BackgroundBehavioral and physiological regulation in early life is crucial for the understanding of childhood development and adjustment. The autonomic nervous system is a main player in the regulative system and should therefore be modulated by the quality of interactive behavior of the caregiver. We experimentally investigated the ANS response of 18–36-month-old children in response to the quality of maternal behavior during a mother–child-interacting paradigm.MethodEighty mothers and their children came to our laboratory and took part in an experimental paradigm, (...) consisting of three episodes: a resting phase, a structured play phase, and a free play situation between mothers and their child. Children’s and mother’s heart rate, the sympathetic nervous system activity via the pre-ejection period and the left ventricular ejection time, and the parasympathetic nervous system activity via the respiratory sinus arrhythmia were continuously measured by an electrocardiogram. Maternal sensitivity of interactive behavior was assessed by using the Emotional Availability Scales.ResultsChildren of mothers with insensitive behavior had a significantly lower RSA at baseline, showed a lack of RSA withdrawal during structured and free play, and had shorter LVET across all episodes compared to children of sensitive mothers.ConclusionOur findings depict the influence of low-quality maternal interaction on the child’s ANS regulation, in calm and more stressful play situations. The overall higher SNS mode with impaired PNS reactivity may negatively influence child’s ANS homoeostasis, which may result in a long-term impact on mental and physical wellbeing. Further, the maternal sensitivity may function as a buffer for the stress response of their child. These results could serve as a basis for the development of appropriate psychoeducational programs for mothers of low sensitivity in their interaction with the child. (shrink)

In Hermann Hesse's work named "Between the Wheels", an outdated education system where childhood period expected to grow mature early creates a danger that the child shall begin to experience a second unrealistic childhood period is criticized. The introverted aggression of the soul, which is deprived of childhood, gradually begins to turn towards itself. In the work, it is stated that the "ideal of high achievement" is adopted by the education authorities and their families to children by alienating them (...) from their selves, and by using a rigid and disciplinary education system and the trauma caused by this ideal on the child self and its irreparable consequences are explained. In the work, negative educational relations exposed by the children at the Maulbronn Monastery school in Schwaben, Germany are addressed. The psychic confusion of the psychic soul of Hans Giebenrath, who enrolled this school in second place under the pressure of his family and town people, but who realized later saw that this school did not give him any opportunity to develop himself, takes him away from both his nature-loving habits and his ideal of success, and he starts to dispose of working. Returning to the town, he continues his life as "the apprentice who bends the iron wheels". The work he performs with his hand skill does not make him happy. He falls into the river and his mysterious death saddens the whole people of the town. When evaluated from an educational and scientific point of view, it is thought that it is of an importance to analyze Hesse's work, in which the contradictory elements existing between the official curriculum and the hidden curriculum draw attention, in terms of the analysis of child-specific values and existential images. The aim of this research is to analyze the existentialist images of the child self in Hermann Hesse's work named "Between the Wheels". The work has been analyzed with narrative analysis technique. From the findings obtained, two themes were reached: Under "Child Self", which is the first theme; Categories named "autonomy of the self," "undirected thinking," "free will" have been identified. Under "Existential Images", which is the second theme; Categories named "nature," "friendship" and "contradictions" have been obtained. The results of the research show that the official curriculum and Hidden Curriculum should provide children with the opportunity to learn by living in line with their interests and abilities and support them to be autonomous individuals in their decisions and actions. This research shows the importance of living together with the child self and the adult self in order for the adults around the children to establish a balanced and healthy communication with the children, and the importance of the life spent by the children with nature for the healthy evolution of the child self to the higher stages. (shrink)

Unlike Hannah, who eventually had a child, there are women today who remain childless. In the modern world, there are various reasons why women choose not to have children. Therefore, when interpreting the Hannah narrative in modern times, it is important to consider these evolving aspects of barrenness. This article applies historical-critical exegesis, narrative reading and a descriptive approach to examine Hannah’s experience in the Nigerian context. It also evaluates African traditional beliefs on childlessness in light of modern realities. (...) The study reveals that many women in pronatalist societies worldwide now choose to be child-free because of reasons such as difficulty finding marriage partners or financial instability. As these factors are also present in Nigeria, childless Nigerian women should embrace their situation and find happiness instead of succumbing to stigmatisation. To support these Christian women, the church in Nigeria must accept and teach the truth that not every woman needs to bear children.Contribution: This article contributes to the discussion on Christian attitudes towards childlessness. It argues that the interpretation of Hannah’s infertility in today’s world should consider new circumstances, such as voluntary childlessness. In light of this argument, Nigerian women without children should embrace their situation and find happiness instead of succumbing to societal stigma. (shrink)

IntroductionMother–child interactions during the first years of life have a significant impact on the emotional and cognitive development of the child. In this work, we study how a prenatal diagnosis of malformation may affect maternal representations and the quality of these early interactions. To this end, we conducted a longitudinal observational study of mother–child interactions from the gestational stage until the baby completed 12 months of age.Participants and MethodsWe recruited 250 pregnant women from a local university (...) hospital. Among them, 50 mother–infant dyads participated in all stages of the study. The study group consisted of 25 pregnant women with fetuses with some structural alteration and the control group consisted of 25 pregnant women with fetuses without structural anomalies. We collected obstetric and socio demographic data and pregnancy outcomes. Anxiety and depressive state data were collected using the COVI and Raskin Scales. We video-recorded the mother–infant interactions during several stages, including when the child was a newborn and when the child was 2, 4, 6, 9, and 12 months of age. The quality of the mother infant interactions were measured using the Coding Interactive Behavior. The interactive moments recorded on video was composed of three different activities, each one lasting appoximately 3 min, which included Free Interaction, where the mother was instructed to interact “as usual” without any toy, Toy Interaction, where the mother and baby played with a puppv, and Song Interaction, where the mother and baby interacted while the mother sang the “Happy Birthday” song.ResultsIn the gestational phase, there was a significant difference between the groups with respect to anxiety and depression scores, which were significantly higher for the study group. In the postnatal phase, we found significant differences between the groups with respect to CIB scales after the child completed 6 months of age: the study group presented significantly higher values of Maternal Sensitivity at 6 months of age, of Baby Involvement at 9 and 12 months of age, and of Dyadic Reciprocity at 6, 9, and 12 months of age, while the control group presented significantly higher values of Withdrawal of the Baby at 6 months of age, and of Dyadic Negative States at 6 and 9 months of age.ConclusionThe support offered by the study favored the mother–infant bond and had a positive effect on the quality of interaction during the first year of life, despite the presence of prenatal diagnosis. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Yet Life Keeps ComingPatricia Romanowski BasheWhile the guidance offered to authors of commentary articles suggests they not write about their personal experiences, the fact is, I would not be here were it not for my personal experience as the mother of a young man with autism spectrum disorder and other diagnoses. Though I left a successful writing career to become a special education teacher and then a Board (...) Certified Behavior Analyst (BCBA), it was not, strictly speaking, a career decision. It was a mom decision. When asked how I came to where I am today, I say, “Well, one day, I looked across the table at an individualized education program (IEP) meeting and asked myself, ‘Could I do as good a job as the people sitting across from me?’ And the answer was, yes.” Some people believe I am joking. I am not.To parent a child with autism is to be confronted daily with a dream of his future and the realization that you probably cannot achieve that alone. Instead, you will rely on a world of professionals, institutions, and systems to make it happen. How well that works out for you depends on a number of factors that should not matter but ultimately do: where you live, how well funded and law abiding your local school district is, how much access you have to qualified professionals, and how well your state agencies charged to care for individuals with disabilities after they leave school does its job. Though essential, love, dedication, and hope may not be enough to hoist your child over the hurdles, whether they are set by immovable bureaucracy or mercurial brain chemistry. We each strive to clear the track, to level the road, and I chose to do that by “going pro” and becoming a small part of the system that will serve my son and countless others with ASDs throughout their lives. Even so, I find myself as daunted by the transition to adulthood and the prospect of preparing him for a life without me as anyone writing here. Anonymous Three, who recounts her son’s struggle for independence, captures the questions that most of us might never get to answer but can’t stop asking: “What happens when we can no longer care for him?”When a pediatric psychiatrist diagnosed my own son with Asperger disorder in 1997, I wished to be one day free of the obligation to explain his diagnosis to people who had never heard of it. Today, thanks to major campaigns to promote autism awareness and the public recognition of a handful of celebrities with autism, there is less explaining required. It seems that everyone knows someone who has a child with autism, and everyone knows Temple Grandin’s story. Contrast this to the world of 1993, shortly after my friend and coauthor Barbara L. Kirby (Romanowski Bashe and Kirby 2001, 2005) turned to the internet to make sense of her son’s Asperger diagnosis. There was no Google, no Bing. It would be months before the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), which included Asperger’s for the first time, was published. Local doctors and teachers had never heard of it; parents and professionals were still gathering facts, trying to put the pieces together to form a coherent picture of what it meant to have autism. [End Page 183]Some things are different now, nearly twenty years later. Professionals, parents, and individuals with autism have developed a culture of autism, complete with opposing views on everything from applied behavior analysis and classroom inclusion to medication and guardianship. As a number of narratives illustrate, parents often find themselves making tough choices around these issues, and the best option in the abstract is not always the best option or even a possibility in the real world, on the ground. These narratives depict how the parents of individuals with ASDs struggle, sometimes mightily, to bridge the gap between what should be in terms of reliability of diagnosis and prognosis, access to effective, affordable, evidence–based education, treatment, and intervention, and—perhaps most important—meaningful, practical, realistic planning and programming for successful transition to adulthood. And... (shrink)

This article discusses how the persistence of child labor, especially in Brazil and the United States of America, constitutes a current facet of neo-colonialism. Cultivated as an educational and dignifying activity, exploited child labor persists and is naturalized. Schools, religions, and the legislation contribute to making the working class come to love and naturalize what in the past was understood as torture and punishment, thus jointly acting as a fundamental means of forming a new cultural form: the love (...) of work. Initially, the article discusses how the culture of work is historically founded and then argues against the idealist and postmodern explanations that naturalize it. The argument is based on the understanding that culture has a material basis and is linked to the production and social reproduction of life. Data from the empirical research on child labor in tobacco farming in Brazil and the USA reveal the persistence of the problem among Latino children and families. We conclude with the need to found a new culture for contemporary society, based on other social and economic relations, which allows the working class to free itself from what dominates and exploits it. (shrink)

Embodiment approaches to cognition and emotion have put forth the idea that the way we think and talk about affective events often recruits spatial information that stems, to some extent, from our bodily experiences. For example, metaphorical expressions such as “being someone’s right hand” or “leaving something bad behind” convey affectivity associated with the lateral and sagittal dimensions of space. Action tendencies associated with affect such as the directional fluency of hand movements (dominant right hand-side – positive; non-dominant left hand-side (...) – negative) and approach-avoidance behaviors (forward – positive; backwards – negative) might be mechanisms supporting such associations. Against this background, experimental research has investigated whether positive and negative words are freely allocated into space (e.g., close or far from one’s body) or resonate with congruent (vs. incongruent) predefined manual actions usually performed by joysticks or button presses (e.g., positive - right; negative - left, or vice versa). However, to date, it is unclear how the processing of affective concepts resonate with directional actions of the whole body that are performed freely within a context enabling lateral and sagittal movements simultaneously. Accordingly, 67 right-handed participants were to freely step on an 8-response pad (front, back, right, left, front-right, front-left, back-right, or back-left) after being presented in front of them valence-laden personal life-events submitted before the task (e.g., words or sentences such as “graduation” or “birth of a child”). The most revealing finding of this study indicates that approach-avoidance behaviors and space-valence associations across laterality are interwoven during whole body step actions: Positive events induced steps highly biased to front-right whereas negative events induced steps highly biased to back-left. (shrink)

