In this article I examine some of the issues involved in taking psychiatric disorders as natural kinds. I begin by introducing a permissive model of natural kind-hood that at least prima facie seems to allow psychiatric disorders to be natural kinds. The model, however, hinges on there in principle being some grounding that is shared by all members of a kind, which explain all or most of the additional shared projectible properties. This leads us to the following question: what grounding (...) do psychiatric disorders qua natural kinds have? My principal method for examining the issue is a case study of a particular psychiatric disorder: the so-called “apathetic children.” I argue that there appear to be at least two competing models that both appeal to non-organic a grounding of the disorder. However, for other psychiatric disorders, such as Alzheimer’s disease, the evidence points toward an organic explanation of the disorder. I contend that what unites psychiatric disorders is not a distinctive type of grounding that all psychiatric disorders share, but the distinctive set of determinable properties that is shared by all psychiatric disorders. (shrink)

This study examined the prevalence and impact of imposter syndrome on a sample of pre-service educators. We report a majority of pre-service educators experience IS; 93% experience moderate levels and 54% had frequent or severe levels of imposter thoughts, and further that IS was negatively associated with educator well-being. We also investigated the effects of minority group membership on experiences of IS, and found that IS was more severe for women and queer minorities, but less severe for racial minorities. (...) Lastly, we investigated the potential for healthy emotion regulation to mitigate the effects of IS on pre-service educator well-being and found that adaptive emotion regulation strategy use mitigates the effects of IS, which may provide a viable means for addressing this pervasive issue among educators, and specifically among those with minoritized identities. We discuss the implications of our findings for educational training and improving the experiences of pre-service educators. (shrink)

Asperger's syndrome is a pervasive developmental condition characterized by features of autism. As observed in clinical practice, individuals with Asperger's syndrome present an impairment related to inflexibility in their everyday routine, an immediate manner of experiencing and relating, and difficulties in estimating periods of time. Following a phenomenological perspective, this study is an attempt to examine these aforementioned aspects in terms of temporality. Thirteen participants with Asperger's syndrome, from 13 to 20 years old, were interviewed about (...) their experience of periods of time, personal history, their past, present and future; and their concept of time and finitude. After the interviews, it was possible to identify three general themes which emerged in the invariant aspects of their experience of time: factual experience of present and future dimensions, chronological time and the past experience. Moreover, participants' descriptions evidenced aspects of experience based on the specificity of lived facts and a sense of time specifically related to what was lived in the past. (shrink)

Locked-in syndrome (LIS) is a severe neurological condition that typically leaves a patient unable to move, talk and, in many cases, initiate communication. Brain Computer Interfaces (or BCIs) promise to enable individuals with conditions like LIS to re-engage with their physical and social worlds. In this paper we will use extended mind theory to offer a way of seeing the potential of BCIs when attached to, or implanted in, individuals with LIS. In particular, we will contend that functionally integrated (...) BCIs extend the minds of individuals with LIS beyond their bodies, allowing them greater autonomy than they can typically hope for in living with their condition. This raises important philosophical questions about the implications of BCI technology, particularly the potential to change selves, and ethical questions about whether society has a responsibility to aid these individuals in re-engaging with their physical and social worlds. It also raises some important questions about when these interventions should be offered to individuals with LIS and respecting the rights of these individuals to refuse intervention. By aiding willing individuals in re-engaging with their physical and social worlds, BCIs open up avenues of opportunity taken for granted by able individuals and introduce new ways in which these individuals can be harmed. These latter considerations serve to highlight our emergent social responsibilities to those individuals who will be suitable for, and receive, BCIs. (shrink)

From a close reading of Frantz Fanon's “The North African Syndrome” (1952), this article draws out Fanon's understanding of “death in life” to suggest that a concept of unlivability in the present must account for the temporal duration of racialized and colonized experiences of pain and trauma. It is thus critical of Judith Butler's and Frédéric Worms's discussion of unlivability in The Livable and The Unlivable (2023) for not centering a phenomenological study of the testimonies of the oppressed. I (...) argue for a greater engagement with Fanon on the longue durée of racial and colonial violence enacted on the bodies, psyches, and histories of racialized and colonized peoples. This article concludes by pointing to possibilities for a shared unlivability in a shared temporality, with potential to move beyond refusal and toward resistance to the colonial control over time. (shrink)

The locked-in syndrome is a state of profound paralysis with preserved awareness of self and environment who typically results from a brain stem stroke. Although patients in LIS have great difficulty communicating, their consciousness, cognition, and language usually remain intact. Medical decision-making by LIS patients is compromised, not by cognitive impairment, but by severe communication impairment. Former systems of communication that permitted LIS patients to make only “yes” or “no” responses to questions was sufficient to validate their consent for (...) simple medical decisions but not for consequential medical decisions such as whether to refuse further life-sustaining therapy. Emerging technologies including computer-tracking assistance of retained partial motor function and brain-computer interfaces promise to improve the communication ability of LIS patients and, when better developed, will allow them to fully exercise their right to actively participate in consequential medical decisions about their own medical care. Although so-called “covert cognition” patients clinically diagnosed as vegetative state that are shown to be aware by functional neuroimaging maybe metaphorically considered locked-in, it is nosologically more coherent not to categorize them formally as LIS. (shrink)

Parental refusal of a recommended treatment is not an uncommon scenario in the neonatal intensive care unit. These refusals may be based upon the parents’ perceptions of their child’s projected quality of life. The inherent subjectivity of quality of life assessments, however, can exacerbate disagreement between parents and healthcare providers. We present a case of parental refusal of surgical intervention for necrotizing enterocolitis in an infant with Bartter syndrome and develop an ethical framework in which to consider (...) the appropriateness of parental refusal based upon an infant’s projected quality of life. (shrink)

Sleep is a major concern, especially in people with Down Syndrome. Beyond Obstructive Sleep Apnea, a number of other sleep difficulties have been reported in children with DS, such as delayed sleep onset, night-time awakenings, and early morning awakenings. The detrimental effect of sleep difficulties seems to contribute to and exacerbate the cognitive and behavioral outcomes of DS. Although the screening for sleep disorders is recommended early in age in DS, only a few studies have evaluated the sleep profile (...) in preschool-age children with DS. The aim of the current study was to assess the association between sleep disturbances and behavioral problems in a group of preschool-age children with DS, by means of a feasible and easy-to-administer parent-report questionnaires. Seventy-one preschool-age children with DS, ranging in age from 3 to 5.11 years, were included in this retrospective study. Sleep disturbances were evaluated by means of the Sleep Disturbance Scale for Children, while emotional and behavioral problems by means of the Child Behavior Checklist. Sleep breathing disorders were the most frequent sleep difficulties reported by parents. Moreover, children with clinical scores in total sleep problems exhibited elevation of psychopathological symptoms, namely Total problems, Affective problems, Anxiety problems, Pervasive Developmental Problems, and Attention Deficit/Hyperactivity Problems. The identification of the broader connection between sleep difficulties and emotional and behavioral problems in preschool-age children with DS leads to important considerations for intervention. (shrink)

Anger gaslighting is behavior that tends to make someone doubt herself about her anger. In this paper, I analyze the case of anger gaslighting, using it as a paradigm case to argue that gaslighting can be an affective injustice (not only an epistemic one). Drawing on Marilyn Frye, I introduce the concept of “uptake” as a tool for identifying anger gaslighting behavior (persistent, pervasive uptake refusal for apt anger). But I also demonstrate the larger significance of uptake in (...) the study of affective injustice: just as the concept of credibility names the epistemic behavior whereby we take someone seriously as an epistemic being, the concept of uptake names the uniquely affective cooperative behavior whereby we take someone seriously as an affective being. I answer Miranda Fricker’s epistemic notion of a prejudicial credibility economy with the affective notion of prejudicial uptake economies: uptake, like credibility, can be produced in a deficit for one social group relative to a surplus for another. Deviating from the parallels with Fricker, for whom the injustice of epistemic injustice is due to prejudice in the motives or character of individuals, as well as from accounts that ground it in aptness or affective goods, I suggest that the injustice of anger gaslighting behavior can be located at the structural scale of power relationships between social groups, in the tradition of Iris Marion Young. Anger gaslighting behavior counts as unjust wherever it (re)produces prejudicial uptake economies. Adapting sociological concepts of feeling rules and the emotion work they demand, I introduce the concepts of “uptake rules” and “uptake work” to further enable analysis of uptake economies as affective social structures, and to suggest a site for resistant or reparative affective agency. (shrink)

Originally published in 1999, this classic textbook includes twenty-six cases with commentary and bibliographic resources designed especially for medical students and the training of ethics consultants. The majority of the cases reflect the day-to-day moral struggles within the walls of hospitals typically described as community hospitals; as a result, the cases do not focus on esoteric, high-tech dilemmas--viz., genetic engineering or experimental protocols--but rather on fundamental problems that are pervasive in basic healthcare delivery in the United States: where to (...) send a frail, elderly patient who refuses to go to a nursing home; what role the family should play in making a treatment decision; what a hospital should do when it is getting stuck with too many unpaid bills. This thoroughly revised and updated second edition includes thirteen new cases, five of which are designated as "skill builder" cases aimed specifically for those participants in the Neiswanger Institute for Bioethics' web-based instructional program. This edition has also been restructured for teachability, and will feature reformatted and revised commentaries. (shrink)

