Inequities shape the everyday experiences and life chances of individuals at the margins of societies and are often associated with lower health and particular challenges in accessing quality treatment and support. This fact is even more dramatic for those individuals who live at the nexus of different marginalized groups and thus may face multiple discrimination, stigma, and oppression. To address these multiple social and structural disadvantages, intersectional approaches have recently gained a foothold, especially in the public health field. This study (...) makes an empirically informed argument for the merits of increasing the use of intersectional frameworks in the mental health field. In the mental health field, the potential for greater attention to multiple unjustified disadvantages appears to be of particular importance, as many mental health service users already face stigma and discrimination because of their mental health issues and thus may benefit particularly frequently and far-reachingly from effective problem awareness about multiple disadvantages. Intersectional approaches may help address the complexity, interdependence, and mutual constitution of social inequalities better than previous approaches that examined only one category of sociostructural stratification. By helping to identify the needs of those at the greatest risk of poor health, intersectional frameworks and tools can contribute not only to better address the needs of multiple disadvantaged individuals with mental health issues but also to the promotion of equity in the field of mental health, contributing to the reduction of health disparities. (shrink)

1. THRENODY Is it any longer possible to talk seriously about justice and rights? Are these words corrupted and debased beyond redemption? There is no need to multiply examples of how anything that any pressure group has the chutzpah to lay claim to forthwith becomes a right, nemine contradicente. Nor is this Newspeak restricted to the vulgar. The President of the Pacific Division of the American Philosophical Association has granted permission to misuse words like rights and justice if you do (...) so in the service of desirable political ends. Our most universally acclaimed theoretician of justice has shown at length that justice is a will perpetual and constant to forcibly take goods from those who have earned them and give them to those who have not; and the leading light of Anglo-American jurisprudence has constructed a “straightforward” argument proving that a citizen's right to equal protection of the laws is fully satisfied if only the bureaucrat denying him or her a public benefit on racial grounds shows “respect and concern” while processing the forms. (shrink)

1. THRENODYIs it any longer possible to talk seriously about justice and rights? Are these words corrupted and debased beyond redemption? There is no need to multiply examples of how anything that any pressure group has the chutzpah to lay claim to forthwith becomes a right,nemine contradicente. Nor is this Newspeak restricted to the vulgar. The President of the Pacific Division of the American Philosophical Association has granted permission to misuse words likerightsandjusticeif you do so in the service of desirable (...) political ends. Our most universally acclaimed theoretician of justice has shown at length that justice is a will perpetual and constant to forcibly take goods from those who have earned them and give them to those who have not; and the leading light of Anglo-American jurisprudence has constructed a “straightforward” argument proving that a citizen's right to equal protection of the laws is fully satisfied if only the bureaucrat denying him or her a public benefit on racial grounds shows “respect and concern” while processing the forms. (shrink)

In my professional role as anatomy administrator and bequeathal secretary at a large surgical training centre, I am the first point of contact both for people wishing to donate their body, and for newly bereaved relatives telling us that their registered loved-one has died. I am involved in every stage of the process from that first phone call, through to eventual funeral service, cremation of the body and return of the ashes to the family. I am also a registered (...) body donor myself, as I strongly believe in the value of cadaveric training having seen it first hand. When prospective donors and relatives find out that I am also a registered body donor they find this to be very reassuring to know that having ‘behind the scenes’ access has not put me off, and is a good endorsement for the process, …. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Helping a Muslim Family to Make a Life–and–Death Decision for Their Beloved Terminally Ill FatherBahar BastaniI live in a city in the Midwest with a population of around two million people. There are an estimated 2,000 Iranians living in this city, the vast majority of which belong to Shia sect of Islam. [End Page 190] However, the vast majority is also not very religious. Over the past two decades (...) that I have been living in this city, professionally in the capacity of a physician and university faculty at a school of medicine, and socially as one of the community leaders with a particular role in religious matters, I have acquired the trust of my community. Following one of my yearly routine travels to my homeland, Iran, I had just returned to work when I received a phone call from one of the Iranian community members. He informed me that his father was very ill and was hospitalized, and that the physicians had introduced the idea of stopping life support. The family was experiencing a significant emotional, moral and religious dilemma as to whether they could consent to this. I was requested by the patient’s children to help them make the right decision.I requested that the oldest son, who had called me, to ask the three other siblings and their mother to be present at the bedside of the patient that night, so that we could discuss the matters face–to–face. That same night, all requisite family members and myself gathered at the bedside of this 88–year–old husband and father, who had developed multi–organ failure, which commenced with an infection following a heart valve replacement, followed by bacteremia and sepsis. Moreover, the patient was hypotensive, had developed respiratory failure requiring intubation and artificial ventilation, and had also developed hematologic coagulation abnormalities secondary to sepsis. Because of the sepsis, hypotension, and multiple drugs, including antibiotics and vasopressors, his kidneys had also failed, and there was a need to start hemodialysis if his life was to be maintained. After speaking with the intensive care physicians who were taking care of this elderly gentleman, it became clear to me that further care was futile, and there was absolutely no hope for him to recover from his multiple organ failure. I presented all the facts that I had acquired to the family members, and expressed my own viewpoint that I agreed with those physicians and that further care of their beloved, terminally ill husband and father was futile and only extended his dying. My assurances made it easier for the family members, particularly for his four sons who were present, to come to the decision to withdraw life support. After I informed the intensive care physicians of the family’s decision, the patient was heavily sedated with morphine, and the intravenous fluids, antibiotics, vasopressors, and the ventilator machine were all stopped. Over the next several minutes, the patient developed agonal breathing, his blood pressure dropped to zero, and his heart stopped. During the last few minutes of his life, I held the hands of the family members, we all prayed Islamic prayers to bless his soul while departing from his body. The next day, I supported the family with funeral services that included the Islamic prayers for the dead, the ceremonial religious washing of the body of the deceased, and the ceremonial religious burial.The dilemma that this family faced was multi-factorial: (1) the children had spent all of their adult life in America, and were unfamiliar with Islamic end of life and funeral traditions; (2) they had been asked by their father’s physicians to make a decision regarding the withdrawal of life support, which posed a moral and ethical dilemma; (3) they did not know whether it was religiously acceptable to withdraw life support; and (4) they did not know what type of funeral service would be acceptable to the religious beliefs of their deceased father.My presence as a trusted community leader, physician and religious leader was reassuring to the family members that the decision to stop life support for their loved one with a terminal illness and multiple organ... (shrink)

