T. A. Cavanaugh's Hippocrates' Oath and Asclepius' Snake: The Birth of the Medical Profession articulates the Oath as establishing the medical profession's unique internal medical ethic - in its most basic and least controvertible form, this ethic mandates that physicians help and not harm the sick. Relying on Greek myth, drama, and medical experience (e.g., homeopathy), the book shows how this medical ethic arose from reflection on the most vexing medical-ethical problem -- injury caused by a physician -- and argues (...) that deliberate iatrogenic harm, especially the harm of a doctor choosing to kill (physician assisted suicide, euthanasia, abortion, and involvement in capital punishment), amounts to an abandonment of medicine as an exclusively therapeutic profession. The book argues that medicine as a profession necessarily involves stating before others what one stands for: the good one seeks and the bad one seeks to avoid on behalf of the sick, and rejects the view that medicine is purely a technique lacking its own unique internal ethic. It concludes noting that medical promising (as found in the White Coat Ceremony through which U. S. medical students matriculate) implicates medical autonomy which in turn merits respect, including honoring professional conscientious objections. (shrink)

Background COVID-19 has greatly impacted the health of incarcerated individuals in the US. The goal of this study was to examine perspectives of recently incarcerated individuals on greater restrictions on liberty to mitigate COVID-19 transmission.Methods We conducted semi-structured phone interviews from August through October 2021 with 21 people who had been incarcerated in Bureau of Prisons (BOP) facilities during the pandemic. Transcripts were coded and analyzed, using a thematic analysis approach.Results Many facilities implemented universal “lockdowns,” with time out of the (...) cell often limited to one hour per day, with participants reporting not being able to meet all essential needs such as showers and calling loved ones. Several study participants reported that repurposed spaces and tents created for quarantine and isolation provided “unlivable conditions.” Participants reported receiving no medical attention while in isolation, and staff using spaces designated for disciplinary purposes (e.g., solitary housing units) for public health isolation purposes. This resulted in the conflation of isolation and discipline, which discouraged symptom reporting. Some participants felt guilty over potentially causing another lockdown by not reporting their symptoms. Programming was frequently stopped or curtailed and communication with the outside was limited. Some participants relayed that staff threatened to punish noncompliance with masking and testing. Liberty restrictions were purportedly rationalized by staff with the idea that incarcerated people should not expect freedoms, while those incarcerated blamed staff for bringing COVID-19 into the facility.Conclusions Our results highlighted how actions by staff and administrators decreased the legitimacy of the facilities’ COVID-19 response and were sometimes counterproductive. Legitimacy is key in building trust and obtaining cooperation with otherwise unpleasant but necessary restrictive measures. To prepare for future outbreaks facilities must consider the impact of liberty-restricting decisions on residents and build legitimacy for these decisions by communicating justifications to the extent possible. (shrink)

Objective: The objective of the current study was to maximise the amount of information children and adolescents understand about the risks and benefits associated with participation in a biomedical research study.Design: Participants were presented with one of six hypothetical research protocols describing how to fix a fractured thigh using either a “standard” cast or “new” pins procedure. Risks and benefits associated with each of the treatment options were manipulated so that for each one of the six protocols there was either (...) a correct or ambiguous choice.Participants and setting: Two hundred and fifty one children, ages 6–15 , and 237 adults were interviewed while waiting for a clinic appointment at the Hospital for Sick Children.Results: Using standardised procedures and questionnaires, it was determined that most participants, regardless of age group, were able to understand the basic purpose and procedures involved in the research, and most were able to choose the “correct” operation. The younger children, however, showed an overall preference for a cast operation, whereas the older participants were more likely to choose the pins.Conclusions: By creating age appropriate modules of information, children as young as six years can understand potentially difficult and complex concepts such as the risks and benefits associated with participation in biomedical research. It appears, however, that different criteria were used for treatment preference, regardless of associated risks; older participants tended to opt for mobility whereas younger participants stayed with the more familiar cast operation. (shrink)

Within the moral/social order maintained and reproduced by biomedical ethics (i.e., the “peaceable community”), suffering is a senseless accident with no value. Insofar as suffering compromises the fundamental pillar of this order, namely, autonomy, it threatens the existence of the “peaceable community”. Consequently, biomedical ethics is only able to offer those who suffer one moral or practical response: that of elimination, embodied most vividly in the increasingly approved practice of assisted-suicide. Another moral/ social order, however, the “peaceable Kingdom” or the (...) “Body of Christ”, provides an alternative understanding of the meaning, purpose, and significance of suffering, through the Roman Catholic sacrament of anointing of the sick. Recognizing the power of sickness and suffering to “dis-inscribe” bodies of their normative self-understandings, the Church responds with a set of liturgical practices which intend to respond to the dynamics of suffering, re-inscribe these bodies, and assist persons in fulfilling the vocation of “participating in Christ's suffering for the salvation of the world”. (shrink)

This is a condensed description of the contents and overarching argument found in Hippocrates’ Oath and Asclepius’ Snake: The Birth of the Medical Profession. In that work, I maintain that the basic medical ethical problem concerns iatrogenic harm. I focus particularly on what I refer to as ‘role-conflation’. This most egregious form of iatrogenic harm occurs when a physician deliberately adopts the role of wounder. A contemporary practice such as physician-assisted suicide exemplifies a doctor’s deliberate wounding. I argue that the (...) author of the Hippocratic Oath – aware of the chronic risk of role-conflation – responds to this threat by having the oath-taker specifically forswear signal acts that wound the sick, such as giving a deadly drug even if asked, giving an abortifacient, sexual predation, and gossiping. I argue that by means of the Oath, Hippocrates founds medicine as a profession, a practice intimately involving promising. (shrink)

If we need a figure to indicate the way in which the influence of Plato has passed through Europe, we must liken it, not to a river continually at the flood, but to an expanding atmosphere enveloping and pervading whatever it meets, an atmosphere with a perfume that has made some sick and others open their nostrils to take in the seed and substance of a new life. A river makes a linear path which, except perhaps for a few sinuosities (...) and an occasional overflow, can be traced with relative ease; but an atmosphere, enlarging itself in all dimensions, with attenuation here and condensation there and precise limits nowhere, offers neither clue nor pattern for the inquisitive historian who would, seek to plot its course. We may be prepared to find it anywhere. So it is with the metaphysics of Plato. No sphere of learning or of art has kept beyond its reach. Anyone who, by comprehending its particular incidence and its total range, would write the most remarkable single chapter in the history, of thought, would have to search the minds not merely of philosophers but also of saints, scientists, poets, painters, sculptors, statesmen, and educationists of all ages. He would even have to search for the breath of it among the innumerable works of fiction that tumble mechanically from our modern undiscriminating presses. The following, for example, is pure Platonism: “We come from a world where we have known incredible standards of excellence, and we dimly remember beauties which we have not seized again; and we go back to that world. Uncle Pio and Camila Perichole were tormenting themselves in an effort to establish in Peru the standards of the theatre in some heaven whither Calderon had preceded them.” To understand, alike in its emotional beauty and in its scientific severity, the metaphysic that underlies such charming phrases is perhaps an obligation, almost a necessity, and certainly a privilege. (shrink)

I served as a medical student and resident in the 1960s. Science as a belief system had reached a pinnacle. Yet Not infrequently in those days, I found myself caring, with little available backup, for a hospital ward filled with sick and dying people. It was a lonely and often frightening responsibility. I began to encounter situations that were at odds with our collective certainty that science would provide the answers. Some of these memories I repressed for almost a decade. (...) I was unable to process them until I had personally experienced a more humanistic side of medicine. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Laying Medicine Open: Innovative Interaction Between Medicine and the HumanitiesLaurence B. McCullough and Warren Thomas ReichThe past three decades have witnessed the emergence and remarkable success of the fields of bioethics and medical humanities. The intellectual landscape of medicine and that of the humanities have been remarkably altered in the process. Twenty-five to 30 years ago in the United States there existed but a few courses in what came (...) to be called “bioethics” in departments of philosophy, religious studies, and theology in colleges and universities, a handful of programs of teaching in medical schools such as the University of Texas Medical Branch at Galveston and Pennsylvania State University School of Medicine at Hershey, and but one independent research center (the Hastings Center) and one university-based research center (the Kennedy Institute of Ethics at Georgetown University). Articles on bioethics began to appear in the peer-reviewed medical, nursing, and humanities literature and some books were published. There was only one journal in bioethics, The Hastings Center Report (which consolidated two previously separate journals from the Hastings Center). Graduate programs in bioethics and medical humanities in colleges and universities and fellowship training in bioethics and medical humanities in medical schools did not exist. Very little existed in colleges, universities, and medical schools in other countries. Now, of course, everything is different.Teachers, scholars, and students of bioethics and medical humanities should not take these remarkable changes for granted, for they represent a sustained and innovative interaction between medicine and the humanities. We have chosen the metaphor of “laying medicine open” to characterize the history of bioethics and medical humanities of the past three decades. This surgical metaphor was used in eighteenth-century Britain by a number of writers who wanted to make medical science and practice more accessible to the sick and to the lay public more generally (Lawrence 1975). We use the metaphor to characterize the efforts of teachers and [End Page 1] scholars over the past three decades and more to make the value-laden dimensions of biomedical science and practice and of health care policy more accessible to patients and to the lay public more generally. The result of this laying open of medicine has gone a long way toward bringing closer together the two cultures of science and the humanities that had, as C. P. Snow famously described, become significantly isolated from each otherAlbert Jonsen (1998) has recently contributed the first book-length history of what he calls the “birth” of bioethics, adding to the work of other scholars such as Warren Reich (1994; 1995) and Robert Baker (1993) and, before them, Corrado Viafora (1990) and David Rothman (1991). The articles in this issue of the Kennedy Institute of Ethics Journal make additional contributions to the developing understanding of the history of the past thirty years of interaction between medicine and the humanities.Laurence McCullough provides an historical context for the three accounts of the recent laying open of medicine that follow. McCullough examines two times in the history of medicine when it has been laid open to accountability (in addition to its being laid open to and by bioethics and medical humanities). The first laying open occurred in the work of the eighteenth-century Scottish physician and philosopher John Gregory, who set out to create a profession of medicine in a true moral sense of a fiduciary profession by making medicine accountable for its scientific and moral quality. The second occurred in the late twentieth century in which the managed practice of medicine in general, and managed care in particular, have begun to lay medicine open to accountability for its scientific and moral quality, as well as its cost and, at least in the public sector, its accessibility. McCullough argues that, just as Gregory responded to the ethical challenges of medicine laid open more than two centuries ago, bioethics should respond to the ethical challenges in the current laying open of medicine.Warren Reich provides an account of André Hellegers, whose premature death left an enormous gap in the field that will never be filled. Reich claims that Hellegers was engaged substantially in much more than the laying open of medicine: he... (shrink)

This is the first English version of Geymonat's work since its publication in Italy in 1957. As the title suggests, it is more than a biography, for it records the vital interplay between the world of Galileo's thought and his vibrant personality. What gave direction to his life, according to Professor Geymonat, was the devotion to the task of "cultural propaganda," of making his radical discoveries palatable to the intellectual elite of the Catholic Church. That he took up this task, (...) testifies to the scope of Galileo's imagination and to his understanding of the deep moral and cultural implications of the new science he was initiating. Professor Geymonat sees in Galileo's belief that experience and mathematical reasoning are commensurable and in his attachment to experiment more an Aristotelian reaction against the Church's perversion of Aristotle's thought, than a reversion to Platonism. Besides the complexity of Galileo's thought, the nobility and strength of a genius, struggling in his early years with financial and familial burdens, silenced in his prime by the censure of the Church, and incapacitated during his old age by sickness, shine through the pages of this book. There are extensive notes and two appendices on the as yet mysterious course of Galileo's second trial.—T. R. H. (shrink)

Kirk Lougheed argues that active euthanasia (here ‘euthanasia’) is impermissible for people who are extremely sick and cannot exercise their vital forcei because (1) exercising vital force does not require volition but only being an object of caring relationships and (2) African philosophy entails other-regarding deontological duties to stay alive.1 In this commentary, we point out an implication of Lougheed’s view that is morally problematic and offer a revision that avoids this implication. We also argue for an additional advantage of (...) this revision. Lougheed’s view implies that a person who is the object of very few relationships has a much weaker duty to stay alive than a person who is well-loved and the object of many relationships. This is because he seems to think that duties to stay alive are derived entirely from one’s relationship with other people. While he is clear that a person, even if terminally ill or permanently unconscious, has a duty to stay alive so that they could remain the object of harmonious relationships, he is silent on whether duties to stay alive could be grounded in reasons that have to do with oneself. Plausibly, on this view, the strength of one’s duty to stay alive depends solely …. (shrink)

The species of vitalism discussed here, to immediately rule out two possible misconceptions, is neither the feverish cosa mentale found in ruminations on ‘biopolitics’ and fascism – where it alternates quickly between being a form of evil and a form of resistance, with hardly any textual or conceptual material to discuss – nor the opaque, and less-known form in which it exists in the worlds of ‘Theory’ in the humanities, perhaps closely related to the cognate, ‘materiality’. Rather, vitalism here is (...) a malleable construct, often with a poisonous reputation, hovering in the realms of the philosophy of biology, the history of medicine, and the scientific background of the Radical Enlightenment. This is a more vital vitalism, or at least a more ‘biologistic’, ‘embodied’, medicalized vitalism. I first distinguish between what I would call ‘substantival’ and ‘functional’ forms of vitalism, as applied to the eighteenth century. Substantival vitalism presupposes the existence of something like a vital force which either plays a causal role in the natural world as studied by scientific means, or remains a kind of hovering, extra-causal entity. Functional vitalism tends to operate ‘post facto’, from the existence of living bodies to the desire to find explanatory models that will do justice to their uniquely ‘vital’ properties in a way that fully mechanistic models cannot. I discuss some representative figures of the Montpellier school as being functional rather than substantival vitalists. A second point concerns the reprisal of vitalism in ‘late modernity’; from Hans Driesch to Georges Canguilhem. I suggest that in addition to the substantival and functional varieties, we then encounter a third, more existential form of vitalism, articulated by Canguilhem, in which vitalism is a kind of attitude towards Life. All of this, I hope, argues for a form of vitalism which is neither tedious scientism nor dangerous political rhetoric of health and sickness; instead, a vitalism with its own discreet charm. (shrink)

Health care begins as an act of conscience, which urges a response to the sick and holds caregivers accountable to moral standards that public authorities ultimately do not define. Conscience nonetheless expresses itself as a type of dialogue within oneself that is influenced by dialogue with others, especially with society in the form of civil law and professional standards. A well-formed conscience for health care relates the foundations of morality to health care practices and contributes sound moral judgment about them (...) to the common good. Some current health care policies and medical education presume a distorted view of conscience as personal sentiment. These policies circumvent serious discussion and possible resolution of society's most vexing bioethics controversies. (shrink)