The captivating premise of the Toy Story movies is that toys have secret lives of which people are completely unaware. People can learn a lot from toys, as it turns out, including what it means to be free. Each of the first three movies explores a different way of thinking about freedom, and together they help people learn that, paradoxically, freedom is choosing the good of another over one's own good. One way of defining freedom is in terms of (...) stability and control. To be free means to have control over one's life and environment. In Toy Story 2 people make a fresh discovery about freedom: its connection with their sense of their own identity. Toy Story 3 embraces a further dimension of freedom: freedom from loss and pain. In so many ways, the human narrative is a story of people desperately trying to escape suffering. (shrink)

The study aims at exploring the salience and functions of media and television contents in children’s lives by focusing on their uses as a discursive resource in naturally occurring peer talk. We observed and recorded Israeli children talk in everyday, natural settings in two separate studies, in 1999–2002 and in 2012–2013. Detailed discourse analysis of television-based interactions from an ethnographic, child-centered perspective reveals the enduring centrality of television as an enjoyable, available, and shared cultural resource with valuable social, cognitive, (...) and discursive affordances: it is frequently mentioned during everyday adult-free interactions; utilized as the basis for drawing and negotiating boundaries and hierarchies within the peer community; and facilitates experiencing a variety of discursive literacy skills, ranging between practicing adherence to original texts and creativity and distancing from them. These findings provide further evidence for the mediatization of everyday life, and may have educational implications, which are discussed. (shrink)

In Abortion and the Ways We Value Human Life, Jeffrey Reiman argues that an overlooked clue to the solution of the moral problem of abortion lies in the unusual way in which we value the lives of individual human beings_namely, that we value them irreplaceably. We think it is not only wrong to kill an innocent child or adult, but that it would not be made right by replacing the dead one with another living one, or even several. (...) Reiman argues that there are only a limited number of facts that could justify such valuing, with the result that human children and adults have the fullest right to protection of their lives, infants have a lesser but substantial right to such protection, and fetuses do not qualify at all. Leading up to this argument, Reiman presents a survey of Western attitudes and laws about abortion from Hammurabi's Code to Roe v. Wade, and a critical analysis of all the major philosophical arguments on the issue, pro and con. The book is written in straightforward, jargon-free language that makes it accessible to college students at all levels and to the educated lay reader as well. (shrink)

Time, space, causality, communicating and acting together set limits on our freedom. Starting from the position of Wittgenstein, who advocates neither a position of pure subjectivity nor of pure objectivity, and taking into account what is implied by initiation into the symbolic order of language and culture, it is argued that the limitations on our freedom are not to be deplored. The problems of conservatism, relativism and scepticismwhich confront us often in the context of education and child rearingare inadequately (...) dealt with if attention is primarily focused on ways to resist or act differently. Following Cavell and his insistence that we should not try to escape from the existential conditions we find ourselves in and look for false certainties, the relevance of embracing a particular stance is elaborated. A commitment to giving substance to an ideal of the good life is neither an injustice towards the other nor an ignorance of her freedom. On the contrary, here responsibility is accepted, and at the same time it is acknowledged that we always have only the particular points of departure that we contingently start from. Coming to terms with this kind of dependency constitutes living out the scepticism that is implied by our being human: the logic of this is given along with our human condition. (shrink)

Prompted by the centenary of the founding of Summerhill, in my contribution to this JOPE Suite on Democratic Education, I briefly explore both the admiring reciprocity and the subsidiary but significant differences of praxis between A.S. Neill and Alex Bloom, two remarkable pioneers of education in and for participatory democracy as a way of life. Because A.S. Neill's work is internationally renowned and Alex Bloom's has yet to re-establish the worldwide recognition it had in his own lifetime, my emphasis (...) is on the contribution of Alex Bloom, in large part because he is amongst the most radical pioneers of democratic education the UK state sector has ever known. To a significant degree, the aspirations and actualities of Bloom's work rebutted Neill's insistence that pioneers within the state sector of education could not innovate in ways that would significantly challenge the status quo. Indeed, Alex Bloom extended participatory democratic educational aspirations in ways which Neill did not. Most importantly, these not only entailed a commitment to community engagement, they did so in conditions of abject poverty and profound psychological trauma following the ravages of the Second World War London Blitz with its attendant evacuation and subsequent return to the ruins of their former homes.In the first section, I take as my starting point Alex Bloom's strongly supportive review of A.S. Neill's book The Problem Family and Neill's visit to Bloom's school in the East End of London, some five years later. Foregrounding the dialectic of practice and aspiration, I touch on some of the key issues that emerged for both Neill and Bloom at that time.Challenging Neill's later affirmation that the only significant freedom one can introduce into a state school is ‘a free attitude on the teacher's part, his or her being on the side of the child’ and his reported view that Bloom and others might be able to experiment in methods of teaching or ways of organising the timetable, ‘but not in methods of living’, the second section explores the nature and interrelationship of six key strands woven into the fabric of Alex Bloom's truly remarkable work that exemplified the grounded possibility and vibrant actuality of participatory democracy as a way of living and learning together that prefigures a more just, creative and caring form of human engagement.Locating the foundation of Alex Bloom's praxis within the 20th-century personalist philosophical tradition and its Adlerian psychological counterpart, the brief concluding section draws in particular on the work of John Macmurray who argues, as did Bloom in his own writing and his daily praxis, that ‘The first priority in education—if by education we mean learning to be human—is learning to live in personal relation to other people. Let us call it learning to live in community’. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Ice Cream for BreakfastMichelle MethvenIn June of 2011, on a warm sunny day in Toronto, Canada, my partner and I brought our daughter Stella into the local hospital emergency room for what we believed would be a routine check–up. She had been exhibiting worsening clumsiness and limping for the previous two weeks and we thought it would be easier just to get her seen and have whatever it was (...) dealt with rather than wait two months to see a specialist. My partner and I believed it was likely a severe ear infection, or maybe Lyme disease from a recent camping trip. We each called our workplaces and said we would be an hour or so late. Nothing could have prepared us for the news 22 hours after arriving at the hospital, that Stella had a cancerous mass in her brain. After a biopsy three days later to confirm the diagnosis, Stella was diagnosed with Diffuse Intrinsic Pontine Glioma (DIPG), and given less than a year to live.Parents most often describe DIPG as “a monster.” The tumour saturates the pons and shuts down nerve pathways one at a time. In no particular order, and in no particular time, sufferers (most often young children) lose the ability to walk, sit up, hold up their head, speak and see. The pons is also responsible for breathing, swallowing and regulating the heartbeat, so death can come in many forms at any given time. Though it destroys the brain’s ability to command, the person continues to think and understand as the main part of the brain is untouched. Different from most cancers, chemotherapy and radiation have almost no effect on DIPG; even trials with the most toxic chemotherapies do not slow its progress.My partner and I were shaken to the core at this diagnosis. Looking at our energetic, redheaded [End Page 31] mop–topped little imp, it was impossible to fathom that she had just been given a fatal diagnosis. Yet we knew the doctors at the hospital were among the best and most sought–after in the world, so denial was never a part of our mantra.A week after Stella was diagnosed, we met with a neuro–oncologist to discuss our plans. The only treatment that is slightly effective for DIPG is focal radiation, which can stall the tumor’s growth, granting what is known as a “honeymoon period” of no new symptoms. The honeymoon lasts approximately six months, but there are no guarantees. Twenty percent of children get no honeymoon whatsoever after radiation, and others get only weeks. The doctor we met with confirmed radiation would not be curative, but would “buy time”. He explained that radiation involved six weeks of treatment, seven days a week. Following the six weeks of treatment, there would be a period of anywhere from one to six months in which Stella would likely be asymptomatic. However, at some point, the symptoms generally return and when they do, children deteriorate relatively quickly. Sometimes it takes a month or two, but on occasion there is as little as two weeks between progression and death.As Stella’s parents, we were not convinced that the prescribed radiation was something we wanted to subject Stella to. Because she was only two, and a very spirited and energetic child, it would have been virtually impossible to have her lie quietly on the table in hospital each day for six weeks while radiation was put behind her ear. The neuro–oncologists’ solution was that Stella be sedated for each daily radiation treatment, which would make her groggy for a big part of the day and necessitate needles and IV. As parents, we were presented with an impossible gamble. Do we risk taking away six weeks of her still somewhat symptom–free life for a possible extra three to six months later? And the timing was difficult as well. It was late June. If we chose to radiate it would mean spending the entire summer shuttling her between hospital and home with no weeks at the cottage, and much less time to attend neighbourhood BBQ’s, parties, trips to the park, the library, science centre and zoo... (shrink)

Time, space, causality, communicating and acting together set limits on our freedom. Starting from the position of Wittgenstein, who advocates neither a position of pure subjectivity nor of pure objectivity, and taking into account what is implied by initiation into the symbolic order of language and culture, it is argued that the limitations on our freedom are not to be deplored. The problems of conservatism, relativism and scepticism—which confront us often in the context of education and child rearing—are inadequately (...) dealt with if attention is primarily focused on ways to resist or act differently. Following Cavell and his insistence that we should not try to escape from the existential conditions we find ourselves in and look for false certainties, the relevance of embracing a particular stance is elaborated. A commitment to giving substance to an ideal of ‘the good life’ is neither an injustice towards the other nor an ignorance of her freedom. On the contrary, here responsibility is accepted, and at the same time it is acknowledged that we always have only the particular points of departure that we contingently start from. Coming to terms with this kind of dependency constitutes living out the scepticism that is implied by our being human: the logic of this is given along with our human condition. (shrink)

Background Previous analyses of democracy and population health have focused on broad measures, such as life expectancy at birth and child and infant mortality, and have shown some contradictory results. We used a panel of data spanning 170 countries to assess the association between democracy and cause-specific mortality and explore the pathways connecting democratic rule to health gains. -/- Methods We extracted cause-specific mortality and HIV-free life expectancy estimates from the Global Burden of Diseases, Injuries, and (...) Risk Factors Study 2016 and information on regime type from the Varieties of Democracy project. These data cover 170 countries and 46 years. From the Financing Global Health database, we extracted gross domestic product (GDP) per capita, also covering 46 years, and Development Assistance for Health estimates starting from 1990 and domestic health spending estimates starting from 1995. We used a diverse set of empirical methods—synthetic control, within-country variance decomposition, structural equation models, and fixed-effects regression—which together provide a robust analysis of the association between democratisation and population health. -/- Findings HIV-free life expectancy at age 15 years improved significantly during the study period (1970–2015) in countries after they transitioned to democracy, on average by 3% after 10 years. Democratic experience explains 22·27% of the variance in mortality within a country from cardiovascular diseases, 16·53% for tuberculosis, and 17·78% for transport injuries, and a smaller percentage for other diseases included in the study. For cardiovascular diseases, transport injuries, cancers, cirrhosis, and other non-communicable diseases, democratic experience explains more of the variation in mortality than GDP. Over the past 20 years, the average country's increase in democratic experience had direct and indirect effects on reducing mortality from cardiovascular disease (−9·64%, 95% CI −6·38 to −12·90), other non-communicable diseases (−9·14%, −4·26 to −14·02), and tuberculosis (−8·93%, −2·08 to −15·77). Increases in a country's democratic experience were not correlated with GDP per capita between 1995 and 2015 (ρ=–0·1036; p=0·1826), but were correlated with declines in mortality from cardiovascular disease (ρ=–0·3873; p<0·0001) and increases in government health spending (ρ=0·4002; p<0·0001). Removal of free and fair elections from the democratic experience variable resulted in loss of association with age-standardised mortality from non-communicable diseases and injuries. -/- Interpretation When enforced by free and fair elections, democracies are more likely than autocracies to lead to health gains for causes of mortality (eg, cardiovascular diseases and transport injuries) that have not been heavily targeted by foreign aid and require health-care delivery infrastructure. International health agencies and donors might increasingly need to consider the implications of regime type in their efforts to maximise health gains, particularly in the context of ageing populations and the growing burden of non-communicable diseases. (shrink)

