The National Anti-Vivisection Hospital opened to patients in 1903, the only district hospital in London not financed by state-controlled funds, which refused it support because of its principles. For three decades the hospital treated the local poor and conscientious objectors to vivisection, who were assured that staff pledged not to experiment on animals or patients. After an overambitious building program, the hospital ran into financial difficulties, and the King’s Fund refused to help unless (...) all references to antivivisection were removed from its statutes. Thus it reopened as Battersea General in 1935, continuing to serve the borough until 1972. (shrink)

Members of the Student Clinical Ethics Committee discussed the ethical issues arising in a case referred for consideration – a homeless man presenting to the emergency department of a busy London hospital with recent self-reported suicide attempts. Should he be admitted overnight in order to address a short-term shelter problem? The case study summarises the reflections of the Committee and focusses on the doctor’s duty of care and patient responsibility, benefits of admission and resource considerations.

The history of the Institute of Medical Ethics has been well recorded. Accounts of its origins in the London Medical Group were published in an academic paper of 2003,1 in the transcript of a Wellcome Witnesses to Twentieth Century Medicine Seminar in 20072 and in a chapter of the 2009 Cambridge World History of Medical Ethics.3 In 2013, 50 years since the inauguration of its first series of lectures and symposia, the LMG as an organisation no longer exists, but (...) its aspirations and achievements are alive and well, both in the Journal of Medical Ethics and in the IME, now exploring a new phase as a membership organisation. Other papers in this issue will discuss the history and prospects of the Journal and Institute. But the LMG, similar medical groups in all other British medical schools and the Society for the Study of Medical Ethics from which the IME derived also have a significant continuing life in the thinking and practice of many medical and healthcare professionals who participated in their activities, and then in turn on those influenced by their thinking and practice. The LMG, it could be said, is ‘no more’ an organisation ‘Now but a whole climate of opinion’.4A bottom-up evolutionThe first medical students to be involved in the LMG may not have foreseen its influence on their future careers, but many were aware of being part of something new and exciting. One of those with whom the first lecture series was planned was Margaret Lloyd . "The beginning of the LMG in 1963 was an exciting time for medical students in London. As a mature student entering St Mary's Hospital Medical School … ". (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Response 4: The Summer of Our DiscontentCaroline EdwardsI write this response on the eve of another wave of industrial action in the UK in November 2022—the Universities and Colleges Union (UCU) “UCU Rising” campaign, the latest in a series of regular disputes over pay and working conditions, the gender and ethnicities pay gap, and casualisation that has been ongoing since 2018. In 2022’s “summer of discontent,” we’ve seen our (...) rail, maritime and transport workers, airport staff, bus drivers, telecommunications workers, postal workers, nurses, refuse workers, and higher and further education staff engage in ongoing industrial disputes with intractable bosses. Even criminal barristers continue with an indefinite, uninterrupted strike after years of government cuts and chronic underinvestment. Everywhere you look, there is a palpable sense of a country on its knees. It’s nearly 100 years since the last General Strike of 1926 and in the UK it’s looking increasingly likely that we will have another General Strike on our hands soon. In “Two Cheers for Blueprints, or, Negative Reasons for Positive Utopianism” Antonis Balasopoulos contextualizes this within the longer economic durée of the shift from Fordist production to so-called flexible accumulation after 1972, writing in this issue that “the turn of capital to the faster and higher [End Page 554] profits involved in financialization rather than infrastructural and industrial investment, form much of the objective, structural ground for what can only be described as the rapid rise of a dystopian structure of feeling in western societies since the early 1970s.” Antonis’s brilliant summary reminds us of the monumental scale of the challenges facing utopian thought and praxis in our current moment. Make no mistake—the “crisis ordinariness” of everyday life under late capitalism that Lauren Berlant identified in Cruel Optimism (2011) has intensified in the years following the Global Financial Crisis (2007–8), the wave of Occupy protests in 2011, and, more recently, the COVID-19 pandemic (2020–). “For some time now,” as Antonis writes, the utopian goals of “happiness, fulfilment, [and] emancipation... have been out of the question altogether.”It’s hard not to agree with this assessment, given the current chaos of life in the UK. Adam Stock’s roundtable contribution “Funding Utopia: Utopian Studies and the Discourse of Academic Excellence” focuses on the academy’s complicity with the neoliberal financialization of what were previously protected as public goods (education, our health service, transport infrastructure, and so on) over the past three decades. As Adam notes, the rhetoric of “excellence” that has come to dominate all areas of university life—teaching, research, public engagement, and the quantifiable “impact” of university research beyond the academy—is really just another way of using competition to mask the market logic of scarcity. Swingeing cuts to publicly funded research have led to a scarcity of resources in scholarly knowledge production, which is legitimated through the discourse of “excellence” and “prestige.” Only a handful of elite research leaders are granted awards and the value of all research becomes judged by its proximity to this distribution (concentration) of wealth within a small number of institutions. Defending education as a public good has long given way to the desperate, existential struggle for survival at UK universities. Numerous institutions are on the brink of bankruptcy, which was the goal all along for the ideologically driven Office for Students (OfS). Market exit, as they euphemistically term it, proves market efficiency.At my own institution, Birkbeck, University of London, the challenge to utopian thinking is all too violently clear. Birkbeck has a special place in the UK higher education system—a university founded nearly 200 years ago in the Crown and Anchor Tavern on the Strand (it was called the London Mechanics’ Institution back then) to offer education to working-class Londoners that [End Page 555] fitted around their busy working lives. As my colleague Joanna Bourke writes in Birkbeck: 200 Years of Radical Learning for Working People (2022), life expectancy in the poorest parts of London was just twenty-nine years; cholera, typhoid, and typhus were major killers; and illiteracy was widespread. At Birkbeck, we are the only university to teach evening classes and offer the requisite support... (shrink)

Background: The law and literature about children’s consent generally assume that patients aged under-18 cannot consent until around 12 years, and cannot refuse recommended surgery. Children deemed pre-competent do not have automatic rights to information or to protection from unwanted interventions. However, the observed practitioners tend to inform young children s, respect their consent or refusal, and help them to “want” to have the surgery. Refusal of heart transplantation by 6-year-olds is accepted. Research question: What are possible reasons to explain (...) the differences between theories and practices about the ages when children begin to be informed about elective heart surgery, and when their consent or refusal begins to be respected? Research design, participants and context: Research methods included reviews of related healthcare, law and ethics literature; observations and conversations with staff and families in two London hospitals; audio-recorded semi-structured interviews with a purposive sample of 45 healthcare professionals and related experts; interviews and a survey with parents and children aged 6- to 15-years having elective surgery (not reported in this paper); meetings with an interdisciplinary advisory group; thematic analysis of qualitative data and co-authorship of papers with participants. Ethical considerations: Approval was granted by four research ethics committees/authorities. All interviewees gave their informed written consent. Findings: Interviewees explained their views and experiences about children’s ages of competence to understand and consent or refuse, analysed by their differing emphases on informed, signified or voluntary consent. Discussion: Differing views about children’s competence to understand and consent are associated with emphases on consent as an intellectual, practical and/or emotional process. Conclusion: Greater respect for children’s practical signified, emotional voluntary and intellectual informed consent can increase respectful understanding of children’s consent. Nurses play a vital part in children's practitioner-patient relationships and physical care and therefore in all three elements of consent. (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)

This “current controversies” contribution describes the recent case of a severely disabled six year old girl who has been subjected to a range of medical interventions at the request of her parents and with the permission of a hospital clinical ethics committee. The interventions prescribed have become known as “the Ashley treatment” and involve the performance of invasive medical procedures (eg, hysterectomy) and oestrogen treatment. A central aim of the treatment is to restrict the growth of the child and (...) thus make it easier for her parents to care for her at home. The paper below discusses the main objections to the treatment. It concludes that the most serious concern raised by the case is that it may set a worrying precedent if the moral principle employed in justification of the treatment is applied again to endorse it in similar circumstances. Finally, it raises the possibility that that same moral principle may even be invoked to justify more radical interventions than those that were actually performed in the Ashley treatment. (shrink)

Spurred by a confluence of factors, most notably the decreasing cost of high-throughput technologies and advances in information technologies, a number of population research initiatives have emerged in recent years. These include large-scale, internationally collaborative genomic projects and biobanks, the latter of which can be defined as an organized collection of human biological material and associated data stored for one or more research purposes. Biobanks are a key emerging research infrastructure, and those established as prospective research resources comprising biospecimens and (...) data from many participants are viewed as particularly promising drivers of biomedical progress. Such biobanks, particularly those publicly funded and set up to promote the public interest, have expanded across the globe in recent years. (shrink)

The truth-conditional theory of sense holds that a theory of truth for a natural language can serve as a theory of sense: if knowledge of a theory of truth for a language L is sufficient for understanding utterance of L-sentences, the T-sentences of the theory 'show' the sense of the uttered object-language sentences. In this paper I aim to show that indexicals create a serious problem for this prima facie attractive theoretical option. The so-called 'instantiation problem' is that a truth-theory (...) for indexical languages needs to contain universal statements that show how the reference of indexicals depends on features of the utterance context. Now one can deduce from such statements T-sentences that do not show the sense of an indexical sentence on an occasion of use. I survey proposed solutions to the instantiation problem by Evans and Sainsbury and, unfortunately, find them all wanting. Perhaps there is nothing like the sense-giving truth-condition for an indexical sentence. (shrink)

Hospital ethics committees have become widespread over the last 25 years, stimulated by the Quinlan decision of the New Jersey Supreme Court, the report of a President's Commission, and most recently by the Joint Commission on Accreditation of Health Care Organizations , which now man dates that each hospital seeking accreditation have a functioning process for the consideration of ethical issues in patient care. Laws and regulations in several states require that hospitals establish ethics committees, and some states (...) stipulate that certain types of cases and disputes be taken to such committees. At least one state grants legal immunity to those who implement recommendations of an ethics committee. (shrink)

Preparing the Next Generation of Oral Historians is an invaluable resource to educators seeking to bring history alive for students at all levels. Filled with insightful reflections on teaching oral history, it offers practical suggestions for educators seeking to create curricula, engage students, gather community support, and meet educational standards. By the close of the book, readers will be able to successfully incorporate oral history projects in their own classrooms.

