A growing body of research has demonstrated significant heterogeneity of hospital ethics committee (HEC) size, membership and training requirements, length of appointment, institutional support, clinical and policy roles, and predictors of self identified success. Because these studies have focused on HECs at a single point in time, however, little is known about how the composition of HECs changes over time and what impact these changes have on committee utilization. The current study presents 20 years of data on the evolution of (...) the Massachusetts General Hospital HEC. Between 1993 and 2012, the average number of committee members per year was 38 ± 3 and the average length of membership was 4.8 ± 0.4 years. During that time, the committee performed 934 consults, averaging 47 ± 3 per year. Attendance rates fell from 61.5 to 23.8 % over the study period and were inversely correlated with the total number of members. Between 1993 and 2012, the committee saw substantial growth in the diversity of the professional backgrounds of its members. Multivariate analysis, however, suggests that substantial changes in committee composition did not impact its utilization and that other factors are more likely to explain fluctuations in consultation volume. (shrink)

We describe the structure, operation, and experience of the Massachusetts General Hospital ethics committee, formally called the Edwin H. Cassem Optimum Care Committee, from January 2007 through December 2013. Founded in 1974 as one of the nation’s first hospital ethics committees, this committee has primarily focused on the optimum use of life-sustaining treatments. We outline specific sociodemographic and clinical characteristics of consult patients during this period, demographic differences between the adult inpatient population and patients for whom the ethics committee was (...) consulted, and salient features of the consults themselves. We include three case studies that illustrate important consult themes during this period. Our findings expand knowledge about the structure and workings of hospital ethics committees and illustrate how one ethics committee has developed and utilized policies on end-of-life care. More generally, we model a sociological approach to the study of clinical ethics consultation that could be utilized to contextualize institutional practices over time. (shrink)

Background: The bioethics literature contains speculation but little data about sociodemographic differences between patients for whom ethics committees (EC) are consulted for conflict about life-sustaining treatment (LST) and the broader hospital population that these committees serve. To provide an empirical context for this discussion, we examined differences in five sociodemographic factors between patients for whom an EC was consulted for conflict over LST and the general inpatient population, hypothesizing that nonwhite patients were most likely to be disproportionately represented. Methods: This (...) was a retrospective cohort study comparing self-reported race/ethnicity, household income, insurance status, primary language, and religious affiliation between patients involved in EC consultations for conflict over LST and the general adult inpatient population at a large academic hospital from January 1, 2007, through December 31, 2013. Results: There were 169 EC consultations involving conflict over LST and 243,197 adult inpatient admissions over the study period. On bivariate analysis, patients for whom the EC was consulted for conflict over LST were more likely to be nonwhite, low-income, and to speak a primary language other than English. They were not more likely to be underinsured or to report a religious affiliation. On multivariate analysis, patients for whom the EC was consulted for conflict over LST were more likely to be nonwhite (odds ratio [OR], 2.5; 95% confidence interval [CI], 1.7–3.7; p <.001). They were also more likely to be low income (OR, 1.8; 95% CI, 1.1–3.0; p =.02). They were not more likely to speak a primary language other than English (OR, 1.4; 95% CI, 0.9–2.1; p =.17). None of the assessed variables were associated with conflict over LST requiring additional meetings beyond the first EC consultation. Conclusions: Nonwhite and low-income status patients are disproportionately represented in EC committee consultation for conflict over LST compared to the general inpatient population. (shrink)

Suicide among Veterans experiencing or at risk for homelessness remains a significant public health concern. Conducting research to understand and meet the needs of this at-risk population remains challenging due to myriad factors. To address this challenge, the United States Department of Veterans Affairs convened the Health Services Research and Development Suicide Prevention in Veterans Experiencing Homelessness: Research and Practice Development meeting, bringing together subject-matter experts in the fields of homelessness and suicide prevention, both from within and outside of VA. (...) During the meeting, attendees identified 10 potential research priorities at the intersection of suicide prevention and homelessness. After the meeting, Delphi methodology was used to achieve consensus on the relative importance of the identified research domains. Through this iterative Delphi process, agreement was reached regarding the need to increase understanding of barriers and facilitators to suicide risk assessment and emergency intervention for Veterans experiencing homelessness by examining the perspectives of both Veterans and healthcare providers. Elucidating the complex relationships between risk periods, subgroups, suicide means, and drivers of suicide among Veterans experiencing homelessness was also considered a top priority. This article documents the Delphi process and provides a research agenda for researchers, funding agencies, and policymakers to prioritize the most relevant and potentially impactful research domains aimed at preventing suicide among Veterans experiencing or at risk for homelessness. (shrink)

