we do in front of a painting by Klee, that is, we must abandon any claim . Silent and devoted. The speaking of the poem here is not clearly different from common speech ( rede ) yet there is, via Heidegger, an invitation to experience that auracular quality of light and stillness that a gentle, dusk tinged snowfall gives; words evoking a quality so clear, so poignant that, in a sense, Heidegger’s work, at this moment, has been done. But what does this naming accomplish? What does the call call? Remember, it is not the poet that calls, but the naming which calls. The poet has only brought the words forward; it is now the words— snow, vesper bell, window— that take new life in the pure language of the poem. Entities are called forth into presence, like the speaking that names the winter evening time. Not to be present amongst us now, however; naming ‘table’ in the poem does not place it in front of us in this room. Rather, the naming places entities into a gathering which is also a sheltering. The naming brings them to be. In an act of appropriation, things come to be purely as their own, unimpeded by a predetermined expectation. They are called to themselves into an arrival. In Being and Time (1962), Heidegger famously describes the movement between present-at-hand and ready-to-hand in his analysis of the hammer, and of equipment in general. This analysis is already known, if not always clear, to most readers of Heidegger. Briefly, a hammer is ordinarily zuhanden or ready-to-hand; it is part of the background of the world, equipment used and never thought about, like this desk, this sheet of paper, this room. Our interaction with it is temporary and it is historically different for each entity and each relation. We need a hammer, we use a hammer. If all goes according to plan, the hammer remains ready-to-hand; it remains, in a sense, undisclosed and certainly unobtrusive. Our world is undisturbed by the hammer. Only when the hammer or the car or the computer is broken (or sometimes unused or unrecognized or missing) does it intrude into our world, become conspicuous as an object present-at-hand, or vorhanden . In this case, we reach for the hammer, it is broken and we suddenly notice it’s being, broken though it is. The thing which was always ready to hand—handy—is suddenly abstract, something to be examined, if only in its absence or disfunction. This can be exhibited for all entities, and it is important to note that in this analysis the zuhanden / vorhanden split is not restricted to a specific form of constructed material; zuhanden does not refer to the car, and vorhanden the sunset. No entity is ever exclusively ready-to-hand or present-at-hand; they are instead, interpenetrated with each others mode of being, one informing the other in a way that both brings things forth into the world—discloses is the word Heidegger chooses—and at the same time conceals them. As one mode is coming to be so another mode is withdrawing. This flux and movement between modes is precisely what brings the world forward, and what makes it manifest. It exists beyond where we tread and before man took dubious control of the world. We go to find a book or turn on the computer and it is missing or broken and we become aware of the object, as though for the first time. We walk to the water to glimpse the sunset and miss it, or it is less than stellar; in the sunset’s grayness, we become aware of it’s being sunset. The thing is disclosed in its withdrawal. Echoing Heraclitus, we can say that as something is coming to be, it is already becoming something other. Of similar importance to the fact that things are never all of one, or all of the other, they are also never alone. The hammer is never a single object, but is in relation always to the whole. Heidegger (1962) states, Equipment—in accordance with its equipmentality—always is in terms of its belonging to other equipment: ink-stand, pen, ink, paper, blotting pad, table, lamp, furniture, windows, doors, room. These ‘Things’ never show themselves proximally as they are for themselves…What we encounter as closest to us…is the room; and we encounter it not as something ‘between four walls’ in a geometrical, spatial sense, but as equipment for residing…it is in this that any ‘individual’ item of equipment shows itself. Before its does so, a totality of equipment has already been discovered (97). Equipment resides—dwells—in its relations, in its proximal being to other beings. Within the structure of totality, a series of relations is always occurring. The hammer is on the workbench in the carpenter’s hand in the workshop in the village under the sky and under the sun. It doesn’t stop there. Equipment surrounds us and the focus is not on what it does, or what one does with it—the carpenter with the hammer, the writer with laptop—but with the fact that it is. Equipment occurs in relation and is always occurring around us overhead, underfoot, by the stream and in the city. There is a constant exchange of relations happening, and as this occurs, so the world occurs, so the world both discloses and withdraws, into and out of itself. In a very real sense, language is also equipment. It is the thing that we use most often without thought, it is ready-to-hand (except when it’s not.) As we re- cognize the world around us, as we offer names for things and make lists, we are using language much like we might use a hammer, that is, bluntly. Most of the time it is invisible and we draw on it without wondering how we are going to say something. When language does intrude, it does so in an awkward moment, that moment when we can’t remember the right word, when we forget a phrase. At that second, it “speaks itself as language,” it reveals itself as malfunctioning equipment, and we “undergo” an experience with language, in Heidegger’s famous formulation. Language is not a tool anymore that we use to bludgeon an object, but something instead that we submit to, that we experience. In “The Nature of Language,” Heidegger (1982) writes, But when does language speak to us as language? Curiously enough, when we cannot find the right word for something that concerns us, carries us away, oppresses or encourages us. Then we leave unspoken what we have in mind and, without rightly giving it a thought, undergo moments in which language itself has distantly and fleetingly touched us with its essential being (59). The poet’s words become themselves, become appropriate, only when they no longer function in the prosaic world; they instead intrude as they come to be. Language itself brings itself to language. Names, like the entities they indicate, are always becoming something else. As noted above, language, through the poet, has brought forth entities from words previously “known.” I thought that I knew snow, but through Trakl’s re- presentation of the word, language calls forth a new image of snow, indeed calls forth snow itself. The vesper bell tolls longer, the table is for many laid. In bringing forth things , language has brought the world to presence. In everyday naming, word occludes world, preventing, in its everydayness, its coming forth, its disclosing. But what is this world that word has been brought forth into? In the same way that language speaks, world worlds. World, left alone, un-interfered with, comes into itself. It worlds. Again, this sounds like a tautology, but it is essential to Heidegger’s thought (and in my mind is more of a “god killer” than Nietzsche.) One of the most overlooked (and under-appreciated) aspects of Heidegger is his later examination and enthusiasm for the “fourfold,” or the system through which things come to be, through which things thing in a world worlding. The fourfold is the interaction of earth and sky, mortals and gods. Things come to be in the interstices and gathering of the fourfold. The fourfold provides both a place of being, and a sheltering, a place to dwell. Heidegger writes that “the things that were named, thus called, gather to themselves sky and earth, mortals and divinities. The four are united primally in being toward one another, a fourfold.” The poet has called, through the act of pure naming, things to come forth. In the purity of the fourfold—that is, when that is all that there is, when there are no other distractions, definitions, things—entities themselves can come to be. It is important to note that Heidegger is not saying that there are four formal things in the world, autonomous entities unto themselves. He is not evoking a pre-Socratic formula as to what makes up the world; instead, the four mirror each other constantly. (Heidegger calls this the ‘mirror-play.’) They interpenetrate in the same way that the modes of being of things interpenetrate themselves. There is no discrete exclusivity in being or the fourfold. What makes up things is not a precise recipe of the four main components; what makes up things is the action of the fourfold coming together, the movement of the fourfold which is a becoming. Heidegger (2001) writes that “this gathering, assembling, letting stay is the thinging of things.” And he later adds that “thinging, things are things. Thinging, they gesture—gestate—world” (197). Language brings the world to be. It works not again as a recipe added to things, but instead it is a bridge, or more precisely, a relation. Language relates world to thing, brings world to thing. In a sense, it does not say anything; rather it allows, or calls in its movement. Heidegger (2001) writes that, The intimacy of world and thing is not a fusion. Intimacy obtains only where the intimate—world and thing—divides itself cleanly and remains separated. In the midst of the two, in the between of world and thing, in their inter, division prevails: a dif-ference (199). It is in this inter that language prevails. Language is difference, it is the differential aspect between world and thing that brings world to thing. In the final stanza of Trakl’s poem “The Winter Evening,” Trakl evokes this difference in the second line when he writes, “Pain has turned the threshold to stone.” Christopher Fynsk, in his essay “Noise at the Threshold,” draws attention to this point when he writes “it is the figure of the threshold that is language itself, inasmuch as language is defined as the articulation of difference by which difference comes about” (25). Language, as used in the pure language of the poem, draws together world and thing, bridging relation between entity and world. The calling of language calls world to thing, world to being. Heidegger (2001) describes this difference as unique; “of itself, it holds apart the middle in and through which world and things are at one with each other” (200). III. Neither reading nor writing, nor speaking—and yet it is by those paths that we escape what has been said already, and knowledge, and reciprocity, and enter the unknown space, the space of distress where what is given is perhaps not received by anyone (99). Maurice Blanchot The Writing of Disaster So far, we have allowed Heidegger to put forward what language does, how it functions as a relation and how it operates as a threshold, as a bridge. What interests me is what happens beyond language, beyond the relation. What happens to the thing without the naming, without the poet, or even without the everyday chatter—Fynsk calls this ‘noise’—intruding on being? If language allows things to become by bringing thing to world, what happens when we remove this bringing, this threshold turned to pain? In “The Nature of Language,” Heidegger examines the work of the poet Stefan George, specifically “The Word”: Wonder or dream from distant land I carried to my county’s strand And waited till the twilight norn Had found the name within her bourn— Then I could grasp it close and strong It blooms and shines now the front along… Once I returned from happy sail, I had a prize so rich and frail, She sought for long and tidings told: “No like of these depths unfold.” And straight it vanished from my hand, The treasure never graced my land… So I renounced and sadly see: Where word breaks off no thing may be. That final line, “Where word breaks off no thing may be” is evoked on nearly every page of Heidegger’s essay. It is the line to which he returns over and over and bears repeating. Where word breaks off no thing may be. Where naming ends, no thing. We can interpret this in two ways (at least.) Where word—naming—breaks off, then there is nothing . Or, as I choose to read it, where word breaks off no thing may be. In this I see a hint forward, a marker left behind by Heidegger. What could this look like? What does no thing look like? Like a zen koan ( there is no mirror ) it is as thrilling and horrifying as contemplating what preceded the Big Bang. Because language as naming wasn’t always here; we weren’t always here. One or maybe two aspects of the fourfold (depending on your view of gods) were not always here, and there is no guarantee that we will always be around. What then? Heidegger (1982) describes the landscape that the poet finds, “It names the realm into which the renunciation must enter: it names the call to enter into that relation between thing and word which has now been experienced” (65). The poet, in renouncing, allows for the “may be” of “where word breaks off no thing may be.” This “may be” becomes “a kind of imperative, a command which the poet follows, to keep it from then on.” No thing is lacking. Where word breaks off, there may be, a totality, a completion. If we place the emphasis on may be , we make it affirmative, make it positive. One allows it. No thing is where the word, that is the name, is lacking. If we remove then (if we can remove) the word, the name, than that is where no thing is, that is where no thing may blossom, enrich, belong, become. What is no thing? Heidegger writes that “thing is anything that in any way is.” And just after this he writes that the “world alone gives being to the thing.” But what happens if there is no word? Word, in this formulation can be seen as an enframing, a challenging of language. By naming, by drawing a perimeter around an object, we hold it, by its definition (that is a brick) to an ordered future. If we borrow from Heidegger’s essay “The Question Concerning Technology” (1993) the idea of this standing-reserve of an ordered future, we see that “everywhere everything is ordered to stand by, to be immediately on hand, indeed to stand there just so that it may be on call for a further ordering” (322). What happens if there is no naming of the thing? Silence perhaps. Stillness. We can name—and do name—that which we know. We equate knowledge with knowing the name of something. A brick is a brick, a hammer is a hammer, the universe is the universe. By naming a thing, we create, and draw its parameters, the parameters of the thing, not as thing thinging in the fourfold, but as blunt object apparent. In the four dimensions relatively available to us, we observe (and name) that the brick takes up possibly six by four by two inches and is, in the sense that it currently occupies this time slot. It fulfills its destiny, its being, its brickness, it bricks . But what happens when we remove the name for this brick. We no longer know what to call this no-thing (if indeed we can even arrive at the point of uncalled calling.) In fact the it (this brick) is no longer a thing in the sense that by not naming—by removing the name—it still occupies the same dimension but is indiscernible from the world. It simply is , un-reliant, un- needed by me. By removing the subject (me) from it (the brick) do I not then also remove the object—or at least the duality objectifying it? Why is this important? Why does this matter? I have not really removed anything. I have not changed any thing , per se . The brick still occupies the same space in geographic and temporal dimensions. I have literally not even touched the brick sitting on my desk. But what I have done is removed the name, removed the word (the bridge, according to Heidegger) and in this (again, if this is even possible) there is something vertiginously liberating, not only for me (and my way of thinking) but also for the brick itself. Like the poet who calls the thing forward, by refusing to name, by avoiding any thing that demands me to name it, I release the thing into the fourfold. I am no longer challenging the thing to be there for me ; I do not en frame it through language. Rather I, in an act of extreme responsibility, am refusing the challenge. By refusing the name (refusing to name) one allows, (or no one allows no thing) the brick to be all things , to manifest its manifold being, to incorporate all things into its thinging . It becomes, quite literally, every thing . Because, in its infinite manifestness, it incorporates everything; the mud that gave it its current being, the water that formed the mud, the sun, the stars, the universe and it also allows it to become mud again, to become landfill, to become again, water and sun and stars and universe in an endless, infinite cycle of coming to be some thing (else). Perhaps this is what Heidegger is suggesting when he talks about the stillness at the end of his essay, “Language” (2001): The dif-ference stills particularly in two ways: it stills the things in thinging and the world in worlding. Thus stilled, thing and world never escape from the dif-ference. Rather, they rescue it in the stilling, where the dif-ference is itself the stillness (206). It is in this stillness that I can imagine a gellasenheit (here I mean both “releasement in the Heideggarean sense, as well as Meister Eckhart’s use of the term meaning “letting the world go and giving oneself to God”) of thing and world, a releasing into the stillness and silence of no thing beyond where word breaks off. It is here where I may no longer be, and yet no thing is, but may be. (shrink)

