Withholding or withdrawing life-saving ventilators can become necessary when resources are insufficient. In the USA, such rationing has unique social justice dimensions. Structural elements of dominant allocation frameworks simultaneously advantage white communities, and disadvantage Black communities—who already experience a disproportionate burden of COVID-19-related job losses, hospitalisations and mortality. Using the example of New Jersey’s Crisis Standard of Care policy, we describe how dominant rationing guidance compounds for many Black patients prior unfair structural disadvantage, chiefly due to the way creatinine and (...) life expectancy are typically considered.We outline six possible policy options towards a more just approach: improving diversity in decision processes, adjusting creatinine scores, replacing creatinine, dropping creatinine, finding alternative measures, adding equity weights and rejecting the dominant model altogether. We also contrast these options with making no changes, which is not a neutral default, but in separate need of justification, despite a prominent claim that it is simply based on ‘objective medical knowledge’. In the regrettable absence of fair federal guidance, hospital and state-level policymakers should reflect on which of these, or further options, seem feasible and justifiable.Irrespective of which approach is taken, all guidance should be supplemented with a monitoring and reporting requirement on possible disparate impacts. The hope that we will be able to continue to avoid rationing ventilators must not stand in the way of revising guidance in a way that better promotes health equity and racial justice, both to be prepared, and given the significant expressive value of ventilator guidance. (shrink)

A phenomenalist philosophy which employs the Principle of Acquaintance (PA) plus the Principle that what exists are the referents of certain meaningful terms, defined by PA, cannot include either universals or particulars in its ontology, but is limited to instances of universals as constituting the range of ontological existents. Universals must be omitted since they are repeatable and, hence, never wholly presented or contained, whereas the objects of direct acquaintance are wholly and exhaustively presented. Furthermore, no entities beyond characters (qualities (...) and relations) are given in direct acquaintance; hence, particulars, too, must be omitted for the phenomenalist who relies on PA. (shrink)

Four models of forgiveness are identified; the health model, the philosophical model, the Christian model and the prosocial model. All define the term ‘forgiveness’ in a way which is consistent with their particular perspective. The authors offer a definition of forgiveness and propose an integrated model of forgiveness which seeks to incorporate contributions from all four areas, but is not biased towards any one model. Four levels of transgression are identified and categorized according to the degree of perceived damage. Apology-automatic (...) and apology-dependent responses are distinguished from a forgiveness response which is restricted to Levels 3 and 4. The advantages of adopting a forgiveness strategy for both the forgiver and forgiven as opposed to other responses, i.e., revenge, denial, and condoning are discussed. The authors provide a definition and model which integrates the important contributions from each of the areas discussed. (shrink)

A Christian analysis of the moral conflicts that exist among physicians and health care institutions requires a detailed treatment of the ethical issues in managed care. To be viable, managed care, as with any system of health care, must be economically sound and morally defensible. While managed care is per se a morally neutral concept, as it is currently practiced in the United States, it is morally dubious at best, and in many instances is antithetical to a Catholic Christian ethics (...) of health care. The moral status of any system of managed care ought to be judged with respect to its congruence with Gospel teachings about the care of the sick, Papal Encyclicals, and the documents of the Second Vatican Council. In this essay, I look at the important conceptual or definitional issues of managed care, assess these concerns over against the source and content of a Catholic ethic of health care, and outline the necessary moral requirements of any licit system of health care. (shrink)

Some people have found my distinction between meaning and significance useful. In the following revision of that distinction, I hope to improve its accuracy and perhaps, therefore, its utility as well. My impulse for making the revision has been my realization, very gradually achieved, that meaning is not simply an affair of consciousness and unconsciousness. In 1967, in Validity in Interpretation, I roundly asserted that “there is no magic land of meanings outside human consciousness.” 1 That assertion would be true (...) if, godlike, we could oversee the whole of human consciousness, past, present, and future. But we language users, being limited creatures, intend our verbal meanings to go beyond what we can pay attention to at any moment. We intend our meanings to transcend our momentary limitations of attention and knowledge. Hence there is a land of meanings beyond past and present human consciousness—the land of the future. What I should have said originally is that there is no magic lance of meanings beyond the whole extent of human consciousness, past, present, and future. This correction of my original statements leads to a deepening of the concept of meaning.In 1960 I first proposed the analytical distinction between two aspects of textual interpretation. One of them, meaning, was fixed and immutable; the other, significance, was open to change.2 I acknowledged that significance, changeable or not, is the more valuable object of interpretation, because it typically embraces the present use of texts, and present use is present value. But I argued that, in academic criticism, the significance and use of a text ought to be rooted in its fixed meaning, since otherwise criticism would lack a stable object of inquiry and would merely float on tides of preference. The claim that one reader’s opinion is as valid as another’s would then be right, despite any indignant protest to the contrary. I did not wish to dissuade people from floating on the tides of preference if that was what they wished to do. I intended to provide a firm justification for those who wished to pursue historical scholarship. 3 I also assumed that even those who did not pursue historical scholarship might sometimes wish to exploit the possibility of historically fixed meaning. In my experience, even antiauthorial theorists sometimes with to regard their own texts as having a historically fixed meaning and will complain if someone misunderstands that meaning. 1. E. D. Hirsch, Jr., Validity in Interpretation, p. 4.2. See my “Objective Interpretation,” PMLA 75 : 463-79.3. See, for instance, W. K. Wimsatt, Jr., and Monroe C. Beardsley, “The Intentional Fallacy,” in Wimsatt, The Verbal Icon: Studies in the Meaning of Poetry, which ends:We submit that this is the true and objective way of criticism, as contrasted to what the very uncertainty of exegesis might tempt a second kind of critic to undertake: the way of biographical or genetic inquiry …. Our point is that such an answer to such an inquiry would have nothing to do with the poem “Prufrock”; it would not be a critical inquiry. Critical inquiries, unlike bets, are not settled in this way. Critical inquiries are not settled by consulting the oracle. [P. 18] E. D. Hirsch, Jr., professor of English at the University of Virginia, is the author of numerous works, including Validity in Interpretation and The Aims of Interpretation. His previous contributions to Critical Inquiry are “Against Interpretation?”, “The Politics of Theories of Interpretation, and “Stylistics and Synonymity”. (shrink)

This essay examines the funeral sermon given by the Baptist theologian Andrew Fuller (1754–1815) for his friend and deacon Beeby Wallis in 1792 as a vantage-point from which to pursue reflection on Fuller’s concept of heaven and the beatific vision. The sermon has two main themes: the rest and rewards of those who die in Christ. The essay examines how Fuller interprets both of these phrases and then, looking at the rest of Fuller’s corpus, notes that ultimately God himself is (...) the believer’s reward. (shrink)

Towards the end of Plutarch's treatise de Pytkiae oraculis Theon quotes a short passage of verse but does not identify its author. The fragment is now customarily printed among the remains of Pindar's Parthenea, most recently by Snell.