Recent scholarship has inquired into the socio-historical, discursive genesis of trauma. Trauma and the Ontology of the Modern Subject, however, seeks what has not been actualized in trauma studies - that is, how the necessity and unassailable intensity of trauma is fastened to its historical emergence. We must ask not only what trauma means for the individual person's biography, but also what it means to be the historical subject of trauma. In other words, how does being human in this current (...) period of history implicate one's lived possibilities that are threatened, and perhaps framed, through trauma? Foucauldian sensibilities inform a critical and structural analysis that is hermeneutically grounded. Drawing on the history of ideas and on Lacan's work in particular, John L. Roberts argues that what we mean by trauma has developed over time, and that it is intimately tied with an ontology of the subject; that is to say, what it is to be, and means to be human. He argues that modern subjectivity - as articulated by Heidegger, Levinas, and Lacan - is structurally traumatic, founded in its finitude as self-withdrawal in time, its temporal self-absence becoming the very conditions for agency, truth and knowledge. The book also argues that this fractured temporal horizon - as an effect of an interrupting Otherness or alterity - is obscured through the discourses and technologies of the psy-disciplines (psychiatry, psychology, and psychotherapy). Consideration is given to social, political, and economic consequences of this concealment. Trauma and the Ontology of the Modern Subject will be of enduring interest to psychoanalysts and psychotherapists as well as scholars of philosophy and cultural studies. (shrink)

This essay is primarily an exposition of a Lacanian view of subjectivity, as one that is literally informed by the fact of speaking. The genesis within speaking is related to a possible bridge between the social and the subjective that has troubled psychology for decades. The inherence of alterity to the structuration of the subject is described as part of this exposition. This intrinsic otherness as a self-difference and as a framing of the speaking act is described as a way (...) to reexamine recalcitrance and everyday problems in diversity. It is argued that diversity, far from being a dalliance or trite new set of rules for civil behavior, taps into a problematic of the subject. Ways of understanding the encounter with the other, as might follow from Lacan's work, are articulated within the context of religious law and of the social contract in current late capitalist society. Each foray into a particular instance of encountering diversity is framed within the overall exposition of subjective structuration. 2012 APA, all rights reserved). (shrink)

This essay reviews four longer arguments regarding the status of critical thinking on psychology. The commentary understands criticality as somehow sitting at the edge of theory itself. Given Psychology's perpetual identity crisis, the question of its edges and thus where criticality should nibble is brought to bear on the basic premises of the paper. Two of the papers are addressed in terms of the implied metapsychology they would presuppose and where that might break down . Two essays are addressed in (...) terms of being a form of reading: one founded in adumbrations of desire and the other in a faith in science. The authors are asked if their work might not be informed by recent trends philosophy of science and through particular psychoanalytic lenses. 2012 APA, all rights reserved). (shrink)

Many legal arguments pertaining to equal rights for gay and lesbian families have relied upon empirical research on the `healthy' childraising environment of these families. While neither disputing recent legal gains nor diminishing their importance, this article looks at some of the conceptual categories that drive this research. The limitations of such research, as salutary as it is, are typically understood in terms of their obvious political context. Such research avoids highlighting any differences between gay/lesbian families and traditional families because (...) an emphasis on such differences feeds cultural stereotypes that are damaging to non-traditional families. This article takes a different tack, looking at how the concepts that frame research are based in binaries and fantasies about families and sex that we argue are too limiting. It assumes that the elision of sexuality within such studies is symptomatic of a broader repression of a variety of meanings of family. In response, the article brings in queer theory and psychoanalysis to broaden our approach to understanding new forms of family and kinship initiated by gay and lesbian families. The article addresses single household lesbian families that are most frequently the object of empirical research. (shrink)

Honor walks are ceremonies that purportedly honor organ donors as they make their final journey from the ICU to the OR. In this paper, we draw on Ronald Grimes’ work in ritual studies to examine honor walks as ceremonial rituals that display medico-technological power in a symbolic social drama (Grimes, 1982). We argue that while honor walks claim to honor organ donors, ceremonies cannot primarily honor donors, but can only honor donation itself. Honor walks promote the quasi-religious idea of donation (...) as a “good death,” and mask the ambiguity and discomfort inherent in organ donation to promote greater acceptance by the medical community. While some goods may be achieved through honor walks, particularly for donor families, it is still important to examine the negative work done by this practice. (shrink)

Recently published consensus recommendations on pediatric decision-making by Salter and colleagues (2023) did not address neonatal decision-making, due to the unique complexities of neonatal care. This essay explores three areas that impact neonatal decision-making: legal and policy considerations, rapid technological advancement, and the unique emotional burdens faced by parents and clinicians during the medical care of neonates. The authors evaluate the six consensus recommendations related to these considerations and conclude that the consensus recommendations apply to neonates.