Profit is a concept that both causes and manifests deep conflict and division. It is not merely that people disagree over whether it is good or bad. The very meaning of the concept and its role in competing theories necessitates the deepest possible disagreement; people cannot agree on what profit is. Still, simply learning the starkly different sentiments expressed about profit gives us some feel for the depth of the conflict. Friends of capitalism have praised profit as central to the (...) achievement of prosperity and to civilized modern life. Calvin Coolidge, that silent sentinel of American business, said, “Profit and civilization go hand in hand.” F. A. Hayek tells us that in the evolution of the structure of human activities, profitability works as a signal that guides selection towards what makes man more fruitful; only what is more profitable will, as a rule, nourish more people, for it sacrifices less than it adds. (shrink)

The aim of UK-REACH (“The United Kingdom Research study into Ethnicity And COVID-19 outcomes in Healthcare workers”) is to understand if, how, and why healthcare workers (HCWs) in the United Kingdom (UK) from ethnic minority groups are at increased risk of poor outcomes from COVID-19. In this article, we present findings from the ethical and legal stream of the study, which undertook qualitative research seeking to understand and address legal, ethical, and social acceptability issues around data protection, privacy, and information (...) governance associated with the linkage of HCWs’ registration data and healthcare data. We interviewed 22 key opinion leaders in healthcare and health research from across the UK in two-to-one semi-structured interviews. Transcripts were coded using qualitative thematic analysis. Participants told us that a significant aspect of Big Data research in public health is varying drivers of mistrust—of the research itself, research staff and funders, and broader concerns of mistrust within participant communities, particularly in the context of COVID-19 and those situated in more marginalised community settings. However, despite the challenges, participants also identified ways in which legally compliant and ethically informed approaches to research can be crafted to mitigate or overcome mistrust and establish greater confidence in Big Data public health research. Overall, our research indicates that a “Big Data Ethics by Design” approach to research in this area can help assure (1) that meaningful community and participant engagement is taking place and that extant challenges are addressed, and (2) that any new challenges or hitherto unknown unknowns can be rapidly and properly considered to ensure potential (but material) harms are identified and minimised where necessary. Our findings indicate such an approach, in turn, will help drive better scientific breakthroughs that translate into medical innovations and effective public health interventions, which benefit the publics studied, including those who are often marginalised in research. (shrink)

CHAPTER I Characteristics of Deliberate Education FOR man education is not a mere adornment, it is a life necessity. ...

In response to Hannah's Child, this essay begins from the reality of “unlikely friendships” and the idea of the “conservative radical”. The essay then moves into a discussion of three particular themes raised in Hauerwas's memoir and in his work generally: Christocentrism as sequela Christi; Christian politics as eschatology; and witness as the heart of Christian life. What draws the various themes of the essay together is the proposal that givenness is the unique and Christocentric key to the (...) Christian unity of thought and practice. (shrink)

Fundamental theological and ethical themes of Luther's thought and tradition provide a basis for appreciating both the role of business in God's providential design and the importance of occupation for living out one's Christian vocation. These same insights establish the ethical basis for a critical appraisal of the current practice of downsizing and its negative impact on the quality of individual lives and whole communities. While Lutheran ethics is realistic about the ambiguities of life, it is also an ethic (...) of compassionate love seeking justice in the world of business as in all of life. (shrink)

Life and works -- The Tractatus, language and logic -- The Tractatus, reality and the limits of language -- From the Tractatus to philosophical investigations -- Intentionality and rule-following -- Mind and psychology -- Knowledge and certainty -- Religion and anthropology -- Legacy and influence.

Fundamental theological and ethical themes of Luther’s thought and tradition provide a basis for appreciating both the role of business in God’s providential design and the importance of occupation for living out one’s Christian vocation. These same insights establish the ethical basis for a critical appraisal of the current practice of downsizing and its negative impact on the quality of individual lives and whole communities. While Lutheran ethics is realistic about the ambiguities of life, it is also an ethic (...) of compassionate love seeking justice in the world of business as in all of life. (shrink)

Donald Davidson offers an explanation of first‐person authority that “traces the source of the authority to a necessary feature of the interpretation of speech.” His account is explained, and an interpretation is offered of its two key ingredients: the idea that by using the device of disquotation, a speaker can state the meanings of her words in a specially error‐free way, and the idea that a speaker cannot generally misuse her own words, because it is that use that gives (...) her words their meaning. The account is defended against misinterpretations and criticisms. But it is argued that Davidson does not explain what is most puzzling about our knowledge of the meanings of our words, or about the asymmetry between our knowledge of our own minds and our knowledge of others' minds. Finally, Davidson's argument for the compatibility of first person authority and semantic externalism is explained and defended. (shrink)

The paper considers three questions. First, what is the connection between economics and agency? It is argued that causation and explanation in economics fundamentally depend on agency. So a philosophical understanding of economic explanation must be sensitive to an understanding of agency. Second, what is the connection between agency and causation? A causal view of agency-involving explanation is defended against a number of arguments from the resurgent noncausalist tradition in the literature on agency and action-explanation. If agency is fundamental to (...) economic explanation, it is argued, then so is causation. Third, what is the connection between causal explanation and the natural sciences? It is argued that, though the explanations given in economics and other social sciences are causal explanations, they are different in kind from the causal explanations of the natural sciences. On the one hand, then, the causal explanations of the social sciences are irreducible to those found in the natural sciences. On the other hand, the causal relations described by the social sciences are not completely autonomous; they do not float free of, or operate independently from, the causal relations charted by the natural sciences. (shrink)

The life–mind continuity thesis is difficult to study, especially because the relation between life and mind is not yet fully understood, and given that there is still no consensus view neither on what qualifies as life nor on what defines mind. Rather than taking up the much more difficult task of addressing the many different ways of explaining how life relates to mind, and vice versa, this paper considers two influential accounts addressing how best to understand (...) the life–mind continuity thesis: first, the theory of autopoiesis (AT) developed in biology and in enactivist theories of mind; and second, the recently formulated free energy principle in theoretical neurobiology, with roots in thermodynamics and statistical physics. This paper advances two claims. The first is that the free energy principle (FEP) should be preferred to the theory of AT, as classically formulated. The second is that the FEP and the recently formulated framework of autopoietic enactivism can be shown to be genuinely continuous on a number of central issues, thus raising the possibility of a joint venture when it comes to answering the life–mind continuity thesis. (shrink)

In the wake of life-changing events—whether as global in reach as the terrorist attacks on September 11 or as personal as the death of a child—the first question that springs to mind is “Why?” Why do good people suffer pain and loss? Why does God allow these things to happen? In this simple, straightforward book, Bruce Henderson tackles some of the most difficult questions that people of faith face in their lives. Drawing from the wisdom of visionary Emanuel (...) Swedenborg, who wrestled with these same questions more than two hundred years ago, Henderson describes a universe in which God allows us free will and choice, subtly guiding the course of our lives with an insight no mortal can comprehend. Pain and suffering ultimately lead to good, and as we walk the path, we draw ever closer to heaven. In the end, the question is not why these things happen, but what good can come of them, and how we can use our gift of free will to create a better world for ourselves and others. In this, Henderson says, God is our partner and guiding hand, turning pain to hope and trust. (shrink)

Fundamental theological and ethical themes of Luther's thought and tradition provide a basis for appreciating both the role of business in God's providential design and the importance of occupation for living out one's Christian vocation. These same insights establish the ethical basis for a critical appraisal of the current practice of downsizing and its negative impact on the quality of individual lives and whole communities. While Lutheran ethics is realistic about the ambiguities of life, it is also an ethic (...) of compassionate love seeking justice in the world of business as in all of life. (shrink)

BackgroundDecision-making in initiating life-sustaining health technology is complex and often conducted at time-critical junctures in clinical care. Many of these decisions have profound, often irreversible, consequences for the child and family, as well as potential benefits for functioning, health and quality of life. Yet little is known about what influences these decisions. A systematic review of reasoning identified the range of reasons clinicians give in the literature when initiating technology dependence in a child, and as a (...) result helps determine the range of influences on these decisions.MethodsMedline, EMBASE, CINAHL, PsychINFO, Web of Science, ASSIA and Global Health Library databases were searched to identify all reasons given for the initiation of technology dependence in a child. Each reason was coded as a broad and narrow reason type, and whether it supported or rejected technology dependence.Results53 relevant papers were retained from 1604 publications, containing 116 broad reason types and 383 narrow reason types. These were grouped into broad thematic categories: clinical factors, quality of life factors, moral imperatives and duty and personal values; and whether they supported, rejected or described the initiation of technology dependence. The majority were conceptual or discussion papers, less than a third were empirical studies. Most discussed neonates and focused on end-of-life care.ConclusionsThere is a lack of empirical studies on this topic, scant knowledge about the experience of older children and their families in particular; and little written on choices made outside ‘end-of-life’ care. This review provides a sound basis for empirical research into the important influences on a child’s potential technology dependence. (shrink)

In this paper the author argues that a narrative approach to understanding assisted suicide has been compromised by the notion that all narratives must be both coherent and unified. He asks what we are to do with those narratives that cannot seem to cohere or be other than full of disunity? Is suicide the only way to make meaning out of suffering? He then proposes that the narrative found in the Gospel of Mark leads Christians to a life in (...) hope and compassion in spite of apparent incoherence and disunity and threats of abandonment and suffering. (shrink)

The article considers the changing position of women and the family from the Second World War until today using the UK as its example. It offers a theoretical perspective by setting out to examine the possibility that the rise of second-wave feminism both reflected and spearheaded an aspect of demographic transition to non-replacement populations. It considers the tension between the formation of ‘sexual difference’ to enable reproduction and what it calls the ‘engendering of gender’ in lateral relations which are indifferent (...) to procreation. With the achievements of feminism as a political vanguard and the demographic transition as its socioeconomic base, women were no longer defined by the family; their definition ceased to depend on procreation. The article proposes that the new use of the term ‘gender’ entered the political arena to become a key concept of feminism to indicate non-procreative sexuality and sexual relations that need not be heterosexual or biologically procreative. Judith Butler’s well-known suggestion that ‘gender’ troubles the status quo in a revolutionary manner cannot be sustained. Rather than disturbing the universe, the advent of ‘gender’ reflects the transition to a new demographic order. (shrink)

On September 28, 2002, 11-year-old Jakob von Metzler, a banker's son, was abducted on the way to his parents' house in Frankfurt. A sum of one million Euro was demanded for his release. Three days after Jakob's disappearance, Magnus Gäfgen, a 32-year-old law student, collected the ransom from the arranged tram stop in Frankfurt during the night. While under observation by the police, he ordered a new Mercedes and booked a holiday abroad. Seventy-six hours after Jakob's disappearance, the police arrested (...) Gäfgen and his 16-year-old girlfriend while simultaneously searching his flat. There they found the missing ransom, but no sign of Jakob. a b. (shrink)

