Deemed consent legislation for deceased organ donation was introduced in England in 2020, and is considered a vital part of the new UK NHS Blood and Transplant’s 10-year strategy to increase consent for organ donation. Despite the legislation containing safeguards to protect the public, the introduction of deemed consent creates ethical, psychological and social un/certainties for healthcare professionals in their practice. In this paper, we offer insights into healthcare professionals’ perspectives on deemed consent, drawn from interview data with 24 healthcare (...) professionals in an NHS Trust in England, prior to the introduction of the legislation. Whilst participants supported deemed consent in principle, they were concerned that it would present a threat to the nature of donation as a ‘gift’; the notion of informed consent (or non-consent); and the autonomy of donors, their relatives, and their own roles as health professionals, posing dilemmas for practice. We argue that healthcare professionals present themselves as guardians of potential (non)donors and thus as having ethics and integrity in their own practice. We draw conclusions around the values and principles that matter to healthcare professionals when contemplating consent in deceased donation which will be useful for organ donation committees and ethics forums. (shrink)

John Dewey (1859-1952) lived from the Civil War to the Cold War, a period of extraordinary social, economic, demographic, political and technological change. During his lifetime the United States changed from a rural to an urban society, from an agricultural to an industrial economy, from a regional to a world power. It emancipated its slaves, but subjected them to white supremacy. It absorbed millions of immigrants from Europe and Asia, but faced wrenching conflicts between capital and labor as they were (...) integrated into the urban industrial economy. It granted women the vote, but resisted their full integration into educational and economic institutions. As the face-to-face communal life of small villages and towns waned, it confronted the need to create new forms of community life capable of sustaining democracy on urban and national scales. Dewey believed that neither traditional moral norms nor traditional philosophical ethics were up to the task of coping with the problems raised by these dramatic transformations. Traditional morality was adapted to conditions that no longer existed. Hidebound and unreflective, it was incapable of changing so as to effectively address the problems raised by new circumstances. Traditional philosophical ethics sought to discover and justify fixed moral goals and principles by dogmatic methods. Its preoccupation with reducing the diverse sources of moral insight to a single fixed principle subordinated practical service to ordinary people to the futile search for certainty, stability, and simplicity. In practice, both traditional morality and philosophical ethics served the interests of elites at the expense of most people. To address the problems raised by social change, moral practice needed to be thoroughly reconstructed, so that it contained within itself the disposition to respond intelligently to new circumstances. Dewey saw his reconstruction of philosophical ethics as a means to effect this practical reconstruction. (shrink)

In ‘The ethics of consent during labour and birth: episiotomies,’ van der Pijl et al 1 respond to the prevalence of unconsented procedures during labour, proposing a set of necessary features for adequate consent to episiotomy. Their model emphasises information sharing, value exploration and trust between a pregnant person and their healthcare provider(s). While focused on consent to episiotomy, van der Pijl et al contend their approach may be applicable to consent for other procedures during labour and beyond pregnancy-related care. (...) One feature of their model for adequate informed consent is trust in the systems in which prenatal and labour and delivery care are provided. Yet, for some pregnant persons, mistrust in health systems is a reasonable sequela of experiences like racism and epistemic injustice. For a programme in which trust is central to adequate consent, it is important to identify—and counter—forms of mistrust toward pregnant persons within healthcare and acknowledge and rectify reasonable mistrust of pregnant persons toward healthcare. Like other kinds of healthcare disparities, van der Pijl et al note that ‘the burden of unconsented procedures is not evenly distributed over groups’ and tracks with ‘racial, socioeconomic and other disparities in maternity care’. They are drawing on data from a less diverse context than the one …. (shrink)