The COVID-19 pandemic has resulted in major stressors such as unemployment, financial insecurity, sickness, separation from family members, and isolation for much of the world population. These stressors have been linked to mental health difficulties for parents and caregivers. Religion and spirituality, on the other hand, is often viewed as promotive of mental health. However, the mechanisms by which R/S might promote mental health for parents during the pandemic remain unclear. Thus, this longitudinal study explores how R/S is associated with (...) better caregiver mental health during the COVID-19 pandemic through higher levels of positive coping skills. A sample of N = 549 caregivers across Canada, the United States, the United Kingdom, and Australia were recruited through the Prolific® research panel [67.8% female; age M = 41.33 years, 72.3% White/European]. Participants were assessed on measures of psychological distress, coping, R/S, and COVID-19 disruption at three time points between May and November 2020. Cross-lagged panel analysis revealed that caregiver coping mediated the relationship between caregiver R/S and caregiver mental health. Findings highlight a mechanism through which R/S naturally conveys a mental health benefit during periods of social disruption, which may provide an important target for public health promotion and clinical intervention. (shrink)

We are printing in its entirety the discussion document which sets out a code of professional conduct for nurses published by the Royal College of Nursing in November 1976 together with commentaries by the Assistant Secretary of the British Medical Association, a professor of nursing studies, student nurses and a lawyer. The image of the nurse is still that of one of Florence Nightingale's young ladies or of a member of a religious order who is wholly dedicated to caring for (...) the sick. Today, as this document and the comments upon it show, 'dedication' is still part of the motive which leads a man or woman to become a nurse but in addition, and this is where the public may be ignorant or choose to be ignorant, nursing offers a career where intellectual achievement and the satisfaction of a demanding job bring their proper financial reward and place in the professional community. We are grateful to the Royal College of Nursing for permission to publish this document. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Sick with PassionAlfred LouchOpera: Desire, Disease, Death, by Linda and Michael Hutcheon; xvi & 294 pp. Lincoln: University of Nebraska Press, 1996, $40.00.IDriving east from the Auvergne you may chance upon La Chaise-Dieu, a charming village where a very acceptable cafe confronts the fortress-like Abbatiale de St Robert across the village square. The church itself is an imposing monument to the ephemeral glory of the Avignon Pope Clement VI, (...) but its most extraordinary feature is a fresco in the aisle to the left of the choir. Called the Danse Macabre, it depicts death as a sequence of skeletons, each of which beckons, pleads with, consoles, or compels its many victims—young and old, rich and poor, exalted or mean—toward their inevitable end. At times the skeleton’s posture is sinister and threatening, at others, as with children, it seems to turn away, as if to shield them from its fearful aspect. The skeletons seem to catch the movement of a single dancer as they select one partner after another, taking the life of each in a graceful though ghastly movement.The fresco depicts the Black Death—art inspired by disease and contagion. But even if you were as innocent of history as the typical American tourists you would confront in the fresco the undeniable image of death, and the caprice of its visitation, a thought contrasting strangely with the enduring granite of the church. Your experience may be enriched by history and lead you to moralize on the contrast [End Page 155] between the pomp and grandeur of the papal builder and the fresco’s depiction of the vanity of human wishes. But it would be a jarring note if some know-it-all in the company of viewers were to lecture for all to hear on the transmission and symptoms of pasteurella pestis. That is another story, and an interesting one, but not here and now.And so it is, if not so abrasively, with a recent book by Linda and Michael Hutcheon on desire, disease, and death in opera. They hope to shed new light, by combining literary analysis and the medical theory of disease and contagion, on the themes and purposes of opera, or certain operas anyway. Somehow the passages on mycobacterium tuberculosis, treponema pallidum, and vibrio cholerae, together with graphic descriptions of the symptoms caused by these micro-organisms, and an accompanying photograph of syphilitic gummæ seem intrusive, just as talk about the etiology and the pathology of the plague strikes a discordant note as we look upon the Danse Macabre in wonder and fear. The Hutcheons, a husband and wife team who practice, respectively, medicine and literary criticism, tell the reader they are opera lovers. I hope their affection is not prompted only by infection.But why shouldn’t medicine and its history be relevant to literary, artistic, or musical creation? Think here of a question Wittgenstein asks in Zettel (paragraph 610): “Why should there not be a psychological regularity to which no physiological regularity corresponds? If this upsets our concept of causality then it is high time it was upset.” He did not mean to say that it would not be surprising if someone talked and acted and looked like a person but turned out to have an empty skull. But he did mean surely that talk about human projects and emotions is complete as it stands; what is going on in the neurons and what busy microbes are doing are other stories. Literature is about human projects, the skill or clumsiness with which they are pursued, the responses to success and failure, achievement and frustration. Opera, which, ever since someone had the idea of putting story to song, raided literary invention for its subject matter, is the same. Heroes and villains may of course be expected to be vulnerable to the various vicissitudes of life. Diseases may lay them low, as well as passing trains. But disease enters their stories to delay or frustrate or put period to their projects, not as new characters on the stage. If you read about the death of Ivan Illych and come away dissatisfied because Tolstoy failed to identify the... (shrink)

In response to the articles by Eibach and Groenhut in this issue, I argue that there is a general connection between sickness and the entrance of sin into the world. There are times when there is a causal link between more specific sin and sickness, though often the patient is the one who has been sinned against. Illness can also expose sin in a patient's life. Integrating the reality of illness into the life history of a patient is a significant (...) pastoral care issue and can be done with humility and sensitivity if done in accordance with the teaching of Job and Ecclesiastes. These books argue that “under the sun” or this side of eternity, human beings can't grasp the coherence of life, including the “why” of illness. Rather, God provides His loving presence, through His people as a comfort to those suffering from illness. (shrink)

It says something about the topic of John Kaag’s book that the subtitle “How William James Can Save Your Life” seems so easy to swallow. It’s hard to imagine a similar subtitle for Peirce or Dewey, or most any contemporary philosopher, and I wouldn’t hold my breath for “How C.S. Peirce Can Mend Your Finances” or “How John Dewey Can Improve Your Writing.” But for James the subtitle works. Maybe it’s because, for James, the connection between philosophy and life seems (...) especially strong and obvious. More than Peirce or Dewey, James is a character in his own writings, making it clear that philosophy matters in both very personal and very profound ways. James seems to have thought that philosophy saved his own life, so... (shrink)

When patients are not able to speak for themselves, surrogate decision makers are asked to guide treatment decisions and formulate a plan of care in accordance with what the patients would have wanted. This necessitates an exploration into the patients’ views about life and how it should be lived, how the patients constructed their identity or life story, and their attitudes towards sickness and suffering. When an individual appoints a surrogate, such as a healthcare power of attorney, a common presumption (...) is that this designation evinces merit. This obscures the possibility of multiple other considerations that influence individual choice. This article presents a clinical case in which the claim to know someone best created a controversy that brought treatment decisions to a standstill. Further, it illuminates how the question, “Given the current medical condition, what would this person want?” risks presuming that a singular, unambiguous preference exists and that one person can provide the answer. Clinical ethicists can play a vital role in situations when there is a dispute among a designated surrogate and family members over a patient’s preference. By embracing the complexity of the desire to synthesize seemingly irreconcilable perspectives about identity, uncovering the reasons that underlie disagreement, and guiding inquiry in such a way that allows stakeholders to move beyond the conflict, clinical ethicists can facilitate decision making that honors the patient and may mitigate moral distress. (shrink)

I’m sick of being treated like a dumb Mum who doesn’t understand the science. As far as I’m concerned, my family’s health is just too important. … If the government can’t protect the safety of my family, then I will.Recent Greenpeace activism in Australia resulted in the destruction of a field trial of a line of wheat “designed” to improve human nutrition. This incident demonstrates that, while there is significant ongoing public and private investment in genetically modified crop research and (...) development in Australia, many people continue to oppose GM foods strongly. We noted with interest that Greenpeace described this activism with language that explicitly connected the actions to the gender.. (shrink)

If James has a latent tuberculosis infection , he is at risk of developing active tuberculosis disease but he is not yet sick. LTBI is a liminal space between health and illness. Diagnosed with LTBI, James could be conceptualised as having a liminal body. Treatments for LTBI are available, but why would a person seek treatment for a disease he does not yet have? One thing is definite: James needs to be educated about the symptoms and severity of active tuberculosis (...) disease. (shrink)

This work investigates which conditions lead to co-driver discomfort aside from classical motion sickness, what characterizes uncomfortable situations, and why these conditions have a negative effect. The automobile is called a “passenger vehicle” as its main purpose is the transportation of people. However, passengers in the car are rarely considered in research concerning driving discomfort. The few studies in this area focus on driver discomfort, automated vehicles, or driver assistant systems. An earlier public survey indicated that discomfort is also a (...) relevant problem for co-drivers. In this paper, these results are confirmed and extended through an online questionnaire with N = 119 participants and a detailed follow-up interview study with N = 24 participants was conducted. The results of the online questionnaire show that co-driver discomfort is a widespread problem. The interviews indicate that the driving style is one factor contributing to co-driver discomfort, in particular close following or fast driving. In those situations, participants experienced a feeling of being exposed, which additionally contributed to their discomfort. Uncomfortable situations were also perceived as safety critical. A model for possible cognitive origins of discomfort in co-drivers, extending theories from the areas of stress and self-regulation, is developed based on the results. Co-driver discomfort is a common problem, highlighting the relevance of further research on supporting co-drivers. The reported correlations and the proposed model can help to explain the origin of this discomfort. The results provide a foundation for the future design of interventions like human machine interfaces aiming at reducing co-driver discomfort. (shrink)

Aren't we actually sick of sex, of difference, of emancipation, of culture? With this provocative taunt, the indomitable sociologist Jean Baudrillard challenges us to face up to our deadly, technologically empowered renunciation of mortality and subjectivity as he grapples with the complex issues that define our postmillennial world. What does the advent and proliferation of cloning mean for our sense of ourselves as human beings? What does the turn of the millennium say about our relation to time and history? What (...) does the instantaneous, virtual realm of cyberspace do to reality? In _The Vital Illusion_--as always--Baudrillard leads his readers to some surprising conclusions. Baudrillard considers how human cloning--as well as the "cloning" of ideas and social identities--heralds an end to sex and death and the divagations of living by instituting a realm of the Same, beyond the struggles of individuation. In this day and age when everything can be cloned, simulated, programmed, and genetically and neurologically managed, humanity shows itself unable to brave its own diversity, preferring instead to regress to the pathological eternity of self-replicating cells. By reverting to our viral origins as sexless immortal beings, we are, ironically, fulfilling a death wish, putting an end to our own species as we know it. Next, Baudrillard explores the "nonevent" that was and is the turn of the millennium. He provocatively puts forward the thesis that the arrival of the year 2000 could never take place because we could neither resolve nor leave behind our history, nor could we stop counting down toward our future. For Baudrillard, the millennial clock reading to the millionth of a second on its way to zero is the perfect symbol of our time: history decays rather than progresses. In closing, Baudrillard examines what he calls "the murder of the real" by the virtual. In a world of copies and clones in which everything can be made present in an instant by technology, we can no longer even speak of reality. Beyond Nietzsche's symbolic murder of God, our virtual world free of referents is in the process of exterminating reality, leaving no trace: "The corps(e) of the Real--if there is any--has not been recovered, is nowhere to be found." Peppered with Baudrillard's signature counterintuitive moves, prophetic visions, and dark humor, _The Vital Illusion_ exposes the contradictions that guide our contemporary culture and rule our lives. (shrink)