Free will can be understood as a novel form of action control that evolved to meet the escalating demands of human social life, including moral action and pursuit of enlightened self-interest in a cultural context. That understanding is conducive to scientific research, which is reviewed here in support of four hypotheses. First, laypersons tend to believe in free will. Second, that belief has behavioral consequences, including increases in socially and culturally desirable acts. Third, laypersons can reliably distinguish (...) free actions from less free ones. Fourth, actions judged as free emerge from a distinctive set of inner processes, all of which share a common psychological and physiological signature. These inner processes include self-control, rational choice, planning, and initiative. (shrink)

The promise of a free, high-quality public education is supposed to guarantee every child a shot at the American dream. But our widely segregated schools mean that many children of color do not have access to educational opportunities equal to those of their white peers. In Integrations, historian Zoë Burkholder and philosopher Lawrence Blum investigate what this country’s long history of school segregation means for achieving just and equitable educational opportunities in the United States. Integrations focuses on multiple (...) marginalized groups in American schooling: African Americans, Native Americans, Latinxs, and Asian Americans. The authors show that in order to grapple with integration in a meaningful way, we must think of integration in the plural, both in its multiple histories and in the many possible definitions of and courses of action for integration. Ultimately, the authors show, integration cannot guarantee educational equality and justice, but it is an essential component of civic education that prepares students for life in our multiracial democracy. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Spirituality in Nursing PracticeRegina Conway–PhillipsPersonally, I am a Christian and follow the principles of Unity, a new thought community that espouses that each individual creates their own reality and that God’s presence is within each individual. I am a spiritual being and I am sustained by my faith.Professionally, I have been a nurse for over 38 years in various capacities including clinical, administrative and academic. When I worked at (...) the bedside in the clinical capacity, I always believed that a person’s spirituality was most evident when dealing with an illness. In practice, I frequently prayed with and for patients that I was caring for regardless of their religion.In my administrative capacity I always encouraged my staff to feel free to incorporate their faith and belief into their practice. As an administrator I felt it important to be an example to my staff and allow them to see a professional practice in a spiritually faith–based capacity.Now, in my role as an academician, I stress to each of my students that it is important for them to get to know themselves. I challenge my students to know and understand what they believe about themselves and others, what they value and why. I encourage them to really reflect and be very honest with themselves about their worldview and what influences has shaped this worldview, their faith, beliefs and values. I explain that it is important for them to know themselves before they can help others. In the health care field it is important for my students to feel comfortable when they encounter a patient in need of spiritual support.Religion and spirituality are terms that are often used interchangeably in the health care setting. Although related, these terms have different meanings to health care practitioners, administrators, academicians and patients. Religion, religiousness, or religiosity is often referred to as membership and participation in the organizational structures, beliefs, rituals and dogma of religious faiths such as Judaism, Christianity, or Islam. While spirituality has been defined as believing in a Higher Power that guides ones life and is a source of unconditional love, peace and strength; as a result, one is able to cope with life’s situations and maintain a positive attitude and assurance that all is well.When presented with the opportunity to submit a story about how I, as a health care provider integrated faith into my practice, I jumped at the opportunity because I think it is an important factor in the care of others, be they patients, peers, students or oneself. One of the concepts I explored in my dissertation research was spirituality. I have always operated from a spiritual faith–based perspective both in my personal and professional life as a nurse and more recently as an academician. Personally, [End Page E3] I define myself as a spiritual being, governed by spiritual laws, guided by spiritual principles, living a human experience. I am a Christian and a beloved child of God, placed on this earth at this time to fulfill the divine potential and purpose I was sent to serve. I believe that every human being on the face of this earth is a spiritual being whether they acknowledge, believe it or accept it themselves. As such I believe we are all one with God and one with each other and I believe that everything in our lives happen for a reason and in due time. My faith and beliefs were never more clear to me than my experience in loosing my 84–year–old mother on January 18, 2013 after a four year battle with lung cancer.Professionally, I have been a nurse for over 38 years in various capacities including clinical, administrative and academic. When I worked at the bedside in the clinical capacity, I always believed that a person’s spirituality was most evident when dealing with an illness. In practice, I frequently prayed with and for patients that I was caring for regardless of their religion. I always felt it was a privilege to witness others resilience and faith. But it was as a cancer nurse navigator that I got to truly develop as a spiritual care... (shrink)

The moral value of law can take many forms. It is instrumentally valuable when it coordinates interaction, provides moral advice and leadership, models the virtues, and motivates us to be moral. It is intrinsically valuable when it constitutes the collective moral conscience of citizens, embodies an ideal form of communal life, and expresses the moral integrity of the community. We analyse all of these potential values of law and assess their moral significance. In doing so, we are careful to (...) distinguish between the general concept of law and the actual law of any particular legal system. We argue that, although in principle law does have the potential to help us to be moral in each of the ways noted, many actual legal systems are conducive to great immorality and injustice. Being moral and living well under such regimes is likely to be much harder than it would be otherwise, even in the absence of any legal system. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Sweating the Small StuffTim CunninghamAs an emergency nurse, I often do not notice the small stressors as compared to the loads of intense physical and emotional suffering I witness while working at a level–one–trauma center. The horrendous deaths and injuries caused by gun violence, motorized vehicles, people in emotional distress and those suffering from chronic diseases build up on the mind as a veritable ‘scrapbook of nightmares.’ Emergency providers (...) know, in taking on this profession, that this is ‘all in a day’s work.’ Consequently, we put our selves at risk for emotional burnout as we bear witness to profound suffering while trying to improve lives.I see the traumas, the end–of–life decision making thrust upon families amidst a medical crisis and the other aspects of emergent suffering as bails of hay, against which I tried to build coping mechanisms in order to experience them but also be able to let go. For the most part I am confident to report that I have been able to work through major traumatic situations without belaboring the emotional residue. What I have failed to notice though are not the bails of hay, but individual straws of which they are made.A straw that nearly broke my back came to my pediatric emergency room as a 9–year–old girl who was involved in a low speed motor vehicle collision. She was restrained in the passenger seat; and although she was walking at the scene and crying, she was backboarded by EMS and placed in a cervical spine brace. On arrival to our emergency department she presented with normal vital signs and mutation. Her only complaint was diffuse abdominal pain. We preformed a FAST (Focused Assessment with Sonography for Trauma) exam, which was negative for free abdominal blood. Despite our efforts to make the patient comfortable, we were unable to ease her pain. The patient reported that her pain decreased after we took her off the backboard, but she still did not feel herself.Our attending and resident physicians decided that this child should have an abdominal computed tomography scan (CT) to rule out organ damage with subsequent bleeding. According to hospital protocol, this decision was within our standards of care. I stood by the family when the physician team discussed the plan of care and noticed the parents’ collective body language, which was troubled. I left the room with the physicians but not long after, the family subtly requested that I speak with them.The family was concerned about the radiation to which their child would be exposed. At the same time, they too were concerned about her abdominal pain and understood that a CT could confirm serious abdominal injury. They knew the gravity of the worst–case scenario and wanted to do what was best for their child.The mother asked me if this girl were my child what would I do.My first thought was: No CT, go home, watch her and return if symptoms worsen. My second thought conflicted with the first as I realized this was instruction that fell out of protocol differing from the opinions of the physician team. I paused before responding and found myself sputtering some pointless information about CT scans and mechanisms of injuries sustained from car accidents—I [End Page E9] was filling space, avoiding their question as I pondered the best answer.The girl’s parents told me that one was leaning towards the CT and the other against, they wanted my advice to make a decision. They pressed me saying, “What would you do.” Although I felt an uneasiness and nausea in that moment, I told them my truth, which was that I would go home without the CT.The family appeared relieved and I felt the sensation of stress leaving my body as if I had just taken a deep breath. Contented, but a daughter still with abdominal pain, the family left that evening with specific instructions to watch for adverse symptoms.In that moment, I felt like I had done the right thing but by the end of my shift I left work questioning my choice. I lost sleep that night because of... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Too Expensive to Treat? Finitude, Tragedy, and the Neonatal ICU by Charles C. CamosyAutumn Alcott RidenourReview of Too Expensive to Treat? Finitude, Tragedy, and the Neonatal ICU CHARLES C. CAMOSY Grand Rapids, MI: Eerdmans, 2010. 208 pp. $18.00In Too Expensive to Treat? Charles Camosy makes an important contribution to bioethics and Christian ethics by making the case for the need to consider social factors when treating imperiled newborns. (...) Arguing for both the full moral status of newborns and Roman Catholic social teaching’s emphasis on the just allocation of resources, Camosy calls the medical community, bioethicists, and [End Page 209] Christian ethicists to account for current practices that disproportionately favor exorbitant costs for imperiled infants over other even more basic medical needs within the US health care system. Written before the adoption of the Affordable Care Act under the Obama administration, Camosy’s argument has only increased in significance given the national need to prioritize resources in view of the government’s expansion of health care coverage.Born within twenty-two to twenty-four weeks of gestation and weighing between 500 and 850 grams, some imperiled infants absorb hundreds of thousands of dollars in short-term care that may extend into millions of dollars given long-term costs (146, 171–93). Recognizing the tragic reality in which “we have virtually unlimited health care needs” coupled with “limited health care resources,” Camosy contends that current Medicaid funds that privilege the NICU (neonatal intensive care unit) should be reevaluated (1–3). In an effort to temper the “autonomous,” patient-driven principle with “justice,” Camosy poses a challenging philosophical, theological, and practical proposal for what he identifies as the “gray area” of the NICU.Maintaining a twofold commitment to human dignity that values the moral worth of the infant, on the one hand, and the common good that privileges a preferential option for the poor, on the other, Camosy develops his argument in four major steps. First, he validates the moral status of newborn infants and rejects social quality of life models that dismiss their intrinsic status as “persons.” Second, he dismisses arguments that emphasize personal dignity at the expense of considering the social quality of life, pointing out that such arguments disregard Catholic social teaching’s emphasis on the link between relational anthropology and human personhood (100). Third, he contends that “weak” social quality of life models that privilege the patient or individual over social considerations do not take seriously either Catholic social teaching’s emphasis on the common good or the potentially overwhelming economic and practical burdens they might place on families and society as a whole. Finally, Camosy presents a constructive proposal for limiting NICU resources that seeks to counter a culture of overtreatment that idolizes technology and is at the mercy of an unrestrained free market (162). Emphasizing the need for a just allocation of resources, he supports withholding and withdrawing life-sustaining treatment in some cases, thus foreseeing the possible death of some infants. Although he does not accept the direct killing of these infants, he does maintain that Catholic social teaching would allow for the withdrawal of life-sustaining treatment based on certain criteria.Camosy raises a host of important considerations relevant to decisions about imperiled infants. Yet a few questions remain. First, from a Christian point of view, does he not fall into a kind of soft utilitarianism, even though he himself desires to avoid the pitfalls of utilitarianism? Second, how might Camosy envision Christian practices that care for “exposed” infants left without life-sustaining treatment? Finally, what about the difficult emotions that accompany [End Page 210] the death of an infant or child? Do certain kinds of grief complicate our rationing choices that appear to pit the old against the young? While perhaps unanswerable, these questions merit further discussion.Autumn Alcott RidenourMerrimack CollegeCopyright © 2015 Society of Christian Ethics... (shrink)

