Business ethics scholars have proposed strategies for mitigating the ill effects brought on by a wealth maximization business strategy by urging managers to either embrace corporate social responsibility (CSR) or to manage according to stakeholder theory. In this article I argue that these strategies are often ineffective in bringing about the behavior they promote because it is antithetical to the nature and logic of capitalism. I examine the organizing principles of capitalism and the role it assigns to capitalists, and juxtapose (...) these with the behavior prescribed by three normative frameworks: strategic management theory (SMT), the CSR initiative, and stakeholder theory. Unlike the behaviors prescribed by the CSR initiative and stakeholder management theory, the behavior prescribed by SMT is consistent with the role of capitalists as defined by the organizing principles of capitalism, and SMT's “rules” have instilled habits that have, in turn, been able to mold managers’ aspirations and purposes. CSR and stakeholder theory must not only combat the habits instilled by the entrenched SMT, they must also find some way of instilling habits that run contrary to those defined by the nature and logic of capitalism itself. (shrink)

This excellent book consists of a translation of Plato's Euthyphro, plus "interspersed comment" intended "partly as a help to the Greekless reader in finding his way, and partly as a means of embedding the discussion of the earlier theory of Forms which follows it." That subsequent discussion is a series of sections aimed at establishing "that there is an earlier theory of Forms, found in the Euthyphro and other early dialogues as an essential adjunct of Socratic dialect" and that it (...) is not the same as the theory of Forms found in the Phaedo, Republic and other middle dialogues. In the Euthyphro Socrates' question of what holiness is assumes that there is a Form of holiness, "that this Form is a universal, the same in all holy things;... that that Form may be used as a standard, by which to judge what things are holy and what are not...; that it is an essence, by which or in virtue of which holy things are holy." As essences Forms are causes--formal, not efficient. They are "causes in the sense that they are that by which things are what they are. They therefore affect the career of the world, in that if they did not exist, the world would not be what it is." They "are not identical with their instances and [are] prior to their instances" and, hence, they are not in their instances. In fact, "Forms are as 'separate' from their instances in the early dialogues as they are" in the later ones. Do they not differ, then, from these latter Forms? Yes, because "of the way in which separation is conceived." In the Phaedo and other middle dialogues separation "involves something more than... nonidentity, independence, or priority. It involves the claim that instances of Forms are deficient imitations or resemblances of Forms.... To that theory was later conjoined, as a natural corollary, the theory that sensibles and Forms differ in their degree of reality, that Forms are more real than their instances." There are, in fact, "Two Worlds, Visible and Invisible.... The objects of the Visible World... are in a perpetually changing mortal realm, never the same with respect to each other or themselves. By contrast, Forms, the reality of whose existence we render an account in questioning and answering, exist always in the same way with respect to the same things, single in nature, alone by themselves, never in any way under any circumstances admitting alteration." This contrast between the Two Worlds is not drawn in the Euthyphro and earlier writings. Hence, between them and the middle dialogues there is a development in the theory of Forms. Of course, there also is "a unity to Plato's thought; but it is not the unity of a monument. It is the unity of growth and development, the unity of life." In these splendid pages one point remains unclear: how can a Form be universal and thus distinct from its instances and yet be their formal cause? Allen leaves no doubt that this is his position: "In Plato's early dialogues Forms are not the being of that of which they are Forms. A universal, being one, cannot constitute the being of a plurality--precisely why Aristotle was led to distinguish substantial form from universal. The Euthyphro does not imply that holiness is the being of any given holy thing or action as holy; it implies only that holiness is that by which holy things are holy. It implies, to borrow another bit of Aristotelian vocabulary, that holiness is a cause." But precisely in what way is a Form "that by which" something is what it is? Plato subsequently answers by distinguishing the Form itself, its character as participated by a particular thing, and the participant : the Form is that by which some thing is what it is through the participated character which the thing has. Is this answer implied in the Euthyphro? Or in what sense is a Form distinct from particular things? In what sense a formal cause? That puzzlement, though, is minor in the context of the entire book, which is valuable not only for the interpretation Allen gives of the early and middle dialogues but also for all sorts of unexpected bonuses. These are points either newly made or brilliantly reiterated--for example, the influence of Anaxagoras on Plato re the notion of essence and in philosophical vocabulary; Aristotle's abandonment of the contrast made in the Categories between primary and secondary substance; the crucial difference between genus/species in Aristotle and in Plato (enriched/impoverished; the analogy of a Platonic definition to mapping a field; the evaluation of Aristotle's interpretation of Plato's Forms, of his report on the "unwritten doctrines," of esoteric and exoteric teachings. This last culminates in a paragraph which all students of Plato should reflect upon constantly: "It is possible to treat Plato's text, not as evidence for something else, but as itself the primary object of historical understanding. The aim of the inquiry is then to interpret a set of literary documents, not to fathom the entertained beliefs of their author. It is reasonable, of course, to assume that the documents are a reliable index to the beliefs; but the connection, after all, is contingent, and as far as interpretation is concerned, unimportant. If Plato, in his heart of hearts, had been a nominalist, an atheist, a sceptic about immortality, and a hedonist, and had yet gone on to write the dialogues which he wrote for some obscure motive now unknown, this would not change the proper interpretation of what he wrote and privately disbelieved by one iota: when a man says what he does not believe, we may still perfectly well understand what it is he has said. The question, then, of whether Plato had beliefs he did not express, or beliefs contrary to what he did express, may be left to those with skill in the arts of divination; the historian may more reasonably limit himself to the study of texts and their meaning. If inquiry is construed in this way, it is self-referentially inconsistent to prefer the testimony of Aristotle to the evidence of Plato's text in the interpretation of Plato."--L. S. (shrink)