The anonymous Life of King Edward, written about the time of the Norman Conquest, is an important and intriguing source for the history of Anglo-Saxon England in the years just before 1066. It provides a fascinating account of Edward the Confessor and his family: his wife Edith, his father-in-law Earl Godwin, and the queen's brothers Tostig and Harold. The foundations of the legend of St Edward the Confessor are apparent from the version of the work supplied by the unique (...) MS of c.1100. Professor Barlow explores the problems raised by this anonymous work in its now incomplete MS, and examines the development of the cult of St Edward. He also investigates the life and works of Folcard and Goscelin of St Bertin, possible authors. Recent discoveries have enabled Professor Barlow to reconstruct in part the lacunae in BL Harley MS 526 with texts closer to the original. For the second edition, he has undertaken a complete revision of the book. (shrink)

Clinical gene transfer research has both a unique history and a complex and layered system of research oversight, featuring a unique review body, the Recombinant DNA Advisory Committee. This paper briefly describes the process of decision-making about clinical GTR, considers whether the questions, problems, and issues raised in clinical GTR are unique, and concludes by examining whether the RAC's oversight is a useful model that should be reproduced for other similar areas of clinical research.Clinical GTR is governed by the same (...) oversight system as most clinical trials, with a significant addition: the RAC. Like other research with human subjects, GTR, if it is affiliated with a federally funded institution, must be approved by an institutional review board whose activities are governed by the common rule, that is, the federal regulations for protection of human subjects in research. Like other research intended to produce a drug, device, or biologic to be marketed in the United States, GTR is also overseen by the Food and Drug Administration. (shrink)

A volume of studies in natural language semantics which brings together work by philosophers, logicians and linguists. The main topics treated are: quantification and reference in natural language; the relations between formal logic, programming languages and natural language; pragmatics and discourse meaning; surface syntax and logical meaning. The volume derives from a colloquium organised in 1973 by the Kings College Research Centre, Cambridge and the papers have been edited for publication by Professor Keenan. It is hoped that the collection will (...) make available some of the best work in this fast-moving field and will stimulate further progress by juxtaposing the different approaches and interests represented here. (shrink)

BackgroundAs hospitals have grown more complex, the ethical concerns they confront have grown correspondingly complicated. Many hospitals have consequently developed health care ethics programs (HCEPs) that include far more than ethics consultation services alone. Yet systematic research on these programs is lacking.MethodsBased on a national, cross-sectional survey of a stratified sample of 600 US hospitals, we report on the prevalence, scope, activities, staffing, workload, financial compensation, and greatest challenges facing HCEPs.ResultsAmong 372 hospitals whose informants responded to an online survey, 97% (...) of hospitals have HCEPs. Their scope includes clinical ethics functions in virtually all hospitals, but includes other functions in far fewer hospitals: ethical leadership (35.7%), regulatory compliance (29.0%), business ethics (26.2%), and research ethics (12.6%). HCEPs are responsible for providing ongoing ethics education to various target audiences including all staff (77.0%), nurses (59.9%), staff physicians (49.0%), hospital leadership (44.2%), medical residents (20.3%) and the community/general public (18.4%). HCEPs staff are most commonly involved in policy work through review of existing policies but are less often involved in development of new policies. HCEPs have an ethics representative in executive leadership in 80.5% of hospitals, have representation on other hospital committees in 40.7%, are actively engaged in community outreach in 22.6%, and lead large-scale ethics quality improvement initiatives in 17.7%. In general, major teaching hospitals and urban hospitals have the most highly integrated ethics programs with the broadest scope and greatest number of activities. Larger hospitals, academically affiliated hospitals, and urban hospitals have significantly more individuals performing HCEP work and significantly more individuals receiving financial compensation specifically for that work. Overall, the most common greatest challenge facing HCEPs is resource shortages, whereas underutilization is the most common greatest challenge for hospitals with fewer than 100 beds. Respondents’ strategies for managing challenges include staff training and additional funds.ConclusionsWhile this study must be cautiously interpreted due to its limitations, the findings may be useful for understanding the characteristics of HCEPs in US hospitals and the factors associated with these characteristics. This information may contribute to exploring ways to strengthen HCEPs. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Martin Luther King, Jr., and the Legacy of Boston PersonalismJ. Edward Hackett1. IntroductionWhen the question of the Rev. Dr. Martin Luther King, Jr.’s philosophical legacy arises in the academy, so far, the question remains open-ended (though, as I will shortly argue, the question has already been answered by King himself). Beyond his presence in public American consciousness, King left behind speeches, sermons, correspondence, and writings (...) that inspire both philosophical and theological reflection. However, King is also interpreted on the merits of the biases and philosophical traditions that we scholars navigate. Such biases and philosophical traditions mediate our experience of encountering King, and this mediation can impact our understanding of what exactly King’s philosophical legacy is.1Accordingly, we should seek to reconstruct King’s thoughts in the philosophical vocabulary King employed rather than displacing King from his own agency and the contexts that shaped him.2 In doing so, we prevent mistakes and misunderstandings that plague the public knowledge of King’s legacy. And yet, serious misunderstanding occurs every January with light fluff pieces in major newspapers and websites from authors who do not read King’s corpus. What’s more, some scholars are guilty of this lack of reading King widely. Consider Martha Nussbaum and her glaring error and omission in her recent contribution to a recent book that purports to look at King as a philosopher: “Although a religious man, [King] did not advance in his political writings a comprehensive and religious doctrine, as Gandhi did” (Nussbaum 123). In an otherwise interesting article about political emotions, Nussbaum completely neglects any historical consideration or development where King describes himself as a personalist.3 Like others, Nussbaum disregards King’s own self-description. This disregard is tantamount to a silent [End Page 45] and implicit racism that results in scholarly efforts that deprive King of his own intellectual agency when interpreting his work. This tendency prevails in both philosophy and theology departments, and this neglect has also been the larger challenge of African American philosophy gaining more acceptance as a field of philosophical inquiry (McClendon and Ferguson 38). My efforts in this article are to put an end to continual misreadings of King. First and foremost, King is a personalist.While this essay defends the personalist interpretation of King, let me lay out briefly those pieces of evidence. The interpretation of King as a personalist rests on four evidential sources: (1) King’s own words, (2) family background, (3) influence of personalist ideas on his writings, and (4) the tradition of King’s reception by other Boston personalists. First, King describes himself in his own words as a personalist. This is perhaps the biggest piece of evidence for why we should read King as a personalist. Second, King was influenced by personalism before studying Brightman’s philosophy with Gregory Davis at Crozers Theological Seminary.4 Before Morehouse College and Crozers Theological Seminary, according to Rufus Burrow, homespun personalism emerges out of King’s upbringing within the Black Church. For this reason, scholars should not doubt that King synthesizes personalist influences with how he was raised (Burrow, God and Human Dignity 17–31). Moreover, given that King chose to go to Boston University to study with Brightman and to be where Boston personalism was known to be strong, all of these facts indicate that King was a personalist (Burrow, God and Human Dignity 24).Homespun personalism gave King a vocabulary to bring together and synthesize many intellectual forces in his life, and this synthesis is recognized by other personalists. Walter Muelder is one such personalist. Muelder was Dean of Boston University’s School of Theology from 1945–1972 when King attended. Muelder and King exchanged correspondence, and Muelder delivered many lectures, some published and others unpublished, on the personalism of King. The most famous of these lectures is one Muelder gave to Morehouse College in 1983, in which Brightman’s moral law system is read into King’s own words. Taking this historical background and also that, to this day, some teachers at Morehouse College, like Lawrence Carter, make their students learn the personalist moral law system from Muelder and Bright-man, the personalist interpretation... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Echoes of Grief:Tales from an Emergency Medicine and Critical Care NurseMarcia KingWell, I have 42 years of stories from working in ICU and Emergency Medicine as a registered nurse. The first situation that comes to mind on the subject of grieving on the job in healthcare happened about 37 years ago. I had a nice lady in ICU for several days in a row as a patient. She had (...) a bad myocardial infarction (MI) and was critical. We tried all the medications and pain meds, and nothing took her chest pain away. Meanwhile, her husband stayed with her all day, and all night. He doted after her 24/7. He slept in a chair and never went home for about three days, even though they lived just a few blocks from the hospital. I was amazed at what an awesome husband he was.Finally, after about three days, she fell asleep for more than 10 minutes. She had said her pain was gone. Her husband didn't want to leave her, but he asked me "if it would be okay" to go home and take a shower, eat a sandwich, and get the mail. He explained that he would be right back.I said, "Sure, now is a good time since her pain is gone and she's sleeping. You must take care of yourself too."The husband ran out in a hurry. About 10 minutes after he left, his wife suddenly had pain again and a run of ventricular tachycardia, (V-tach), which is a type of abnormal heart rhythm, or arrhythmia. Even though the V-tach stopped on its own, I called the husband and told him to come back because he wanted to be there if anything happened. A few minutes later, she had another run of V-tach, but this time, she coded and died. About two minutes after she died, the husband came running into the room—panicked and crying and talking to her dead body.He was saying, "I'm so sorry I left you! I shouldn't have left you!" I felt awful because I was the one who told him it was okay to go. Then I was crying with him and for the poor man.He then left for home, and their doctor (who was a well-known grouch-ass) appeared and saw that I was upset, and he asked me what my problem was. Why was I so sad about it? I thought, "Jerk, you are in the wrong career."Thinking about that doctor's reaction at the time, I wondered, "WTF is wrong with him!" I had known the doctor for several years because his mom was the head nurse of the surgical floor. I thought for a moment and then said to him, "How could you be a decent doctor if that death didn't bother you?" I was [End Page 74] in my 20s at the time—a fairly new nurse—and was just starting to be able to feel comfortable speaking up and being assertive.I just felt so bad for that poor man. I felt terrible that I told him it was okay to run home. He really wanted to be there if something happened to her, and from what I saw, he was an amazing husband to her. Looking back, she probably was waiting for the minute he stepped out to go.Another time, while working in the emergency department, a trauma alert was called on a patient who came in by ambulance. We were told the woman had fallen off a hayloft while pushing hay onto the floor in her barn. She hit her head bad in the fall. She wasn't my patient, but I ran into the room to help when she arrived. There was a bunch of staff around blocking my view. Without even looking at her, I grabbed her arm to put in an IV as I had done thousands of times before. Suddenly, I noticed it was weirdly quiet. I looked up, and the ER Doc and tech were looking at me funny. Then the Doc said, "Marcia, you know who this is, don't... (shrink)

