In At the Will of the Body , Arthur Frank told the story of his own illnesses, heart attack and cancer. That book ended by describing the existence of a "remission society," whose members all live with some form of illness or disability. The Wounded Storyteller is their collective portrait. Ill people are more than victims of disease or patients of medicine they are wounded storytellers. People tell stories to make sense of their suffering when they turn their diseases (...) into stories, they find healing. Drawing on the work of authors such as Oliver Sacks, Anatole Broyard, Norman Cousins, and Audre Lorde, as well as from people he met during the years he spent among different illness groups, Frank recounts a stirring collection of illness stories, ranging from the well-known--Gilda Radner's battle with ovarian cancer--to the private testimonials of people with cancer, chronic fatigue syndrome, and disabilties. Their stories are more than accounts of personal suffering: they abound with moral choices and point to a social ethic. Frank identifies three basic narratives of illness in restitution, chaos, and quest. Restitution narratives anticipate getting well again and give prominence to the technology of cure. In chaos narratives, illness seems to stretch on forever, with no respite or redeeming insights. Quest narratives are about finding that insight as illness is transformed into a means for the ill person to become someone new. (shrink)

Contemporary health care often lacks generosity of spirit, even when treatment is most efficient. Too many patients are left unhappy with how they are treated, and too many medical professionals feel estranged from the calling that drew them to medicine. Arthur W. Frank tells the stories of ill people, doctors, and nurses who are restoring generosity to medicine--generosity toward others and to themselves. The Renewal of Generosity evokes medicine as the face-to-face encounter that comes before and after diagnostics, pharmaceuticals, (...) and surgeries. Frank calls upon the Roman emperor Marcus Aurelius, philosopher Emmanuel Levinas, and literary critic Mikhail Bakhtin to reflect on stories of ill people, doctors, and nurses who transform demoralized medicine into caring relationships. He presents their stories as a source of consolation for both ill and professional alike and as an impetus to changing medical systems. Frank shows how generosity is being renewed through dialogue that is more than the exchange of information. Dialogue is an ethic and an ideal for people on both sides of the medical encounter who want to offer more to those they meet and who want their own lives enriched in the process. The Renewal of Generosity views illness and medical work with grace and compassion, making an invaluable contribution to expanding our vision of suffering and healing. (shrink)

In 1995 the People's Republic of China passed a controversial Eugenics Law, which, after a torrent of international criticism, was euphemistically renamed the Maternal and Infant Health Law. Aimed at "the implementation of premarital medical checkups" to ensure that neither partner has any hereditary, venereal, reproductive, or mental disorders, the ordinance implies that those deemed "unsuitable for reproduction" should undergo sterilization or abortion or remain celibate in order to prevent "inferior births." Using this recent statute as a springboard, Frank (...) Dikötter explores the contexts and history of eugenics in both Communist China and Taiwan. Dikötter shows how beginning in Late Imperial China, Western eugenics was imported and combined with existing fears of cultural, racial, or biological degeneration in Chinese society, leading to government regulation of sexual reproduction. _Imperfect Conceptions_ is a revealing look at the cultural history of medical explanations of birth defects that demonstrates how Chinese assumptions about the relationship of the individual to society form the very core of their attitudes toward procreation. Dikötter explains the patrilineal model of descent, where a person is viewed as the culmination of his or her ancestors and is held responsible for the health of all future generations. By this logic, a pregnant woman's behavior and attitude directly influence the well-being of her baby, and a deformed or retarded child reflects a moral failing on the part of the parents. Dikötter also shows how the holistic medicine practiced in China blurs any distinction between individual and environment so that people are held responsible for illness. Drawing on cultural, social, economic, and political approaches, Dikötter goes beyond a simple authoritarian model to provide a more complex view of eugenic policy, showing how a variety of voices including those of popular journalists, social reformers, medical writers, sex educators, university professors, and politicians all disseminate information that supports rather than questions the state's program. _Imperfect Conceptions_ reveals how Chinese cultural currents--fear and fascination with the deviant and the urge to draw clear boundaries between the normal and the abnormal--have combined with medical discourse to form a program of eugenics that is viewed with alarm by the rest of the world. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Wellspring or Circuit?Commentary on Dewey and the Aesthetic UnconsciousnessFrank X. RyanEditor's note: This article contains material similar to a book review by the same author previously published in The Pluralist, vol. 18, no. 2, pp 114–21. The present article represents a further critical use of this material that we deem worthy of publication.in this vital and splendidly crafted work, Bethany Henning recovers a philosophy of aesthetic wisdom far richer (...) than the narrow epistemological lens dominant today. From its start, American philosophy looked beyond Europe's atomistic empiricism toward a continuity between our thought and nature's aesthetic splendor. Jonathan Edwards found beauty in the structure of being reflected in relations among ideas. For Emerson, each of us is a "transparent eyeball" in which nature's beauty fortifies our moral and spiritual agency. At the apex of this tradition is John Dewey, for whom "aesthetic experience [is] the highest mode of human experience" (Henning 55).Although aesthetic theory is usually associated with the cognitive evaluation of art, Dewey explores a broader non-reflective or unconscious dimension. Henning's appropriation of "unconscious"—the cradle of Freud's infantile id—is intentionally provocative. American culture, reflected in academic thought, has largely resisted appeals to subterranean urges and drives. In doing so, however, we perpetuate a myth of rational and moral exceptionalism masking a history of colonialism, oppression, and crass commercialism. In accepting the unconscious, European thought has taken strides to acknowledge and address such ills. Henning wonders whether America might accept "a dynamic unconscious, were it presented with an alternative mythology" (10) and finds a viable candidate in Dewey's underappreciated notion of qualitative immediacy: an "aesthetic (directly felt) connection between ourselves and [End Page 77] the world" (Henning 5). In affirming the unconscious depth of experience, this American reconfiguration welcomes "aesthetic experience back into our philosophical lives" (Henning 5).When embodied meaning supplements cognitive reflection, we come to champion "the sensuous, lived body" as "the primary reality" of qualitative immediacy—a felt aesthetic unity punctuated by "impulsions" arising from an organism's needs (Henning 69). As "a site of adaptive adjustments," Henning continues, "the body is responsive to the brink of coalescence at the point of contact with the world, in which things that are 'outside of it' belong to it" (71). "To move adeptly into aesthetic experience means to be skilled at loosening focal consciousness" so as to cultivate "the essential porousness of the world" (130).With this, the body-mind relation becomes a problem of normative aesthetics, not epistemology. The Cartesian detachment of intellect from nature perpetuated our cultural alienation from our bodies, our environments, and one another (Henning 81–84). With the re-emergence of the body, however, we can begin to acknowledge and heal this trauma.In tapping the significance of qualitative immediacy, of "having" beyond "knowing," Dewey and the Aesthetic Unconscious strives to recover Dewey's remarkable insight into our essential situatedness in the world. This alone establishes its importance. But Henning's book is equally ambitious in suggesting how Dewey's aesthetic understanding can(1). reconfigure the shadowy daemons of Freud's id;(2). replace the myth of American exceptionalism with authentic relationships rooted in pluralist values;(3). rehabilitate the body as an authentic vehicle of expression and communication;(4). vindicate the bold claim that all unified experience is aesthetic; and(5). identify and promote connections forged in shared human experiences.These aims are of inestimable value. I pledge to do whatever I can to defend and advance them. At the outset, however, I feel we must shore up the relationship between two different approaches to thinking about our situatedness in the world: (1) of organic beings existing in a porous world they dynamically interact with, and (2) a phenomenology of experience wherein nonreflective having is an unanalyzed totality from which thought and thing, subject and object, organism and environment, functionally emerge in what Dewey calls the pattern of inquiry. [End Page 78]The general consensus that Dewey failed to reconcile these two approaches—of existence with experience—was dubbed the "deep crack" in Dewey's thought, by Richard Bernstein in 1961. Bernstein laments Dewey's being caught between (1... (shrink)