continent. 2.1 (2012): 6–21. The French philosopher and novelist Tristan Garcia was born in Toulouse in 1981. This makes him rather young to have written such an imaginative work of systematic philosophy as Forme et objet , 1 the latest entry in the MétaphysiqueS series at Presses universitaires de France. But this reference to Garcia’s youthfulness is not a form of condescension: by publishing a complete system of philosophy in the grand style, he has already done what none of us (...) in the older generation of speculative realists has done so far. His book is sophisticated, erudite, rigorous, imaginatively rich, and abundant in worldly wisdom– despite the author’s conclusion that wisdom does not exist. The quality and scope of Forme et objet took few observers by surprise, since Garcia has been treated as an emerging philosopher to watch across half a decade of Parisian oral tradition. But Garcia was not just the subject of rumor, being already well known to the French public as a writer of fiction. His debut novel, La meilleure part des hommes , 2 was awarded the 2008 Prix de Flore 3 and has already appeared in English as Hate: A Romance . 4 His follow-up novel, Mémoires de la jungle , 5 made clever use of a chimpanzee narrator. Nor was Garcia only published as a novelist before last November: his philosophical study L’Image 6 had already appeared when the author was just twenty-six, a year before he was crowned by the muses at the historic Café de Flore. And then in 2011, just months before the appearance of Forme et objet , Garcia published a widely distributed work entitled Nous, animaux et humains , 7 with its focus on Jeremy Bentham’s ideas about animals. Given this prolific and versatile track record, an optimistic scenario might envisage the young Garcia as one of those combined literary/philosophical talents who appear intermittently in France across the centuries: Jean-Paul Sartre is merely the most famous recent case. While more time is needed to see how Garcia will channel his impressive mental energies, Forme et objet displays such breadth of insight that its author has a good chance to emerge as one of the leading philosophers of his generation. If we accept Aristotle’s dictum that the peak mental age is fifty-one, then to read Garcia’s massive book is to gain some idea of what European philosophy might look like in the futuristic-sounding 2030’s. The present article is confined to Forme et objet . At 486 pages, the work is obviously daunting in size. Indeed, it is even longer than it sounds, given that many of its early sections are printed in a smaller typeface to designate them as supplemental commentary to the main flow of the argument. But while the length of the book reportedly led to delays in French publication, and will probably slow the inevitable appearance of an English translation, the length of the book should not deter interested readers– much of it results from Garcia’s teacherly writing style. Whereas Quentin Meillassoux’s prose displays an arctic economy of means, Garcia’s style is reminiscent of the repeated lessons of oral classroom proceedings. Rarely is the reader given fewer than three or four chances to master an idea before the author moves on to the next. In practice, the style feels welcoming rather than long-winded. Otherwise, the structure of Forme et objet is surprisingly simple. There is a useful Introduction of less than twenty pages. Then comes Book I: Formally , running to approximately 135 pages. Here Garcia outlines the most basic features of a thing “no matter what it is,” or n’importe quoi , an everyday phrase that Garcia shapes into a technical term. This part of the book feels at times like a more amiable version of Hegel’s Science of Logic , a parallel emphasized further by the threefold articulation of its theme: 1. Thing; 2. Thing and World; 3. Being and Understanding. This is followed by the much longer Book II: Objectively , totaling more than 300 pages. It contains sixteen essay-like meditations on specific kinds of objects—including time, animals, humans, history, gender, and death. Here each chapter rolls smoothly into the next, making this second part of the book feel more like a different work of Hegel: The Phenomenology of Spirit . But these are merely analogies. Garcia is no Hegelian, even if the book contains a few dialectical flourishes that seem to reflect his early enthusiasm for the Frankfurt School. Forme et objet ends with a six-page Coda, followed by the usual page of acknowledgments. In what follows, I will briefly summarize each of these four parts of the book before ending with some more general remarks. Before doing so, it will be useful to situate Garcia biographically (as much as I am able) and philosophically. Though Toulouse is his native city, his formative years were spent largely in Algeria, where his family has deep roots. During our sole private conversation, Garcia mentioned that his parents are professors of literature. 8 As a student of philosopher Garcia flourished so early that many of his current ideas date to his teenaged years: “There are sentences in Forme et objet that I wrote when I was seventeen,” he said in response to a question on that cold night on the Canal St.-Martin. I recalled that remark when reading his brilliant account, late in the book, of the central role of adolescence in contemporary culture. While many prodigies blow through their formal academic training without serious obstruction, Garcia’s student memories are rich in tales of isolation and struggle, though equally rich in gratitude for a half-dozen or so exceptional teachers who provided the intellectual space he needed: Meillassoux and Alain Badiou are simply two of the most prominent figures on that list. Though there are many points of agreement between Garcia’s philosophical position and my own, he not only reached his position years before reading my work, 9 he arrived along a rather different path: not through phenomenology, but via the Frankfurt School, which may be one of the reasons for his profound fascination with aesthetics. Garcia’s cultural background is as broad as one could wish: he is no less informed about punk rock and European football leagues than about the spiritualist roots of Bergson’s philosophy. Curious about everything and contemptuous towards nothing, Garcia can be expected to write insightfully on dozens of topics in the years to come. Given that his philosophy is so personally tantalizing in its agreements and disagreements with my own, and given the great internal richness of Forme et objet itself, the present review is no better than a first effort at coming to terms with the challenges posed by this minstrel from the rising generation. This is especially intriguing for older Generation X’ers like me, since confrontation with the younger generation is one of the many themes treated insightfully in Garcia’s book. 1. Introduction Garcia begins in defense of a so-called “flat ontology,” in which all things are equally things. While Roy Bhaskar 10 used this term pejoratively to refer to anti-realist philosophies that flatten everything onto an epistemic plane of human access, Manuel DeLanda 11 (an admirer of Bhaskar) reversed it into the positive principle that all realities are equally realities. Similar notions can be found in the “absistence” of Alexius Meinong, 12 the “irreduction” of Bruno Latour, 13 and my own critique 14 of the undermining/overmining pair. Also noteworthy is Levi Bryant’s use of the term “flat ontology” throughout The Democracy of Objects 15 and his earlier essay “The Ontic Principle.” 16 But for Garcia, flatness is only one face of the cosmos, and one that he ultimately declares to be rather impoverished. Even so, he always remains an advocate of a flat ontology. Insofar as everything is equally something, no matter what it is ( n’importe qui ), everything is equally a thing, equally solitary in its relation with world. This is why his book abounds in those long lists of random, ontologically equivalent entities that Ian Bogost has playfully termed “Latour Litanies.” 17 The first litany in Garcia’s book runs as follows: “We live in this world of things, where a cutting of acacia, a gene, a computer-generated image, a transplantable hand, a musical sample, a trademarked name, or a sexual service are comparable things.” (7) Yet Garcia is frankly dualistic; his flat ontology only lasts until page 159 and the end of Book I (entitled “Formally”), which deals entirely with things that are equally things. Thereafter Garcia turns his attention from things to objects, which are not flat in the least, but engage in hierarchical relations with one another. In agreement with both DeLanda and the speculative realists, Garcia proclaims that his book “proposes to put to the test a thought about things rather than a thought about our thought about things .” (8) Just as ducklings are “imprinted” (9) after hatching and treat the first creature they see as their mother, philosophers are imprinted by the idea with which they begin. Hence, philosophies that begin with human access will never truly find their way back to things. This makes Garcia rather suspicious of twentieth century philosophy, since “the twentieth century—to which in some way this work proposes to bid adieu—has been a period of theorizing modes of access to things rather than things...” (9) Among other possible benefits of the philosophy of things that Garcia proposes, it is fully able to account for thought as a special variant of things, while the reverse is not possible.(10) In Book I of Forme et objet , Garcia’s “things” are so flat, so de-determined, that he is forced to renounce some of the most basic features ascribed to things by most realists. As he tells us in his foreboding third footnote: “We will maintain that the solitude [of things] is less than unity, less than identity, and that it does not imply acceptance (any more than refusal) of the principle of non-contradiction.” (11) In a contemporary world cluttered with too many things, Garcia’s flat and formal plane provides us with some breathing room: “The formal plan of thought enables or re-enables us to cut short all accumulation—whether of knowing, experience, or action—by a simplicity, an impoverished surface...” (13) As Garcia says elsewhere in responding to a Deleuzian critic of the book, his starting point in flat ontology is designed to obstruct the claims of both analytic philosophy and Hegelianism: “Hence, this work seeks to protect each thing—real, imaginary, inconsistent, contradictory—both against Ockham’s Razor and against the Aufhebung or dialectical process.” 