On September 12, 1949, the liberal politician Theodor Heuss, party leader of the „Freie Demokratische Partei“ (FDP), was elected by the Bundesversammlung (Federal Convention) as the first Bundespräsident, i. e. head of state, of the newly founded Bundesrepublik Deutschland. As a young man Heuss had been a close friend and political ally of Friedrich Naumann, the protestant pastor and left wing liberal politician, supported by Ernst Troeltsch. Heuss then working as a political journalist for liberal newspapers and Naumann’s weekly journal (...) Die Hilfe, was an admirer of Troeltsch, and since 1910 they often met in Heidelberg, at Villa Fallenstein, Ziegelhäuser Landstraße 17, where Max and Marianne Weber as well als the Troeltschs lived; Heuss frequently visited Max Weber’s Sunday jour fixe. When in 1915 Troeltsch became a professor at the Philosophical Faculty of Berlin University Heuss regularly kept in contact with him especially through Hans Delbrück’s „Mittwochabend“, a weekly gathering of liberal intellectuals, professors, politicians and journalists discussing political reforms and the ongoing war. Both Troeltsch and Heuss, 19 years younger, demanded the democratization of the Deutsches Reich, and after the end of the war and the revolution of 1918/19 they became members of the newly founded left wing liberal party „Deutsche Demokratische Partei“ (DDP). After Troeltsch’s sudden death on February 1st, 1923, Heuss wrote an obituary, and, together with his wife Elly Heuss-Knapp, attended the funeral service conducted by Adolf von Harnack. Heuss was a member of the „Demokratischer Klub Berlin“, founded in 1919 by liberal politicians, bankers and academics to regularly discuss the political situation of the new democratic state, the Weimar Republic. Unknown until now, seven weeks after Troeltsch’s death the „Demokratische Klub“ invited its members (the club only had male mebers!) to a memorial act for Troeltsch. On this occasion Heuss delivered a speech „Zu Ernst Troeltschs Gedächtnis“ („To the Memory of Ernst Troeltsch“) which is published here for the first time. (shrink)

Many Christian churches in parts of Ghana dominated by Akans do not allow corpses to be brought inside the church during funerals services. Others face constant and vehement objection when it is done. Cultural differences on the subject have fuelled heated disputes that have led in some cases to severe congregational division. Opposition is often sustained by a culturally biased approach to biblical texts concerning sacredness and defilement as related to Old Testament sanctuary and temple ritual. Particularly, the religious philosophy (...) of mmusuo provides the psycho-emotive motivation from which many Akan Christians vehemently oppose the practice as sacrilegious. It also provides an analytical and rhetorical framework for appropriating various biblical passages relating to religious sacrilege. This paper unpacks this framework and proposes effectively contextualized theology as a means of avoiding such erroneous conflations and resolving the disputes that arise at the interface of African culture and Christian religion, especially in multicultural congregations. (shrink)

Japanese Buddhism is sometimes called “funeral Buddhism” contemptuously. Buddhism is often criticized in that it serves only the dead and does not useful for the living. In truth, the main duties of Buddhist monks are to perform funeral services, maintain graves and perform memorial services for the dead in Japan today. Modern Buddhist leaders in Japan tried to argue against such criticism and insisted that Buddhism in origin was not a religion for the dead but for the living. (...) In the post-modern situation, however, the philosophy of the dead is becoming necessary instead of the philosophy of the living that has been prevalent in modern ages. The living human beings cannot live without thinking of the dead. For example, the war victims in Auschwitz, Hiroshima, Nanjing and other places do not forgive us even today. In this situation, it is necessary to evaluate Buddhist tradition in Japan that shows us the way how to go with the dead. In this paper, first, I will introduce the philosophy of Tanabe Hajime (1885-1962) who insisted the existential co-operation with the dead under the influence of Zen Buddhism and next, examine some Mahayana Buddhist sutras from the viewpoint of the relation between the living and the dead. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.1 (2003) 81-85 [Access article in PDF] "What's in the Box Then, Mum?"—Death, Disability, and Dogma Sheila Colman OVERHEARD IN AN EXCHANGE between a bereaved woman and her son outside the church just prior to a funeral service: "What's in the box, then?" "Daddy." The son is in his late 30s and has a learning disability. His mother had prepared him as well as (...) she could; his father had been ill for some time and was not expected to recover. Death, and the rituals surrounding it, had been explained and it was not the first family funeral he had attended.Trying to field such childlike questions is typical of living with a person with a learning disability; trying to find the right words is difficult enough without the added pressure of personal emotional distress.The generally accepted norm in life is that a child is parented within the home until adulthood and then independence is attained. Roles may well be reversed in later life in that the "child" may find responsibilities in caring for, and making decisions for, elderly parents. Few people can stop parenting when their offspring are fledged—even though it is at arms length and any advice may be ignored. Life with a child with a learning disability is unbalanced in this respect; as carers we do not lead lives considered to be normal because our children continue to be childlike for the rest of their, and our, lives. Some of us know that our sons and daughters do not have "apparently limitless potential... to develop skills and autonomy if only they are given the right help" (but try, as a parent or carer, saying that to a professional working in the field of learning disability!) and know that the best we can hope for is mature, rather than immature, dependence.No one tells parents of a learning disabled child—or any other, for that matter—what their responsibilities to that child are. Food, warmth, love, support, and so on are givens, but it takes a conscious effort to move a child toward adulthood when it involves changes in life, for example, moving away from the family home. The debate rages; is it letting go or getting rid of?We all delight in the pleasures our children experience in childhood; we know the magic has gone from the family Christmas once realisation dawns on the youngest child. If you consider that your son or daughter has been dealt a very poor hand in life, the temptation to prolong and promote that innocence is very tempting. It is much easier to prevaricate than to admit that life has its unpleasant sides; that failure and disappointment exist: my son was a great fan of Thomas the Tank engine videos until he was in his early teens, long after it was age appropriate. I passed them onto a younger child, having told him the videos were lost. The fall-out was spectacular [End Page 81] (but fortunately short lived!) and he eventually became very interested in Formula 1 motor racing. I had to push him to grow up.For all of us, the transition from childhood to adulthood is a process, not an event. Although I agree with the professionals that the child with a learning disability should be part of any discussions concerning his or her future, if that child does not have the intellectual capacity to make informed choices, someone else has to do it. That someone else is usually a parent, but is it a parent who is prepared to let go to help that person become an adult with his or her own life away from the family home, or is it a parent who has protected and coddled the child by promising they will never have to go?Lest you think I am a particularly hard, confrontational, and unfeeling mother, I would point out that I have almost 50 years of experience of living with learning disability in the immediate family; my son is 20 but my brother... (shrink)