In recent years, increasingly advanced artificial intelligence (AI), and in particular machine learning, has shown great promise as a tool in various healthcare contexts. Yet as machine learning in medicine has become more useful and more widely adopted, concerns have arisen about the “black-box” nature of some of these AI models, or the inability to understand—and explain—the inner workings of the technology. Some critics argue that AI algorithms must be explainable to be responsibly used in the clinical encounter, while supporters (...) of AI dismiss the importance of explainability and instead highlight the many benefits the application of this technology could have for medicine. However, this dichotomy fails to consider the particular ways in which machine learning technologies mediate relations in the clinical encounter, and in doing so, makes explainability more of a problem than it actually is. We argue that postphenomenology is a highly useful theoretical lens through which to examine black-box AI, because it helps us better understand the particular mediating effects this type of technology brings to clinical encounters and moves beyond the explainability stalemate. Using a postphenomenological approach, we argue that explainability is more of a concern for physicians than it is for patients, and that a lack of explainability does not introduce a novel concern to the physician–patient encounter. Explainability is just one feature of technological mediation and need not be the central concern on which the use of black-box AI hinges. (shrink)

Medical trainees should learn from the actions of Nazi physicians to inform a more just contemporary practice by examining the subtle assumptions, or moral orientations, that led to such heinous actions. One important moral orientation that still informs contemporary medical practice is the moral orientation of elimination in response to suffering patients. We propose that the moral orientation of presence, described by theologian Stanley Hauerwas, provides a more fitting response to suffering patients, in spite of the significant barriers to enacting (...) such a moral orientation for contemporary trainees. (shrink)

Objectives To characterize the prevalence and content of pediatric triage policies.Methods We surveyed and solicited policies from U.S. hospitals with pediatric intensive care units. Policies were analyzed using qualitative methods and coded by 2 investigators.Results Thirty-four of 120 institutions (28%) responded. Twenty-five (74%) were freestanding children’s hospitals and 9 (26%) were hospitals within a hospital. Nine (26%) had approved policies, 9 (26%) had draft policies, 5 (14%) were developing policies, and 7 (20%) did not have policies. Nineteen (68%) institutions shared (...) their approved or draft policy. Eight (42%) of those policies included neonates. The polices identified 0 to 5 (median 2) factors to prioritize patients. The most common factors were short- (17, 90%) and long- (14, 74%) term predicted mortality. Pediatric scoring systems included Pediatric Logistic Organ Dysfunction-2 (12, 63%) and Score for Neonatal Acute Physiology and Perinatal Extensions-II (4, 21%). Thirteen (68%) policies described a formal algorithm. The most common tiebreakers were random/lottery (10, 71%) and life cycles (9, 64%). The majority (15, 79%) of policies specified the roles of triage team members and 13 (68%) precluded those participating in patient care from making triage decisions.Conclusions While many institutions still do not have pediatric triage policies, there appears to be a trend among those with policies to utilize a formal algorithm that focuses on short- and long-term predicted mortality and that incorporates age-appropriate scoring systems. Additional work is needed to expand access to pediatric-specific policies, to validate scoring systems, and to address health disparities. (shrink)

While the Web Ontology Language (OWL) provides a mechanism to import ontologies, this mechanism is not always suitable. Current editing tools present challenges for working with large ontologies an...

Background: There are numerous benefits to ethics consultation services, but little is known about the reasons different professionals may or may not request an ethics consultation. Inter-professional differences in the perceived utility of ethics consultation have not previously been studied.Methods: To understand profession-specific perceived benefits of ethics consultation, we surveyed all employees at an urban tertiary children’s hospital about their use of ethics committee services (n = 842).Results: Our findings suggest that nurses and physicians find ethics consultations useful for different (...) reasons; physicians were more likely to report normative benefits, while nurses were more likely to report communicative and relational benefits.Conclusions: These findings support an open model of ethics consultation and may also help ethics committees to better understand consultation requests and remain attuned to the needs of various professional groups. (shrink)

Three ethical conflicts in particular are paradigmatic of what we define as “clerkship ethics.” First, a distinction that differentiates the clerkship student from the practicing physician involves the student’s principal role as a learner. The clerkship student must skillfully balance her commitment to her own education against her commitment to patient care in a fashion that may compromise patient care. While the practicing physician can often resolve the tension between these two goods when they come into conflict, the clerkship student (...) is left with a more ambiguous set of choices. Second, evaluative scrutiny during clinical clerkships often forces medical students to balance doing what is morally fitting against the perceived expectations of the medical teams in which they work. Third and finally, a deeply entrenched culture of medical hierarchy presents a particular challenge to innovation and improvement in ethics education during the clerkship years. Students regard faculty as exemplars, but are not provided with the tools to assess when technical medical competence is not matched by moral competence; moreover, these faculty are unlikely to have experienced the ethics education in which students are asked to demonstrate mastery. (shrink)