Cultural competence, a clinical skill to recognise patients' cultural and religious beliefs, is an integral element in patient‐centred medical practice. In the area of death and dying, physicians' understanding of patients' and families' values is essential for the delivery of culturally appropriate care. Dementia is a neurodegenerative condition marked by the decline of cognitive functions. When the condition progresses and deteriorates, patients with advanced dementia often have eating and swallowing problems and are at high risk of developing malnutrition. Enteral tube (...) feeding is a conventional means of providing artificial nutrition and hydration to meet nutritional needs, but its benefits to the frail population are limitedly shown in the clinical evidence. Forgoing tube feeding is ethically challenging when patients are mentally incompetent and in the absence of an advance directive. Unlike some developed countries, like the United States of America, death and dying is a sensitive issue or even a taboo in some cultures in developing countries that forgoing enteral tube feeding is clinically and ethically challenging, such as China and Malaysia. This article in three parts 1) discusses the clinical and ethical issues related to forgoing tube feeding among patients with advanced dementia, 2) describes how Hong Kong Chinese, North American, and Malaysian Islamic cultures respond differently in the decision‐making patterns of forgoing tube feeding for patients with advanced dementia, and 3) reiterates the clinical implications of cultural competence in end‐of‐life care. (shrink)

Jerome Popp's monograph is a part of the SUNY series in philosophy and biology, and accordingly is narrowly focused upon discussion of an evolutionary model of value theory. As Popp explains at the outset, Daniel Dennett—among others—has proposed that any naturalized moral theory must provide a naturalized account for its own existence. Popp's thesis for this work is that, in conjunction with his longoverlooked insight into the significance of Darwin's thought to the area of epistemology generally, Dewey solved this philosophic (...) problem long ago. This emphasis upon reconciling Dewey's work with Dennett's thought is reiterated in Popp's conclusion that "It is remarkable how Dewey's use of evolution in his arguments .. (shrink)

Altruism is a well-established reason underlying research participation. Less is known about altruism in adolescent-parent decision-making about clinical trials enrolling healthy adolescents. This qualitative investigation focused on identifying spontaneous statements of altruism within adolescent-parent discussions of participation in a hypothetical phase I clinical trial related to adolescent sexual health. Content analysis revealed several response patterns to each other’s altruistic reasoning. Across 70 adolescent-parent dyads in which adolescents were 14 to 17 years of age and 91% of their parents were mothers, (...) a majority of dyadic discussions included a statement reflecting altruism. Parents responded to adolescents’ statements of altruism more frequently than adolescents responded to parents’ statements. Responses included: expresses concern, reiterates altruistic reasoning, agrees with altruistic reasoning, and adds to/expands altruistic reasoning. Since an altruistic perspective was often balanced with concerns about risk or study procedures, researchers cannot assume that altruism will directly lead to study participation. Optimizing the informed consent process for early phase clinical trials involving healthy adolescents may include supporting parents to have conversations with their adolescents which will enhance their capacity to consider all aspects of trial participation. (shrink)

