When is it permissible to allow a newborn infant to die on the basis of their future quality of life? The prevailing official view is that treatment may be withdrawn only if the burdens in an infant's future life outweigh the benefits. In this paper I outline and defend an alternative view. On the Threshold View, treatment may be withdrawn from infants if their future well-being is below a threshold that is close to, but above the zero-point of well-being. I (...) present four arguments in favor of the Threshold View, and identify and respond to several counterarguments. I conclude that it is justifiable in some circumstances for parents and doctors to decide to allow an infant to die even though the infant's life would be worth living. The Threshold View provides a justification for treatment decisions that is more consistent, more robust, and potentially more practical than the standard view. (shrink)

Birth asphyxia is the most common single cause of death in term newborn infants. The majority of deaths in developed countries follow decisions to withdraw intensive care. Recent technological advances, particularly the use of magnetic resonance imaging (MRI) of the brain, may affect the process of prognostication and decision-making. There is little existing evidence about how prognosis is determined in newborn infants and how this relates to treatment withdrawal decisions.An exploratory qualitative study was performed using in-depth semi-structured interviews with a (...) sample of ten neonatologists from tertiary intensive care units in the UK. Participants were purposively selected to ensure a range of experience and type of unit. They were asked about the process of prognostication for infants with birth asphyxia and decisions about treatment withdrawal. Interviews were transcribed and thematically analysed.MRI played a significant role in decision-making about life-sustaining treatment for a number of clinicians. Clinicians did not identify particular ethical concerns related to MRI, though wider discussion revealed issues relating to uncertainty around predictions, the timing of prognostication and decision-making, and difficulty in predicting quality of life. (shrink)

Are there some newborn infants whose short- and long-term care costs are so great that treatment should not be provided and they should be allowed to die? Public discourse and academic debate about the ethics of newborn intensive care has often shied away from this question. There has been enough ink spilt over whether or when for the infant's sake it might be better not to provide life-saving treatment. The further question of not saving infants because of inadequate resources has (...) seemed too difficult, too controversial, or perhaps too outrageous to even consider. However, Roman Catholic ethicist Charles Camosy has recently challenged this, arguing that costs should be a primary consideration in decision-making in neonatal intensive care. In the first part of this paper I will outline and critique Camosy's central argument, which he calls the ‘social quality of life (sQOL)’ model. Although there are some conceptual problems with the way the argument is presented, even those who do not share Camosy's Catholic background have good reason to accept his key point that resources should be considered in intensive care treatment decisions for all patients. In the second part of the paper, I explore the ways in which we might identify which infants are too expensive to treat. I argue that both traditional personal ‘quality of life’ and Camosy's ‘sQOL’ should factor into these decisions, and I outline two practical proposals. (shrink)

In many forms of severe acute brain injury there is an early phase when prognosis is uncertain, followed later by physiological recovery and the possibility of more certain predictions of future impairment. There may be a window of opportunity for withdrawal of life support early, but if decisions are delayed there is the risk that the patient will survive with severe impairment. In this paper I focus on the example of neonatal encephalopathy and the question of the timing of prognostic (...) tests and decisions to continue or to withdraw life-sustaining treatment. Should testing be performed early or later; and how should parents decide what to do given the conflicting values at stake? I apply decision theory to the problem, using sensitivity analysis to assess how different features of the tests or different values would affect a decision to perform early or late prognostic testing. I draw some general conclusions from this model for decisions about the timing of testing in neonatal encephalopathy. Finally I consider possible solutions to the problem posed by the window of opportunity. Decision theory highlights the costs of uncertainty. This may prompt further research into improving prognostic tests. But it may also prompt us to reconsider our current attitudes towards the palliative care of newborn infants predicted to be severely impaired. (shrink)

In this paper, we explore three separate questions that are relevant to assessing the prudential value of life in infants with severe life-limiting illness. First, what is the value or disvalue of a short life? Is it in the interests of a child to save her life if she will nevertheless die in infancy or very early childhood? Second, how does profound cognitive impairment affect the balance of positives and negatives in a child’s future life? Third, if the life of (...) a child with life-limiting illness is prolonged, how much suffering will she experience and can any of it be alleviated? Is there a risk that negative experiences for such a child will remain despite the provision of palliative care? We argue that both the subjective and objective components of well-being for children could be greatly reduced if they are anticipated to have a short life that is affected by profound cognitive impairment. This does not mean that their overall well-being will be negative, but rather that there may be a higher risk of negative overall well-being if they are expected to experience pain, discomfort, or distress. Furthermore, we point to some of the practical limitations of therapies aimed at relieving suffering, such that there is a risk that suffering will go partially or completely unrelieved. Taken together, these considerations imply that some life-prolonging treatments are not in the best interests of infants with severe life-limiting illness. (shrink)