18 Yet contrary to the equalizing spirit of many flat ontologies, “we will add to our formal ontology of the equal, an objective ontology of the unequal.” (13) But initially, Garcia joins all flat ontologists in holding that everything is irreducible: “this irreducibility, which we will term the ‘chance’ of each thing... also marks the refusal of a positive thought that reduces things exclusively to natural things, or social things, or historical things, etc.” (15) This irreducible “chance” of a thing emerges as an important technical term in the book, always paired with its inverted brother, the “price to pay” ( prix à payer ). On pages 17-19, we find the only diagrams in the book. What they illustrate is that Garcia wishes to avoid two equally dangerous extremes. The first is the philosophy of substance, featuring the thing-in-itself as a mighty river fed by attributes as if by subordinate tributary streams. This model can be found in many of the classic thinkers of West and East alike. In it, “there is obviously a hierarchization between that which is dragged towards something other than itself, and this other which serves it as an ontological support while supporting its proper being.” (16) For Garcia, the second extreme worth avoiding is the philosophy of events: “One thus conceives trajectories of being, identified as events, facts, powers, intensities, or intentionality. These vectors of being come first, bearing and supporting being, displacing it, but without ever finding a stopping point, a buffer, an objective consistency.” (17) The first model gives us a thing too wrapped up in itself, too compact . This word “compact” (the French and the English are the same) is another technical term for Garcia. But if the “compact” model of things leads us to something more than things, the philosophy of events gives us less than things, by dissolving them into a play of vectors. Garcia’s alternative lies midway between these two extremes: Being enters the thing, being comes out of it. And a thing is nothing other than the difference between the enters and the being that comes out. Thus, the circuit of being is never halted. In the thing, there is never the thing-in-itself. And the thing is never in-itself, but outside of itself. Nonetheless, being is not eventally “pollinated” by vectors: it possesses an objecting halting-point... (19) This single idea is the key to Garcia’s book: the thing is neither a self-contained durable lump nor some sort of evental flux. Instead, the thing is the difference between its various components and its relations with its environment. Or stated differently: “the price to pay for this disposition is a circulation of being that systematically distinguishes two senses of things: that which is in the thing , and that in which the thing is , or that which encompasses it and that which it encompasses,” (19) translating comprendre here as “encompass.” 19 In a beautiful description of a piece of black slate, Garcia sums up the various minerals, qualities, and shapes that compose [ comprend ] it, and calls them “that which is in the thing,” (20) noting that this tells us nothing about “that in which [the slate] is”—namely, all the various situations in which the black slate can be found. Instead, the slate is the difference between these two: the most characteristic principle of Garcia’s philosophy. 2. Formally Book One of Forme et objet , “Formally,” is concerned with the formal equality of all things in a flat world. “Two questions mark the boundaries of reflection: of what is everything composed [ composé ], and: what do all things compose?” (27) Looking downward, we wish to know what everything is made of; looking upward, we want to know the ultimate result of the combination of all things. Here we must turn our attention to the thing n’importe quoi— no matter what it is. (30) Anything with finite qualities is obviously too specific to be relevant to global ontological questions. To an equal degree, something possessing all qualities (think of Whitehead’s God) 20 would not be n’importe quoi either, since it would still be too definite, even if incredibly vast. The same holds for contradictions, since these all differ from each other. The square circle, the non-white black white, and the non-city city are all too distinct to count as the thing no matter what it is. The n’importe quoi must be devoid of all specific qualities, including contradictory ones. In one of the more intriguing points in his book, so reminiscent of Meinong, Garcia proclaims that “the ‘no matter what it is’ is neither a reality nor an abstract construction, nor both of these at once; the ‘no matter what it is’ is simply the plane of equality of that which is real, that which is possible, that which is inexistent, that which is past, that which is impossible, that which is true, that which is false, that which is bad.”(39-40) Since everything has two faces, it would be a grievous mistake to focus on just one of them at the expense of the other, as physicalism or materialism do when reducing the world to minuscule physical underpinnings. For scientistic materialism, “it is either atoms, particles, or fields of force... which are the things.” (47-48) Moreover, “these more-than-things are accompanied by less-than-things: for example, ideas or facts of consciousness are determined by the state of matter and are not autonomous things, but manifestations reduced to secondary effects of material processes...” (48) On this point, Garcia’s position is in complete accord with my own critique of undermining and overmining. 21 Where we disagree is that Garcia is more deeply suspicious of the notion of substance, which I view as salvageable with a few needed changes, while Garcia sees this operation as hopeless: “A substance, in the history of philosophy, is the more-than-thing par excellence.” (51) Another agreement between our positions is visible when Garcia claims (correctly, in my opinion) “that it is vain to distinguish between things which are material and those which are not.” (52) Yet we also find an even more important disagreement, since for Garcia withdrawal cannot be the quality of a thing. Instead, the absence of a thing is simultaneous with it, embodied in all that is not it– the absence of the sculpture of a woman is to be found in the mold that appears at the same time as it, and thus withdrawal must be viewed as an “event” rather than as something pertaining to an object. For Garcia, nothing withdraws beyond access. Since we must distinguish between “that which is something” and “that which something is,” and since the former is identified with “no matter what it is is” and the latter with “ not no matter what it is,” we can say that “everything is thus a milieu, a fragile link between ‘no matter what it is’ and ‘ not no matter what it is.’” (62) And here we find Garcia’s critique of the thing-in-itself: “A thing is never defined en bloc . We can affirm that a thing is this or that, but that does not suffice. It is still necessary to state precisely that which is this thing .” (62) Stated differently, “something is not in itself : for that which is in the thing is not the thing, and that in which the thing is is not the thing.” (62) And here Garcia and I, facing the same evidence, draw opposite conclusions. For me, the fact that nothing can be identified with either its components or its concrete location means that the thing must be something in-itself distinct from both of these. Yet for Garcia, to be in-itself would mean to be identified with just one of these two extreme terms, and hence the thing can only be the difference between them. Garcia is equally suspicious of the classical tendency to view “unity” as a property of the thing, since in his eyes unity is too relational a property to belong to things. (65) While specific things are situated determinately with respect to other things, we are still speaking here about the thing no matter what it is, and this can be viewed only in terms of solitude, which all things share: a human being, a hand, or a chair or all equally things insofar as they are on their own , not insofar as they are one . (64) A thing is alone, and relates only to the one thing that is not another thing: world. In a striking parallel to my own argument for a partial revival of occasionalism, Garcia tells us that “the things communicate only by their solitude: it is because everything is equally on its own in the world that things can be together, enmeshed in one another.” (67) Alone in their solitude, things all relate to world, which serves as a mediator allowing them to become mixed up in one another. As we have seen, one reason that nothing can be in itself is because everything is in something else. For Garcia, “to be in something and to be something are equivalent.” (69) Stated more broadly, “being is thus the difference between the two aspects of each thing: that which is it, and that which it is.” (70) And even more vividly: “a thing is almost like a sack: there is that which one puts in the sack and that which remains outside the sack.” (70) But not quite like a sack, “since a thing is not a thin skin or film. Instead, a thing is comparable to a sack that is immaterial and without thickness: it is nothing other than the difference between that which is this thing and that which thing is, between content and container.” (71) Nothing can be in-itself because everything is two selves at once. For example, we cannot say that our self is defined by our consciousness: “Everything has a self because nothing is in itself. The self is not the quality of that which is related to itself (which is conscious, for example) or which thinks itself related to itself. Nonetheless, for an entity called ‘conscious’ to be related to itself, it is necessary that this very relation should be another thing than the self to which it is related.” (71) Consciousness cannot be the self, precisely because it is other than that of which it is conscious. Nothing is able to grasp itself. The self is “the function by which being and composition [ compréhension ] are mutually excluded...” (72) The self is “the point of shadow of everything that projects some light...” (72) The in-itself faces two opposite dangers: “For something to be in-itself is to be a self. Something which is a self flies out through one of its two sides... Stated differently, being in-itself is simply the possibility of a double failure.” (73) The in-itself can be termed compact : “There remains to us a means of thinking that which does not fully enter into the world, though without exiting from it. This means is what we call the compact.” (76) In a sense, the compact is the opposite of the world. For in the case of the world, everything enters it and it enters nothing; as for the compact, it enters the world (since it is something, after all) while nothing enters it. (77) The compact marks the presence of the impossible in the world. (78) It is not impossible, but possible only on the condition that it fails. (78) The time has come to speak of where a thing is located. “The sole condition of a thing is that of being in another thing than itself, and thus in another thing than something.” (78) A condition is “that which determines something, that which forms something, that in which something is.” (78) As for humans, “the condition of someone is his situation; my social condition is that which socially determines me, my place and my function...” (79) More generally, “to be conditioned is to find oneself reduced to that in which one is.” (79) Everything is conditioned, but nothing is reducible to this condition. To determine the condition of something is to determine in what it is. A thing is located in that which contradicts it, just as a statue exists in its mold, which is precisely that which it is not. Since the thing is finite and definite, its condition or form must be infinite and indefinite. That in which all things are is the world, which Garcia also terms “the whole.” (81) “To try to be in-itself is to attempt to remain outside the world. And indeed, to try to be in-itself is only a path of entry into the world.” (83) For Garcia, “the world is not the pre-existent container of the things it contains, a priori , nor the construction by the mind of a fictional ensemble of all things, a posteriori .” (85) Instead, the world is simultaneous with all things; the two always go together. The world cannot be a determinate world, such as the physical universe or mathematical space, since these are already too specific and limited. “Every determinate world, which is in fact a universe , is a ‘big thing’ [ grosse chose ]: it is a set, however vast, of composite things which itself embodies a thing.” (85) Every determinate world is really just a “big thing.” Stated differently, “it is nothing other than a balanced milieu between the things that compose it and the thing that it composes.” (85) We generally picture the world as a physical univer. (shrink)

