Introduction While quizzing during informed consent for research to ensure understanding has become commonplace, it is unclear whether the quizzing itself is problematic for potential participants. In this study, we address this issue in a multinational HIV prevention research trial enrolling injection drug users in China and Thailand. Methods Enrolment procedures included an informed consent comprehension quiz. An informed consent survey followed. Results 525 participants completed the informed consent survey (Heng County, China=255, Xinjiang, China=229, Chiang Mai, Thailand=41). Mean age was (...) 33 and mean educational level was 8 yrs. While quizzing was felt to be a good way to determine if a person understands the nature of clinical trial participation (97%) and participants did not generally find the quiz to be problematic, minorities of respondents felt pressured (6%); anxious (5%); bored (5%); minded (5%); and did not find the questions easy (13%). In multivariate analysis, lower educational level was associated with not minding the quizzing (6–10 yrs vs 0–5 yrs: OR=0.27, p=0.03; more than 11 yrs vs 0–5 yrs: OR=0.18, p=0.03). There were also site differences (Heng County vs Xinjiang) in feeling anxious (OR=0.07; p=<0.01), not minding (OR=0.26; p=0.03), being bored (OR=0.25; p=0.01) and not finding the questions easy (OR=0.10; p=<0.01). Conclusions Quizzing during the informed consent process can be problematic for a minority of participants. These problems may be associated with the setting in which research takes place and educational level. Further research is needed to develop, test and implement alternative methods of ensuring comprehension of informed consent. Trial Registration clinicaltrials.gov number NCT00270257. (shrink)

Many medical ethicists accept the thesis that there is no moral difference between withholding and withdrawing life-sustaining therapy. In this paper, we offer an interesting counterexample which shows that this thesis is not always true. Withholding is distinguished from withdrawing by the simple fact that therapy must have already been initiated in order to speak coherently about withdrawal. Provided that there is a genuine need and that therapy is biomedically effective, the historical fact that therapy has been initiated entails a (...) claim to continue therapy that cannot be attributed to patients who have not yet received therapy. This intrinsic difference between withholding and withdrawing therapy is of moral importance. In many instances, patients will waive this claim. But when one considers withdrawing therapy from one patient to help another in a setting of scarce resources, this intrinsic moral difference comes into sharp focus. In an era of shrinking medical resources, this difference cannot be ignored. (shrink)

We elaborate the kind of metaphysical, ontological arguments and positions put forth by Martin and Sugarman in several ways, in an attempt to clarify that it is the assumption of psychological and sociocultural entities as fixed ontological categories that makes psychological—sociocultural dualism problematic, not the necessary distinction it draws between sociocultural and psychological processes. In so doing, we develop an emergent, mutable metaphysics and ontology for psychological and sociocultural processes that emphasizes their dynamic interrelation. We then attempt to articulate and (...) defend a neorealist hermeneutics as a viable epistemological accompaniment to this dynamic, interactionist metaphysics, and to indicate its appropriateness to psychological inquiry in particular. (shrink)

Experiments have suggested that umbilical cord blood stem cells can be used to prevent diseases such as atherosclerosis. This paper discusses ethical issues surrounding such usage such as the uncertainty that individuals at risk of a disease will actually get the disease; issues related to research with children; safety issues; from where these stem cells would be obtained; and whether these usages should be considered as therapies or as physical enhancements.

As part of a larger research study, we present model language for disclosing financial interests in clinical research to potential research participants, and we describe the empirical basis and theoretical assumptions used in developing the language. The empirical process for creating appropriate disclosure language resulted in a generic disclosure statement for cases in which no risk to participants’ welfare or the scientific integrity of the research is expected, and nine more specific disclosure statements for cases in which some risk is (...) expected. The disclosure statements are not meant to be canonical, but were instead designed to reflect the typical situations in which disclosure of financial interest might be considered by an institutional review board or conflict of interest committee. Individual institutions could modify key phrases to suit their purposes, and others could use the language in future empirical work on informed consent to better refine the options for disclosing financial interests in clinical research. (shrink)

Television medical dramas sometimes depict medical professionalism and bioethical issues, but their nature and extent are unclear. The authors systematically analysed the bioethical and professionalism content of one season each of Grey's Anatomy and House M.D., two of the most popular current television medical dramas. The results indicate that these programmes are rife with powerful portrayals of bioethical issues and egregious deviations from the norms of professionalism and contain exemplary depictions of professionalism to a much lesser degree.