Life goals or aspirations can be distinguished as intrinsic or extrinsic, with different implications for well-being. In this study we used network analysis to reexamine this intrinsic-extrinsic distinction, illustrating how novel candidate aspirations can be mapped along this dimension using innovative methods. We identify four previously unexamined life aspirations, predicting that aspiring for power and social adherence would group with extrinsic goals, whereas aspiring for self-expression and mastery would group with intrinsic goals. In two samples (n = 196; n = (...) 346) we analyze both the original life-goal variables and these novel aspirations using factor analysis, multidimensional scaling, circumplex modeling, and a network analysis using a graphical least absolute shrinkage and selection operator (glasso) to estimate the network structure of aspirations using EBIC. Replicating past intrinsic-extrinsic distinctions, all four methods further classified power and social adherence as extrinsic goals, and self-expression and mastery as intrinsic goals. The intrinsic-extrinsic distinction was also clearly visible in the network analysis. Finally, consistent with hypotheses, power and social adherence were unrelated to wellness indicators, whereas self-expression and mastery correlated positively with well-being indicators and negatively with ill-being indicators, supporting their hypothesized nature as extrinsic and intrinsic, respectively. (shrink)

Mild and moderate mental illnesses can hinder labor force participation, lead to work interruptions, and hamper earning potential. Targeted interventions have proven effective at addressing these problems. But their potential depends on labor protections that enable people to take advantage of these interventions while keeping jobs and income.

Antonio Gramsci was one of the most original political thinkers in Western Marxism and an exceptional intellectual. Arrested and imprisoned by the Italian Fascist regime in 1926, Gramsci died before fully regaining his freedom, yet he wrote extensive letters while incarcerated, rich with insight into the physical and psychological tortures of prison. In meticulous detail, Gramsci records how political prisoners, himself included, contend with the fear of illness and death and the rules and regulations that threaten to efface their individuality. (...) Forming an incomparable link between Gramsci's intellectual passion and his emotional vulnerability, _Letters from Prison_ shows a man reconstructing his life while being separated from it, struggling to recapture the primary relationships that once defined his identity. Frank Rosengarten divides more than four hundred Gramsci letters into two companion volumes, complete with a chronology of the thinker's crucial life experiences, biographical notes on his correspondents, and a bibliography of works cited in his letters. (shrink)