This chapter will focus on the biomedical moral enhancement of offenders – the idea that we could modify offenders’ brains in order to reduce the likelihood that they would engage in immoral, criminal behaviour. Discussions of the permissibility of using biomedical means to address criminal behaviour typically analyse the issues from the perspective of medical ethics, rather than penal theory. However, recently certain theorists have discussed whether brain interventions could be legitimately used for punitive (as opposed to purely therapeutic) purposes. (...) For instance, Jesper Ryberg argues (although he himself is not a retributivist) that there is nothing to prevent retributivists from endorsing brain interventions as a legitimate form of retributive punishment. Legal academics have not yet paid sufficient attention to whether this proposal would be compatible with international human rights law, nor have retributivist philosophers discussed whether their favoured penal theories have the conceptual resources to explain why brain interventions would not be an appropriate method of punishment. This chapter considers whether there is any indication that these interventions are being used at present for punitive purposes and whether this would violate the European Convention on Human Rights. It examines different versions of retributivism and considers which theory is in the best position to challenge the use of brain interventions as a form of punishment. Finally, it considers whether offering these interventions as an alternative to punishment would violate principles of proportionality. (shrink)

O presente trabalho pretende analisar a influência de Einstein na teoria da ciência de Popper. Procuramos mostrar que o falibilismo e o conjecturalismo defendido por Popper é fruto das leituras que ele fez das obras de Einstein. Muito embora Einstein tenha antecipado muitas das idéias do filósofo austríaco, foi ele quem deu unidade, fundamento e consistência a essas ideias esboçadas de forma fragmentada nos textos de Einstein.

Communication, when defined as an act intended to affect the psychological state of another individual, demands the use of inference. Either the signaler, the recipient, or both must make leaps of understanding which surpass the semantic information available and draw from pragmatic clues to fully imbue and interpret meaning. While research into human communication and the evolution of language has long been comfortable with mentalistic interpretations of communicative exchanges, including rich attributions of mental state, research into animal communication has balked (...) at theoretical models which describe mentalized cognitive mechanisms. We submit a new theoretical perspective on animal communication: the model of inferential communication. For use when existing proximate models of animal communication are not sufficient to fully explain the complex, flexible, and intentional communication documented in certain species, specifically non-human primates, we present our model as a bridge between shallower, less cognitive descriptions of communicative behavior and the perhaps otherwise inaccessible mentalistic interpretations of communication found in theoretical considerations of human language. Inferential communication is a framework that builds on existing evidence of referentiality, intentionality, and social inference in primates. It allows that they might be capable of applying social inferences to a communicative setting, which could explain some of the cognitive processes that enable the complexity and flexibility of primate communication systems. While historical models of animal communication focus on the means-ends process of behavior and apparent cognitive outcomes, inferential communication invites consideration of the mentalistic processes that must underlie those outcomes. We propose a mentalized approach to questions, investigations, and interpretations of non-human primate communication. We include an overview of both ultimate and proximate models of animal communication, which contextualize the role and utility of our inferential communication model, and provide a detailed breakdown of the possible levels of cognitive complexity which could be investigated using this framework. Finally, we present some possible applications of inferential communication in the field of non-human primate communication and highlight the role it could play in advancing progress toward an increasingly precise understanding of the cognitive capabilities of our closest living relatives. (shrink)

A growing number of theorists have launched an epistemic challenge against retributive punishment. This challenge involves the core claim that it is wrong (intentionally) to inflict serious harm on someone unless the moral argument for doing so has been established to a high standard of credibility. Proponents of this challenge typically argue that retributivism fails to meet the required epistemic standard, because retributivism relies on a contentious conception of free will, about whose existence we cannot be sufficiently certain. However, the (...) scope of the epistemic challenge should not be limited to doubts about free will or retributivism. In this article, I argue that the epistemic challenge should be expanded beyond the original focus on justifications of punishment. By “expanding the epistemic challenge” I mean demanding that other purported justifications for serious (intentional) harm be held to a high standard of credibility. To provide a focus for the argument, I will concentrate on the “Public Health Quarantine Model” defended by Gregg Caruso, but my arguments have wider implications beyond this model. A growing number of “abolitionist” theorists believe that punishment is wrong in principle. If retributive punishment, or punishment in general, were abandoned, we would need to ask, “how else should we respond to crime?”. My arguments suggest that all such abolitionists will have to face the same epistemic standard as penal theorists if they wish to replace punishment with the intentional imposition of non-punitive severe coercive measures. (shrink)