The consensus recommendations by Salter and colleagues (2023) regarding pediatric decision-making intentionally omitted adolescents due to the additional complexity their evolving autonomy presented. Using two case studies, one focused on truth-telling and disclosure and one focused on treatment refusal, this article examines medical decision-making with and for adolescents in the context of the six consensus recommendations. It concludes that the consensus recommendations could reasonably apply to older children.

Loneliness in medicine is a serious problem not just for patients, for whom illness is intrinsically isolating, but also for physicians in the contemporary condition of medicine. We explore this problem by investigating the ideal physician-patient relationship, whose analogy with friendship has held enduring normative appeal. Drawing from Talbot Brewer and Nir Ben-Moshe, we argue that this appeal lies in a dynamic form of companionship incompatible with static models of friendship-like physician-patient relationships: a mutual refinement of embodied virtue that draws (...) both persons together. The ideal physician-patient relationship has a dialectical character that fosters each member's improvement of phenomenologically recognizing and embodying moral virtues. A key component of this dynamic is a commitment to the common goal of the patient's health, realized through joint interactivities and conversations over time. The physician's presence to the patient's suffering—understood best as an alienating phenomenological condition for the patient—orients and discloses possibilities for virtuous caregiving by structuring the meanings of the goals, conversations, and joint narrative constitutive of their relationship. Presence to suffering, paradoxically, is perhaps an important prerequisite for this dynamic partnership. These activities dialectically build an interpretive horizon of understanding through which moral goods and character refinement—in and for the other—may become revealed for both persons in their shared being-in-the-world. This analysis of suffering, mood, and revealing of (possible) moral goods has implications for addressing the modern problem of loneliness for patients and physicians, who are increasingly inhibited from building flourishing relationships with each other. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:AN ANTHROPOLOGICAL VISION OF CHRISTIAN MARRIAGE GERMAN MARTINEZ Fordham University Bronx, New York VIEWED FROM the institutional, interpersonal, or religious standpoint, marriage is not a distinctively Christian phenomenon, but it is a human partnership with inherently religious symbolism. Consider the complexity of its dimensions : it is a personal bond that is consummated in a sexual relationship; yet its full human reality contains different levels of meaning which point (...) to a transcendent mystery; it is secular and social and at the same time spiritual and personal. Philosophical anthropology and the phenomenology of religion explore these dimensions and stress the complexity of marriage. An entire range of questions stem from the nature and mystery of the conjugal bond as well as from the multiplicity of forms in which this human partnership has been realized in different historical periods and cultures. Precisely because marriage actually takes place in a concrete historico-cultural context, theological reflection must recognize the complexity of this human experience, and this calls for interdisciplinary study. Theological anthropology sees a profound meaning in the created reality of marriage, for it recognizes therein the essential components of a community of love open toward God. An understanding of human values reveals how the experience of marriage touches the roots of people's lives; an understanding of redemption reveals how marriage belongs to both the order of creation and the order of redemption. An anthropological approach is essential. " In good theology one can no longer adopt the simplistic distinction between ' natural mar451 452 GERMAN MARTINEZ riage' and 'sacramental marriage....'" 1 Marriage is not only a meaningful sign of an anthropological reality but also the expression of the human response toward transcendence. Furthermore, the lived experience of marriage in modern society makes us more and more conscious of human existential needs, and theology has to interpret and respond to them in correlation with the content of faith. Against the background of the human sciences and our awareness of the present historical reality, study of this complex experience that is marriage calls for constructive reflection on its anthropological roots. That is where the sacramental mystery is anchored. The crisis in the theological understanding of marriage stems primarily from a crisis of culture, and new anthropological perspectives can establish the possibility of a more personal theology. In fact, the underestimation of its human values or, more precisely, the lack of a personalist anthropology and of an adequate theological consideration of sexuality has been at the root of the weakness of the traditional approach to marriage.z As Theodore Mackin puts it, " The marriage sacrament, like all sacraments, has as its matrix a complex human experience. And there is no understanding of the sacrament unless we first understand its 1 W. Ernst, "Marriage as Institution and the Contemporary Challenge to It," in Contemporary Perspectives on Christian Marriage, ed. R. Malone and J. R. Connery (Chicago: Loyola University Press, 1984), p. 69. The following studies are especially valuable in terms of an anthropological approach to Christian marriage: J. Ratzinger, "Zur Theologie der Ehe,'' in Theologie der Ehe, ed. H. Greven (Regensburg 1972), pp. 81-115; H. Doms, "Zweigeschlechtlichkeit und Ehe,'' in Mysterium Salutis, ed. J. Feiner and M. Lohrer, vol. 2, pp. 707-750; T. Mackin, "How to Understand the Sacrament of Marriage,'' in -Commitment to Partnership; Explorations of the Theology of Marriage, ed. W. P. Roberts (New York: Paulist Press, 1987), pp. 34-60. z Two major Catholic documents of the magisterium insist on the need for further theological reflection in terms of the personalistic reason behind the theology of marriage: John Paul II, The Apostolic Exhortation on the Family (see Origins, 2 (1981): 438-467); Gaudium et Spes, 47-52 (ed. W. M. Abbot, pp. 249-259). " The beginning, the subject and the goal of social institutions is and must be the human person, which for its part and by its very nature stands completely in need of social life" (Gaudium et Spes, 25; Abbott ed., p. 224). VISION OF CHRISTIAN MARRIAGE 453 matrix-experience." 3 In theological terms, the covenant v1s1on governs the partnership reality, but that divine call without this created reality would be meaningless. While the present essay does not include all the... (shrink)