Antonio Gramsci was one of the most original political thinkers in Western Marxism and an exceptional intellectual. Arrested and imprisoned by the Italian Fascist regime in 1926, Gramsci died before fully regaining his freedom, yet he wrote extensive letters while incarcerated, rich with insight into the physical and psychological tortures of prison. In meticulous detail, Gramsci records how political prisoners, himself included, contend with the fear of illness and death and the rules and regulations that threaten to efface their individuality. (...) Forming an incomparable link between Gramsci's intellectual passion and his emotional vulnerability, _Letters from Prison_ shows a man reconstructing his life while being separated from it, struggling to recapture the primary relationships that once defined his identity. Frank Rosengarten divides more than four hundred Gramsci letters into two companion volumes, complete with a chronology of the thinker's crucial life experiences, biographical notes on his correspondents, and a bibliography of works cited in his letters. (shrink)

Antonio Gramsci (1891-1937) was one of the most original political thinkers in Western Marxism and an exceptional intellectual. Arrested and imprisoned by the Italian Fascist regime in 1926, Gramsci died before fully regaining his freedom, yet he wrote extensive letters while incarcerated, rich with insight into the physical and psychological tortures of prison. In meticulous detail, Gramsci records how political prisoners, himself included, contend with the fear of illness and death and the rules and regulations that threaten to efface their (...) individuality. Forming an incomparable link between Gramsci's intellectual passion and his emotional vulnerability, _Letters from Prison_ shows a man reconstructing his life while being separated from it, struggling to recapture the primary relationships that once defined his identity. Frank Rosengarten divides more than four hundred Gramsci letters into two companion volumes, complete with a chronology of the thinker's crucial life experiences, biographical notes on his correspondents, and a bibliography of works cited in his letters. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Happiness in Premodern Judaism: Virtue, Knowledge, and Well-BeingDaniel H. FrankHava Tirosh-Samuelson. Happiness in Premodern Judaism: Virtue, Knowledge, and Well-Being. Cincinnati: Hebrew Union College Press, 2003. Pp. xi + 596. Cloth, $50.00.Franz Rosenzweig tried hard to convince the neoKantian Hermann Cohen of the merits of Zionism and the normalization it would bring to Jews and Jewish life. His attempt met with this response from Cohen: "Oho! So the gang (...) now wants to be happy, does it?" For those ignorant of the history of Jewish philosophy, one might imagine that Jewish philosophers, no less than their non-philosophical kinsmen, were so weighed down by the burdens of history and persecution that happiness could play no role in their theorizing. But happiness plays a key role in the history of Jewish moral and political philosophy, especially in the premodern period. Even Spinoza, the last of the medievals and the first of the moderns, the great critic of the rabbinic tradition and of Maimonides in particular, is concerned in his Ethics with identifying those activities that together constitute human well-being and the good life. Only lately, since the Enlightenment and Kant, has non-eudaimonism been a live option for Jewish thinkers. Only with the rise of (modern) Orthodoxy, and its predilection for construing goodness as rectitude and rule-following, has eudaimonism fallen out of favor. But with Tirosh-Samuelson's weighty volume on happiness in premodern Judaism, there can be no excuse in the future to imagine that all Jews are, or must be, closet Kantians, strict deontologists. To think otherwise seems to come close to taking on the classical (anti-Semitic) dichotomy of legalistic Judaism vs. spiritual Christianity. In it own way, Happiness in Premodern Judaism is a critique of such a one-sided, monochromatic view of Judaism, whether from the Christian or even from the Jewish side.Tirosh-Samuelson writes explicitly as an intellectual historian, rather than as a philosopher. She understands herself and her project as one that presents just the facts, without evaluating them. While one may cavil at a lost opportunity, in the present case this would be churlish, given the enormous erudition on display. After an introductory chapter outlining the foundational moral theories of Plato, Aristotle, and the Hellenistic philosophers, the text presents the (Greek-inspired) areteic wisdom literature of the Second Temple period, the teleological theocentrism of the rabbis, the Greco-Arabic Islamicate culture that nurtured Jewish philosophers from Saadia in the tenth century to Maimonides in the twelfth, the rabbinic and kabbalistic critiques of the philosophical ideal of happiness commencing [End Page 338] with the translation (into Hebrew) of Maimonides' Guide of the Perplexed at the beginning of the thirteenth century, and finally, very important and the focus of much recent scholarly work, the transformation of Jewish eudaimonism through direct contact with Christian Scholasticism and later with the humanist Renaissance. All in all, a millennium and a half of Jewish intellectual history is presented in a sober and scholarly way.Not surprisingly Maimonides plays a pivotal role in the story that Tirosh-Samuelson relates. A Janus-like figure, he represents the culmination and height of accommodation with Greek and Greco-Arabic philosophical culture. However, with the gradual worsening of the socio-economic condition of European Jewry in the thirteenth century, his accommodationism seemed traitorous, and as a result generations of thinkers, mystics and philosophers alike, strove to critically distance themselves from Maimonidean Aristotelianism. Tirosh-Samuelson is admirably clear in pointing out that such anti-Maimonidean tendencies are ill-characterized as anti-philosophical. Hasdai Crescas in the late-fourteenth and early-fifteenth centuries launched a massive critique of Maimonides' physics, metaphysics, and moral philosophy, but did so in as rigorous a manner as any philosopher would. The picture that enfolds over the course of the text is one of vigorous dialectic between partisans of 'alien' (Greek) wisdom and those who viewed such wisdom with considerable suspicion. Such a dialectic parallels, not surprisingly, developments in Christian philosophy.The trajectory of the story of premodern Jewish musings on happiness is from the centrality of reason and intellect, and the contemplative activity that is reason's preeminent actuality, to the primacy... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Hume Against Spinoza and Aristotle1 Frank J. Leavitt It is always good to try to make peace, to try to resolve differences between whatsomebelieveare conflictingpoints ofview. Nevertheless, sometimes the points ofview which are believed to be opposed to each other really do oppose one another and so the most ingenious attempts at reconciliation turn out to have been ill-conceived. Wim Klever has brought considerable scholarship to bear in (...) his attempt to show that Hume and Spinoza were not so far apart as we thought.2 It was an especially pleasant surprise to see the comparison of their views on personal identity,3 for example. And he has made a convincing case for doubt that Hume's "sharp anti-Spinözistic utterings"4 in Treatise 1.4.5 were really sincere. In my opinion, however, Klever has gone too farin trying to bring together what should have been left asunder. Some ofhis points ofthe purportedly common ground shared by Hume and Spinoza are based on what I believe to be a blatant misreading ofSpinoza. Other points show a failure to appreciate a fundamental disagreement between Hume and Spinoza on central issues in the old Aristotelian tradition. Hume and Spinoza, like other philosophersofthe seventeenth and eighteenth centuries, can be best understood when one is aware ofthe Aristotelian background against which they were writing and with which they expected their readers to be familiar. Hume shows familiarity with Aristotelianism in his discussion of the "antient philosophy" at Treatise 1.4.3 as well as in his various remarks about scholasticism.6Spinoza'srelationshipto ChristianAristotelianism has been discussed by Wolfson6 and by myself,7 among others. And his relationship to Maimonides, who was his link to Jewish Aristotelianism, has been discussed by Harvey.8 1 shall base my claim that Hume and Spinoza were much further apart than Klever makes them out to be upon an attempt to identify some scholastic and Aristotelian issues and doctrines with respect to which Hume and Spinoza took very different stands. The firstthing which I wanttodraw attention toisKlever'sreading ofthe scholia to 2 Ethics 40, which bears on medieval disputes over the nominalistic, conceptualistic and realistic approaches to Aristotle's treatment of the problem of the universels. Since Spinoza allows that universal notions "are notformed by all men in the same way,"9 Klever Volume XVII Number 2 203 FRANK J. LEAVITT makes him out to be holding the same position which Hume expresses when he adopts Berkeley's opinion that "all general ideas are nothing but particular ones, annexed to a certain term" (T 17). And Klever claims "Hume and Spinoza are both thorough nominalists."10 But Klever misses the point that Hume denies that there are, in addition to particular ideas, universal ones, that is, common notions, while Spinoza clearly admits, in the second scholium to 11 Ethics 40, the difference which Hume denies. According to Spinoza we have (1> confused representations of particular things, and (2) remembered ideas which are "similar to those through which we imagine things." These latter are ideas of the sort which Hume recognized. But in addition tothese two, which Spinoza calls "opinion" and "imagination," Spinoza claims that we have (3) "notions common to all men, and adequate ideas ofthe properties ofthings." These are notions of"those things which are common to all, and which are equallyin a part and in the whole [and which] cannotbe conceived exceptadequately"(2Ethics 38). These notions, which parallel Descartes' "clear and distinct ideas" are the general abstract ideas which Hume denies in Treatise 1.1.7. There Hume denies that ideas can be general "in their nature" but allows that they can be general "in their representation." To the extent to which Hume's position can be called "nominalism," the passages to which I have referred show that Spinoza, who basically accepted the Cartesian doctrine ofclear and distinct ideas, was not a nominalist. Aristotle drew a sharp distinction between imagination and thought in De anima 2.3. Descartes preserved the distinction between imagination and intellection at the beginningofthe fourth Meditation, among other places. The passage from the second scholium to 2 Ethics 40, which I have already cited adheres to this distinction, which was already... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Dewey and the Aesthetic Unconsciousness: The Vital Depths of Experience by Bethany HenningFrank X. RyanDewey and the Aesthetic Unconsciousness: The Vital Depths of Experience Bethany Henning. Lexington Books, 2022.In this important and splendidly crafted book, Bethany Henning recovers a philosophy of aesthetic wisdom distinct from the narrow epistemological lens dominant today. Unlike the psychological atomism of European Empiricism, from its outset, American philosophy embraced nature's aesthetic splendor and (...) the continuity between our thought and our world. Jonathan Edwards held that relations among ideas reflect beauty in the structure of being. For Ralph Waldo Emerson, each of us is a "transparent eyeball" where the cultivation of nature's spontaneous beauty fortifies our moral and spiritual agency. At the apex of this tradition is John Dewey, for whom Henning touts "aesthetic experience as the highest mode of human experience" (55).Although the aesthetic is generally associated with the cognitive evaluation of art, of special significance for Dewey is its non-reflective or unconscious dimension. Henning's appropriation of "unconscious"—the cradle of Freud's infantile id—is intentionally provocative. American culture, reflected in academic thought, has largely resisted appeals to subterranean urges and drives. In so doing, however, we perpetuate a myth of rational and moral exceptionalism that masks our history of colonialism, oppression, and crass commercialism. In accepting the unconscious, European thought has taken strides to acknowledge and address such ills. Despite America's disdain for psychoanalysis, Henning wonders whether it "could have accepted a dynamic unconscious, were it presented with an alternative mythology" (10).Dewey's alternative, says Henning, arises from his underappreciated notion of qualitative immediacy. In Henning's interpretation of this, meaning is embodied as a "sense of fulfillment" among accumulated habits—a "coming to terms with the world around us" through an "aesthetic (directly felt) connection between ourselves and the world." As such, to appreciate meaning, we must affirm the tacit, unconscious depth of experience; that is, we must "welcome aesthetic experience back into our philosophical lives" (5).Embodied meaning signifies that "the sensuous, lived body" is "the primary reality" (69). In this reality, qualitative immediacy is a non-reflective, aesthetic unity punctuated by "impulsions" arising from an organism's needs. Such needs are satisfied in organism-environment interactions where, says Dewey, "the epidermis is only in the most superficial way an indication of where an organism ends and its environment begins" (LW 10:61). As "a site of adaptive adjustments," Henning continues, "the body is responsive to the [End Page 114] brink of coalescence at the point of contact with the world, in which things that are 'outside of it' belong to it" (71). As such, the body-mind relation is a problem of aesthetics, not epistemology. For Dewey, as for Merleau-Ponty, the body "is the organic and dynamic condition of my thought" (75). The body is not a thing, however, but a process "always organically involved in exchanges" (86).Following the feminist thought of Susan Bordo, Henning agrees that the ascendance of the body amounts to a kind of philosophical recovery. Seventeenth-century science eviscerated the organic "female" universe of the Middle Ages. But this loss of an integrated world evoked existential fright, which Descartes tried to calm by subjugating feminine vagaries of the body to a masculine cognitive certitude bent upon controlling the whole of nature. In America today, this neurosis perpetuates our cultural alienation from our bodies, our environments, and one another (81–84). With the re-emergence of the body, however, it is possible to acknowledge and address this trauma."Feeling," in Dewey's sense, is unconsciously affective: a constant rhythm of disequilibrium and equilibrium, of need and resolution noticed only when a problem rises to the point of requiring our conscious attention. This affective "charge," this rhythm of sensed need and the desire to overcome it, is Dewey's appropriation of Plato's Erōs. Thomas Alexander casts Dewey's Erōs broadly as humanity's aesthetic investment in our world—our collective effort "to transform a biophysical environment into a world filled with meaning" (Alexander 11). But Henning turns to the more familiar sense of Erōs attuned not to the world at... (shrink)