Smoking consequences are seen disproportionately among low-SES smokers. We examine the self-regulatory strategy of mental contrasting with implementation intentions as a smoking reduction tool and whether its effectiveness depends on subjective-SES. This pre-registered online experiment comprised a pre-screening, baseline survey, and follow-up. Participants reported past-week smoking, subjective-SES, perceived stress, and were randomized to an active control or MCII condition. Data were collected via MTurk, during the U.S.’ initial wave of COVID-19. Participants were moderate-to-heavy smokers open to reducing or quitting. The (...) primary outcome was self-reported smoking reduction, computed as the difference between recent smoking at baseline and follow-up. The secondary outcome was cessation, operationalized as self-reported 7-day point-prevalence abstinence at follow-up. Among those low—but not high—in subjective-SES, MCII improved smoking reduction by an average of 1.09 fewer cigarettes smoked per day, though this effect was not conclusive. Similarly, quitting was descriptively more likely for those in the MCII than control condition, but the effect was non-significant. Per an exploratory analysis, we observed that stress significantly moderated the condition effect, such that MCII facilitated reduction among those experiencing high, but not low stress. Consistent with prior findings that MCII works best in vulnerable populations, MCII may be more effective for smoking reduction among high-stress than low-stress individuals. These findings contribute to growing research on income-related health disparities and smoking behavior change tools. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Nomadic Turns:Epistemology, Experience, and Women University Band DirectorsElizabeth GouldMusic education occupations in the U.S. have been segregated by gender and race for decades. While women are most likely to teach young students in classroom settings, men are most likely to teach older students in all settings, but most particularly in wind/percussion ensembles.1 Despite gender-affirmative employment practices, men constitute a large majority among band directors at all levels.2 At the (...) postsecondary level in the U.S., women constitute less than 10%.3 In all cases and all levels, the vast majority of band directors are white. Occupational segregation inhibits the development of individuals' careers as well as the development of the profession as individuals choose or are hired for positions based on their gender and/or race rather than their abilities.In terms of women university band directors, researchers have investigated employment trends,4 personal and occupational characteristics,5 occupational role models, and professional identity.6 Their findings generally have supported the hypotheses that historical precedent, traditional socialization, discrimination, segregation, and lack of role models contribute to their persistently low percentage as band directors. Longitudinal studies7 demonstrate that the percentage of women band directors has not increased significantly, and may be actually [End Page 147] declining after thirty years of enforcing affirmative action laws, which would suggest that these interventions have not provided the basis for enacting change in the profession. Further, change does not seem possible if members of the profession do not understand what causes the situation to persist. For example, while the College Band Directors National Association has supported the Linda A. Hartley and Deborah A. Sheldon study,8 their concern seems to be in only identifying the extent of the situation with the intention of increasing the number of women and non-white individuals who are band directors within the profession as it currently is constructed. This empirical approach is inadequate because it addresses neither the values held by members of the profession, nor its structure, which as previous research indicates, is poorly understood and must change to make possible meaningful increases in the number of women and non-white people.The profession of conducting university bands exists within the profession of music education in general, which, of course, exists within the profession of music. Clearly, one cannot be adequately understood without placing it in the context of the others. What is needed, then, are richer, more substantive, and meaningful understandings of the professions in general and of specific questions within them in particular, as they may provide the basis on which change can be possible. In addition to addressing the issue of persistent occupational gender and racial segregation, questions that may be addressed include positionalities9 of bands in the music education profession, the relationship of performance/conducting to the music profession, and the role of the musician in society in general. In order to accomplish this, I propose an analytical method that is both postmodern and feminist, and in which the philosophical figuration of the nomad, as explicated by Rosi Braidotti,10 is central.Postmodern/Feminist AnalysisDescribed variously as a "philosophical perspective,"11 a "sensibility,"12 and a historical moment,13 postmodernism resists definition. It may be understood as a way of perceiving the world that accepts and even embraces contradictions and uncertainties while rejecting commonly accepted cultural beliefs and practices, including humanist understandings of identity, representation, and the subject. This is a "postmodernism of resistance"14 that interrogates cultural practices, focusing on what is unexpected, marginalized, and silenced, opening spaces for change. In contrast, analysis based on modernism is constrained by binary oppositions that inscribe the positionalities of social groups. These oppositions are exemplified by Subject/Other (for example, male/female, reason/emotion) and consist of asymmetrical power relations in which the former is privileged over the latter, and the latter is defined in terms of not-the former. Postmodern analysis [End Page 148] reveals what these dualisms exclude, distort, or obscure, and provides flexibility for research from a variety of perspectives. Braidotti describes it as a "new kind of theoretical style"15 in terms of thinking, design, and analysis of research, a style... (shrink)