Bullying often results in negative coping in victims, including an increased consumption of alcohol. Recently, however, an increase in alcohol use has also been reported among perpetrators of bullying. The factors triggering this pattern are still unclear. We investigated the role of empathy in the interaction between bullying and alcohol use in an adolescent sample (IMAGEN) at age 13.97 (±0.53) years (baseline (BL), N = 2165, 50.9% female) and age 16.51 (±0.61) years (follow-up 1 (FU1), N = 1185, 54.9% female). (...) General empathic distress served as a significant moderator of alcohol use in perpetrators (F9, 493 = 17.978, p < 0.01), which was specific for males and FU1. Male perpetrators, who are generally less sensitive to distress, might thus be more vulnerable to alcohol abuse. (shrink)

This is the first complete, one-volume English translation of the ancient Chinese text Xunzi, one of the most extensive, sophisticated, and elegant works in the tradition of Confucian thought. Through essays, poetry, dialogues, and anecdotes, the Xunzi articulates a Confucian perspective on ethics, politics, warfare, language, psychology, human nature, ritual, and music, among other topics. Aimed at general readers and students of Chinese thought, Eric Hutton's translation makes the full text of this important work more accessible in English than (...) ever before. Named for its purported author, the Xunzi has long been neglected compared to works such as the Analects of Confucius and the Mencius. Yet interest in the Xunzi has grown in recent decades, and the text presents a much more systematic vision of the Confucian ideal than the fragmented sayings of Confucius and Mencius. In one famous, explicit contrast to them, the Xunzi argues that human nature is bad. However, it also allows that people can become good through rituals and institutions established by earlier sages. Indeed, the main purpose of the Xunzi is to urge people to become as good as possible, both for their own sakes and for the sake of peace and order in the world. In this edition, key terms are consistently translated to aid understanding and line numbers are provided for easy reference. Other features include a concise introduction, a timeline of early Chinese history, a list of important names and terms, cross-references, brief explanatory notes, a bibliography, and an index. (shrink)

"The king is dead. Long live the king!" In early modern Europe, the king's body was literally sovereign—and the right to rule was immediately transferrable to the next monarch in line upon the king's death. In The Royal Remains, Eric L. Santner argues that the "carnal" dimension of the structures and dynamics of sovereignty hasn't disappeared from politics. Instead, it migrated to a new location—the life of the people—where something royal continues to linger in the way we obsessively track (...) and measure the vicissitudes of our flesh. Santner demonstrates the ways in which democratic societies have continued many of the rituals and practices associated with kingship in displaced, distorted, and usually, unrecognizable forms. He proposes that those strange mental activities Freud first lumped under the category of the unconscious—which often manifest themselves in peculiar physical ways—are really the uncanny second life of these "royal remains," now animated in the body politic of modern neurotic subjects. Pairing Freud with Kafka, Carl Schmitt with Hugo von Hofmannsthal,and Ernst Kantorowicz with Rainer Maria Rilke, Santner generates brilliant readings of multiple texts and traditions of thought en route to reconsidering the sovereign imaginary. Ultimately, The Royal Remains locates much of modernity—from biopolitical controversies to modernist literary experiments—in this transition from subjecthood to secular citizenship. This major new work will make a bold and original contribution to discussions of politics, psychoanalysis, and modern art and literature. (shrink)

In On the Psychotheology of Everyday Life, Eric Santner puts Sigmund Freud in dialogue with his contemporary Franz Rosenzweig in the service of reimagining ethical and political life.