This article gives brief results of a Norwegian empirical project where the main purpose has been to study the burial rite versus bereavement and the role of religiousness in relation to the disposing of the dead. The theoretical perspective is that loss of a significant close, as well as religiousness are primary life experiences which flow together in the bereaved person's grieving conduct during the burial rite. 70 bereaved persons who had lost a close relative during a certain time period (...) have filled in questionnaires with information about the death, the funeral, religiousness and bereavement. The sample is treated statistically by means of indexes for grieving conduct during the burial week, religiousness, and grief. The sample is coherent and unambiguous, and shows that those who let the burial rite be a time to mourn experienced more benefit from the funeral service and had less anxiety, depression and intrusive experiences during the first year of bereavement. But sadness was independent of the grieving conduct during the burial rite, a result which makes sadness an aspect of mourning which qualitatively differs from the other aspects described. External conditions as urbanity and institutionalizing, as well as internal matters as the dramatical character of the loss, and personal religiousness affected the bereaved person's grieving conduct during the burial rite. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:In Memoriam:Masao Abe (1915–2006)James FredericksProfessor Masao Abe, a pioneer in the international dialogue among Christians and Buddhists, died in Kyoto, Japan, on September 10, 2006. He was 91 years old. Professor Abe was given a quiet funeral service reserved to family and close friends, according to sources in Kyoto.After the death of his mentor D. T. Suzuki, Abe became a leading exponent of Zen in the West and (...) a driving force in the encounter between Buddhism and Christianity. Abe must be credited with much of the intellectual vitality of this dialogue, as well as its relevance to contemporary social problems.Abe was a tireless exponent of the Buddhist doctrine of emptiness as the standpoint for realizing the True Self, yet was also willing to place this basic Buddhist teaching in dialogue with Christianity. Rejecting the notion that Christianity and Buddhism were either fundamentally similar or completely different, Abe saw in interreligious dialogue an opportunity for the mutual transformation of dialogue partners and pursued dialogue to help Buddhists and Christians in confronting the threat of nihilism in the modern world.In the ruins of postwar Japan, Abe began his studies with Hajime Tanabe at the University of Kyoto, a prominent figure in the Kyoto school of contemporary Zen Buddhist philosophy in Japan. But it was his encounter with Shin'ichi Hisamatsu, another philosopher of Zen at the University of Kyoto, that would be decisive for Abe's turn to Zen. In a series of Zen retreats with Hisamatsu at Myoshinji Temple in western Kyoto, Abe was forced to confront the reality of nihilism within himself and eventually resolve this problem by entering the Zen standpoint of emptiness, wherein the enlightened self arises.At age 40, Abe left Kyoto for New York to study at Union Theological Seminary with two of the most prominent Christian theologians of his day, Paul Tillich and Reinhold Niebuhr. This encounter began a distinguished career of teaching, writing, and, above all, dialogue with leading Christian thinkers, including David Tracy, Langdon Gilkey, Rosemary Radford Ruether, Jurgen Moltmann, and Hans Kung. Abe served as visiting professor at the University of Chicago, Purdue University, Claremont College, Columbia University, Princeton University, the University of Hawai'i, and other schools. In Germany, [End Page 139] Abe taught at Heidelberg, Tubingen, and Munich. In addition to his many Japanese publications, Abe wrote extensively in English. These works include Zen and Western Thought, an award-winning collection of essays, and a ground-breaking reflection on Christian belief in Christ interpreted from a Buddhist perspective, "Kenotic God and Dynamic Sunyata." This essay appeared in conjunction with responses from several Christian and Jewish theologians, making the book itself a dialogue. Abe also engaged Jewish intellectuals with his Buddhist reflection on the Holocaust.In 1984, Abe and John Cobb convened a group of Buddhist and Christian intellectuals from Japan, North America, and Europe for dialogue in depth over a sustained period of time on a number of fundamental issues. He was also a guiding influence on the Society for Buddhist-Christian Studies, which continues his work of dialogue today.Masao Abe is survived by his wife Ikuko Abe, his constant companion in a life of sojourn and dialogue in the West. [End Page 140]James FredericksLoyola Marymount UniversityCopyright © 2007 The University of Hawai'i Press... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:In Memoriam:Masao Abe (1915–2006)James FredericksProfessor Masao Abe, a pioneer in the international dialogue among Christians and Buddhists, died in Kyoto, Japan, on September 10, 2006. He was 91 years old. Professor Abe was given a quiet funeral service reserved to family and close friends, according to sources in Kyoto.After the death of his mentor D. T. Suzuki, Abe became a leading exponent of Zen in the West and (...) a driving force in the encounter between Buddhism and Christianity. Abe must be credited with much of the intellectual vitality of this dialogue, as well as its relevance to contemporary social problems.Abe was a tireless exponent of the Buddhist doctrine of emptiness as the standpoint for realizing the True Self, yet was also willing to place this basic Buddhist teaching in dialogue with Christianity. Rejecting the notion that Christianity and Buddhism were either fundamentally similar or completely different, Abe saw in interreligious dialogue an opportunity for the mutual transformation of dialogue partners and pursued dialogue to help Buddhists and Christians in confronting the threat of nihilism in the modern world.In the ruins of postwar Japan, Abe began his studies with Hajime Tanabe at the University of Kyoto, a prominent figure in the Kyoto school of contemporary Zen Buddhist philosophy in Japan. But it was his encounter with Shin'ichi Hisamatsu, another philosopher of Zen at the University of Kyoto, that would be decisive for Abe's turn to Zen. In a series of Zen retreats with Hisamatsu at Myoshinji Temple in western Kyoto, Abe was forced to confront the reality of nihilism within himself and eventually resolve this problem by entering the Zen standpoint of emptiness, wherein the enlightened self arises.At age 40, Abe left Kyoto for New York to study at Union Theological Seminary with two of the most prominent Christian theologians of his day, Paul Tillich and Reinhold Niebuhr. This encounter began a distinguished career of teaching, writing, and, above all, dialogue with leading Christian thinkers, including David Tracy, Langdon Gilkey, Rosemary Radford Ruether, Jurgen Moltmann, and Hans Kung. Abe served as visiting professor at the University of Chicago, Purdue University, Claremont College, Columbia University, Princeton University, the University of Hawai'i, and other schools. In Germany, [End Page 139] Abe taught at Heidelberg, Tubingen, and Munich. In addition to his many Japanese publications, Abe wrote extensively in English. These works include Zen and Western Thought, an award-winning collection of essays, and a ground-breaking reflection on Christian belief in Christ interpreted from a Buddhist perspective, "Kenotic God and Dynamic Sunyata." This essay appeared in conjunction with responses from several Christian and Jewish theologians, making the book itself a dialogue. Abe also engaged Jewish intellectuals with his Buddhist reflection on the Holocaust.In 1984, Abe and John Cobb convened a group of Buddhist and Christian intellectuals from Japan, North America, and Europe for dialogue in depth over a sustained period of time on a number of fundamental issues. He was also a guiding influence on the Society for Buddhist-Christian Studies, which continues his work of dialogue today.Masao Abe is survived by his wife Ikuko Abe, his constant companion in a life of sojourn and dialogue in the West. [End Page 140]James FredericksLoyola Marymount UniversityCopyright © 2007 The University of Hawai'i Press... (shrink)

In traditional Jewish funerals, beggars usually join family and friends of the deceased in the kaddish prayer. When the funeral service ends, the beggars start chanting their own prayer: Charity will Save from Death! Charity will Save from Death! (sdaka tasil mimavet!). As the dead body of communism is interred in the ground of history, East European intellectuals accompany the funeral march chanting their own version of “Charity will Save from Death” (and political instability, rabid ideologies, xenophobia, war, (...) hunger, and pestilence). The main donor (nadvan) at the funeral of communism is the Hungarian-born financier George Soros. Since Soros does not plan for his philanthropic enterprises to outlive him, East European intellectuals pray for his longevity. (shrink)

A common argument for the social value of sport is that athletes serve as heroes who inspire people – especially young people – to strive for excellence. This argument has been questioned by sport philosophers at a variety of levels. Not only do athletes seem unsuited to be heroes or role models in the conventional sense, it is unclear more generally what the social and educational value of athletic excellence could be. In this essay, I construct an argument for the (...) social and educational value of sport built upon the relationship between athletes, heroes, and the song culture that celebrated them in ancient Greece. On this model, athletes are neither heroes nor role models in the conventional sense. Rather, athletes, athletics, and the poets who extolled them were part of a cultural conspiracy to celebrate and inspire virtue by connecting a community with its heroic past. Festivals such as the Olympic Games, but also local events such as funeral games, educated and unified communities by cultivating an aesthetic appreciation for virtue and by inspiring youth to strive for it. Ancient athletes were not heroes, rather they re-enacted heroic struggles, thereby experiencing heroic virtues, and inspiring both artists and spectators to bond with the higher ideals implied by their shared belief in divine ancestry. In this way, athletes, athletics, and the media that celebrated them played important social and educational roles. Insofar as modern sport performs a similar service, its association with heroism and with moral education may ultimately be justified. (shrink)