Elements of Formal Semantics has already been reviewed twice :42, 2016; Erlewine in Comput Linguist 42:837–839, 2017). As well, the website for the work is accompanied by evaluative quotes by noted scholars. All are very positive concerning its clarity and its utility as an introduction to formal semantics for natural language. As I agree with these evaluations my interest in reiterating them in slightly different words is limited. So my reviews of the content chapters will be accompanied by a Reflections (...) section consisting of my own reflections on the foundations of model theoretic semantics for natural language as laid out in EFS. The issues I address—alternate ways of accomplishing the tasks Winter treats—should not be included in an introductory work but they may be helpful for those who teach classes for which EFS is an appropriate text. They might also help with queries about the content of the text by those using it. I note that a mark of a clear text is that it allows the reader to reflect on its content not its presentation. (shrink)

The article draws a conceptual distinction the (French) structuralism of the 50’s–60’s and the post-structuralism of the 70’s, which are discussed as overlapping in their intellectual paths; their mutual dynamics is defined as a reaction of the intelligence to the pressure of depersonalized unified schemes within the logic of structuralism against free improvisation and loose interpretation instead of total explanations in the post-structuralism interpretation. The article establishes a conceptual identity of the paradoxical nature between post-structuralism (and deconstructionism, which is homogeneous (...) and identical thereto in a number of aspects), on the one hand, and constructionism with its specific process of language dismantling – social/ideological languages, social group dialects, on the other hand, which naturally leads the authors to the analysis of the paradoxicality principles, defined by post-structuralism (five principles of paradoxicality of Gilles Deleuze – paradox of regress, paradox of sterile reiteration, paradox of neutrality, paradox of absurd, paradox of Levi-Strauss); poststructuralists’ paralogisms are examined through paradoxical denotation; the late Roland Barthes’ phenomenon of paradoxicality, becoming a plot-forming principle of narration, is analyzed. Poststructuralism is conceptualized in the article as the first decisive step of post-modernism; the affinity of post-structuralist and postmodernist commitment to parody, game and irony is stated; the theory of language games in post-modern interpretation is explored; one of those games – a game of carnival – is explored within the diachronic retrospective; the affinity of parody and carnival tradition of post-structuralism and post-modernism to the romantic irony of the XIXth century and its inconsistency with the popular culture of laugh is established. The genesis of poststructuralism and post-modernism is connected with the ideological restart of the Western society before the “very end” of the Resistance ideas and the disappointment of the left European intellectuals in the “great legends” and illusions of Marxism. The blurred concepts of relativism are connected with the mutual disproportion of different layers of historical experience. (shrink)

John Paul II's encyclical Fides et Ratio reiterates in a new and fresh way the harmony of faith and reason. The dominant tradition of Catholic thought isone that sees this harmony, but the tradition is not uncritical. Throughout the history of the Church, there have been thinkers wary of reason. The thoughtof Karol Wojtyla, both before and during his papacy, has looked to a focus on the human person as a way to reconcile faith and reason.

. This paper is on Ward Goodenough's recent article , suggesting that his points can be clarified by reiterating the distinction between the realms of meaning and relevance. Religion's “truth” is in the form of its ualue; the “proof” which it requires is uindication; and the resulting “faith” must be understood as commitment.