Clinicians at quaternary centers see part of their mission as providing hope when others cannot. They tend to see sicker patients with more complex disease processes. Part of this mission is offering longshot treatment modalities that are unlikely to achieve their stated goal, but conceivably could. When patients embark on such a treatment plan, it may fail. Often treatment toward an initial goal continues beyond the point at which such a goal is feasible. We explore the progression of care (...) from longshot to fantasy using two pediatric cases. This progression may be differentiated into four distinct stages of care related to the potential of achieving the initial goals of care. Physicians are often ill prepared for the progression of treatments from a longshot hope to an unfeasible and, therefore, typically unjustified intervention. We present a structured approach to guide clinicians at referral institutions where these situations may be common. The transition of care from “longshot” to “fantasy” is an inherent part of quaternary care for the sickest of patients that has been underexplored. Physicians are often poorly equipped to approach that transition. We advocate this approach to the shift from longshot to fantasy with the belief that such a structured method will have multiple benefits, including: reduced suffering for the patient; decreased emotional burden on patient and family; decreased provider moral distress; increased likelihood of seeking high quality palliative care earlier; and provision of honest and straightforward information to patients and their families. (shrink)

The recent declaration of the largest municipal bankruptcy in US history has propelled Detroit’s plight into the international spotlight. Though a victim of the general decline of US manufacturing, drawing on Thomas Sugrue’s pioneering work I argue that Detroit’s crisis is better understood as a specifically urban crisis. The city’s concentrated poverty and desolation and its fiscal straits are not reducible to broader economic trends, nor are they exclusively the product of political mismanagement. Rather, they are the outcome of a (...) long history of economic decentralization and racial segregation, made worse by a politico-administrative arrangement that distributes wealth and services unequally across the metropolitan area. By imposing municipal austerity, Detroit’s bankruptcy is unlikely to do much to address these fundamental inequalities. Any plan to revitalize the city must move beyond boosterism and tackle head on the problems of racial and economic segregation that continue to affect Detroit’s 700,000 residents. (shrink)

Background The American Society for Bioethics and Humanities (ASBH), a professional organization that certifies ethics consultants who pass the qualifying examination, published standards for the conduct of ethics consultations (EC). A national survey of adult hospital ethics consultants identified adherence to these standards, but no assessment of pediatric hospitals’ adherence has been done.Methods In this cross-sectional study, a national questionnaire was distributed electronically in 2022 to pediatric ethics consultants at children’s hospitals, collecting information about adherence to the ASBH standards. Hospital (...) characteristics were extracted from the Children’s Hospital Association Annual Benchmark Report. Quantitative analysis included descriptive statistics to assess adherence and analyses of variance to investigate associations between hospital characteristics and the time taken to respond to consultations.Results Of the 181 eligible pediatric hospitals, we received 104 completed surveys (57%) from 45 states. Pediatric EC have similar adherence rates to ASBH standards as adult hospitals. High-adherence (>75%) areas included having an expert available for EC and permitting any staff member to request EC. Low-adherence areas included having comprehensive policies covering all aspects of EC activities, having a response plan for egregious violations, and the elicitation of formal feedback after EC. There is an increased average response time for ethics consultation services in smaller pediatric hospitals and church-operated hospitals.Conclusions Pediatric hospitals overall have moderate adherence to the ASBH EC standards, with the highest rates occurring for standards that are shared by the American Academy of Pediatrics. Additional research into the barriers to standard adherence and the effectiveness of standards is warranted with emphasis on the impact of adherence on consultation quality. (shrink)

The aim of this article is to draw attention to the breadth and importance of Mumford's philosophical outlook by exploring his critical appropriation of the theories of Marx and Jung which he employed to create a penetrating, visionary collection of works that offer us a powerful and timely insight into the ills besetting our current technological civilization. Mumford partially accepted Marx's matter–psyche dynamic but expanded it to include architecture, technology and urban planning. He surpassed the one-way process of Marxist historical-economic (...) teleology to form a conception of historical process based upon a dialectic interaction between mind and material conditions. He constructed a Jungian model of mind and explored its formative effect on material conditions. At the same time he criticized Jung's failure to engage with the external world, namely with those material conditions in urgent need of transformation. Like Jung he was concerned by the exclusion of religion from the modern scientific idolum, the dominant ideological presence, yet unlike Jung he extended his analysis further, considering not only the effect of religion on the individual but also its effect on the community. His theory of the dialectic interaction of material conditions and psyche is partly drawn from these two thinkers but transcends both by refusing to commit wholly to either. His incorporation, modification and rejection of elements of both Marx and Jung contributed more significantly than has so far been noted to his own critique of the present civilization and vision for the future. This vision involved a deeper awareness of the human personality, liberation from automatism and increased sensitivity to others and the natural world. This, according to the Mumfordian project, would be inexorably followed by a gradual withdrawal from the consumerism of the current technological civilization, the construction of a more personal and organic ideology and the subsequent regeneration of material conditions to nurture human nature. I therefore argue that it is essential to our understanding of Lewis Mumford that we witness his critical engagement with Marx and Jung and see the ways in which they inform and inspire this project. (shrink)