Focuses on the encounters of feminist and queer theories, on the ways in which basic terms such as - sex, gender, and sexuality change meaning as they move from one body of theory to another. This book includes essays by Judith Butler, Evelynn Hammonds, Biddy Martin, Kim Michasiw, Carole-Anne Tyler, and Elizabeth Weed.

This article presents a model of employee dishonesty and formation of stakeholders' images of organizations, which applies theories of moral judgment and attribution. It describes the person-situation interaction effects of characteristics of employee behavior and of persons making moral judgments on stakeholders' moral judgments, amounts of blame, loci of blame, and images of organizations. Using a situationally based definition of dishonesty, the article examines the effects of the act, the actor, the result, the person affected, and the intent of an (...) employee's behavior on stakeholders' images of the organization, as well as the effects of the characteristics of the person making the moral judgment. The situationally based definition of dishonesty provides a theoretical basis for understanding how differences in situations lead to differences in moral judgments by the same individuals. The person making the moral judgment is presented as a part of the model to explain how differences in viewpoints result in different moral evaluations of the same situations by different judges. Research directions are identified and discussed. (shrink)

This article explores two central notions of ‘dialectics’ and ‘dialogics’ based on the work of Vygotsky and Bakhtin respectively, as well their varying interanimations within Stalin-Marxist Russian societyIt is proposed that these two positions are incommensurably located alongside one another in contemporary education. I argue that Bakhtin offers diametrically oppositional educational provocations to those of Vygotsky.The implications of these interpretations will be explored with consideration of their underlying philosophical incompatibilities and contradictions, as well as the opportunities such a consideration pose (...) for educational practice today. (shrink)

This article claims that postmodernity necessarily, and perhaps opportunely, undermines the bases upon which political democracy traditionally has rested; and that therefore some significant work must be done in order to redefine, restore, or otherwise reconfigure democratic values and institutions for a changed cultural condition. This situation presents the opportunity to explore the new options, positive openings, and discursive opportunities that postmodernity presents for political practice; for this the problem of agency provides a focal issue.The practices of postmodernity, taken together, (...) represent substantial challenges, not just to this or that cherished habit, but to modernity itself and all its corollaries, including its inventions of objectivity, of "the individual" , and of all the related values which still underwrite so much of what we do as citizens, consumers, and professionals not to mention as more private persons, parents, and partners. Fortunately, postmodernity does not demolish all our most cherished beliefs, values, and practices; but it does require recognition of how those beliefs, values, and practices actually function and of what alternatives they suppress. (shrink)