Domestic violence is a pervasive problem in our society that has only recently come to be acknowledged in public discussion. Though many see it as a social and political problem grounded in unequal gender roles, this level of analysis fails to explain adequately why many battered women return to their abusers despite intense suffering and the certainty of more physical violence. The Illusion of Love challenges the prevailing model, which views the victim of abuse as a normal woman who (...) is unable to escape from her batterer due to the effects of terror and psychological collapse. Instead, David Celani offers a new answer--that women who are battered have a fundamental attraction to partners who are abusive. Based on his years of clinical experience treating battered women, Celani applies object relations theory and case examples from his own practice to show that many women--and indeed some men--are unconsciously drawn to abusive partners because of personality disorders caused by childhood abuse and neglect. He argues that any effective treatment for battered women must help unravel futile and self-defeating patterns, such as ones that spring from fears of abandonment and fascination with men who produce exaggerated promises of love followed by extreme rejecting behaviors. _The Illusion of Love_ examines the personalities of abusers as well, many of whom suffer from narcissism, a disorder that is also often associated with childhood abuse and neglect. Narcissistic men lash out violently in an attempt to control their own fears or abandonment and to compensate for unsatisfied emotional needs. Celani concludes that domestic violence is often the tragic result of a union between individuals with complementary personality disorders. His findings fly in the face of the politically correct refusal to examine the behavior of the victim of abuse, a strategy that has led to a severe misunderstanding of the dynamics of the battering scenario. _The Illusion of Love_ calls for primary prevention of neglectful parenting to stem the tide of abuse in the future, offering tangible hope for the treatment of victims of abuse as they attempt to extricate themselves from unhealthy, damaging relationships. (shrink)

Domestic violence is a pervasive problem in our society that has only recently come to be acknowledged in public discussion. Though many see it as a social and political problem grounded in unequal gender roles, this level of analysis fails to explain adequately why many battered women return to their abusers despite intense suffering and the certainty of more physical violence. The Illusion of Love challenges the prevailing model, which views the victim of abuse as a normal woman who (...) is unable to escape from her batterer due to the effects of terror and psychological collapse. Instead, David Celani offers a new answer--that women who are battered have a fundamental attraction to partners who are abusive. Based on his years of clinical experience treating battered women, Celani applies object relations theory and case examples from his own practice to show that many women--and indeed some men--are unconsciously drawn to abusive partners because of personality disorders caused by childhood abuse and neglect. He argues that any effective treatment for battered women must help unravel futile and self-defeating patterns, such as ones that spring from fears of abandonment and fascination with men who produce exaggerated promises of love followed by extreme rejecting behaviors. _The Illusion of Love_ examines the personalities of abusers as well, many of whom suffer from narcissism, a disorder that is also often associated with childhood abuse and neglect. Narcissistic men lash out violently in an attempt to control their own fears or abandonment and to compensate for unsatisfied emotional needs. Celani concludes that domestic violence is often the tragic result of a union between individuals with complementary personality disorders. His findings fly in the face of the politically correct refusal to examine the behavior of the victim of abuse, a strategy that has led to a severe misunderstanding of the dynamics of the battering scenario. _The Illusion of Love_ calls for primary prevention of neglectful parenting to stem the tide of abuse in the future, offering tangible hope for the treatment of victims of abuse as they attempt to extricate themselves from unhealthy, damaging relationships. (shrink)

In this age of “free-sex”, gurus, Hare-Krishna chanters and transcendental meditation teachers J. Кrisimamurti stands almost alone as a non-guru of outstanding grandeur. His lecture tours in major centers of the world remind one of the historical Buddha who reversed the Upanishadic tradition of teaching in a forest hermitage to a select few by travelling on foot from village to village in North-Eastern India to carry his message of love, compassion and understanding to the masses regardless of caste, color or (...) sex. But historical comparisons are never complete. Whereas the Buddha used the local dialect, adapted his message to the intellectual level of his audience and made free use of stories and parables, Krishna-multi lectures in the English language in his intense analytic style to rapt audiences without any such aid. No wonder the Buddha's appeal and impact historically has been infinitely wider than that of Krishnamurti. And yet, both eschewed dogma, tradition and metaphysical subtleties, and deliberately refused to offer any sugar-coated pills and panaceas for overcoming the pervasive human condition of suffering. They endeavoured to make people “see” and “understand” the human condition in an act of total awareness so as to take them to the very brink of that “creative emptiness”, ultimate freedom and radical change which alone is conducive to the attainment of transcendent peace. In other words, the doctrine of Krishnamurti as that of the Buddha is not for the weak and effeminate who need “crutches” of all kinds but for those who have the courage to help themselves by an act of understanding the way things are without being entangled in theories and conceptual puzzles. It is the intention of this paper to analyze, understand and critically evaluate Krishamurti's concepts of self, action and freedom. (shrink)

How far should we go in protecting and promoting public health? Can we force people to give up unhealthy habits and make healthier choices, or does everyone have the right to decide their own lifestyle? Should we stop treating smokers who refuse to give up smoking? Should we put a tax on fatty foods and ban vending machines in schools to address the obesity epidemic? Should parents be required to have their children vaccinated? Are some of our screening programmes unethical (...) Downs syndrome screening, for example or should we be screening people for more conditions, such as Huntington disease? Such questions are at the heart of public health ethics. Holland shows that to understand and debate these issues requires philosophy: moral philosophies, such as utilitarianism and deontology, as well as political philosophies such as liberalism and communitarianism. And philosophy informs other aspects of public health, such as epidemiology and health promotion. The aim of this book is to provide a lively, accessible and philosophically informed introduction to such issues. It is an ideal textbook for students taking courses in public health ethics. And since this book develops systematic discussions of issues in public health ethics, there is also much here to engage and challenge the more advanced reader. (shrink)

Long considered "the noblest of the senses," vision has increasingly come under critical scrutiny by a wide range of thinkers who question its dominance in Western culture. These critics of vision, especially prominent in twentieth-century France, have challenged its allegedly superior capacity to provide access to the world. They have also criticized its supposed complicity with political and social oppression through the promulgation of spectacle and surveillance. Martin Jay turns to this discourse surrounding vision and explores its often contradictory implications (...) in the work of such influential figures as Jean-Paul Sartre, Maurice Merleau-Ponty, Michel Foucault, Jacques Lacan, Louis Althusser, Guy Debord, Luce Irigaray, Emmanuel Levinas, and Jacques Derrida. Jay begins with a discussion of the theory of vision from Plato to Descartes, then considers its role in the French Enlightenment before turning to its status in the culture of modernity. From consideration of French Impressionism to analysis of Georges Bataille and the Surrealists, Roland Barthes's writings on photography, and the film theory of Christian Metz, Jay provides lucid and fair-minded accounts of thinkers and ideas widely known for their difficulty. His book examines the myriad links between the interrogation of vision and the pervasive antihumanist, antimodernist, and counter-enlightenment tenor of much recent French thought. Refusing, however, to defend the dominant visual order, he calls instead for a plurality of "scopic regimes." Certain to generate controversy and discussion throughout the humanities and social sciences, _Downcast Eyes_ will consolidate Jay's reputation as one of today's premier cultural and intellectual historians. (shrink)

Belief in conspiracy theories is often taken to be a paradigm of epistemic irrationality. Yet, as I argue in the first half of this paper, standard criticisms of conspiracy theorising fail to demonstrate that the practice is invariably irrational. Perhaps for this reason, many scholars have taken a relatively charitable attitude toward conspiracy theorists and conspiracy theorising in recent years. Still, it would be a mistake to conclude from the defence of conspiracy theorising offered here that belief in conspiracy theories (...) is on an epistemic par with belief in other theories. I argue that a range of epistemic errors are pervasive among conspiracy theorists. First, the refusal of conspiracy theorists to accept the official account of some target event often seems to be due to the exercise of a probabilistic, and fallacious, extension ofmodus tollens. Additionally, conspiracy theorists tend to be inconsistent in their intellectual attention insofar as the effort they expend on uncovering the truth excludes attention to their own capacities for biased or otherwise erroneous reasoning. Finally, the scepticism with which conspiracy theorists tend to view common sources of information leaves little room for conspiracy theorists to attain positive warrant for their preferred explanations of target events. (shrink)

Long considered "the noblest of the senses," vision has increasingly come under critical scrutiny by a wide range of thinkers who question its dominance in Western culture. These critics of vision, especially prominent in twentieth-century France, have challenged its allegedly superior capacity to provide access to the world. They have also criticized its supposed complicity with political and social oppression through the promulgation of spectacle and surveillance. Martin Jay turns to this discourse surrounding vision and explores its often contradictory implications (...) in the work of such influential figures as Jean-Paul Sartre, Maurice Merleau-Ponty, Michel Foucault, Jacques Lacan, Louis Althusser, Guy Debord, Luce Irigaray, Emmanuel Levinas, and Jacques Derrida. Jay begins with a discussion of the theory of vision from Plato to Descartes, then considers its role in the French Enlightenment before turning to its status in the culture of modernity. From consideration of French Impressionism to analysis of Georges Bataille and the Surrealists, Roland Barthes's writings on photography, and the film theory of Christian Metz, Jay provides lucid and fair-minded accounts of thinkers and ideas widely known for their difficulty. His book examines the myriad links between the interrogation of vision and the pervasive antihumanist, antimodernist, and counter-enlightenment tenor of much recent French thought. Refusing, however, to defend the dominant visual order, he calls instead for a plurality of "scopic regimes." Certain to generate controversy and discussion throughout the humanities and social sciences, _Downcast Eyes_ will consolidate Jay's reputation as one of today's premier cultural and intellectual historians. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Sigewiza’s CureJennifer H. Radden (bio)Keywordsbiopsychosocial model, Hildegard of Bingen, associationist presuppositions, causation, power of suggestionSuzanne Phillips and Monique Boivin provide us with a sympathetic and compelling account of how the various elements of Hildegard’s sophisticated amalgam of ritual, magic, religion, dietary and other medical remedies, caring, and community, formed a seamless cure for Sigewiza’s affliction. Whether Hildgard’s approach reflects an early instance of the biopsychosocial “model” is a separate (...) claim, and may be challenged. But that her ministrations somehow effected a cure in this case seems—if not without a doubt, then very likely.Descriptions of Sigewiza’s condition, with its “clumping together of blackness and steam” caused by a “constellation of humors,” echo those of other medieval writers speaking of the humoral disorder of melancholia—at that time an encompassing category for a range of symptoms and syndromes that would today be assigned as different mental disorders. In these descriptions a variety of explanations for mental illness are quite typically introduced, including biological, social, supernatural, dietary and astrological ones. Phillips and Boivin take care to point out that Hildegard was not offering her remedies as alternatives, but rather proposing them as at work jointly and in a range of causal directions, exhibiting mutual influence, and feedback loops. As these authors say, multiple explanations “were often held simultaneously... in reference to a specific case” (Phillips and Boivin 2007, XX). And the factors that might cause the system to move out of balance are many: food, emotions, the soul, the mind, actions, and spiritual forces. So although deeds may cause bodily changes and their psychological accompaniments, “problems in the diet might affect the humors which would then have psychological effects, which demons might... use as opportunities to cause further trouble in the spirit, mind, and body” (Phillips and Boivin 2007, 365).What first struck me about Hildegard’s description of these many distinct causes interacting in complex ways is its compatibility with the multi-causal accounts of depression (and other mental disorder) frequently proffered in our own time. Daily habits (e.g., diet, sleep and exercise regimes), genetic predispositions, including biological states of fragility, external events, experiences of loss, social roles, and cultural beliefs—not to mention spontaneous recovery, and placebo effects—are all regularly implicated in the onset and course of conditions such as depression.Still, the similarity to these modern causal accounts may be somewhat misleading and we must beware of overstating it. In favoring and pressing on Hildegard’s holistic understanding, moreover, Phillips and Boivin perhaps insufficiently emphasize significant dissimilarities between Hildegard’s and our contemporary accounts.It is the interaction between the various elements making up Sigewiza’s cure that is most noteworthy [End Page 373] in this account, as Phillips and Boivin recognize. Yet that relationship itself seems in some ways surprisingly problematic: difficult for us to make sense of, and profoundly unmodern. Granted, we think we see the way these approaches probably influenced how Sigewiza felt and responded; but it is not so clear how Hildegard saw things. Like a lot of thinking in medieval times, Hildegard’s account provides us with glimpses of an understanding of the world that today looks prescientific and in that respect, almost precausal. (So, to the extent that the biopsychosocial model is understood as a causal one, the case of Sigewiza may exemplify it only inexactly.)It is not merely the range and type of causes, including supernatural and astrological ones, in accounts such as Hildegard’s that distinguish it from today’s analyses. It is also the reliance of such accounts on what seems to be a different metaphysics, one of associations or qualities.Associationist presuppositions can be found in accounts of health and illness from before, during, and long after, Hildegard’s time. Three examples of this pervasive, but puzzling thinking serve to illustrate. The melancholiac’s perceived swarthiness and darkened skin color—regularly noted from the time of the Greek physicians and an established part of the medieval iconography in images of melancholy—were not, or not primarily, thought to be a causal result of the darkness of his bile, as one might suppose. Instead, this coloring seems... (shrink)