Don't tell terrible stories—everyone here has enough of their own. Everyone here has a whole bloody sack of terrible stories, and at the bottom of the sack is a hammer the narrator uses to pound you on the skull the instant you dare not believe your ears. Or to pound you when you do believe. Not long ago I saw a tomboyish girl on Khreshchatyk Street demand money of an elderly woman, threatening to bite her and infect her with syphilis. (...) Don't stroll through Volodymyr Hill Park, don't stroll around the botanical garden, and especially don't stroll on Kontraktova Square. Don't stroll anywhere. Don't go to the pavilion with the Golgotha panorama near St. Alexander's Church. Not even the twelve-meter-tall crucified Christ will save you. Don't go outside when it's dark and people turn into shadows a shade darker than dark. Also don't go where you can be seen from far away. Not to imply that people used to be like a bunch of lilies, but now they stink like a cellar of cabbage.The city, which earlier might have had some fun, is now going crazy. It's like a fish in warm water: it doesn't react to anything, swims slowly like it doesn't care if it swallows a hook or not. The excitement and exaltation pass into oppression, just as our necks have sunk into our shoulders, our shoulders into our lumbars, our lumbars into our nether regions. The holiday turns into a funeral, the parades into explosions, depression into mania. Winter passes into summer, people turn into beasts, the hours into ages, and the ages into hours. It's worth simply walking around the city to see a soldier from an unknown army taking a piss near the opera. Farther on is a row of identical old widows selling ball gowns and candelabra. Then there are the aristocrats and manufacturers who throw so much at the prostitutes that they'll soon be richer than their wives.I returned late through the Kyryliv Wood, not heeding all the warnings that I myself have given here. It really is dangerous—the place is famous for it. There's a madhouse nearby, caves where criminals and the sick can hide out. Also, once upon a time, as they say in fairy tales, the great dragon Zmei Gorynich lived here beside the Puchai River. The stench in these places drives away the most committed misanthropes and even one type of philanthrope—that is, perverts. It sounds dumb, but the stench is cleansing. I don't know where it comes from. After the operating theaters and the rooms with amputees, the stench no longer repelled or attracted me; it just was. And this was a great place to think. As I walked, I considered an incident with our patient.The patient, a respectable individual whose name carries too much weight for me to state it directly, one day began to assault people. He nearly strangled a merchant who he believed asked too much for a beaver coat. He likewise wanted to kill his business partner when he didn't say hello loudly enough. But the worst was, he lost all shame of his own nakedness. At first it was the police who took care of it. When our future patient slipped off his pants and undergarments, he was taken to Kyrylivska, which has had means for dealing with such cases dating back to the day when unhinged Cossacks and composers from Kyiv Mohyla Academy were taken there.During the examination we determined that the patient was experiencing a severe breakdown. His wife added that lately, more than once, he had allowed himself strong words in front of the children and often suffered from ennui. Furthermore, she said, the patient had been undergoing treatment for “the French disease” for some years—which was, obviously, where we needed to start.“Syphilis!” Skorsky spat out the matchstick he was chewing on. He was a specialist on the psychological aspects of diseases related to the venereal. “Tertiary syphilis! When poorly treated, over time ‘the French disease’ can destroy the central nervous system. Hence the patient's chicanery. Such theater!”Skorsky and I had not spoken since the incident at Bilinsky's. Meanwhile, something significant had happened to him. The most boring person on earth, Skorsky had simply caught fire. He said hello and kibitzed. I even heard the doctor got drunk alone in his office, then wandered through the forest. Could he be using narcotic substances?“Cocaine!” was the doctor's second proclamation. It was his favorite treatment for the psychological complications of syphilis. Skorsky himself never took what he called “the universal drug”—good for alcoholism and toothaches, neuroses and morphine dependency—though he had read in an article by a respectable Viennese physician, who used cocaine as a panacea, that it was not addictive. That doctor subsequently recanted, but Skorsky paid no attention. He believed the retraction was made under pressure from pharmacologists who had no incentive to cease production of the medications that cocaine might supplant. Their representatives either paid or threatened the Viennese to repent.As the patient was escorted to his room, he assaulted the orderly, Alevtyna. They tried pulling him off her, but, though he released his fingers from her neck, he buried his teeth in her leg. The poor orderly, who had not until then been attacked by a psychotic, nearly died of fear. Later, panic set in over Skorsky's diagnosis. He told her about the consequences of syphilis: grotesque patterns on one's face due to infection of the skin, mucous membranes, cartilage, and bones. He went on about the devastation to the central nervous system, which they had just observed in real life: “The face starts to look like lace some mangy dogs fought over before rolling in the mud.”Alevtyna, who had not yet regained her faculty of speech, straightened up. Ignoring the slavering male orderlies, she bared her leg to get a better look at the wound. She then ran down the hall and out into the garden, where she fell on the ground to rip up grass and small bunches of daisies. Alevtyna ate them along with the soil in their roots.“Minor hysteria. She needs fifteen milligrams of cocaine.”Skorsky took a snuff box out of his pocket and scooped up some white powder with a toothpick made from a goose feather. He gave the order to close Alevtyna's mouth and one of her nostrils, forcing her to snort the medication.We fretted over her so long that evening fell. I decided to walk down, along the ravine, behind the church.It was unlikely there were any large beasts there, but something was rustling. The pits and mounds, ravines, paths, graves of witches whose living sisters flew in the treetops from time to time, the whispers of the forest spirits, the spirits of the nutcases who died in the hospital, the spirits of the monks from the St. Cyril Monastery, Zmei Gorynich and the bogatyrs who wanted to defeat him. The city would be calmer without this forest. I saw the gaps between the trees and went off in the direction of the tram tracks.As I was coming out of the forest, there was a patch of Amanita muscaria that had been trampled into porridge. A bit farther on, the body of Professor Bilinsky lay killed in the blackberry bushes. The way he was lying it looked as though he had not struggled before death. I quickly examined his body but saw nothing out of the ordinary. There were no wounds, no dirt under the fingernails. Animals had not yet smelled the carrion, but swarms of various insects covered him. Oh, why did I have to find the putrid body?The best thing would be to take the tram to his house to inform his relatives. The doors closed, and I noticed my own calm. This death had not evoked any emotions in me other than a feeling of responsibility, the need to tell the family. But also—some alarm at the thought of who the murderer could be. I knew that it was murder.“Your nose is bleeding.” A woman as round as an onion, carrying two baskets full of strawberries, offered me an ironed and starched handkerchief.“Have I dirtied my shirt?”“No, it's as neat as a pin. It's just your nose that's dirty. Wipe it now before you spray blood on my strawberries.”“No one will see the red on red.”“Ah, but it's salty!”“You know why it's not sweet? We'd drink it like syrup.”“Those with Christ in their heart do not talk that way.”“Are your strawberries expensive?”“Why? What?”“I'm checking to see if you have God in your heart.”“Child, if you knew how I have to work for this berry! I have to weed it a hundred times. In a week, the quitch grass grows as high as a horse. And I water it with water I carry from the stream, it kills my arms... ”“How much are the berries?”“They're not for sale. Anyway, soon money won't mean a thing. Soon all money, all these papers made from the skins of sinners on their satanic presses will be annulled. What matters is how we treat each other.”“So if I try your strawberries for free, my ‘thank you’ will be enough?”“Hands off!” she said and thwacked my fingers.I heard loud laughter behind me—same laughter as from the café near the Continental. There was no one sitting near Alina. (This is what fate looks like, remember.) Without asking, I sat next to her, away from the old lady.“Excuse me, but the night before last didn't you, yes, didn't you intrude on my privacy?” She started right away.“I saw it a little differently. Who was that young man with the mustache who paid me for you?”“Are you checking to see if you can flirt?”The tram stopped. People got on and off.“Are you coming back from the hospital?” she asked. “Don't be shocked. My uncle works there. He's told me all about you.”“An uncle by the name of Skorsky?”(Remember: this is what fate looks like.)“Yes. Skorsky's been strange recently—says things that make me wonder if he hasn't lost his mind. Have you noticed anything?”“I don't know.”“You know perfectly well.”“Where are you going?” I tried to change the subject.“I have to send something to my theater friends in Odesa. By the way, they'll be putting on Oedipus Rex soon in Kyiv—in Ukrainian.”“Greek tragedy in Ukrainian! That's a first.”“Exactly. The troupe is rehearsing now in Odesa. The theater where they will perform this fall is being remodeled.”“Wait. Now I remember where I've seen you before—it was at a performance! Vynnychenko's Black Panther and White Bear, at the Bergonier on Fundukleivska.“The same director is doing the Oedipus. He's my friend.”“He's your friend in what sense?”“Again with that tired subject. By the way, I've been thinking about you.”“And I about you.”“That's good. I was thinking not about you, to be precise, but about that elevator you invited me on.”“Who was that man with you?”“Like a broken record! Even if he had been my fiancé, I'm not bought or inherited. I'm not a brooch or a hundred acres of land, and I'm not a house in Kaniv!... Who was with you when you saw Black Panther?“Ah, so.”“Answer!”“That was my mother. She looks very young. She is coming to Kyiv the day after tomorrow. I can introduce you.”“Oh, this is my stop.”I looked out the window and realized that I had long since passed the stop for Bilinsky's.“Can we see each other again?”“We can. But you have only one chance.”Alina the anarchist wrote something on a scrap of paper and handed it to me.Morning, not morning but a thick porridge (I hate porridge). Dew, thick spit, crushed fruits, urine, all on the sparkling cobblestones. The sun, just barely having made its appearance, is already scorching. The human masses scurry and grumble like poorly digested food inside a stomach.I walked diagonally across St. Sofia's Square, then along the perimeter, then one edge, then again diagonally across. I went underground. The basement café of the Continental Hotel was practically empty. I again asked the server to bring the cloth with the embroidered portrait, but I couldn't remember the musician's last name, only that it ended with -sky. The server said that -sky was currently in the southern cities of Yalta and Odesa. I added that Kurbas, the director, Alina's friend, was also in Odesa, rehearsing Oedipus Rex, and that he'd previously put on Black Panther.I was bored, so I walked along Khreshchatyk and then headed down, calling to mind all the Kyiv churches of Podil: there's Birth of Christ, St. Nicholas on the Shore, Intercession, Pyrohoshcha, Holy Presentation, St. Dymytrii Rostovsky, St. Illia's. And also the Epiphany Brotherhood Monastery, Ascension Convent, and St. Katherine's, all these whipped-cream churches on the waffles of our streets. A few of them reminded me of themselves by appearing suddenly out of nowhere.The smells on Kontraktova Plaza where commerce buzzed were like multicolored light bulbs turning on one after another. Here you could catch the aroma of Balabukha jam, which blended with the next smell, English shoe polish at the Raiskys’ shop. Then the crunchy-smelling cabbage from old women standing in a row like herons and spitting out the shells of sunflower seeds. Farther on, the stench of a good-sized rat that crawled under Mrs. Shevchuk's shop where she sells broadcloth. Oh, she can't scream: no, she'll quietly dig that rat out herself so as to not scare off her clients.I bought a paper and two pairs of underwear. I asked two laughing young chambermaids who were secretly puffing in a grape-filled yard for a smoke. I wandered around Podil until evening when I came across a sawmill near the Dnipro that surprisingly smelled pleasantly of mazut fuel oil. The weather was dry, yet in the middle of the road was an enormous puddle, a deep dark black. A forty-year-old woman in a pale pink dress stood near it. The theatricality of it all provoked me to pose her a question,“Ma'am, what should I do?”But she paid me no attention. I shouted,“What should I do?”“What to do, what to do?” she said in Polish. “Jump in the water and swim so far away that you cannot return.”I quickly crossed a section of the forest. The wind brought a mixture of unpleasant air, like a stinky handkerchief held under one's nose. Passing the trees, I saw light in the spaces between them and exited at the hospital.Outside the windows, two orderlies lay in chairs with their heads thrown back. Two others—fools—ran around the yard in different directions, peering out at... something. The lights on the first floor of the hospital were on, and the staff milled about.“You're just in time!” said Ivan, a tall, young orderly.“For what?”“Your patient ran away! We went into his room and he wasn't there.”“What patient?”“The one who bit Alevtyna,” said Danylo, the other orderly, short and middle-aged.“That's Skorsky's patient, not mine.”I had no intention of helping them. This was all history—like my family, Kyiv, and my previous life. I had no intention of thinking about it. I wanted to go to my office, pack up my field surgery kit, and get out. So what? Their psychotic syphilitic ran away—it happened.Of course, that patient could have something to do with Bilinsky's murder. But that was no longer my problem.“What a strange coincidence!” the doctor on duty said. “Comrade doctor, the other one responsible for this patient was just here.”“And where is he now?”“He took off toward the church to look for the patient.”“Didn't the patient escape earlier?”“Don't know.”“How do you not know? You had better call the police, moron, before he kills someone. And get those sleeping orderlies to look for him.”“They can't... ”“Why not? Should I go wake them?”“They're on morphine.”“And you, I can see, have lost your mind. Go, catch your psycho! If it turns out that he killed Bilinsky—and on your watch—you can't imagine what's in store for you.”I adjusted my homburg and set off in the direction of St. Cyril's, that unwelcoming monolithic cube. I glanced around—what if our escaped syphilitic were to jump out of the bushes and bite or strangle me. I looked around because I wasn't sure of my actions, wasn't sure of my choices. Tripping over a clump of clover, I reached the open doors of the church. I couldn't stop myself from going in.The walls and ceiling were covered with frescoes. There was what used to be an angel rolling up the sky on the southern column of the narthex. But also graffiti: people scratched their names on it so as not to be forgotten—their idea of eternity. Prince Volodymyr the Great compared this activity to the desecration of graves. The vandals paid a fine and were beaten with canes. During the raids of Batu Khan, the church was deserted and cracks appeared all over it. Wild martens and feral dogs sought shelter here; insects swarmed under the ceiling with its red mosaics. Birches grew in its midst. Water seeped in the cracks, the water became ice, the ice widened the cracks, more water seeped in the cracks, becoming more ice that further widened the cracks, the wall split and nearly fell over, and then the wall fell over. Yet the angel is still rolling up the sky... When I reached the exit, I heard a rustling behind me. I turned after I stepped outside: in the depths of the church, like a stick in a pot of tar, stood a man with a large bag thrown over his shoulder and a revolver pointed right at me.“Is that you, Doctor?“Don't move!”“What's... Skorsky, what's with you?”“Don't move, I say!”“What are you doing here?”And finally I understood... Skorsky was himself the psycho! (Really, I had known for a while.)“You are the murderer! I knew it! But—why?”“Shut up.”“It was you. You! The stolen cigarettes, the strange behavior, Bilinsky. If I shout, everybody will come running. They've already called the police!”There was heavy breathing behind me. And then a gun rang out.The city is overgrown with new buildings. They encircle everything that was once on the periphery. Kyiv has become an old lady that can no longer restrain herself in the face of pastries. The city climbs farther. It steps over the swamps, turns the old rivers into a series of lakes; the other bodies of water it drives into canals. The grain that falls from the wild wheat is black. When the sun heats it, the grain melts and trickles into the earth. St. Cyril's stands indestructible. No one spackles the small cracks in its walls with either expensive putty or glues, nor with cheap cement and whitewash. One day a small fox appears in the doorway. It runs inside and along the floor of simple gray tiles. The gods watch from the walls, watch and fall into ruin. The fox runs to the iconostasis. Before it is a time-darkened Virgin Mother and Child in oil on sheets of zinc. The fox runs the metal steps that wind up to the second floor. The fox runs past all the vaults, naves, all the frescoes. A buckthorn seed flies in through a broken window. It will be the first. Soon the buckthorn will grow everywhere. A dumb hare will make its nest in the buckthorn bushes and nightingales will settle in the upper branches to sing until the end of the world. The fox runs between the thick rays that penetrate the windows. It catches one of the rays, squints its eyes, and warms itself in the sun.The shot rang out, but I did not fall. I looked around—and on the church threshold was our syphilis patient bearing a rod. His head lay on the rocks by the doorway.“If only he'd been at the stage of nose deformity! Just imagine: a hole instead of a nose plus a hole from the bullet—like an extra pair of eyes!” Skorsky laughed at the corpse.“We need to call the orderlies.”“They heard the shot. They'll run here on their own. You see, Professor Bilinsky believed it would take two or three years to wrap up this patient's case,” Skorsky told me. “But I took care of it much faster!”“Excuse me, but I'm going crazy in this city. I thought that you were Bilinsky's murderer.”“Just so. Why not? I am Bilinsky's murderer.”“Don't tease. You've changed a lot recently, so... ”“Yes, I've started killing people. You might term such a change significant.”“You have the right to irony.”“I am not being ironic.”“Let's call it sarcasm.”“It's the honest-to-God truth.”“And yes, you have the right to mock me.”“Well then, let's be done. To the horses!”“What horses?”“Alina's waiting!”Alina, her uncle Skorsky, a few others I didn't know, and I rode like the wind that ripped off my homburg and carried it back to Kyiv.“There's a fresco in the choir loft at St. Cyril's where Vrubel painted himself and patients from the hospital as the apostles. When I came across it by accident, I really believed they were saints,” Alina said.“I've never been up there. I've only seen the church from below.”“Remember the way back so you can see it sometime.”“The Puchai River used to flow here. You shouldn't trust the landscape,” Skorsky said, reaching for something, perhaps his bag, just when we left the darkness of the trees and saw the endless steppe ahead of us.We rode all night without stopping. Though no one was chasing us. Though we had nowhere to be. We rode like beasts released from a cage. The promises of the horizon turned what we'd left behind into a cage fit for those from whom freedom had been severed, like an anomaly, at birth.The pre-morning sky looked at first like a sack of turnips—filled with something heavy. But with each verst, the sky became lighter. When it was finally light enough to see clearly, we arrived at a knoll at the foot of a stone wall that from a distance had appeared to be a gigantic piece of halva. The exterior ruins of the castle gave no hint of how it was when all was fine here, when people defended themselves successfully from the nomads’ raids. From far off, the wreckage looked like a natural agglomeration of stones—a rocky elevation, no more: a cluster of cliffs. It would rain a few hundred more times, a few hundred more winds from a few hundred directions would blow on this heap, and it would collapse as though nothing had ever been here.A few stalks of wheat grew from one of the rocks. Someone had probably cast a handful of grain here for some birds that forgot to eat it.“Who could this castle belong to?” I asked Skorsky.“I reckon the Swan Princess,” the doctor rejoined, hoping to sound knowledgeable.From behind one of the piles of gray sandstone emerged a young man in a black reptilian coat and a white papakha as lush, bright, and out of place as a dahlia. His name was Artem. The heat was melting our brains, but he was dressed like that, in rooster fashion, which was popular among the otamans. Artem helped Alina dismount her horse and tried to kiss her on the lips, but she offered him a cheek instead.Had she been racing to see this clown?We entered the yard—the ruins had fashioned an internal space that was more or less protected, at least from strangers’ eyes. It turned out that there were even places where it was possible to hide from the rain, and from there the ruins didn't look half bad.In the center of the court was a table, and on it a wooden bucket with pink gladiolas. How romantic! It all looked like it came from outer space. Where on earth, in the middle of the steppe, far from any village or town, did this table, this simple table, come from? And the gladiolas? The steppe hadn't been plowed in so long that any cultivars would have gone wild, degenerated, dried up completely.A campfire crackled nearby—a little preview of what we would soon do to the houses, villages, and cities. Artem the otaman brought over a cezve from the fire and poured the first portion into a small, copper cup for Alina. He also got out a porcelain cup with images of rosy cherubim—but how...?“Who else would like coffee?”Only Skorsky and I responded. The question excited me, even distracted me from the thought of the kiss I had recently witnessed and the Kyiv I had recently left.“It's obvious who the professors here are; cultured people drink coffee. Are you both doctors?”“Uh-huh.”“For wolves of the steppe, like us, doctors are gold, even more precious than gold. Actually, a Hippocrates like you should eat more, because those in your profession will soon be worth your weight in gold. Work on your figures, both of you.”“Who will take pity on the horses that have to carry us?”“We'll find the horses. And very large doctors can be transported on machine-gun carts. We'll need to seat the otamans near you. Only a fool would shoot at a doctor.”“I think we'll find quite enough fools here.”“With your beard, Doctor, you look like Tsar Nicholas II. But even so you won't be shot. You might even be canonized!”“We've only just arrived and you're going on about executions,” Skorsky grumbled and checked to make sure that he still had his bag.“Apologies, apologies, pardonnez-moi. But you are not merely a doctor. A venereologist! Skorsky, you're a specialist! A venereologist is the most important person in wartime. The most valuable! You are the botanists of war. You can't imagine what varieties of flowers grow here, and these beds have long awaited a proper gardener. Or even just a man with a scythe!”