Disaffection from organized religion in the twentieth century led to rising levels of religious apathy as well as atheism. This is explored in this essay by enumerating the scale of change in a number of nations, and then by listening to the accounts of those who have lost religion. The influence of parents, childhood alienation, adult trauma, wartime combat, and scientific reasoning are each examined through the narratives of those who have left the religious tradition of family and community. To (...) conclude, the essay reflects on the nature of being of no religion, including the impulses to a new secular morality, and to humanistic service in charitable work or providing celebrants for weddings and funerals. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy of Music Education Review 12.1 (2004) 64-66 [Access article in PDF] Response to Bennett Reimer, "Once More with Feeling: Reconciling Discrepant Accounts of Musical Affect" Anne Sinclair Indiana University Mary Reichling's exploration of form, feeling, and isomorphism in the writings of Susanne Langer accomplishes its goal to examine and elucidate aspects of these concepts. I find several of the ideas presented very engaging. Musical form and feeling are (...) very real to me in my experience as a music and liturgy director in the Catholic Church. I wholeheartedly agree with the concept of the processual nature of both, which has been well articulated. In my life experience, the musical form, the feeling inherent in it, and its process of coming to life in a given moment, is a near-weekly event. The church continually solemnizes life events, and musical form is an integral part of that solemnization. My response centers on the following claim: "Feeling is not a product but a process, it follows that the feeling ends when the music stops"; and question, "How can it be educational?"The example of the drama, King Lear, is very interesting. Indeed, as we get caught up in the action of the production, we become connected to the feelings and lives of the characters. I agree that it might be easier to experience feeling in a drama or epic, rather than in the visual arts, or in our sonorous art. The drama connects us to the human condition and we "feel" for the characters. In my position [End Page 64] as a liturgist, I find myself in a situation similar to that of the director of a play. Indeed, at times there is a very fine line between drama and good liturgy. However, in the liturgy we are connecting with real lives, the lives of our assembly members, not the lives of fictitious characters. Good musician liturgists strive to give voice to the emotions of the assembly. While I admit this is not always accomplished in weekly Sunday liturgies, I think especially of funeral liturgies where the music strives to speak of the hope and promise of eternal life for the departed loved one and also of the feelings of grief experienced by the assembled family and friends.I take issue with the idea "that the feeling stops when the music does." Throughout the body of the paper, Reichling highlights Langer's ideas on music's "sonorous image of feeling in an imaginatively perceptible form" and her use of the terms "semblance," "illusion," and "virtual" in regard to feeling. However, in contemplating the points brought forth, I mentally wrestled with the idea of feeling stopping when the music did. Could this position be held because it was based on what might be referred to as a "virtual" experience (for example, a musical concert or show) rather than a "real-life" moment?During the process of this contemplation, I had the occasion to attend the funeral of a friend's husband. This funeral occurred in a faith tradition other than Catholicism and I participated in the service as a member of the congregation. My friend is a music educator, her husband had been a musician, and both had been active in the music ministry of their church for nearly thirty years. As one might imagine, music was a central element in the solemnization of this man's life. The music was brought to life by an extraordinary group of musicians, including many graduate students and faculty members of the Indiana University School of Music. The music was superb and each piece had relevance to the life being celebrated as well as to the moment at hand, saying goodbye. The choir was wonderful, sharing movements from both the Brahms and Fauré Requiems, which were very moving. The soloist was renowned soprano, Sylvia McNair, an "adopted" member of the family since her days years ago as an Indiana University graduate student. Musical form and feeling came together in a powerful way for me during her singing of Fauré's Pie Jesu as she... (shrink)

"Michael Psellos was the 'Cicero of Byzantium,' except that his interests were more wide-ranging than those of his Roman predecessor. In addition to being a politician, poet, and writer of letters, speeches, and treatises on philosophy and rhetoric, he was an innovative historian and a practical educator who interested himself in all aspects of learning, from mathematics and medicine to theurgy. Before now, only his 'Chronographia' has been at all well known. Anthony Kaldellis has done a great service in making (...) accessible a collection of texts bearing upon personal familial relationships, of which we know so little in Byzantium. His translations read well, are accurate, and reflect Psellos' literary subtlety. His commentaries are scholarly and give vital information for the better understanding of this facet of Byzantine society." —_Antony R. Littlewood, University of Western Ontario_ “Anthony Kaldellis is a skilled and gifted translator, one of the best I have ever encountered. I am very excited that we will have access to Psellos’ two important encomia of his mother and daughter in an accurate and readable translation, so that more scholars and students will be able to read these works which offer such fascinating insights into family life in eleventh-century Byzantium. This book will be an excellent lead-off volume in the Psellos series, and make scholars anxious for the subsequent volumes to appear.” —_Alice-Mary Talbot, Director, Byzantine Studies, Dumbarton Oaks_ _Mothers and Sons, Fathers and Daughters_ makes available for the first time complete English translations from the works of Michael Psellos, a key philosopher of the Byzantine Empire. This book contains the works that Psellos wrote about his family, including a long funeral oration for his mother that features unique recollections from a childhood spent in Constantinople; a funeral oration for his young daughter Styliane, which includes a detailed description of her physical appearance and a moving account of her illness and death; a legal work pertaining to the engagement of his second, adopted, daughter; and various letters and other works that relate to the private life of this Byzantine family. (shrink)

The deeper teachings of yoga state that "We are a soul, and have a body," but how do yogis respond when confronted with death-with their own time of passing? In Transitioning in Grace (based on the teachings of Paramhansa Yogananda, author of the classic Autobiography of a Yogi), Nalini Graeber presents true accounts of how longtime yogis and meditators have left their bodies. Some struggled with pain or illness. Others passed suddenly or unexpectedly. Most of these accounts are inspiring; all (...) have something to teach about the transitioning experience. More than just a collection of uplifting stories, this work can serve as a handbook for individuals helping family or friends to leave this world-for those soon to make the transition themselves-and for all thoughtful souls who recognize the wisdom of gaining important insights into early preparation for "Life's Final Exam." Included in these pages: How to prepare for death. A yogic "astral ascension" ceremony (funeral/memorial service) that can be adapted for your particular needs. A description, by a great master of yoga, of what we experience during the moments when we leave our bodies. A simple meditation technique that can help greatly to bring calmness to the event. Stories, descriptions, and poems that offer helpful insights and inspiration. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy of Music Education Review 12.1 (2004) 64-66 [Access article in PDF] Response to Bennett Reimer, "Once More with Feeling: Reconciling Discrepant Accounts of Musical Affect" Anne Sinclair Indiana University Mary Reichling's exploration of form, feeling, and isomorphism in the writings of Susanne Langer accomplishes its goal to examine and elucidate aspects of these concepts. I find several of the ideas presented very engaging. Musical form and feeling are (...) very real to me in my experience as a music and liturgy director in the Catholic Church. I wholeheartedly agree with the concept of the processual nature of both, which has been well articulated. In my life experience, the musical form, the feeling inherent in it, and its process of coming to life in a given moment, is a near-weekly event. The church continually solemnizes life events, and musical form is an integral part of that solemnization. My response centers on the following claim: "Feeling is not a product but a process, it follows that the feeling ends when the music stops"; and question, "How can it be educational?"The example of the drama, King Lear, is very interesting. Indeed, as we get caught up in the action of the production, we become connected to the feelings and lives of the characters. I agree that it might be easier to experience feeling in a drama or epic, rather than in the visual arts, or in our sonorous art. The drama connects us to the human condition and we "feel" for the characters. In my position [End Page 64] as a liturgist, I find myself in a situation similar to that of the director of a play. Indeed, at times there is a very fine line between drama and good liturgy. However, in the liturgy we are connecting with real lives, the lives of our assembly members, not the lives of fictitious characters. Good musician liturgists strive to give voice to the emotions of the assembly. While I admit this is not always accomplished in weekly Sunday liturgies, I think especially of funeral liturgies where the music strives to speak of the hope and promise of eternal life for the departed loved one and also of the feelings of grief experienced by the assembled family and friends.I take issue with the idea "that the feeling stops when the music does." Throughout the body of the paper, Reichling highlights Langer's ideas on music's "sonorous image of feeling in an imaginatively perceptible form" and her use of the terms "semblance," "illusion," and "virtual" in regard to feeling. However, in contemplating the points brought forth, I mentally wrestled with the idea of feeling stopping when the music did. Could this position be held because it was based on what might be referred to as a "virtual" experience (for example, a musical concert or show) rather than a "real-life" moment?During the process of this contemplation, I had the occasion to attend the funeral of a friend's husband. This funeral occurred in a faith tradition other than Catholicism and I participated in the service as a member of the congregation. My friend is a music educator, her husband had been a musician, and both had been active in the music ministry of their church for nearly thirty years. As one might imagine, music was a central element in the solemnization of this man's life. The music was brought to life by an extraordinary group of musicians, including many graduate students and faculty members of the Indiana University School of Music. The music was superb and each piece had relevance to the life being celebrated as well as to the moment at hand, saying goodbye. The choir was wonderful, sharing movements from both the Brahms and Fauré Requiems, which were very moving. The soloist was renowned soprano, Sylvia McNair, an "adopted" member of the family since her days years ago as an Indiana University graduate student. Musical form and feeling came together in a powerful way for me during her singing of Fauré's Pie Jesu as she... (shrink)