In 1960, a relatively new ‘syndrome’ began appearing with growing frequency in psychiatric hospitals and in doctors’ offices. Eventually termed ‘delicate self-cutting’, this new model for typical self-mutilative behavior was developed in conjunction with a description of the ‘typical’ self-mutilator: young (adolescent to just post-adolescent), female, and almost always attractive. This article contends that, despite recent efforts to change the nature of research on self-mutilation, the myth of a typical mutilator, developed from a particular historical bias, continues to work (...) in popular and medical discourses on the subject. I will begin with a detailed discussion of the medical discourse in an effort to ask how the myth was made. Noting that the female body, here, is singled out as pathological at a time when, specifically in the USA, the emergent Women’s Movement was beginning to contest certain gender lines, I would like to examine how the medical discourse and material bodies interrelate and interact with each other and with the cultural narratives around them. Finally, I end with examples from the 1999 film Girl, Interrupted, as well as other recent popular and medical accounts, to illustrate not only the perpetuation of the myth of the ‘typical’ self-mutilator but also the inability or refusal to recognize the biased nature of the medical discourse in the instance on self-mutilation. (shrink)

Autism spectrum disorders (ASDs) are an issue of growing public health significance. This set of neurodevelopmental disorders, which includes autistic disorder, Asperger syndrome, and pervasive developmental disorder not otherwise specified (PDD-NOS), is characterized by abnormalities in one or more of the following domains: language use, reciprocal social interactions, and/or a pattern of restricted interests or stereotyped behaviors. Prevalence estimates for ASDs have been increasing over the past few decades, with estimates at ~5/10,000 in the 1960s, and current estimates (...) as high as 1/88 (Newschaffer et al. 2007; CDC 2012).1 While ASDs encompass a wide range of phenotypes and degrees of severity, the disorders .. (shrink)

Discourses of public education reform, like that exemplified within the Queensland Government's future vision document, Queensland State Education‐2010 , position schooling as a panacea to pervasive social instability and a means to achieve a new consensus. However, in unravelling the many conflicting statements that conjoin to form education policy and inform related literature , it becomes clear that education reform discourse is polyvalent . Alongside visionary statements that speak of public education as a vehicle for social justice are the (...) visionary or those reflecting neoliberal individualism and a conservative politics. In this paper, it is argued that the latter coagulate to form strategic discursive practices which work to secure dominant relations of power. Further, discussion of the characteristics needed by the ‘ideal’ future citizen of Queensland reflect efforts to ‘tame change through the making of the child’ . The casualties of this vision and the refusal to investigate the pathologies of ‘traditional’ schooling are the children who, for whatever reason, do not conform to the norm of the desired school child as an ‘ideal’ citizen‐in‐the‐making and who become relegated to alternative educational settings. (shrink)

This paper traces the development of parental rights to accept or to refuse treatment for a defective newborn infant in the United Kingdom and in the United States of America; its main purpose is to explore the common trends from which an acceptable policy may be derived. It is probable that the British law on parental decision-making in respect of infants suffering from Down's syndrome is to be found in the civil case of In Re B rather than in (...) the criminal case of R v Arthur. United States court decisions are strongly influenced by constitutional law and reflect the right to personal privacy. The position on each side of the Atlantic seems very similar but this similarity includes a sense of uncertainty as to legal responsibility. There is a case for agreed guidelines and a suggested format is offered for consideration. (shrink)

Using criteria of relative plausibility, it is possible to make a case for significant group selection over the 100,000 years that Anatomically Modern Humans have been both moral and egalitarian. Our nomadic forebears surely lived in egalitarian communities that levelled social differences and moralistically curbed free-riding behaviour, and this egalitarian syndrome would have had profound effects on levels of selection. First, it reduced phenotypic variation at the within-group level. Second, it increased phenotypic variation at the between-group level. Third, and (...) crucially, moral sanctioning also permitted groups to sharply curtail free-riding tendencies at the level of phenotype. The result was group selection strong enough to support altruistic genes, and a human nature that was set up for social ambivalence: that nature was mainly selfish and strongly nepotistic, but it was at least modestly and socially significantly altruistic. The effects on human social and moral life were pervasive, both in hunting bands and in more recent manifestations of human society. (shrink)

In everyday language as well as scientific language, there are but few terms and concepts with such a comprehensive negative meaning and connotation as the term "disease." Disease is a universal evil. Nobody wants disease and everybody would agree that disease should be defeated and eradicated. But what if disease strikes one's own body and mind? What if the imperative of disease eradication targets properties of the body, which is me? This is the reality for many patients with psychiatric diagnoses (...) and their families. This is the reality of psychiatry. Psychiatry is a clinical discipline in the borderland between natural sciences and humanities. Psychiatric concepts of mental health and disease affect the self-image and self-worth of patients and their families in a very pervasive manner. Therefore, it is important to reflect on what we mean with psychiatric diagnoses, how we define it and how we delineate phenomena we would regard as unusual but healthy from those we would consider reflecting a disease. In this paper, the different meanings of the concept of normality will be presented. I will briefly discuss if or not there is a generally accepted concept of what a disease is. Then I will address the definition of what a psychiatric disorder is. Based on the example of autism, I will finally illustrate that phenomenologically identical medical syndromes can be regarded as well as a norm variant, as a psychological disorder, and as a psychiatric disease. This comprehensive perspective on the diverse phenomena of body and mental functioning illustrates that many if not most of the present psychiatric diagnoses cannot be considered as names of diseases, but as umbrella terms for a wide range of differently caused mental phenomena. (shrink)

Although the use of ECT has declined dramatically from its inception, this decrease has recently shown signs of leveling out because of ECT's powerful therapeutic effect in severely ill depressed individuals who either do not respond to pharmacologic alternatives or are too ill to tolerate a relatively lengthy drug trial. Notwithstanding its therapeutic benefits, ECT has also remained a controversial treatment modality, particularly in the eye of the public. Given the unsavory qualities associated with the word “electroconvulsive,” claims of possible, (...) probable, or even certain brain damage with ECT have easily found listeners. A careful, nonselective assessment of data covering the areas of pathology, radiology, electrophysiology, biochemistry, and neuropsychology leads both to certain conclusions and to certain unanswered questions. ECT is not the devastating purveyor of wholesale brain damage that some of its detractors claim. For the typical individual receiving ECT, no detectable correlates of irreversible brain damage appear to occur. Still, there remains the possibility that either subtle, objectively undetectable persistent deficits, particularly in the area of autobiographic memory function, occur, or that a rarely occurring syndrome of more pervasive persistent deficits related to ECT use may be present. Clearly, more research directed toward answering these questions needs to be carried out so that the role of ECT can be more rigorously defined. While such research is pending, however, we cannot expect that the conditions that predispose to clinical referrals for ECT will disappear. Given the misery, anguish, and risk of death by suicide, starvation, or debilitation associated with severe depressive illness, for example, it still appears that ECT, at least for the present, must continue to be available. (shrink)

Discourses of public education reform, like that exemplified within the Queensland Government's future vision document, Queensland State Education‐2010 (QSE‐2010), position schooling as a panacea to pervasive social instability and a means to achieve a new consensus. However, in unravelling the many conflicting statements that conjoin to form education policy and inform related literature ( ), it becomes clear that education reform discourse is polyvalent ( ). Alongside visionary statements that speak of public education as a vehicle for social justice (...) are the (re)visionary or those reflecting neoliberal individualism and a conservative politics. In this paper, it is argued that the latter coagulate to form strategic discursive practices which work to (re)secure dominant relations of power. Further, discussion of the characteristics needed by the ‘ideal’ future citizen of Queensland reflect efforts to ‘tame change through the making of the child’ (, p. 201). The casualties of this (re)vision and the refusal to investigate the pathologies of ‘traditional’ schooling are the children who, for whatever reason, do not conform to the norm of the desired school child as an ‘ideal’ citizen‐in‐the‐making and who become relegated to alternative educational settings. (shrink)