The considerable attention to financial interests in clinical research has focused mostly on academic medical centers, even though the majority of clinical research is conducted in community practice settings. To fill this gap, this article maps the practices and policies in 73 community hospitals and several hundred specialized facilities around the country for reviewing clinical investigators’ financial relationships with research sponsors. Community hospitals face a substantially different mix of issues than academic medical centers do because their physician researchers are usually (...) not employees, and more of their studies are later-phase, multicenter trials. Accordingly, community physicians stand to benefit personally from per capita payments, but they tend to have less direct influence over research findings when compared with their academic peers. These and other contrasts require separate guidance for community-based organizations that takes into account their particular needs, circumstances, and institutional capacities. (shrink)

Television medical dramas frequently depict the practice of medicine and bioethical issues in a strikingly realistic but sometimes inaccurate fashion. Because these shows depict medicine so vividly and are so relevant to the career interests of medical and nursing students, they may affect these students' beliefs, attitudes, and perceptions regarding the practice of medicine and bioethical issues. We conducted a web-based survey of medical and nursing students to determine the medical drama viewing habits and impressions of bioethical issues depicted in (...) them. More than 80% of medical and nursing students watch television medical dramas. Students with more clinical experience tended to have impressions that were more negative than those of students without clinical experience. Furthermore, viewing of television medical dramas is a social event and many students discuss the bioethical issues they observe with friends and family. Television medical dramas may stimulate students to think about and discuss bioethical issues. (shrink)

Participants in clinical research sometimes view participation as therapy or exaggerate potential benefits, especially in phase I or phase II trials. We conducted this study to discover what methods might improve cancer patients’ understanding of early-phase clinical trials. We randomly assigned 130 cancer patients from three U.S. medical centers who were considering enrollment in a phase I or phase II cancer trial to receive either a multimedia intervention or a National Cancer Institute pamphlet explaining the trial and its purpose. Intervention (...) participants were 32 times more likely to believe that the trial’s purpose was to examine safety and 60 % less likely to believe they would experience long-term benefit or cure. There was no difference in enrollment decision. However, while patients’ understanding of the trial’s purpose improved and expectations of long-term benefit diminished, half the respondents still believed they would experience long-term benefit or cure from participation. Therefore, we conclude that multimedia interventions such as this one may help oncologists to explain the risks and benefits of early-phase cancer trials in a way that patients can more easily understand, helping them to make more informed decisions about participation. But further research into other factors that influence patients’ beliefs about the outcome of enrollment is needed, both to modify the interventions and to determine how malleable patient beliefs are. (shrink)

Book reviewed in this article: Wrong Medicine. By Lawrence J. Schneiderman and Nancy S. Jecker.

Pragmatic clinical trials offer important benefits, such as generating evidence that is suited to inform real-world health care decisions and increasing research efficiency. However, PCTs also present ethical challenges. One such challenge involves the management of information that emerges in a PCT that is unrelated to the primary research question, yet may have implications for the individual patients, clinicians, or health care systems from whom or within which research data were collected. We term these findings as?pragmatic clinical trial collateral findings,? (...) or?PCT-CFs?. In this article, we explore the ethical considerations associated with the identification, assessment, and management of PCT-CFs, and how these considerations may vary based upon the attributes of a specific PCT. Our purpose is to map the terrain of PCT-CFs to serve as a foundation for future scholarship as well as policy-making and to facilitate careful deliberation about actual cases as they occur in practice. (shrink)

This paper argues that Sulmasy and Sugarman have not succeeded in showing a moral difference between withholding and withdrawing treatment. In particular, they have misunderstood historical entitlement theory, which does not automatically prefer a first occupant by just acquisition.