In his _Duino Elegies,_ Rainer Maria Rilke suggests that animals enjoy direct access to a realm of being—the open—concealed from humans by the workings of consciousness and self-consciousness. In his own reading of Rilke, Martin Heidegger reclaims the open as the proper domain of human existence but suggests that human life remains haunted by vestiges of an animal-like relation to its surroundings. Walter Benjamin, in turn, was to show that such vestiges—what Eric Santner calls the _creaturely_—have a biopolitical aspect: (...) they are linked to the processes that inscribe life in the realm of power and authority. Santner traces this theme of creaturely life from its poetic and philosophical beginnings in the first half of the twentieth century to the writings of the enigmatic German novelist W. G. Sebald. Sebald’s entire oeuvre, Santner argues, can be seen as an archive of creaturely life. For Sebald, the work on such an archive was inseparable from his understanding of what it means to engage ethically with another person’s history and pain, an engagement that transforms us from indifferent individuals into neighbors. An indispensable book for students of Sebald, _On Creaturely Life_ is also a significant contribution to critical theory. (shrink)

In his _Duino Elegies,_ Rainer Maria Rilke suggests that animals enjoy direct access to a realm of being—the open—concealed from humans by the workings of consciousness and self-consciousness. In his own reading of Rilke, Martin Heidegger reclaims the open as the proper domain of human existence but suggests that human life remains haunted by vestiges of an animal-like relation to its surroundings. Walter Benjamin, in turn, was to show that such vestiges—what Eric Santner calls the _creaturely_—have a biopolitical aspect: (...) they are linked to the processes that inscribe life in the realm of power and authority. Santner traces this theme of creaturely life from its poetic and philosophical beginnings in the first half of the twentieth century to the writings of the enigmatic German novelist W. G. Sebald. Sebald’s entire oeuvre, Santner argues, can be seen as an archive of creaturely life. For Sebald, the work on such an archive was inseparable from his understanding of what it means to engage ethically with another person’s history and pain, an engagement that transforms us from indifferent individuals into neighbors. An indispensable book for students of Sebald, _On Creaturely Life_ is also a significant contribution to critical theory. (shrink)

This volume presents a comprehensive analysis of the Confucian thinker Xunzi and his work, which shares the same name. It features a variety of disciplinary perspectives and offers divergent interpretations. The disagreements reveal that, as with any other classic, the Xunzi provides fertile ground for readers. It is a source from which they have drawn—and will continue to draw—different lessons. In more than 15 essays, the contributors examine Xunzi’s views on topics such as human nature, ritual, music, ethics, and politics. (...) They also look at his relations with other thinkers in early China and consider his influence in East Asian intellectual history. A number of important Chinese scholars in the Song dynasty sought to censor the Xunzi. They thought that it offered a heretical and impure version of Confuciansim. As a result, they directed study away from the Xunzi. This has diminished the popularity of the work. However, the essays presented here help to change this situation. They open the text’s riches to Western students and scholars. The book also highlights the substantial impact the Xunzi has had on thinkers throughout history, even on those who were critical of it. Overall, readers will gain new insights and a deeper understanding of this important, but often neglected, thinker. (shrink)

A growing number of scholars have come to view Confucians and other Chinese thinkers as virtue ethicists. Other scholars, though, have challenged this classification. This essay discusses some of the problems that surround this debate, points out shortcomings in some of the criticisms that have been made, and offers suggestions about how best to develop a productive discussion about the issue.

My purpose is to examine two of the foundations of medical ethics: the principle of autonomy and the concept of the human. I also investigate the extent to which health technology makes autonomy and humanness possible. I begin by underlining Illich's point that the same health technology designed to promote health and autonomy also is pathogenic. I proceed to analyse the Kantian concept of autonomy, a concept which is closely associated with health and which continues to determine current ethical thinking. (...) In so doing, I uncover an unexpected ontological function of health technology, a function described in Heidegger's work on technology. Based on this discovery, I suggest that calls for Kantian autonomy may often be self-defeating or even sometimes harmful. I conclude by calling for continued ethical vigilance, but also for a questioning of the hitherto virtually unquestionable concepts of ethics and humanness which may themselves play a role in our era's greatest problems. (shrink)

Christianity, at its heart, is a therapeutic faith. In this companion to Foundations for Soul Care, Eric L. Johnson presents a systematic account of Christianity as divine therapy. A groundbreaking achievement in the synthesis of theology and psychology, this is an indispensable resource for students, scholars, pastors, and clinicians.