CQ: The Baby Bas Ross case stirred much public debate in The Netherlands since 1988 -a newborn infant with Down's syndrome whose parents refused to consent to a surgery that would have repaired an otherwise fatal congenital anomaly. Can you share your thoughts with us on this case?HD: I was the first ethicist to comment on this case because I was a friend of Dr. Molenaar, who was the final surgical decision maker for Baby Bas. A physician and I (...) supported his decision throughout the prosecution that followed. We also summarized the case in the N.T.V.G., the Dutch Magazine of Medicine. We argued In the article that parents should have the option to make nontreatment decisions. Moreover, In cases where the physician has to perform aggressive medical interventions, there certainly must be thorough and sound justification to ensure that the decision to Intervene Is in the best interest of the child.Heleen M. Dupuis, Ph.D., is Professor of Bioethics at the Leiden University School of Medicine, where she heads the Department of Metamedica and teaches in the Department of Philosophy. She is also a member of the Institutional Review Board/Ethics Committee of the Leiden University Hospital and a member of the Ethics Committee of the Royal Dutch Society of Medicine. (shrink)

In his case report, A Logic in Madness, Aaron Hauptman details the case of Mr. A, an intelligent college student with Asperger’s syndrome, who became severely depressed subsequent to what he perceived as a rejection by what he viewed as “the love of his life.” Dr. Hauptman describes Mr. A as suicidal and as suffering from all the hallmarks of a major depression. At the urging of his family, he presents himself to a psychiatric inpatient unit and agrees to (...) a voluntary hospitalization. However, he refuses pharmacological treatment or electroconvulsive therapy, both of which his clinicians are considering given the severity of his case. Dr. Hauptman describes the young man’s response... (shrink)

This paper analyzes post-Mao China as a complex risk society in which social, economic, and ecological risk syndromes pertaining to highly diverse levels and systems of development are manifested simultaneously. Complex risk society is a theoretical extension of Ulrich Beck’s thesis on risk society, focusing on complex developmental temporalities that are pervasively symptomatic of rapidly but asymmetrically developing political economies. In my earlier study, Korea was defined as a complex risk society in which risk syndromes of developed, undeveloped, and compressively (...) developing societies are concurrently generated. In the current study, post-Mao China is also analyzed as a complex risk society which is, in fact, more complex than Korea. Paradoxically, due to its explosive development in the post-Mao era which even dwarfs Korea, China is now confronted by all of its capitalist neighbour’s risk syndromes. Besides, due to its so-called gradual approach to reform, China is beset with a complicated mix of socialist and post-socialist syndromes of risks. Gradual reform is in practice a sort of peripatetic pluralism in economic and social reform for maximizing developmental utilities of all types of human, material, and institutional resources—a policy line inevitably accompanied by similarly plural sources and factors of social, economic, and ecological risks. The unprecedented temporal and systemic complexity in China’s risk structure has crucial implications for the country’s much deplored tendency for inequalities. In particular, class inequalities and regional disparities seem to be manifest in risk dimensions no less critically than in material dimensions. The state’s developmentalism alone is no solution for risk complexities or inequalities. (shrink)

Untangling the Surrogacy WebSurrogacy agreements represent unique legal questions that must be answered with great care. In Australia we had the recent “Baby Gammy” scandal that involved an international surrogacy agreement and claims of abandonment of a child with Down’s syndrome. This story served to reinforce concerns that surrogacy turns children into a commodity that can be put to one side if expectations are not met. Of course, surrogacy agreements do not always end in this manner and often the (...) outcome is positive. There are, however, underlying legal questions regarding the status of the child, with some children, born as the result of international surrogacy agreements, being practically stateless when the nation of the commissioning parents refuses to issue passports to allow the children to return “home” with their “parents.” Where the relationship is local, however, and there is clear legislation, the issues can be less problematic but can become complex where a party wishes .. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 14.3 (2004) vii-viii [Access article in PDF] John C. Fletcher 1931-2004 John Fletcher was one of the pioneers in the still-young field of bioethics. In this short tribute, I can only hope to highlight a few of the many contributions he made to the field.For many of us, our first introduction to John occurred in October 1971. At an international symposium sponsored by the (...) Kennedy Foundation, the film "Who Should Survive?" depicted the dramatic case of an infant with Down syndrome and an intestinal blockage. The parents of the infant refused surgery to relieve the obstruction, and the healthcare providers for the infant decided not to pursue a court order permitting the surgery. During a period of approximately two weeks the infant was allowed to die.In the second part of "Who Should Survive?" John was one of several panelists invited to discuss the decisions made in this case. After acknowledging how troubling the infant's death was to him, John nonetheless sought to be empathic with the parents. He pointed out that in the re-enactment of the case the faces of the parents were never seen, and he worried that the film did not permit the parents to discuss the reasons for the choice they had made. John realized that his position would not be shared by most other panelists. Yet he had the courage to take an unpopular stand and to challenge other panelists—and the audience—not to reach premature closure on complex ethical dilemmas.Already in 1967, John had begun contributing to the literature of bioethics. His essay "Human Experimentation: Ethics in the Consent Situation," appeared in Law and Contemporary Problems. At the time, John was deeply immersed in studying the ethical dimensions of research with human subjects at the NIH Clinical Center. Paul Ramsey cited John's work with appreciation in his 1970 book, The Patient as Person. By the time he completed his dissertation at Union Theological Seminary in 1969, John was arguably one of the best trained bioethicists in the world—before there was a field of bioethics.After serving as chaplain, teaching at Virginia Theological Seminary, and founding and leading a seminary without walls in Washington, DC, John became the chief of the ethics program at the NIH Clinical Center in 1977. There he had the unenviable task of providing a second review for all clinical protocols emerging from the intramural programs of the NIH institutes. John discovered that in some cases the institutional review boards of the institutes had overlooked important ethical questions. This role also [End Page vii] required courage. At times John found it necessary to challenge senior NIH researchers, even institute directors, and to request protocol revisions that in his view were required for the protection of human subjects.In 1980, after Martin Cline had performed an unauthorized gene transfer experiment involving thalassemia patients, John joined with physician W. French Anderson to write an essay entitled "Gene Therapy in Human Beings: When Is It Ethical to Begin?" [New England Journal of Medicine 303: 1293-97]. Not only did this essay help to defuse a potentially explosive problem for NIH, which had funded Cline's research. It also provided a set of guidelines for the conduct of human gene transfer research that is of continuing relevance today.At times John disagreed with federal policies on research, for example, conservative policies on human embryo research. He also chafed at the idea of subjecting his publications to prior NIH review, both for accuracy and for political correctness. Thus, he welcomed the opportunity to move to the University of Virginia in 1987. There his academic career flowered, and he enjoyed some of his most productive years of research and writing.Among his many contributions during these later years, John participated as Committee co-chair in an effort to "redress the wrongs of Tuskegee." The Tuskegee Syphilis Study Legacy Committee proposed in May 1996 that President Clinton apologize to the participants in the Tuskegee study on behalf of the federal government. In May 1997, the President did in... (shrink)

Background Compulsory treatments represent a legal means of imposing treatment on an individual, usually with a mental illness, who refuses therapeutic intervention and poses a risk of self-harm or harm to others. Compulsory outpatient treatment in psychiatry, also known as community treatment order, is a modality of involuntary treatment that broadens the therapeutic imposition beyond hospitalization and into the community. Despite its existence in over 75 jurisdictions worldwide, COT is currently one of the most controversial topics in psychiatry, and it (...) presents significant ethical challenges. Nonetheless, the ethical debate regarding compulsory treatment almost always stops at a preclinical level, with the different ethical positions arguing for or against its use, and there is little guidance to support for the individual clinicians to act ethically when making the decision to implement COT. Main body The current body of evidence is not clear about the efficacy of COT. Therefore, despite its application in several countries, evidence favouring the use of COT is controversial and mixed at best. In these unclear circumstances, ethical guidance becomes paramount. This paper provides an ethical analysis of use of COT, considering the principlist framework established by Ross Upshur in 2002 to justify public health interventions during the 2002–2004 severe acute respiratory syndrome outbreak. This paper thoroughly examines the pertinence of using the principles of harm, proportionality, reciprocity, and transparency when considering the initiation of COT. Conclusion Ross Upshur’s principlist model provides a useful reflection tool for justifying the application of COT. This framework may help to inform sounder ethical decisions in clinical psychiatric practice. (shrink)

The “expressivist objection” argues that prenatal screening leading to termination of embryos or fetuses with disabilities sends a harmful message to people with disabilities, such as the message that their lives are not worth living. I first argue that whether it sends such a message depends on how a reasonable person would see the motives behind the screening. I then argue that a reasonable person would see a harmful message, not when individuals terminate embryos, and not for severe disabilities, but (...) when the state allows the screening and termination of embryos with less severe conditions, such as Down syndrome. This sends the message that it is permissible not to pay a higher cost to support people with disabilities, when there is an abled alternative. This attitude is harmful to the welfare, rights and self-worth of people with disabilities because it reinforces the refusal to provide them with equal opportunity. The state therefore has a strong pro tanto reason to ban prenatal screening for less severe disabilities. (shrink)