The authors examine the nursing practice of disposing unaltered controlled substances into public water systems as an issue for nurses concerned with the environmental harm it can cause. A summary of the history of controlled substance management reveals inconsistencies in the interpretation of current regulations that have led to disposal policies that vary by institution, according to a benchmarking survey of regional hospitals. Much attention has been given to the phenomenon of conscientious objection in the context of patient care that (...) conflicts with a nurse’s moral integrity. Nurses who are compelled to dispose narcotics down drains may also face this struggle. The authors submit that this disposal method is based on a type of double effect logic where preventing diversion is viewed as a good effect of flushing unused controlled substances that outweighs any harm it may cause, though there is little evidence to support this conclusion. Consequently, the topic deserves further study so that nurse managers and administrators can support and offer alternatives to nurses who object to flushing drugs down the drain. (shrink)

I was born in Boston, Lincolnshire (actually in Wyberton West Hospital, which no longer exists), educated (if that's the word) first at St Mary's Primary School (run by nuns at the time, which probably explains a lot about my later career if you're a Freudian, which I'm not. Its new incarnation is here), then at Boston Grammar School . At the latter I successfully navigated 'O'-levels, but nearly half-way through my 'A'-levels I developed a number of extra-curricular interests which (...) distracted me from my studies. More importantly, I began to think rather more broadly than some of my teachers (and especially my appalling headmaster) cared for. This led to an almost total cessation of interest in my 'A'-levels. It did, however, involve a number of stage rôles at Blackfriars Theatre and elsewhere, and a good deal of time spent in the theatre bar. (shrink)

It was reported in 2006 that a regime of ‘supervised self harm’ had been implemented at St George’s Hospital, Stafford. This involves patients with a history of self-harming behaviour being offered both emotional and practical support to enable them to do so. This support can extend to the provision of knives or razors to enable them to self-harm while they are being supervised by a nurse. This article discusses, and evaluates from an ethical perspective, three competing responses to self-harming (...) behaviours: to prevent it; to allow it; and to make provision for supervised self-harm. It is argued that of these three options the prevention strategy is the least plausible. A tentative conclusion is offered in support of supervised self-harm. (shrink)

Emmanuel Levinas identifies Husserl’s lectures on the internal consciousness of time as of central phenomenological importance. However, Levinas gives two different readings of these lectures: the first argues that Husserl’s concept of the proto-impression is the receptivity of sensation that provides the basis for intentional constitution. The second reading, by contrast, argues that Husserl’s account is ultimately bound to the category of the Same, as whatever enters consciousness is not put into question. Most commentators either conflate the readings or interpret (...) them as an ambiguity in Levinas’s thought. I argue to the contrary that while Levinas sees Husserl’s account as an advance in the articulation of the otherness presented to us in the world of perception and how such otherness funds consciousness, he claims that Husserl’s presentation of internal time consciousness is unsuitable to account for the ethical relationship with the other person. Thus, Levinas’s two readings mark out how Husserl’s description of temporal consciousness can and cannot be used in articulating the ways in which the ego is decentered by otherness. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Changing Functions, Moral Responsibility, and Mental IllnessCraig Edwards (bio)Keywordsmental illness, responsibility, character, dysfunction, personhoodI thank both Wakefield and Tomasini for their illuminating comments. Both commentaries are thought provoking and warrant a full response. However, as always, space is limited and I must make the all-too-predictable apology for not addressing both commentaries in full. Wakefield's contribution more directly engages with, and challenges, my claims, and so I focus on addressing (...) his concerns.ClarificationsWakefield correctly notes that I am interested in how mental illness (and illness generally) operates to remove moral responsibility for one's actions. Despite this, it seems at several points that he and I are talking about two different, albeit related, concepts of mental illness. 'Mental illness' is used to both explain and excuse certain behaviors, but these two functions, explanatory and exculpable, do not always operate simultaneously. As we discover biological explanations for apparently immoral behaviors, the question arises as to whether the explanation should remove the immorality and liability for punishment. The 'sick role' can be divided into two aspects. One is the role of deserving and warranting medical treatment. The other is the negation of moral responsibility. Wakefield's own example, pedophilia, involves the first sense of the sick role but not the second. Wakefield's use of this example is unusual, because it deftly highlights the limitation of his HD account. Pedophilia is a mental disorder in the sense of warranting treatment, and is a mental illness under Wakefield's model, but it is not something that negates moral responsibility. There is a sense of the term 'mental illness'—an important and, as I argue, an objective sense—that is relevant to establishing one's moral responsibility for such behaviors.In addressing my account of mental illness as though it contained two distinct answers, 'mental illness as dysfunction of rational agency, or 'mental illness as moral judgment,' it is unclear whether Wakefield takes them to be conjunctive or alternative. Hence it is worth reiterating in point form the structure of my account:1. Illness involves dysfunction;2. The 'proper function' of a bodily or psychological mechanism is determined by the purpose that we impose upon that mechanism (within the constraints of our biological needs);3. Dysfunction of rational agency is necessary, but not sufficient, for 'mental illness' in the normative sense relevant to negating moral responsibility; and [End Page 105]4. The distinction between 'mental illness' (in the above sense) and the many dysfunctions of rational agency for which we are morally responsible, turns upon (objective) normative facts rather than features internal to the dysfunctions themselves.Functions and ValueWakefield misses the point when he criticizes my comment that, although bodily mechanisms are fairly uniformly valued, there is substantial historical and cross-cultural variation in the way people value personhood. He notes—accurately, but irrelevantly—that people almost always place great value on their capacity for rational agency, probably more so than many aspects of their physical health. My comment, taken in context, has nothing to do with how much people value personhood, but has everything to do with what kinds of purposes people want their mental and physical processes to achieve. A heart has the same function for a Londoner today as it did for a Japanese peasant a thousand years ago, and although it is possible for us to want it to achieve other purposes, any culture that seriously imputes a different set of vital functions on the heart is likely to be rather disappointed. By contrast, our species has experienced vast changes in the demands we make of our rational and intellectual capacities—dysfunctions like dyslexia and alcoholism were irrelevant before the availability of written communication and alcohol.Wakefield's HD account is unable to deal with the relevance of such change. The link between evolutionary function and illness is tenuous in any event. Evolutionary explanations of specific mechanisms are often untestable, simply positing some evolutionary purpose that happens to fit our understanding of what the mechanism does. If we were to discover that alcoholism evolved as a means of increasing birthrates, or (perhaps more plausibly) that anxiety disorders occur among those for whom... (shrink)

