We argue for the addition of trauma informed awareness, training, and skill in clinical ethics consultation by proposing a novel framework for Trauma Informed Ethics Consultation (TIEC). This approach expands on the American Society for Bioethics and Humanities (ASBH) framework for, and key insights from feminist approaches to, ethics consultation, and the literature on trauma informed care (TIC). TIEC keeps ethics consultation in line with the provision of TIC in other clinical settings. Most crucially, TIEC (like TIC) is systematically sensitive (...) to culture, history, difference, power, social exclusion, oppression, and marginalization. By engaging a neonatal intensive care ethics consult example, we define our TIEC approach and illustrate its application. Through TIEC we argue it is the role of ethics consultants to not only hold open moral spaces, but to furnish them in morally habitable ways for all stakeholders involved in the ethics consultation process, including patients, surrogates, and practitioners. (shrink)

This case raises questions of what “trauma-informed care” (TIC) means to the medical team caring for Maurice and how they embrace a TIC approach. There are established principles of trauma-informed...

We are grateful for the excellent and incisive commentaries on our paper “Trauma Informed Ethics Consultation” (Lanphier and Anani 2022). It is heartening to see most commentators agree with why cl...

Elizabeth Lanphier and Uchenna E. Anani provide a powerful argument for the value of a trauma-informed approach to the ethics consultation, which acknowledges the perspectives of all stakeho...

Berger and Miller argue that cultural competency as an educational tool for physicians-in-training fails to address structural inequality and systemic oppression. Instead, it focuses on “cul...

We reject the concept of a default option of withdrawal as proposed by Syltern and colleagues, and will outline here potential consequences on parental trust, particularly in historically marginali...

This paper responds to a proposal for an intersectional approach to the clinical encounter between patient and medical provider. We agree that an intersectional framework offers new insights and information in the clinical encounter. Intersectionality involves awareness of the physician-patient dynamic, and understanding the various privileges and disadvantages of all parties involved, at a micro and macroscopic level. Yet, this analysis alone is insufficient to aid in the clinical encounter and risks harm. We worry about a clinician making assumptions about (...) her patient’s race, gender, economic status, and how these influence the patient’s own views of her life and health. We argue that a narrative supplement is a necessary element of intersectional clinical encounters. Prioritizing patient narrative curtails assumptions, builds trust, and improves care. (shrink)

Not only is deception commonplace in medical encounters, according to Christopher Meyers (2021), but the clinical ethicist might have moral obligations to support and even enact deception. Descriptively Meyers is right that there are “opportunistic, self-interested and benevolent reasons” for deception through omission and commission in clinical medicine. But it is possible to retain this premise while rejecting the normative conclusion that the clinical ethicist “should sometimes be an active participant in the deception of patients and families.” One reason to (...) reject the normative conclusion is its incompatibility with providing trauma informed ethics consultation (TIEC). In the TIEC framework I developed with Uchenna Anani, we defend the integration of trauma informed care (TIC) into ethics consultation (Lanphier and Anani 2021). While ethicists narrowly attend to the question and scope of the ethics consults made to them, doing so in alignment with trauma informed principles is tantamount to providing good ethics consultation. According to Meyers, the clinical ethicist is an “advocate for the best ethical choices.” The best ethical choices are also trauma informed ones. (shrink)

Francis Fukuyama postulated that there are two powerful forces at work in human history. One, he calls, ‘the logic of modern science’ and the other, ‘the struggle for recognition’. I agree with Fukuyama that human developmental progression is propelled by these twin principles. It is my position that these principles have been the drivers of geopolitics. In this paper, I argue that, in addition, knowledge production is a major factor in geopolitics and that the Euro-American worldview has occupied the place (...) of hegemony by reason of knowledge production. Africa has been denied having any form of epistemic tradition by the Euro-American world to sustain itself in the position of hegemony. In the era of Fourth Industrial Revolution, it will be antithetical for Africa to continue to adopt or consume technologies driven by Eurocentrism without projecting its contribution to the global space. Hence, using a critical hermeneutical approach, I contend that Africa needs to make a unique African contribution in the era of Fourth Industrial Revolution. It is Africa’s unique contribution that will guarantee Africa a place in geopolitics. (shrink)