An Asian Indian Hindu family chose no intervention and hospice care for their newborn with hypoplastic right heart syndrome as an ethical option, and the newborn expired after five days. Professional nursing integrates values-based practice and evidence-based care with cultural humility when providing culturally responsive family-centered culture care. Each person’s worldview is unique as influenced by culture, language, and religion, among other factors. The Nursing Team sought to understand this family’s collective Indian Hindu worldview and end-of-life beliefs, values, and (...) practices, in view of the unique aspects of the situation while the team integrated evidence-based strategies to provide family-centered culture care. Parental care choices conflicted with those of the Nursing Team, and some nurses experienced moral distress and cultural dissonance when negotiating their deeply held cultural and religious views to advocate for the family. The inability to reconcile and integrate a stressful or traumatic experience impacts nurses’ well-being and contributes to compassion fatigue. Nurses need to be intentional in accessing interventions that promote coping and healing and moral resilience. Reflection and cultural humility, assessment, and knowledge in context, increase evidence-based culture care and positive outcomes. U.S. society’s views on ethical behavior continue to evolve, and some may argue that the law should place more limits on parents’ right to choose or to refuse treatment for their infants and children. Moral distress can lead to moral resilience and satisfaction of compassion when nurses provide family-centered culture care with cultural responsiveness and integrate values-based practice with evidence-based care, and aim to first do no harm. (shrink)

Objective: To develop an approach for seeking informed consent to examine tissues retained from a previous study of sudden infant death syndrome as part of a study on asthma, and to document responses and participation rate.Design: Pilot open-ended approach to 10 volunteer SIDS parents, followed by staged approach to seek consent from the target SIDS families for the asthma study.Participants: Parents of SIDS infants known to SIDS and Kids Victoria and parents of SIDS infants from the 1991–2 SIDS in (...) Victoria case–control study.Main outcomes: Qualitative responses of the piloted parents and study parents, and participation rates.Results: The pilot group responses were used to refine the written material to be provided. Of the 72 families for which contact details were available, 45 gave verbal consent for contact by the Victorian Institute of Forensic Medicine regarding the asthma study, three refused and 24 did not respond to two letters. Thirty-three completed consent forms, all positive for participation in the asthma study, giving a positive response rate of 73% .Conclusions: The use of postmortem tissue for research is acceptable to the next of kin when an approach is sensitive to their concerns and needs and is made by experienced counsellors from a familiar organisation. Despite the painful memories evoked by the approach of the research group, the acceptance rate among those who could be contacted was high. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:XY/XOLianne SimonAs a boy child I might once have thrived, but the loss of a Y chromosome in one of the first few cell divisions left me a faie half–girl struggling for life—like some changeling left in place of a human baby. My genetic mosaic of XY and XO cell lines created a fetal legacy of Turner Syndrome medical issues. Among these were delayed growth, a largely absent (...) puberty, and micrognathia—a small jaw that feminized my face. [End Page E11]At two I weighed just eighteen pounds. My parents worried they might lose their little boy, I was that frail. All I knew was I was the smallest of my peer group and had a cute pixie face. I imagined myself a high–spirited elfin princess, but was in truth shy—almost timid—and prone to tears.I first responded to the Gospel at vacation Bible school. One of the women there read me Bible stories. I didn’t understand them all, but I wanted to love Jesus and be a good girl.At nine I was the size of a 6–year–old. By then I’d started growing faster, so my mother stopped taking me to the doctors. I didn’t see one again until an emergency appendectomy in college.Fifth grade brought surprises. Jim melted my heart with his Beatles love songs and cute smile. I dreamed of being his bride. Karen was the first classmate ever shorter than me. We were best friends, but one day the principal said I should play softball with the boys instead of hopscotch with her.My parents allowed me dolls and tea sets, even an Easy–Bake oven. But wearing my sister’s clothes triggered a sad–eyed lecture—boys didn’t do such things. No dresses. No talking with my hands. No long hair. And no crushes on boys.If I prayed hard enough, if I was really good, maybe God would make me a real boy—tall and strong, fast and agile—like my older brother. Two years later, puberty cracked my high–pitched squeal of a voice and sent it sliding down to a mellower soprano. I grew taller, but didn’t get muscles or body hair, and I remained hopelessly uncoordinated. An inguinal hernia kept me from running very far.High school turned my prayers into pleas for mercy. I despaired of ever fitting in. Some Christians might not have welcomed a feminine boy, but the pastor of our Southern Baptist mission considered me one more sinner in need of the saving grace of a forgiving God. He led me to faith in Christ. As a new believer, I assumed I could be a boy for real. Maybe even find a girlfriend. Instead, the mask that allowed me to function socially crumbled, leaving me no place to hide.In the spring of 1970, I registered for the draft. Me fighting in Vietnam seemed a real possibility. Or at least spending time in prison for refusing induction. Except that a delicate intersex kid would never have passed the physical. Nearly perfect SAT scores won me a scholarship to Miami, so I left a supportive home in Illinois for a boys’ dorm in south Florida.My surname then was Klett. The worst of the guys called me Clit, or sometimes Clitoris. Others derided my small size and lack of virility. One propositioned me. Another used to pin me to my bed and lie on top of me until I quit struggling. Though he stopped each time I surrendered, my defenses lay in ruin.A few of the boys were nice. David took me for long rides on his motorcycle, with my arms wrapped tight around his waist. He treated me with gentle kindness and asked nothing in return.To escape the dorm, I studied in the library stacks, where only honors and graduate students were allowed. The next year I found a derelict building where the university stored old theatrical sets. It even had a quiet place to sit in the sun. Best of all—nobody ever went there.One day my imagination wandered through the wardrobe. What would I have worn... (shrink)

More than 95 per cent of criminal convictions in the USA never go to trial, as the vast majority of defendants forfeit their constitutional rights to due process in the pervasive practice of plea bargaining. This article analyses the relationship between American mass incarceration and this mass forfeiture of procedural justice by situating the practice of plea bargaining in the normative framework drawn by recent Supreme Court rulings and the proliferation of criminal statutes, including mandatory minimum sentencing legislation. Looking (...) at systemic racial disparities in sentence severity and incarceration rates for otherwise similarly situated defendants, I argue that, rather than a voluntary waiver of constitutional rights, this mass forfeiture of due process rights ought to be conceptualized as the product of an entrenched system of procedural entrapment. Such entrapment, I argue, ought to be abolished not only on grounds of procedural injustice, but because the practice refashions rather than redresses forms of racial domination derived from prior eras. The article concludes by exploring the tactic of mass conscientious plea refusal through the collectively organized assertion of constitutional due process rights as a strategy of resisting mass incarceration. (shrink)

The theological foundations of Ghazali's causal theory are fully expressed in the chapter on the attribute of divine power in his al-Iqtiṣād fi al-I'tiqād. The basic doctrine which he proclaims and argues for is that divine power, an attribute additional to the divine essence, is one and pervasive. It does not consist of a multiplicity of powers that produce a multiplicity of effects, but is a unitary direct cause of each and every created existent. In a defense of the (...) doctrine of kasb, Ghazali argues that power in all animate creatures is created directly by God and that there is created with it the object of power, normally, but erroneously regarded as its effect: the object of power is in fact directly created by God. It exists with the created power, but not by it. In his critique of the Mu'tazilite theory of the generated act he again denies that created power has any causal efficacy and denies that inanimate things have any causal efficacy. What one normally regards as the effects of inanimate causes are in reality their concomitants, directly caused by divine power. The discussion of kasb, the longest in the chapter, includes Ghazali's spirited defense of it against possible objections. The defense, however, as will be shown, is not immune against criticism. At the same time, the discussion of kasb, central as it is, has to be understood in the context of the chapter as a whole, whose intricate arguments remain integrated and unified. Hence a brief exposition of the chapter's arguments will first be given, followed by a critical comment on some aspects of Ghazali's defense of kasb. This is then followed by an annotated translation of the entire chapter, a chapter so very basic for the study of Ghazali's position on causality. Les fondements théologiques de la théorie de la causalité chez Ghazali trouvent leur pleine expression dans le chapitre de son al-Iqtiṣād fī al-i'tiqād, portant sur l'attribut de la puissance divine. La doctrine fondamentale qu'il proclame et en faveur de laquelle il plaide, c'est que la puissance divine, attribut qui s'ajoute à l'essence divine, est une et partout présente. Elle ne consiste pas en une multiplicité de pouvoirs produisant une multiplicité d'effets, mais elle est la cause unitaire et immédiate de chaque existant créé. Défendant la doctrine du kasb, Ghazali fait valoir que le pouvoir présent chez les créatures animées est créé directement par Dieu et que se trouve créé, en même temps que ce pouvoir, l'objet sur lequel il s'exerce, objet considéré ordinairement quoique de façon erronée, comme l'effet de ce pouvoir. L'objet de ce pouvoir est, en fait, directement créé par Dieu. Il existe avec le pouvoir cr´, mais non par lui. Dans sa critique de la théorie mu'tazilite de l'acte engendré, Ghazali dénie ā nouveau au pouvoir créé toute efficace causale et refuse de considérer que les réalités inanimées aient une quelconque efficace causale. Ce que l'on considère habituellement comme les effets des causes inanimées sont en réalité leurs concomitants, directement causés par la puissance divine. Dans la discussion du kasb, qui occupe la plus large place dans ce chapitre de l' Iqtiṣād, Ghazali présente une défense passionnée de cette doctrine contre les objections qui pourraient lui être opposées. Cependant, cette défense, comme on le montrera, n'est pas a l'abri de toute critique. Dans le même temps, la discussion du kasb, centrale comme elle est, doit être comprise dans le contexte de ce chapitre pris comme un tout et dont les arguments complexes demeurent intégrés et unifiés. Aussi exposera-t-on d'abord brièvement ces arguments, avant de proposer un commentaire critique de certains aspects de la défense par Ghazali du kasb. Cet exposé et ces remarques critiques sont suivis d'une traduction annotée de l'mtégralité de ce chapitre, si fondamental pour l'étude de la position de Ghazali concernant la causalité. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 8.4 (2001) 295-298 [Access article in PDF] A Dialectical Conception of Autism Giovanni Stanghellini Some Reasons for the Philosophical Turn in the Psychopathology of Schizophrenia There are many ways to become a schizphrenic. Each individual has her own schizophrenia, coherent with her life history, her problems and alternatives deriving from them (Binswanger 1960). What clinical psychiatry calls "schizophrenia" is not a unitary illness but a (...) common final state—a "syndrome" in the etymological sense, that is, a condition to which different psychopathological pathways may lead. Schizophrenic symptoms, like Schneiderian first-rank symptoms (delusions, hallucinations, experiences of passivity), are nothing but a rather uniform type of reaction. First-rank Schneiderian symptoms may be interpreted as attempts to explain disturbing basic experiences of change in self, body, and world perception (Klosterkoetter 1988) or as the epiphenomena of complex interactions between sensory disorders (aberrations in the perception of self, body, and world), conceptualisation disorders (impairments in the constitution of meanings and intentions), and attitudinal disorders (eccentric structure of values and beliefs) (Stanghellini 2000a). Since the schizophrenic syndrome, as defined by current diagnostic manuals, lacks any authentic core phenomena, and so-called schizophrenic symptoms are not specific (Berner and Kufferle 1982), the clinical diagnosis of schizophrenia finally becomes a diagnosis by exclusion (Maj 1998). This conceptual weakness is obviously unacceptable (not only for old dissenters from operational diagnostic criteria) and is kindling a velvet revolution in nosological studies and a renaissance of philosophically oriented psychopathological research (Parnas and Zahavi 2000). Autism: The Loss of Vital Contact with Reality Eugène Minkowski was a forerunner in the field of philosophical psychopathology: "The psychiatrist and the metaphysician become one in their common research concerning what is human and human experience" (Minkowski 1947). Indeed, his doctoral thesis on autism (Minkowski 1926) was dedicated to his teachers, the psychiatrist E. Bleuler and the philosopher H. Bergson, and his conceptualisation of autism is an ideal example of the link between philosophical perspectives and psychopathological research. The term "autism" was introduced by Bleuler (1911) to describe detachment from outer reality and immersion in inner life. Bleuler's concept of autism relied on Freud's (1905) notion of autoerotism and on associationistic psychology. According to Bleuler, autism was a consequence of the [End Page 295] splitting of psychic functions: a defense mechanism serving to avoid conflicts between desires and reality testing, promoting the shift to inner fantasy life and entailing social withdrawal, emotional indifference, inappropriate behaviors, and idiosyncratic values and beliefs.Minkowski, who was influenced by Bergson and phenomenology, departed from Bleuler's conceptualisation and defined autism as "loss of vital contact with reality" (Minkowski 1926, 1927). For Minkowski, autism is not a symptom, but a global phenomenon investing the whole person. Autism is a way of being whose essential feature is a pragmatic deficit: Autistic activity consists in the reduced capacity to interact with the external world. Autistic thought is characterized by its lack of communicative action. The pragmatic deviance of autistic language is a good example: The autistic person is not interested in communicating her inner world to the others; language is not a means of communication which serves mutual understanding, a cooperative process whose aim is interlacing one's own world with that of others. The autistic person's use of language is much like a soliloquy, the monologue of the solitary thinker more focused on ex-pression—the outward portrayal of immanent contents of consciousness—than on dialogue—the exchange of meanings between speaker and listener. Moreover, each meaning is presented in its manifold profiles or adumbrations and the task of selecting the context-relevant meaning is left to the listener.The pragmatic weakening of the autistic person, according to Minkowski, is not simply a social or occupational dysfunction (APA 1994), that is, a renunciation or refusal to act according to social expectations and standards. It involves the loss of vital contact with reality. The meaning Minkowski attributes to the term "vital" is essential for understanding his philosophical approach to defining the schizophrenic condition. Minkowski assumes that contact with reality is vital when it is established through action (and language... (shrink)