If a disabled newborn infant dies, her parents may be able to conceive another child without impairment. This is sometimes referred to as 'replacement'. Some philosophers have argued that replacement provides a strong reason for disabled newborns to be killed or allowed to die. In this paper I focus on the case for replacement as it relates to decisions about life support in newborn intensive care. I argue (following Jeff McMahan) that the impersonal reason to replace is weak and easily (...) outweighed. I assess and reject several possible ways in which the impersonal reason to replace could be defended. I then address an alternative justification for replacement - as an individual-affecting benefit. The strongest justification for replacement may be the interests of parents. In the latter part of the paper I look at a related question. What role should replacement play in decisions about the funding of newborn intensive care? (shrink)

Infants who are born extremely prematurely can survive if they receive intensive medical treatment. However, they also have a high chance of dying, and a proportion of survivors have long-term health problems and disabilities. In many parts of the world, if parents request it, an extremely premature infant can receive palliative care rather than active survival-focused care at birth. But there are variations between countries as to whether or when this is permitted. To help inform ethical debates across Asia and (...) more widely, we present two contrasting views about parental discretion and the treatment of extremely preterm infants. In questions of this nature, disagreement and dissensus are inevitable. Differences in the outcomes of treatment, the resources available, and the values of society mean that we should not expect a uniform approach. We identify points of potential consensus and compromise despite disagreement. (shrink)

Disability might be relevant to decisions about life support in intensive care in several ways. It might affect the chance of treatment being successful, or a patient’s life expectancy with treatment. It may affect whether treatment is in a patient’s best interests. However, even if treatment would be of overall benefit it may be unaffordable and consequently unable to be provided. In this paper we will draw on the example of neonatal intensive care, and ask whether or when it is (...) justified to ration life-saving treatment on the basis of disability. We argue that predicted disability is relevant both indirectly and directly to rationing decisions. (shrink)

The four thoughtful commentaries on our feature article draw out interesting empirical and normative questions. The aim of our study was to examine the views of a sample of the general public about a set of cases of disputed treatment for severely impaired infants.1 We compared those views with legal determinations that treatment was or was not in the infants’ best interests, and with some published ethical frameworks for decisions. We deliberately did not draw explicit ethical conclusions from our survey (...) findings, both because of the acknowledged limitations of survey methodology, and because survey conclusions cannot, in themselves, yield answers about what the right threshold should be for providing or withholding treatment.2 In this brief response, we are going to address head-on the important ethical question raised within our survey – when life is worth living for an infant. We follow-up on the suggestion of two commentators that the presence or absence of “relational potential” might be ethically important to report in studies of the outcome of severely impaired infants,3 and to whether parental requests for treatment should be supported.4 The notion of “relational potential” was introduced by John Arras in a 1984 commentary.5 Arras was responding to the Baby Doe Regulations and a …. (shrink)

Ethical discussions about medical treatment for seriously ill babies or children often focus on the ‘value of life’ or on ‘quality of life’ and what that might mean. In this paper, I look at the other side of the coin—on the value of death, and on the quality of dying. In particular, I examine whether there is such a thing as a good way to die, for an infant or an adult, and what that means for medical care. To do (...) that, I call on philosophy and on personal experience. However, I will also make reference to art, poetry and music. That is partly because the topic of mortality has long been reflected on by artists as well as philosophers and ethicists. It is also because, as we will see, there may be some useful parallels to draw. (shrink)

Huang and colleagues provide some intriguing insights into the attitudes about end of life care of practising Taiwanese neonatal doctors and nurses.1 There are some similarities with surveys from other parts of the world. Most Taiwanese neonatologists and nurses agreed that it was potentially appropriate to withhold or limit treatment for infants who were dying. A very high proportion was opposed to active euthanasia of such infants. But there were also some striking differences. Only 21% of Taiwanese doctors ‘agreed’ with (...) withdrawal of mechanical ventilation for dying newborn infants. This proportion is lower than reported in any European country.2 More than 90% of neonatologists surveyed in the UK, the USA, The Netherlands and Sweden found withdrawal of mechanical ventilation acceptable.2 ,3 Taiwanese doctors also seemed reluctant to give analgesia or sedatives to such infants, with almost 60% disagreeing with their use in dying infants where there was a risk of hastening death.1 In contrast, two-thirds or more of European neonatologists thought this was acceptable .2The results of the survey of Huang et al highlight three beliefs about end-of-life care that are widespread, but all of which are seriously mistaken1. None are new, but …. (shrink)

In this commentary I assess the possible harms to a fetus with trisomy 18 of continued life. I argue that, although there is good reason to avoid subjecting infants to major surgery and prolonged intensive care where there is little chance of benefit, doctors should support and engage honestly with parents who decide to continue their pregnancies. We should ensure that infants with trisomy 18 have access to high quality palliative care.