In lieu of an abstract, here is a brief excerpt of the content:Buddhist-Christian Studies 20 (2000) 311-315 [Access article in PDF] Book Review Fire and Water: Basic Issues in Asian Buddhism and Christianity Fire and Water: Basic Issues in Asian Buddhism and Christianity. By Aloysius Pieris, S. J. Maryknoll: Orbis Books, 1996. Aloysius Pieris, Jesuit priest and Buddhist scholar, is well known in theological and interreligious dialogue circles in Asia, and this is the third collection of essays of his to (...) be published in the Faith Meets Faith Series of Orbis Books. The eighteen essays which make up this book, all previously published elsewhere, are conveniently put together in three sections, under the following headings: 1) Women and Religion: Buddhist and Christian Appropriation of Feminist Criticism; 2) issues in Theology, Religion and Society; and 3) questions of Spirituality and Human Liberation. To merely summarize the content of the essays and offer a third-party critique would do injustice to the book, and could even mislead one who peruses such a summary into thinking one thereby "knows" what the book or Pieris is about. Such a hasty conclusion would deprive a would-be reader of the powerful experience that awaits in wrestling with Pieris through each essay of this volume. Judith Berling puts it well in her blurb at the back, pointing out that the author "uses poetry, evocative symbolism, and humor to offer a theological call to action in a voice that is liberationist, Asian, and feminist." Indeed, this volume invites one to a way of seeing that can also transform one's way of being in this world marked by increasing violence, poverty, and a systemic kind of oppression dehumanizing to both the perpetrators as well as the victims.The title of the present volume, Fire and Water, alludes to a dynamic dipolarity, masterfully sketched for the reader by Paul Knitter in his foreword, which underlies the author's vision of reality and vivifies much of his writing. The masculine and the feminine, the (Buddhist) gnostic and the (Christian) agapeic, the metacosmic (transcendent) [End Page 311] and the cosmic (immanent), the prophetic and the mystical, are different ways of naming this dipolarity. The way to ultimate liberation is in the effective embrace of both poles in complementarity and mutual interplay, whereas taking one pole in preference over the other results in a warped vision or mode of being, in imbalance, or even in abuse.In this review I would like to simply echo some key themes that will jump at one perusing the essays, reiterating that the very act of reading them can of itself be a transformative experience for an open-minded, open-hearted, and open-handed reader.The thrust of the six essays comprising the first section can perhaps be summed up in the thesis as formulated by the author himself: "Religion cannot survive in the future without appropriating the feminist critique, just as feminism cannot achieve its liberative goal without the aid of a religion so critiqued" (p. 62). Behind this statement is Pieris' emphatically critical stance, on the one hand, against all forms of patriarchal religion, whether Christian, Buddhist, Hindu, or other, which has justified, lent a hand in, or continued to perpetrate the physical, psychological, and especially religious abuse of women, and on the other hand, against secularist (or anti-religious) kinds of feminist theory that take off on what he enumerates as "five false starts" (pp. 50-51), which only result in unnecessary dichotomies that truncate the understanding of the goal of liberation, and consequently of the human as such.Pieris offers a vision of liberation centered on what he terms the humanum. This refers to the point of ultimate perfection to which the human, that is, "whatever pertains to men and women as self-conscious, other-oriented, and dreaming components of the cosmos," has the capacity to carry the cosmos. In this context, the human is no other than "this self-transcendent capacity immanent in the cosmos, this power to unfold within itself the Other, which is ever present from the first moment of evolution." To be human is inherently to be endowed... (shrink)

This book stands as a panegyric of the glories and grandeur of Indian philosophy without managing to embody or display those heights of attainment itself. In the few essays that are worthwhile, the author attempts to correct a number of misconceptions about Indian thought: that it is world-denying, that it promotes spiritual pessimism, that it bases its philosophical claims more on intuition than on rational argument, and that it is concerned more with inner than with outer reality. In support of (...) his claims, he sets forth what he believes to be the basic tenets of Indian philosophy, which are: the divine or spiritual nature of the universe, the ultimate moral order of the universe, the transmigration of the soul, the ultimate destiny of man through "the liberation of the soul from bondage to the body," and the implicit trust placed in the testimony of seer-saints "to whom they [truths] are supposed to have been revealed beyond doubt in their direct and immediate experience." In a chapter entitled, "Svapramanatva and Svaprakasatva: An Inconsistency in Kumärila's Philosophy," he presents a fairly informative and well-reasoned argument that the validity of cognitions cannot be verified on the basis of both the inherent quality of the senses which give immediate satisfaction and the quality of external conditions which must await subsequent investigation. Finally, he soundly criticizes R. C. Zaehner's The Comparison of Religions for interpreting and evaluating Hindu religion and philosophy through the spectacles of Catholic Christianity. But his own contention, reiterated again and again throughout the book, that "there is nothing in common between Hindu religion and philosophy," makes no sense. Surely, one thing which distinguishes Indian philosophy from Greek and modern philosophy in the western world is the continual insistence by Indian thinkers that philosophical reflection and rational argumentation are not ends in themselves but merely means to salvation, paths to Enlightenment.--J. B. L. (shrink)