A history of injustices to diverse groups of human subjects in medical research has resulted in concerted efforts by U.S. policymakers in the second half of the twentieth century to provide greater protection for future subjects. However, in the context of patient populations demanding better therapies, potential medical advances, and greater attention to issues of social justice, Kahn, Mastroianni, and Sugarman set out to reconceptualize the principle of justice in human subjects research to address these urgent concerns. In BeyondConsent, Kahn (...) and colleagues advance a framework of justice in terms of access to participation in research, instead of protection. Their worthy cause, developed out of collaboration on the White House Advisory Committee on Human Radiation Experiments, aims to demonstrate how previously unaddressed notions of justice now require greater consideration in research. Specifically, they emphasize how fairness requires a greater distribution of risks and benefits, and that The volume does not report new research findings but rather draws on multidisciplinary approaches, including law, medicine, philosophy, history, and health policy, to argue that justice must go beyond informed consent. The editors posit that this challenge to protectionism is necessary given the heightened urgency for patients to benefit from investigational therapies although they incur increased risks. (shrink)

In contemporary forms of psychoanalysis, particularly intersubjective systems theory, the turn towards contextualism has permitted the development of new ways of thinking and practicing that have dispensed with the notion of isolated individuality. For many who embrace this "post-subjectivist" way of thinking and practicing, the recognition that all human experience is fundamentally immersed in the world makes the question of individuality seem confusing, even anachronistic. Yet the challenge of individuality remains an important and pressing issue for contemporary theory and practice; (...) many clinicians are left to wonder about the role of "individual" experience and how to approach it conceptually or clinically. This volume of original essays gives the problem of individuality its due, without losing sight of the importance of contextualized experience. Drawing on a variety of disciplinary backgrounds - philosophical, developmental, biological, and neuroscientific - the contributors address the tension that exists between individuality and the emergence of contextualism as a dominant mode of psychoanalytic theory and practice, thereby providing unique insights into the role and place of individuality both in and out of the clinical setting. Ultimately, these essays demonstrate that individuality, no matter how it may be defined, always occurs within a contextual web that forms the basis of human experience. _Contributors:_ William J. Coburn, Philip Cushman, James L. Fosshage, Roger Frie, Frank M. Lachmann, Jack Martin, Donna Orange, Robert D. Stolorow, Jeff Sugarman. (shrink)

Patient narratives from two investigational deep brain stimulation trials for traumatic brain injury and obsessive‐compulsive disorder reveal that injury and illness rob individuals of personal identity and that neuromodulation can restore it. The early success of these interventions makes a compelling case for continued post‐trial access to these technologies. Given the centrality of personal identity to respect for persons, a failure to provide continued access can be understood to represent a metaphorical identity theft. Such a loss recapitulates the pain of (...) an individual's initial injury or illness and becomes especially tragic because it could be prevented by robust policy. A failure to fulfill this normative obligation constitutes a breach of disability law, which would view post‐trial access as a means to achieve social reintegration through this neurotechnological accommodation. (shrink)

In this paper I critically examine the implications of the uncodifiability thesis for principlism as a pluralistic and non-absolute generalist ethical theory. In this regard, I begin with a brief overview of W.D. Ross’s ethical theory and his focus on general but defeasible prima facie principles before turning to 2) the revival of principlism in contemporary bioethics through the influential work of Tom Beauchamp and James Childress; 3) the widespread adoption of specification as a response to the indeterminacy of abstract (...) general principles and the limitations of balancing and deductive approaches; 4) the challenges raised to fully specified principlism by the uncodifiability thesis and 5) finally offer a defense of the uncodifiability thesis against various critiques that have been raised. (shrink)

In Revering God, author and scholar Thaddeus Williams bridges the gap between abstract theology and awe-inspired devotion, helping readers better understand God and drawing them into a deeper state of joy and reverence for their Creator.

Healthcare priority-setting institutions have good reason to want to demonstrate that their decisions are morally justified—and those who contribute to and use the health service have good reason to hope for the same. However, finding a moral basis on which to evaluate healthcare priority-setting is difficult. Substantive approaches are vulnerable to reasonable disagreement about the appropriate grounds for allocating resources, while procedural approaches may be indeterminate and insufficient to ensure a just distribution. In this paper, we set out a complementary, (...) coherence-based approach to the evaluation of healthcare priority-setting. Drawing on Rawls, we argue that an institutional priority-setter’s claim to moral justification can be assessed, in part, based on the extent to which its many normative commitments are mutually supportive and free from dissonance; that is, on the ability to establish narrow reflective equilibrium across the normative content of a priority-setter’s policy and practice. While we do not suggest that the establishment of such equilibrium is sufficient for moral justification, we argue that failure to do so might—like the proverbial canary in the coalmine—act as a generalised warning that something is awry. We offer a theoretical argument in support of this view and briefly outline a practical method for systematically examining coherence across priority-setting policy and practice. (shrink)