It is no accident that the book Benjamin wrote as a reader of himself, A Berlin Childhood, also begins with the description of a park, that of the Tiergarten zoo. However great the difference may seem between this collection of short prose pieces and Proust's three-thousand-page novel when viewed from the outside, Benjamin's book illustrates [his] fascination... A sentence in his book points to the central experience of Proust's work: that almost everything childhood was can be withheld from a person (...) for years, suddenly to be offered him anew as if by chance. "Like a mother who holds the new-born infant to her breast without waking it, life proceeds for a long time with the still tender memory of childhood" . Also reminiscent of Proust is the description of the mother who, on evenings when guests are in the house, comes in to see her child only fleetingly to say good night; so, too, is that of the boy attentively listening to the noises which penetrate into his room from the courtyard below and thus from a foreign world. The studied elevation of the newly invented telephone to the level of a mythical object is anticipated in Proust as well. And the relationship to and influence of the earlier work can be demonstrated even in the use of metaphor. But little is gained by this approach, and it would not be easy to refute the objection that such similarities lie in the authors' common raw material: childhood, the fin de siècle epoch, and the attempt to bring them both into the present. Peter Szondi was professor of comparative literature at the Free University of Berlin at the time of his death in 1971. His many influential works include Theorie des modernen Dramas , Versuch über das Tragische , and a five-volume collection of his lectures. Harvey Mendelsohn is the principle translator of the fourteen-volume Dictionary of Scientific Biography; he is currently working on translations of a French commentary on Heraclitus and a selection of Szondi's essays to be published by Yale University Press. (shrink)

DI.1 On everything that lives, if one looks searchingly, is limned the shadow line of an idea – an idea, dead or living, sometimes stronger when dead, with rigid, unswerving lines that mark the living embodiment with the stern immobile cast of the non living. Daily we move among these unyielding shadows, less pierceable, more enduring than granite, with the blackness of ages in them, dominating living, changing bodies, with dead, unchanging souls. And we meet, also, living souls dominating dying (...) bodies – living ideas regnant over decay and death. Do not imagine that I speak of human life alone. The stamp of persistent or of shifting Will is visible in the grass blade rooted in its clod of earth, as in the gossamer web of being that floats and swims far over our heads in the free world of air. DI.2 Regnant ideas, everywhere! Did you ever see a dead vine bloom? I have seen it. Last summer I trained some morning glory vines up over a second story balcony; and every day they blew and curled in the wind, their white, purple dashed faces winking at the sun, radiant with climbing life. Higher every day the green heads crept, carrying their train of spreading fans waving before the sun seeking blossoms. Then all at once some mischance happened, some cutworm or some mischievous child tore one vine off below, the finest and most ambitious one, of course. In a few hours the leaves hung limp, the sappy stem wilted and began to wither; in a day it was dead, – all but the top which still clung longingly to its support, with bright head lifted. I mourned a little for the buds that could never open now, and tied that proud vine whose work in the world was lost. But the next night there was a storm, a heavy, driving storm, with beating rain and blinding lightning. I rose to watch the flashes, and lo! the wonder of the world! In the blackness of the mid NIGHT, in the fury of wind and rain, the dead vine had flowered. Five white, moon faced blossoms blew gaily round the skeleton vine, shining back triumphant at the red lightning. (shrink)

When is commodification acceptable?Preimplantation genetic diagnosis is usually restricted to couples who are eligible for in vitro fertilisation —infertile couples or those with a history of genetic disease. The Human Fertilisation and Embryology Authority in England and the Infertility Treatment Authority in Australia have both given permission for PGD with tissue typing to detect human leucocyte antigen compatibility in order to save an existing sibling with a life threatening condition. The procedure has also been carried out in the United (...) States.1Heavy criticism followed the February 2002 ruling of England’s HFEA to allow a family to try for a child who is free of thalassaemia and a “perfect match” for a sick sibling.2 Then in August …. (shrink)

Human life is finite. Given that lifetime is necessarily limited, the experience of time in any given society is a central ethical problem. If all or most of human lifetime is consumed by routine tasks then human beings are dominated by the socially determined experience of time. This article first examines time as the fundamental existential framework of human life. It then goes on to explore the determination of time today by the ruling value system that underlies advanced (...) capitalist society. It concludes that the equation ‘time is money’ rules the contemporary experience of time, and goes on to argue that this experience deprives those who live under this ruling value system of a central requirement of free human life: the experience of time as an open matrix of possibilities for action. (shrink)