Although the family is the safest environment for each member, sometimes violence and abuse can come from the family members. Violence causes family relationships to deteriorate as in all other relationships among people. Sibling violence, as a form of domestic violence, can sometimes have dire consequences that can result in family breakup, death or long-term loss of one of the siblings. In this study, sibling violence, which has the potential to harm family relations in such a way, will be discussed (...) in the context of two stories in the Qurʾān. It is aimed to contribute to other disciplines that study on this subject by examining the attitude of Islam against this violence, which affects the family, and the solutions of the Qur’ān to sibling violence. These stories in the Qur’ān are the story of Prophet Adam’s two sons who narrate an incident of violence that result in the brother killing his brother, and the story of Prophet Joseph and his brothers who narrate the sibling violence resulting in long-term loss. Both stories provide clues to the prevention of violence in the light of the causes of sibling violence and the behavior of the victim sibling in the development of events. In addition, because of the fact that these stories have taken place in the family of the prophets, they give people the message that sibling violence can happen in any family.Summary: Because of the social nature of the mankind, it must live in structured societies. Family is the medium for him where he is born, raised, socializes and prepares for his future life. It is normal sentiments of love, mercy and tolerance which dominate in a family. But despite this, it is possible for a family member to be a transgressor against another family member’s rights. Emotions like jealousy and hostility can cause violence between siblings. Psychologists generally attribute the source of this kind of violence to the parents’ failure to show equal love and affection to all children. While this is an important cause for violence among the siblings, craving for attention and acceptance from society, trying to achieve material and sensual superiority and desire for social success can incite feelings of envy among the siblings. While feelings of jealousy is unproblematic when its intensity can be considered normal, it can cause psychological imbalance if it increases to the level beyond manageable limits. If the latter case occurs, this produces a state of mind where a sibling becomes capable of committing every act of transgression to another sibling, which is the most important cause for the violence among siblings.Archetypical stories of Cain and Abel, and Prophet Joseph in the Qur’ān provide some clues pertaining to recognition and prevention of violence among the siblings. In these two parables, the real reason for envy does not lie in the other sibling. According to the Qur’ān, the true reason for this envy is attributed exclusively to the transgressor. In the parable of Cain and Abel, source of the problem between the siblings is the sacrificial offering to Allah. While the offering of Abel was accepted, Cain’s was not. Cain felt jealous and threatened his brother with death. Facing with his brother’s threat, Abel stayed firm and peaceful, said to his brother that if he were to attack him, he will not retaliate even for self-defence. He reminded Cain that his envy and anger was not due to him, Abel. Abel reminded Cain that the act that Cain was contemplating was a great sin in Allah’s eyes and that it is punishable by eternal hellfire. Cain, despite these warnings, went on to implement his intention of murder successfully.When we inspect the parable we can see that Abel was free from any guilt on his part for his brother’s envy which is the source of his transgression. His sacrifice was accepted because Abel was among the pious and this doesn’t harm or effect negatively Cain in anyway. Therefore the main cause for the jealousy of Cain is his unworthiness in the eyes of Allah, in reality, the reason is solely Cain himself. Therefore it is totally unfair when Cain put the blame on his brother Abel. By the way of this example, the Qur’ān reminds mankind not to blame others for his problems and to take responsibility. Envy, which is the main reason for violence among siblings, will cloud judgment and prevent clear thinking. In the parable of Cain and Abel, the Qur’ān recommends not to taunt the already jealous sibling by way of words and actions and instead, encourages warning against the grave consequences of evil intentions both in this world and in the hereafter. In the parable of Prophet Joseph, because of jealousy of their father from Joseph, bigger brothers of Joseph planned to kill him but they give up on the idea of killing him and instead they dumped him in a well. Later on in the parable, some merchant finds Joseph and brings him to Egypt. There, Joseph becomes a high ranking statesman and meets with his older brothers. Because of the famine, older brothers are in need of Joseph for food and asks him for it, without knowing that the person they are asking from is their little brother, Joseph. Although Joseph faces with his brothers on a superior position his behavior exemplifies the best course of action to end violence among the siblings. In order to remove animosity and callousness from his brothers’ heart, the gradual plan that Joseph had implemented is a great example for healing the wounds that violence among the siblings can cause. It is unreasonable to expect all the animosity and jealousy that brothers of Joseph held for years to go away completely in a moment. Prophet Joseph did not remind his brothers of their crime, on the contrary he was very generous to them. He brought their father and their brother Benjamin to Egypt and in front of them Prophet Joseph forgave his older brothers for the crimes they had committed against him. In this way, Prophet Joseph prevented his brothers potentially denying every transgression they did if he were to confront them in their first meeting, and made them ready to accept their evil deeds.Parables of Cain and Abel and Prophet Joseph are important for recognizing that envy can destroy the mercy that the siblings innately have for each other. It is understood from the parables that envy must be controlled and violence can’t be realized under any circumstances. It is clear from these parables that violence is never a solution for the jealousy among the siblings. A positive and viable solution would be for Cain to seek Allah’s approval instead of killing Abel and for brothers of Joseph this would be to earn their father’s love and respect. Introspection and analysis regarding possible reasons for jealousy and trying to resolve them and striving to be a better human, sibling, or child is a solution prescribed by the Qur’ān. Also, importance of speaking in a soft tone with the person who is experiencing intense jealousy, avoiding provocative language and behavior and trying every possible way to set this person straight is emphasized. The Qur’ān reminds us through these two parables that the human nature is prone to evil suggestions from the satan and for this reason humans need generous and benevolent help from others in order to clear themselves from these evil temptations. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Buddhist-Christian Studies 21.1 (2001) 107-108 [Access article in PDF] Sixth International Conference of the Society for Buddhist-Christian Studies John Berthrong Boston University The society's sixth international conference, held 5-12 August 2000, was an exceptionally successful event for the five hundred plus participants. In great measure the success was due to the conference's scenic and user-friendly location at the Pacific Lutheran University, Tacoma,Washington, and to the untiring work of Professor (...) Paul Ingram and his staff. The spirit of Mount Rainier towered over the whole event, reminding us that both Buddhism and Christianity have a stake in global healing.One of the most enjoyable aspects of the conference was how well the various panels, presentations, plenary programs, and workshops matched the announced theme of the conference. Although I cannot speak for all the participants, in my extensive sampling of the events, care was given in addressing the question of global healing from a diverse set of spiritual perspectives and academic disciplines.Whether you attended the section on meditation or the erudite papers on orthodoxy, the presenters strove to show how their work could be understood as a way to promote global healing.Nowhere was this attention to the theme of the conference more clearly demonstrated than in the evening plenaries. I confess that I am not a fan of evening meetings. However, in each case the various panels presented their analysis as a gift to the larger mosaic of the conference. The evenings began with Dr. A. T. Ariyaratne and Dr. Cecil Murray addressing nonviolent struggle for economic justice. This was followed by presentations on the Earth Charter; gender, justice, and oppression in Buddhism and Christianity; and consumerism and ecology. I would also be remiss if I did not note that we were treated to wonderful musical performances not only at the opening and closing ceremonies but during all the other plenaries as well.One of the most noteworthy features of the work of the society over the last two decades has been its conviction that erudite scholarship and the actual profession and practice of religion are not mutually exclusive. Furthermore, the society was founded on the belief that dialogue between Buddhists and Christians is a good thing in and of itself. The workshop on the interior dialogue of meditation was a gentle refutation to those in the academic world who maintain that only analysis of isolated religious practices or texts makes any sense. The society has always urged its members to bring their practices as well as their ideas to the dialogical encounter. [End Page 107]Music played a moving role in the life of the conference. The plenary sessions took place in the magnificent new music center at PLU, wherein resides a huge concert organ.We were literally moved by the organ's powerful rendition of the classic works of the Western religious musical tradition. Matching the organ was the gentle call of the shakuhachi. An organ and a shakuhachi may seem mismatched in theory and performance--much less sheer volume for the bamboo flute--but they blended into a symphony of shared sacred music.Having praised the thematic attentiveness, musical brilliance, and spiritual depth of the conference, I must likewise highlight the academic integrity of the papers. Many of the professorial types mentioned over and over again how pleased they were with the thoughtfulness of the academic presentations. Here we need not only to thank the authors but also the conference planning committee for its ability to select the best representatives of erudite, informed, and engaged models of academic scholarship. Those who were not present will simply have to wait for many of these fine papers to be published in various scholarly journals. Another helpful detail was the conference bookstore, which stocked many of the recent publications of the participants.The only criticism I heard during the whole conference was that it was, alas, a bit too long. In this busy world it is difficult for most people to block out a whole week for one conference. I mention this only in... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Buddhist-Christian Studies 21.1 (2001) 107-108 [Access article in PDF] Sixth International Conference of the Society for Buddhist-Christian Studies John Berthrong Boston University The society's sixth international conference, held 5-12 August 2000, was an exceptionally successful event for the five hundred plus participants. In great measure the success was due to the conference's scenic and user-friendly location at the Pacific Lutheran University, Tacoma,Washington, and to the untiring work of Professor (...) Paul Ingram and his staff. The spirit of Mount Rainier towered over the whole event, reminding us that both Buddhism and Christianity have a stake in global healing.One of the most enjoyable aspects of the conference was how well the various panels, presentations, plenary programs, and workshops matched the announced theme of the conference. Although I cannot speak for all the participants, in my extensive sampling of the events, care was given in addressing the question of global healing from a diverse set of spiritual perspectives and academic disciplines.Whether you attended the section on meditation or the erudite papers on orthodoxy, the presenters strove to show how their work could be understood as a way to promote global healing.Nowhere was this attention to the theme of the conference more clearly demonstrated than in the evening plenaries. I confess that I am not a fan of evening meetings. However, in each case the various panels presented their analysis as a gift to the larger mosaic of the conference. The evenings began with Dr. A. T. Ariyaratne and Dr. Cecil Murray addressing nonviolent struggle for economic justice. This was followed by presentations on the Earth Charter; gender, justice, and oppression in Buddhism and Christianity; and consumerism and ecology. I would also be remiss if I did not note that we were treated to wonderful musical performances not only at the opening and closing ceremonies but during all the other plenaries as well.One of the most noteworthy features of the work of the society over the last two decades has been its conviction that erudite scholarship and the actual profession and practice of religion are not mutually exclusive. Furthermore, the society was founded on the belief that dialogue between Buddhists and Christians is a good thing in and of itself. The workshop on the interior dialogue of meditation was a gentle refutation to those in the academic world who maintain that only analysis of isolated religious practices or texts makes any sense. The society has always urged its members to bring their practices as well as their ideas to the dialogical encounter. [End Page 107]Music played a moving role in the life of the conference. The plenary sessions took place in the magnificent new music center at PLU, wherein resides a huge concert organ.We were literally moved by the organ's powerful rendition of the classic works of the Western religious musical tradition. Matching the organ was the gentle call of the shakuhachi. An organ and a shakuhachi may seem mismatched in theory and performance--much less sheer volume for the bamboo flute--but they blended into a symphony of shared sacred music.Having praised the thematic attentiveness, musical brilliance, and spiritual depth of the conference, I must likewise highlight the academic integrity of the papers. Many of the professorial types mentioned over and over again how pleased they were with the thoughtfulness of the academic presentations. Here we need not only to thank the authors but also the conference planning committee for its ability to select the best representatives of erudite, informed, and engaged models of academic scholarship. Those who were not present will simply have to wait for many of these fine papers to be published in various scholarly journals. Another helpful detail was the conference bookstore, which stocked many of the recent publications of the participants.The only criticism I heard during the whole conference was that it was, alas, a bit too long. In this busy world it is difficult for most people to block out a whole week for one conference. I mention this only in... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Radicalizing the Local: 60 Linear Miles of Transborder ConflictTeddy Cruz (bio)2008estudio teddy cruzmedium: collage and vinyl wallpaperThe international border between the US and Mexico at the San Diego-Tijuana checkpoint is one of the most trafficked in the world. A 60-linear-mile cross-section—tangential to the border wall—between these two border cities compresses the most dramatic issues currently challenging our normative notions of architecture and urbanism.This transborder “cut” begins 30 miles north (...) of the border, on the periphery of San Diego, and ends 30 miles south of the border. We can find along this section’s trajectory a series of collisions, critical junctures, or conflicts between natural and artificial ecologies, top-down development and bottom-up organization. It is in the midst of many of these metropolitan and territorial sites of conflict where contemporary architectural practice needs to reposition itself.1. Conflict between master-planned gated communities and the natural topography +30 miles / San DiegoTop-down private development has been installing a selfish, oil-hungry sprawl of detached McMansions everywhere, forming massive subdivisions that collide with the natural topography.2. Conflict between large infrastructure and the watershed +28 miles / San DiegoLarge freeway and mall infrastructure runs the length of coastal San Diego, colliding with a natural network of canyons, rivers, and creeks that descend toward the Pacific Ocean.3. Conflict between privatization and everyday life +25 miles / San DiegoThe archipelago of beige tract homes also exacerbates a land use of exclusion, leading to an apartheid of everyday life, as gated communities retreat from the complexities of mixed uses.4. Conflict between military bases and environmental zones +20 miles / San DiegoIronically, the only interruptions along an otherwise continuous sprawl, 30 miles inland from the border, occur as the military bases that dot San Diego’s suburbanization overlap with environmentally protected lands.5. Conflict between the formal and informal +15 miles / San DiegoThe informal densities and economies produced by immigrants yield three-dimensional land use that collides with the one-dimensional zoning that defines suburban tract subdivisions. [End Page 107]6. Conflict between two border cities 0 miles / San Diego-TijuanaThis territorial conflict is currently dramatized by the hardening of the border wall that divides these cities, incrementally transforming San Diego into the world’s largest gated community.7. Conflict between the natural and political +0.5 miles / TijuanaAs the large infrastructure of the Tijuana River clashes with the border wall, a faint yellow line is inscribed on the dry river’s concrete channel to indicate the trajectory of the border. The border checkpoint is exactly at this intersection.8. Conflict between the informal and natural ecologies-10 miles / TijuanaAdjacent to the checkpoint we can find many slums crashing against the border. The wall acts as a powerful dam, containing the density of Tijuana and preventing it from contaminating San Diego’s picturesque sprawl.9. Conflict between factories and emergency housing-15 miles / TijuanaThese American-style, mini-master-planned communities are intertwined with a series of informal communities or slums, and both provide maquiladora factory enclaves with cheap labor.10. Conflict between density and sprawl-20 miles / TijuanaThousands of miniaturized replicas of typical suburban Southern California McMansions are now scattered around the periphery of Tijuana. In recent years, dwellers have radically transformed them into socioeconomic microengines.11. Conflict between two horizons-30 miles / TijuanaAs we reach the sea on the Mexican side, we witness the most dramatic of all territorial collisions across this 60-mile-section of local conflict. Here, the border metal fence finally sinks into the Pacific Ocean. [End Page 108] Click for larger view View full resolution[End Page c1] Click for larger view View full resolution[End Page 2] Click for larger view View full resolution[End Page 12] Click for larger view View full resolution[End Page 22] Click for larger view View full resolution[End Page 32] Click for larger view View full resolution[End Page 42] Click for larger view View full resolution[End Page 52] Click for larger view View full resolution[End Page 62] Click for larger view View full resolution[End Page... (shrink)