The men and women who serve in the armed forces, in the words of Major General Joseph Caravalho, “sign a blank check, co-signed by their families, payable to the Army, Navy, Air Force, or Marines, up to and including their lives.” It is human nature to consider such a pact in polarized terms; the pact concludes in either a celebratory homecoming or funereal mourning. But in reality, surviving catastrophic injury may incur the greatest debt. The small but real possibility of (...) losing the ability to bear biological children due to genitourinary combat injury has been a topic of discussion in hushed tones, behind closed doors. But as policy changes move the conversation into the open, we must be fully aware of the far-reaching and long-term impacts of decisions on those who have sustained genitourinary injury. In January 2016, Secretary of Defense Ashton Carter outlined a set of reforms that would improve the quality of life for military families by recognizing the importance of maintaining fertility, even in the face of severe injury. This first promising step could build a solid foundation of insuring fertility preservation for wounded service members with genitourinary injury, and it could set a precedent beyond the military for insuring treatment for people who have lost their reproductive capacity. Thus, the ethical challenges raised by the new policy require careful analysis. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 13.1 (2003) 53-64 [Access article in PDF] Incentives for Providing Organs Patricia Milmoe McCarrick and Martina Darragh After a contentious debate at its 2002 annual meeting, the American Medical Association's House of Delegates voted to endorse the opinion of its Council on Ethical and Judicial Affairs that the impact of financial incentives on organ donation should be studied (Josefson 2002). The shortage of organs (...) for transplantation has been an ongoing problem for more than 20 years. In June1981, Representative Philip Crane (R-IL) introduced legislation in the U.S. House of Representatives proposing a $25,000 income tax deduction and a $25,000 estate tax exclusion for donating an organ (Tax Incentives 1981). Still the National Organ Transplant Act enacted in October 1984 prohibited the offering of any "valuable consideration" in return for organs (United States 1984).The developments of a legal market for tissues in the United States and a black market for organs around the world have raised the question of whether donation without compensation is the only ethically viable option. Some critics of the current system claim reliance on donation actually promotes a black market in organs (Kaserman and Barnett 2002, p. 38; Palmer 1999, p. 36). In addition, a new set of compensation issues has arisen as living kidney donor transplantations begin to rival those performed with cadaveric organs (United States 2001).As a result, current suggestions for incentives go far beyond the traditional death benefit payment to include such ideas as medals of honor for donors, reimbursement for funeral expenses, exchange programs for organ donation, and special medical insurance for living organ donors. Numerous bills introduced into the 107th Congress have proposed such incentives (Delmonico et al. 2002.) In October 2002, the U.S. Department of Health and Human Services awarded $5.2 million in grants to study both clinical and behavioral interventions for increasing organ donations that do not involve incentives. The inspiration for some of the funded proposals comes from the successes of Spain's social services and the United Kingdom's clinical administration of organ procurement programs (Robeznieks 2002). [End Page 53]With a nod to evidence-based medicine, the underlying concern expressed in much of the current literature is that no idea for increasing the supply of organs should be discounted before it is studied. This bibliography provides a short introduction to the range of opinions expressed on the issue of incentives for providing organs.al-Mousawi, M.; Samhan, M.; al-Mezairee I.; Razzak, M.A.; and Khawari, F. Cadaver Organ Procurement in Kuwait. Transplantation Proceedings 31 (8): 3375-76, 1999.The authors describe a protocol that significantly increased cadaveric organ donation and credit it with fostering the expansion of an organ sharing program among the Arab Gulf states. Developed by Kuwaiti neurologists and anesthetists after a continuing education course on transplantation, the protocol places a special emphasis on the role of local transplant coordinators who facilitate the investigation of brain death cases by neurologists.Arnold, Robert; Bartlett, Steven; Bernat, James; et al. [Ethics Committee of the American Society of Transplant Surgeons] Financial Incentives for Cadaver Organ Donation: an Ethical Reappraisal. Transplantation 73 (8): 1361-67, 27 April 2002.To prepare for proposed studies of financial incentives for organ donation, the American Society of Transplant Surgeons convened a panel to develop a methodology for evaluating the ethics of such research. Comprised of organ procurement organization executives, physicians, surgeons, and ethicists, the panel generated a list of nine criteria for use in judging any incentives proposal. While opposed to direct payment or tax incentives for organ donation, a majority of the members support funeral expense reimbursement or charitable contributions as incentives that would not violate or undermine the ideal of altruism.Cameron, J. Stewart, and Hoffenberg, Raymond. The Ethics of Organ Transplantation Reconsidered: Paid Organ Donation and the Use of Executed Prisoners as Donors. Kidney International 55 (2): 724-32, February 1999.After reviewing arguments for and against payment for organ procurement, the authors apply these arguments to the specific case of obtaining organs from executed... (shrink)

In his follow-up to Tavern League: Portraits of Wisconsin Bars, Carl Corey turns his camera on Wisconsin family-owned businesses in existence fifty years or longer. The businesses portrayed here—bakeries and barbecue joints, funeral homes and furniture builders, cheesemakers, fishermen, ferry boat drivers—have survived against all the odds, weathering tough economic times and big-business competition. The owners are loyal to their employees, their families, and themselves. And they are integral to their local economies and social fabric. The services and goods (...) they provide are usually for neighbors and friends. Generations serve generations, creating lasting relationships and strong, vibrant neighborhoods and rural communities. In For Love and Money, Carl Corey provides indelible glimpses of an increasingly endangered way of life. The Museum of Wisconsin Art’s Graham Reid has said, “As current and future generations come and go, these pictures will survive in the hands of the subjects, collectors, museums, and galleries. Will the businesses featured enjoy a similar longevity? Only time will tell, and we can only watch and hope, but Carl Corey has ensured that they will not be forgotten.”. (shrink)