The contributions in the current issue of Ethical Perspectives mainly derive from a conference on Catholic Intellectual Traditions organized jointly by the Katholieke Universiteit Leuven and the Erasmus Institute, University of Notre Dame, and held at Leuven from November 10th to the 11th, 2000. As the reader can see from a quick perusal of the table of contents, the contributions cover a diverse range of topics. The reader might well ask what such contributions have to do with a journal concerned (...) with ethical perspectives. What do contributions bearing on religious themes from literature, or reflections on mystical love, or on Catholicism and modern scholarship, have to do with a journal devoted to ethics? Surely we have all learned to our benefit from Kant that ethics is entirely autonomous with respect to religion. If there is a relation, it is one that must respect that autonomy, and not muddy the waters by bringing back the outmoded promiscuity of religion and ethics, and especially it must guard against religion trying to sly its way back to dominion over ethics once again.A reply to this line of reflection would be that Ethical Perspectives is concerned not only with perspectives, not only with what happens within perspectives, but with ethical perspectives as themselves coming to articulation within contexts that contain all the richness of human life as lived. Such contexts cannot be considered apart from serious reflection on religion as expressing the sense of ultimate worth that humans understand and try to live diversely. Contexts have to do with the ethos within which ethical perspectives, and our determinate address to specific ethical dilemmas occur. The practice of a religion, or the absence of it, or indeed the rejection of such practice, communicates something of our sense of the most ultimate ethos of being, and its goodness.Clearly this communication will also be effected in a diversity of ways: for instance, in the understanding we have of the economy and the state as serving, or despoiling, the worth of human life; or in the art and literature that offer us images of significant human possibility set forth for imaginative contemplation with a forthrightness more integral than the confused flux of everyday life allows; or in the secret love of prayer that draws the human soul towards its most extreme abandonment and adoration. Ethical perspectives do not make full sense in the determinate terms they overtly set forth, but draw from sources of value that more often than not remain implicit and intimate to the perspectives themselves. Full ethical reflection requires mindfulness of these more intimate sources, and an honest address towards our religious being is demanded by such reflection. Such honesty is asked of a non-believer as of a believer. Both indeed may be differently called into question by that honesty.If the conference was organized with reference to Catholic Traditions, does this indicate a kind of sectarian narrowness for the intellectual, despite what the word `catholic' might betoken? It will be evident from the contributions that no such narrowness is here at work. Quite the opposite: it is the rich diversity that is striking. One does hear reference to the `ghetto' of Catholic ways, perhaps Church ways, perhaps Christian ways generally. This is a very interesting word: `ghetto'. The discerning reader will note in some of the contributions a strong sympathy for Judaism. But in some instances we will be urged to get out of our `ghetto'. It might seem that as `Catholics' or `Christians' we are already `Jews'. Who put us into the `ghetto'? Is this self-incurred? It seems there are some who have consigned themselves to their own `ghetto', but while this may be true, are there not `ghettos' of religion that are the afterlives of certain Enlightenment ways of thinking about religion, afterlives internalized by those religious who would get out of this now self-imposed ghetto, and make their accommodation with more enlightened ways. How delightfully tangled it all is! We preach repentance and wonder at the end who it is that needs to repent, perhaps we the preachers! One thinks of Lear telling the judge to bring the lash to himself. I don't believe Lear was a Catholic, but he certainly was not an Enlightenment intellectual.There is a question worth asking here, in that for not a few the notion of a `Catholic intellectual' or `Christian intellectual' is an oxymoron. To be a real intellectual is not to be affiliated to an organization that already knows in advance what the truth is. One is reminded of those debates earlier in the 20th century between Bertrand Russell and Frederick Copleston. Russell: You are a Catholic, ergo you already know the answer, ergo you cannot honestly ask the question, ergo what you do cannot be philosophy, that is, free thinking.Very clever, of course, and not without some truth. Do we have to agree with Heidegger that a Christian philosophy is a round square? The problem here, of course, is philosophical. I would say: to be a philosopher is to be able to ask about anything, including religion. But the how of the asking is very important. The asking about religion might well seek a confirmation for what is held beforehand. But this holds true of the critics of religion as much as the sympathizers. The shoe is sometimes on the other foot. It is not only the apologetic Catholics who bring presuppositions to bear on the asking of a question, but so also do those critics who, mirabile dictu, strangely often find their own presuppositions confirmed once again. How easy to accuse the other of not being a `real' intellectual; how galling when it turns out that one's own practice of the free intellect mirrors one's chained opponent.The lesson I take: we inevitably bring fundamental presuppositions to bear in the asking of determinate questions. And it is these presuppositions we need to understand as much as the determinate questions and determinate answers. We are all put to the test. This is more catholic than the offensive critic or the defensive apologist. But you must have trust in mind to be willing to let one's thought be thus open. Such trust cannot be accounted for fully in the determinate ideas one explores or defends. It is interesting also that this trust, in the how of asking questions, mirrors the trust in the how of a person's faith or hope in God. This trust bears on this and that situation or difficulty, but it is in excess of this or that determinate situation or difficulty. It concerns sources of expectation in truth and goodness that are more than we can determine in advance. They are more than we can ever determine completely, since they make our determining possible. We are given to be in this expectation which we cannot completely determine through ourselves alone. And one might say that religion is the way we are given to keep open our communication to these sources of ultimate trust. Russell's cleverness is admirable, but that cleverness will not do to deal with the issue. If the issue concerns ethos or context in the sense implied above, cleverness will never do justice to that. While religion has the power to make us more discerning here, there is a cleverness that tends to make us obtuse.Of course, we intellectuals and academics love cleverness, since we think we are very clever ourselves. Here is one of our sources of difficulty with religion. People who are not clever like us also seem to be religious. If so, one might be tempted to say: being religious then cannot be the same as being clever; it might not even be clever to be religious; ergo to be a truly clever intellectual and academic, I must leave religion in my youth, and put on adult ways of thinking. One might even add to the clinching argument: for ethical reasons we must leave that behind, for just as our thinking must be autonomous, so we must our being ethical become entirely autonomous. Adieu religion!There is an argument here, but one wonders if there are also hints of the operation of a sly process of shaming. We now live in a time where processes of embarrassment are often at work in the initiation of young academics and intellectuals. I hear it said, or rather I hear the significant silence saying this: “It is not that we argue against religion, it's just that well, we real intellectuals don't talk about such things anymore”. We may speak at the top of our heads as post-modernists who have robustly deconstructed the Enlightenment ideal, but at the level of the more elusive and intimate embarrassment we are unself-conscious children of the Enlightenment. But did not the Enlightenment tell us no longer to be children. But now, with our heads we postmoderns tell ourselves we no longer want to be children of the Enlightenment, but in our hearts with regard to religion we are still such children — I mean children of the Enlightenment. Is it not time for that child also to grow up. If I were allowed to prophesy — and of course I am not allowed, since prophecy is now said not only to be inadmissible but impossible — I would inadmissibly and impossibly have to say that at the end of that growing up being religious might again wait gently for this stout child. How galling this will be, I do not prophesy, since we will then have to make our peace with all those people there who are not as clever as we are.We all know Kant's remarks about Enlightenment freeing us from self-incurred tutelage. And of course, our servility to spiritual despots and priestly powers was part of that tutelage. And so we have become autonomous thinkers. What if this autonomy comes to mean that we substitute for self-incurred tutelage a kind of self-incurred spiritual mutilation? If God is the distinguished thing, this may be so; and no amount of self-exculpation, not even ethical self-exculpation, in terms of our being denizens of the epoch of the death of God, will quite exonerate our blasé lack of urgency about divine ultimacy. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:John R. Boly NIHILISM ASIDE: DERRIDA'S DEBATE OVER INTENTIONAL MODELS DERRIDA'S PHILOSOPHY, or perhaps antiphilosophy, emerges from phenomenological thought. But to a great extent, he has been permitted to define that emergence on his own terms, particularly in his writings on Hegel, Husserl, and Heidegger. This is, of course, highly questionable. It in effect licenses Derrida to become a revisionist historian of his own origins. So I propose a (...) variation. Instead of placing phenomenology against Derrida's backdrop, I want to question his deconstructive project in its relation to the phenomenological venture. The difficulty with this is apparent. What would such a venture be? Even posing the question raises problems in that it presupposes an impossible vantage, an uninvolved point from which to look down in serene mastery at a game rigged in advance. Yet perhaps a synoptic point ofview may be indulged in for a while, provided no one forgets its provisional nature. In that case, the phenomenological venture includes four moments. 1. Suspension (or epoche). Human beings cannot perceive reality in itself. They can only experience meaning through the operations of intentionality, which may be thought of as the exclusions, selections, and combinations of a mediating system. This truism is no less terrifying for being so true, and every mediating system bears within itselfan impulse towards protective closure, an impulse to veil its own forming activity. Such closure eventually encrusts a mediating system and hardens into what Marxists call ideology, the early Barthes called myth, or contemporary response theorists call repertoire. Suspension involves a questioning attentiveness that remains within the closure it questions. Every fact is reconsidered, as factum, a deed brought forth through a process ofmaking. The consequently bracketed "fact" is both sacred object, granting reflexive ac152 John R. Boly153 cess to its formative process, and utter pretension, trying to conceal that process and thereby promote itself as fact rather than facture, origin rather than product. Phenomenology begins with a questioning of that pretension. Like a difficult child, it is perplexed at the self-evident and wonders at the obvious. 2.Reduction. Yet this questioning attentiveness takes only a first step. Suspension disenchants or disillusions, but it does not advance toward an understanding of the intricate patterns through which meaning emerges from the infinite possibilities of perception. That is the task of reduction, to which Husserl assigned two phases, the eidetic and the transcendental.1 In the eidetic phase, phenomena are released, so far as this is possible, into a preflective and preconceptual mode, as pure perceptions still awaiting the activity of mediation. Here, phenomena are boundless as well as exhilarating in their semantic potential. This return to primary perception, however, generates an opposing phase, the transcendental reduction, which traces the way in which mediating systems or what John Wild called versions of the life-world, select and arrange a potentially infinite semantic potential into actual meanings.2 Eidetic and transcendental phases work together, as inseparable antagonists within a continuous dialectic of disclosure. Because these two phases oppose one another, reduction involves a continuous interplay between energy and order, dynamism and system, with the result that it tirelessly traces patterns in the life-world, yet does so only to modify and transform those patterns through the very act of its tracing. Efforts to set the patterns of a life-world into a stable structure at the same time set free their infinite possibilities.3 The eidetic phase of the reduction thus provides a relentless semantic pressure that qualifies, elaborates, and eventually disperses every order of the transcendental phase. Yet without the revealing provocation of such inadequate orders, the eidetic phase would become incoherent and lapse into a speechless nihilism. Though it enacts a comic drama, reduction is the central task of the phenomenological venture, which halts the instant it is denied access to the intentional realm of the life-world. 3.Opening. So important is this access that it generates a separate moment, which pauses to meditate on the conditions of such access. The issues that arise here dominated Heidegger's thought after Being and Time, and they are among the most abstruse yet important concerns of phenomenology. How can models of intentional patterning be... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:216 Feminist Studies 46, no. 1. © 2020 by Feminist Studies, Inc. Sealing Cheng Pikachu’s Tears: Children’s Perspectives on Violence in Hong Kong How do children experience the sudden onset of massive unrest, violence, and police brutality? It has been difficult even for many adults to process how Hong Kong—a cosmopolitan city known for its stability and low crime rate—descended overnight, on June 12, 2019, into tear gas and (...) violent confrontations. What began as a mass protest against amendments to a bill that would have facilitated the extradition of fugitives in Hong Kong to mainland China for trial turned into a protracted struggle for universal suffrage and investigations into police brutality. In the process, countless scenes of excessive police violence against protestors have challenged any dichotomous, black-and-white worldview of good cop/bad criminal; the geography and tempo of the city have been remade by protests, crackdowns, and transportation shutdowns; and social and familial tensions and divisions about the source of the violence have plagued the routines of everyday life. Children, like adults, have to find new ways of being and becoming in the city during this political upheaval. Their existential liminality, however, provides children with a unique perspective from which to sense, experience, and engage with the volatility around them. Careful listening allows children’s “small voices” to speak to “big issues.”1 1. Allison James, “Giving Voice to Children’s Voices: Practices and Problems, Pitfalls and Potentials,” American Anthropologist 109, no. 2 (2007): 261–72. Sealing Cheng 217 Unmooring children from “the restrictive and constricting frameworks of innocence and/or victimhood” with “incomplete moral and social personhood,” Karen Lury analyzed the child as a version of Berlant’s “infantile citizen,” whose “‘stubborn naïveté’ gives her/him enormous power to unsettle, expose, and reframe the machinery of national life.”2 I offer reflections below as an observer of the ways my children participate in their changing world as socio-moral beings. I write as a mother who searches for her own ethical anchor with and through my children in a collective project of engaging with our fears, hopes, and possibilities. “Will the Government Talk to Us?” I am a mother of two girls, ages six and nine. My daughters usually want to go swimming on Sundays, but since June 9, 2019, our family has instead spent many Sundays at marches and protests against the anti-extradition law and police brutality, reiterating the “five demands” of the movement. Our family has participated in protest marches before, but the prospect of walking in a crowd through the city streets for hours in the summer heat—rather than swimming in the pool—was highly unappealing to my kids. I had to explain to them why it was important. I said that if amendments to the Extradition Law passed, we could be accused of committing a crime under mainland Chinese laws, and we would lose our rights to do many of the things we had taken for granted. As an example, I explained that they would not be allowed to watch Winnie the Pooh again because President Xi did not like that people likened him to the cute bear. My daughters found it puzzling why anyone would object to such an innocuous comparison. I also said that if the law passed, we might no longer be free to say the words “8964” commemorating the June 4, 1989, Massacre on Tiananmen Square. (While these changes might not really happen, they speak to Hongkongers’ utter distrust of the judicial system in China.) I explained to my daughters that we needed to tell Chief Executive Carrie Lam and her government that we did not want this law passed. They agreed. 2. Karen Lury, “Children in an Open World: Mobility as Ontology in New Iranian and Turkish Cinema,” Feminist Theory 11, no. 3 (2010): 284; Lauren Berlant, The Queen of America Goes to Washington City: Essays of Sex and Citizenship (Durham, NC: Duke University Press, 1997), 29, quoted in Lury, “Children in an Open World,” 284–5. 218 Sealing Cheng When we joined our first anti-extradition march toward the government headquarters on June 9, we were among one million people who... (shrink)