Untying Things Together helps to clarify the stakes of the last fifty years of literary and cultural theory by proposing the idea of a sexuality of theory. In 1905, Freud published his Three Essays on the Theory of Sexuality, the book that established the core psychoanalytic thesis that sexuality is central to formations of the unconscious. With this book, Eric L. Santner inverts Freud’s title to take up the sexuality of theory—or, more exactly, the modes of enjoyment to be (...) found in the kinds of critical thinking that, since the 1960s, have laid claim to that ancient word, “theory.” Santner unfolds his argument by tracking his own relationship with this tradition and the ways his intellectual and spiritual development has been informed by it. Untying Things Together is both an intellectual history of major theoretical paradigms and a call for their reexamination and renewal. Revisiting many of the topics he has addressed in previous work, Santner proposes a new way of conceptualizing the eros of thinking, attuned to how our minds and bodies individually and collectively incorporate or “encyst” on a void at the heart of things. Rather than proposing a “return to theory,” Santner’s book simply employs theory as a way of further “tying together” the resources of philosophy, art and literature, theology, psychoanalysis, political thought, and more. (shrink)

Surveillance is a core function of all public health systems. Responses to the COVID-19 pandemic have deployed traditional public health surveillance responses, such as contact tracing and quarantine, and extended these responses with the use of varied technologies, such as the use of smartphone location data, data networks, ankle bracelets, drones, and big data analysis. Applying Foucault’s (1979) notion of the panopticon, with its twin focus on surveillance and self-regulation, as the preeminent form of social control in modern societies, we (...) examine the increasing levels of surveillance enacted during this pandemic and how people have participated in, and extended, this surveillance, self-regulation, and social control through the use of digital media. Consideration is given to how such surveillance may serve public health needs and/or political interests and whether the rapid deployment of these extensive surveillance mechanisms risks normalizing these measures so that they become more acceptable and then entrenched post-COVID-19. (shrink)

In his Mann ohne Eigenschaften, Robert Musil has the character Clarisse comment on a debate between her husband, Walter, and Ulrich, the “man without qualities,” about the “impossible” relation between art and life. “‘Ich find das doch sehr wichtig,’ sagte sie, ‘daß in uns allen etwas Unmögliches ist. Es erklärt so vieles. Ich habe, wie ich zuhörte, den Eindruck gehabt, wenn man uns aufschneiden könnte, so würde unser ganzes Leben vielleicht wie ein Ring aussehen, bloß so rund um etwas.’ Sie (...) hatte schon vorher ihren Ehering abgezogen und guckte nur durch seine Öffnung gegen die belichtete Wand. ‘Ich meine, in seiner Mitte ist doch nichts, und doch sieht er genau so aus, als ob es ihm nur darauf ankäme.’” The English translation is even stronger: “There is nothing inside, and yet it looks as though that were precisely what matters most.” This essay interrogates this “nothing” that matters most in relation to the crown of royal authority, the “hollow crown,” as Richard II calls it in Shakespeare’s play. I further flesh out the matter and materiality of this bit of nothing in relation to the struggle between Creon and Antigone in Sophocles’ play about the foundations of royal authority. The queen in the former play and Antigone in the latter are presented as being too much sad, as manifesting a grief that pertains to this nothing, to an indeterminate loss they both “encyst” (upon) in their subjective stances. (shrink)

Confucian thinkers have traditionally stressed the importance of li 禮, or “ritual” as it is commonly translated, and believed that ancient sages had established an ideal set of rituals for people to follow. Now, most scholars of Confucianism understand li as distinct from law, and hence do not typically discuss Confucian sages as great lawgivers. Nevertheless, I suggest that there is something valuable to be learned from considering the similarities and dissimilarities between great lawgivers and the sages. In particular, this (...) essay reviews some of the challenges for, and virtues of, great legislators, and compares and contrasts these with the challenges for, and virtues of, master inventors of ritual, with the aim of showing how such observations might deepen our understanding of the conception of sages in the Confucian tradition, while perhaps also bringing out certain insights about good lawgivers. I end by using these reflections to point to some challenges for developing rituals to fit our modern context. (shrink)

In recent years, there has been a rapidly growing body of work in the social sciences that underscores the prevalence of the phenomenon of ‘social acceleration'—the speeding up of social life— in many parts of the Western world. Although research on social acceleration has tended to analyze the phenomenon on a social-structural level, there is also a need to investigate how social acceleration has ‘ramifications for the socially dominant forms of self-relation’. One way to gain a more in-depth understanding of (...) this facet of social acceleration is to investigate the speeding up of social life through the prism of the self. The central argument of this article is that there are at least five images of the self which can be associated with the social acceleration phenomenon: the ‘detached’ self, the ‘reflexive’ self, the ‘reinventive’ self, the ‘stationary’ self and the ‘decelerating’ self. By explaining how these kinds of self relate to the speeding up process, we seek to advance a more nuanced and sophisticated theory of social acceleration, which captures some of the complexities and paradoxes that the phenomenon involves. (shrink)