The non-clerical („unpfäffisch“) Schleiermacher. Karl Glutzkow and the Schleiermacher image of Young Germany. Towards a construction of a countermyth. After Friedrich Schleiermacher’s death on February 12, 1834, his disciples and his family endeavoured to idealize him as an exemplary figure of the church by publishing a complete edition of his published and unpublished works as well as a selection from his letters. (1) Schleiermacher’s Christian death („christliche Euthanasie“). This endeveaour began with the sermons delivered at the funeral and the (...) notes of his wife, Henriette Schleiermacher, about his pious death. (2) Gutzkow’s obituary in the „Allgemeine Zeitung“. The journalist Gutzkow in particular protested against this portrayal in an obituary in which the old Schleiermacher was declared to have been senile and without substantial importance for the present time. On the other hand, an image of the young Schleiermacher, the friend of the Romantics, was to be preserved for the younger generation. (3) The replies of Schleiermacher’s disciples. A forthright reply to Gutzkow’s obituary appeared in the same journal. His view was contradicted by means of an extensive biographical sketch by Friedrich Lücke, one of Schleiermacher’s disciples. (4) Gutzkow’s publication of „Schleiermacher’s Vertraute Briefe über Friedrich Schlegels Lucinde“. Gutzkow supported his view with a new edition of Schleiermacher’s early work, to which he added a provocative preface. As a result, the edition was banned. (5) Abuse of Schleiermacher or a gallant service to him? The reception of the „Vertraute Briefe“. The reactions were divided between considering the work as an early youthful indiscretion of Schleiermacher, and the idea of an intellectual identity running through Schleiermacher’s whole life. The other authors of Young German aligned themselves with Gutzkow. (6) The end of the myth of Schleiermacher: Gutzkow’s „Wally. Die Zweiflerin“. This novel, which derives the protagonist’s suicide from his religious doubts, caused the literary movement Young Germany to be banned in all of Germany, and also led to the imprisonment of the author. In the novel itself, Schleiermacher’s role is rather minor. Later on, Gutzkow did not renew the image of an non-clerical Schleiermacher. – I shall also re-edit a conventional obituary, Gutzkow’s obituary as well as an anonymous reply in the Allgemeine Zeitung (Augsburg). (shrink)

The epic life of Pope John Paul II touches virtually all aspects of the human being in time and space. His successful world outreach achieves unprecedented superlative proportions in his search for universal harmonies among peoples, cultures and religions. Significantly, his death confirms the success of his positive mission on the Earth as his death caused an extraordinary unity of people, cultures, and religions during his funeral. No one else has unified such opposing opposites in a memorial service in (...) a millennium! Thus, Pope John Paul II by his calling served the sacred; his deeds achieve a synchronized symphony of the sacred and secular. This paper examines the views of Pope John Paul II, as expressed in Laborem Excercens, through the concept of the unity of oppositesin sacred and secular architecture. (shrink)