Photo ID 222412412 © US Navy Medicine | Dreamstime.com ABSTRACT In a non-military setting, the answer is clear: it would be unethical to treat someone based on non-medical considerations such as nationality. We argue that Battlefield Triage is a moral tragedy, meaning that it is a situation in which there is no morally blameless decision and that the demands of justice cannot be satisfied. INTRODUCTION Medical resources in an austere environment without quick recourse for resupply or casualty evacuation are often (...) limited. The shortage extends not only to supplies like blood products and drugs, but physicians and other medical personnel. In the midst of a mass casualty scenario, such as a battle that includes intense ground fighting, the medical staff will stretch scarce resources and triage casualties according to specific criteria. Typically, they proceed by providing care for the most severely wounded first, referred to here as conventional triage. At times, though, the staff may reverse the triage so that soldiers with minor wounds can return to the fight. In a mass casualty situation, when medical personnel apply conventional triage and treat casualties from opposing forces, a dilemma may arise. We argue that it can be permissible for military physicians to prioritize their own soldiers over enemy combatants in a mass casualty triage, where reverse triage does not apply. The case we will focus on is as follows: Battlefield Triage: During combat operations on a remote island in the Pacific Ocean, a compatriot soldier and an enemy combatant arrive at the compatriot soldier country’s medical treatment facility. Both have similar gunshot wounds to the abdomen, and they arrive with similar conditions. Both have low oxygen saturation and excessive blood loss. The sole physician only has enough time to stabilize one person. The scenario is brief, and we are aware that medical rules of eligibility will most often dictate how the physician proceeds,[1] but this scenario is useful in setting up the question we focus on in this paper: would it be wrong to favor the stabilization of a soldier just because the soldier is the physician’s compatriot? In other words, can nationality serve as an ethically justified tiebreaker in a situation such as Battlefield Triage?[2] In a non-military setting, the answer is clear: it would be unethical to treat someone based on non-medical considerations such as nationality. The AMA’s Code of Medical Ethics asserts that physicians have “ethical obligations to place patients’ welfare above their self-interest and above obligations to other groups.”[3] The World Medical Association’s Declaration of Tokyo affirms that “no motive, whether personal, collective or political, shall prevail against this higher purpose” of alleviating distress.[4] Physicians are taught early on that triage decisions must be medically indicated and made without consideration of factors such as race, ethnicity, religion, social status, and nationality. They are taught that public trust and obligations of justice grounded in equality demand that only medical indications be considered. But military physicians in a military setting are beholden to obligations, duties, and responsibilities as members of the military, and when these obligations, duties, and responsibilities conflict, as they do in Battlefield Triage, which loyalties win out and why?[5] Critics of partiality on national grounds argue that partiality undermines public trust in medicine and justice because everyone should be treated equally regardless of nationality.[6] Proponents of partiality argue that military obligations supersede equality and that justice requires partiality in such cases.[7] Despite the critics’ disagreement, both agree that there is a morally right, perhaps even blameless, course of action. Drawing on insights from virtue ethics, we argue that Battlefield Triage is a moral tragedy in which justice is unattainable and there is no action without moral cost. The assumption that there is a morally right choice is flawed. We argue that while no decision in this scenario is free from moral blame, there are reasons to favor treating one’s soldiers over enemy combatants. I. The Case Against Partiality There is a common assumption that there is a morally right or just decision in Battlefield Triage. A number of organizations and scholars claim that it is wrong for military physicians to favor their own soldiers on the grounds of nationality or some form of ‘group membership.’ (In a conflict involving service members from multiple nations working as a coalition, a soldier from an allied country may receive the same priority as the US service member due to ‘group membership.’) The World Medical Association’s WMA Declaration of Lisbon on the Rights of the Patient, which was reaffirmed in 2015, posits that, “[i]n circumstances where a choice must be made between potential patients for a particular treatment that is in limited supply, all such patients are entitled to a fair selection procedure for that treatment. That choice must be based on medical criteria and made without discrimination.”[8] This echoes what was set forth in Article 12 of the Geneva Conventions, which states that “[o]nly urgent medical reasons will authorize priority in the order of treatment to be administered.”[9] The argument for impartiality in Battlefield Triage is that every person is morally equal, and equality entails that medical distribution is, “based on a combination of medical need and urgency.”[10] This is in keeping with the bioethical principles that are generally applied.[11] II. The Case for Partiality On the other side, there are arguments that favoritism is the ethically right decision in Battlefield Triage.[12] The argument asserts that members of the military form a morally significant community of friends and participation in these relationships demands partiality. Just as parents have strong ethical duties to their children and not just any children, military personnel have ethical duties to their group, a group that involves an affirmation of mutual aid and support. Some have termed these ‘associative duties. According to Michael Gross, obligations of friendship, care, and solidarity “leave very little room for generally applicable principles of justice that would obligate a medic to treat enemy or non-compatriot wounded ahead of their compatriots.”[13] This is true in Battlefield Triage, but it may also be true even if the enemy’s soldier were more seriously wounded: “the ethics of small group cohesion, largely an ethics of care, mostly replaces the demands of impartial justice.”[14] In a more recent article, Gross explains that preferential treatment is ethically justified based on fighting capability and “the special obligations people owe friends, family, and, no less, comrades-in-arms.”[15] To not show partiality to the US soldier would be morally wrong on the grounds of friendship and mutual care.[16] III. The Moral Tragedy of Battlefield Triage Defenders and critics of Battlefield Triage favoritism based on nationality both frame their position as just or fair. For example, Justin List argues that physicians are “bound to practice medical neutrality,”[17] Marcus Adams denies that physicians “possess special ethical obligations” to enemy combatants because of their profession.[18] These perspectives assume that there is a morally right decision and that justice is attainable. The assumption that there is or can be a morally right Battlefield Triage decision, and we need to put our heads together to figure it out, remains strongly entrenched. However, the facts of the situation should give us pause; there are too many people and too few resources, and this demands a decision-making process that determines who will receive scarce resources. By its very nature, a battlefield triage decision has to be made based on some characteristic or value, a characteristic or value that will inevitably favor some at the expense of others. This is precisely why competing analyses “in the military context struggle to resolve these conflicts satisfactorily.”[19] Drawing on the insights of virtue ethics, we suggest that Battlefield Triage is a moral tragedy. Virtue ethics suggests that morality is about acting virtuously, which is to say that we should do what a virtuous person would do in the situation. Ethics is about figuring out how a just, wise, compassionate, loving, and fair person would act, and then doing that, as one grows in virtue. But life is not always clear cut, and it is possible that virtuous people may find themselves in a moral tragedy, a situation in which, through no fault of one’s own, a person must make a morally objectionable decision. After the action the virtuous person “emerges having done a terrible thing, the very sort of thing that the callous, dishonest, unjust, or in general vicious agent would characteristically do.”[20] Stated differently, a moral tragedy presents a virtuous person with two or more courses of action, all of which have a moral cost.[21] In Battlefield Triage, no matter how the physician goes about deciding, there is going to be defensible concern from those not saved. The fact that there are more people than can be helped fosters competing values in battlefield triage: maximize lives saved, treat people equally, treat the worse off, and support the war effort. Treating people equally may create tension between treating the worse off, maximizing lives saved, and supporting the war effort. Reverse triage is a case in point, as supporting the war effort conflicts with treating the worse off first, as is a fair lottery system since deploying a lottery may not maximize lives saved or support the war effort. There can be reasons why one person is selected over another, to be sure. Yet, there are reasons for making a decision, and that the decision is subject to legitimate moral concern is another. To recognize the moral tragedy of Battlefield Triage is to recognize the impossibility of acting blamelessly in the situation. In this situation, the virtuous military physician is going to have to sacrifice important values such as justice, compassion, and respect for others, even with a defensible criterion in hand. The physician will grieve this sacrifice accordingly. The physician may find her decision difficult or stressful, and rightly so, because of what her circumstances require of her. This kind of moral tragedy results “in actions which betray and violate the rights of persons to whom there may be a strong duty of care. When this happens, it properly triggers an appropriate moral emotion since our moral integrity has been violated and this affects how we think of ourselves and what we have become.”[22] Rather than view her triage decision as the morally superior choice, the virtuous military physician will view her decisions in these circumstances in a different light: it is the least bad option in a terrible situation, and she did something ethically problematic, something that is contrary to her moral character. She deeply regrets the circumstances in which she had to act. IV. Virtue Ethics A virtue ethicist has insight into how one should go about deciding what to do in a moral tragedy, although virtue ethics may not be as helpful as one may hope. The goal of the virtuous military physician in Battlefield Triage is to adopt the best course of action or the action that she feels she ought to do, all things considered. This does not make her choice devoid of serious wrongdoing—a decision must be made, but that does not make it just. The virtuous military physician will approach the situation with courage, responsibility, and insight. She will think about the decision carefully, wisely, and conscientiously; she will weigh the goods and harms of the choices before her, in conjunction with a proper conception of the good life, human worth, and understanding of her obligations to others—including chain of command, fellow soldiers, and the medical community. She is attuned to the value of human life and has a reasonable idea of the various ways her decisions will affect others. She recognizes that she is in this non-ideal situation through no fault of her own: she is not the one fighting in battles; she is serving her country as a physician, whose job it is to save lives, treat everyone justly, and promote military objectives. She regrets the decision she is forced to make in battlefield triage, acting “with immense regret and pain,” Hursthouse explains, “instead of indifferently or gladly.”[23] This is because, no matter what decision is made, the virtuous military physician “does something terrible or horrible,” something she otherwise would not do and is contrary to her values.[24] V. A Resolvable Moral Tragedy Instead of asking whether there is a morally right decision, in which a decision is morally blameless and above reproach, the virtue ethicist asks whether there is a decision with a convincing rationale, knowing that a decision can have a clear rationale but still be morally tragic. It is perfectly reasonable to think that different virtuous persons will arrive at different courses of action: “two virtuous agents, in the same situation,” Hursthouse writes, “may act differently” in irresolvable moral tragedies, in cases in which there is no clear course of action.[25] Because a person must act in a moral tragedy, one goal is to identify reasons for choosing the chosen action. Some decisions are clearly indefensible—treating neither the compatriot soldier nor the enemy combatant in Battlefield Triage would be wrong—and some decisions are more problematic than others. If the military physician selects to treat the soldier because she does not like the enemy combatant’s skin color, such a reason would be deeply problematic. But much of the debate over how to act in a moral tragedy is not over clearly indefensible or problematic criteria. Instead, the literature is largely about different standards or implementations of justice. Some scholars defend nation-impartial triage as right, while others defend nation-aware triage as right, and each argues that the other side is promoting an unjust or otherwise wrong solution to Battlefield Triage. We suggest that Battlefield Triage is a resolvable moral tragedy and that virtue ethics offers convincing reasons to prefer the treatment of the compatriot soldier rather than the enemy combatant on the grounds of national identity. Virtues are integral to living a good life, a flourishing life, but as Aristotle observed long ago, human beings are inherently social, interdependent and interconnected in profound ways.[26] This goes beyond the obvious fact that we need each other to survive day to day (one person makes clothes, another farms, and another makes tools); the claim is that a good or flourishing life depends in large part on one’s social network or community. This is why many of Aristotle’s moral virtues are other facing: justice, friendship, generosity, and magnanimity, to name a few. Courage, a typically self-facing virtue, is understood by Aristotle to be the virtue that regards one’s fear of death in battle, a battle fought on behalf of one’s city.[27] All of this remains true today. Namely, there is an important sense in which our community matters to our lives: it is easier to live a good, flourishing life if one is part of a good, flourishing community. Our community is made up of smaller groups, and it is more accurate to say that we are simultaneous members of different groups within a broader community. A person may be part of a family, friend group, research team, large state university, city, state, and nation. Groups can function well or not, as we all have experienced, and this suggests that there are virtues or excellences that groups can instantiate. Good groups are unified in purpose, with each member doing their duty alongside others for the attainment of that purpose. Good groups manifest solidarity among their members. Although Aristotle does not list solidarity as a virtue, a number of modern-day virtue ethicists have begun examining how group solidarity can be a virtue that contributes to a good or flourishing life.[28] Solidarity is not conceptualized as an individual virtue, a virtue possessed by a person in isolation of others; instead, it is a collective virtue, a virtue that is shared among members of a defined group with particular ends.