It is a mark of arrogance to try to minister in a liturgical or ritual way to individuals of other religions. A hospital chaplain is not a generic brand, all-purpose religious figure capable of fulfilling the religious needs of any. A chaplain should not try to fill in for specific religious ministers, but rather, he should see himself as a human companion to those who need human love and care. In doing this, he can surely be motivated, informed, and (...) sustained by his inner, spiritual life, but should not see himself as replacing the patient's own religious pastor. Excellent examples of how to carry out pastoral duties in pluralist communities come from two contemporary Christians: Mother Theresa and Father Porphyrios. Both of whom remained non-judgmental toward those for whom they cared, while maintaining a strict view of the historical teachings of Christianity and obedience to them. (shrink)

We have witnessed the athleticization of political discourse, whereby debate is treated like an athletic contest in which the aim is to vanquish one's opponents. When political discourse becomes a zero-sum game, it is characterized by suspicions, accusations, belief polarization, and ideological entrenchment. Unfortunately, athleticization is ailing the classroom as well, making it difficult for educators to prepare students to make valuable contributions to healthy civic discourse. Such preparation requires an educational environment that fosters the intellectual virtues that characterize an (...) examined life. This, in turn, requires an amicable and hospitable atmosphere in which a student enjoys the freedom to discover and articulate what she believes, how well her beliefs hang together, and what underlying assumptions or biases might be at work—without the fear that her self-disclosure will trigger immediate accusations and pigeonholing from fellow students. Educating for intellectual virtue is crucial for meeting these challenges and in this chapter we contribute to this strategy by offering some tools and guidance for promoting productive discussion of controversial issues. In the first two sections, we identify and explain two fallacious patterns of thought that often encumber discussion of controversial issues: assailment-by-entailment and the attitude-to-agent fallacy. In effect, these sections diagnose two diseases of discourse. We conclude each section with practical suggestions—in the form of thinking routines—for curing these ills. We will argue that part of the cure is to be found in the intellectual virtues. In particular, we will discuss how the virtues of intellectual charity, humility and carefulness can inoculate the mind against the fallacies we identify. (shrink)

On January 1, 2006, Medicare Part D prescription drug coverage was initiated. Concern was immediately voiced by the American Association of Retired Persons (AARP) and Families USA that, in response to this program, the pharmaceutical industry may raise prices for drugs most often used by the elderly. This article examines the ethical implications of a revenue-maximizing pricing strategy in an industry in which third party financing mitigates an end product's true cost to the user. The perspectives of three stakeholder groups (...) are examined: the elderly, as consumers of prescription drugs, the pharmaceutical industry, as product manufacturer and beneficiary of derived profits, and the total U. S. population, as the ultimate payer for the program via tax revenues. Key questions explored include the relationships among price strategy and access to drugs at both the micro (Medicare cohort) and macro (total population) levels, and on drug development or enhancement. The role of profit in a capitalism-based health care system is also examined. Hospital industry impact on these same stakeholder groups in response to the original 1965 Medicare law is used to compare and contrast possible outcomes of the new drug program. It is predicted that pharmaceutical firms will mimic the hospital industry, adopting a price maximizing strategy for drugs covered by the program. In the process, a utilitarian effect occurs: the benefits of increased access and diffusion of drugs counterbalance inequities in financing Medicare Part D. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:THE FATE OF THEISM REVISITED I THEISM SEEMS to be caught in a dilemma. Speaking persuasively to the surrounding culture seems to demand hat theism sacrifice its own integrity as a significantly distinctive world-view; affirming its distinctiveness seems to result in moving itself to the periphery of the culture. Briefly, then, either theism acquires relevance at the price of forfeiting any claim to distinctiveness or it takes seriously precisely (...) those things that make it seem significantly distinctive and thereby isolates itself from the rest of the culture. Such is the fate of theism as portrayed by (friendly?) critics of theism like Jeffrey Stout, Alasdair Macintyre, and Van A. Harvey.1 The main question addressed in this paper is whether or not the theist (or his more specific variant, the Christian theist) has a sound response to this dilemma? How, if at all, can the Christian theist avoid the horns of the dilemma of redundancy and irrelevance? 1 Jeffrey Stout, The Flight from Authority: Religion, Morality, and the Quest for Autonomy (London and Notre Dame: University of Notre Dame Press, 1981), especially Part 2. Alasdair Macintyre, "God and the theo· logians," in Against the Self-Images of the Age (London: Duckworth, 1971), pp. 12-26; see also Macintyre's essay, "The Fate of Theism," originally delivered as one of his Bampton Lectures at Columbia University in 1966. Macintyre's lectures were published in The Religious Si,qnificance of Atheism (New York: Columbia University Press, 1969). For "The Fate of Theism," see pp. 3-29. Van A. Harvey, The Historian and the Belie1Jer: The Morality of Historical Knowledge and Christian Belief (New York: Macmillan, 1966); see also Harvey's essay, "The Pathos of Liberal Theology," Journal of Religion 56 1976: 382-391. For an illuminating discussion of the fate of theism, see Peter L. Berger, The Heretical Imperatives: Contemporary Possibilities of Religious Affirmation (New York: Doubleday 1980). 63~ THE FATE OF THEISM REVISITED 633 The practical relevance of this dilemma for Christian doctrine was recently evidenced in Thomas Sheehan's review of Hans Kiing's latest book in the New York Review of Books.2 After summarizing Kiing's views on the Christian doctrine of eternal life, Sheehan writes: Kiing... has pushed Catholic theology to the limits of its own language. In fact, he has brought it to the point where one can ask what its teachings have to offer that cannot be found outside the scope of its experience and discourse. For example, the hope in immortality he evokes is certainly not peculiar to Catholicism or Christianity. Nor is it an exclusively religious doctrine: we find it in pagan philosophy from the Greeks onward, even in thinkers who did not believe in a personal god.... On a broader scale, it is clear that religious experience is available outside Catholicism and Christianity; and for many people natural human experience, with no religious or transcendent dimension, is satisfying enough. What, then, does Catholicism claim to provide that cannot be found beyond its boundaries? I am not asking about the subjective aspects of experience, be it natural or religious (its felt quality, psychological genesis, personal meaning, and so on). I am asking an objective theological question: what does Catholicism claim that makes it unique, essentially different from non-Catholic religions and non-religious humanisms? 3 Sheehan's answer to this last question is clear. That which makes Christianity unique and essentially distinctive and which traditional believers sought to clarify and defend moves Christianity to the periphery of the culture. By identifying themselves primarily with the tradition in terms of classical Christianity, no one hears what Christians have to say but themselves. The only alternative to this self-imposed isolation, holds Sheehan, is to be intelligible to contemporary educated, secularminded men and women: in which case Christian theism may well have interesting things to say, but these will not be significantly distinctive in any Christian sense. To put this last 2 Thomas Sheehan, "Revolution in the Church," The New York Review of Books, June 14, 1984, pp. 35-39. s Ibid., p. 38. 634 EDWARD J. ECHEVERRIA point another way, the strategy of accommodation raises the question why one should be Christian at all... (shrink)

While early modern Spain may seem a world away, it is an extremely rich and relevant context for gaining a better understanding of the Rhetoric of Health, specifically the power of metaphor, in the related spheres of policy-making and public debate. It was a time and place in which the urban populace’s physical well-being depended upon the fortunes of theatrical performances due to a system of alms for hospitals driven by ticket receipts. Anti-theatricalists argued that the immoral nature of theatrical (...) performances made them spiritually and medically detrimental to society. Pro-theatricalists argued that plays were always a public good on balance because they raised much-needed funds for hospitals. Instead of producing a conflict between morality and public health, each side reinforced their connection until the two topics became nearly inseparable in the sphere of public debate. While pro-theatricalists mainly stayed with their arguments about funding hospitals, anti-theatricalists developed a new strategy of literalising the metaphor of theatre as a “plague of the republic” and arguing that immoral entertainment brought literal disease to the populace as a punishment from God. This exemplifies Stephen Pender’s observation of how, in an early modern medical context, “Rhetoric as a way of perceiving probabilities and adjusting one’s argument to the audience and circumstance offers a model of ethical action and interaction”. This article is organised chronologically to track specific adjustments to a specific public-health debate that rely upon moral metaphors of medicine. Each side wrangled over these metaphors in an effort to break a deadlock in a public-health policy debate with entertainment, finance, and morality at its centre. By the end of the seventeenth century, anti-theatricalists finally found their best rhetorical weapon in the literalisation of the “plague of the republic” metaphor, but it only offered a short-term solution to banning theatre contingent upon the ebb and flow of epidemics. Simultaneously, the finance structure of funding hospitals began to erase the role of hospitals from the longstanding debate about the morality of public theatre. The case of early modern Spain provides valuable lessons about the power of metaphor in the Rhetoric of Healthcare that are still applicable today. (shrink)