On 24 July 2017, the long-running, deeply tragic and emotionally fraught case of Charlie Gard reached its sad conclusion. Following further medical assessment of the infant, Charlie’s parents and doctors finally reached agreement that continuing medical treatment was not in Charlie’s best interests. Life support was subsequently withdrawn and Charlie died on 28 July 2017.Box 1 ### Case summary and timeline21–23 Charlie Gard was born at full term, apparently healthy, in August 2016. At a few weeks of age his parents (...) noticed early signs of muscle weakness. At 2 months of age, he was admitted to Great Ormond Street Hospital with poor feeding, failure to thrive and respiratory failure. He was admitted to intensive care, where investigations led to the diagnosis of a rare severe mitochondrial disorder – infantile onset encephalomyopathic mitochondrial DNA depletion syndrome. The specific genetic form of MDDS in Charlie Gard had previously been reported in approximately 15 infants, with typical clinical features including early onset, rapid progression and death in infancy.24 By that point, Charlie was paralysed and unable to breathe without respiratory support. He was found to have congenital deafness, and his heart, liver and kidneys were affected by the disorder. Doctors felt that Charlie’s prognosis was extremely poor. In early 2017, Charlie’s parents identified an experimental treatment, previously used in a different form of MDDS, which they hoped might benefit Charlie. In mouse models of a myopathic form of MDDS, early supplementation with deoxypryrimidine nucleosides apparently bypasses the genetic defect and leads to a reduction in the biochemical defect and in the severity of the clinical phenotype.25 26 Doctors at GOSH initially planned to use nucleoside treatment in Charlie, but in January he developed evidence of electrical seizures, and clinicians became convinced that treatment, both continued intensive care and the requested …. (shrink)

This chapter begins by sketching an account of morally responsible agency and the general conditions under which it may fail. We discuss how far individuals with psychiatric diagnoses may be exempt from morally responsible agency in the way that infants are, with examples drawn from a sample of diagnoses intended to make dierent issues salient. We further discuss a recent proposal that clinicians may hold patients responsible without blaming them for their acts. We also consider cognitively impaired subjects in the (...) light of related issues in moral and political theory, asking whether they have been unjustly excluded from liberal conceptions of political community due to their presumed lack of agency. (shrink)

In the case that triggered this round-table discussion there are three separate factors that contribute to moral uncertainty.1 First, the infant, baby T, is extremely premature with suspected brain injury and potentially poor prognosis. Second, the gestational mother is critically unwell herself and her outlook is guarded. Third, as linked commentaries make clear, the legal status of the intended parents is complex and ambiguous.2 3 Any of these factors on their own would be enough to generate ethical complexity and distress (...) in the neonatal intensive care unit. The combination of the three is likely to be highly stressful for all concerned.4 Commentaries on the case emphasise the complex legal questions and the potential need to involve the court. One resource that is not mentioned is the potential value of clinical ethics input in such a case. This is complementary to the need for legal advice. Its aim would be to help think through the specifically ethical, rather than legal questions. There are several things that I would aim to clarify if chairing a clinical ethics discussion on the case. First, it may be useful to draw on the concept of the …. (shrink)

Infants are unable to make their own decisions or express their own wishes about medical procedures and treatments. They rely on surrogates to make decisions for them. Who should be the decision-maker when an infant’s biological parents are also minors? In this paper, we analyse a case in which the biological mother is a child. The central questions raised by the case are whether minor parents should make medical decisions on behalf of an infant, and if so, what are the (...) limits to this decision-making authority? In particular, can they refuse treatment that might be considered best for the infant? We examine different ethical arguments to underpin parental decision-making authority; we argue that provided that minor parents are capable of fulfilling their parental duties, they should have a right to make medical decisions for their infant. We then examine the ethical limits to minor parents’ decision-making authority for their children. We argue that the restricted authority that teenagers are granted to make medical decisions for themselves looks very similar to the restricted autonomy of all parents. That is, they are permitted to make choices, but not harmful choices. Like all parents, minor parents must not abuse or neglect their children and must also promote their welfare. They have a moral right to make medical decisions for their infants within the same ‘zone of parental discretion’ that applies to adult parents. We conclude that adult and minor parents should have comparable decision-making authority for their infants. (shrink)

We report the results of a survey of the attitudes and practices of paediatricians in Warsaw, Poland, with respect to the treatment of infants born with severe handicaps. The results are compared with a similar survey conducted by Australian researchers (1). In the Polish medical community surveyed, unconditional respect for life is a dominant attitude. Our study has revealed a deeply-entrenched paternalistic attitude among Polish doctors and a strong unwillingness to distinguish between 'ordinary and extraordinary means' of prolonging life, as (...) well as an ambivalent attitude towards legal regulations binding in Poland. (shrink)

Suffering patients (when able), grieving families and compassionate physicians have always sought the least detrimental alternative while deciding care in the face of tragedy. Modern medical technology has brought great benefits to patients but has blurred traditional concepts of life and death and created new dilemmas for practising doctors. While this technology has given doctors great control over living and dying, their dominance in critical decision making is being challenged. More and more their decisions are liable to public and legal (...) scrutiny, intense publicity by the news media and exploitation by lobbyists with opposing aims. Increasing pressure of this kind may deflect the physician form his primary responsibility to patients and their families. For infants with gross malformations or a distressing terminal illness we believe that the parents and their doctors must be allowed primary decisional power even if the chosen course of action involves the death of the infant. Choices for death should be permitted but only after suitable family and professional consultation. Some general guidelines are suggested. As these situations are so varied and so complex, much latitude in decision-making should be expected and tolerated. (shrink)