North American music education is a commodity sold to pre-service and in-service music teachers. Like all mass-produced consumables, it is valuable to the extent that it is not creative, that is, to the extent that it is reproducible. This is demonstrated in curricular materials, notably general music series textbook and music scores available from a rapidly shrinking cadre of publishers, as well as rigid and pre-determined pedagogical practices. Distributing resources and techniques that produce predicable, consistent, and repeatable goods and services, (...) the economy of music teacher preparation and development must necessarily exclude creativity, which consequently must be viewed as not only inefficient but unprofitable. More than undesirable, however, creativity is constructed as dangerous as it injects difference in a system that relies on sameness. Because of its implications for music education discourse and practices, I focus my discussion on research in general and feminist critique in particular in music education. Reading through Monique Wittig's ‘The Trojan Horse’ as literary war machine, I argue that creative writing and academic research are not mutually exclusive, and that it is only through infusing the literary or creative in scholarly writing that interlocking systems of oppression may be altered and difference implicated in music education. My analysis of Roberta Lamb's (1995) research piece, ‘Tone Deaf/Symphonies Singing: Sketches for a Musicale’ depicts it as Trojan Horse, albeit one that Lamb herself, most likely as a function of editorial imperative, hobbles. (shrink)

The premise of this symposium is that the principle and ideal developed in Brown v. Board of Education2 and its successor cases lie at the heart of the rationale for affirmative action in higher education. The principle of the school desegregation cases is that racial segregation is an injustice that demands remediation. The ideal of the school desegregation cases is that racial integration is a positive good, without which “the dream of one Nation, indivisible”3 cannot be realized. Both the principle (...) and the ideal make racial integration a compelling interest. The Supreme Court recognized these claims in Grutter v. Bollinger. However, it failed to take full advantage of them. It thereby failed to answer crucial questions that must be answered by policies subject to strict scrutiny. In this essay, I shall display the links tying Grutter to Brown, discuss the vulnerabilities of Grut- ter in the absence of an explicit grounding in Brown, and demonstrate how the affirmative action policy upheld in Grutter, when explicitly grounded in Brown, survives strict scrutiny. To understand this argument, it is helpful first to explain the integrationist perspective that underlies it. (shrink)

This chapter will discuss ethical issues connected with neuroscientific research on prisoners, focusing specifically on whether participating in such research should always be disregarded when making decisions about early release from prison. It was once routine in some jurisdictions for a prisoner’s participation in medical research to count as “good behaviour”, which could be given weight in decisions about early release. However, medical ethicists now widely regard this practice as ethically problematic, because prisoners might feel pressurised to participate in medical (...) research programmes by the desire to escape a coercive and harsh prison environment, and thus their agreement to take part in the programme might not satisfy the freedom requirement for valid consent. Yet, there may be a tension between traditional medical ethics and theories of punishment (a tension which also arises in other contexts at the interface between medicine and punishment). From the perspective of retributive or communication/reform-based theories of punishment, it might seem unfair for parole boards to disregard willingness to participate in medical research, if the prisoner were motivated by altruistic considerations. This altruism might indicate that the prisoner “deserves” a shorter sentence or may be a sign that the prisoner has reformed. This chapter will consider whether/how this tension between traditional medical ethics and penal theories can be resolved. For example, if the medical research involves relatively safe interventions such as fish oil pills or transcranial direct current stimulation (tDCS), then the above-mentioned worries about prisoners’ ability to provide free consent may be less pressing than if the risks of side-effects were greater. Furthermore, the validity of consent also seems to depend partly on whether the prison conditions are humane or excessively harsh. In addition, problems also arise in this context from within penal theories. Ironically, transparency about what factors will be taken into account in decisions about early release, which would presumably be encouraged by communication/reform theories, could raise the possibility that the prisoner was motivated to participate in the research programme by a desire for early release rather than altruism, thus making it harder to determine whether participation is a genuine sign of reform. (shrink)