The practical difficulties that trouble any effort to discuss “pluralism” in American literary studies can be glimpsed in the following exchange. In a 1980 interview in the Literary Review of Edinburgh, Ken Newton put this question to Derrida:It might be argued that deconstruction inevitably leads to pluralist interpretation and ultimately to the view that any interpretation is as good as any other. Do you believe this and how do you select some interpretations as being better than others?Derrida replied:I am not (...) a pluralist and I would never say that every interpretation is equal but I do not select. The interpretations select themselves. I am a Nietzschean in that sense. You know that Nietzsche insisted on the fact that the principle of differentiation was in itself selective. The eternal return of the same was not repetition, it was a selection of the more powerful forces. So I would say that some are more powerful than others. The hierarchy is between forces and not between true and false.1­­The irony of Newton’s identification of pluralism with the very interpretive irresponsibility that it accuses others—Derrida foremost among them—of embracing is certainly not lost on those critics who call themselves pluralists; it comes as no surprise to them that Derrida declines to join their company. Nevertheless, the breezy gloss of pluralism as “the view that any interpretation is as good as any other” is bound to seem plausible to the large numbers of readers for whom the word denotes a generalized tolerance the refusal of dogmatism. That Derrida should be called upon to dissociate himself from pluralism is in fact symptomatic of the profound confusion surrounding the term. At present, the pervasiveness of such loose talk compels pluralists to defend themselves regularly against this kind of misinterpretation. Thus, the colloquial reading of pluralism that construes it as mere relativism, the absence of principled constraints, is frequently acknowledged, if only to be rejected. Even Bruch Erlich must emphasize that pluralism does not want “a totally free critical market, for that involves the proliferation of a hundred flowers, what Booth dismissively terms ‘chaotic warfare.’ ”2 1. James Kearn and Ken Newton, “An Interview with Jacques Derrida,” Literary Review 14 , p.21.2. Bruce Erlich, “Amphibolies: On the Critical Self-Contradictions of ‘Pluralism,’ ” this volume, p. 527; all further references to this essay will be included in the text. Ellen Rooney teaches English and women’s studies at Brown University. She is currently at work on a study entitled Seductive Reasoning: Pluralism and the Problematic of General Persuasion. (shrink)

Josef Pieper’s insight into Aquinas’s metaphysics, that “createdness determines entirely and all-pervasively the inner structure of the creature,” applies equally to philosopher William Desmond.1 For at the heart of Desmond’s metaphysical project lies a refusal to take creation for granted, a challenge to Bertrand Russell’s assertion that “the universe is just there, and that’s all.”2 Desmond work aims at “renewing metaphysical astonishment before the enigma of being that was, and is, and always will be too much for us, in (...) excess of our groping efforts.”3 This “enigma of being” arouses a sense of astonishment at creation’s givenness, “that it is,” and at creation’s contingency, for all that is “might not have been .. (shrink)

This chapter describes the process of shaping ethical guidelines for an influenza pandemicInfluenza pandemic by the North Carolina Institute of Medicine (NC IOM)/North Carolina Department of Public Health (NCDPH) Task Force. The author discusses the threat of a pandemicPandemic in the twenty-first century, comparing a potential pandemic with past flu pandemics as well as the Severe Acute Respiratory Syndrome (SARS) outbreak in Canada and parts of Asia. Also discussed are the ways in which influenza would spread, be treated, and (...) hopefully contained. Addressed are the ways in which one becomes ethically prepared for an influenza pandemic, as well as the challenges to incorporating ethical guidelines in preparations. Tong also addresses the role of a dutyDuty/obligationObligation/responsibilityResponsibility to work by health care personnelHealth/ healthcare, right topersonnel, the role of volunteers, and when health care personnel may refuse to treat someone. Also taken into consideration are such issues as the distribution of food and vaccinesFlu vaccine, quarantinesQuarantine, work stoppage, both physical and social infrastructure, the role of military and police forces, and the effect of a pandemic, isolation, and quarantine on various industries. Tong shows the complicated nature of working on a task force and the complexity of incorporating ethicsCareethics of into logistical planning. (shrink)

Theorists have long sought to repress or domesticate the shaggy, obscene, and transgressive satyr that ranges through satire’s long history, lurking in dark corners, and to make it into a model of a moral citizen.Unruly, wayward, frolicsome, critical, parasitic, at times perverse, malicious, cynical, scornful, unstable—it is at once pervasive yet recalcitrant, basic yet impenetrable. Satire is the stranger that lives in the basement.Instead of trying to resolve all the problems that arise from the particular of a given tragic (...) dignification, the dramatist in his satyrplay throws out tragic dignification per se. He thus gets freedom by a flat refusal to accept any of the norms that had caused the .. (shrink)

Although Booker T. Washington stands outside the theological canon, his writings offer a pragmatic theology that connects the desire for dignity to a kenotic Christology through an ethic of unceasing work. While Washington's project to improve the lives of African Americans in the Jim Crow–era South was severely compromised by political circumstances, problems within his theology of work made his project especially susceptible to those circumstances. The tragedy of Washington's theology stems from his making dignity contingent upon work being recognized (...) as useful by a worker's community. His kenotic ideal of “Christlike” work can actually degrade workers, if their community refuses to recognize their work's merit. Workers’ anxiety about dignity causes them to pour themselves into their work, but a racist society sees African American workers as inherently undignified. Even without Jim Crow's pervasive violence, the postindustrial reappearance of economic doctrines that characterized Washington's era makes his theological ethic relevant again. (shrink)