The ethical value—and to some scholars, necessity—of providing trial patients with post-trial access (PTA) to an investigational drug has been subject to significant attention in the field of research ethics. Although no consensus has emerged, it seems clear that, in some trial contexts, various factors make PTA particularly appropriate. We outline the atypical aspects of psychedelic clinical trials that support the case for introducing the provision of PTA within research in this field, including the broader legal status of psychedelics, the (...) nature of the researcher-therapist/participant relationship, and the extended time-frame of the full therapeutic process. As is increasingly understood, the efficacy of psychedelic-assisted psychotherapy is driven as much by extrapharmacological elements and the cultural therapeutic container as by the drug itself. As such, we also advocate for a refocusing of attention from post-trial access to a broader concept encompassing other elements of post-trial care. We provide an overview of some of the potential post-trial care provisions that may be appropriate in psychedelic clinical trials. Although the World Medical Association’s Declaration of Helsinki calls on researchers, sponsors, and governments to make provisions for post-trial access, such provision may feel impracticable or out-of-reach within psychedelic trials that are already constrained by a high resource demand and significant bureaucratic burden. We show how conceiving of post-trial provision as an integral site of the research process, and an appropriate destination for research funding, will serve to develop the infrastructure necessary for the post-legalisation psychedelic medicine ecosystem. (shrink)

One of the most striking features of Athenian laws regulating commercial activities is the absence of any concept akin to the modern legal notion of the partnership or corporation. Despite the presence in Athenian society of numerous koinoniai, groups of individuals cooperating for some purpose, be it commercial or otherwise, Athenian law concerned itself solely with individual persons and did not recognize the separate legal existence of collective entities. And just as Athenian law did not recognize the legal existence of (...) partnerships or corporations, it also did not possess the notion of corporate liability. This meant that if someone entered into an agreement with a group of individuals and one of those individuals violated the terms of the agreement, the plaintiff proceeded only against the individual who acted contrary to the agreement, not against the group as a whole. If the plaintiff won his suit, he only had a right to receive compensation from the defendant's private property; he did not have a claim on all the funds held in common by the group. (shrink)

ABSTRACT:Officials must understand why and how the public lost confidence in the federal government’s ability to manage financial turmoil. Officials outsourced to private parties responsibility for monitoring and policing the safety-net exposures that were bound to be generated by weaknesses in the securitization process. When the adverse consequences of this imprudent arrangement first emerged, officials claimed for months that the difficulties that short-funded, highly leveraged firms were facing in rolling over debt reflected only a shortage of aggregate liquidity and not (...) individual-firm shortages of economic capital. Then, in September 2008, the president and other officials created an unwise sense of urgency that delays in implementation show to have been greatly exaggerated.That authorities and financiers violated common-law duties of loyalty, competence, and care they owe to taxpayers indicates a massive incentive breakdown in industry and government. Taxpayers deserve a thorough-going reorientation of: (1) how regulatory agencies report on their regulatory performance and back-room interactions with Congress and the Treasury, and (2) the contract structures and performance measures used by the financial industry and its government overseers. (shrink)

Plato, in his dialog Charmides, presents the question of how society can determine whether a person who claims superior expertise in a particular field of knowledge does, in fact, possess superior expertise. In the modern era, society tends to answer this question by funding institutions (universities) that award credentials to certain individuals, asserting that those individuals possess a particular expertise; and then other institutions (the journalistic media and government) are expected to defer to the credentials. When, however, the sequential reasoning (...) and theorizing and conclusion-stating of generation after generation of credential-bearing experts (i.e., scientists) leads to the assertion of the truth of statements that large segments of society find to be in conflict with the statements of persons who have earned credentials of expertise bestowed by an alternative institutional structure (i.e., religious teachers), representatives of the people are put to a choice. And when the conflicting statements present substantial implications for the moral and sexual behavior of people in the society, addressing the conflict brings into play not only the highest intellectual speculations and analyses, but also the most animal emotions and motivations. This paper, taking the form of a dialog, presents a scientist (Avram Codosia) named after an ancient Jewish patriarch and makes him a supplicant to a U.S. Senator (Helen Astartian) named after a pagan goddess. The stakes turn out to be not merely financial and intellectual, but personal and moral, involving the scientist's son (Isaac), an art student, and the senator's niece (Halia), a philosophy student. In a four-phase encounter, the paper hopes to offer some innovative observations on age-old issues and to stimulate productive new thinking on questions that too often seem to be debated by means of repetitions of the same old points. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:KARL ASCHENBRENNER, 19x 1-1988 Karl Aschenbrenner was born in Bison, Kansas, on November 20, 1911. He received the A. B. degree from Reed College in 1934 and his graduate degrees at Berkeley (M. A., 1938; Ph.D., 194o). After two years as an instructor at Reed College, he served in the U.S. Naval Reserve (Lieutenant in Meteorology ) from 1943 to 1946. From 1946 to 1948, he taught in the (...) Department of Speech at Berkeley and thereafter in the Department of Philosophy until his retirement in 1978. His teaching was devoted mainly to aesthetics and to the history of philosophy, most notably his course on Kant. For many years he was active as a trustee of the American Society for Aesthetics, and from 1961 as a member of the Journal's founding executive committee and, after incorporation, of the Board of Directors. Karl's first two years of attachment to theJournal coincided with service as chairman of the Department of Philosophy. This conjunction enabled him to be extraordinarily helpful in dealing with problems of bringing the Journal to birth--problems of funding, editorial appointments, publication policies, and business arrangements with the University of California Press. He welcomed the opportunity offered the Philosophy Department of collaborating in the publishing venture recommended by a special committee of the American Philosophical Association in 1958. The recognition early won by the Journal for its articles and reviews answered to his hope and work for success. At the annual meeting of the Board of Directors in San Francisco in 1987, the twenty-fifth birthday of the Journal was celebrated as was his twenty-seven years of diligent care for theJournafs excellence. Karl was a regular contributor to the philosophy series published by the University of California prior to three books issued by D. Reidel: The Concepts ofValue(1971), The ConceptsofCriticism(1974) and AnalysisofAppraisiveCharacterization (1983). He received Guggenheim, Fulbright, and NEH fellowships. Despite a physically disabling stroke in 1979, he continued his trips to Budapest which he began in 1972. He was concerned to study a non-IndoEuropean language spoken by people of European culture and had selected the Magyar tongue spoken in Hungary. He learned the language to test theories he advanced about appraisive concepts. He discovered in the structure of Magyar a mode of valuing embodied in verb usage differing significantly [333] 334 from the special appraisive vocabularies of English and German. Besides his lectures in Hungary, he responded to invitations to lecture received from universities in England, Austria, Poland, Bulgaria, and Romania. Shortly after his return to Budapest on his eleventh trip, he died of a massive stroke on July 4, 1988. He is buried there in a city he loved, especially for its music. He is survived by Marie, his wife of fifty-one years, and three children: Lisabeth, an attorney in Los Angeles; Peter, a judge in Fairbanks; and John, a composer in New York. E. W. STRONG... (shrink)

David Hume (1711–1776) was born in Scotland and attended Edinburgh University. In 1734, after a brief spell in a merchant's office in Bristol, he went to France to write A Treatise of Human Nature, published anonymously in 1739 (Books I and II) and 1740 (Book III). An Abstract, also anonymous and written as if by someone other than the author of the Treatise, appeared about the same time, and provides an invaluable account, in a brief compass, of what Hume thought (...) most important about the Treatise. The Treatise was not well received, and Hume was unsuccessful in his candidature for the chair of moral philosophy at Edinburgh. He rewrote Book I of the Treatise, adding a controversial discussion of miracles and providence; and a revision of this was published as An Enquiry Concerning Human Understanding in 1748. His Enquiry Concerning the Principles of Morals, which was a rewriting of Book III of the Treatise, was published in 1751, and his Dissertation on the Passions, corresponding to Book II of the Treatise, but with significant omissions, such as the account of the psychological mechanism of sympathy, in 1757. In 1752 he had been made keeper of the Advocates' Library at Edinburgh, and wrote his History of England which, at the time, brought him more approbation than his philosophy. During this time, he wrote the Dialogues Concerning Natural Religion, published posthumously in 1779. In 1763 he became secretary to the British Embassy in Paris. He returned to London in 1766, and a year later was Undersecretary of State. In 1769 he returned to Edinburgh and worked on final editions of his writings, and on an autobiography, dated 18 April 1776, a few months before his death. (shrink)

Lesbian, gay, bisexual, trans and/or queer (LGBTQ) people experience profound health and social care inequalities. Research suggests that staff with negative attitudes towards LGBTQ people, are more likely to hold strong, traditional, religious beliefs. This article reports on a single case study with a newly qualified UK nurse who has since left the National Health Service. This is based on a single interview taken from a larger dataset derived from a funded scoping research study exploring religious freedoms, sexual orientation and (...) gender identity rights in older age care spaces. The interviewee described a toxic nursing culture on a hospital ward for older people. She recounted various incidents involving homophobic and transphobic practice and LGBTQ microaggressions which reportedly impacted the quality of nursing care. The findings are considered in relation to standards for anti-oppressive practice in nursing care, and how nursing students and staff can be supported in addressing practice relating to equality and diversity issues, specifically LGBTQ issues. They confirm the direct significance of addressing the needs and circumstances of LGBTQ people in nursing curricula and ongoing professional practice, and the need to further research, evaluate and progress translation of learning into improved quality care for diverse populations. (shrink)