This paper concerns the relationships between persons, brains, behaviour, and psychological explanation. Tye defines a ‘psychological framework’ (PF) as a set of token beliefs, desires, intentions, memories, streams of consciousness, higher-order mental states, etc., that ‘form a coherent whole’ and against which a creature’s ‘behavior can be explained’ (p. 141). A person is the subject of such a psychological framework. Each person has one PF, and with each new PF there is a new person. Meanwhile materialism tells us, according to (...) Tye, that brains are the bearers of mental states. In other words, ‘each person is a brain’ (p. 142) — or rather a ‘global physical state of the brain,’ since Tye believes that a single brain might realize multiple PFs and thus constitute multiple persons. Most of this paper simply assumes Tye’s account of personal identity, in order to expose certain contradictions within what Tye says about personhood in split-brain subjects. Towards the end of the paper, however, I turn to alternative accounts of persons. While a method of individuating persons grounded in scientific psychology would identify persons with psychological frameworks, as Tye does, perhaps an account of personhood grounded either in a non-psychological science, or in non-scientific psychology, would better fit the interests we have in personal identity. (shrink)

ArgumentMontpellier vitalists upheld a medical perspective akin to modern “holism” in positing the functional unity of creatures imbued with life. While early vitalists focused on the human organism, Jean-Charles-Marguerite-Guillaume Grimaud investigated digestion, growth, and other physiological processes that human beings shared with simpler organisms. Eschewing modern investigative methods, Grimaud promoted a medically-grounded “metaphysics.” His influential doctrine of the “two lives” broke with Montpellier holism, classifying some vital phenomena as “higher” and others as “lower” and attributing the “nobility” of the human (...) species to the predominance of the former. In place of Montpellier teaching that attributed health to the holistic equilibration of vital activities, Grimaud embraced spiritualist dualisms of soul and body, Creator and created. Celebrating the divinely-ordained “wisdom” evident in involuntary physiological processes, he argued that such life functions were incomprehensible to human investigators. While Grimaud's work encouraged inquiry into the division between the central and “vegetative” nervous systems that became paradigmatic in nineteenth-century neuroscience, it also opened Montpellier vitalism to charges of conservatism and obscurantism that are still lodged against it to the present day. (shrink)

This chapter contains sections titled: Introduction The Elements of Tragedy and Its Definition Plot and Character Simple and Complex Plots Good and Bad Tragic Plots Conclusion Notes Bibliography.

Kim (1998) has argued that a genuine robust physicalism does not leave any room for real, causally efficacious mental properties. Despite all of his concerns about the reality and causal efficacy of mental phenomena Kim does not eliminate all higher-level macro causation. Kim’s problem with the mental is that most current cognitive theories imply that the mind is not higher-level but higher-order. In this paper I argue that connectionism makes meaning higher-level and therefore by Kim’s own standards puts meaning on (...) the same footing as other real causally efficacious higher-level properties. The upshot is that we can side-step the current debate about mental causation by moving the mind to the shared uncontroversially real and physical common-ground. (shrink)

Aby Warburg's Nachlass, the heart of the Warburg Institute Archive, is complemented by other large holdings which are no less remarkable. Quietly accumulating over the decades, still only provisionally cataloged, the vast corpus of letters filed as “General Correspondence” reveals itself to be a spectacularly rich resource for twentieth-century cultural and intellectual history. The secretariat was efficient: most everything was kept, letters received as well as copies of letters sent, meaning that the visitor to Woburn Square can sit in a (...) single archive, read both sides of exchanges, and follow conversations over years — a rare circumstance. The academic staff maintained contact with an impressively large number of internationally active scholars, working in many fields, and the letters are characteristically substantive. In this article, the author indicates how a book she is presently writing, Warburg Circles, 1929 – 1964, has been shaped by these archival holdings. She offers a brief history of the consolidated archive now located on the fourth floor of the Warburg Institute, a story that throws light on recent scholarly trends; and she gives examples of the sorts of historical insight that may be gained from this corpus of correspondence. (shrink)

In order to strengthen civic education in elementary schools, research is needed to understand preservice teachers’ ideas about civic teaching. The current study examined the degree to which elementary preservice teachers’ civic competencies (i.e., civic awareness, dispositions, and interpersonal skills) and the grades they plan to teach are associated with expected future civic teaching. Survey data were collected from 235 undergraduate students majoring in early childhood or elementary education. Results from hierarchical multiple regression showed that greater civic awareness and lower (...) levels of trust in the American promise were associated with expected future teaching about politics, while greater civic awareness, stronger commitment to social issues, and better interpersonal skills were associated with expected future teaching about community engagement. Additionally, those who plan to teach the upper elementary grades (third–fifth) were more likely to report that they will teach about politics and community engagement in their future classrooms when compared to those who plan to teach younger grades (PreK–second). Practical implications for preservice teacher preparation are discussed. (shrink)