Y a-t-il une experience de la sante? La sante n'est-elle que l'absence de maladies? Etre en bonne sante, est-ce la meme chose qu'etre normal? Dois-je attendre de voir ce que l'avenir me reserve pour juger de l'etat de ma sante? La difference entre sante et maladie est-elle une difference comme les autres? Voila certaines des questions que pose le present ouvrage, grace a une methode qui croise la philosophie avec d'autres types de savoirs : la medecine, la biologie, mais aussi (...) la litterature et les sciences humaines. Cette etude conduit a confronter l'approche issue de Canguilhem avec d'autres conceptions philosophiques moins connues en France : celles de Boorse, Engelhardt et Nordenfelt. Il en ressort que les notions de sante et de maladie sont d'un maniement extremement delicat du fait de leur imprecision, sans doute irreductible, et du poids ideologique qui est le leur. Elles n'en sont pas moins centrales dans notre experience et dans les enjeux politiques d'aujourd'hui. (shrink)

Is God's foreknowledge compatible with human freedom? One of the most attractive attempts to reconcile the two is the Ockhamistic view, which subscribes not only to human freedom and divine omniscience, but retains our most fundamental intuitions concerning God and time: that the past is immutable, that God exists and acts in time, and that there is no backward causation. In order to achieve all that, Ockhamists distinguish ‘hard facts’ about the past which cannot possibly be altered from ‘soft facts’ (...) about the past which are alterable, and argue that God's prior beliefs about human actions are soft facts about the past. (shrink)

Wittgenstein’s concepts shed light on the phenomenon of schizophrenia in at least three different ways: with a view to empathy, scientific explanation, or philosophical clarification. I consider two different “positive” wittgensteinian accounts―Campbell’s idea that delusions involve a mechanism of which different framework propositions are parts, Sass’ proposal that the schizophrenic patient can be described as a solipsist, and a Rhodes’ and Gipp’s account, where epistemic aspects of schizophrenia are explained as failures in the ordinary background of certainties. I argue that (...) none of them amounts to empathic-phenomenological understanding, but they provide examples of how philosophical concepts can contribute to scientific explanation, and to philosophical clarification respectively. (shrink)

El propósito de este texto es ofrecer una visión general de la relación entre nación e historia en los debates que se generaron por parte de los historiadores y otros intelectuales de las ciencias sociales a finales del siglo XIX y durante gran parte del siglo XX. La reflexión central que se plantea consiste entonces en estudiar y mostrar cómo al mismo tiempo que las naciones modernas eran objeto de un proceso de redefinición política, en el escenario intelectual de las (...) ciencias sociales, y en particular de los historiadores, fueron apareciendo también un conjunto de debates y obras que intentaban problematizar y someter a consideración las relaciones que pretendían establecerse entre la nación y la historia como un elemento que las justificaba. (shrink)

É bem conhecida a oposição estabelecida por Kant entre experiência possível e dialética, na medida em que esta última é caracterizada como a “lógica da ilusão”. Ao mesmo tempo, o modo de pensar metafísico, que ocorre dialeticamente, em sentido kantiano, é uma tendência inevitável da razão, expressa na exigência formal de completude das categorias. Como o pensar, enquanto exercício livre da razão, é em si mesmo mais amplo do que a atividade de conhecer, própria do entendimento, o pensar contém o (...) conhecimento, embora este se qualifique pelas regras e pelos limites determinantes da objetividade. A pergunta que tentaremos formular é se essa relação continente-conteúdo não poderia configurar também uma dependência da experiência em relação ao raciocínio dialético, que estaria de algum modo indicada na função reguladora das idéias da razão. Nesse caso, a oposição formal entre conhecer e pensar seria inseparável da inclusão estrutural (dependência) da experiência no âmbito da razão. Na raiz do problema estaria talvez a tensão (dialética) entre a aspiração subjetiva de totalidade e as exigências objetivas de limitação e segmentação da experiência e a forma da experiência teria de ser finalmente concebida a partir de um fundo de inteligibilidade problemática. Dialectics and experienceThe separation of possible experience as objective knowledge and dialetics as a non-objective or non-theoretical knowledge is one of the most important aspects of kantian critical philosophy. But Kant also says that the activity of reason, as a pure thinking, has more amplitude than understanding knowledge. So we could say that theoric knowledge would depend on rational ( and non-theoretical) knowledge, as something contained in it. If we accept that, the consequence would be a relation of dependence between the form of objective knowledge and the background of a problematic – even doubtful – inteligible knowledge. (shrink)

An important contribution to the foundations of probability theory, statistics and statistical physics has been made by E. T. Jaynes. The recent publication of his collected works provides an appropriate opportunity to attempt an assessment of this contribution.