“Bite your tongue,” Alina said. “I don't need to listen to this.”“Yes, yes, of course. Excuse me, my r—. ” He almost said “rose.”We rested all day. We went down to a surprisingly close river overgrown with lilies. We rowed the boats left by fishermen. I talked to Skorsky. He took his bag everywhere, refusing even to swim so he wouldn't have to part with it. I asked him what he had in it, but he said it wasn't my damned business.Alina rowed with the otaman to the middle of the river. They were having a loud discussion. She was waving her hands. The current carried their boat downstream slowly and smoothly. What a nuisance, that current!I tried to meet with Alina one-on-one, but she was avoiding me. In the morning I was confused, by lunch I was sad, and after lunch I got angry.In the evening, I lay on the hot grass and drank another cup (I have no idea where they got such good coffee), which had no effect at all on my sleep. I watched the Perseids. Every year, the Earth passes through the tail of Comet Swift-Tuttle. People can see the meteor shower and make a wish. I wished. I counted forty-seven falling stars. All forty-seven of my wishes were for the same thing.Around the campfire, they were sitting, talking. I saw how he tickled her face with a piece of grass and she brushed him off in annoyance. Then they were screaming at each other. Later they again spoke kindly, after which they again quarreled. My joy grew after each tiny mistake that Artem made. I wanted him to show the worst he was capable of.They were screaming at each other, but all I could hear was beautiful opera singing. The stars fell to the sound of their screaming. The stars blessed my joy.Then this happened: Alina kicked the fire, scattered burnt kindling, and burned some of the grass. Artem grabbed her by the arm, but she broke away from him and ran off to the horses.“Go then! I guarantee you'll get to Katerynoslav and return with your tail between your legs.”“I'm going to Huliai-Pole! To Father Makhno!”I jumped up and ran after her.“Where do you think you're going?” Artem shouted.Really—where was I going? I was going after her: to Huliai-Pole, to Katerynoslav, to Rome, to Washington, to Istanbul, to Montevideo... “Go to sleep,” he said. “Come morning, this coquette will be here, right as rain. We've already been through this show. Tomorrow she'll be right here next to my boot!”... No, she won't.In some sort of shape we entered some town. There were some buildings that were some colors, some trees, some streets, some roads, and some signs. Posts, flustered birds’ nests, echoes, colors, shapes—each of some kind. A wedding procession was coming toward us. If you want to make orange, you need to add yellow to red, and then bam—it's black. If you want to salt the soup, shake in a little, and then bam—two handfuls. You want to say a kind word, and then bam—a punch in the face. I was rocked around like a watermelon on a boat and threw up my breakfast straight into the horse's fluffy mane. Sanko found this hilarious, but I said I'd pulverize him. So Sanko sped ahead.No one knew anything about Alina. The daytime sky was like a poorly washed bowl. The sun was a squashed, rotten apricot. The night sky looked like the sole of a boot to me. The moon was a dirty cheap copper coin that had gotten stuck to the sole. Everything seemed spoiled to me, irrelevant, unnecessary. Without her, this journey was a waste of time.“You'd better stay away from everyone,” Artem said. “You'll infect us with your pining, and pining is worse than the clap.”The wedding procession was before us. The young couple, still utter children, walked so calmly it was as if they didn't see us. As if we were made of a light breeze—our bodies, clothes, our horses and their iron shoes—of the lightest gasses. As if we were visible only to ourselves and the coal-black dog that barked, panting and gasping.The wedding was headed straight for us. We were in the middle of the road, and so were they. We approached each other slowly, a wave going toward a wave. Some ten meters before their indifferent faces, I noticed the color of the bride's eyes. And the coral-colored tulips that fell on the road before her. Round goose eggs on meaty stems, the flowers were falling and falling before her. The bride's eyes were almond shaped.“Hey there,” Artem shouted at me. “Wake up!”I came to and saw the whole village, everyone there, not realizing my group had turned left onto a side street away from the procession. The tulips disappeared—where'd they get tulips in the fall? I was sitting alone on my horse in the middle of the road, and the entire wedding procession came to a stop. I moved to the side, and the throng marched on, cutting off our escape route. We rode a few more meters and came across the synagogue.“You know what, you're right,” said the otaman.“Who is?”“Oleksii is the only one here who's right.”“About what?”Artem turned his horse and raced back. Everyone stood still while he ran his horse into the crowd and began firing his revolver. People scattered in all directions. Artem trotted, cackling like an imbecile. The horse kicked an old guy in the mouth. The man fell, spitting out his gold teeth. We rode up to the commotion and formed ranks, but none of us wanted to join the otaman.The bride stopped in the middle of the street. On both sides were buildings and trees, as well as dust, sky, and sun. She stood still, beautiful, as if nothing had happened. Then she adjusted her garland and walked calmly on.“Well, should we get some sugar now?” Artem laughed, looking at the bride, and off he went toward the sugar factory.It was then I noticed that all of the houses had shutters—fuchsia, blue, ocher—and that all the shutters were closed.We flew toward the dirty building, whistling and shouting. If there had been aesthetes among the otamans, they would certainly have razed the abomination in this field after seizing it. They would have spread soil on top and sown buckwheat. Long live buckwheat!, that wonderful crop. Like hunting dogs hot on the trail, we raced to our defenseless victim, with the baying of hundreds of hounds behind us. The field shook beneath us. We became an artist's canvas, evolving from Realism to Romanticism, Romanticism to Expressionism, Expressionism to Suprematism. If we had been painted in black and white, we would have been splotches (until the ink ran, annihilating all remaining patches of white).Two men stood near the gate—unarmed and undressed, in nothing but their undershirts and boots. Our fervor, our kinship with the elements, our entirety, were all for naught.“Jesus Christ! What bores!” Artem exclaimed. “How boring you are!”“Maybe boring for us, but fireworks for them,” Sanko said, dismounting his horse.“The fear of death engenders creativity,” our otaman—a distinguished philosopher of the early twentieth century, that demonic breed—prophesied.He went on, “Excuse me, but with all due respect, we are not going to search you. Just show us right away where the money is. Why are there so few of you? Don't say there's not much money. I want piles and piles of money! If you don't show it to us, we'll print our own on your skin. Believe me, we will.”We entered the factory grounds. There were no workers, only an enormous mountain of sugar beets that looked like a pile of coal from a distance and a pile of dead rats from up close.“So, did you have a good year?” Artem asked a man in an undershirt.“Not really—too dry.”“Nah, that's fine. You wouldn't have been able to gather most of the harvest this year anyway. There's a fire burning across all of Ukraine, all of Russia. The whole world!”While Artem tossed thoughts like well-chewed sunflower seeds into the crowd, the two men quietly stepped aside and then ran fast ahead to the factory's main hall. The gigantic door slammed shut. The gate was locked behind us! The windows were smashed! The factory roared from inside like a cumbersome machine starting up. Bullets whirred through every window.“Bastards! It's a trap! Quick, after me!”Still on horseback, Artem bounded over to a vast window, low to the ground, and smashed it mercilessly. He broke the frame and jumped inside on his horse. I and a few others followed. We broke into their lair, threw open the doors, and let the other warriors inside.Iron vats of hot sugar were steaming, pipes were clattering; machinery groaned.“Parasites!” Artem gritted his teeth. “I'll get you. I'll get you red sons of bitches. Painted whores!”At the word “painted,” his horse fell to the ground. Lying prone, Artem continued fighting, but the red soldiers wouldn't let him stand. Fighting nearby, I rode over to assist but did not know where to aim. Artem got up, ran forward, and brought his sword down on the head of the closest soldier, all the way to the middle of his skull, to the bridge of his nose. It was like butchering a pig. Artem thrust the sword into the buttock of another who was fleeing and cut off his leg at the bend in the knee.“I'll cut off every last one of your asses! Cut off your asses!” Artem bellowed.A half hour later, the dead were lying, the captured sitting, and the victors doing anything they pleased.“Skorsky, are there a lot of casualties?” I asked the doctor, whose hour it was. I hoped not, because I was too tired to help him.“Just a few. The dead are already dead, and the wounded are not ours.”Though Skorsky rarely asked my help, and though I'd become an ordinary soldier, the doctor in me was still present in the most unpleasant attribute—knowledge. Others saw an eviscerated man, pieces of dusty flesh smeared with clay, soil, sand, and straw. I saw a perfectly formed kidney hanging perfectly from the rest of its body like a child's mitten from its coat. You could try this death on for size. Wear it like a sanbenito of the Inquisition.Artem counted the money and then lay on the floor alongside the gigantic sugar mountain in the middle of the room. From time to time, the crystals rustled as they fell.“I didn't think you'd be such a fighter!” the otaman said without turning toward me. “I thought you'd be healing us. You'd keep to the rear and we'd hide you like a girl. But here you are, in the vanguard, like a lion!”“I got excited,” I told him, choosing not to react to the “girl” part.“’Cause Alina said there was no sense counting on you to fight.”“Really?”“Does that sting?”“Why would it? I'm a doctor—not everyone is. It requires a brain. Unlike waving a sword.”“Yeah, yeah. I gave her gladiolas. We were lying in the boat near that castle, doing all manner of things, and she told me all about you. How you met.”“You were lying in that boat talking about me?”“It was the day before you left Kyiv. You agreed to go with the anarchists so quickly!”“Were you surprised? Doctors make fast decisions.”“But you probably had great prospects. Your parents are rich, right?”“And who are your parents?”“Probably all your relatives fled abroad—bourgeois. Why did you stay?”“What the hell's your point?”“Alina, by the way, died a while ago. Probably.”“Don't jinx her.”“Listen here,” he said, staring at the ceiling. “And listen good. If you have designs on her—dead or alive—it's best you castrate yourself now.”“After you.”“If I want to kill somebody, you know, I just do it.”At last he looked at me. I was lying on the floor nearby and looking in his direction, sweaty and relaxed, my appearance complemented by my disdain for his opinion, his authority, his stupid hat. His everything.Artem raised his arm above his head, stuck a finger in the sugar mountain, and licked it. We both got up. Had I anticipated this turn of events, I would have readied a gift for him. Artem held his revolver. Under my hand I found a knife the workers used for gathering beets: it was a deliberately sharpened arc they sank into the swollen brassicas. I jumped up and quickly stepped around the sugar mountain.Artem's bullet hit a pane and broke the glass.“Not man enough for hand-to-hand?”The otaman shot again.“You should've challenged me to a duel, you romantic!”Encrusted with white crystals, I charged Artem from the sugar mountain. We fell in, and the sugar stuck in our hair, mustaches, nostrils, armpits.The gang ran in to get us apart, then backed off because it had nothing to do with them. By now the sugar mountain had burst its banks. Of the once perfect pyramid, a deformed mound remained.Wounded, Artem fell on the sugar mound, turning the white red.I stood before the gang sugar-coated and holding a bloody hook. The old otaman was drawing his last breath. Blood trickled from the corner of Artem's mouth and streamed from the left side of his breast.“What's the commotion?” Old Roman had just come in.“Be quiet,” the boys told him. And a good thing they did.“You killed him? You killed the otaman!”“Shut your mouth,” the boys told him.“You... ”I slugged Roman's stinky herring mouth. How did that son of a bitch find pickled herring in a sugar factory? My fist was now bigger and stronger than ever before, a steel anvil that could split nails and shatter memorial plaques. The unfortunate man's jaw twisted like an upper millstone that had gone off track from the lower.“Let's get out of here and go to Makhno's camp,” I gave my first order.We galloped so fast the grass burned beneath us. The birds and bugs had no time to fly out of the way; hooves trampled the burrows of rodents who didn't dare crawl out of their holes for a long time after. We raced like no one had ever raced before.The steppe, that sly fox, pretended to be an innocent fool. The steppe said, “I'm like Adam: I don't even know my own name.” But its grass harbored the tracks of thousands of armies and the heels of Herodotus, the crunch of Trypillia vessels, and the smell of Scythian hemp, Roman coins, clay figures of wolf people, the chevrons of Denikin's army, glass from the Chekists’ ruby stars, traces of uranium from flying saucers. I threatened it: “Steppe, show me your layers, or I will burn you, plow you under, flood you.” But it just replied: “I'm like Adam: I don't yet know my name.”I lost geography as if it were a silver coin. It fell out of my pocket and rolled through the feather grass that blanketed the steppe in white foam. The open space ahead was so endless that the whole world might as well have been steppe. If people ended up here from somewhere else, they would conclude they were on another planet. The coin fell and became an argentum, became one with the ring on the hand of the princess who had one green eye and one blue, with the twisted candlestick at the monastery on the other side of the steppe, with melted ingots. It broke down into simpler elements, simpler and simpler yet. The horse carried me spreading the seeds of northern plants to the south, just as southern riders had once brought flowers and weeds to the north. And then I turned back. Just as I had no geography, I had no time. Every night I fell asleep with the thought that the next day I would again race. Through all spacelessness, all timelessness. I exchanged one horse for another, got on a train, on a boat, traversed forty versts on foot—in rain that brought the river up to the road, in heat that overturned cattle. The earth I walked on became mine. Mine was the water in the lakes and springs, clean water, dirty water, enlightened water, contaminated with oil, stinking of algae, of fish that died in wells, stinking of the memory of atrocities, water as clean as broken bread. The water did not become Alina.I was doing this for her: I got the basturma out from under my saddle, sodden with the horse's sweat, sliced the throat of a rich man whose daughter I had danced with at a ball, climbed into a vat of beet juice and took a sugar bath, carried out the expropriation of the savings banks, wiped the sweat from my face with my shirt—and the cloth turned red; I didn't know from what. If it was someone else's blood, I didn't care; if it was my own, even less.We mostly came across Reds. We scraped them up like old red paint on a door in order to repaint the boards black. Black looked better. Red is tasteless, but black has style. Healthy men died before us of myocardial rupture like bunnies found in the nest. The ones whose hearts were sewn of steel wire envied the deceased. Seizing estates, banks, distilleries, and prisons reminded us of gathering in the harvest. If you're too lazy to pick an apple, you can shake the tree; some of the fruit gets bruised when it falls. We seized buildings like we were shaking apple trees. No one picked the fruits, we just shook: shook under the beds, under the tables, behind the curtains. No, there was no picking. We just shook until the red juice spurted from the apples.Near the Khorol River with Father Makhno and me in charge, we captured sixteen machine guns and four cannons, as well as five hundred prisoners who immediately came over to our side. The villagers voluntarily gave us bread and cheese, chickens and kvas. People joined us. The front of the machine-gun cart said “You can't run,” and “You won't catch us” at the back. We took factory after factory. Millions of karbovantsi, thousands of poods of sugar, weapons. We smashed the telephone exchanges and captured the telegraphs. We made alliances with some and then with others. Lenin, Wrangel, Frunze, the Germans, Chinese, Australians, Kaiser Wilhelm II, Cleopatra, Maria Theresa Walburga Amalia Christina. We ran the steppe. There were a hundred thousand of us. There were three hundred thousand of them. There were three hundred thousand of us. There were a million of them. There were two million of them. We were all of humanity. We were so many that we were none.The nobles’ estates were long ago forsaken. In the people's deepest trunks lay silks and guipure laces that were once perhaps used only to cover a table. Five steps from the barn in the direction of the pear tree, some silver candlesticks are buried; there's a plaster figure of an angel in the chicken coop, covered with shit and feathers.I was reluctant to be going to my home, but I didn't see any way out. Fate intended me to be a different being from the one I was before.Here my grandfathers and great-grandfathers were born. Here the ones who caused my grandfathers and great-grandfathers to flee had stopped. When we were still far off I noticed that someone was in the house. It was our men—Skorsky had brought them here, about twenty in all. I asked Sanko, whom I had walked with side by side more than once, where the doctor was now. All the men answered that he was around somewhere, but I didn't see him that evening.In 1918, the spirit of my great-grandfather Stepan, along with my mother and uncle, had gotten into a britzka and scrambled off to Paris, to Napoleon, against whom my great-grandfather had fought with the Cossacks, to whom the Russians promised to return self-rule. Following him in the cart went the soul of Grandpa Oleh, who lost a finger when he cut down the old linden near the house; his second finger was blown off by a cannonball near Balaklava, and later his entire hand was cut off by some Turk. Next went the spirit of my father, also Stepan, who did not take part in any war but died of measles at the age of forty. They all got the hell out of here. First, they went to Kyiv, led by my mother, Tamara Makarivna, in order to collect Uncle's family and me, their son. And their son, it turns out, has now come back to rob his own home (I didn't drive my war buddies away, did I?). It's a shame that I didn't know where the bathtub was, or whatever they bathed me in when I was small. It would have been good to walk through the ranks of anarchists with that basin and tell them all to spit into it.Remembering every room, I carried Alina upstairs to my mother's bedchamber. There was no longer furniture or pictures, only bare walls. The bed and mattress remained, but that was enough. Mother hated noise, so she set up her room far away from the running in the halls and the creaks on the stairs. I adjusted the mattress; in a gap, looking like a stalk of wheat, there lay a gold bracelet that she lost in the haste and that the thieves could not find in the mayhem. I tucked it into my pocket.The place could still be saved. It was strong, built under the leadership of my grandfather, who knew how to do it right. He built a sawmill, a gristmill, a dress factory (today it's probably been ransacked, maybe even by our own men).Alina had a complete, displaced break in her right fibula. We needed water first. I went downstairs—the guys were dragging out the piano like an old cow to the slaughter.“What are you doing with that?”“Taking it out.”“Why?”“What's it to you? We want to have fun.”“Can you play?”“We're not your bourgeois lily-handed bitches.”They couldn't play, but they were famous at destruction. “Noise is the music of the new time,” one of the smarter among them might have said. “But noise is the opposite of music. Just as a rose is the opposite of your ugly mugs,” I'd have responded if there was anyone to say it to. I could also have said that this was a Bosendorfer grand piano, that it was very valuable—but do the guys not deserve such a luxury?“Why are you so boring? We're relaxing.”“Then let me play a little first.”“Go ahead, but fast. One-two.”So I played. As before. My fingers ran up and down the black and white keys, which weren't simply keys of these, the simplest, colors. These were the keys that remembered my fingers specifically—achieved by that slovenly German Katerina, our governess. She knew a bundle of languages, could play the piano, and was interested in the latest scientific discoveries. But she had not an ounce of sympathy for anyone who couldn't master anything on the first try. More than once she hit my pinkie against the black key that remembered every one of its four thousand touches. She would pound it on the key and shout, “Si bémol! Si bémol,” and later bang my fingers and translate, “B flach! B flach!”I played. I could not expose myself, so the only thing I could do was believe in miracles. What if these coarse men saw value in this bit of furniture so unintelligible to them? And what if they didn't destroy it, this emblem of my childhood, my land, my air, which I could protect in no other way? My air. My water.“Shchedryk, shchedryk, shchedrivochka,” one of them who recognized the tune began to sing along.“Look at you.” They did not expect music from me, who had until recently been drinking blood like water.They said, “Again, again!”A group of curious men gathered around me. They were ordinary farmers, thieves, and recidivists, peasants and workers, everyone except for Skorsky. They needed this music as they needed baths. The music cleansed them from the inside, perhaps. They had not heard anything besides the whistle of a bullet, the neighing of a horse, or the knocking of a chisel and the whirring of a saw, amputating limbs, for a long time.But it could not go on long. I did not close the piano lid, just stood and went to fetch water for Alina, leaving the unfinished song for later. The well was to the north—that is, at the “Head.” My father once promised to give me a compass if I could learn to identify the ends of the earth by means of the sun. And to make it easier to remember, I gave each one of them a name: the east where the day begins was “Right” (my right hand), the west “Left,” the north “Head,” and the south “Feet.” Back when I could still do whatever I wanted all day long, I would wake in the morning and say: I'm going to the Feet. The mound was at the Feet, Left had the river, Right had the forest. It was only to the Head that I rarely went, because a village was located there. When the villagers saw me, they would speak in whispers and avoid the master's son.... I wiped her brow and her burning, sunken cheeks. I lay down next to her to feel the heat of her skin.When the fire in Alina calmed slightly, I went out into our orchard. My father had once been given a gift from Japan—a tulip tree that blossomed with yellow-green flowers. It had to have grown in the time that I was away. It would have been fatal had it been cut down. I again took the stairs down into the drawing room and came across nobody—they had all disappeared in search of food or were hidden away in their burrows. In the middle of the hall, like an opened rib cage, was the piano, irreparably shattered.B Flach! B Flach!Translation © Ali Kinsella 2022. (shrink)