The epic life of Pope John Paul II touches virtually all aspects of the human being in time and space. His successful world outreach achieves unprecedented superlative proportions in his search for universal harmonies among peoples, cultures and religions. Significantly, his death confirms the success of his positive mission on the Earth as his death caused an extraordinary unity of people, cultures, and religions during his funeral. No one else has unified such opposing opposites in a memorial service in (...) a millennium! Thus, Pope John Paul II by his calling served the sacred; his deeds achieve a synchronized symphony of the sacred and secular. This paper examines the views of Pope John Paul II, as expressed in Laborem Excercens, through the concept of the unity of oppositesin sacred and secular architecture. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.1 (2003) 99-102 [Access article in PDF] Living with Contested Knowledge and Partial Jennifer Clegg and Richard Lansdall-Welfare THESE CAREFUL AND CONSTRUCTIVE comments bring grist to our mill. Before responding to them, we observe first that they offer no substantive challenge to our thesis: ambiguities associated with meaning in the disabled life make it more likely that professional service providers will make dogmatic responses to (...) bereavement, and perhaps other essentially contested topics, responses that are defended by isolationism.Some welcome ideas came from left field to refresh our thinking, such as Colman's observations on the gendered nature of care. She reminded us that although the audit from which these cases came was established to investigate bereavement in general among adults with intellectual disability, its rough and ready sampling failed to ensure the expected range of bereavement types. Somehow the bereavements constructed as relevant for audit all transpired to concern the death of mothers. Moreover, of the six relatives who agreed to be interviewed concerning these bereavements, two were stepfathers and four were sisters. Colman underlines the invisibility of care work usually done by female family members: how wise or less wise decisions create the conditions for bereavement reactions, and how changes to care arrangements following bereavement fall most heavily on them. Traustadottir (2002) discussed the way new care initiatives often put pressure on female family members and staff to do more unpaid work. For example, Circles of Support encourages them to include people with intellectual disability in their personal social networks, without considering the personal costs. Such observations have yet to emerge from the umbrella of feminist research. Separatism has served feminism well, but issues of women and care do need to find their place in mainstream reviews.Another useful reminder from Colman is that the person with intellectual disability is not the only concern to families, although only a few adult services manage to hold wider systemic factors in mind (Clegg and Burnham 2000). If the person may make naïve comments at a funeral that would devastate family members whose needs take priority, the person will be excluded.The potency of bereavement was discussed twice. Casenave suggests that because "disability is a loss experience" bereavement resonates with it, casting some doubt onto the suggestion that our thesis generalizes to other contested topics. Reinders criticizes clinicians for being purblind to the tragic. The anonymous reviewer who questioned [End Page 99] the relevance of our discussion of the quality of "presence," a quality Reinders considers highly relevant, illustrates the point better than we can. Recognizing the way clinicians have little "patience with the notion of the tragic" encourages reflection on what other human experiences fail to capture our attention.Although these are all potentially valuable directions, we focus here on comments that may enhance our ability to work without dogma. Since at least the 1980s, clinicians in intellectual disability have criticized the discipline for using linear and univariate rather than complex and multivariate theories, and for a naïve search for magic answers (reviewed in Clegg 1993). It is our contention that little has changed, and that uncertain meaning and normalization combine to create ideal conditions for dogma. Reinders' exposition of the various uses of meaning in our article and in different linguistic and historical traditions develops a vital but neglected topic in intellectual disability, which we consider in some detail. We conclude by arguing that developments require us to distance ourselves from the universality and commonality inherent to normalization, and create new ways to appreciate particularity and diversity.The gist of Reinders' complex argument appears to be that the problems we identify in managing bereavement in intellectual disability stem from a modernist understanding of meaning that is erroneous. Implicitly, those who eschew its pursuit demonstrate the greater wisdom, because neither dialogue nor activities such as reflection can generate meaning that is unattainable. If we understand his position correctly, he contrasts two principal understandings of meaning: comprehension and apprehension.Comprehension is the illusory modernist idea that humans are agents who make sense of themselves... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Rhetorical Landscapes in America: Variations on a Theme from Kenneth BurkeLawrence W. RosenfieldRhetorical Landscapes in America: Variations on a Theme from Kenneth Burke. Gregory Clark. Columbia: University of South Carolina Press, 2004. Pp. 181. $34.95, hardcover.Once again we are indebted to the University of South Carolina Press for a fine contribution from its Studies in Rhetoric/Communication series. Gregory Clark sets parallel aims: to apply Kenneth Burke's critical vocabulary (...) to cultural history, and to read American tourist sites and literature in the frame of Burke's notion of "identity" (147). Clark sees the American public landscape as "constituting in individual citizens a shared sense of common identity as members of a national public" (148). He claims that such shared experiences are as rhetorical as are more typical instances of public discourse. Thus American tourism has contributed to developing us into a national community.Clark supports his theme of rhetorical influence with six case studies: New York City, Shaker villages, Yellowstone National Park, the Grand Canyon, the Lincoln Highway, and the 1915 San Francisco Panama Exposition. While Burke's vocabulary offers a handy point of departure, the real news is in [End Page 172] Clark's discussion of the meaning and prominence of each of his six exemplars as cultural icons.This may be most evident (and endearing) as Clark recalls his own boyhood visits to Yellowstone, where he stood in the parking lot and was as captivated by the variety of license plates from across the country as by the hot springs and mudpots (69). This too was a celebration of nationhood. Equally fascinating is his consideration of the efforts of Stephan Mather, Mary Colter, and the Fred Harvey Company both to preserve national parklands and to develop a befitting "National Park Service Rustic" architectural style to enhance the natural landscape (this long before Disney's theme parks). Such typical excerpts almost cry out for Ken Burns or the History Channel to recreate the optimistic climate of a Romantic Post-Bellum civic culture depicted by Clark.The book becomes more tedious when its repeated invocation of Burkian terms tilts toward veneration. In his lifetime, Burke was unnerved by uncritical academic worship. He sought understanding, not deification. As he remarked, "They are an evangelical brood, bejeez. So... I [became] an observer at my own funeral."1 His wariness of academic enthusiasm is well taken. It does no disservice to Burke, for example, to recognize that his "identification" is a reworking of Vico's "ingenium" outfitted in creaky 1920s literary machinery.2 Shorn of some of the cumbersome Burkian baggage, the book's exemplars emerge as epideictic celebrations of the American tourist phenomenon and its part in shaping a national Romantic consciousness:And as rhetoric they traffic not in actions but in attitudes. People can encounter them without ever thinking of themselves as anything but spectators. Even in that role they are being educated... in matters of individual and collective identity.(148)Seen thus as reminders of our forebears' vision in pioneering the development of a national landscape trust, Clark's work edifies and opens us to the quiet excitement of meditative discovery. Clark guides us to monuments of cultural memory; his project is remarkably readable and a uniquely American enterprise.Lawrence W. RosenfieldUniversity of New HampshireNotes1. Letter to Malcolm Cowley, dated 11 August, 1955. Newberry Library Collection, Chicago.2. Cf. M. Mooney, Vico in the Tradition of Rhetoric (Princeton: Princeton UP, 1985), 151. [End Page 173]Copyright © 2006 The Pennsylvania State University... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:BOOK REVIEWS 99 the movement of the Dutch to France. Only in the second half of the century, as DutchFrench relations deteriorated, and Protestantism was actively persecuted, did Dutch students turn away from France. Professor Dibon reveals the kinds of untapped source materials that exist for tracing these student voyages, for assessing the intellectual conditions in France, and for tracing the course of ideas. Items found ill funeral (...) orations, guide books, letters, unpublished student travel diaries, various Album amicorum that students carried with them, university records, applications of students for funds, etc., provide the basis for Professor Dibon's sketch of where Dutch students went, how they were received in Paris and elsewhere, whom they met, what universities they attended, and how long they spent at various stages of their tours. Professor Dibon clearly shows that there is a rich mine of information to be found through careful, painstaking research in these many manuscripts or rare printed sources. The picture he presents of the travels of Gronovius' brother-in-law, Samuel Ten Nuyl, later professor of history and eloquence at the University of Nijmegen, indicates the valuable materials that can be unearthed from such labors. Ten Nuyl was in and around Paris from 1659-1661. Letters of Introduction from Gronovius, Heinsius, and Van Schooten led to his being accepted in the highest Protestant and Catholic intellectual circles, got him into the Royal Library (t), and into the circles of Pierre-Daniel Huet, Mfinage, DailI~, Guy Patin, Chapelain, and many others. A study of these Dutch voyagers throws much light on the milieu at certain university centers, such as Caen and Orleans, on the possible exchanges and interchanges of ideas, and on the careers of some of the major figures in the Dutch universities. Professor Dibon has performed a most valuable service in this superbly written and documented study in pointing to an area of research that can aid us greatly in understanding the actual intellectual currents and cross-currents of the seventeenth century. His concluding paragraph (pp. 34-35) sums up what we can learn from such data. Ainsi nous pouvons esp6rer voir naitre de la convergence de multiples d6tails recueillis dans les journaux, dans les albums amicorum, les registres universitaires et autres documents d'archives une ~tude d'ensemble du Voyage en France des ~tudiants n6erlandais au XVIIe sidle. Une telle ~tude, fond~e sur une connaissance, qui serait ~t ~largir et h preciser, des milieux universitaires et des cercles ~rudits de la France du XVIIe sidle, nourrie de la substance de rant de correspondances en grande partie in6dites, constituerait h coup stir le chapitre le plus attachant d'une histoire des relations culturelles franco-nberlandaises. Elle ne manquerait pas par surcrolt de faire apparaitre en pleine lumi~re ce fait trop souvent m6connu que les relations culturelles en ce temps restaient, en d~pit des conflits politiques ou des rivalit& ~conomiques, au sein m~me des pol~miques religieuses, des &hanges de personne ~t personne. I1 faut se bien convaincre que c'est dans une tr6s large mesure /~ partir de tels 6changes,--. (shrink)

The initial successes in recent years in harnessing machine learning technologies to improve medical practice and benefit patients have attracted attention in a wide range of healthcare fields. Particularly, it should be achieved by providing automated decision recommendations to the treating clinician. Some hopes placed in such ML-based systems for healthcare, however, seem to be unwarranted, at least partially because of their inherent lack of transparency, although their results seem convincing in accuracy and reliability. Skepticism arises when the physician as (...) the agent responsible for the implementation of diagnosis, therapy, and care is unable to access the generation of findings and recommendations. There is widespread agreement that, generally, a complete traceability is preferable to opaque recommendations; however, there are differences about addressing ML-based systems whose functioning seems to remain opaque to some degree—even if so-called explicable or interpretable systems gain increasing amounts of interest. This essay approaches the epistemic foundations of ML-generated information specifically and medical knowledge generally to advocate differentiations of decision-making situations in clinical contexts regarding their necessary depth of insight into the process of information generation. Empirically accurate or reliable outcomes are sufficient for some decision situations in healthcare, whereas other clinical decisions require extensive insight into ML-generated outcomes because of their inherently normative implications. (shrink)

Developments in Machine Learning (ML) have attracted attention in a wide range of healthcare fields to improve medical practice and the benefit of patients. Particularly, this should be achieved by providing more or less automated decision recommendations to the treating physician. However, some hopes placed in ML for healthcare seem to be disappointed, at least in part, by a lack of transparency or traceability. Skepticism exists primarily in the fact that the physician, as the person responsible for diagnosis, therapy, and (...) care, has no or insufficient insight into how such recommendations are reached. The following paper aims to make understandable the specificity of the deliberative model of a physician-patient relationship that has been achieved over decades. By outlining the (social-)epistemic and inherently normative relationship between physicians and patients, I want to show how this relationship might be altered by non-traceable ML recommendations. With respect to some healthcare decisions, such changes in deliberative practice may create normatively far-reaching challenges. Therefore, in the future, a differentiation of decision-making situations in healthcare with respect to the necessary depth of insight into the process of outcome generation seems essential. (shrink)