Some organisations make vaccination a condition of employment. This means prospective employees must demonstrate they have been vaccinated (eg, against measles) to be hired. But it also means organisations must decide whether _existing_ employees should be expected to meet newly introduced vaccination conditions (eg, against COVID-19). Unlike prospective employees who will not be _hired_ if they do not meet vaccination conditions, existing employees who fail to meet new vaccination conditions risk being _fired_. The latter seems worse than the former. Hence, (...) objections to vaccination mandates commonly centre on the harms that will be visited on existing employees who are unwilling to be vaccinated. However, because this objection does not necessarily entail the claim that vaccination is unnecessary for the effective and safe performance of certain jobs, those making this objection should have less of an objection, or no objection at all (at least on these grounds), to introducing vaccination requirements in some cases for _prospective_ employees. Yet, in this paper, I shall argue that if one has reason to believe vaccination requirements can be justified for prospective employees, one should also believe they are justified for existing employees _despite_ any asymmetry in consequences experienced by the two groups. As a consequence, common objections made against vaccination mandates grounded solely in the harms that may be experienced by existing employees who are unwilling to be vaccinated should be considered unpersuasive. (shrink)

The imagery we adopt when recalling the personal past may involve different perspectives. In many cases, we remember the past event from our original point of view. In some cases, however, we remember the past event from an external “observer” perspective and view ourselves in the remembered scene. Are such observer perspective images genuine memories? Are they accurate representations of the personal past? This chapter focuses on such observer perspectives in memory, and outlines and examines proposals about the nature of (...) such imagery. (shrink)

Rooted in the field of cathedral studies, this paper draws into dialogue three bodies of knowledge: Edward Bailey’s notion of implicit religion that, among other things, highlights the continuing traction of the Christian tradition and Christian practice within secular societies; David Walker’s notion of the multiple ways through which in secular societies people may relate to the Christian tradition as embodied within the Anglican Church and John Fisher’s notion of spiritual wellbeing as conceptualised in relational terms. Against this conceptual background, (...) this paper draws on data provided by 1234 participants attending one of the Christmas Eve carol services in Liverpool Cathedral to explore the perceived impact of attendance on the spiritual health of people who do not believe in God and yet feel that Liverpool Cathedral is their cathedral, and it is this sense of belonging that brings them back at Christmas time.Contribution: Situated within the science of cathedral studies, this paper links in an original way three fields of discourse: Edward Bailey’s notion of implicit religion, David Walker’s notion of the four ways of belonging to God facilitated by the Anglican Church and John Fisher’s conceptualisation and operationalisation of the notion of spiritual wellbeing. The hypothesis developed from this original integration of theoretical perspectives is then tested empirically on data provided by 404 participants at carol services who do not believe in God. (shrink)

Hasdai Crescas fue un importante pensador, autor y líder comunitario judío de finales del siglo XIV y principios del XV, cuyas obras son estudiadas con detalle en el mundo académico. No obstante, su impacto sobre la comunidad judía tradicional ha sido casi inexistente. Nunca terminó su obra legal, la que podría haber tenido impacto en los judíos tradicionales. Sus escritos filosóficos conservados son difíciles de seguir; solo sobrevive una de las dos polémicas anticristianas vernáculas, en una traducción/paráfrasis hebrea. Aunque Crescas (...) fue bien recordado en el siglo posterior a su muerte, ya en este período se pueden detectar las razones de su posterior olvido. Un examen de la historia de la recepción de la obra de Crescas en el siglo XV demuestra hasta qué punto sus posiciones polémicas, dogmáticas y filosóficas fueron mayoritariamente rechazadas, más allá de que tuvo partidarios, fundamentalmente entre sus alumnos más cercanos. No es de extrañar, entonces, que en los siglos posteriores, la memoria de Crescas fuera casi borrada de la conciencia comunitaria judía. (shrink)