Biodefense and emerging infectious disease animal research aims to avoid or ameliorate human disease, suffering, and death arising, or potentially arising, from natural outbreaks or intentional deployment of some of the world’s most dreaded pathogens. Top priority research goals include finding vaccines to prevent, diagnostic tools to detect, and medicines for smallpox, plague, ebola, anthrax, tularemia, and viral hemorrhagic fevers, among many other pathogens (National Institute of Allergy and Infectious Diseases [NIAID] priority pathogens). To this end, increased funding for conducting (...) research, developing research facilities, and purchasing (stockpiling) developed vaccines, diagnostic tools, and therapeutics .. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Oberlin's First Philosopher* EDWARD H. MADDEN ASA MAHANWAS THE FroST president of Oberlin College (1835-50) and professor of moral philosophy--the usual pattern during these years of "academic orthodoxy" when Christianity was purveyed in American colleges as the philosophy.1 The orthodox professors argued philosophical points very little but rather "presented" and "illustrated" their basic truths. 2 In some ways Mahan fit the stereotype. He did not always probe deeply into (...) questions or always offer reasons for his conclusions. His books are full of phrases like "it could not be otherwise", "no one, it is presumed, will deny that", "it is intuitively evident", "everyone cannot but know", and so on. And he frequently cited other philosophers, as well as the Scriptures, as "authorities." He even cited lengthy passages from Jonathan Edwards whenever he could, even though he differed with Edwards on almost every major point f In more important ways Mahan, however, does not fit the stereotype. Unlike Francis Wayland and most of the other academic orthodoxy before 1850, he had read, and been influenced by, German and French philosophers as well as the Scottish realists. Mahan was particularly influenced by Kant and Cousin. An astute contemporary reviewer remarked that Mahan, like Cousin, was an eclectic. "His eclecticism degenerates sometimes into the merely aggressive, and he delights occasionally in strange and incongruous combinations of Kant, Coleridge, Cousin and himself, but showing here and there great vigor and acuteness, and very considerable philosophical ability." a The aggressiveness of Mahan also sets him apart from the rest of the orthodoxy. He was too fiery by temperament to pass up polemics and hence got to the heart of some basic philosophical problems. He attacked the Edwardian doctrine of determinism and was led, by the vigor of his attack, into what many nineteenth-century Christians considered heresy3 He attacked utilitarianism in all its forms, including Paley's, in a far more consistent and thorough fashion than Francis Wayland and the other followers of Scottish realism and English intuitionism. And first and foremost he vigorously attacked the moral philosophy of his colleague Charles Grandison Finney, famous evangelist, professor of theology, and president-to-be of Oberlin. The spiritedness of his criticisms frequently aroused the ire of his Oberlin colleagues, but the spirited- *Research for some of the material in this paper was made possible by a grant from the Penrose Fund of the AmericanPhilosophicalSociety. ~Cf. Herbert W. Schneider, A History o] American Philosophy (2nd ed.; New York: Columbia University Press, 1963),pp. 195-220; and Joseph L. Blau, Men and Movements in American Philosophy (New York: Prentice-Hall, Inc., 1952). 2Cf. E. H. Madden, "Francis Wayland and the Limits of Moral Responsibility," Proceedings o] the American Philosophical Bociety, Vol. 106 (1962),pp. 348-359. *Quoted by R. S. Fletcher in his History o] Oberlin College (Oberlin, Ohio, 1943),II, 701. 4Fletcher, I, 223-231. [57] 58 HISTORY OF PHILOSOPHY hess fortunately was accompanied by a "considerable philosophical ability" that merits close attention. I Mahan's critique of Edwards appears in his Doctrine o] the Will, first published in 1844. According to Mahan, "Edwards stands convicted of a fundamental error in philosophy, an error which gives form and character to his whole workmthe confounding of the Will with the Sensibility, and thus confounding the characteristics of the phenomena of the former faculty with those of the phenomena of the latter." 5 The trouble is that the whole of Edwards' work "is constructed without an appeal to Consciousness, the only proper and authoritative tribunal of appeal in the case." 8 If we attend carefully to consciousness, said Mahan, we can distinguish volition from the strongest desire and hence must distinguish between the separate faculties of will as personal activity and sensation as mere passive impression. The latter does not "act," it merely "suffers." The will is the moving force in life and unless it can be shown that there is some necessary connection between will and sensation--which, in fact, cannot be done--then it follows that the will is free, that is, the source of "personal activity." Mahan's rejection of universal determinism, of course, entailed the rejection of the Calvinistic doctrine of election... (shrink)

Shanker & King (S&K) rightly stress that recent ape language research has important implications for language development and origins. But the evidence does not warrant their conclusion that we can dispense with representations. Indeed, their own discussion of the nature of communication highlights the central role that representations must play in our models of communicative competence, in and out of language.

By 1910 the Cambridge University physiology department had become the kernel of British physiology. Between 1909 and 1914 an astonishing number of young and talented scientists passed through the laboratory. The University College department was also a stimulating place of study under the dynamic leadership of Ernest Starling.I have argued that the reasons for this metropolitan axis within British physiology lie with the social structure of late-Victorian and Edwardian higher education. Cambridge, Oxford, and University College London were national institutions (...) attracting students from all over England and Wales. In contrast, the provincial colleges drew their clientele from relatively narrow geographic radii. Generally, also, these institutions were regarded as socially inferior to the longer-established universities.A brief survey of the biographies of some British physiologists demonstrates how physiology, as an occupation, became, over the later decades of the century, socially elite. The scientists who achieved full-time posts in the 1870s generally came from somewhat marginal backgrounds. Foster, like his mentors T. H. Huxley and William Sharpey, came from a non-conformist family. Edward Schäfer was also a dissenter and, like Foster, began his professional career as a general practitioner.Physiologists of the succeeding generation, however, came from wealthy families with established intellectual traditions. John Scott Haldane, nephew of John Burdon Sanderson, was the brother of the politician R. B. Haldane and uncle of the historian A. R. B. Haldane.71 Joseph Barcroft was one of the most affluent of all physiologists.72 His family's wealth derived from linen manufacturing. He attended the Ley's School Cambridge, where his schoolmates included Henry Dale, later Director of the National Institute for Medical Research; F. A. Bainbridge, who eventually became Professor of Physiology at St. Bartholomew's Hospital; and the Cambridge historian J. H. Clapham. A. V. Hill, Professor of Physiology at Manchester and, subsequently, London, married Margaret Keynes, sister of John Maynard Keynes and niece of Sir Walter Langdon Brown, Professor of Physic at Cambridge. Margaret Keynes's younger brother, the surgeon Sir Geoffrey Keynes, married a granddaughter of Charles Darwin; their son Richard Keynes also became a physiologist at Cambridge.These families were part of a new class emerging during the late Victorian period, descendants of the great reforming radicals of the 1830s, who had begun to achieve power through positions in the universities, the professions, and the civil service. Their social prestige rested upon their intellectual expertise. Physiology was an appealing research discipline to these groups because of its clear dissociation from industry and commerce. And because physiology's “practical” face was medicine, its acceptability was reinforced by professional ties.The nature of the Physiological Society confirms this image of physiology as an elite science. By the turn of the century the Society had taken on some of the characteristics of a dining club. The scientific meetings were generally followed by dinner: if the Society met at Oxford, they were entertained at Burdon Sanderson's college, Magdalen.73 Through a “black ball” system, unwanted candidates could be excluded. In 1912, when the question of admitting foreigners was discussed, E. H. Starling wrote to Edward Schäfer: “the Society has very much in it the nature of a club, and a certain amount of personal knowledge of the candidate is always desirable.”74.The developing institutional structure of physiology in late Victorian Britain indicates, therefore, that we must look beyond the achievements of individuals and departments to understand why physiology flourished. The discipline became part of a new social order in which the professional middle classes assumed increasing power. These groups valued intellectual skill, especially in the pure scienes, as forces both for self-advancement and for progress within society. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:BOOK REVIEWS 379 the minister of a very influential and liberal congregation. In 1860 he began publication in Cincinnati of The Dial, successor to the New England transcendentalist journal, and used its pages to promote religious liberalism, philosophical transcendentalism, and social reform. In 1863 he went to London where he became the head of the Ethical Society. Under the influence of Feuerbach and "left-Hegelians" he travelled widely in (...) the interests of "free thought." The most amazing of these four, however, is August Willich: an East Prussian soldier, ready to fight again to restore the 1848 revolution in Germany, discouraged by Marx from doing so, emigrating to Cincinnati to raise funds among the German 1848 refugees there and urging them to continue the lost cause in Germany, then wholeheartedly fighting for the Union Cause as a General in the Civil War, and finally joining the Populist revolt. As Easton points out, these four all illustrate the close relation between Hegel and the spirit of 1848. In addition to the stories of these men and their ideals, the volume contains a hundred pages of excellent specimens of their writngs, and copious references to obscure source-materials. The book is both a valuable reference work and an entertaining set of short stories. I--IERBERTW. SCHNEIDER Claremont, CaliJornia Theory of. Man. By Francisco Romero. Translated from the Spanish by William F. Cooper, with an Introduction by William J. Kflgore. (Berkeley and Los Angeles: University of California Press, 1964. Pp. xxix + 324. $8.00.) The late Argentinian philosopher Francisco Romero, who died unexpectedly in 1962 after a brilliant career of more than thirty years of teaching and writing, was by common acclaim of his fellow-philosophers in Latin America their most distinguished philosopher in recent years. He received many honors and distinctions both at home and abroad, including the grand award of honor of the Argentinian Society of Writers. The most eminent philosophers in Latin American prepared a notable Festschri]t in honor of his 70th birthday, whose publication was unfortunately delayed and, therefore, could not be presented to him personally in his life time.1 Franci~o Romero was in fact as well as in acclaim the "Dean of Latin American Philosophy." It was high time that his central work Teorga del Hombre 2 should be translated. It is his magnum opus and represents the most comprehensive and systematic development of his philosophy. Romero was fortunate in having as his translator William F. Cooper who knew Romero personally, and was intimately acquainted with his philosophy. In addition, he had the unusual privilege of doing much of the translation in Romero's own library in Buenos Aires. In short, the translation is a labor of love and esteem.8 I myself had the privilege of coming to know Professor Romero in 1943, when as secretarygeneral of our Philosophical Association I was commissioned to make contact with our Latin American fellow-philosophers with a view to exploring the possibility of organizing InterAmerican congresses of philosophy and of forming an Inter-American society of philosophy, both of which projects, in due season, were accomplished. Romero welcomed these undertakings with characteristic enthusiasm and offered his fullest cooperation and support. He had always been a most active and indefatigable promoter of better understanding between North and South America and, especially, of closer cooperation between the philosophers of 1Homenaje a Francisco Romero, Faculdad de Filosofia y Letras, Universidad de Buenos Aires. Editorial Losada, Buenos Aires, 1952. 8In further attestation of Professor Cooper's special qualification for this translation it should be mentioned that he prepared for the Homenaje, already referred to, the most complete, up-to-date bibliography of Romero's extensive publications as well as an inventory of Romero's many works still in progress at the time of his death. 380 HISTORY OF PHILOSOPHY the two Americas. All members of our association who came to know him in Buenos Aires were warmly welcomed, and no doubt also experienced, as I did, the warm and generous hospitality of Professor Romero and his wife in their home in Martinez. Francisco Romero was not only professor of philosophy at the Universities of Buenos Aires and La Plato, but was also... (shrink)