In this article I will introduce and outline the concept of resistance as it relates to health and healthcare. Starting with a number of examples of action, I will then turn to the broader literature to discuss some conventional definitions and related concepts, outlining debates, controversies and limitations related to conceptualizing resistance. I conceptualize resistance broadly, as any act, performed by any individual (or collective) acting as or explicitly identifying as a healthcare professional, that is a response to power, most (...) often in opposition to contentious, harmful or unjust rules, practices, policies or structures. Practically this could account for any public action, marches, sit‐ins and civil disobedience, but also forms of ‘everyday resistance’, such as working slowly, feigning sickness, or even providing care for marginalized groups that would otherwise not have access. Such action could go unrecognized by those in power and perhaps more contentiously, those resisting needn’t even recognize their actions as resistance. I will then apply this conceptualization to explain action that has been undertaken by healthcare professionals, identifying its key features. I will briefly discuss future directions for inquiry that appear particularly pressing. These including ongoing conceptual development, identifying the functions of resistance in health and healthcare along with what makes it distinct from healthcare as usual and other forms of resistance and finally, the range of normative questions resistance raises. (shrink)

In some utterances, some material does not seem to be explicitly expressed in words, but nevertheless seems to be part of the literal content of the utterance rather than an implicature. I will call material of this kind implicit content. The following are some relevant examples from the literature. (1) Everyone was sick. (2) I haven’t eaten. (3) It’s raining. In the case of (1), we are supposed to have asked Stephen Neale how his dinner party went last night (Neale, (...) 1990, pp. 94–95) and received this as the reply. Obviously, we do not take Neale to be saying that everyone in the world was sick; we interpret him as saying that everyone who attended his dinner party was sick. How, then, do we come to incorporate the property of attending Neale’s dinner party into the proposition expressed, when it does not seem to be the denotation of any overt lexical items in the utterance? In uttering (2), I might be asserting that I have not eaten dinner today (Bach 1994, pp. 135–136), even though I do not use any audible words meaning ‘dinner’ or ‘today’. (I might thereby intend to create an implicature to the effect that we should go to a restaurant.) And in saying (3), I might be claiming that it is raining at 11.59pm on Halloween 2008 in Arkham, Massachusetts, even though I do not appear to mention any time or place (Perry 1986; Stanley 2000; Recanati 2002, 2004, 2007; Mart´ı 2006; Neale 2007). (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Grieving One More TimeNeethi Pinto"The deeper sorrow carves into your being, the more joy you can contain."—Kahlil GibranI take care of very sick children in the pediatric intensive care unit (PICU). When a child dies, grief strikes in three distinct waves. First, I grieve for the child we couldn't heal, the unfairness, and the complete and utter sadness of a life cut too short. Then, I grieve for the (...) survivors—the families whose lives will be changed forever and who must find the strength to go on. It's not until later, in solitude, that I am able to grieve a third time—this time by and for myself.As clinicians, we are also survivors. Yet, our culture in medicine rarely affords us the permission or the grace to unpack the depth of the sorrow and grief we regularly witness and suffer. Instead, we must summon up the fortitude to take care of the child in the next room before we can pause and process our grief. As a field, we have been more intentional about having "hot" (soon after the event) and "cold" (days to weeks later) debriefings, but these short conversations about our shared experience are limited. The sheer reality of our day-to-day lives in the PICU is that the next critically ill patient is waiting.My processing of grief happens when I replay the events leading up to the patient's death over and over and over again. Was there something I missed? Could I have done better? In fact, I teach my medical students, pediatric residents, and PICU fellows that this very questioning makes us better physicians—as long as we don't let our second-guessing or fear of making a mistake paralyze our actions in the future.Little did I know I would grieve a fourth time …"How would you feel if this was your daughter?" These words were harshly spoken by my patient's father, a former police officer, the day his daughter died of respiratory failure. I had cared for her on many occasions during her prolonged admission, including that very sad last day. Undoubtedly, he was grieving, but I could feel his anger when he interrogated me. I wondered if he remembered how he profusely thanked me for caring for his daughter when we first met or the many times our team had resuscitated her, saving her life. I spent countless hours at her bedside, during the day, in the middle of the night, away from my own young family. Sure, these hours—nights, weekends, and holidays—are "part of the job," but I chose a career in pediatric critical care because of a commitment to caring for the most medically vulnerable children—the sickest of the sick—despite these hours. As pediatric intensivists, we have a unique opportunity to help children and their families at the most harrowing times in their lives—when they face the possibility of death. Although we know at the outset that some children will not survive, the grief we experience when a child dies still runs deep. It hurts every single time. In this case, my profound grief was exacerbated by the father's hostility. One year later, my sorrow deepened when I answered my doorbell at home to find a police officer handing me a subpoena for a malpractice lawsuit regarding this child's death—a delivery intended to intimidate me. I found myself grieving a fourth time—grieving for the loss of joy—joy that had been central to my identity as a physician. [End Page 72]Then, the feeling of shame crept in and haunted me. I always understood that I entered a high-risk/high-stakes field where children die because of the severity of their illness despite state-of-the-art medicine and technology. Over the years, I've learned that not only is it rewarding to help a child survive critical illness but it is incredibly moving to forge an intense human connection with families when their children are dying. So, my shame was not due to a sense of failure in preventing this child's death but rather due to the... (shrink)