This paper, which has both a historical and a polemical aspect, investigates the view, dominant throughout the eighteenth and nineteenth centuries, that the sense of sight is, originally, not phenomenally three-dimensional in character, and that we must come to interpret its properly two-dimensional data by reference to the sense of 'touch'. The principal argument for this claim, due to Berkeley, is examined and found wanting. The supposedly confirming findings concerning 'Molyneux subjects' are also investigated and are shown to be either (...) irrelevant or disconfirming. Recent investigations on infant and neonatal perception are discussed and are also found to be disconfirming. An innatist version of the theory is then considered and is shown to be undermined by the largely 'Gibsonian' character of early space-perception. Finally three recent arguments in favour of the theory - two from psychologists, one from a philosopher - are considered and answered. (shrink)

Recent animal research suggests that it may soon be possible to support the human fetus in an artificial uterine environment for part of a pregnancy. A technique of extending gestation in this way (“ectogestation”) could be offered to parents of extremely premature infants (EPIs) to improve outcomes for their child. The use of artificial uteruses for ectogestation could generate ethical questions because of the technology’s potential impact on the point of “viability”—loosely defined as the stage of pregnancy beyond which the (...) fetus may survive external to the womb. Several medical decisions during the perinatal period are based on the gestation at which infants are considered viable, for example decisions about newborn resuscitation and abortion, and ectogestation has the potential to impact on these. Despite these possible implications, there is little existing evidence or analysis of how this technology would affect medical practice. In this paper, we combine empirical data with ethical analysis. We report a survey of 91 practicing Australian obstetricians and neonatologists; we aimed to assess their conceptual understanding of “viability,” and what ethical consequences they envisage arising from improved survival of EPIs. We also assess what the ethical implications of extending gestation should be for newborn and obstetric care. We analyze the concept of viability and argue that while ectogestation might have implications for the permissibility of neonatal life‐prolonging treatment at extremely early gestation, it should not necessarily have implications for abortion policy. We compare our ethical findings with the results of the survey. (shrink)

BackgroundDecisions about withdrawal of life support for infants have given rise to legal battles between physicians and parents creating intense media attention. It is unclear how we should evaluate when life is no longer worth living for an infant. Public attitudes towards treatment withdrawal and the role of parents in situations of disagreement have not previously been assessed.MethodsAn online survey was conducted with a sample of the UK public to assess public views about the benefit of life in hypothetical cases (...) similar to real cases heard by the UK courts (eg, Charlie Gard, Alfie Evans). We then evaluated these public views in comparison with existing ethical frameworks for decision-making.ResultsOne hundred and thirty participants completed the survey. The majority (94%) agreed that an infant’s life may have no benefit when well-being falls below a critical level. Decisions to withdraw treatment were positively associated with the importance of use of medical resources, the infant’s ability to have emotional relationships, and mental abilities. Up to 50% of participants in each case believed it was permissible to either continueorwithdraw treatment.ConclusionDespite the controversy, our findings indicate that in the most severe cases, most people agree that life is not worth living for a profoundly disabled infant. Our survey found wide acceptance of at least the permissibility of withdrawal of treatment across a range of cases, though also a reluctance to overrule parents’ decisions. These findings may be useful when constructing guidelines for clinical practice. (shrink)

Volume 19, Issue 10, October 2019, Page 61-63.

We briefly respond to Bursztajn and colleagues’ commentary on our article, “Clinical Wisdom in Psychoanalysis and Psychodynamic Psychotherapy: A Philosophical and Qualitative Analysis.”.

Although cognitively oriented theories of emotion are now dominant in the psychological study of emotion, there remain issues upon which these theories do not agree. Central among these are questions regarding the minimal cognitive processes necessary to have an emotion. A potentially productive approach to such questions is the study of the relation of cognitive development and the development of emotions in infants. Such an approach was featured in ancient philosophical and psychological treatises, some of which formed the very foundations (...) of later cognitive theories. However, the recent literature has been nearly indifferent to just these foundations. Ancient commentators, especially Aristotle and the Stoic and Epicurean philosophers, understood emotions as fundamentally sociomoral constructs. Owing to a lack of socialisation and moral understanding, infants are not fully capable of experiencing emotions as they are typically understood. Contemporary work in the area of emotion, including that of Michael Lewis, as well as work in other emotion-related areas, is shown to address only inadequately the sociomoral components of emotion and thus to address only inadequately the emotion-cognition relationship. (shrink)