Many metaphor theorists argue that our mental experience of time is grounded in our understanding of space, including motion through space. Results from recent experiments – in which people think about motion, which in turn influences their thinking about time – support this position. Still, many questions remain about the nature of the metaphorical connection between time and space. Can the mere suggestion of motion influence how people reason about time, and if so, when and how? Three experiments investigated how (...) thinking about “abstract” motion through sequences of numbers or letters would influence reasoning about time. Our results extend earlier psychological work on the link between time and space by showing that even motion in non-physical domains can influence temporal reasoning. The results provide further evidence that metaphorical understanding is grounded in our everyday physical and conceptual experience. (shrink)

The introduction of normothermic regional perfusion (NRP) in controlled donation after circulatory determination of death (cDCDD) protocols is by some regarded as controversial and ethically troublesome. One of the main concerns that opponents have about introducing NRP in cDCDD protocols is that reestablishing circulation will negate the determination of death by circulatory criteria, potentially resuscitating the donor. In this article, I argue that this is not the case. If we take a closer look at the concept of death underlying the (...) circulatory criterion for determination of death, we find that the purpose of the criterion is to show whether the organism as a whole has died. I argue that this purpose is fulfilled by the circulatory criterion in cDCDD protocols, and that applying NRP does not negate the determination of death or resuscitate the donor. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:VIOLENCE AND NONVIOLENCE IN HINDU RELIGIOUS TRADITIONS Francis X. Clooney, SJ. Boston College Outline I.Violence, Sacrifice and Ritual 1. Some basic attitudes toward the killing of animals 2.Resolving the problem of sacrificial violence by internalization 3.Substitutions 4.Renunciation and nonviolence: an elite pathway 5.Violence andnonviolenceinrelation to vegetarianism: Hans Schmidt's theses?. Traditional Hindu Theorizations of Violence in Mimamsa Ritual Theory and Vedanta Theology 1. The ritual analysis (at Mimamsa Sutra 1.1.2) (...) of the Shyena rite which is performed in order to harm enemies 2.The Vedanta analysis (at Uttara Mimamsa Sutra 3.1.25) of ritual violence in relation to the prohibition of violence??. Violence in the Life of the State HOFrancis X. Clooney, S.J. 1. The royal power to punish (danda) 2.The synthesis of the ideals of brahmin and king a..The distribution and management of violence in the Laws ofManu (1st century CE) b. Policy toward warfare in the Arthashastra of Kautilya 3.The collapse of the brahmanical synthesis—and the emergence of a (seemingly) more nonviolent Hinduism 4.A comment on Gandhi (1 869-1948) and the contemporary emergence of post-Gandhian Hindu perspectives IV.Alternate Views from Outside the Sanskritic Tradition 1. Tamil Wisdom on Violence and Nonviolence: a.Tirukkural (c. 2nd century CE) b.Cilappatikaram (5th century CE) 2.Blood and Goddesses 3.From a Village Perspective a. Some Trouble with Cows b.Mahasweta Devi and the Literary Exposure of Violence V.The Question of a Christian Perspective on the Hindu Treatment of Violence and Religion: Are Victims Necessary? Some Presuppositions: • The following reflections, complex as they are, are governed by a reluctance to simplify Hindu teaching. I seek to avoid the view that the Hindu traditions had only one view of violence and nonviolence. • I use the term "Hindu" loosely and as a shorthand, without claiming that there is a single Hindu tradition, or a single creed shared by all Hindus, or a single attitude toward violence. But neither do I claim that there are simply many traditions without any common elements which justify the appellation "Hindu." • I am reluctant to idealize the Hindu traditions as if nonviolence must necessarily be taken as the epitome ofHindu thought. India's traditions are complex, and require complex treatment. • A serious artificiality of this paper is that I treat Hinduism without simultaneously lookinginto Buddhist andJain materials, though both were traditions with important and enduring commitments to nonviolence. Particularly with respect to the renunciant, marginal components of traditions, one ought not to make overly neat or decisive distinctions Violence and Nonviolence in Hindu Religious Traditions 1 1 1 between the Hindu, Buddhist, and Jain theories and practices related to violence and nonviolence. • I attempt to give preference to indigenous discussions ofissues related to violence and nonviolence; the context and mode of thinking are important, notjust the conclusions drawn. I therefore avoid simply mining Hindu texts for an answer to a contemporary