This article examines tafsir (interpretation of the Qurʾān) - translation relationship in the example of the translation of verse 184 of the Surat al-Baqara into Turkish. Undoubtedly, when the verses are translated into another language, it is necessary to reflect to translate what the first interlocutors understood from them. The fact that the rules (hukm) in some verses were repealed (naskh) or allocated (takhsis) later does not change this requirement. In verse 184 of surat al-Baqara, those who can afford to (...) fast but choose not to fast are ordered to pay ransom (fidya) for every day, that is, to pay the daily amount to feed a poor person. According to the detailed information and rumors in the tafsir literature; this rule was applied when the fast was made obligatory (fard) for the first time, and then it was abrogated. However, this practice, which was canceled for healthy and unexcused people, remained as a permission (rukhṣa) for those who were too old and sick to fast. Both the narrations conveyed from the companions (sahaba) and the general opinions of the mufassirs confirm the abrogation of this rule and that it remains a rukhṣa. The fact that the situation is described as naskh or takhsis does not make a difference in terms of transferring the verse to Turkish or another language. The verses on the subject were examined in the light of the most basic tafsir sources. To give an example that reflects the general opinion; It is stated in the thirty-five narrations reported by Tabari from the companions and tābiʿūn that the 184th verse expresses the option (takhyir) of not fasting in return for fidya for those who can fast. This option has been canceled in the next verse but it has remained for, -some people with special conditions-, as the elderly who cannot afford to fast, pregnant women and breastfeeding women who worry about harm to themselves or their childrens. According to the qirāʾa that is "وعلى الذين يُطوَّقونه", it is said that the verse is not abrogated, it is meant for old men and women. But as emphasized by Abū Ḥayyān, it is understood that this qirāʾa is not actually a qirāʾa but a kind of interpretation of the expression "وَعَلَى الَّذِينَ يُطِيقُونَهُ" in terms of rukhṣa. Therefore, the claim that it has not been repealed is probably due to the continued practice of fiqh. On the other hand, also rational evidence shows that the right to choose (takhyir), which was given initially, was later repealed. For example, in verse 184, it is stated that those who are sick and travelers should perform fasting on other days with the expression "فَمَنْ كَانَ مِنْكُمْ مَرِيضًا أَوْ عَلَى سَفَرٍ فَعِدَّةٌ مِنْ أَيَّامٍ أُخَرَ"; The same issue is stated in verse 185 with the expression "وَمَنْ كَانَ مَرِيضًا أَوْ عَلَى سَفَرٍ فَعِدَّةٌ مِنْ أَيَّامٍ أُخَرَ". The repetition in question shows that the two verses were sent not together but at different times. This state of affairs confirms that the second verse has repealed the right of choosing (takhyir) in first one. In addition, as Imam Māturīdi's determined by hit, if those who cannot endure fasting were meant in verse 184, it would be unwise to call these people at the end of the verse as "However, that you fast is better for you, if you only knew!" In the overwhelming majority of Turkish translations of the Qurʾān, it is seen that there is no emphasis on the meaning of the verse when it was first sent. Even the expression “Upon those who are able to fast...” in the verse is translated as “Upon those who aren’t able to fast...”. Whereas it is more consistent and appropriate to reflect the literal meaning of the verse in the translation and explain the situation with additional notes. In this way, it will be understood that two verses that contain the same words and come one after another are sent different times and about different things, hence the reader will be given accurate information. In the nearly thirty examples of translations in the article, it is seen that the translations belonging to Mehmet Akif and Süleyman Tevfik and the translation of the delegation chaired by Hüseyin Kazım are in full harmony with the data in tafsir literature and the general opinion of mufassirs. Rifat Börekçi, the first president of Religious Affairs of the Republic of Turkey, has criticized the translation committee headed by Hüseyin Kazım extremely harshly. Then, with the choice made by Elmalılı Hamdi, almost the direction of the wind changed and the translators could not surpass it. Although there have been some translations in line with the text of the verse, the relevant explanations of these authors reveal that they did not understand the issue in detail and did not make a conscious translation. Meantime the analysis made in the aforementioned verse example shows that reliable translations cannot be made without referring to detailed tafsir information and therefore a correct Qurʾān translation is often not possible without tafsir. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:My Lost SurvivorVirginia HammondI can’t remember the exact words as I brought my 7–year–8–month–old daughter Ann to the university medical center late spring for a review of her brain surgery from March 1990, but the words were something like it was a remarkable 98% resection, then the team went on to say 75% was considered successful and they were surprised since the surgery was not done at a major (...) medical facility. I explained to the team we had three neurosurgeons in our town from major facilities out of state who were very well regarded so I opted to stay in town for her surgery, but valued the university medical center’s recommendation for radiation treatment. The next decision I had to make was where. I not only had to consider my daughter, but my toddler that I had to drag everywhere through all this as I had no family nearby to help me. I opted for a 75–mile drive.The radiation protocol was for eight weeks of hyperfractionated radiation. I would leave the house with the both kids by 7:30 a.m. and stay until 3:30 p.m. because there were two treatments a day around six hours apart. I had thoughts that I would be able to take the kids to the zoo or children’s museum in between treatments, but Ann was much too sick for that. We spent most of our day at the playroom in the cancer patient house next to the radiation facility. We eventually got a room at the cancer home.Even before the radiation therapy, Ann became sick and would wake up every morning vomiting very much like she would before the tumor resection. This vomiting went on for almost two years after her surgery and radiation. We were bounced around between doctors and specialist then finally a pediatric neurologist was concerned about how thin and frail she was and prescribed a medication that goes by the generic name Cyproheptadine hoping it would help her appetite. Within a couple of days, much to my surprise, the medicine stopped the morning vomiting and she began to eat and regain some strength as she approached the age of ten.Now that Ann was no longer showing the outward physical signs of being ill, her school didn’t think it was necessary to make accommodations for Special Education, or follow the recommendations made by a neuropsychologist’s report. I was told her educational performance was average for her age and grade level. The school did discover she could not hear in her left ear and sent home a note that demanded I seek medical attention. I explained to [End Page E4] them her doctors were well aware of her perforation in her ear and decided they wanted more time to pass from the brain surgery before performing ear surgery.There was one bright spot during her elementary school years. She had a teacher who went out of his way to make sure Ann was responding to what was being taught. Aware of her hearing deficit in her left ear and some of her cognitive deficits, he sat her in the classroom where she could hear at her best and placed her next to classmates who would not distract her. When she would forget to bring her homework home, he would stop by the house with it rather than write a disciplinary action against her. She responded so well to this teacher, she was one of a couple of students in her class that was sent to the countywide science competition. She thrived that year, but never again was she to have a professional teacher that made sure she got it!When Ann was 11, the ear doctor decided it was time for her left ear perforation to be repaired and that would restore her hearing in that ear. She had the surgery, but the hearing was never restored.Ann’s ability to learn was becoming more difficult. I pulled her out of traditional public school to home school her through public charter school. I wish I had another option as she didn’t always appreciate my... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:William James, W. E. B. Du Bois, and the Art of New Religious IdealsKolby Knight (bio)And I don’t know a soul who’s not been batteredI don’t have a friend who feels at easeI don’t know a dream that’s not been shatteredOr driven to its knees...Oh, and it’s alright, it’s alright, it’s alrightYou can’t be forever blessedStill, tomorrow’s going to be another working dayAnd I’m trying to get some restThat’s (...) all, I’m trying to get some rest—Paul Simon, “American Tune” (1973) / Recreated by Allen Toussaint (2016)William James and W. E. B. Du Bois believed that an artful life could produce new and world-changing religious ideals. As cosmopolitan scholars who studied in the United States and Europe, both men confidently interlaced original interpretations of Shakespeare, Wagner, and Goethe into their academic accounts of individual and social behavior. Beyond their patronage of the arts, James and Du Bois also saw themselves as scientists and artists who had the responsibility to create new pathways and religious ideals at a time when many European and American intellectuals depicted Western civilization as the endpoint of history.This article explores the pragmatic visions of science, art, and religion respectively offered by James and Du Bois. Pragmatism, here, refers to an active mode of study that looks closely at the interaction between specific thoughts and behaviors in particular situations without assuming a standard of truth which influences or evaluates human life from the outside of experience. As pragmatists, James and Du Bois did not believe their work consisted of merely the explication and description of preexisting truths, but more importantly the religious creation of what James called “new facts,” including healthier habits of thought and practice.1 [End Page 71]In this article, I will trace how the two men, as religious naturalists and leaders in the development of a pragmatic social science at the turn of the twentieth century, challenged evolutionary theories which envisioned Western civilization as the highest standard of aesthetic and intellectual development. Part one demonstrates how James, as a psychologist who prioritized the study and development of “first-hand” experiences, worked against visions of science that saw “lower” emotions as a hindrance to impartial intellectual discovery. It also explores how James centered personal religious experiences in his effort to de-center “impersonal” scientific frameworks which depicted human behavior and thinking as beholden to evolutionary laws which transcended individual experience. Part two considers James’s dissatisfaction with the “bad habits” of his privileged intellectual class, and how his own experience of “soul-sickness” and “stage fright” led him to contest both celebratory histories of Western progress and institutional arrangements which juxtaposed his “mystifying” intellectual performances to the lives of everyday people.Part three moves to how Du Bois, as a sociologist and former student of James, refocused James’s religious pragmatism within the context of his experience of anti-Black racism in the United States. This section traces how Du Bois saw his intellectual career as a work of art which could empower Black individuals to see themselves beyond what David Lloyd describes as “the racial regime of aesthetics” which imagines the progress of “lower humans” as dependent on higher civilizational and educational agents. This section also offers a tripartite interpretation of Du Bois’s experience of “double-consciousness” that considers its aesthetic, social, and political dimensions.2 While James expressed a desire to discard his own sense of double-consciousness, Du Bois’s experience of anti-Black racism made his two-ness more enforced and insidious. The fourth section looks at Du Bois’s disillusionment with white standards of beauty and intelligence as an experience akin to what James described as “soul-sickness.” It shows that whereas James believed that his negative emotional experiences could lead him to “new religious ideals” taking shape within the spiritual energy [End Page 72] and discomforts of his own individual body, Du Bois’s negative experience of racism led him to immerse himself in the religious and artistic vitality of Black social worlds which resisted the oppressive mechanisms and caricatures of... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Masao Abe: D. T. Suzuki’s Legacies and an “Academic Dharma Lineage” in North AmericaMichiko YusaProfessor Abe is generally regarded as the torch bearer of D. T. Suzuki. But how did that come about? This essay sheds light on the relationship between Suzuki and Abe.Abe’s professor, Hisamatsu Shin’ichi, had come to know Suzuki through his mentor Nishida Kitarō. Suzuki was one of Nishida’s closest friends. It appears that Hisamatsu’s and (...) Suzuki’s cordial relationship became closer after Nishida’s death in 1945. Hisamatsu in turn was the link for Abe to come to know Suzuki. Abe recalls his first encounter with Suzuki, which took place in the winter of 1947, when Suzuki was in bed with a bad cold and Abe was sent by Hisamatsu to make a sick call on his behalf. Abe was then Hisamatsu’s teaching assistant ( joshu). Seeing Suzuki in person for the first time, Abe could not help but feel the unique spiritual presence of this man. At that time, Abe, though a committed follower of Pure Land Buddhism, was deeply troubled with his spiritual quest. Perhaps sensing Abe’s agony, Suzuki gave him a copy of his imperial lecture The Essence of Buddhism, in which he had treated Zen and Pure Land thought as sharing the same Mahayana roots.1Abe’s second visit to Suzuki came in the spring of 1949, when Suzuki was preparing to leave for the United States to spend “the rest of his life in order to bring the message of Zen Buddhism” to the West. At that time Abe was to convey Hisamatsu’s concern that Suzuki ought to remain in Japan and contribute to internationalizing Zen by translating Zen texts into English, for, in Hisamatsu’s mind, there was no one better qualified than Suzuki to carry out that task.2Suzuki was ready to make a bold move, however. Having witnessed Hiroshima-Nagasaki, he was convinced that the message of wisdom and compassion based on the awakening to the “true self” that Zen speaks of was an effective and necessary antidote to the egocentric mindset, which manifested also as national ego-centrism, rampant in the post–World War II world. He was convinced that the message of awakening and compassion would give the humanity a better chance at peace. In fact, by the early 1950s, with the intensification of the Cold War and the turmoil in Korea, there was a palpable fear that World War III might break out any day, and Suzuki certainly shared that ominous sense.3 [End Page 111]Zen Must Adopt New ExpressionsSuzuki left for the United States on June 16, 1949, to attend the Second East-West Philosopher’s Conference and to teach at the University of Hawai‘i in the summer and the fall semesters. Through his interaction with Western and Asian thinkers at the conference as well as with his students at the university, he came to feel strongly that (1) it was important to emphasize compassion (hi) in the face of an excessive Zen emphasis on the koan practice, (2) Zen Buddhists must develop their “logical” expression to articulate Zen teaching in language understandable to Westerners, and, in this connection, (3) it was incumbent on him to introduce the thought of Nishida Kitarō to the West. In Suzuki’s own words, “Contemporary Zen is short of compassion (hi). Therefore, it lacks the momentum to engage society and work from within it. Again, it lacks a logical discourse (riron). This is something Nishida always used to say. In order to make Western thinkers understand Zen teaching, one must have a logical system (ronri).” 4These three points are clearly present and developed in Abe’s works. In his introduction to Zen and Western Thought (1985), Abe wrote that (1) Zen embraces a profound philosophy (echoing Suzuki’s concern for the necessity for logical articulation), (2) the ultimate in Zen and in Buddhism is “absolute Nothingness” or “Emptiness” (echoing Nishida’s philosophy), (3) Buddhism is a radical realism and a compassionate way of life (echoing Suzuki’s concern for compassion), and (4) a new cosmology, not a new humanism, is needed in... (shrink)

Most people would agree that compulsive lying is a "sickness." In his provocative Lying, Paul Griffiths suggests that consistent truth telling might evoke a similar response. After all, isn't unremitting honesty often associated with stupidity, insanity, and fanatical sainthood? Drawing from Augustine's writings, and contrasting them with the work of other Christian and non-Christian thinkers, Griffiths deals with the two great questions concerning lying: What is it to lie? When, if ever, should or may a lie be told? Examining Augustine's (...) answers to these questions, Griffiths grapples with the difficulty of those answers while rendering them more accessible. With rhetorical savvy Augustine himself would applaud, Griffiths aims to "seduce" rather than argue his readers into agreement with Augustine. Augustine's historically significant, characteristically Christian, and undeniably radical thoughts on lying ignite Griffiths's searching discussion of this challenging and crucial topic. Marvelously erudite and energetic, Lying will draw Augustine enthusiasts, students of ethics, and anyone who is committed to living a more honest life. (shrink)

Lilly has a story to tell. It is her story. She sits comfortably in her hospital bed, with a nasal cannula under her nose providing a steady stream of oxygen. She says she really does not need it now but is more comfortable with it. She straightens the hem of her hospital gown. She folds her hands and places them carefully on her lap. This diminutive, carefully groomed elderly woman, a widow for 7 years, likes to be presentable when she (...) has a guest." “Please sit down,” she says, pointing to the chair. She would be no more inviting if we were in her own living room. “You’re in the hospital. What happened?” “Heart problems”, she says. “Heart failure. I’ve been sick for years. I’m old, my heart is old. When it gets bad I have to struggle to breathe.” “Is that what happened this time?” “I didn’t know it was happening this time,” she says with some surprise. “I am very active. I go out every day, I do my shopping, cooking. I like to cook. I was walking. It started. The hill is very steep from the avenue to my house so I made nothing of it. Out of breath. I took my time, rested and then walked again. It was also hard for me to walk up the four flights to my apartment. I stopped every few steps. So what? An old lady getting tired and out of breath. Nothing new about that. I missed all the signs. Sonya didn’t. She’s a neighbour and when she saw me she said what she was seeing wasn’t right. I don’t know what she saw. I do know how I felt. I was getting sick … ". (shrink)