National identity and attachment to national culture have taken root even in this era of globalization. National sentiments find expression in multiple political spheres and cause troubles of various kinds in many societies, both domestically and across state borders. Some of these problems are rooted in history; others are the result of massive global immigration. As US Secretary of State John Kerry tries to broker a new round of Israel-Palestine peace talks, the Israeli government continues expanding its settlements in disputed (...) territories. As this proposal is being written, Japanese citizens are debating whether their politicians should visit the Yasukuni Shrine (靖國神社), where the spirits of fourteen Class A war criminals from WWII and more than one thousand others convicted of war crimes by the International Military Tribunal for the Far East are honored with a distinguished resting place. As the Chinese government’s plan to bring economic prosperity to the Xinjian province unfolds, ethnic conflicts between Han Chinese and local Uyghur Muslims intensify. Tibetans still demonstrate to the Chinese government, some through the dramatic sacrifice of self-immolation, their determination to pursue a Tibet that is truly free and autonomous. The recent inflow of Muslim immigrants across Europa and North America forces those liberal democratic societies to rethink the meaning of multiculturalism. Should the state respect Muslim women’s freedom to wear burkas in public? What about other aspects of certain Muslim traditions such as arranged marriages or the honor killing of teenage girls who see boys their parents do not approve? Since these immigrants voluntarily moved from their homeland to a new society, do they have a duty to give up such practices, which conflict with their new societies’ fundamental commitment to individual autonomy? Eric Hobsbawm suggests that nationalism is a contingent phenomenon in history—it arises with important historical events such as industrialization and print journalism; eventually, it will disappear. Anthony Smith, on the other hand, argues that nationalism is deeply rooted in the human need for collective faith and dignity. How should we understand today’s nationalism? Is it a transient phenomenon that eventually will be eradicated from the world, or is it a timeless issue that confronts and will remain a challenge for every society? Is the conventional distinction between civic and cultural nationalism still relevant or helpful? The problems and ongoing challenges of nationalism are very much alive throughout East Asia where the myth of ethnically and culturally homogeneous nations is still paramount. In addition to the examples provided above, East Asian societies are increasingly multicultural, inevitably forcing their governments to come up with new immigration and border-control policies, revisit their laws regarding labor policies, sociopolitical discrimination, socioeconomic welfare, and, more fundamentally, rethink the constitutional make-up of the citizenry and the ideal of social harmony, one of their most cherished political values. Nevertheless, contemporary theoretical analyses, whether philosophical or empirical, of the phenomena surrounding nationalism, in all its forms, are almost exclusively focused on cases in western cultures and societies, preventing the East Asian people from developing a coherent idea of who they are or should be in a way that can track their deeply-held values and norms (such as Confucianism). One of the primary aims of this conference therefore is to address this ongoing neglect and explore new concepts and theories that are socially relevant in East Asia. Not only will this provide access to the particular experiences of nation, citizenship, and nationalism throughout East Asia but it will bring to bear philosophical concepts, approaches, and styles of reasoning about them that currently are not part of this critical debate. Providing an opportunity to hear these distinct and different East Asian voices and opening up these conceptual and methodological resources to scholars around the world will greatly advance the understanding and appreciation of nationalism. In addition to this primary aim, the proposed conference will achieve two other, novel, and important goals. First, by design, it will bring to bear a multi and interdisciplinary approach to the problems of nationalism. We are not privileging either conceptual or empirical studies in the organization of our conference and will bring together philosophers, political scientists, sociologists, and historians, making every effort to invite scholars who explicitly employ or are interested in exploring different and at times hybrid approaches. Second, we will draw together scholars from around the world: China, South Korea, Japan, Taiwan, North America, and Europe, including leading figures in the field, who will serve as keynote speakers for the conference. Combining these two additional goals will enable us to organize a uniquely diverse conference, both in terms of intellectual discipline and national origin. Along with our primary aim of introducing East Asian voices and theories, this will make our event original, distinctive, and unprecedented in value. Our age is one in which it is unavoidable for people of different cultural backgrounds to live together in many different places. For the sake of justice and stability, a comprehensive re-examination of nationalism is both urgent and necessary. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:BOOK REVIEWS The Abuse of Casuistry: A History of Moral Reasoning. By ALBERT R. JoNSEN & STEPHEN TOULMIN. Berkeley: University of California Press, 1988. Pp. ix +420. This volume results from the collaborative efforts of a social philosopher and an ethician. The two authors undertook the book's composition while taking part in the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. Set up by (...) the United States Congress in 1974, this federal commission worked for some three years. Thus, it was in the course of political discussions, which concerned governmental control of scientific experimentation involving human persons, that the authors generated new perspectives on and, to be sure, a new definition of casuistry. Furthermore, in Abuse of Casuistry, Albert R. Jonsen and Stephen Toulmin purport to establish an historical perspective for concerns which figure prominently in the cacophony of contemporary moral discourse. Towards this end, they set forth an innovative interpretation of the history of moral reasoning. Regretfully, this task constrains them. Throughout the book, the authors deal selectively with any data which do not conform to their fundamental intuition concerning the ultimate particularity of moral decisions. In short, the authors advance the argument that " casuistry " (as they understand and define it) provides a basic paradigm for all practical moral decisions, so that the validity of moral " rules " meets with a priori suspicion. Undoubtedly the problem-solving situation which gave rise to the collaborative research abets such a point de depart. We are not surprised, then, to discover a sub-heading like "the tyranny of principles " (p. 5) early along in the book's prologue. The authors explain their focus: "[I]t is just those situations that are not covered by appeal to any single simple rule that begin to be problematic; and in just those cases our concern to act rightly gives rise to genuinely moral "questions" and "issues" (p. 7). Furthermore, they insist: " Even a simple rule may leave us in genuine doubt in situations to which it applies only marginally or ambiguously." This exclusive emphasis on what moralists once called the " situation " launches an ambitious project to re-capitulate the history of moral reasoning from perspectives broadly characteristic of casuistry. The basic plan of the book incorporates six major parts. In a 151 152 BOOK REVIEWS cursory way, the first three parts consider large fields of research: first, classical philosophy, which, argue the authors, forms the " roots of casuistry in antiquity," next, the early and medieval Christian "precursors " of casuistry, and, finally, the renaissance phenomenon, which scholars usually identify as the period of casuistry. All in all, we move from the peripatetic Greeks of the 5th and 4th centuries B.C. to the European casuists of the 16th and 17th centuries A.D. Part one locates the remote origins of casuistry in classical Greek philosophy and its concern for the difference between theory and practice in moral mat· ters. In part two, the authors consider representative figures from Athens, Rome, and Jerusalem in order to illustrate clearly that the resolution of moral perplexities has always formed part of any serious moralist's work. We also encounter the medieval canonists, confessors, and theologians. Unfortunately, the authors sometimes press a theologian into unwilling service for their working hypothesis. To cite one example, as expected, they focus their study of Aquinas onto his consideration of moral circumstances in Summa theologiae, Ia-Hae, qq. 7 and 18. It is true, their general theory holds: serious moralists do take into account those "special circumstances that mark the individual's lot" (George Eliot, "The Mill on the Floss"). However, the authors also overstate their conclusions. For instance, they implicate Aquinas as follows: In sum, ' the human act ought to vary according to diverse circum· stances: this is the entire matter of morality.' That last text from Thomas Aquinas could almost serve as the motto for the whole enterprise of casuistry (p. 135). Of course, such an evaluation does not take even partial account of Aquinas's moral theory. What is more to the point, the quotation does not exist in any of the three different places named by the authors, viz., Summa theologiae, Ia-Hae, q. 18, aa... (shrink)

This paper develops a political economic explanation of the 2007–9 US subprime crisis which focuses on one of its central causes: the transformation of racial exclusion in US mortgage-markets. Until the early 1990s, racial minorities were systematically excluded from mortgage-finance due to bank-redlining and discrimination. But, then, racial exclusion in credit-markets was transformed: racial minorities were increasingly given access to housing-credit under terms far more adverse than were offered to non-minority borrowers. This paper shows that the emergence of the subprime (...) loan is linked, in turn, to the strategic transformation of banking in the 1980s, and to the unique global circumstances of the US macro-economy. Thus, subprime lending emerged from a combination of the long US history of racial exclusion in credit-markets, the crisis of US banking, and the position of the US within the global economy. From the viewpoint of the capitalist accumulation-process, these loans increased the depth of the financial expropriation of the working class by financial capital. The crisis in subprime lending then emerged when subprime loans with exploitative terms became more widespread and were made increasingly on an under-collateralised basis – that is, when housing-loans became not just extortionary but speculative. (shrink)

There is an ongoing discussion concerning personal vs. impersonal considerations in professional care. In this article, three different positions within the ethics of closeness will be discussed. These are: (a) reserving the ethics of closeness for close experienced others, ‘including the experienced Other’, which is Nortvedt's position; (b) trying to bring the distant, non‐experienced others closer, ‘including the Third’; and (c) finally, an examination of whether a perspective of closeness may lead to the exclusion of various groups in need of (...) help, ‘including the Other at the expense of the Third’. These positions are discussed with a view to clarifying some of the challenges that the ethics of closeness faces when it maintains that greater ethical obligation is associated with personal than with impersonal relations, without discussing the terms on which the obligation is based. Key questions that arise for a nurse or other health professional are: If our primary moral responsibility is for those that are close to us, the experienced others, who is to be responsible for those that are outside the established health services, the non‐experienced others? Is it evident that favouring the experienced others is based on legitimate needs? Can a discussion on the legitimate basis of nursing be avoided in questions relating to closeness and priorities? This discussion touches the heart of our discipline. Is a one‐sided perspective of closeness, rejecting moral responsibility for those with whom we have no relationship, a defensible ethical position? (shrink)

There is an ongoing discussion concerning personal vs. impersonal considerations in professional care. In this article, three different positions within the ethics of closeness will be discussed. These are: (a) reserving the ethics of closeness for close experienced others, ‘including the experienced Other’, which is Nortvedt's position; (b) trying to bring the distant, non‐experienced others closer, ‘including the Third’; and (c) finally, an examination of whether a perspective of closeness may lead to the exclusion of various groups in need of (...) help, ‘including the Other at the expense of the Third’. These positions are discussed with a view to clarifying some of the challenges that the ethics of closeness faces when it maintains that greater ethical obligation is associated with personal than with impersonal relations, without discussing the terms on which the obligation is based. Key questions that arise for a nurse or other health professional are: If our primary moral responsibility is for those that are close to us, the experienced others, who is to be responsible for those that are outside the established health services, the non‐experienced others? Is it evident that favouring the experienced others is based on legitimate needs? Can a discussion on the legitimate basis of nursing be avoided in questions relating to closeness and priorities? This discussion touches the heart of our discipline. Is a one‐sided perspective of closeness, rejecting moral responsibility for those with whom we have no relationship, a defensible ethical position? (shrink)

While most of the mortality associated with severe acute respiratory syndrome coronavirus 2 has been in elderly populations and adults with significant medical comorbidities, there has been death and morbidity in paediatric populations. As vaccine trial data is released to the public, many people look to the future with hope ; with good vaccine uptake there is the opportunity to reduce the spread of infectious pandemics. Initial vaccine trials were completed with adults and were expanded to include paediatric (...) populations delaying paediatric COVID-19 vaccine initiatives. The exclusion of children from initial vaccine trials during a pandemic is not morally justifiable and fosters distrust with the pharmaceutical and medical industries and inevitably postpones vaccinating children when there is a surplus of available vaccines. The delayed vaccination of children under twelve may have significant public health and economic consequences as there may be ongoing viral transmission in the context of reopening strategies. The safety and efficacy of these candidate vaccines in children should be assessed expeditiously so that distribution to vulnerable paediatric populations is not impacted. Vaccine uptake compliance in the general population is important in establishing herd immunity and ensuring that there is thorough scientific evidence to support vaccination for children is important in establishing community trust. (shrink)

