This paper introduces the model of Utilitarian Principlism as a framework for crisis healthcare ethics. In modern Western medicine, during non-crisis times, principlism provides the four guiding principles in biomedical ethics—autonomy, nonmaleficence, beneficence, and justice; autonomy typically emerges as the decisive principle. The physician–patient relationship is a deontological construct in which the physician’s primary duty is to the individual patient and the individual patient is paramount. For this reason, we term the non-crisis ethical framework that guides modern medicine Deontological Principlism. (...) During times of crisis, resources become scarce, standards of care become dynamic, and public health ethics move to the forefront. Healthcare providers are forced to work in non-ideal conditions, and interactions with individual patients must be considered in the context of the crisis. The COVID-19 pandemic has forced healthcare to shift to a more utilitarian framework with a greater focus on promoting the health of communities and populations. This paper puts forth the notion of Utilitarian Principlism as a framework for crisis healthcare ethics. We discuss each of the four principles from a utilitarian perspective and use clinical vignettes, based on real cases from the COVID-19 pandemic, for illustrative purposes. We explore how Deontological Principlism and Utilitarian Principlism are two ends of a spectrum, and the implications to healthcare as we emerge from the pandemic. (shrink)

Journal of Political Philosophy, Volume 30, Issue 1, Page 94-115, March 2022.

The number of children with chronic critical illness (CCI) is a growing population in the United States. A defining characteristic of this population is a prolonged hospital stay. Our study assessed the proportion of pediatric patients with chronic critical illness in U.S. hospitals at a specific point in time, and identified a subset of children whose hospital stay lasted for months to years. The potential harms of a prolonged hospitalization for children with CCI, which include over treatment, infection, disruption of (...) family life, and the intensive utilization of resources—combined with the moral distress experienced by the clinicians who care for the children, suggest the need for ethical analysis of this growing issue to identify actions that could be taken at the clinical and health systems levels to reduce the harms associated with prolonged hospital stay.In this article we present three real cases from our study that involved a very long hospital stay. We applied a framework developed by Mackenzie, Rogers, and Dodds to analyze inherent, situational, and pathogenic vulnerabilities to examine the ways that interventions intended to remedy one source of harm for the children in our cohort inadvertently created other harms. We examined the complex ways that children with protracted hospitalization are vulnerable to the choices made by their family and clinicians, as well as by healthcare systems and communities. Finally, we used this analysis to summarize actions and ethical responses to this growing patient population. Such an understanding is essential to making clinical and ethical decisions that arise for children who are at risk for a very long stay in the hospital. (shrink)

This study explores how Machiavelli's unique understanding of founders and the nature of their enterprise reflects his judgments about what constitutes the highest human excellence. Both virtue and founding are examined before Machiavelli's treatments of the "most excellent" founders of Prince 6 are considered in detail. Ultimately, comprehending the excellence peculiar to these founders facilitates an understanding of the standard by which Machiavelli evaluates humans; this standard is a key element in unlocking Machiavelli's thoughts.

This paper revisits Tocqueville’s famous portrait of the American female, which begins with assertions of her equality to males but ends with her self-cloistering in the domestic sphere. Taking a cue from Tocqueville’s extended sketch of the “faded” pioneer wife in “A Fortnight in the Wilderness” and drawing connections to Tocqueville’s criticisms of the division of industrial labor, I argue that the American girl’s ostensibly free choice to remove herself from public life is not an act of freedom. Rather, it (...) is a manifestation of a particular type of unfreedom that reveals underappreciated connections between the two great dangers about which Democracy in America warns: tyrannical majoritarianism and soft despotism. My argument that the girl’s choice to withdraw from public life is coerced rather than free thus highlights the nonpolitical sources of oppression that exist within democratic societies. The paper concludes by raising questions about the need for coercion within Tocquevillian democracy and the implications of this for Tocqueville’s “new” political science—indeed, for his liberalism more generally. (shrink)

Alexis de Tocqueville asserted that America had no truly great literature, and that American writers merely mimicked the British and European traditions of the eighteenth and nineteenth centuries. This new edited collection masterfully refutes Tocqueville's monocultural myopia and reveals the distinctive role American poetry and prose have played in reflecting and passing judgment upon the core values of American democracy. The essays, profiling the work of Mark Twain, F. Scott Fitzgerald, John Updike, Edith Wharton, Walt Whitman, Henry James, Willa Cather, (...) Walker Percy, and Tom Wolfe, reveal how America's greatest writers have acted as society's most ardent cheerleaders and its most penetrating critics. Christine Dunn Henderson's exciting new work offers literature as a portal through which to view the philosophical principles that animate America's political order and the mores which either reinforce or undermine them. (shrink)

In this paper, I argue that Michelangelo Antonioni, in his first full-length colour feature, Red Desert (Il Deserto Rosso, 1964), uses cinematic language to explore what contemporary psychoanalyst Julia Kristeva, decades later, has called the crisis of primary narcissism, one of the 'new maladies' afflicting the modern subject, that she describes in Tales of Love (1983). In examining the struggles of subject formation, Antonioni poetically describes the devastating breakdown of both subjectivity and intersubjectivity in conditions of late modernity that Kristeva (...) details through her own psychoanalytic account. Into Antonioni's infamous statement 'Eros is sick', we can read Kristeva's suggestion that Narcissus, our capacity for love and loss, separateness and idealization—the very foundation for our being with others—is in a state of serious affliction. Through the trials of his main protagonist, Giuliana, Antonioni reveals that the acquisition of a distinct, differentiated identity, one that allows the subject to establish and maintain meaningful relationships and ethical bonds, without the risk of psychic disintegration, has become highly problematic—reaching the level of a collective crisis, rather than remaining an issue of individual illness. For Antonioni, psychic survival in the modern world is not merely a question of seamless integration, but a form of (dis)adaptation: the recognition of severance and of separation, both from nature and our own nature, that allows one to affirm her environment and act as an responsive agent in the world, without being overwhelmed or engulfed by otherness, or alterity. In Kristeva's terms, this involves the capacity to bear and, even, to creatively elaborate, the necessity of loss and separation from the primal (m)other—a painful process to which Giuliana eventually submits. (shrink)