Human population growth, along with technological development and levels of consumption, is a key driver of our devastating impact on the environment. This must be acknowledged as a matter of urgency. Otherwise, we risk bequeathing future generations a tragic choice between introducing explicitly impermissible coercive population policies, becoming incapable of securing even basic human rights, and worsening climate change and other environmental damage. However, this chapter warns against approaching questions of population from too narrow an environmental ethics viewpoint. If this (...) debate is conducted in isolation from considerations of global justice, there is a real danger of advocating policies that are plausible on the surface but impermissible when assessed in terms of their implicit impact on individual human lives. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Elizabeth Hanson-Smith AUGUSTINE'S CONFESSIONS: THE CONCRETE REFERENT The chief problem facing critics who would consider the Confessions as both a literary work and a philosophical treatise remains the connection between the first nine books, the autobiography, and the last four, the metaphysical speculations on time, eternity, epistemology, and theology. A persistent desire to justify the work as an aesthetic whole has led critics on a search for thematic (...) and structural unity; they have been more successful in the former endeavor than in the latter. The interpretation of the work's plot as a peregrinatio animae, a pilgrimage of the soul, is now generally accepted as definitive; but attempts to find structural unity within that broad outline have not progressed beyond Marrou's characterization of the work as a "musical composition."1 His analogy to music has not been anchored to any concrete structural features of the Confessions and does not illuminate the connections between its content and its form. I shall attempt to prove that a unified structural model for the development of the soul in the Confessions does indeed exist and is outlined in Augustine's earlier discursive work, the De quantitate animae.2 The seven degrees or steps (gradus) of the soul's ascent to God, as sketched in the De quantitate, are deliberately fleshed out and translated into a mimetic, narrative version in the Confessions. Placing the two works side by side gives us a unique opportunity to examine a typically medieval literary form, the educative journey, in its relationship to its philosophical premises. Such a study reveals the inner formal unity of the literary work and, further, provides us with significant evidence for a re-examination of Augustine's Neo-Platonism, his supposed dualism, and his influence on later works, both literary and philosophical. In the Confessions we see one of the earliest Christian blendings of several models: first, the educative journey, the archetypal pattern familiar from the Odyssey, the Aeneid, and even The Golden Ass of Apuleius. Augustine's version, like later medieval cosmologies, also 176 Elizabeth Hanson-Smith1 77 includes a vision of the cosmic order and its relationship to human order, elements of significance in pagan philosophical works such as the Timaeus and the Dream of Scipio. But Augustine's journey also depends upon the Judeo-Christian conception of history as a series of figurae or types of the Messiah: the protagonist of the Christian educative journey joins thefigurae of the Biblical past. Christ's incarnation as Mansoul and his life on earth are the pattern of universal history from Fall to Apocalypse; Christ's life becomes a figurative pattern for the actions of Everyman.3 The Confessions is one of the earliest Christian works to apply this pattern in a narrative context. Augustine was also preoccupied with the Hexaemeron, the six days of creation and the seventh of rest. He views the exegesis of Genesis as an explanation of all subsequent life; the Ages of Man recapitulate the days of creation, as do the sacraments and the seven steps in the ascent of the soul. Thus, to the figurative pattern of Christ's "pilgrimage" from creating Logos to Incarnate God and finally to judge at the Second Coming, Augustine applies the schematic seven-fold ascent found in the De quantitate: the soul passes through the ascending steps of animation, sense, art, religion, tranquillity, initiation, and contemplation—each of which is figured by or patterned on a stage in Christ's life, as represented by the sacraments, and each of which, further, reflects a segment of universal history. The seven steps are not simply the movement of the individual soul, but the progress of Mansoul on its journey to Apocalypse. The stylistic differences between the two works—one an exposition written as Socratic dialogue, the other a metaphorical personal narrative —will no doubt give rise to differing interpretations; but one may, I think, object to certain details I suggest while still agreeing that the De quantitate provides the structuring model. Let me first define the major areas of difference between the two works. In the De quantitate, each of the levels or steps of the soul takes on a discrete, separate... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Patient Self-Determination ActElizabeth Leibold McCloskey (bio)What are the ethics of extending the length of life? We know that we cannot artificially end life (Thou Shalt not Kill), but how about artificially extending life? Is that always good, sometimes good?... In ethics, is keeping people alive the highest good? Should our priority be to keep people breathing?... What does basic religious ethics say about this?(John C. Danforth, letter to (...) the author, 19 August 1989)The Patient Self-Determination Act, signed into law as part of the Omnibus Budget Reconciliation Act of 1990 (OBRA '90) last November, marks the first time that Congress has passed legislation concerning the ethics of life-sustaining medical treatment. The bill was spearheaded by Senator John C. Danforth (RMO), who has a special interest in this area. An Episcopal priest, Danforth was formerly an assistant chaplain at New York's Memorial Sloan-Kettering Cancer Center and now sits as a senior member of the Senate Finance Committee, which oversees Medicare and Medicaid. Although Senator Danforth's legislative initiative was not a result of the Cruzan case, it was in his state of Missouri that the U.S. Supreme Court case involving removal of Nancy Cruzan's feeding tube arose (Cruzan v. Director of Missouri Department of Health, U.S. Supreme Court, 58 LW 4916, 26 June 1990). From his unique vantage point, he felt it was time to craft a legislative response to some of the difficult issues surrounding prolongation of life.The short answer to Senator Danforth's questions about when to artificially extend life is simple enough: people must be free to determine that for themselves. Common law and common sense dictate such a conclusion; living will and health care proxy statutes, enacted in almost every state, codify that right. The Catholic moral tradition teaches that one is not morally obligated to use extraordinary means to prolong life, a tradition shared both by the mainline Protestant and the reform and conservative Jewish community. Yet most people are unaware of their fundamental legal right to make such decisions, and as court cases from Quinlan (In re Quinlin, 137 N.J. Super. 227, 1975) to Cruzan demonstrate, few know [End Page 163] how to make arrangements for this right to be exercised if they become incapacitated.Meanwhile, health care practices are often driven by a denial of death. When Senator Danforth and Senator Daniel Patrick Moynihan (D-NY) introduced the bill on October 17, 1989, Senator Danforth said:More and more it is arguable that we play God by subjecting people to unwanted and sometimes unnecessary treatment, treatment that unnaturally prolongs the dying process. Our health care system has become obsessed with extending life, at times neglecting the caring component of medicine and trampling on the rights of patients.(Congressional Record 1989, 135:5.13566)The American Hospital Association estimates that 70 percent of deaths now occur after a determination to withhold or withdraw medical treatment. Many of those decisions are made without the benefit of an incapacitated patient's views, yet a Harvard study revealed that 95 percent of the population would like to prepare in advance for such decisions. Only 4 percent of hospitals have a systematic method of asking patients if they have an advance directive. Family members confront painful choices in the face of uncertainty about their loved one's wishes and it can be even more painful when a family knows the patient's desires but providers and the courts act otherwise because clear evidence is lacking.The Patient Self-Determination Act is rooted in the belief that people should be given information that enables them to specify the extent of medical treatment they wish to receive should they become incapacitated. The public should be educated about applicable state laws that protect the individual's right to make such choices through the use of an advance directive.The Act moves toward that goal by promoting knowledge of state laws. It requires every hospital, nursing home, home health agency, hospice, and health maintenance organization that participates in Medicaid or Medicare to routinely give all adult patients information about advance directives. Patients will also be given information on the... (shrink)