question, "What is the Hindu attitude toward violence and nonviolence?" • In most ofwhat follows we must distinguish contexts where "violence" indicates "physical action which causes pain to some living being," from contexts where "violence" indicates "an intention, rooted in anger or malice, to hurt someone." I use the word "violence" for both in order to highlight the complex issues of distinction involved. In considering the Sanskrit formulations, one likewise has to distinguish himsa as "causing pain" from himsa as "intending to harm." • It is often difficult to date ancient texts, and even when one narrows down a date—within 200-300 years—its significance still depends on other, often equally broadly stated dates. Nevertheless, I do offer dates throughout, as summarized here: •ancient Vedic sacrificial practices, from before 1200 BCE •Vedic ritual analyses and reformulations of sacrifices as ritualized acts, in the Brahmanas, from after 1000 BCE •the Upanishadic exploration of the deeper meanings of ritual and interiorized alternatives to ritual, from after 900 BCE •the Buddha, c. 500 BCE •key texts in the theorization of royal power, The Laws of Manu (beginning of Common Era) and Arthashastra (c. 150 CE) •the Tamil wisdom text Tirukkural (100 CE) •Goddess texts as evidenced in Sanskrit formulations, from after 500 CE... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Call for New Theological Reflection on the Sacramental Character of Marriage and the Thought of St. ThomasLawrence J. WelchTheologians across the theological spectrum have called attention to the urgent need for a new reflection on the theological and sacramental character of marriage. Peter Hünermann, known for his strong criticism of magisterial teachings on marriage, and the late Cardinal Carlo Caffarra, known for his equally strong defense of them, (...) have both drawn attention to this need. At an international symposium in September 2015, held in Rome prior to the Ordinary Synod of Bishops on Marriage and the Family, Hünermann gave a presentation entitled "On the Specific Theological Character of the Sacrament of Matrimony."1 The symposium aimed at providing a critical and scholarly discussion of new and constructive perspectives for the Church doctrine on marriage and family life in time for the 2015 synod on the family.2 Some of Hünermann's work from this paper also came to be known from an interview in Commonweal magazine where he summarized some of the main points of his symposium presentation.3 In the interview, he also revealed that before the 2015 synod he [End Page 845] was invited to speak with Pope Francis about the theology of marriage. Understandably, this meeting heightened interest in the German theologian's thought.Hünermann argues that "the specific character of the sacrament of marriage, which is very closely connected to the dying of the marriage bond,... has scarcely been the object of theological reflection, [and] is almost unknown in the consciousness of the bishops." 4 Hünermann appeals to St. Thomas as a way forward for understanding the theological character of marriage. This appeal is situated within a wider examination5 that offers an elaboration and new interpretation of "the specific dogmatic characteristics of the sacrament of matrimony that emerge in today's situation from a critical comparison of the encyclical Casti connubii and the Catholic theological tradition, especially the theology of St. Thomas."6 Sharply critical of the encyclical, Hünermann sees it as having saddled the Church with a legalistic concept of marriage elevated above history that is too far removed from the Catholic theological tradition and St. Thomas's theology of marriage.The year before his death, Cardinal Caffarra gave the 2016 graduation address at the John Paul II Institute for Marriage and Family in Washington, DC.7 Among the challenges he identified for the institute to address was the [End Page 846] need for theological reflection on the sacramental character of marriage. Referring to his earlier work, he pointed out that theology after the Council of Trent "lost the awareness of sacramental ontology, of the real transformation produced by the sacrament in the persons of the spouses [res et sacramentum]."8 Furthermore, according to Caffarra, the "theology of the conjugal covenant was supplanted by the notion of a contract, as a human act by which two persons commit to one another." The sacramental character was thought of as consisting of the assurance of divine graces given to fulfill the contract. Caffarra claimed that, "consequently, the words of Jesus 'What God has joined together, let not man put asunder,' lost all their realistic force. Absolute indissolubility, once the sacrament was perfected [=a ratified, consummated marriage], became essentially indefensible."9The primary interest of this paper is to respond to the call for a renewed theological reflection on the specific character of the sacrament of marriage. I wish to take up Caffarra's suggestion to focus on the sacramental character (res et sacramentum) on the one hand, and on the other hand, Hünermann's suggestion that a kind of ressourcement from St. Thomas Aquinas's theology of marriage can be of great help for a fresh theological reflection on the specific character of the sacrament of marriage. Although I agree with Hünermann that a renewed consideration of the thought of St. Thomas can be a way forward, I differ from him on how it can be. Hünermann notices that St. Thomas speaks of the grace of the sacrament of marriage as a helping grace.10 St. Thomas does indeed speak this way of the... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:THE GREAT GATSBY: ROMANCE OR HOLOCAUST? Thomas J. Cousineau Washington College In an otherwise appreciative response to The Great Gatsby, H. L. Mencken expressed a reservation about the plot ofthe novel, which he characterized as "no more than a glorified anecdote" (Claridge 156). Writing to Edmund Wilson, Fitzgerald suggested, in turn, that what Mencken did not find in Gatsby was "any emotional backbone at the very height of it" (...) (Turnbull 342). Critics ofthe novel, however, have tended to overlook the self-evident fact that the novel's ostensible emotional center—the reunion between Gatsby and Daisy—does not possess sufficient significance to justify the classic status that has been largely accorded to Fitzgerald's novel. We need only remember Daisy's effusive appreciation ofGatsby's "beautiful shirts," or the even more telling detail that the truly "romantic" moments in Daisy and Gatsby's relationship all occurred several years earlier in Louisville and that the period of the reunion is scarcely mentioned in the novel to convince ourselves that the putative grandeur of Gatsby's dream does not adequately account for the novel's power or its lasting significance. Reading Gatsby as a novel about its hero's dream makes of it, in fact, a precarious literary achievement, one whose numerous absurdities were perceptively delineated by the English novelist L.P. Hartley, who admired Fitzgerald's literary gifts but thought that he had squandered them in Gatsby. In a 1926 review of the novel, Hartley offered the following summary of its plot: An adventurer of shady antecedents builds a palace at a New York seaside resort, entertains on a scale which Lucullus would have marveled at but could not have approved, and spends untold sums ofmoney, all to 22Thomas J. Cousineau catch the eye ofhis one time sweetheart, who lives on an island opposite, unhappily but very successfully married. At last, after superhuman feats ofostentation and display, the fly walks into the web. A train ofdisasters follows, comparable in quantity and quality with the scale ofthe Great Gatsby's prodigies of hospitality. Coincidence leaps to the helm and throws a mistress under a motor-car. The car does not stop, which, all things considered, is the most natural thing that happens in the book. An injured husband finds the Great Gatsby in suicidal mood sitting on a raft in his artificial lake and (apparently) forestalls him; anyhowthey are both discovered dead. The elder Gatsby is unearthed and gives a pathetic account ofhis son's early years. All the characters behave as though they were entitled to grieve over a great sorrow, and the book closes with the airs oftragedy. (Claridge 178) Minor inaccuracies aside, this must be among the most cogent, disabused responses that the plot of The Great Gatsby has ever received. It is such a welcome antidote to the reams of interpretation ofthe novel produced by critics who, dutifully aping Nick Carraway in this respect, have allowed their conviction as to Gatsby's "greatness" to be matched only by their equally adamant certainty as to the moral tawdriness of Tom and Daisy Buchanan. As Hartley's exasperated summary reminds us, The Great Gatsby, read as the account ofthe eponymous hero's dream, simply cannot support the weight of morally serious interpretation that it would like to invite or that so many ofits critics, in their turn, would like to bestow upon it.1 Nor do we move any closer to appreciating the greatness of Gatsby by shiftingourattention tothe growth in moral awareness thatcountless critics have attributed toNick Carraway, whose self-evaluation as "one ofthe few honest people that I have ever known" (64) should in itself arouse our suspicions.2 As we shall see, the fruits ofNick's presumed moral education The seemingly indestructible resistance to Hartley's lucidity that has been displayed by the great majority ofthe novel's critics may be observed in the chapter that Jeffrey Hart devotes to Gatsby in his recently published Smiling Through the Cultural Catastrophe. Arguing that "magical transformation" is the novel's true subject (230), Hart credits Nick with achieving an "epiphany" whereby he recognizes Gatsby's superiority to "the whole damn bunch put together" (238) and concludes that the larger... (shrink)