It is quite obvious why the antireductionist picture of mental causation that rests on supervenience is an attractive theory. On the one hand, it secures uniqueness of the mental; on the other hand, it tries to place the mental in our world in a way that is compatible with the physicalist view. However, Kim reminds us that anti-reductionists face the following dilemma: either mental properties have causal powers or they do not. If they have them, we risk a violation of (...) the causal closure of the physical domain; if they do not have them, we embrace epiphenomenalism, which denies any sort of causal powers to the mental. So, either we violate the causal closure of physics, or we end up with epiphenomenalism. The first two sections of the article describe the problem of causal exclusion and Kim’s causal dilemma. The last two introduce Horgan’s antireductionist answer and my objection to that answer. (shrink)

This article argues that while the presence and influence of “futility” as a concept in medical decision-making has declined over the past decade, medicine is seeing the rise of a new concept with similar features: suffering. Like futility, suffering may appear to have a consistent meaning, but in actuality, the concept is colloquially invoked to refer to very different experiences. Like “futility,” claims of patient “suffering” have been used (perhaps sometimes consciously, but most often unconsciously) to smuggle value judgments about (...) quality of life into decision-making. And like “futility,” it would behoove us to recognize the need for new, clearer terminology. This article will focus specifically on secondhand claims of patient suffering in pediatrics, but the conclusions could be similarly applied to medical decisions for adults being made by surrogate decision-makers. While I will argue that suffering, like futility, is not sufficient wholesale justification for making unilateral treatment decisions, I will also argue that claims of patient suffering cannot be ignored, and that they almost always deserve some kind of response. In the final section, I offer practical suggestions for how to respond to claims of patient suffering. (shrink)

Brain tumors are a common form of solid tumors in children and, unfortunately, they are characterized by a very uncertain prognosis. The treatment of this pathology often includes one or more very invasive surgical procedures, quite often in the very first steps of the treatment. Cases of brain tumors in children represent one of the greatest challenges for health care professionals in the domain of pediatric neurosurgery. This is clearly due to the complexity of the therapeutic plan, but also (...) to the nature of the bond that is established between the child, the parents, and the members of the staff during the often-dramatic initial phase of the illness. In this phenomenological-hermeneutic study, we explore both the emotional and organizational needs, as well as the available professional and personal resources of the staff in the Neurosurgery ward of the Meyer Children’s Hospital in Florence. The ward staff, composed of 7 surgeons, a pediatric neuro-oncologist, 12 nurses, and 4 auxiliary health care professionals, underwent in-depth interviews that were recorded. The recordings were then transcribed and submitted to content analysis according to COREQ standards. A complex picture of emotional as well as organizational demands emerged from the data. Shared experiences were pointed out, together with more specific and idiosyncratic contents characteristic of different professional roles. The focus of the present paper was twofold, first, we considered the needs that are overtly expressed by the staff, and then we discussed the main sources of their motivational drives. We found that the latter is mainly found in the quality of the therapeutic bond that is established with the children and the family members, together with the deep interest in one’s own professional activity and the effective complementarity and integration of the personal and professional qualities of the staff members within the multidisciplinary caring group. (shrink)

The philosophy of family‐centered care (FCC) promotes partnerships between families and staff to plan, deliver, and evaluate services for children and has been officially adopted by a majority of pediatric hospitals throughout North America. However, studies indicated that many parents have continued to be dissatisfied with their decision‐making roles in their child's care. This is particularly salient for parents of children with chronic ongoing complex health problems. These children are dependent upon medical technology and require frequent hospitalizations during which (...) parents must contribute to difficult decisions regarding their child's care. Given this clinical issue, an alternative theoretical perspective was explored to redress this problem. Pierre Bourdieu's theoretical concepts of field, capital, and habitus were used to analyze the hierarchical relationships in pediatric acute care hospitals and to design a briefing intervention aimed at improving parents' satisfaction with decision making in that health care setting. (shrink)

Jaegwon Kim maintains that his ‘exclusion argument’ forces us to accept reductive physicalism, which identifies mental and other high-level properties of the world with lower-level properties, over nonreductive physicalism, which avoids such identifications. According to Kim, the exclusion argument shows that any nonreductive view leads to either epiphenomenalism or unacceptable overdetermination of physical effects by physical causes. However, a popular nonreductive physicalist approach called ‘compatibilism’ aims to show that physicalism need not collapse high-level properties into lower-level physical. Compatibilism attempts to (...) block the exclusion argument by attending to the tight modal relationship between higher and lower properties required by nonreductive physicalism. Unfortunately, a similarly tight modal relationship will be embraced by any dualists who hold that natural laws are metaphysically necessary. Despite its increasingly widespread popularity among nonreductive physicalists, it thus seems that the compatibilist’s proposed solution cannot be upheld without removing the barriers to dualists of this sort. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:260 HISTORY OF PHILOSOPHY Christian business" is not knowledge but experience. He founds religious certainty on individual inspiration and emphasizes charity against external written law. A man inspired by God becomes autonomous and acquires a mind of his own--independent of external authorities. This valuable study (pp. 5-109) is followed by an extensive bibliography (pp. 113--209) in which it could be added that Vald~s' Al[abeto Cristiano was reprinted in 1948 (...) by the Editorial "La Aurora" of Buenos Aires. In 1946 this publisher considered (in the Preface to his reprint of Vald~s' Dicilogo de Doctrina Cristiana, p. 12) republishing also Vald6s' Ciento y diez consideraciones divinas. PAUL T. FUrIRMAN~ Columbia Theological Seminary Descartes. Oeuvres philosophiques. Tome I (1618-1637.) Textes 6tablis, pr6sent6s et annot6s par Ferdinand Alqui6. l~dition illustr6e. (Paris: Garnier Fr6res, 1965. [Glassiques Garnier.] Pp. 829 + 12 plates.) The publication of this massive paperbound volume is an event in Descartes studies. It is the first in a three-volume edition of Descartes' complete philosophical works in French, an edition which is original in its plan, up-to-date in scholarship, worked from the sources, and superbly annotated, the only truly new edition since Charles Adam completed the great AT in 1913. Professor Alqui6 defines the word "philosophical" almost as broadly as Descartes did. To the specifically philosophical texts he adds generous portions of the non-mathematical scientific works. All Latin texts are given in French translation (the Meditations are to appear bilingually.) The spelling is modern. The AT pagination appears in the margin, but the volume number should be given there too. Scholars working with AT and AM (Adam-Milhaud's Correspondance de D.) should take note of the textual corrections and emendations in this Edition dlquid. In the battle of Descartes interpretation Professor Alqui6 takes the chronological stand. Where Martial Gueroult sees a marvellously wrought monolithic system, there Alqui6 sees development and growth: to understand Descartes one must follow his "itin6raire philosophique" step by step. In his new role as editor he practices what he preached. This is the first edition to take us in unbroken, rigorously chronological sequence from the first extant writing through the year of the Discours de la mdthode. Even the correspondence is broken up and inserted between the writings in its chronological place. (Just about half of Descartes' letters of this period--none written to him--are given:.58 as against 27 in the Pl6i'ade edition.) The volume opens with a few (too few) paragraphs from the Compendium Musicae of 1618 and sections from the Cogitationes privatae, including the complete text of Baillet's account of the Dream of Descartes. The Regulae appear in a new, annotated translation by Jacques Brunschvicg. Le Monde et le Traitd de l'Homme, treated as one manuscript, is here, all but complete. After the Discours de la mdthode we get the first six chapters of the Dioptrique and four of the ten chapters of Mdtdores. All omitted chapters are summarized. The little Traitd de la m~canique brings up the rear. The missing Gdom(trie is to appear in a companion volume of collected mathematical writings, promised for some later date. The reader who never read all of Descartes' writings between 1618 and 1637 in fl~eir chronological order will find a new vista opening up. This is particularly true of the sixty-odd pages of earliest writings. But here the editor's principle of excluding "mathematical " texts works against his clear intention of keeping interpretation out: "Une ~dition BOOK REVIEWS 261 de Descartes," he writes, "n'est pas une th~se sur la philosophie de Descartes." Alqui6 here (and only here) excludes not only all purely mathematical texts but also those on mechanics, optics, acoustics, hydraulics, automata, etc., and even epistemologically significant items like "hi omni questione debet dari aliquod medium," "Si funis," and the full text of the ars memoriae passage. The only exception is Descartes' answer to Beeckman's problem regarding free fall, truncated at the point where Descartes with the characteristic dlan of these years continues: "Ut autem hujus scientiae fundamenta jaciam...". AlquiCs general justification for the exclusion of "mathematics" rests upon the evidence that Descartes himself... (shrink)

This paper problematizes the precision medicine approach embraced by the All of Us Research Program (US) and by Genomics England (UK) in terms of benefits distribution, by arguing that current “diversity and inclusion” efforts do not prevent exclusiveness, unless the framing and scope of the projects are revisited in public health terms. Grounded on document analysis and fieldwork interviews, this paper analyzes efforts to address potential patterns of exclusion upstream (from participating in precision medicine research) and downstream (from benefitting from (...) precision medicine outputs). It argues that efforts for inclusion upstream are not corresponded downstream, and this unbalance jeopardizes the equitable capacities of the projects. It concludes that enhanced focus on socio-environmental determinants of health and aligned public health interventions as precision medicine outputs would be to the benefit of all and especially of those who are most at risk of (upstream as well as downstream) exclusion. (shrink)

Genetic cancer predisposition testing in the paediatric population poses unique ethical dilemmas. Using the hypothetical example of a teenager with cancer with a high probability of having an underlying cancer predisposition syndrome, we discuss the ethical considerations that affect the decision-making process. Because legally these decisions are made by parents, genetic testing in paediatrics can remove a child’s autonomy to preserve his or her own ‘open future’. However, knowledge of results confirming a predisposition syndrome can potentially be beneficial in (...) modifying treatment and surveillance plans and enabling at-risk family members to obtain cascade testing for themselves. Considering virtue ethics to envision the best characters of the patient, parents and healthcare providers can guide them to the better choice to test or not to test, with the ultimate goal of achieving the best outcome for survival andeudaimonia, human flourishing reliably sought out. (shrink)