This article provides new information on the publication history of the first edition of the text that, according to many scholars, laid the ground for the growth of international law: Hugo Grotius’s De iure belli ac pacis. Drawing on the preliminary findings of the Grotius Census Project at the Max Planck Institute for Comparative Public Law and International Law, funded by the German Research Foundation (Deutsche Forschungsgemeinschaft), the following pages shed light on the first three states of the typescript, the (...) sources that Grotius had access to in France while drafting the book, and the early circulation of the 1625 edition, published by Nicolas Buon in Paris. The goal of this publication is to disseminate updated information on the printing history of this key text in the history of legal and political thought, and to invite readers to come forward with more information about the location of the remaining copies of the text, in order to advance our understanding of the rise of international law around the world. (shrink)

This paper explores the deeply interwound histories of art and robots from their roots in the Greek myth of the sculptor-king Pygmalion to the work of contemporary artists, such as Norman White. By analyzing the myths of Pygmalion, the Golem, Frankenstein's monster, and other notable automata of legend, a framework emerges for understanding how various cultures have expressed desires and fears about technology and the future and defined values with respect to human. This context offers insight into the role (...) of artists in creating metaphors and working models of a posthuman, cyborgian future. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Bioethics ConsultationPat Milmoe McCarrick (bio)(John La Puma, M.D., from the Department of Medicine at Lutheran General Hospital in Chicago, contacted the National Reference Center for Bioethics Literature and suggested bioethics consultation as a topic for the Scope Note Series. He provided an extensive list of citations about ethics consultations collected by him and by David Schiedermayer, M.D., for their new book Ethics Consultation: A Practical Guide.)In Ethics Consultation (...) in Health Care, editors John Fletcher, Norman Quist, and Albert R. Jonsen (I, 1989) define ethics consultation as "the provision of specialized help in identifying, analyzing, and resolving ethical problems that arise in clinical care. In medical ethics the area of consultation has grown rapidly since 1978 when Edmund D. Pellegrino (II, 1978) noted, "we cannot separate technical-moral decisions from the philosophic principles we use to justify them. Medicine and ethics must be engaged with each other at every level."In 1980 Albert Jonsen raised the question of whether an ethicist could be a consultant and said that the ethicist as consultant is a casuist, one whose moral reasoning is based on a system of reasoning that is applied to particular cases. He describes historical casuistry in Western culture, comparing it to modern moral philosophy, and suggests that a "new casuistry seems timely" for ethics consultation (II, Jonsen 1980). By 1984 ethicist Ruth Purtilo recorded her thoughts following an ethics consultation. She raised questions about the ethicist's place on a hospital staff and how to make that role appropriate and beneficial to all concerned, saying that "the ethicist retreats after the consultation; under no circumstances would the outcome of an ethics consultation be that the ethicist became the primary care giver or assumed ongoing responsibility for the clinical management of a case" (II, Purtilo 1984). Nevertheless, in 1992 two physician-ethicists who had been called as ethics consultants for a patient who had requested that he be removed from his ventilator reported that they became the persons who turned off the ventilator and administered the drugs that eased his dying (II, Edwards and Tolle 1992).In recognition of the growing number of persons identifying themselves as [End Page 433] consultants, the Society for Bioethics Consultation was founded in October 1985 as a professional society of persons engaged in bioethics consultation. It encourages and supports consultation, assists in establishing clinical education programs, and raises funds for consultation education. Although the Society has no permanent office, the president (currently, George Kanoti in the Cleveland Clinic Foundation's Bioethics Department) conducts its work and plans an annual meeting.The Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) established new criteria concerning ethics in its 1992 Manual (III, JCAHO 1992) and in a special issue of QRB devoted to ethics consultation (I, Defining Quality 1992). These publications undoubtedly have contributed to the increased use of experts in medical ethics. The Manual notes that all organizations seeking accreditation should have some sort of "mechanism for the consideration of ethical issues arising in the care of patients and to provide education to care givers and patients on ethical issues in health care." A health care institution's eligibility for JCAHO accreditation, which is required for federal reimbursement, requires adherence to this specification (III, JCAHO 1992).The new International Directory of Bioethics Organizations provides an index of 129 different groups that indicated to the authors that they offer bioethics consultations. Of these, 83 are in the United States and 46 are in other countries. The ethics consultants included in the directory encompass a broad group of professionals who will assist patients, families, and primary care medical staff in finding solutions to ethical dilemmas resulting from use of new technologies or new treatments in health care. Consultants often come from the health fields: physicians, nurses, and other health personnel, but other professionals are also active as ethics consultants. Lawyers, pastoral counselors, philosophers, and social workers also offer bioethics consultation services (III, Nolen and Coutts 1993).Drs. Siegler, Pellegrino, and Singer wrote in 1990 that "Physician-ethicists and professional ethicists will continue to work side by side in the future. One is not likely to replace the other, nor is this desirable, because... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Ethics Committees in HospitalsPat Milmoe McCarrick (bio)(Literature about hospital ethics committees has grown enormously since Scope Note 3 first appeared. This update provides new information about resources and documents now available while continuing to include important earlier sources.)Hospital ethics committees increasingly have taken hold in the United States since 1983, when the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research (...) encouraged their creation in its report, Deciding to Forego Life-Sustaining Treatment (III, 1983, p. 5).The President's Commission report (pp. 160-64) suggested the following roles for ethics committees: 1) review of treatment decisions made on behalf of incompetent, terminally ill patients; 2) review of medical decisions having ethical implications with the option, in cases of disagreement, to refer cases to a court with proper jurisdiction; 3) provision of social, psychological, spiritual, or other counseling for patients, family members, physicians, or other hospital staff; 4) establishing guidelines regarding treatment or other medical decisions; and 5) sponsoring or conducting educational programs to inform all concerned, including the public, about ethical problems in medicine.No exact count of these committees is available. According to estimates cited by Donald F. Phillips, managing editor of Hospital Ethics, about two-thirds to three-fourths of hospitals with more than 200 beds have ethics committees, as do about one-third of hospitals under 200 beds. He thinks that about half of the 6,000 hospitals in the United States now have working ethics committees.Several journal articles and a court decision in the late 1970s influenced their formation. A 1975 journal article by pediatrician Karen Teel (VII A) urged the use of hospital ethics committees to provide for dialogue in individual care situations as an appropriate sharing of responsibility. Another early article suggested that beyond parents and treating physicians, a "disinterested," mixed lay and medical committee could consider cases about defective newborns to improve the ethical decisionmaking process (VII A, Robertson and Fost, 1976). Three 1977 discussions in the Hastings Center Report highlighted this new concept (VII A, Levine; Shannon; Veatch).Produced at the National Reference Center for Bioethics Literature, Kennedy Institute of Ethics, Georgetown University, Washington, DC 20057. It is supported by funds provided under grant number LM04492 from the National Library of Medicine, National Institutes of Health. Literature available through June 1992 is represented in this Scope Note. [End Page 285]The court decision was the March 31, 1976 ruling by the New Jersey Supreme Court in the Karen Quinlan case. The parents of a young woman in a persistent vegetative state had requested that she be taken off a respirator. The court designated a "prognosis" role for the hospital ethics committee and stipulated that the committee must concur that the patient will never return to a "cognitive, sapient state" before the life-support system can be withdrawn (In the Matter of Karen Quinlan, 70 N.J. 10, 355 A.2d 647, cert. denied sub nom. Garger v. New Jersey, 429 U.S. 922 (1976)). Shortly after the Quinlan decision, Massachusetts General Hospital's Clinical Care Committee created an ad hoc subcommittee (a psychiatrist, a legal counsel, an ICU nurse, an oncologist/internist, a surgeon, and a lay person who had recovered from serious cancer disease) which looked at 15 cases. Based on the subcommittee's success, establishment of a permanent committee to review treatment of the terminally ill was recommended by the critical care committee (VII A, Clinical Care Committee 1976).In its 1984 Baby Doe rules, the federal government recommended establishment of infant care review committees, which promoted the growth of hospital ethics committees (VII C, Povar 1991). In July 1987 Maryland became the first state to require by law that hospitals establish patient care advisory committees to offer advice about choices available in the care of life-threatening illnesses; this requirement was extended to nursing homes in 1990 [codified as amended at Md. Health-Gen. Code Ann. Sections 19-370 to -374 (1990)] (VII C, Hollinger 1991).Recently the role for these committees has been noted in the Accreditation Manual for Hospitals, 1992 Supplement (p. 10, Patient Rights, Section RI. 1.1.6.1) of the Joint Commission... (shrink)