A major difficulty for currently existing theories of inductive inference involves the question of what to do when novel, unknown, or previously unsuspected phenomena occur. In this paper one particular instance of this difficulty is considered, the so-called sampling of species problem.The classical probabilistic theories of inductive inference due to Laplace, Johnson, de Finetti, and Carnap adopt a model of simple enumerative induction in which there are a prespecified number of types or species which may be observed. But, realistically, this (...) is often not the case. In 1838 the English mathematician Augustus De Morgan proposed a modification of the Laplacian model to accommodate situations where the possible types or species to be observed are not assumed to be known in advance; but he did not advance a justification for his solution. (shrink)

That Darwinism has been immune generally from philosophical and scientific criticism says something about its iconic status as a paradigm. As Alvin Plantinga has said, “Darwinian evolution has become an idol of the contemporary tribe... part of the intellectual orthodoxy of our day.” After many decades of presumptive authority as a paradigm, some philosophers and scientists are at last examining whether Darwinian theory ought to be persuasive. Dennis Bonnette’s book is an outstanding addition to this important new examination. In fourteen (...) chapters and an epilogue, compressed into 145 pages of exposition, Dennis Bonnette summarizes both the strengths and weaknesses of modern evolutionary theory. In the first four chapters of the book he tests whether evidence for macroevolution is convincing. Relying on the unpublished manuscripts of the Australian philosopher Austin M. Woodbury, he concludes that neither the fossil record nor the fact of microevolution justifies the enthusiastic conviction, so common in the academy and even the popular culture, that macroevolution is the case. In addition to criticisms marshaled by Woodbury, creation scientists have exposed over the past several decades a number of problems endemic to the way paleontologists have interpreted the fossil record. Still, Bonnette is willing cheerfully to concede that evolution may be true: “we should remember that the weakness of arguments favoring evolution does not necessarily prove that evolution does not occur”. As a Catholic and a philosopher, Bonnette wonders what its truth would mean for philosophy and theology. In accord with the way Catholic thinkers have commented on the subject, Bonnette argues that the doctrine of evolution, if rightly interpreted, coheres with a sound philosophy of nature, metaphysics, and theology. This conclusion, reiterated and justified throughout the book, and effectively summarized in the closing chapters, separates Bonnette’s position from that of the creation scientists, whom he treats with scrupulous fairness, as he does representatives of atheistic or naturalistic evolutionism. (shrink)

Brian Skyrms (1987, 1990, 1993, 1997) has discussed the role of dynamic coherence arguments in the theory of personal or subjective probability. In particular, Skryms (1997) both reviews and discusses the utility of martingale arguments in establishing the convergence of beliefs within the context of radical probabilism. The classical martingale converence theorem, however, assumes the countable additivity of the underlying probability measure; an assumption rejected by some subjectivists such as Bruno de Finetti (see, e.g., de Finetti 1930 and 1972). This (...) brief note has a very modest goal: to briefly consider the extent to which Skyrms’s argument can be extended to the finitely additive case. (shrink)

In an international survey of rationing we have found that European physicians encounter scarcity-related ethical difficulties, and are dissatified with the resolution of many of these cases. Here we further examine survey results to explore whether ethics support services would be potentially useful in addressing scarcity related ethical dilemmas. Results indicate that while the type of help offered by ethics support services was considered helpful by physicians, they rarely referred difficulties regarding scarcity to ethics consultation. We propose that ethics consultants (...) could assist physicians by making the process less difficult, and by contributing to decisions being more ethically justifiable. Expertise in bringing considerations of justice to bear on real cases could also be useful in recognising an unjust limit, as opposed to a merely frustrating limit. Though these situations are unlikely to be among the most frequently referred to ethics support services, ethics consultants should be prepared to address them. (shrink)

Junior researchers can be abused and bullied by unscrupulous senior collaborators. This article describes the profile of a type of serial abuser, the White Bull, who uses his academic seniority to distort authorship credit and who disguises his parasitism with carefully premeditated deception. Further research into the personality traits of such perpetrators is warranted.