Introduction, by J.R. Strayer.--History, popular and unpopular, by Jacques Barzun.--The science of history, by Hajo Holborn.--The economic impact on history, by Herbert Heaton.--Biography and history, by Dumas Malone.--Theology of history, by George La Piana.

This study reports on the development of scale items derived from the pluralistic moral philosophy literature. In addition, the manner in which individuals combine aspects of the different philosophies in making ethical evaluations was explored.

A Leibniz class is a class of logics closed under the formation of term-equivalent logics, compatible expansions, and non-indexed products of sets of logics. We study the complete lattice of all Leibniz classes, called the Leibniz hierarchy. In particular, it is proved that the classes of truth-equational and assertional logics are meet-prime in the Leibniz hierarchy, while the classes of protoalgebraic and equivalential logics are meet-reducible. However, the last two classes are shown to be determined by Leibniz conditions consisting of (...) meet-prime logics only. (shrink)

I am idebted to members of the Wellington Logic Seminar for useful discussions of work of which this essay forms part, in particular to M. J. Cresswell for comments in the earlier stages of the investigation and to R. I. Goldblatt who suggested the definition ofB infD supu and made numerous other suggestions.

Three arguments are proposed against the idea that ordinary talk about the mind constitutes a folk psychology, a sort of prescientific theory which explains human behaviour and which is ripe for replacement by a neurological or computational theory with better scientific credentials. First, not all talk of the mind is introduced to explain in the way assumed by those who think that mental talk hypothesizes inner processes to explain behaviour. Second, the individuation of the behaviour which is explained by the (...) inner processes itself requires reference to ?mental? states such as intentions or desires. Consequently the project is circular. Finally, scientific theory is a practice with a history which may be matched in the case of ordinary talk of the mind. Certainly ordinary talk of motives, intentions, and thoughts may be infected by the theorizing of economists and sociologists et al., but it is impossible that all talk of the mind should be theoretical in this way. (shrink)

Scholars and practitioners across domains are increasingly concerned with algorithmic transparency and opacity, interrogating the values and assumptions embedded in automated, black-boxed systems, particularly in user-generated content platforms. I report from an ethnography of infrastructure in Wikipedia to discuss an often understudied aspect of this topic: the local, contextual, learned expertise involved in participating in a highly automated social–technical environment. Today, the organizational culture of Wikipedia is deeply intertwined with various data-driven algorithmic systems, which Wikipedians rely on to help manage (...) and govern the “anyone can edit” encyclopedia at a massive scale. These bots, scripts, tools, plugins, and dashboards make Wikipedia more efficient for those who know how to work with them, but like all organizational culture, newcomers must learn them if they want to fully participate. I illustrate how cultural and organizational expertise is enacted around algorithmic agents by discussing two autoethnographic vignettes, which relate my personal experience as a veteran in Wikipedia. I present thick descriptions of how governance and gatekeeping practices are articulated through and in alignment with these automated infrastructures. Over the past 15 years, Wikipedian veterans and administrators have made specific decisions to support administrative and editorial workflows with automation in particular ways and not others. I use these cases of Wikipedia’s bot-supported bureaucracy to discuss several issues in the fields of critical algorithms studies; critical data studies; and fairness, accountability, and transparency in machine learning—most principally arguing that scholarship and practice must go beyond trying to “open up the black box” of such systems and also examine sociocultural processes like newcomer socialization. (shrink)