The article addresses the issue of rationing health care services, a topic currently being hotly debated in many countries. The author argues that the aspect of causal responsibility ought to play a decisive role in the allocation of limited medical resources. Starting out from Ronald Dworkin's distinction between option luck and brute luck, the appropriate and meaningful uses of the term causal responsibility are clarified first. A discussion of the conditions which might justify giving lower priority to patients whose illnesses (...) are the result of unhealthy behavior, like e.g. alcohol abuse, follows. Causal responsibility is then viewed in the context of private health insurance and the club model of organ donation. It is argued that individuals themselves are basically responsible for their decisions regarding insurance coverage and membership in organ donors' clubs. Causal responsibility is shown to be a more suitable criterion for rationing scarce medical resources than other criteria which might alternatively be considered, such as patients' age. (shrink)

In _A Philosophy of the Unsayable_, William Franke argues that the encounter with what exceeds speech has become the crucial philosophical issue of our time. He proposes an original philosophy pivoting on analysis of the limits of language. The book also offers readings of literary texts as poetically performing the philosophical principles it expounds. Franke engages with philosophical theologies and philosophies of religion in the debate over negative theology and shows how apophaticism infiltrates the thinking even of those who attempt (...) to deny or delimit it._ In six cohesive essays, Franke explores fundamental aspects of unsayability. In the first and third essays, his philosophical argument is carried through with acute attention to modes of unsayability that are revealed best by literary works, particularly by negativities of poetic language in the oeuvres of Paul Celan and Edmond Jabès. Franke engages in critical discussion of apophatic currents of philosophy both ancient and modern, focusing on Hegel and French post-Hegelianism in his second essay and on Neoplatonism in his fourth essay. He treats Neoplatonic apophatics especially as found in Damascius and as illuminated by postmodern thought, particularly Jean-Luc Nancy’s deconstruction of Christianity. In the last two essays, Franke treats the tension between two contemporary approaches to philosophy of religion—Radical Orthodoxy and radically secular or Death-of-God theologies. _A Philosophy of the Unsayable _will interest scholars and students of philosophy, literature, religion, and the humanities. This book develops Franke's explicit theory of unsayability, which is informed by his long-standing engagement with major representatives of apophatic thought in the Western tradition. "William Franke is an articulate spokesman for what cannot be said not only with regards to modern European poetry but also with respect to contemporary theology. _A Philosophy of the Unsayable _is essential reading for everyone working in religion and literature and in modern theology." — Kevin Hart, Edwin B. Kyle Professor of Christian Studies, University of Virginia __ "By now, it would seem that there could be no more to say about not-saying. Apophatic language and negative theology have been accused of meaninglessness, nihilism, and even ill-concealed ontologies. In this lovely and surprising book, William Franke not only deftly undoes these criticisms but shows that apophasis underlies and strangely grounds all language and thought, even of those very discourses that most vigorously reject it. _A Philosophy of the Unsayable_ demonstrates with elegance that there is indeed more to say, and more that is both meaningful and important." — Karmen MacKendrick, Le Moyne College__ "William Franke is an eminent scholar in comparative literature, who is schooled in philosophy and religion. He is recognized as one of the most creative contemporary thinkers working at the double intersection of philosophy and literature and philosophy and theology. _A Philosophy of the Unsayable_ shows an intellectual grasp of a dizzying array of discourses and sheds real light on all thinkers who are discussed." — Cyril O'Regan, Huisking Professor of Theology, University of Notre Dame_. (shrink)