This paper expands the definition of gray-marketing to include some ethically problematic marketing activities and techniques used in personal selling in China. Based on this, a conceptual model of gray-marketing for a particular type of selling in which both the sellers and the buyers exhibit problematic ethics in an exchange and the associated hypotheses are developed and tested. The findings show that, first, the respondents have different ethical evaluations of different marketing practices used in personal selling such as giving and (...) accepting gifts, buying and accepting meals, and offering and accepting kickbacks. Some of these practices may not be considered unethical. Second, in terms of ethical assessment, gray-marketing practiced by buying agents is more unacceptable than when practiced by sales agents. Third, a person's ethical evaluation of gray-marketing behavior, empathy for gray-marketing, and belief that gray-marketing has serious consequences, significantly affects his inclination to use gray-marketing. This paper concludes with a discussion of some possible applications of our research findings. (shrink)

The National Blood Policy in India relies heavily on voluntary blood donors, as they are usually assumed to be associated with low levels of transfusion-transmitted infections . In India, it is mandatory to test every unit of blood collected for hepatitis B, hepatitis C, HIV/AIDS, syphilis and malaria. Donors come to the blood bank with altruistic intentions. If donors test positive to any of the five infections, their blood is discarded. Although the blood policy advocates disclosure of TTI status, donors (...) are not, in practice, informed about their results. The onus is on the donor to contact the blood bank. Out of approximately 16 000 donations in the past 2 years, 438 tested positive for TTI, including 107 for HIV. Only 20% of the donors contacted the blood bank; none of them were HIV positive. Disclosure by blood banks of TTI status by telephone or mail has resulted in serious consequences for some donors. Health providers face an ethical dilemma, in the absence of proper mechanisms in place for disclosure of test results, regarding notification to donors who may test positive but remain ignorant of their TTI status. Given the high cost of neglecting to notify infected donors, the authors strongly recommend the use of rapid tests before collecting blood, instead of the current practice, which takes 3 h to obtain results, and disclosure of results directly to the donor by a counsellor, to avoid dropouts and to ensure confidentiality. (shrink)

I argue that sentences ascribing beliefs to non-human animals have the same logical form as sentences of the "perceives that" variety. Pace D.M. Armstrong, I argue that animal belief sentences can be referentially opaque, just as perception sentences containing a propositional clause are. In both cases, referential opacity requires our assuming that the animal believer and the human perceiver has each identified the object of the belief or perception.

I argue that the time-gap argument poses no objection to Direct Realism. In the case of exploded stars many light years from us, what we see is no longer the star, but its light. I argue that in all cases of seeing we see light, but only when physical objects exist at the time of our seeing do we see them.

In this paper we present some algorithms for computing minimal conflicts. First of all we discuss the relationship between minimal conflicts and minimally inconsistent subsets. Then we introduce an algorithm for computing all minimally inconsistent subsets, which is applied to generating all minimal conflicts. Furthermore, an algorithm for computing all minimal conflicts using structured description is introduced, and its correctness is proved; its time complexity is also shown. The algorithm using structured description terminates in polynomial time for some special system, (...) such as the tree–structured systems. The algorithms are also complared with related works. (shrink)

The Unknowable, arguably the greatest Russian philosophical work of the 20th century, was the culmination of S. L. Frank's intellectual and spiritual development, the boldest and most imaginative of all his writings, containing a synthesis of epistemology, ontology, social philosophy, religious philosophy, and personal spiritual experience.