continent. 2.2 (2012): 76–81 Comments on Eugene Thacker’s “Cosmic Pessimism” Nicola Masciandaro Anything you look forward to will destroy you, as it already has. —Vernon Howard In pessimism, the first axiom is a long, low, funereal sigh. The cosmicity of the sigh resides in its profound negative singularity. Moving via endless auto-releasement, it achieves the remote. “ Oltre la spera che piú larga gira / passa ’l sospiro ch’esce del mio core ” [Beyond the sphere that circles widest / penetrates (...) the sigh that issues from my heart]. 1 The axiomatic sigh of the pessimist is in a way the pure word of philosophy, a thought that thinks without you, speaks where you are not. The live pneumatic form of the soul’s eventual exit from the dead body’s mouth, the sigh restores consciousness to the funeral of being, to the passing away that is existence. Pessimism speaks in piercing aphorisms because first it sighs. “Beyond the sphere passeth the arrow of our sigh. Hafiz! Silence.” 2 … pessimism is guilty of that most inexcusable of Occidental crimes—the crime of not pretending it’s for real. To the pessimist, the ‘real’ world—the world on whose behalf we are expected to wake up in the morning—is a ceaseless index of its own unreality. The pessimist’s day is not an illumined space for the advancement of experience and action, but a permanently and inescapably reflective zone, the vast interior of a mirror where each thing is only insofar as it is, at best, a false image of itself. Within this speculative situation, inside the doubleness of the mirror, pessimism splits into two paths, false and true, one that tries to fix pessimism (establish a relation with the mirror) and decides in favor of the apparent real, and another that totally falls for pessimism (enters the mirror) and communes with the greater reality of the unreal. These two paths are distinguished by their relation to pessimism’s guilt vis-à-vis the world’s reality-project. The first form, that which remains pessimism for the world and puts on a smiling face, stays guilty to itself (i.e. unconscious) and thus turns hypocritical, becoming at once the pessimism of the commoner who really just wants things to be better for himself and the pessimism of the elite who wants to critically refashion reality in his own image. The general form of this worldly, hypocritical pessimism is the impulse to ‘make the world a better place’, which is the global mask under which the world is diurnally made worse. The second form, that which follows pessimism away from the world and ceases to put on a smiling face, refuses guiltiness as itself theessential Occidental mode of pretense and turns honest, becoming at once the intelligent pessimism required of all ordinary action and the radical pessimism necessary for self-knowledge: seeing that no one is capable of doing good. The general form of this universal, honest pessimism is the impulse not to worry, to give up and embrace dereliction, which is the only real way the world is actually improved. Where worldly pessimism is the engine productive of interminably warring secular and sacred religions (good-projects), universal pessimism strives hopelessly for the paradise of a supremely instantiated pessimus: things are getting so bad that there is no longer any time for them to get worse; things are so constantly-instantly worst that this is BEST. Cosmic pessimism is the mode of universal pessimism which can yet discourse with the world, which has not chosen silence and can spread the inconceivably BAD NEWS in an orderly form ( kosmos ) that the world can understand (if it wanted to). … the result of a confusion between the world and a statement about the world. That is what the world is (the result of a confusion between the world and a statement about the world). … a generalized misanthropy without the anthropos. Pessimism crystallizes around this futility—it is its amor fati , rendered as musical form. Pessimism’s love of fate is a blind love, a love of the blindness of being human in a cosmos conceived around the human’s eclipse, a heavy levitation in the contradictory space between the inescapability of its having been and the impossibility of its will-be. Pessimism’s song of futility is a sensible way of loving fate, with a minimum of eros, by means of a kind of matrimonial love of the fatal. As music, pessimism stays open to the irreparable and the inexorable without the binding of affirmation, in the apparent absence of the radical, infinitely surplus will that absolute amor fati seems to require. Crying, laughing, sleeping—what other responses are adequate to a life that is so indifferent? “Unless a man aspires to the impossible, the possible that he achieves will scarcely be worth the trouble of his achieving it. We should aspire to the impossible, to absolute and infinite perfection [….] The apocatastasis is more than a mystical dream: it is a norm of action, it is a beacon for high deeds [….] For true charity is a species of invasion [….] It is not charity to rock and lull our fellow men to sleep in the inertia and heaviness of matter, but rather to arouse them to anguish and torment of spirit.” 3 … the impossibility of ever adequately accounting for one’s relationship to thought. “The paroxysm of interior experience leads you to regions where danger is absolute, because life which self-consciously actualizes its roots in experience can only negate itself [….] There are no arguments [….] On the heights of despair, the passion for the absurd is the only thing that can still throw a demonic light on chaos [….] I live because the mountains do not laugh and the worms do not sing .” 4 It took three attempts before she was fully decapitated, all the while she continued, perhaps miraculously, to sing. According to the earliest account of Cecilia’s martyrdom, the beheading turns out worse. After not severing her head in three strokes, “the cruel executioner left her half dead” (seminecem eam cruentus carnifex dereliquit). 5 Cecilia’s effortlessly powerful endurance of the three strokes—a fitting icon for pessimism as an art of dereliction—demonstrates the “passivity and absence of effort [….] in which divine transcendence is dissolved.” 6 There’s a ghost that grows inside of me, damaged in the making, and there’s a hunt sprung from necessity, elliptical and drowned. Where the moving quiet of our insomnia offers up each thought, there’s a luminous field of grey inertia, and obsidian dreams burnt all the way down. Like words from a pre-waking dream. There is no reason to think that they are not. NOTES 1. Dante Alighieri. Vita Nuova . ed. and trans. Dino S. Cervigni and Edward Vasta. Notre Dame: University of Notre Dame Press. 1995. 41:10. 2. Hafiz of Shiraz. The Divan . trans. H. Wilberforce Clarke. London: Octagon Press. 1974. 10.9. 3. Miguel de Unamuno. The Tragic Sense of Life in Men and Nations . trans. Anthony Kerrigan. Princeton: Princeton University Press. 1972. 305-6. 4. E.M. Cioran. On the Heights of Despair . trans. Ilinca Zarifopol-Johnston. Chicago: University of Chicago Press. 1992. 9-10. 5. Giacomo Laderchi. S. Caeciliae Virg[inis] et Mart[yris] Acta. . . Rome. 1723. 38. 6. Georges Bataille. On Nietzsche . trans. Bruce Boone. London: Continuum. 2004. 135. See Nicola Masciandaro. “ Half Dead: Parsing Cecilia .” A Commentary on Eugene Thacker’s "Cosmic Pessimism" Gary J. Shipley Pessimism is the refusal to seek distraction, the refusal to remodel failure into a platform for further (doomed) possibilities, the refusal of comfort, the acceptance of the sickness of healthy bodies, the cup of life overflowing with cold vomit. If, as Ligotti suggests when discussing Invasion of the Body Snatchers , 1 humans prefer the anxieties of their familiar human lives to the contentment of an alien one, then the pessimist, we could argue, represents some perverted combination of the two, preferring (presuming he has a choice) the defamiliarization of human life to the contentment of its unquestioned mundanity. The quasi-religious state of mind that Wittgenstein would mention on occasion, that of “feeling absolutely safe,” 2 is a state the pessimist could only imagine being approximated by death, or perhaps some annihilative opiate-induced stupor. This Wittgensteinian commingling of certainty and faith looks every bit the futile gesture, a mere rephrasing of collapse or partial collapse. The only certainty open to the pessimist is that of the toxic formula of life itself—a formula known and lacuna-free. Certainty, far from being the gateway to deliverance, becomes the definitive impediment; and the possibility of salvation, as long as it remains, becomes crucially reliant on postulations of ignorance, epistemic gaps, a perennial incompleteness: “the perfect safety of wooed death […] the warm bath of physical dissolution, the universal unknown engulfing the miniscule unknown.” 3 The height of Leibniz’s Panglossian insanity nurtured the idea that our knowing everything—via the universal calculus—could be accurately described a triumph, as opposed to a nightmare in which our every futility is laid bare. Stagnancy and boredom are perhaps two of the greatest ills of Western civilisation, and the most potent pessimism tells you that you’re stuck with both. The most we can hope for, by way of salvation, is to throw open our despair to the unknown. The fact that Schopenhauer’s pessimism stopped short of morality and allowed him to play the flute, as Nietzsche complained, highlights the predicament of a man who despite having adorned nothingness with a smiling face still found himself alive. The demand here is that it be felt: a cross-contamination of intellect and emotion. The safety net of numerous parentheses makes for a failed philosophy, rather than a philosophy of failure. Depressives make bad pessimists, because, unless they choose to die, living will always infect them with necessities of hope, forcing them to find something, anything (all the various “as ifs”) to make existence tolerable. For as Cioran observed, while “[d]epressions pay attention to life, they are the eyes of the devil, poisoned arrows which wound mortally any zest and love of life. Without them we know little, but with them, we cannot live.” 4 And even when cured of our depressions we’ll find ourselves consumed, eaten alive by the hyper-clinical (borderline autistic) mania that replaces them: a predicament captured all too clearly in the microscriptual fictions of Robert Walser, where spectral men and women stifle their depressive madness with protective comas of detail, their failed assimilations buried beneath thick crusts of remote data. Like Beckett’s Malone their stories may have ended, but cruelly their lives have not. Pessimism is an extraneous burden (a purposeless weight) that makes everything else harder to carry, while at the same time scooping it out and making it lighter. If pessimism had a sound it would be the harsh non-noise of tinnitus—the way that every person would hear themselves if they refused their distractions long enough to listen: a lungless scream from the extrasolar nothing of the self. The music of pessimism—if indeed we can imagine such a thing—is the reverberating echo of the world’s last sound, conjectured but never heard, audible only in its being listened for. The one consolation of this hollow paradox of audibility being, that “he will be least afraid of becoming nothing in death who has recognized that he is already nothing now.” 5 The pessimist suffers a derangement of the real, a labyrinthitis at the nucleus of his being: he’s the stumbling ghost relentlessly surprised that others can see him. If Cioran’s refusal is manifested in sleep (when even saying ‘no’ is too much of a commitment), then Pessoa’s resides in the dreams inside that sleep. Pessoa chooses to exploit the fact that he’s being “lived by some murmuring non-entity both shadowy and muddied” 6 by growing more voids to live him. His is a Gnostic breed of sleep, “sleeping as if the universe were a mistake,” 7 a sleep that dreams through Thacker’s cosmic pessimism (“a pessimism of the world-without-us.”, “the unhuman orientation of deep space and deep time” 8 ), through the critical error of there being anything at all when there could be nothing. The metaphysical pessimist is someone who, however well life treats them, still desires to wake from it, as from the poisonous air of a bad dream. Pessimism is a paradox of age, being simultaneously young and old; its youth residing in a refusal to accept the authority of existence (its rich history, its inherent beneficence), a refusal to “get over” the horror of what it sees with its perpetually fresh eyes, and its maturity in the unceremonious disposal of the philosophical playthings (those futile architectures) of adolescence. As Thacker remarks: “Pessimism abjures all pretenses towards system—towards the purity of analysis and the dignity of critique.” 9 A sentiment shared with Pessoa, who duly categorizes those that choose to enact this futile struggle: “The creators of metaphysical systems and of psychological explanations are still in the primary stage of suffering.” 10 If the pessimist has shared a womb with anyone, it’s with the mystic and not the philosopher. As Schopenhauer tells us: “The mystic is opposed to the philosopher by the fact that he begins from within, whereas the philosopher begins from without. […] But nothing of this is communicable except the assertions that we have to accept on his word; consequently he is unable to convince.” 11 The crucial difference between the mystic and the pessimist is not the latter’s impassivity and defeatism, but his unwillingness/inability to contain in any way the spread of his voracious analyticity, his denial of incompleteness, his exhaustive devotion to failure. The truth of our predicament, though heard, is destined to remain unprocessed. Like the revelations of B.S. Johnson’s Haakon (“We rot and there’s nothing that can stop it / Can’t you feel the shaking horror of that?” 12 ) the pessimist’s truths are somehow too obvious to listen to, as if something inside us were saying, “Of course, but haven’t we gotten over that?” Pessimism is simple and ugly, and has no desire to make itself more complex or more attractive. The true moral pessimist knows that the Utilitarian’s accounts will always be in the red. He can see that for all his computational containments, his only honest path is a negative one, and that such a path has but one logical destination: that of wholesale human oblivion. Thacker notes how at the core of pessimism lies the notion of “the worst,” through which death is demoted by the all-pervasive suffering of a life that easily eclipses its threat. And so with doom made preferable to gloom, death begins to glint with promise, “like beauty passing through a nightmare.” 13 But even among pessimists suicide is, for the most part, thought to be an error. Schopenhauer, for instance, regarded suicide a mistake grounded in some fundamentally naïve disappointment or other. Pessoa too thought suicide an onerous escape tactic: “To die is to become completely other. That’s why suicide is a cowardice: it’s to surrender ourselves completely to life.” 14 There is a call here to be accepting of and creative with the puppetry of your being, an insistence that it’s somehow a blunder to attempt to hide in death from the horrors you find inlife. 15 Tied up with this perseverance is the slippery notion of the good death, for maybe, as Blanchot warns, suicide is rarely something we can hope to get right, for the simple reason that “you cannot make of death an object of the will.” 16 “Even in cases where the entire corpus of an author is pessimistic, the project always seems incomplete,” 17 and this is not simply because the project itself belies something yet to be disclosed, but because the project itself is a thing waiting. It waits on a cure it knows will not come, but for which it cannot do anything (as long as it continues to do anything) but wait. NOTES 1. See Thomas Ligotti. The Conspiracy Against the Human Race . New York: Hippocampus Press. 2010. 91. 2. Ludwig Wittgenstein. “A Lecture on Ethics.” Philosophical Review . (74) 1. 1965. 8. 3. Vladimir Nabokov. Pale Fire . New York: Vintage. 1989. 221. 4. E. M. Cioran. The Book of Delusions . trans. Camelia Elias. Hyperion. 5.1. (2010): 75. 5. Arthur Schopenhauer. The World as Will and Representation. vol. 2 . trans. E .F J. Payne. New York: Dover. 1966. 609. 6. Eugene Thacker. “Cosmic Pessimism.” continent. . 2.2 (2012): 67. 7. Fernando Pessoa. The Book of Disquiet . trans. Richard Zenith. London: Penguin. 2002. 35. 8. Eugene Thacker. “Cosmic Pessimism.” continent. . 2.2 (2012): 68. 9. Ibid. 73. 10. Fernando Pessoa. The Book of Disquiet . trans. Richard Zenith. London: Penguin. 2002. 341. 11. Arthur Schopenhauer. The World as Will and Representation. vol. 2 . trans. E .F J. Payne. New York: Dover. 1966. 610-11. 12. B.S Johnson. “You’re Human Like the Rest of Them.” in Jonathan Coe. Like a Fiery Elephant: The Story of B.S. Johnson . London: Picador. 2004. 177. 13. Fernando Pessoa. The Book of Disquiet . trans. Richard Zenith. London: Penguin. 2002. 415. 14. Ibid. 199. 15. “Suicide is, after all, the opposite of the poem.” Anne Sexton. No Evil Star: Selected Essays, Interviews and Prose . ed. Steven Gould Axelrod. Ann Arbor: University of Michigan Press. 1985. 92. 16. Maurice Blanchot. The Space of Literature . trans. Ann Smock. Lincoln: University of Nebraska Press. 1989. 105. 17. Eugene Thacker. “Cosmic Pessimism.” continent. . 2.2 (2012): 75. (shrink)