Internet plagiarism continues unabated and may even be increasing. Questions pertaining to the ethical-moral construct employed by students to justify Internet plagiarism among high school students have remained relatively untouched. Understanding not simply the prevalence of Internet plagiarism but also the variety of explanations used by students to justify their plagiarism seems crucial to curtailing its practice. In this study, I surveyed 160 high school students and endeavored to understand and describe the practices of students who use the Internet for (...) schoolwork and who engage in copy-paste plagiarism or paper-buying practices. The results indicate that students are more easily able to justify copy-paste plagiarism for a variety of reasons that mirror justifications of other forms of conventional plagiarism. Most students indicated they would never purchase a paper for reasons ranging from fear of getting caught to more principled and nuanced ethical claims. Based on these results I also offer educators suggestions for refining assignments and evaluation methods. (shrink)

This paper discusses the economic impact and political consequences of ethical investing, with particular attention to the case of South Africa. The origins of ethical investing are examined, along with the institutions and strategies by which ethical investing operates today. Of immediate relevance to managers is a recent judicial decision upholding Baltimore's divestment ordinance. The discussion concludes with an assessment of the likely consequences of ethical investing for U.S. multinationals in Southern Africa.

Do children’s single words related to motion and change also encode aspects of environmental events highlighted by Talmy’s motion event analysis? If so, these meanings may predict children’s early verb meanings. Analyzing the kinds of meanings expressed in single “dynamic event words” through motion event semantics yields links between early true verbs in sentences and the semantics encoded in these single words. Dynamic event words reflect the sense of temporal and spatial reversibility established in the late sensorimotor period. We propose (...) that these dynamic meanings provide the semantic foundation for the most common verbs included in early sentences, and thus a bootstrap to full development of the verb repertoire. In this study, we followed the spoken language development of five children. We identified dynamic event words as encoding dynamic change in the following dimensions: spatial direction in relation to self; vertical spatial direction; figure/ground relationships; and temporal event sequences. Verbs continuing the semantics previously identified in dynamic event words occurred early and dominated the verb repertoire through 24 months of age. (shrink)

Klugman et al. (2018) describe how new medical devices track treatment adherence more accurately than a clinician relying on his or her patient’s self-report. For example, these devices promise to...

Volume 19, Issue 10, October 2019, Page 86-88.

Decision making capacity (DMC) is a fundamental concept grounding the principle of respect for autonomy and the practice of obtaining informed consent. DMC must be determined and documented every time a patient undergoes a hospital procedure and for routine care when there is reason to believe decision making ability is compromised. In this paper we explore a path toward ethically informed development and implementation of a hospital policy related to DMC assessment. We begin with a review of the context of (...) DMC assessment before discussing some considerations relevant to policy creation by healthcare ethics committees. The discussion concludes in a presentation of a typology of capacity assessment policies, which draws upon a sampling of currently used hospital policies to illustrate relevant ethical considerations. (shrink)

To precisely define wisdom has been an ongoing task of philosophers for millennia. Investigations into the psychological dimensions of wisdom have revealed several features that make exemplary persons "wise." Contemporary bioethicists took up this concept as they retrieved and adapted Aristotle's intellectual virtue of phronesis for applications in medical contexts. In this article, we build on scholarship in both psychology and medical ethics by providing an account of clinical wisdom qua phronesis in the context of the practice of psychoanalysis and (...) psychodynamic psychotherapy. With the support of qualitative data, we argue that the concept of clinical wisdom in mental healthcare shares several of the key ethical dimensions offered by standard models of phronesis in medical ethics and serves as a useful, albeit overlooked, reference point for a broader development of virtue-based medical ethics. We propose that the features of clinical wisdom are pragmatic skills that include, but are not limited to, an awareness of balance, the acceptance of paradox, and a particular clinical manner that maintains a deep regard for the other. We offer several suggestions for refining training programs and redoubling efforts to provide long-term mentorship opportunities for trainees in clinical mental healthcare in order to cultivate clinical wisdom. (shrink)

Discharge planning for vulnerable infants and children is a collaborative, inter-disciplinary, decision-making activity that is grounded in the ethical complexities of clinical practice. Although it is a psychosocial intervention that frequently causes moral distress for professionals and has the potential to inflict harm on children and their families, the process has received little attention from ethicists. An ongoing study of the transition of technology-dependent children from hospital to home suggests that the ethical issues embedded in the discharge-planning process may be (...) concealed by dominant cultural values, institutional policies, clinical standards, historical precedents, and legal regulations. (shrink)

Gathers medical and legal documents, opinions from various perspectives, and a timeline of events in the Terri Shiavo case to provide a resource for examining the moral and ethical issues surrounding end-of-life decisions.