:Freedom is often analysed in terms of the absence of intentionally imposed constraints. I defend the alternative view on which the relevant constraints are those for which some agent can be held morally responsible. I argue that this best captures the relation between freedom and respect. Berlin correctly points out that intentional restrictions exhibit ill will and hence are disrespectful. However, the same holds, I argue, for restrictions that are due to indifference. Berlin also observed that it would be counterintuitive (...) if an agent could increase her freedom by changing her preferences. I criticize the argument that Dowding and Van Hees present according to which this observation counts in favour of explicating freedom in terms of intentionality. (shrink)

Programmed cell death (PCD) is a process aimed at the removal of redundant, misplaced, or damaged cells and it is essential to the development and maintenance of multicellular organisms. In contrast to the relatively well‐described cell death pathway in animals, often referred to as apoptosis, mechanisms and regulation of plant PCD are still ill‐defined. Several morphological and biochemical similarities between apoptosis and plant PCD have been described, including DNA laddering, caspase‐like proteolytic activity, and cytochrome c release from mitochondria. Reactive oxygen (...) species (ROS) have emerged as important signals in the activation of plant PCD. In addition, several plant hormones may exert their respective effects on plant PCD through the regulation of ROS accumulation. The possible plant PCD regulators discussed in this review are integrated in a model that combines plant‐specific regulators with mechanisms functionally conserved between animals and plants. BioEssays 25:47–57, 2003. © 2002 Wiley Periodicals, Inc. (shrink)

Theorists who support the legalisation of active euthanasia usually base their arguments on the principle of autonomy. In their view the wish of a severely ill person not to continue his or her life must be respected. However, some opponents of the legalisation of active euthanasia refer to the principle of autonomy as well. They are concerned that patients may be held responsible for burdening others with the provision of care. Thus family members, physicians or nurses may exert pressure on (...) patients to opt for active euthanasia. In this article it is argued that these worries are justified; the occurrence of social coercion poses a real danger. However, neither the prohibition nor the permission of active euthanasia enables each individual to make an autonomous choice. Comparing the risks involved in both options, legalisation seems to be preferable to maintaining the status quo. (shrink)

A collection of stories by bioethicists writing about their own illnesses displays the importance of microethics. From this perspective, ethics happens not in the application of principles to specific decisions, but rather in the moment-to-moment flow of clinical interaction, as healthcare workers and patients make decisions, especially in their use of language. Microethical issues that are common to multiple stories are described as dense junctures of ethical concern. Three junctures are discussed in detail: conflicts between medical and patient rationalities, issues (...) of how clinicians represent patients, and practices of truth telling. These junctures are illustrated with examples from the bioethicists’ personal stories of treatment. (shrink)

In a recent review article published in this journal, Hansen and Schaltegger discuss the architecture of sustainability balanced scorecards. They link the architecture of SBSCs to the maturity of the value system of a firm as well as to the proactiveness of a firm’s sustainability strategy. We contend that this argument is flawed and that the architecture of SBSC does not matter since—irrespective of their architecture—SBSCs are ill-suited to achieve substantive corporate contributions to sustainability. First, we assess the SBSC against (...) three fundamental conditions for an effective management of corporate sustainability—the generation of positive outcomes at the societal level, the consideration of complexities and tensions, and the integration of heterogeneous and competing logics—to show that the SBSC is diametrically opposed to the complex and multi-facetted nature of corporate sustainability and ill-suited to achieve transformational change of for-profit organisations towards sustainability. Second, we address the question whether architecture of the SBSC matters and find that it is a fallacy to believe that the architecture of SBSCs can address this fundamental misfit. Rather, our argument reveals that irrespective of its architecture the SBSC is not a suitable tool for achieving strategic change for sustainability beyond incrementalism because it is deeply rooted in the idea of aligning sustainability with established core business routines. We propose that the emerging integrative view on corporate sustainability offers a more promising route for scholars and practitioners who are truly concerned with a deep transformation of private firms towards more sustainability. (shrink)