Citizenship regimes are institutionalized systems of formal and informal norms that define access to membership, as well as associated rights and duties. This paper studies illegalized migration as one of the major tests to assess whether citizenship regimes are fair institutions, based on a historical analysis of legislation meant to reduce illegalized migration in the United States between 1995 and 2022. We build our empirical research starting from a simple observation: despite the great number of bills introduced to reduce illegalized (...) migration to the US, most of such initiatives fail to become law. In fact, 93.5% of all immigration initiatives did not even pass the chamber of Congress in which they were originally presented. Such a high rate of failure shows that these proposals are motivated by electoral aspirations, rather than coming from a genuine wish to help migrants or grant them citizenship. Furthermore, there is also an economic interest that justifies the maintenance of low-cost disposable immigrant labor, with no right to citizenship. Our analysis is an example of how state regulation processes seem to work to formalize, rather than alleviate or eradicate, the precarious legal statuses of illegalized migrants. We conclude that a globalized phenomenon such as citizenship requires going beyond merely institutional and formal conceptions. We need to rethink the institutional notion of citizenship, as a merely status held under the authority of a state and consider it from a cosmopolitan perspective and a multilateral basis. But as long as citizenship remains under the responsibility of states, illegalized migrants will continue to experience precarious citizenship. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Road to Understanding and Acceptance of the Late Effects of Pediatric Brain Tumors and TreatmentJeanne CarlsonWe had little warning or time to adjust to our daughter’s diagnosis. A call from her third grade teacher reporting that Sarah seemed to be having vision problems rapidly led to eye exams, an MRI, and the discovery of a Germinoma brain tumor in the suprastellar region of Sarah’s brain. We were terrified (...) but began treatment feeling optimistic about the outlook for Sarah’s recovery. Luckily, Sarah’s treatment was relatively non–invasive and quick, chemotherapy and radiation, five months start to finish. We were thrilled to have Sarah’s treatment behind us.As any parent of a child with a life–threatening illness knows, family life is seriously disrupted by the countless doctor, lab, and hospital visits, the worry, and the financial strain that are suddenly added to the demands of everyday life. We did our best to balance our focus on both of our children as Sarah is a twin and we didn’t want her brother Will to suffer as a result of his sister’s illness. It wasn’t easy but we found a way to schedule Will’s usual play dates, baseball practice, and family time. We were all happy and relieved when Sarah’s treatment was completed, yet we would later learn that we had been incredibly naïve in two ways; we thought that our brain tumor journey was over after Sarah’s treatment was completed and we thought that we’d brought Will through the process without effect. We had a lot to learn.At the time of diagnosis we knew that Sarah’s memory and ability to express emotion had already been impacted by the tumor but we didn’t yet know what that would mean to her quality of life. We were virtually unaware however that at age nine the chemotherapy and radiation treatments that Sarah received would result in profound late effects. Following treatment Sarah successfully completed 3rd grade and even received excellent STAR test scores (California state standardized tests). In 4th grade however, Sarah’s performance began to diverge from that of her peers and she found herself struggling in school and unable to make friends. We began looking for ways to help our daughter.What followed was a five year long journey through testing, evaluations, individualized education plans (IEPs), and therapies, which, in the end, left our family needing to accept the fact that although Sarah remains intelligent and artistically talented, she suffers from a constellation of late effects that will always affect her ability to function in the world. As a result of Sarah’s tumor and treatment she struggles with Auditory Processing Disorder, word finding problems, poor executive function, inability to recognize how she feels, significant difficulty making decisions, inability to read social cues, poor memory, slow processing, an emotional age of about nine, and lots of anxiety. She is also panhypopituitary, meaning that she has no remaining pituitary function and must take replacement medications by pill and injection, has hypothalamic obesity (HO), which is primarily controlled by more medication, and Raynaud’s Disease. The HO is an ongoing challenge because if Sarah does gain weight she can’t lose it again and exercise is not an easy solution because, like many pediatric brain tumor survivors, Sarah is easily fatigued. Finally, although Sarah’s vision improved after treatment her vision loss is significant enough to prevent her from driving. We pieced together this understanding of Sarah’s challenges and disabilities slowly so it wasn’t until the end of our children’s middle school years that we finally accepted the magnitude of the damage caused by the tumor and treatment. Thereafter we changed our focus from what Sarah might achieve in life to how to support [End Page 21] her in the activities at which she still excels and how to keep her active, interested in life, and feeling good about herself.It would have been a huge gift if we had been provided with information about the possible late effects that can result from treating the brain of a 9–year–old... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:A Bittersweet Score:A Father’s Account of His Family’s 20-Year Journey After a Pediatric Brain Tumor DiagnosisChristopher RileyI hadn’t seen him for 20 years, not since the day he drilled a hole in Peter’s head and left the stainless steel drill and bloody bit on the bedside table. He figured prominently in the story I often told of that day when he, a doctor in training, [End Page 3] informed (...) my wife Kathy and me that, “Wow,” our five-year-old son had “an impressive tumor” in his brain. He announced it with the admiration I reserve for a touchdown pass or stunning sunset. Since that day, he had become a venerable physician. Back then he was the resident who met us in the ER after our pediatrician told us that the MRI of Peter’s brain was “not normal,” that “there might be a growth.” As if there might not be. I imagined that Peter’s brain might simply have an unusual shape, or that the scan revealed some undiscovered fracture and the authorities only wanted to lock me up and all with my son would be well. The thrilled young doctor slew those hopes with an ice pick: “Wow, that’s an impressive tumor.” I said, “That’s the first time anyone has used the word tumor.” The doctor appeared mortified and started over.Now 20 years later we found ourselves at the same party and I felt a compulsion to introduce myself, remind him we’d met that day in 1993, and tell him what had become of Peter and his family in the decades since he’d made that mortifying mistake, one I hoped had become for him a defining moment. To my disappointment, he didn’t seem to remember.Peter was my red-haired boy. Fearless and whip smart, he told a stream of knock-knock jokes and performed dance routines choreographed by his 8-year-old sister Rachel. Six months of headaches, vomiting and clumsy falls led to discovery of the tumor. When I phoned my parents with the news, I couldn’t speak the words, words that felt as if they spelled my boy’s doom. My body refused to pronounce them.The war for Peter’s life began with surgery. I sat with Kathy in the surgical waiting area, fearing every minute that I would see the surgeon approaching with his shoulders slumped in mortal defeat. I learned during those hours that fear of your child’s death is a physical pain, a constriction in the chest, a suffocation. At the end of that wait, the surgeon told us the tumor was out and Peter had survived. The pathology indicated the tumor was a medulloblastoma. Without additional treatment, including radiation, it was certain to come back. Kathy’s knees buckled. Having just endured one life-and-death battle, we were plunged into another. To complicate matters, Peter wasn’t waking from surgery. Even after the anesthesia wore off, Peter remained groggy, unable to move or focus his eyes.Through the following days, Peter failed to rouse or speak. Sores formed at the back of his neck where his unswallowed saliva pooled. Neurologists doubted he knew us. His doctors hoped Peter would recover but it was possible he would remain as he was indefinitely. As I sat holding his useless hand, watching his useless body, I thought I’d never loved him as much as I did now.Peter’s doctors presented two treatment options. The first consisted of relatively high doses of daily radiation, the most effective known method for preventing the return of the cancer. But radiation wasn’t good for young brains. It “shaved IQ points,” they said in wild understatement. So they offered a second, experimental option, one that reduced radiation by a third and added months of chemotherapy. The doctors hoped this new regimen would be as effective as the old but cause less cognitive damage. They asked us to choose. It seemed impossible. We gathered the scant available data. We weighed the risks. We prayed. We took a leap. Without asking him, we made a decision for Peter we knew... (shrink)

A challenge of performing research in the paediatric emergency and acute care setting is obtaining valid prospective informed consent from parents. The ethical issues are complex, and it is important to consider the perspective of participants, health care workers and researchers on research without prospective informed consent while planning this type of research. We performed a systematic review according to PRISMA guidelines, of empirical evidence relating to the process, experiences and acceptability of alternatives to prospective informed consent, in the (...) paediatric emergency or acute care setting. Major medical databases and grey sources were searched and results were screened and assessed against eligibility criteria by 2 authors, and full text articles of relevant studies obtained. Data were extracted onto data collection forms and imported into data management software for analysis. Thirteen studies were included in the review consisting of nine full text articles and four abstracts. Given the heterogeneity of the methods, results could not be quantitatively combined for meta-analysis, and qualitative results are presented in narrative form, according to themes identified from the data. Major themes include capacity of parents to provide informed consent, feasibility of informed consent, support for alternatives to informed consent, process issues, modified consent process, child death, and community consultation. Our review demonstrated that children, their families, and health care staff recognise the requirement for research without prior consent, and are generally supportive of enrolling children in such research with the provisions of limiting risk, and informing parents as soon as possible. Australian data and perspectives of children are lacking and represent important knowledge gaps. (shrink)

Professional philosophy in the United States has recently enjoyed a revival of discussion regarding the inclusion of Asian philosophies in the discipline, a revival that includes popular press articles, journal articles, books, and blog discussions.1 Such discussions can prompt hope that change is afoot and the discipline may, at long last, become more genuinely inclusive. However, for those of us who have been in the profession long enough, it is likewise difficult to resist a certain cynicism. After all, episodic bursts (...) of attention to Asian philosophy come around sufficiently often that new discussion can register as but rehearsals of familiar laments, laments that include, for example: the small numbers of... (shrink)

Environmental ethics deals with discussing the ethical framework of environmental values, their organization and regulation, and their ethical premises. One of the main cul-de-sacs that environmental ethics has is its anthropocentrism that can be observed through its diverse ethical approaches—even ecocentric ones, developed as non-anthropocentric egalitarian alternatives. This article aims to question the exclusiveness of Anthropos, the practices, values, and discourses that determine the scope and course of environmental ethics, and the exclusion of nonhuman animals or more-than human beings from (...) its focus. It first examines the main approaches in environmental ethics (land ethic, deep ecology, social ecology, and postmodern environmental ethics)—biocentric, ecocentric, anthropocentric, socialist, postmodern—and reveals that they are but limited to the human perspective, deeply rooted in human exceptionalism. All of these approaches provide us with a critical frame that still needs to be deconstructed so that they will not project an anthropocentric orientation. This article posits that the compass of environmental ethics, recently aligning itself to embrace the more-than-human world in its ecocentric attitude, still needs to be revisited for its discourses of exclusion. At this point, new materialism functions as a prolific theoretical site as it diminishes the classical boundaries between human and animal or subject and object that anthropocentric environmental ethics relies on. With such concepts as “agential realism” (Barad), “transcorporeal ethics” (Alaimo), “vibrant matter” (Bennett), or “storied matter” (Oppermann and Iovino) the new materialist view of the human and the nonhuman evolves to end set dualities in the discourses of environmental ethics. This article concludes that the new materialist theory destabilizes any anthropocentric position in environmental ethics and includes more-than-human beings in its ethical focus, discarding any dualities that serve anthropocentrism or human exceptionalism. (shrink)