The philosophy of emotions has long been dominated by the view called «cognitivism». According to it, emotions are characterized not by mere physical impulses but by a cognitive evaluation of their object. However, despite their success, cognitive theories have to deal with various objections and are divided on how to answer to them. In this essay I want to defend the form of cognitivism claimed by Martha Nussbaum from the most common criticisms. After a brief summary of her account, I (...) confront some of the objections that have been raised against it. In Section 2 I deal with the classic problem of emotions in infants and animals, which lack linguistic abilities. Later, I confront the potential problem represented by cases in which one’s emotion and reasoned judgment seem to differ: in paragraph 3 I consider irrational phobias and fears, to show how they can be accounted for in terms of judgments and thoughts, and not only of perceptions; in paragraph 4 I deal with the objection that «judgementalist» theories violate the «principle of charity», for they ascribe an excessive irrationality to people. I argue that experimental evidence suggest that it is not implausible to assume that people have contradictory beliefs under conditions of uncertainty, and that perceptual theories of emotion fail to account for some fundamental aspects of these phenomena. Finally, in paragraph 5, I deal with the objection according to which a cognitive-evaluative theory cannot explain the sense of passivity that we commonly experience in emotions. (shrink)

Health, Disease, and Illness brings together a sterling list of classic and contemporary thinkers to examine the history, state, and future of ever-changing "concepts" in medicine.

The dominant conceptions of moral status in the English-speaking literature are either holist or individualist, neither of which accounts well for widespread judgments that: animals and humans both have moral status that is of the same kind but different in degree; even a severely mentally incapacitated human being has a greater moral status than an animal with identical internal properties; and a newborn infant has a greater moral status than a mid-to-late stage foetus. Holists accord no moral status to any (...) of these beings, assigning it only to groups to which they belong, while individualists such as welfarists grant an equal moral status to humans and many animals, and Kantians accord no moral status either to animals or severely mentally incapacitated humans. I argue that an underexplored, modal-relational perspective does a better job of accounting for degrees of moral status. According to modal-relationalism, something has moral status insofar as it capable of having a certain causal or intensional connection with another being. I articulate a novel instance of modal-relationalism grounded in salient sub-Saharan moral views, roughly according to which the greater a being's capacity to be part of a communal relationship with us, the greater its moral status. I then demonstrate that this new, African-based theory entails and plausibly explains the above judgments, among others, in a unified way. (shrink)