ABSTRACT Socioeconomic disparities between whites and blacks are pervasive in American society. Structuring of the discussion of these disproportions is the liberal race relations paradigm. According to Racial Liberalism, racial inequalities are an impermanent feature of American society because they are due primarily to race prejudice and discriminatory practices, which are continuously diminishing among whites. Challenging this view is Racial Realism. Racial Realism attributes the persistence of racial inequality to institutional privileges whites retain and refuse to relinquish whether or (...) not they are conscious of them. I argue that Racial Realism, with some qualification, is the better explanation for the persistence of racial inequality. Racial inequalities will persist, because American society and its entrenched institutions continue to affirm, white supremacy. (shrink)

--Do patients have the right to know their physician's HIV status?-Can a dentist refuse treatment to an HIV-positive patient?-How do educators determine whether to allow an HIV-positive child to attend school, and if they do, should the parents of other children be informed?-Should a counselor break confidentiality by disclosing to a wife that her husband is infected with HIV?This collection of original essays carefully examines the difficult moral choices the AIDS pandemic has presented for many professionals-physicians, nurses, dentists, teachers and (...) school administrators, business managers, psychotherapists, lawyers, clergy, journalists, and politicians. In the workplace, problems posed by HIV and AIDS have led to a reexamination of traditional codes of ethics. Providing systematic and reasoned discussions, the authors explore the moral, legal, and ethical issues involved in the reconsideration of policies, standards of conduct, and the practicality of balancing personal and professional ethics. Author note: Elliot D. Cohen is Professor of Philosophy at Indian River Community College and Editor-in-Chief of the International Journal of Applied Philosophy.Michael Davis is Senior Research Associate at the Center for the Study of Ethics in Professions, Illinois Institute of Technology. (shrink)

Background As a number of commentators have noted, SARS exposed the vulnerabilities of our health care systems and governance structures. Health care professionals (HCPs) and hospital systems that bore the brunt of the SARS outbreak continue to struggle with the aftermath of the crisis. Indeed, HCPs – both in clinical care and in public health – were severely tested by SARS. Unprecedented demands were placed on their skills and expertise, and their personal commitment to their profession was severely tried. Many (...) were exposed to serious risk of morbidity and mortality, as evidenced by the World Health Organization figures showing that approximately 30% of reported cases were among HCPs, some of whom died from the infection. Despite this challenge, professional codes of ethics are silent on the issue of duty to care during communicable disease outbreaks, thus providing no guidance on what is expected of HCPs or how they ought to approach their duty to care in the face of risk. Discussion In the aftermath of SARS and with the spectre of a pandemic avian influenza, it is imperative that we (re)consider the obligations of HCPs for patients with severe infectious diseases, particularly diseases that pose risks to those providing care. It is of pressing importance that organizations representing HCPs give clear indication of what standard of care is expected of their members in the event of a pandemic. In this paper, we address the issue of special obligations of HCPs during an infectious disease outbreak. We argue that there is a pressing need to clarify the rights and responsibilities of HCPs in the current context of pandemic flu preparedness, and that these rights and responsibilities ought to be codified in professional codes of ethics. Finally, we present a brief historical accounting of the treatment of the duty to care in professional health care codes of ethics. Summary An honest and critical examination of the role of HCPs during communicable disease outbreaks is needed in order to provide guidelines regarding professional rights and responsibilities, as well as ethical duties and obligations. With this paper, we hope to open the social dialogue and advance the public debate on this increasingly urgent issue. (shrink)

This is an engaging book on a subject which most people in our culture assume went out of fashion long ago. The book had its genesis in one of a series of symposia convened by the Church Society for College Work of Cambridge to explore certain themes and ideas which have great import for our time. The various authors of the essays eschew the habit of viewing Transcendence as the traditional content of metaphysical arguments or revelatory statements about the nature (...) of God outside or independent of the world and seek for signs of the possibility of achieving a renewed sense of Transcendence in the domains of inner experience, history, culture, language, science, technology, and the arts. Huston Smith suggests two options of human fulfillment: psychological and ontological, both providing a kind of transcendence of self and society. He refuses to accept one and reject the other but instead to convince us that both are legitimate. M. Murphy claims that the experience of psychological and social transcendence can be fostered by educational projects such as encounter groups, gestalt therapy workshops and sensitivity training programs. In his "Manifesto for a Dionysian Theology," Sam Keen analyzes the Apollonian way of reasoning and planning which has come to dominate in Western culture and makes a plea for a reassertion of the Dionysian principle in religion which might be expressive of life as dance, centrality of feelings and sensations, a pantheistic conception of God and a theology of play. Harvey Cox asserts that our society has lost its capacity for utopian fantasy resulting in the inability to conceive of any world which is not a mere modification or extension of our own world. He suggests that we consciously become "fools for Christ" again and give full rein to our powers of creative fantasizing even at the risk of contracting "religious madness." Donald Schon urges post-modern man to give up hope for achieving a stable political order and to develop an "ethic for change" appropriate to the demands of our society where change is all-pervasive. Essays by R. Bellah and H. Richardson explore myths of transcendence as ordering structures in society and plead for increased attention to correspondences among the disciplines of theology, sociology, and psychology. E. Fackenheim and W. Kaufman seek to clarify the notion of transcendence in Judaism and Christianity respectively and to "clear the way for a positive revelation." In keeping with the shared notion that transcendent reality is present and active within the human process, two eminent process philosophers, Wieman and Hartshorne discuss the "implications for a concept of transcendence that follows from affirming the creative freedom of man." The essays singly and together reject the notion that the existence and nature of transcendent reality can be arrived at by pursuing a single line of argumentation to its bitter end and instead they work together from various points of view to reinforce our sense of man's renewed thirst for the Divine and the subsequent rediscovery of God's uninterrupted presence within the world of "Immanent Possibility."--J. B. L. (shrink)