_History, the Human, and the World Between_ is a philosophical investigation of the human subject and its simultaneous implication in multiple and often contradictory ways of knowing. The eminent postcolonial theorist R. Radhakrishnan argues that human subjectivity is always constituted “between”: between subjective and objective, temporality and historicity, being and knowing, the ethical and the political, nature and culture, the one and the many, identity and difference, experience and system. In this major study, he suggests that a reconstituted phenomenology has (...) a crucial role to play in mediating between generic modes of knowledge production and an experiential return to life. Keenly appreciative of poststructuralist critiques of phenomenology, Radhakrishnan argues that there is still something profoundly vulnerable at stake in the practice of phenomenology. Radhakrishnan develops his rationale of the “between” through three linked essays where he locates the terms “world,” “history,” “human,” and “subject” between phenomenology and poststructuralism, and in the process sets forth a nuanced reading of the politics of a gendered postcolonial humanism. Critically juxtaposing the works of thinkers such as Friedrich Nietzsche, Adrienne Rich, Frantz Fanon, Edward Said, Michel Foucault, Maurice Merleau-Ponty, Martin Heidegger, David Harvey, and Ranajit Guha, Radhakrishnan examines the relationship between systems of thought and their worldly situations. _History, the Human, and the World Between _is a powerful argument for a theoretical perspective that combines the existential urgency of phenomenology with the discursive rigor of poststructuralist practices. (shrink)

Among Plato's later dialogues, the _Parmenides_ is one of the most significant. Not only a document of profound philosophical importance in its own right, it also contributes to the understanding of Platonic dialogues that followed it, and it exhibits the foundations of the physics and ontology that Aristotle offered in his _Physics_ and _Metaphysics _VII. In this book, R.E. Allen provides a superb translation of the _Parmenides_ along with a structural analysis that procedes on the assumption that formal elements, logical (...) and dramatic, are important to its interpretation and that the argument of the _Parmenides_ is aporetic, a statement of metaphysical perplexities. Allen's original translation of and commentary on the _Parmenides_ were published in 1983 to great acclaim and have now been revised by the author. (shrink)

ABSTRACT Pippin treats Nietzsche's moral psychology as the key to his philosophy. Three aspects of the psychology are meant to bear this weight: a critical and deflationary, but irreducibly hermeneutic, conception of the nature of moral psychology itself; a thesis that eros is central to Nietzsche's theory of valuing; and an expressivist theory of action, which replaces the causal role of intention with an interpretive notion of expression in explaining action. Pippin's handling of all three, but especially the third, places (...) Nietzsche's philosophy in a Hegelian light, as does his view that genuine action arises from a deep-going self-dissatisfaction. I raise doubts about whether the expressivist theory of action can be adequate to all actions and suggest that the centrality of self-dissatisfaction for Pippin stands in tension with Nietzsche's own construal of the demand for affirmation of life. (shrink)

Professor R. J. Getty has drawn attention to a tenth- or early eleventh-century manuscript of Statius’ Thebaid, hitherto examined only in Book I, namely Turonensis . Dr. Klotz, in his Teubner edition of 1908, gave citations from Book I, and wrote , ‘dolendum est sane de hoc codice primum tantum librum innotuisse, sed cum Roffensis libri maxime affinis accuratiorem notitiam haberemus, collatione quamvis -aegre careri posse nobis visum est.’ I have collated both T and Roffensis in full, and find firstly (...) that the citations of r by Klotz are far from accurate, especially in the last six books, and secondly that while it is indeed true thatT and r are very closely related, T is a much better representative than r of their common source. (shrink)

Wnts are a recently described family of secreted glycoproteins related to the Drosophila segment polarity gene, wingless, and to the proto‐oncogene, int‐1. Wnts are thought to function as developmental modulators, with signalling distances of only a few cell diameters. In Xenopus, at least six Wnts, including Xwnts‐1, ‐3A, and ‐4, are expressed initially in the developing central nervous system, with some regions expressing multiple Xwnts. Xwnt‐8 is expressed by mid‐blastula stage, in ventral and lateral mesoderm. Xwnt‐5A mRNAs are stored in (...) the egg, and later are expressed throughout the embryo in both ectoderm and mesoderm, but with a pronounced enrichment in the head and tail. Recent studies in Xenopus have pursued the diverse roles of Xwnts in early development, the mechanisms by which Xwnts signal information between cells, and the cell physiological responses to Xwnt signals. (shrink)