Zusammenfassung Die Forschungs- und Regulierungsebene bei datenintensiver Forschung in der Medizin liegen auseinander. Ein heterogenes Feld aus regulierenden Institutionen mit regional ungleichen Regelungen, sowohl hinsichtlich der Dichte als auch der Restriktivität von Regelungen, steht einer globalen Entwicklung der Technologien entgegen. Trotz oder gerade wegen mangelnder global-gültiger Regulierungen können auch unverbindliche oder nur bedingt verbindliche normative Vorgaben der Orientierung dienen. Doch wie soll eine solche normative Regulierung angesichts datenintensiver Forschung in der Medizin ausgestaltet werden und woran soll sie sich orientieren? Die (...) Frage, wie konkret und detailliert man eine solche Forschung regulieren sollte, lässt sich nur im Einzelfall für bestimmte Situationen und Institutionen beantworten. Ob dabei neue Normen oder Gewichtungen von Normen vorgenommen werden sollen, oder ob die Normen und deren Gewichtung weiterhin bestehen bleiben sollen, lässt sich nur mit Verweis auf starke normative Argumente beantworten. An zwingenden Argumenten für neue Normen angesichts der datenintensiven medizinischen Forschung mangelt es bisher. Dennoch ist eine Umsetzungsarbeit von Normen, egal ob neue oder alte, und deren Anwendung auf eine neue Methode oder Technologie allemal zu erbringen. Es bedarf daher – wie schon bisher – beider: sowohl etablierter und transparent kommunizierter Normen als auch des unabhängigen Urteils zur Anwendung dieser Normen. Angesichts der besonderen Eignung für diese Aufgabe sollten auch weiterhin Ethik-Kommissionen als prozedurale Instanz bei der Bewilligung von datenintensiver Forschung in der Medizin gefordert und befähigt werden, die als unabhängige Institution ein Urteil im Einzelfall anhand vorgegebener Normen fällen. Nichtsdestotrotz können sich die veränderten Praktiken datenintensiver Forschungsprojekte auch in neuen Anforderungen an Ethik-Kommissionen niederschlagen, denen mit Reformen der Arbeitsweise begegnet werden sollte. (shrink)

Machine learning-driven clinical decision support systems (ML-CDSSs) seem impressively promising for future routine and emergency care. However, reflection on their clinical implementation reveals a wide array of ethical challenges. The preferences, concerns and expectations of professional stakeholders remain largely unexplored. Empirical research, however, may help to clarify the conceptual debate and its aspects in terms of their relevance for clinical practice. This study explores, from an ethical point of view, future healthcare professionals’ attitudes to potential changes of responsibility and decision-making (...) authority when using ML-CDSS. Twenty-seven semistructured interviews were conducted with German medical students and nursing trainees. The data were analysed based on qualitative content analysis according to Kuckartz. Interviewees’ reflections are presented under three themes the interviewees describe as closely related: (self-)attribution of responsibility, decision-making authority and need of (professional) experience. The results illustrate the conceptual interconnectedness of professional responsibility and its structural and epistemic preconditions to be able to fulfil clinicians’ responsibility in a meaningful manner. The study also sheds light on the four relata of responsibility understood as a relational concept. The article closes with concrete suggestions for the ethically sound clinical implementation of ML-CDSS. (shrink)

Definition of the problemHealth Apps are becoming increasingly important for a preventive and responsible orientation of the health system. Currently, most of these digital health applications (DiGA) are based on so-called self-tracking technologies which record physiological and psychological data via sensors, usually combined with personalized everyday information. In the last few years, these digital developments have launched an intense and clearly polarized debate about the opportunities and dangers of self-tracking in healthcare.ArgumentsAfter a brief overview of medical self-tracking, this essay wants (...) to systematize and check the polarized discourse on the basis of its decisive individual and social potentials. It turns out that self-measurement techniques have long been an integral part of medical practice in diagnostics and therapy.ConclusionThe area of tension between individual empowerment and potential loss of control by the users will be emphasized as being especially important for the implementation of health Apps in primary health care. Finally, possible implications for the current design of the new German Digital Care Law (Digitale-Versorgung-Gesetz) are shown and some existing “blind spots” are highlighted. (shrink)

Zunehmend gewinnen Health Apps an Bedeutung für eine präventive und eigenverantwortliche Ausrichtung des Gesundheitssystems. Die meisten dieser digitalen Gesundheitsanwendungen basieren derzeit auf sog. Selftracking-Technologien, mit deren Hilfe physiologische und psychische Daten sensorgestützt aufgezeichnet und diese zumeist um personalisierte Alltagsinformationen ergänzt werden. Die digitalen Entwicklungen dieser Art lösten in den letzten Jahren eine intensive und deutlich polarisierte Debatte über die Chancen und Gefahren von gesundheitlichem Selftracking aus. Ziel dieser Arbeit ist es, nach einem kurzen Überblick über das Feld des medizinischen Selftracking (...) den polarisierten Diskurs zunächst anhand seiner entscheidenden individuellen und gesellschaftlichen Potenziale zu systematisieren und zu prüfen. Es stellt sich heraus, dass Selbstvermessungstechniken keineswegs ein neues Phänomen, sondern vielmehr seit langem fester Bestandteil medizinischen Wirkens in Diagnostik und Therapie sind. Als für die Implementierung von Health Apps in die medizinische Regelversorgung besonders bedeutend wird das Spannungsfeld zwischen individuellem Empowerment und potentiellem Kontrollverlust der Nutzenden herausgestellt. Abschließend werden mögliche Implikationen für die aktuelle Ausgestaltung des neuen Digitale-Versorgung-Gesetzes aufgezeigt und auf einige bestehende „blinde Flecken“ hingewiesen. (shrink)

Giorgia Pozzi’s feature article1 on the risks of testimonial injustice when using automated prediction drug monitoring programmes (PDMPs) turns the spotlight on a pressing and well-known clinical problem: physicians’ challenges to predict patient behaviour, so that treatment decisions can be made based on this information, despite any fallibility. Currently, as one possible way to improve prognostic assessments of patient behaviour, Machine Learning-driven clinical decision support systems (ML-CDSS) are being developed and deployed. To make her point, Pozzi discusses ML-CDSSs that are (...) supposed to deliver physicians an accurate estimation of the likelihood of narcotic, sedative and stimulant opioid misuse by a given patient (like, e.g., ‘NarxCare’). Regarding cases of deviating assessment between human evaluators and automated systems, the medico-ethical discussion has so far mainly focused on disagreement between clinicians and Machine Learning (ML) algorithms,2 for example in ‘second opinions’ that have been reconstructed as disagreements between physician testimony and ML-CDSS testimony.3 Examples such as those of PDMPs, by contrast, draw attention to situations in which patient testimony potentially contradicts ML-CDSS testimony. Pozzi examines decision-making situations in which ML-CDSS testimony factually overrides the testimony of the person affected. Thus, in the presented case of patient Kathryn, the testimony of her own physical and mental condition was insufficient to overturn the unfavourable outcome for …. (shrink)

A methodical study of the primitive cultures of the hunting-gathering peoples which focuses on their social structures and economic relations.

Chapter on The Australian class system previously published as Sociocentre relationship terms and the Australian class system qv. for annotation.