The political philosopher Hannah Arendt actively engaged in the problem of a Jewish homeland and the politics of Zionism in the years 1941–1948. She advocated a Binational solution to Palestine – a single political commonwealth with two national identities, Jewish and Arab, integrated in a federation with other countries in the region. In the crucial period leading up to the establishment of the State of Israel, Arendt became increasingly disillusioned with the Jewish Agency and the Zionist movement for failing to (...) organize a Jewish response to Nazism (a Jewish Army) and rejecting the Palestinian right to a homeland. (shrink)

The suggestion of seeking specificity in a higher-order array is attractive, but Stoffregen & Bardy fail to provide a compelling empirical basis to their claim that specificity exists solely in the global array. Using the example of relative motion, the alternate hypotheses that must be considered are presented.

Though hippocampal volume reduction is a pathological hallmark of schizophrenia, the molecular pathway responsible for this degeneration remains unknown. Recent reports have suggested the potential role of impaired blood-brain barrier function in schizophrenia pathogenesis. However, direct evidence demonstrating an impaired BBB function is missing. In this preliminary study, we used immunohistochemistry and serum immunoglobulin G antibodies to investigate the state of BBB function in formalin-fixed postmortem samples from the hippocampus and surrounding temporal cortex of patients with schizophrenia and controls without (...) schizophrenia matched for age, sex, and race. Since a functional BBB prevents the extravasation of IgGs, detection of IgGs in the parenchyma is used as direct evidence of BBB breakdown. We also developed a semi-quantitative approach to quantify the extent of IgG leak and therein BBB breach. Analysis of our immunohistochemistry data demonstrated a significantly higher incidence of IgG leak in patients with schizophrenia compared to controls. Further, BBB permeability was significantly higher in advanced-age patients with schizophrenia than both advanced-age controls and middle-aged patients with schizophrenia. Male patients with schizophrenia also demonstrated a significant increase in IgG permeability compared to control males. Interestingly, the extravasated IgGs also demonstrated selective immunoreactivity for neurons. Based on these observations, we suggest that BBB dysfunction and IgG autoantibodies could be two key missing pathoetiological links underwriting schizophrenia hippocampal damage. (shrink)

God gave Scripture to his people for many reasons. Two of the most important are the subversive and the therapeutic. This article concentrates on the former. All humans are blind to the extent of their alienation from God, others, and themselves. Christians have begun the process of salvation, part of which includes growth in theocentric self-awareness, and God uses Scripture to promote this growth. Christians, however, face a formidable challenge at this point, because in our remaining sin, we can also (...) distort Scripture for sinful purposes. As a result, God has to use Scripture subversively and indirectly in order to enable Christians to read the Bible to promote the healing of inward deepening. A case for this agenda will be made from the Bible itself and the Christian tradition. (shrink)

By a "developed" economy, people roughly mean ones with a high, persistently-growing per-captia income which is not simply based on resource extraction (i.e., oil) or remittances or rentierism — an industrial (or, if there is such a thing, post-industrial) economy which makes most of its participants reasonably and increasingly prosperous. While there are of course differences among them --- the United States is not New Zealand, which is not Belgium, which is not Finland, which is not Japan --- they are (...) all more similar to each other than they are to the vast variety of "undeveloped", "under-developed", or (most optimistically) "developing" economies across the world. (Some people refer to the developed countries as "the North" and the others as "the South"; this drives me up the wall, if only from looking at where China and Australia are on the map.) Economies in the first category tend to stay there; so, sadly, do countries in the second. Development economics is the sub-discipline of economics which attempts to study how economies which have not attained this happy condition can be made to do so, and the factors which hold others back. (shrink)

A collection of essasys on the philosophy of Moses Maimonides.

ExcerptI.In her study of the role of theater and popular entertainments in the dissemination of the doctrine of the “king's two bodies” in the second half of the sixteenth century, Marie Axton emphasizes that this period was one of high anxiety with respect not only to the problem of royal succession but more generally to “the very principles by which government and authority are perpetuated.”1 The legal and political problem of succession was, of course, especially acute because of Elizabeth's status (...) as “virgin queen.” The lawyers who participated in the debates about succession—in large measure by way of propagandistic…. (shrink)