International migration has a female face in the beginning of the twenty-first century; since at least 1990, a total of 49 percent of international migrants have been women (UN 2008).1 Many women relocate in pursuit of goals that they can’t realize in their countries of origin, and many women move on their own to developed countries as caregivers to the very old or the very young, as nurses to attend to the sick in hospitals, and as domestic workers.2 How should (...) we regard their decisions to do so? One way of thinking about such moves is to deplore the fact that women have to move in order to attain certain goals in their lives; it would be more desirable to live in a world that would not make such moves necessary... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Grieving the Loss of What Medicine Was Supposed to BeKaterina V. LiongI attended a conference this year. The timing was less than ideal because it was held the weekend before the Internal Medicine clerkship exam. But as with all things, especially during medical school, there is never a "right time" to be doing anything. It was fortunate that I attended the conference anyway because I met an incredible doctor (...) there. She had given a talk called "The Myth of Physician Wellness," and somewhere in our lengthy discussion, she asked me this:"Have you ever considered that since entering medical school, you've never been able to stop and really grieve the loss of what you thought medicine would be?"I am writing this in the downtime during my surgery rotation, regretting that I didn't wait until I got home to fully feel the feelings of writing this because I cannot cry here in front of others. At the same time, I feel guilty spending time writing at all; I should instead be doing UWorld practice questions for my upcoming exam. I can feel it in my body, the feeling of being plugged up—I have allowed tears to leak out too many times this year.The first time was in Internal Medicine, after seeing an elderly patient with a terminal rectal cancer that was so far along you could see it grossly. The bulging mass was so obvious during the patient's digital rectal exam that the senior resident was able to take off his still-clean gloves mere seconds after putting them on. The patient had come in for abdominal pain and difficulty defacating; the [End Page E20] only management he'd been able to receive for his known cancer was multiple hospitalizations in the last few months for emergency blood transfusions when his Hemoglobin level, indicating blood loss from the cancer, got too low. As I was taught to do, I gave a summary statement: "So you're here because you had a primary care appointment for a regular checkup, but they wouldn't see you because they didn't take your insurance? And they sent you to the county hospital, but even though they take uninsured patients, you are technically insured, just under a terrible plan … so they transferred you here. Is that right?" Unfortunately, the man's sí of affirmation was enough to make me lose composure, and I had to step out to let the resident finish the interview.After that, all it takes recently for the tears to well up is for an attending to pull me aside for feedback and ask, "How is third year going for you?" or even "What do you feel you've done well?"I almost wonder if holding in tears is like constipation. In medical school, we learn that sometimes what we think is diarrhea in patients is actually constipation—the stool is so impacted that the only thing that can leak past the plug is liquid. We see the leakage and first interpret that as diarrhea. I have to wonder if people interpret the same about me—emotional lability? Or is my inability to prevent the tears from leaking out simply a product of all the plugging up I have been doing all along? My inability to properly grieve the loss of what medicine was going to be? Maybe the first step in processing that loss is identifying it:I thought medicine meant caring for patients. Why am I going through 7+ years of training if insurance companies are allowed to undermine us so easily?I thought medicine meant connecting with patients. Why am I spending 30 minutes seeing my patients and 2 hours writing notes?I thought medicine meant leadership. Why are others bypassing two-thirds of my time in training and ending up with almost the same job … but the only "leadership" left is that their liability falls on physicians?I thought one must be well to take care of others. Why are students working all day and studying all night, residents too overworked to take a lunch break, and attendings made to work while visibly sick and diaphoretic?I thought... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Carmen MirandaJessica LesCarmen Miranda, she called herself today. She suffered from decades of schizoaffective disorder and now more recently, end–stage renal disease from uncontrolled diabetes. I first met Carmen two weeks prior when she had been brought to the hospital on a 72 hour psychiatric hold for self–harm. She failed to go to dialysis for a week, an act that would kill her if allowed to continue. Now she (...) was here again, for the same reason.Everyone of competent mind has the right to refuse medical treatment. Unfortunately, Carmen’s mind was not currently grounded in reality. So against her will, our family medicine team admitted her to the hospital and arranged for dialysis early the next morning. None of us liked doing this. Fortunately, when the time came for the dialysis tech to insert the dialysis catheter into her shunt, Carmen agreed peacefully. After her dialysis, we had no right to keep her in the hospital because her life was no longer in danger, at least until the next week. We discharged her to home. However the question remained, what about next time?To navigate this ethical gray zone, we called an ethics committee meeting. An ethicist, nurses, hospital social workers, the inpatient family medicine resident team, and most importantly, two people who knew her very well—her caseworker and long–term psychiatrist—discussed her case for an [End Page 103] hour. Our medicine team learned that in her last period of clarity two months prior, Carmen made contradictory statements regarding her wishes. Carmen told her caseworker she was tired of dialysis and being sick and stated it was time to let herself go. During the same lucid week she told her psychiatrist that she was grateful she had been forced to complete dialysis against her wishes after a run of non–adherence while suffering psychosis a couple of months prior. Now months later she was in a downward spiral, exacerbated by the deterioration of her mentally ill husband. If she missed a dialysis treatment here and there, it was okay, but when she went on a run missing several treatments, it was slow suicide.The ethics meeting concluded that Carmen needed to complete an advanced directive and select a power of attorney other than her gravely incompetent husband as soon as she was deemed competent. If she did not become lucid again, her psychiatric team should apply for conservatorship, a legally appointed person who serves as guardian for a gravely disabled mentally ill person. However, conservatorship would take months. In the interim, the ethics committee ruled that our medicine team would continue to provide lifesaving treatment for her, against her wishes if necessary.The ethics meeting adjourned but our medicine team remained in a gray area. To what length should we go to treat her? If she continued to refuse dialysis would we hold her in the hospital until she became sufficiently docile by inevitable uremia that we could peacefully dialyze her? Possibly. Would we go so far as to put her under anesthesia to complete her dialysis? Personally, I hoped not.Just three days after the ethics committee meeting, her caseworker found Carmen yelling nonsensical phrases through the front door of her home while her husband held the door shut with his beer belly and good shoulder. After gaining entry later in the day, Carmen’s caseworker found their mutual medication collection strewn in the bathtub and no food in the house. He placed Carmen on a psychiatric hold and transported her to the hospital. The emergency department paged me when Carmen arrived. I braced myself for the possibilities that lay ahead. When I reached Carmen, she was sitting in a room reserved for psychiatric patients and under watch by a friendly police officer accustomed to these situations.“Hi, Carmen,” I said, one step into her room. She sat on the edge of the gurney, wrapped in three blankets.“Cold,” she said.The police officer spoke from behind my shoulder, “She has been requesting cup after cup of ice water, she won’t take anything else.”“Let’s get you more comfortable.” I returned with a warm blanket and draped it over her... (shrink)

This paper is not an article in a regular sense. It is a dialogue between François-David Sebbah, one of the two editors of this topical collection, and Jean-Luc Nancy, one of the most eminent representatives of the contemporary French Thought. This dialogue took place in the first half of 2022 in a written form, because of the sanitary restrictions related to the COVID-19 pandemic and because Nancy was heavily sick. Sebbah sent to Nancy a text, corresponding to Section 2.1, and (...) Nancy responded to it with another text, corresponding to Section 2.2. Unfortunately, Nancy died on August 23, 2022, and could not revise his own text nor pursue the dialogue, as it was originally planned. For this reason, an introductory clarification by Sebbah, corresponding to Section 1, has been added. The purpose of such clarification is to introduce the reader to Nancy’s philosophy of technology—although technology never had a central role in Nancy’s reflections. In Section 2.1, Sebbah proposes a distinction between “French Theory,” “French Thought,” and “French Philosophy.” He also proposes a list of twelve possible intersections between the French Thought and the philosophy of technology. In Section 2.2, Nancy criticizes the use of expressions such as “French Thought.” He also insists, in a Heideggerian vein, on the fact that Technology (with a capital “T”) does not depend on human ends but has its own ends. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Journal of the History of Ideas 63.3 (2002) 425-446 [Access article in PDF] Giving Orders: Theory and Practice in the Fundamental Constitutions of Carolina Vicki Hsueh Indians. Of Edisto Ashapo and Combohe to the South our friends. Of Wando Ituan Sewee and Sehey to the north came to our assistance and were zealous and resolute in it 1000 bowmen In our want supplied us. Q. Spaniards. What we shall (...) doe to the Spaniards if we invade them we brake the peace, if we sit still we loose our reputation with the Indians our friends. Westoes. Inland man eaters. Country. To the northward more sickly, about Ashley River fertile and of a wonderful growth. Tatchequea. A very fruitfull Country 8. days jorney by the North west the Emperor our friend and enemy to the Westoes and to hard for them. Q. Settlem't. 500 people will secure the settlement 1000 perfect it. desires supplys of necessarys till that time Excerpt from Carolina Memoranda in the handwriting of John Locke, Esq., 15 September 1670 Within the last decade, scholars such as James Tully, Barbara Arneil, and Bhikhu Parekh have performed a crucial intervention on modern constitu-tionalism's behalf. 1 Not only has constitutionalism in the modern age been [End Page 425] plagued by assumptions of cultural uniformity and an on-going inability to adjudicate between competing cultural claims, but it has been unable effectively to diagnose those limitations and dilemmas. The root of the problem, James Tully suggests, is ultimately a matter of historical perspective. "[T]he tendency," he writes, "is not to notice the philosophical and ideological debates over the last three hundred years... only the result of these debates is seen—the victorious modern language of constitutional uniformity—and claims for recognition are viewed through its framework as if it were impartial and universal." 2 In response Tully and others have sought to tackle this predicament at its historical root. Identifying modern constitutionalism's colonial origins as a significant part of the problem, their studies address the development of constitutionalism and colonialism as an entwined phenomenon in the early modern period, focusing particularly on the British-American context. In this sense, Locke's Two Treatises of Government stands as an exemplary illustration of the period's entangled colonial and constitutional temperaments. Well-known for its influential articulation of compact and resistance, the Two Treatises, Barbara Arneil argues "were written as a defence of England's colonial policy in the new world against the sceptics in England and the counter-claims of both the aboriginal nations and other European powers in America." 3 Accordingly, present-day constitutionalism continues to bear the weighty legacy of those colonial rationales. "[T]he language of modern constitutionalism," Tully further explains, "which has come to be authoritative was designed to exclude or assimilate cultural diversity and justify uniformity. The design is difficult to see because this 'modern' language has become the customary way of thinking about, reflecting on and envisioning a just constitutional order." Ultimately, Tully submits, citing Wittgenstein, "A picture held us captive. And we could not get outside it, for it lay in our language and language seemed to repeat it to us inexorably." 4This much-needed thickening of constitutionalism's historical context has enriched our awareness of constitutionalism's vexed origins, as it has proffered potent tools for interrogating current cultural adjudication. Yet, a troubling predicament persists. As if caught within the tenacious grip of the language of modern constitutionalism, Tully, Arneil, and Parekh insistently portray seventeenth-century British-American colonialism solely as a straightforward process of appropriation and assimilation without addressing or incorporating the [End Page 426] complex and contingent elements of that history in its emergence. Lacking the various negotiations and accommodations between settler and indigene in ambition and actualization, their portrayals crucially underplay the dynamic relationship between theories of constitutionalism and practices of colonialism—an approach that ultimately serves to reinscribe the narrative of triumphalist progress within their critiques. 5This problematic is the context for my reading of the Fundamental Constitutions of Carolina,1669... (shrink)

Twenty-five years ago, when I went down to the countryside to live and work in a production team, I took a few books with me, one of which was Ovid's Metamorphoses. The people in our team looked through it many times, read and reread it, until it was as ragged as a roll of dried seaweed. Then people from other teams borrowed it, and I spotted it in several different places, looking more and more dilapidated. I believe that in the (...) end the book was read to death. Even now I still can't forget what a sorry state it was in. Life in the team was very hard—We didn't have enough to eat, we couldn't get used to the climate, and many people got sick; but the worst hardship of all was that there were no books to read. If we had had a lot of books to read, Metamorphoses would not have disappeared so tragically. On top of this, we never had the pleasure of thought. I do not believe I was alone in this experience: As you sat lonely and forlorn under the eaves in the twilight, and watched the sky slowly darken, you felt that you'd been deprived of your life. I was young then, but I was scared of having to go on living like that, of growing old like that. To my mind, that would be even more frightening than death. (shrink)