[29] “A group has solidarity to the extent that its members are disposed to: (1) share values, aims, or goals; (2) care about those values, aims, or goals; (3) act in accordance with those values, aims, or goals; (4) trust the testimony of other group members with respect to those values, aims, and goals; and (5) feel a sense of belonging to the group.”[30] The virtue of collective or group solidarity involves individuals having special concern for each other, shared aims and values, trust, loyalty, and a sense of belonging with these specific others. There is a oneness to the group in the pursuit of a definite goal or purpose, involving mutual support and affirmation of each member. As such, the group has ends and goods above and beyond the good of each individual person. Sometimes solidarity requires personal sacrifice for the collective (for example, a father sacrificing food so his child can eat). The virtue of collective or group solidarity is important to the military and medical community at every level, and for clear reasons. In the military, there is a clear hierarchy of command, unity of purpose and end, mutual trust and support in complex settings, and so on. Soldiers need to know they can count on one another, and solidarity grounds a soldier’s ability to trust others and be assured of mutual aid. In medicine, solidarity maintains self-regulation of the profession, shared values and goals, as well as public support, not to mention that day-to-day operations require physician trust, engagement, and effort toward the ends of clinical care. Physicians need to work together, along with others, in pursuit of health, and disunity is sowed when there is mistrust, selfishness, or disengagement among the healthcare team and organization. Importantly, just as we are all members of various groups and hence may manifest group solidarity in different settings, the virtuous military physician instantiates collective solidarity with both the medical profession and the military. Her dual loyalty contributes to the moral difficulty of acting in Battlefield Triage. The military physician has competing obligations to distinct groups and cannot satisfy all obligations in Battlefield Triage. Solidarity with the military supports the consideration of favoring the soldier for reasons of national identity, whereas solidarity with the medical community does not. Something has to give, which is why it is a moral tragedy. The virtuous military physician, therefore, must weigh the costs of each course of action. To fulfill her obligations to the medical community would require that she does not use nationality and other non-medical considerations in Battlefield Triage. Since the soldier and enemy combatant are equally injured, justice would demand a random process, perhaps a flip of the coin. Although this may satisfy obligations the military physician has to the medical community, this would be costly to the physician’s military group. If word gets out that the physician decides who to treat based on a coin toss, soldiers, families, and citizens may become frustrated and angry. Soldier morale may go down if it becomes known that a coin flip led to the preventable death of a soldier and the saving of an enemy combatant who had killed (or attempted to kill) other soldiers. As Gross highlights, military solidarity involves a mutual aid promise that military personnel promise to help one another.[31] A military physician is part of the military and, as such, is part of the mutual aid promise, which would appear to be violated if the physician flips a coin. Treating a member of one’s own team may be psychologically more beneficial than treating an enemy combatant and may lead to less moral distress.[32] Finally, treating soldiers rather than enemy combatants promotes broader military and social aims, including returning soldiers to health, maintaining unity of purpose, and minimizing community suffering from a soldier’s death. Favoring members of one’s group, that is, triage based on nationality in Battlefield Triage, would fulfill obligations of military group loyalty, which is contrary to the values and duties of medicine. It does not seem as though showing favoritism in this particular situation is very costly to the medical community or general public, but this is because there is recognition that the physician is in the military. Medicine is impartial to non-medical indications partly because of fairness and to promote public trust in medicine. However, Battlefield Triage is unique, as medicine is being practiced in a non-public, wartime setting. In ordinary circumstances, a patient’s identity is irrelevant, and physicians ought not play favorites. Since Battlefield Triage is not an ordinary circumstance, decisions based on patient identity may not undermine public trust in medicine. In addition, it is contestable that fairness in Battlefield Triage requires that no consideration be paid to one’s nationality. Fairness is about giving each person their due, what is owed to them, and the case can be made that soldiers who place themselves in danger for the sake of the common good or a just cause are owed special attention when they suffer harm in the line of duty. In other words, soldiers voluntarily undergo risk to themselves for the greater good, and society owes them for this sacrifice. This plausibly includes preferential treatment in a situation such as Battlefield Triage. So, while the medical community affirms justice demands non-preferential treatment, the military community can affirm the opposite. The demands of fairness are unclear at best or in conflict in this situation: demands of physician justice decry favoritism, while demands of military justice support favoritism. Triage not based on nationality is arguably unfair and triage based on nationality may not undermine public trust, after all. All things considered, there is a clear rationale for favoring nationality-based preferential treatment in Battlefield Triage. Adopting a nationality-based preference in this situation is more defensible than not. This does not make such a decision ethically right or just. Preference based on nationality is the least bad decision, but it is not morally blameless. It involves one in a serious moral wrong, a wrong otherwise avoided and contrary to one’s character. The virtuous military physician is in a situation in which obligations conflict, and we disagree with Gross, who posits that care of fellow soldiers “is important to the near exclusion of all else.”[33] Gross fails to appreciate the collective virtue of solidarity as applied to those in medicine. The military physician has duties to fellow soldiers but also to fellow physicians, to the medical community, and humanity. To favor a soldier on grounds of nationality violates her duties and responsibilities to this latter group. She is involved in a moral tragedy and can only seek the most just action given the circumstances, yet, at least in virtue ethics, the action remains far from blameless. CONCLUSION We argue that Battlefield Triage is a moral tragedy, meaning that it is a situation in which there is no morally blameless decision and that the demands of justice cannot be satisfied. As such, the virtuous military physician incurs a moral cost to acting as she does—there is a moral residue. However, despite being a moral tragedy, there are clear reasons to act in favor of treating one’s own, considering group solidarity. As such, these kinds of tragedies are resolvable: virtuous military physicians should favor treatment of their own, although they would do so with sorrow. - [1] Militaries set forth medical rules of eligibility or guidelines used to determine whether a person qualifies for specific medical interventions or treatments in certain circumstances, and these guidelines are binding for a military physician. For example, despite opposition from medical organizations, militaries have adopted reverse triage guidelines for military physicians to follow. For ethical discussion, see Falzone, Elisabeth, P. Pasquier, C. Hoffmann, O. Barbier, M. Boutonnet, A. Salvadori, A. Jarrassier, J. Renner, B. Malgras, and S. Mérat. "Triage in military settings." Anaesthesia Critical Care & Pain Medicine 36, no. 1 (2017): 43-51. https://doi.org/10.1016/j.accpm.2016.05.004 [2] There are issues that are related to this, including the triage of civilians and allied soldiers. We set related issues aside for purposes of this paper [3] American Medical Association, Code of Medical Ethics: Current Opinions with Annotations, 2004–2005 ed. (Chicago, IL: AMA, 2004), 300. [4] American Medical Association, Code of Medical Ethics: Current Opinions with Annotations, 2004–2005 ed. (Chicago, IL: AMA, 2004), 300. [5] This is termed the “dual loyalty” dilemma in military medicine and has been described at length elsewhere: Institute of Medicine (US) Board on Health Sciences Policy. Military Medical Ethics: Issues regarding Dual Loyalties: Workshop Summary. Washington (DC): National Academies Press (US); 2008. Toward a Framework for Resolving Dual Loyalties. Available from: https://www.ncbi.nlm.nih.gov/books/NBK214853/ [6] See Kenneth G. Swan and K.G. Swan, Jr., “Triage: The Past Revisited,” Military Medicine 161:8 (1996): 448–452. https://doi.org/10.1093/milmed/161.8.448; Jerome A. Singh, “American Physicians and dual loyalty obligations in the ‘war on terror,’” BMC Medical Ethics 4.4 (2003): 1–10. https://doi.org/10.1186/1472-6939-4-4; Beam, Thomas E. "Medical Ethics on the Battlefield." Military Medical Ethics: Sect. IV. Medical ethics in the military. Medical ethics on the battlefield: the crucible of military medical ethics 2 (2003): 369-402; Hereth, Blake. "Health justice for unjust combatants." Journal of Military Ethics 20, no. 1 (2021): 67-81. https://doi.org/10.1080/15027570.2021.1949782. [7] See Adams, Marcus P. "Triage priorities and military physicians." In Physicians at war: The dual-loyalties challenge, pp. 215-236. Dordrecht: Springer Netherlands, 2008. Gross, Michael L. "Comradery, community, and care in military medical ethics." Theoretical medicine and bioethics 32 (2011): 337-350. https://doi.org/10.1007/s11017-011-9189-6. Gross, Michael L. "The limits of impartial medical treatment during armed conflict." In Military medical ethics for the 21st century, pp. 71-84. Routledge, 2016. [8] World Medical Association, WMA Declaration of Lisbon on the Rights of the Patient. 5 December 2022, https://www.wma.net/policies-post/wma-declaration-of-lisbon-on-the-rights-of-the-patient/ [9] Geneva Convention for the Amelioration of the Condition of Wounded, Sick in Armed Forces in the Field. 12 August 1949. https://www.un.org/en/genocideprevention/documents/atrocity-crimes/Doc.30_GC-I-EN.pdf. [10] List, Justin M. "Medical neutrality and political activism: physicians' roles in conflict situations." In Physicians at war: The dual-loyalties challenge, pp. 237-253. Dordrecht: Springer Netherlands, 2008. 240 [11] Beauchamp, T., and J. Childress. 2013. Principles of Biomedical Ethics, 7th ed. Oxford, United Kingdom: Oxford University Press. [12] Adams, Marcus P. "Triage priorities and military physicians." In Physicians at war: The dual-loyalties challenge, pp. 215-236. Dordrecht: Springer Netherlands, 2008. [13] Gross, "Comradery, community, and care in military medical ethics," 347. [14] Gross, “Comradery, community, and care in military medical ethics,” 349. [15] Gross, Michael L. "When medical ethics and military ethics collide." Narrative inquiry in bioethics 13, no. 3 (2023): 199-204. 202 https://dx.doi.org/10.1353/nib.2023.a924191 [16] Our argument draws on virtue ethics, from which care ethics derives, and it is worth clarifying how our argument relates to Gross’s. We do not think that the virtue of friendship grounds triage decisions, for we think it is unlikely that the physician and wounded soldier are friends. Instead, as explained below, we think the collective virtue of group solidarity better captures the moral significance of group loyalty and that Gross would agree with us. But since military physicians are part of distinct groups, with competing obligations, the military physician will be forced to sacrifice a value in battlefield triage cases. In other words, we think Gross downplays the dual group membership of a military physician. [17] List,”Medical neutrality and political activism,” 250. [18] Adams,”Triage priorities and military physicians,” 235. [19] London, Leslie, Leonard S. Rubenstein, Laurel Baldwin-Ragaven, and Adriaan Van Es. "Dual loyalty among military health professionals: human rights and ethics in times of armed conflict." Cambridge Quarterly of Healthcare Ethics 15, no. 4 (2006): 381-391. 383. [20] Hursthouse, R. On Virtue Ethics. OUP 1999. 74 [21] Nussbaum, Martha C. "The costs of tragedy: Some moral limits of cost-benefit analysis." The Journal of Legal Studies 29, no. S2 (2000): 1005-1036, 1007. [22] De Wijze, S. (2005). Tragic-remorse–the anguish of dirty hands. Ethical theory and moral practice, 7(5), 453-471, 457. https://doi.org/10.1007/s10677-005-6836-x [23] Hursthouse, 73 [24] Hursthouse, 81 [25] Hursthouse, 72 [26] Aristotle, Politics 1253a8. Reeve, C. D. C., Indianapolis: Hackett Publishing Co., 2017 [27] Aristotle, Nicomachean Ethics. III.6.114a, 34-35. 2002, Nicomachean Ethics, Christopher Rowe (trans.), Oxford: Oxford University Press [28] Byerly, T. Ryan, and Meghan Byerly. "Collective virtue." The Journal of Value Inquiry 50, no. 1 (2016): 33-50. https://doi.org/10.1007/s10790-015-9484-y; Federico, Veronica. "Conclusion: solidarity as a public virtue." Solidarity as a Public Virtue (2018): 495-542. https://doi.org/10.5771/9783845290058. Rehg, William. "Solidarity and the common good: An analytic framework." Journal of Social Philosophy 38, no. 1 (2007): 7-21. https://doi.org/10.1111/j.1467-9833.2007.00363.x [29] Byerly and Byerly. "Collective virtue." 43 [30] Battaly, Heather. "Solidarity: Virtue or vice?." In Social virtue epistemology, pp. 303-324. Routledge, 2022. 304 [31] Ibid., 2011: 341 [32] It might be thought that displaying altruism by helping an enemy combatant at the expense of one’s fellow soldier may be psychologically satisfiying. For evidence that military physicians find it difficult to treat enemy combatants, see Lundberg, Kristina, Sofia Kjellström, Anders Jonsson, and Lars Sandman. "Experiences of Swedish military medical personnel in combat zones: adapting to competing loyalties." Military medicine 179, no. 8 (2014): 821-826. https://doi.org/10.7205/MILMED-D-14-00038. Lamblin, Antoine, Clément Derkenne, Marion Trousselard, and Marie-Ange Einaudi. "Ethical challenges faced by French military doctors deployed in the Sahel (Operation Barkhane): a qualitative study." BMC Medical Ethics 22 (2021): 1-13. https://doi.org/10.1186/s12910-021-00723-2 [33] Ibid., 2011: 344. (shrink)

Feminism is sometimes equated with demands for equal rights for women. Mary Wollstonecraft in the eighteenth century argued, against Rousseau, that women should be accorded the same rights and freedoms based on rational principles that were being demanded for men. In the nineteenth century, John Stuart Mill and Harriet Taylor Mill, rejecting prevailing views of the time, called for an end to the subjection of women through an extension to women of equal rights and equal opportunities. Women, they argued, should (...) have the same rights as men to own property, to vote, to receive education, and to enter any profession. In the twentieth century, women's movements often focused their attention on winning for women the right to vote, achieved in the United States in 1920, in England in 1918 and 1928, in France in 1946, and in Switzerland only in 1971. The second wave of the women's movement in the United States, starting in the late 1960s, placed strong emphasis on achieving an Equal Rights Amendment to the US Constitution (the amendment failed to be ratified by the required number of states), and on ending discrimination against women in all its forms. Arguments for welfare rights, valid independently of feminism, were seen as particularly important to women: how could a person enjoy rights to freedom or equal protection of the laws without assurance of the means to stay alive and to feed her children? Either employment and child care must be available, or persons must have access by right to the basic necessities of life. Negative freedoms from discriminatory interferences are insufficient; positive enablements to be free and equal agents must also be assured by rights. (shrink)