On 22 July, 2011, we were confronted with the horror of the actions of Anders Behring Breivik. The instant reaction, as we have seen with similar incidents in the past—such as the Oklahoma City bombings—was to attempt to explain the incident. Whether the reasons given were true or not were irrelevant: the fact that there was a reason was better than if there were none. We should not dismiss those that continue to cling on to the initial claims of a (...) wider Jihadist plot behind the actions of Timothy McVeigh and Terry Nichols as Islamophobes (or merely lacking common sense): for, it is often easier to rely on reason—no matter how fictional—than not to have anything to cling on at all. In many ways, it is even better if the reason is fictional: for, if grounded in a certain fact, or reality, it can then go away. However, if it is in the realm of the imaginary, it is then always already metaphorical: thus, can be applied to any and every situation. And it is this, if we echo Friedrich Nietzsche, that gives us our “metaphysical comfort”; that we can know what is going on. This is why conspiracy theories are so popular: underlying them is the logic that someone—no matter how implausible—is in control of the situation. One would rather believe that all acts of terror stemmed from Osama bin Laden (and the narrative worked even better when he was in a ‘cave in Afghanistan’) than if they were the actions, and decisions, of singular individuals. For, if there is a head organizing everything, it can be cut off; there is no controlling a mass of singularities. As Jean Baudrillard continues to teach us, the term ‘mass’ is not a concept. It is a leitmotif of political demagogy, a soft, sticky, lumpen-analytical notion. A good sociology would attempt to surpass it with ‘more subtle’ categories: socio-professional ones, categories of class, cultural status, etc. This is wrong: it is by prowling around these soft and acritical notions (like ‘mana’ once was) that one can go further than intelligent critical sociology. Besides, it will be noticed retrospectively that the concepts ‘class’, ‘social relations’, ‘power’, ‘status’, ‘institution’, and ‘social’ itself—all these too-explicit concepts which are the glory of the legitimate sciences—but also only ever been muddled notions themselves, but notions upon which agreement has nevertheless been reached for mysterious ends: those of preserving a certain code of analysis. To want to specify the term ‘mass’ is a mistake—it is to provide meaning for that which has none.1 And it is this lack of meaning—this nothingness of not only the mass, but our inability to know in general—that truly scares us. For, if we are never able to legitimately make a generalizing statement, this suggests that we can never actually posit beyond a singular, situational, moment. Hence, we can never claim to know anyone: at best, we can only catch momentary glimpses. It is for this very reason that the insanity plea Breivik’s lawyer will attempt is the one that horrifies us the most. For, if Breivik is insane, this foregrounds our inability to understand, know. And as Aristotle has taught us, it is more important that something is plausible than if something were probable—in this context, we would rather have Breivik as a calculating mass murderer than someone who was completely out of his mind. This is especially ironic in the light of the fact that none of us would say that we have any similarity with Breivik. If that were so, the declaration that he was mad should be no more than a logical consequence. However, we also want Breivik to be accountable for his actions. And in order for that to be so, we need him to be of sound mind. But if that were true, we can then no longer distinguish ourselves from him. And it is precisely this that scares us. For, we are horrified not when there are abnormalities to our way of life. There are usually two different reactions to this—either oppose and destroy it; or subsume it under the dominant logic. We see this most clearly in reactions to immigration: there are either calls for immigrants to ‘pack up and leave’ or pseudo-liberal notions of ‘we are all alike’. Both of which are merely version of “all men are brothers”—the brutal translation of which is that you are my brother if you live the same way as me; otherwise not only are you not my brother, you are also potentially not part of mankind (you might as well be, to echo Giorgio Agamben, bare life ). This is played out in our age of what is commonly termed post-political bio-politics —an instance of horribly awkward theoretical jargon that Slavoj Žižek channeling Agamben unpacks rather elegantly: “ post-politics is a politics which claims to leave behind old ideological struggles and, instead, focus[es] on expert management and administration, while bio-politics designates the regulation of the security and welfare of human lives as its primary goal.”2 Žižek continues: Post-political bio-politics also has two aspects which cannot but appear to belong to two opposite ideological spaces: that of the reduction of humans to ‘bare life,’ to Homo sacer , that so-called sacred being who is the object of expert caretaking knowledge, but is excluded, like prisoners at Guantanamo or Holocaust victims, from all rights; and that of respect for the vulnerable Other brought to an extreme through an attitude of narcissistic subjectivity which experiences the self as vulnerable, constantly exposed to a multitude of potential harassments [….] What these two poles share is precisely the underlying refusal of any higher causes, the notion that the ultimate goal of our lives is life itself. That is why there is no contradiction between the respect for the vulnerable Other and […] the extreme expression of treating individuals as Homini sacer .3 This is why the ones that are harshest towards new immigrants are the recently naturalized citizens of any country. For, if there is no longer any “ideological struggle” and all life is reduced to mere automaton-living, there is the realization that we are all the same—not in a tree-hugging hippie sense—but that the immigrant is the same as us precisely because we are all immigrants. And since all nations, and by extension peoples in a nation (especially those who believe in the notion of nationality, and national identity), have to find some manner, no matter from where or what it is, to distinguish themselves from those around them, the other (in spite, and especially in the light, of its absence) is the most crucial aspect of the discourse of nationality. More precisely, in the interests of what Baudrillard calls “preserving a certain code of analysis” (nationality in this case), what has to be maintained is the absolute otherness of the other. Very rarely is Boris Johnson right: “it is not enough to say he is mad. Anders Breivik is patently mad.”4 However, much like Breivik in his manifesto, he should have stopped whilst he was ahead. By attempting to diagnose Breivik—“the fundamental reasons for their callous behavior lie deep in their own sense of rejection and alienation. It is the ideology that gives them the ostensible cause … that gives them an excuse to dramatize the resentment … and to kill.”