The article considers some problems with the pairing of joking and disability, and then questions whether the world of the ill is pseudotheological, as Stronach and Allan quote Kundera saying it is. Aspects of Kundera's argument that Stronach and Allan omit suggest a more complex relation between disability, the body and the presence of the person in the multiple texts that end up being involved: Stronach and Allan's text, autobiographical texts such as Robert Murphy's, and the text of several jokes, (...) including one of my own which frames the article. (shrink)

IntroductionMilitary personnel and Veterans are at increased risk of mental and physical health conditions, which can impact their families. Spouses often perform a vital role in caring for service members and Veterans facing illness or injury, which can lead to caregiver burden. In turn, this may contribute to relationship issues. Research suggests that ensuring that spouses are well supported can alleviate some of these negative effects. The current study examined whether social support received by spouses of newly released Veterans buffers (...) the impact of Veterans’ health on caregiver burden, subsequently impacting spouses’ relationship satisfaction.MethodsData were collected as part of the Canadian Armed Forces Transition and Well-being Survey. The sample included N = 595 spouses of Regular Force Veterans who released in 2016 with at least 2 years of service. We examined Veterans’ mental and physical health and spouses’ caregiver burden, social support, and relationship satisfaction. A moderated mediation model was tested using structural equation modeling.ResultsThere was a significant indirect association between Veterans’ health and spouses’ relationship satisfaction through caregiver burden. Furthermore, social support moderated the association, as evidenced by a weaker association between Veterans’ health and caregiver burden at low levels of social support compared to high levels.ImplicationsFindings suggest additional efforts should be made to ensure sufficient support is provided to spouses, especially when they are caring for a service member or Veteran facing illness or injury, to strengthen their families’ well-being. (shrink)

Despite Newman’s negligible direct familiarity with the works and thought of John Duns Scotus, there has been recent discussion of affinities between the two along a range of philosophical approaches and sensibilities. These notes introduce the thesis that both Scotus and Newman share a disposition to appeal to aesthetic rationality when it comes to asserting certain basic truths critical to Christian understanding. Recent Scotus studies have demonstrated the deep and pervasive presence of the aesthetic dimension in Duns Scotus’s thought. In (...) the latter half of this paper I argue for the importance of aesthetic rationality in understanding Newman’s illative sense, which is perhaps his most important contribution to philosophical thought. (shrink)

Across Tibet during the 1940s, young Han Chinese weather observers became stranded at their weather stations, where they faced illness, poverty and isolation as they pleaded with their superiors for relief. Building on the premise that China exercised ‘imperial nationalism’ in Tibet, and in light of scholarship that emphasizes the desirous ‘gaze’ of imperial observers toward the frontier, this essay considers how the meteorological archive might disrupt our understanding of the relationship between observation and empire. Meteorology presented a new way (...) of viewing the landscape that deliberately disregarded the embodied experience of the observer in favour of instrument-mediated readings. The process produced a bifurcated archive, in which stations disseminated quantitative weather charts as a matter of public interest while privately recording the embodied and often miserable experiences of observational staff on the frontier. Unpublished letters between observers and supervisors offer a rare glimpse into the frontier as experienced by reluctant or unwilling agents of the state. (shrink)

This essay begins with a metaphor describing who enters the field of humanities in medicine and healthcare and the types of work they do. The role of witness is discussed, underscoring tensions between witnessing and analyzing. The essay then turns to my own background as an example of how each professional in this field brings something distinct. I briefly describe the three basic principles of my work with narrative: the injunction to keep the stories in the foreground, the work of (...) amplifying and connecting stories, and the need for generous interpretation. The second half of the essay tells three illness stories, describing their importance to me over several decades. These stories are by Audre Lorde, Reynolds Price, and Stewart Alsop, dealing with problems of silences imposed on ill people, problems caused by physicians’ perceived lack of time, and dilemmas of the end of life, respectively. (shrink)

During the set-up phase of an international study of genetic influences on outcomes from sepsis, we aimed to characterise potential differences in ethics approval processes and outcomes in participating European countries. Between 2005 and 2007 of the FP6-funded international Genetics Of Sepsis and Septic Shock project, we asked national coordinators to complete a structured survey of research ethic committee approval structures and processes in their countries, and linked these data to outcomes. Survey findings were reconfirmed or modified in 2017. Eighteen (...) countries participated in the study, recruiting 2257 patients from 160 ICUs. National practices differed widely in terms of composition of RECs, procedures and duration of the ethics approval process. Eight countries used a single centralised process for approval, seven required approval by an ethics committee in each participating hospital, and three required both. Outcomes of the application process differed widely between countries because of differences in national legislation, and differed within countries because of interpretation of the ethics of conducting research in patients lacking capacity. The RECs in four countries had no lay representation. The median time from submission to final decision was 1.5 months; in nine approval was received within 1 month; six took over 6 months, and in one 24 months; had all countries been able to match the most efficient approvals processes, an additional 74 months of country or institution-level recruitment would have been available. In three countries, rejection of the application by some local RECs resulted in loss of centres; and one country rejected the application outright. The potential benefits of the single application portal offered by the European Clinical Trials Regulation will not be realised without harmonisation of research ethics committee practices as well as national legislation. (shrink)