Background Although the importance of clinical ethics in contemporary clinical environments is established, development of formal clinical ethics services in the Australia health system has, to date, been ad hoc. This study was designed to systematically follow and reflect upon the first 18 months of activity by a newly established service, to examine key barriers and facilitators to establishing a new service in an Australian hospital setting. Methods: how the study was performed and statistical tests used A qualitative case (...) study approach was utilised. The study gathered and analysed data using observations of service committee meetings, document analysis of agendas and minutes, and semi-structured interviews with committee members to generate semantic themes. By interpreting the thematic findings in reference to national capacity building resources, this study also aimed to provide practice-based reflections for other health agencies. Results: the main findings An overarching theme identified in the data was a strong commitment to supporting clinicians facing difficult patient care decisions and navigating difficult discussions with patients and families. Another key theme was the role of the new clinical ethics support service in providing clinicians with a pathway to raise system-wide issues with the organisation Executive. While there was strong clinical engagement, consumer and community participation remained a challenge, as did unresolved governance issues and a need for clearer policy relationship between the service and the organisation. Conclusions: brief summary and potential implications Considering these themes in relation to the national capacity building resources, the study identifies three areas likely to require ongoing development and negotiation. These are: the role of the clinical ethics support service as a link between the workforce and the Executive; the incorporation of consumers and patients; and ethical reasoning. To improve the effectiveness of the service, it is necessary to increase clarity on the service’s role at the governance and policy level, as well as develop strategies for engaging consumers, patients and families. Finally, the capacity of the service to reflect on complex cases may be enhanced through explicit discussions of various different ethical frameworks and ways of deliberating. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The View from GadshillFrancis SparshottII once had a furious confrontation with that learned and passionate scholar, the late Milton C. Nahm. He had been giving a paper that involved Falstaff—I forget how, but it included the familiar appeal to the fat knight as the comic spirit of untrammelled life, so that the newly crowned Hal’s final repudiation—“I know thee not, old man”—chills the audience as a denial of humanity (...) in favor of impersonal administration. But I told Nahm that I could not see Falstaff that way. As a boy, if I cycled home from Gravesend to Rochester I had to pass over the North Downs at Gadshill. And it is at Gadshill, when we first meet him, that Falstaff’s gang is planning to waylay a band of innocent travelers. I could never take kindly to a man who made a living mugging and rolling people like me. Nahm was contemptuous of my incompetence to deal with literature: I was prevented from appreciating the portrait of the comic monster, appalling but breathtaking, by my inhibited and inhibiting moralism. But I insisted that I saw no reason why one should abandon one’s identity or one’s morality while one was watching a play or reading a book.Nahm would have been right if I had been insensitive to Falstaff’s outrageousness, his unscrupulous energy and vivacity, his wit and candor. But I think my appreciation was sharpened rather than nullified by my awareness of the real menace Falstaff represents to people who happen not to be his pals. And I think Nahm’s enthusiasm blinded him to something else that Shakespeare wrote into the part. At that very first meeting, we find Falstaff trying to negotiate for himself a position of power or privilege when the young prince shall succeed to the throne. And it is just this negotiation that Falstaff is trying to resume [End Page 398] from the sidewalk at the end, when the new king brushes him off. Nahm did not notice this because it did not occur to him that Henry V was going to be a real king with real power over real people, just as it did not occur to him that Falstaff’s robbed and brutalized pilgrim victims would be real people suffering real injury and loss. If my personal angle, the potential victim’s view, had so usurped my vision that it blinded me to whatever else the playwright had made of his character and its situation, it would have made me a bad viewer of the play. But it might have added depth to my understanding and my criticism if it gave me an angle that other viewers and readers could imaginatively share. 1 Since each of us has some sort of angle on everything, sharing perspectives can always be valuable.III have been reminded of my encounter with Nahm by reading Edward W. Said’s Culture and Imperialism. 2 The book appears to start from the position that imperialism is the “determining political horizon of modern Western culture” (p. 60), imperialism being defined as the policy of establishing and maintaining an empire, and an empire as “a relationship... in which one state controls the effective political sovereignty of another political society” (p. 9). Because this is the determining horizon, the right way to think of any “Western” author is as an agent of imperialism, although of course this is most easily shown in the case of authors and works in which the imperial connection is explicit.If there is to be a uniform curriculum and canon for the teaching of English literature everywhere in the world, that canon obviously should not be based on works that assume the rightness and normality of an imperialism that defines most readers of that literature as racially and culturally inferior; such a canon is itself a tacit agent of an offensive and gratuitous imperialism. This much seems clear. But Said’s book then moves off into a hackneyed recitation of the evils that the West (or the north, or the developed world 3 ) inflicts on a world of passive victims, followed by a denunciation of the... (shrink)

The objectives of this book are to provide a new translation of Plato's M eno together with a series of studies on its philcisophical argument in the light of recent secondary literature. My translation is based mainly on the Oxford Classical Text, 1. Burnet's Platonis Opera (Oxford Clarendon Press 1900) Vol. III. In conjunction with this I have made extensive use of R.S. Bluck's Plato's Meno (Cam bridge University Press, 1964). At critical places in the dialogue I have also consulted (...) A. Croiset's Gorgias, Menon (Bude text). My debt ~o two other sources will be clearly in evidence. They are E.S. Thompson's Plato's Meno (London, MacMillan 1901), and St. George Stock's The Meno of Plato (Oxford Clarendon Press, 1894). One of the greatest difficulties facing a translator is to achieve a balance between accuracy and elegance. Literal translations are more likely to be accurate, but, alas, they also tend to be duller. Free translations run into the opposite danger of paying for elegance and liveliness with the coin of inaccuracy. Another hurdle, for a translator of a Platonic dialogue, is posed by the challenge to maintain the conversational pattern and fast moving character of the discussion. This is easier where the exchang~s are short, but much more difficult where Socrates gets somewhat long-winded. (shrink)

‘Patient satisfaction’: Knowledge for ruling hospital reform — An institutional ethnography Driven by funding restraint, Canadian health‐care has undergone over a decade of significant reform. Hospitals are being restructured, as text‐based practices of accountability bring a new business‐orientation into hospital and clinical management. New forms of knowledge, generated through records of various sorts, are a necessary resource for managing care in the new environment. This paper's research uses Canadian sociologist Dorothy E. Smith's institutional ethnographic methodology to critically analyse (...) one instance of text‐based management. I analyse information about ‘patient satisfaction’ as it is generated through a patient survey (in which I was implicated through my involvement with a hospitalized family member). Subsequently, I have studied the management environment into which that information would be entered. I argue that in the instance analysed, the information becomes part of a dominant consumer oriented healthcare discourse that subordinates concerns about ‘what actually happened’ as a professional caregiver would have known it. On this basis, I contend that this sort of taken‐for‐granted approach to making decisions about quality care in hospitals may be seriously, even dangerously, flawed. (shrink)

The author reviews the planned withdrawal of healthcare from the primary public hospital, Grady Memorial Hospital, of Atlanta, Georgia. Prior to passage of the Affordable Care Act of 2010, at least half of the patients had no public or private health insurance and their care was financially supported by State and County funding as well as supplementation from Emory University. New administration in the elected positions of the State and County and at the University reached agreement to decrease (...) care. The University President stated that the Hippocratic Oath was no longer valid for salaried physicians who must follow the direction of their business manager. The author, a tenured Professor, was forcibly transferred to the Veterans Hospital, which also was withholding standard medical care, including life-saving medications. Organizing multiple concerned organizations including members of the King Center, the Carter Center, the Open Door Community Center, Gay Rights, etc., (Grady Coalition) multiple public protests were successful in raising the necessary funds to continue adequate care at Grady and begin an investigation of the Veterans Affairs Hospital. (shrink)