Among your closest associates is a certain human animal – a living, breathing, organism. You see it when you look in the mirror. When it is sick, you don't feel too well. Where it goes, you go. And, one thinks, where you go, it must follow. Indeed, you can make it move through sheer force of will. You bear, in short, an important and intimate relation to this, your animal. So too rest of us with our animals. Animalism says that (...) this relation is nothing short of identity. According to animalists, we do not only coincide with or constitute or inhabit or otherwise hang out with these close associates, our animals: we are them. In this article, I offer an opinionated take on what animalism might be and situate it against contemporary rivals. Then, I outline a simple case for animalism. Finally, I sketch non-standard routes for animalists to take in light of standard challenges. My goal in all of this is to open up some new avenues of animalist thinking. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:If You’re Not Part of the Solution...Sarah GilesI worked on an island that lured people to their deaths. I have come to realize that there are certain resources that every population must have in order to continue to exist. Health care providers are needed if a group is to continue to reside in one place. Without nurses and doctors, people tend to refuse to go to a location or (...) choose not to stay. Perhaps if doctors like me refused to work in places where people have their basic human rights ignored, those places would cease to exist. It’s wishful thinking, but it’s the only way I can imagine the events of December 15th, 2010, could have been prevented. [End Page E11]Australia has a large offshore detention center on Christmas Island, a tiny dot in the middle of the Indian Ocean. Housed in a collection of prison–like facilities are men, women, and children who have come to an Australian Island claiming they are refugees. They have paid an average of $10,000 (U.S. dollars) to be smuggled by boat from nearby Indonesia and are then, usually, intercepted by the Australian navy or coast guard, and brought to the island to await processing. This processing can take two to four years and, even then, it can end with deportation. The asylum seekers spend years in a massively overcrowded and unstimulating purgatory.To say that I was not familiar with the political situation on the island would be a farcical under-statement. As a Canadian family doctor, I went to work on Christmas Island because of its exotic location and reputation for world–class SCUBA diving. It sounded like a dreamy place to do a locum. The little research I had done told me that there was a detention center on the island, but I had been told that I would only deal with those patients if they were sick enough to come into hospital. I didn’t imagine that I would end up feeling culpable for the deaths of 48 people who dreamed of restarting their lives in Australia.On December 15th, 2010, a rickety boat carrying approximately 100 asylum seekers somehow slipped past the navy and coast guard into the water just off of Christmas Island. The weather was foreboding and the waves were massive. As the boat approached the island, it lost power and, horrifically, smashed into the cliffs, leaving an estimated 48 men, women, and children to drown and an almost equal number in need of rescue and medical attention. My name was on the call schedule that day. All survivors were brought to the hospital. Our worlds collided.At the time, I thought it was good luck there was an extra doctor on the island that day. I was relieved that we were able to cope with the mass casualty situation and that only few survivors were sick or injured enough to require evacuation to the main land. Three years later, I wonder if the accident would have happened at all had we not been there.I had felt smug providing care in the public hospital, believing it was morally superior to working as a mercenary at the detention center. But I now realize that all of the health care providers had a role in allowing the tragedy to occur. What would have happened if all of the doctors refused to work with people held under those conditions? If that critical infrastructure of health care were not available on the island, the detention center could not be there. If the detention center weren’t there, the government would stop processing people there and perhaps desperate people would stop risking their lives to get to Christmas Island. Maybe the women and men who lost their children or the children who lost their parents would never have gotten on that boat. Maybe.Parts of that awful day stay with me. My job as a doctor prevented me from offering the compassionate care I wanted to provide and forced me to turn into a medical conveyor belt. When a young patient was laid in front of me, I assessed her, started... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:MONADOLOGY OF 7HE BROTHERS KARAMAZOV by Michael Wreen THE WORLD AND THOUGHT of Dostoyevsky's The Brothers Karamazov are not easily entered into. There is something, some barrier, which seems to hinder, if not prevent, a feeling of belonging, a feeling of ease, citizenship, and camaraderie. What is it diat holds die reader back, what makes him feel particularly Ul-at-ease in the world of The Brothers Karamazov, and especially in (...) die presence of the Karamazovs? The answer is that the world of the novel resembles the world of Leibniz's Monadology, a world so different from the world of our everyday conceptions, and so different from the world of most novels, that the reader is left "freefloating," so to speak, until he, as a spirit, has been accommodated and then assimilated by it. To begin with, there is the matter of setting. There are practically no landscapes in The Brothers Karamazov and no extended descriptions of nature. Secondly, buildings, both their interiors and exteriors, are barely sketched, and when described at all, it is usually the psychological state that the human design excites ("It was an odd arrangement ofrooms") that is important, and not the design or structure itself. Objects existing in their own right and "pure surfaces" are not to be found. The one building (with grounds) that is described at length is the monastery, but even here description is used symbolically, as a reflection ofthe spiritual states ofthe monks and The Elder. Similarly, clothing exists only as a clue to the psychological or spiritual state of its wearer. Dmitri's rag with the 1,500 roubles is the analogue of his condition, just as Smerdyakov's hoped-for foppish apparel is of his. 318 Michael Wreen319 Still more unusual is the infrequent mention of two of the biological necessities of life, food and sleep. Food seems to be something that the characters can take or leave, but more often than not, simply forget about; the stomach does not seem to exist for any except one of them. Once or twice the characters do eat, but eating seems to be an accidental side-effect of spending time with, a spiritual infection caught from, the thoroughly carnal Fyodor. The monks, it must be admitted, are concerned with food — though it would be more accurate to say diat they are concerned with die lack of it, or even more strongly, widi maintaining the lack of it. As for sleep, collapse from complete exhaustion (from sustained physical exertion and/or emotional excitement, or from orgiastic debauchery), sickness, and brain fever seem to be preferred to normal sleep. Days are long— so long, in fact, that night is more like an extension of day dian night. Another descriptive element which warrants notice is the physical appearances and personal histories of die dramatic personae. The truth, as far as physical appearances are concerned, is clear and simple: everyone, with the exception ofIvan, is described once and briefly. In the first thirtyfive pages or so, most of the major personages are introduced, "outfitted" with noses, eyes, ears, bearings, statures, mannerisms, traits, etc., and — here we come to the second aspect noted above — then given summary histories. After that, diey are set in dramatic motion. The opening chapters are descriptive and expository, a report of what was and is the case as far as mise en scene and physical equipage are concerned; and except for brief moments when the never-named narrator indulges in short "sermons" about man or God, the mode of narration never returns to descriptive exposition, but remains dramatic and focused on the interplay and clash of personality. Characters do act and think for themselves, and we see diem directly in the acting out of dieir lives. A bit of background information having been provided, we don't have to be told anydiing more; we can observe for ourselves, from the inside. The catalogue offacts is discarded, and in its place is put the experience of events and feelings. The objective, external perspective yields to the internal, subjective perspective, and the reader crosses over from the familiar and cozy world of Dickensian externality to the strange and disconcerting world ofDostoyevskian intemality... (shrink)

Principles of expert deference say that you should align your credences with those of an expert. This expert could be your doctor, the objective chances, or your future self, after you've learnt something new. These kinds of principles face difficulties in cases in which you are uncertain of the truth-conditions of the thoughts in which you invest credence, as well as cases in which the thoughts have different truth-conditions for you and the expert. For instance, you shouldn't defer to your (...) doctor by aligning your credence in the de se thought 'I am sick' with the doctor's credence in that same de se thought. Here, I generalise principles of expert deference to handle these kinds of problem cases. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Moral Responsibility in a Context of Scarcity:the Journey of a Haitian PhysicianPaul PierreAlmost all Haitian physicians have been involved in some sort of "social movement" at one point in their professional life. In a country characterized by a natural inclination to question authority, fighting the status quo of the ineffective, corrupt and disorganized [End Page 89] Haitian health system often appears to be the right thing to do.In 2002, (...) I played an active role in a large protest movement for better working conditions at the largest health facility in Port-au-Prince: the General Hospital (GH). Port-au-Prince is the capital and economic center of Haiti. It is home to close to a third of Haiti's ten million people. At that time, the situation at the GH facility was dire. All of the 400 beds at the GH were dirty. The staff was underpaid and unhappy. Drug and medical supply stock-outs were routine. Medical equipment was rarely maintained and only one of the six operating theatres in the surgery block was working. Unsupervised physicians in training (like me) were the main health care providers. Attending physicians were busy running their own private clinics, and most of them would come to the hospital solely to "recruit" the less poor patients for their clinics. As physicians-in-training, we had the responsibility of caring for the poor, but we had no means. We grew frustrated and angry witnessing our powerless patients losing legs, arms and their lives for lack of care. On many occasions, I had the parents of my patients buy the gloves that I would use to examine their sick relatives. I've seen patients fighting for the inheritance of medications left by others who had just passed away. There was no way for this hospital to fulfill its mission, and no way for its staff to deliver anything other than mediocre care. We could not accept that situation at such an early stage in our medical development, and so we refused to continue to work. We went on a strike, which completely paralyzed the delivery of care at the hospital for nearly two months. After intense negotiation, the strike ended with a signed agreement with the Minister of Health that addressed, more or less, the reasons of our movement. However, the implementation of the agreement was permanently delayed by other competing "state emergencies" including a general insurrection.At the time of our movement, I thought we were making history. After witnessing 11 "social movements" that similarly paralyzed the GH in the following decade for reasons identical to ours, I am now convinced that we were not. We were temporary actors performing in the cynical play of scarcity on permanent display in Port-au-Prince. The social movement that we started ended up hurting the very same people that we were trying to help.Extending access to heath care to poor people seemed to me at that time to be too complicated and too expensive for an unorganized state like Haiti. I realized that local protests could, at best, influence the allocation of local resources. But so-called local resources are so limited in "resource-limited" countries. Haiti spends only $40 U.S. dollars per capita for health care. This is not enough for good care. The options we were provided were not real ones—since all of them would end in more suffering. The case of providing health care to poor people needed to be approached differently.I was born in Port-au-Prince at the same general hospital in which I would later work. I am the third of four children, and the first male child in my family. My father made me understand very clearly that my first responsibility was for my siblings. My sisters made me understand equally clearly that I had no authority over any of them. I ended up with a lot of responsibility but with very little authority. The few of us who completed school, entered university, studied abroad and "emerged" were considered, to some extent, responsible for the others—the ones who couldn't go to school, university, or abroad, the ones who had "sunk... (shrink)

Lawrence Johnson advocates a major change in our attitude toward the nonhuman world. He argues that nonhuman animals, and ecosystems themselves, are morally significant beings with interests and rights. The author considers recent work in environmental ethics in the introduction and then presents his case with the utmost precision and clarity. Written in an attractive, nontechnical style, the book will be of particular interest to philosophers, environmentalists and ecologists.

In lieu of an abstract, here is a brief excerpt of the content:How was Haiti?Sadath Sayeed"She smelled of milk and urine. Chacko marveled at how someone so small and undefined, so vague in her resemblances, could so completely command the attention, the love, the sanity of a grown man."—Arundhati Roy from The God of Small ThingsFather and SonTwenty minutes before I was to be taxied to the airport in Port-au-Prince, the baby boy handed to me did not breathe continuously. He (...) didn't breathe at all. Born a few hours earlier at home—probably in one of the hundreds of make-shift tent cities. I did ask if the baby cried after he came out of mom. Yes. He didn't suckle well and stopped crying. Dad decided to get help. Climbed onto a moped with his baby wrapped in a blanket. Must have tucked him under one arm and rode between piles of rubble to the closest health care facility.People at this other place tried to help his baby boy breathe. They pushed air into his mouth like you are doing. After a few minutes, they said that they couldn't help anymore."Go to the University hospital."From a shirt sleeve pocket, he pulled a crumpled white piece of paper with some writing scribbled on it. I gathered it documented this last visit. They took the time to hand him a note before they sent him on his way.What did Dad think? Thanks for the note. Okay, now what? Swaddle my baby. Tuck him under one arm. Hop on my moped.Strained ResourcesL'Université d'État d'Haïti has been the main teaching hospital for all of the country for decades. Many, if not most, formally trained Haitian health care providers have spent some time in Port-au-Prince at this institution. As important as it is, it has suffered from neglect over many, many years. The earthquake made matters exponentially worse. [End Page 98]Dad must have been directed to the pediatric service when he arrived. There, a few Haitian pediatric residents and nurses were doing what they did every morning. Tending to an overcrowded patient population of babies, children, and parents. The pediatrics building was left uninhabitable. All inpatient and outpatient care took place on a street where the tents had been erected.In the ICU, tent twenty beds filled a space probably meant for ten military style cots. Metal cribs and full adult hospital beds were jammed next to one another to fill every possible nook. Parents slept on the adult beds with their sick children or underneath the cribs. Siblings too. Outside, hundreds of parents would line up starting at six a.m. and stand in line for hours so that they could get their children seen in a couple of smaller tents that were used to run the outpatient clinics. Moms would fan their kids under the shade of trees on the side of the road. Feed them some milk or juice while they waited. Smile at us passers-by. They seemed to possess a bottomless well of patience.Power cords with extension wires littered the street-hospital floor under the canopy.When it rained, we were only modestly concerned about electrocution. A single 1950's style metal desk with two worn out chairs greeted visitors to the entry way and was usually occupied by some of the medical staff. A single, large metal fan that had collected enough dust and soot in its circular cage to look bearded hummed a breeze toward the desk.A bottomless well of patience and resiliency. In the popular media, this last word has been thrown around a lot to describe the character of the Haitian people. It is insufficient. Their adversity is truly absurd. Sense cannot be made of the scene in the pediatrics tents months after the earthquake struck, nor elsewhere on that campus, let alone outside its walls.The local medical staff hadn't been paid a dime in many months even prior to the earthquake. They suffered unimaginable losses during the earthquake. They still came to work."We love our children. They love us too."What so many of us think of as charity... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Difficult Road to Deciding on CircumcisionAnonymous TwoAnonymous TwoWhen I got my results back from my noninvasive prenatal testing, NIPT and found out I was going to have a little boy, one of my first thoughts was, "I don't want to circumcise him," which sounds silly because I just found out the gender of my baby and my first thought is about his genitalia. The idea of growing and (...) carrying this perfect little baby for nine months and then hurting him was unthinkable to me. I simply did not want to hurt him. The idea of it made me feel sick. Anytime the subject came up, I would protectively put my hand over my belly. And I do admit there were a lot of times I wished I was having a girl so I didn't have to deal with the circumcision debate.There was a lot of conversation between myself and my husband about it. My husband was adamant about getting it done. He referred to uncircumcised penises as "snake penises" and said our son will be made fun of for being different. He said it would be easier for him to clean and when he's old, he won't have to worry about infection. I would counter with, "well what if he falls in love with a girl from a culture that doesn't circumcise? She will think his penis is weird." The more we talked about it, the more ridiculous it felt thinking that far in advance and all these hypothetical situations he might get in over his penis. My parents wanted it done for religious reasons, but that wasn't a factor for me. My mom kept saying it's in the Bible and it needs to be done. My boss is Jewish and she joked that I could just convert to Judaism and the choice would be taken away from me so I didn't have to stress over it. Everything I read on my mommy groups and sites like Reddit called male circumcision child abuse and stated how barbaric it was. Terms like "genital mutilation" were thrown around a lot, and I didn't want to be part of a group that was seemingly looked down upon by so many.I spent my whole pregnancy saying how much I did not want to circumcise my baby. About a week after he was born and we were starting to get settled, my husband started to call around trying to get him an appointment for circumcision. It was unusual to do it this way, as typically it's done when babies are still in the hospital. But the hospital wasn't doing circumcisions because it was elective, and they weren't doing elective procedures because of COVID. At his first doctor's appointment, I talked to our pediatrician about it. She is Indian and told me she didn't circumcise her boys and said that it was very normal in many parts of the world to not do it. I would watch her pull back the skin to check it for fibers and think, "Is it really that bad to keep it? It's just skin." Our pediatrician didn't do it, as she doesn't perform procedures in the office, and she gave us some names of doctors that were supposed to be doing it. My husband called them all and none of them were doing circumcisions either. Finally, my husband found a doctor, but he was booked out for almost a month and a half. With no other option, we made the appointment. I was not thrilled about it, and made my husband do all the calls and arrange it because I did not agree with it.What made me change my mind about circumcising him was I didn't want him to be different. My husband assured me this was the best choice and he was very concerned our son would be bullied for being different. I have a good friend that is a nurse in a long term care facility currently. I called her and asked if it was really that bad for old men to care... (shrink)

It’s widely agreed that animal pain matters morally – that we shouldn’t, for instance, starve our animal companions, and that we should provide medical care to sick or injured agricultural animals, and not only because it benefits us to do so. But do we have the same moral responsibilities towards wild animals? Should we feed them if they are starving, and intervene to prevent them from undergoing other forms of suffering, for instance from predation? Using an example that includes both (...) wild and domesticated animals, I outline two contrasting ways of thinking about our moral responsibilities with respect to assisting animals that are apparently in need. One approach is based entirely around animals’ capacities; the other takes context and historical relations into account as well. While not attempting to adjudicate between these views, I’ll point out the advantages and difficulties of both. (shrink)

Traditionally, medicine has been considered a practical art. It seeks the patient’s well-being through technical means and specific skills in healing. On the other hand, healing means are connected to the life sciences, through which knowledge has developed systematically. Due to research and technological development, we can easily reveal the true meaning of medicine as science. Hippocratic practice and Aristotelian ethics have offered us a humanitarian approach, oriented to the sick person, which set the virtuous human character of each person (...) who practices the virtues. The medicine people approached to the medicine preserving an ancient picture of the practice. They have know-how of the practice, recognize the characteristics of each field of art or science appreciating its utility and benefits, but often they don’t know why or where the boundary between the two fields, science and art, falls. They are scientists and artists, too. In this article I intend to fix what science means and what art means, based on Aristotelian arguments, which lead to a perspective of a virtuous professional life. Also, it is relevant to find its common issues. No physicians can successfully practice their profession without respecting the rigor of science and training their creativity. I plead for a moral practice, for the understanding of humanity's state in any medical act. Medicine is the moral community where practice meets science and arts merge both. Medicine is not between practice and science; it is the art itself of medical practice and science. (shrink)