Schizophrenia is a mental disorder that calls the mineness of one's own sensations, thoughts and actions into question and threatens the person with a loss of self. In order to understand this illness in its essence, an approach based on phenomenological psychopathology is therefore indispensable. Conversely, disorders of the self in schizophrenia should be of crucial interest for any philosophy of subjectivity in order to test its concepts of self-awareness, personhood and intersubjectivity by reference to empirical phenomena.Contemporary neurobiological concepts of (...) schizophrenia predominantly emphasize the importance of impaired integration of somatosensory inputs into stable central-nervous representations... (shrink)

The clinical ethics literature is striking for the absence of an important genre of scholarship that is common to the literature of clinical medicine: systematic reviews. As a consequence, the field of clinical ethics lacks the internal, corrective effect of review articles that are designed to reduce potential bias. This article inaugurates a new section of the annual "Clinical Ethics" issue of the Journal of Medicine and Philosophy on systematic reviews. Using recently articulated standards for argument-based normative ethics, we provide (...) a systematic review of the literature on concealed medication for the management of psychiatric disorders. Four steps are completed: identify a focused question; conduct a literature search using key terms relevant to the focused question; assess the adequacy of the argument-based methods of the papers identified; and identify conclusions drawn in each paper and whether they apply to the focused question. We identified seven papers and provide an assessment of them. While none of the papers fully meet the standards of argument-based ethics, they did provide rationales for the use of concealed medications, with the important requirement such a practice be accountable in explicit organizational policy to prevent abuse of patients with mental illness or dementia. (shrink)

Background Regionalised models of health care delivery have important implications for people with disabilities and chronic illnesses yet the ethical issues surrounding disability and regionalisation have not yet been explored. Although there is ethics-related research into disability and chronic illness, studies of regionalisation experiences, and research directed at improving health systems for these patient populations, to our knowledge these streams of research have not been brought together. Using the Canadian province of Ontario as a case study, we address this gap (...) by examining the ethics of regionalisation and the implications for people with disabilities and chronic illnesses. The critical success factors we provide have broad applicability for guiding and/or evaluating new and existing regionalised health care strategies. Discussion Ontario is in the process of implementing fourteen Local Health Integration Networks (LHINs). The implementation of the LHINs provides a rare opportunity to address systematically the unmet diverse care needs of people with disabilities and chronic illnesses. The core of this paper provides a series of composite case vignettes illustrating integration opportunities relevant to these populations, namely: (i) rehabilitation and services for people with disabilities; (ii) chronic illness and cancer care; (iii) senior's health; (iv) community support services; (v) children's health; (vi) health promotion; and (vii) mental health and addiction services. For each vignette, we interpret the governing principles developed by the LHINs – equitable access based on patient need, preserving patient choice, responsiveness to local population health needs, shared accountability and patient-centred care – and describe how they apply. We then offer critical success factors to guide the LHINs in upholding these principles in response to the needs of people with disabilities and chronic illnesses. Summary This paper aims to bridge an important gap in the literature by examining the ethics of a new regionalisation strategy with a focus on the implications for people with disabilities and chronic illnesses across multiple sites of care. While Ontario is used as a case study to contextualize our discussion, the issues we identify, the ethical principles we apply, and the critical success factors we provide have broader applicability for guiding and evaluating the development of – or revisions to – a regionalised health care strategy. (shrink)

This is an excerpt from the contentWhen Christopher Hitchens died in 2011 from cancer of the esophagus, he was arguably the best-known writer of non-fiction in the English language. His books include political journalism, history, and polemic in the most serious sense although those who value his politics regret that he may be most widely known for his militant atheism. His best-selling memoir, Hitch-22, had just been published when he was diagnosed in 2010. Mortality comprises seven articles that Hitchens wrote (...) for Vanity Fair in which he chronicles his experiences in “Tumortown,” plus a collection of fragmentary notes.Writers who have brought considerable insight to other topics are expected to rise to the occasion of their own critical illnesses and death’s imminence. Hitchens’s expected himself to remain witty, effortlessly well-informed, and perhaps most of all, conversational. “The most satisfying compliment a reader can pay is to tell me that he or she feels personally addressed,” Hitchens writes . He recalls. (shrink)

Bioethicists have long been concerned that seriously ill patients entering early phase (‘phase I’) treatment trials are motivated by therapeutic benefit even though the likelihood of benefit is low. In spite of these concerns, consent forms for phase I studies involving seriously ill patients generally employ indeterminate benefit statements rather than unambiguous statements of unlikely benefit. This seeming mismatch between attitudes and actions suggests a need to better understand research ethics committee members’ attitudes toward communication of potential benefits and risks (...) of early phase studies to potential subjects. We surveyed the members of two U.S. research ethics committees using a phase I gene transfer study scenario, and compared the results to a previous survey of potential subjects’ perceptions and attitudes toward benefit and risk for the same protocol. The results show that there is indeed a gap between the subjects’ perceptions and the committee members’ views on what is appropriate to be communicated to research subjects. This discrepancy is the product of both the commonly assumed optimism of the subjects and to a “protective pessimism” of the research ethics committee members. We discuss this discrepancy using “frameworks of trust” and demonstrate the need to incorporate these frameworks into the existing model of informed consent. (shrink)