Joachim Schulte’s introduction provides a distinctive and masterful account of the full range of Wittgenstein’s thought. It is concise but not compressed, substantive but not overloaded with developmental or technical detail, informed by the latest scholarship but not pedantic. Beginners will find it accessible and seasoned students of Wittgenstein will appreciate it for the illuminating overview it provides.

In lieu of an abstract, here is a brief excerpt of the content:Editors’ NoteJames M. DuBois, Ana S. Iltis, and Heidi A. WalshFrom childhood, David Slakter had undergone tests and invasive procedures to monitor his nephritis. It was not a surprise when in 2015, doctors told him he needed a kidney transplant. The wife of a childhood friend was a close match and gave him one of her kidneys. Before his transplant, aerobic exercise was difficult; a few months after transplant, (...) Slakter could ride his bike, hike, and work out with a personal trainer. He no longer had to weigh food or gauge his potassium consumption, a concern for people with kidney failure. For Slakter, “life post-transplant has been a significant improvement.”Individuals or family members of those who have received an organ transplant from a living or deceased donor share their stories in this issue of Narrative Inquiry in Bioethics. The symposium is titled “Receiving the Gift of Life: Stories from Organ Transplant Recipients.” Organ transplantation can extend an individual’s life by decades. It can also greatly improve an individual’s quality of life, as was Slakter’s experience. At the same time, organ transplantation is expensive and stressful. Recipients can experience complications, including organ rejection, and there are few appealing alternatives.After her heart transplant, author Leilani R. Graham required four open-heart surgeries, ECMO, and an intra-aortic balloon pump. She experienced delirium, necrotizing pneumonia, and severe muscular atrophy that required her to re-learn how to walk. She struggled with weight gain, explosive mood swings, hair loss, and was terrified that her body would reject the new heart. For Graham, “[Transplant] was not the miracle [she] was hoping for.” Graham says she felt unprepared for and inadequately informed about what to expect after her transplant, which left her “battered, beaten, and bruised” with a 12-inch line from neck to navel and “bullet holes” up and down her torso from the chest tubes. When reflecting on her experience post-transplant, Graham says, “It wasn’t the physical trauma that hurt the most. It was that no one seemed surprised [by the aftereffects of transplant].” Seemingly no one, that is except Graham, who calls on transplant providers to “prioritize empathy.”The symposium editors are Jason T. Eberl and Tristan McIntosh. Three commentary articles, written by Macey Leigh Levan, Heather Lannon, and Vidya A. Fleetwood, Roslyn B. Mannon & Krista L. Lentine, offer important insights into the authors’ stories. The editors thank Mid-America Transplant, the UCSF Lung Transplant Program, Donor Connect, William L. Freeman, MD, MPH, MJIL, CIP, Janet Monk, and the individuals who gave anonymous donations to support the publication of this issue, an open-access VOICES edition of the symposium, and accompanying teaching guides.The research article in this issue, “‘A Shell of My Former Self’: Using Figurative Language to Promote Communication about Patient Suffering,” was written by Tyler Tate, Elizabeth Stein, and Robert A. Pearlman. The relief of suffering is a primary goal of medicine. However, the authors note that clinicians often miss or ignore suffering because they focus on the causes rather than the experience of suffering, or the subjective nature of suffering makes it difficult to discuss. The authors believe that “the key to communicating about suffering lies in finding [End Page vii] the right kind of words to describe the experience” and say that figurative language offers a promising approach. In their research, the authors performed qualitative analysis on 52 works of literature and identified 254 excerpts of figurative language with themes of non-physical or psychological suffering. The authors found 13 salient themes: brokenness, diminishment, disorientation, drowning, emptiness, imprisonment, battle, darkness, isolation, invisibility, lifelessness, punishment, and torture. The authors reiterate that developing a shared language of suffering could foster a therapeutic patient-clinician relationship and improve clinicians’ ability to recognize and address a patient’s experience of suffering.María Susana Ciruzzi wrote the first of two case studies included in this issue. “The Sword of King Solomon” addresses a tragic and difficult subject—how to navigate the situation posed by conjoined twins when “any decision will produce damage and suffering.” The case involves two infant male patients born at 37 weeks gestation as omphalo-ischiopagus conjoined twins... (shrink)