—Johnson falls into the same trap that he accuses others of: “to try to advance any other explanation for their actions … is simply to play their self-important game.” More crucially, and this is the point that Johnson completely misses, attempting to rationalize Breivik’s actions—to rehabilitate reason—is a desperate attempt at maintaining his otherness. In fact, we’ll end up going one step further, insist on Breivik’s sanity, put him on the stand, and hope that he will display such a difference from all of us that we can rest safe that we are unlike him and his kind. That, in itself, is a dangerous game to play. One should not forget that the turning point in Mary Shelley’s Frankenstein is in the central part of her novel where she lets the monster speak. At that moment, the monster moves from an ‘it’ to a fully subjectivized person; with his own stories, historicities, emotions, and so on. In Slavoj Žižek’s reading of Frankenstein , this is the moment where “the ultimate criminal is thus allowed to present himself as the ultimate victim. The monstrous murderer reveals himself to be a deeply hurt and desperate individual, yearning for company and love.”5 But, in the case of Breivik, this goes beyond just a risk of us feeling for him: for, no right-minded person should ever deny another the opportunity to put forth her or his own case. The problem lies with us trying to deny the madness of Breivik’s act by putting him back under reason. The problem is in our inability to differentiate the act from the person; the singular from the universal.6 In our desperation to preserve the notion that we are rational beings incapable of becoming monsters, we’ve had to deny the meaninglessness—in the strict sense of it lying outside of reason—of Breivik’ act; we’ve had to “provide meaning where there is none.” For, if this act were a moment of madness—a moment that comes from elsewhere—we cannot say that it will not descend upon us one day. If Breivik’s actions were that of a sane person, one who is in control of his being, his self, we can then locate the otherness in his being. More importantly, this would allow us to distinguish ourselves from that said being. Breivik’s sanity is the only thing that allows us to say that ‘this act of terror is borne out of one with an ultra-right ideology’; and ‘since I am not of that ideology, I would never do such a thing’. By doing that, we attempt to protect ourselves by claiming that people who share Breivik’s ideology are foreign to us, other to us. However, if Breivik’s act was a moment of insanity, his otherness is no longer locatable: and the notion of ‘us and them’ shifts from a geographical, physical, religious, or cultural notion, to one in the realm of ideas. And this is what truly scares us. For, if what is foreign is not phenomenological, then it cannot be seen, detected, sensed. Anders Behring Breivik, Timothy McVeigh, and Terry Nichols, terrify us not merely for the fact that they were white in a white society, but more pertinently that their skin color did not matter: we would not be able to spot them even if they were blue, even if they were right next to us, even if we had known them all our lives. Even as we are grappling with holding Breivik accountable by declaring him of sound mind, what truly terrifies us is that deep down we know that Breivik’s act is a moment of madness; beyond all comprehensibility. And this means that we would not be able to spot the idea; even if it were in our heads at this very moment. We have gone to lengths to rehabilitate Breivik, McVeigh, Nichols, and such perpetrators of massive incomprehensible violence, in order to preserve our difference from them. What we have really been trying to deny is the fact that everyone, at any given moment, could have a moment of madness. And this is the true radicality of Mary Shelley: in allowing us to momentarily enter the head of the monster, she shows us not just the fact that he is like any one of us, but that any one of us could, in the right (or wrong) circumstance, be like him. Perhaps here, there is a lesson to be learned from Wes Craven’s A Nightmare on Elm Street . The most dangerous thing that one could do on Elm Street was to mention Freddy’s name—once you had knowledge of him, you were open to the possibility of a visit during your dreams. This suggests that Freddy is a combination of externalities (after all, when you die, he survives) and your self (if you have never heard of him, he cannot come for you). In this sense, Freddy would be the manifestation par excellence of what Avital Ronell calls a “killer text”—it is one’s relationality with the text (and the ideas, notions, in the said text) that opens oneself to it, to the lessons of the text, to being changed, affected, even to the dangers of the text. After all, one should never forget Plato’s warning that ideas can corrupt, can be perilous. To compound matters, as Ronell reminds us, “the connection to the other is a reading—not an interpretation, assimilation, or even a hermeneutic understanding, but a reading.”7 Thus, in attempting to differentiate ourselves from Breivik by concocting some reason(s) why we are not like him, we have done nothing but read him, open a connection to him. *** Bang bang, he shot me down Bang bang, I hit the ground Bang bang, that awful sound Bang bang, my baby shot me down. “Bang Bang (My Baby Shot Me Down)” Sonny Bono, 1966. This is the part that we all know and remember. Whilst never quite remembering that this is a song that is not so much about violence, love, but about remembering. For, after the bridge comes the accusatory stanza: “Now he's gone, I don't know why/ And till this day, sometimes I cry/ He didn't even say goodbye/ He didn't take the time to lie.” Bang Bang is a game that the two lovers used to play; and all she has now is the memory of the game to remember him by. And the only reason she has to recall this game is: he never provided her a reason for his leaving, his death. Not that she will, can, ever get that satisfactory answer. This is precisely the game we are playing with Anders Behring Breivik. Even though he has left a 1500 page manifesto, even though we will allow him to use the court-room as his platform, we will continue screaming at him “tell me why …” For, what we want him to say is that we are not like him: what we really want him to do is, “take the time to lie …” Perhaps here, we should allow the echo of the infans to resound in baby . As Christopher Fynsk reminds us, the infans is one that is pre-language, pre-knowing, pre-understanding: it is the very finitude, and exteriority, of relationality itself.8 And thus, it is a position of openness to the fullness of possibility—and nothing else. This would be, in Ronell’s terms, a “connection to the other” that knows nothing other than the fact that it is a connection. The true horror of 22 July, 2011, is the fact that it is not Anders Behring Breivik who is mad, but the act itself that is. And this is precisely why only “my baby” that could have “shot me down.” For, it is an act that is from beyond, a sheer act of madness that—as Plato warns us—is whispered into our ears (and can so easily be mistaken for inspiration, and even wisdom), an act that can both seize, and cease, us at the same time. And what can this utter openness to an other, the other, be but a moment of love, a true ‘falling in love’. At the moment of whispering, nothing can be known as we are babies as our baby shoots us down …. Hence, all attempts at analyzing this event (including this one) are not only futile, but border on the farcical. The real tragedy is that we forget that all of us have the possibility of becoming Breivik. NOTES Jean Baudrillard. In the Shadow of the Silent Majorities . Trans. Paul Foss, John Johnston, Paul Patton, & Andrew Berardini. Los Angeles: Semiotext(e), 2007. p. 37. Slavoj Žižek. Violence: Six Sideway Reflections . London: Profile Books, 2009. p. 34 Ibid: 35-36. Boris Johnson. “ Anders Breivik: There is nothing to study in the mind of Norway’s mass killer .” The Telegraph . (25 July, 2011): Slavoj Žižek. Violence: Six Sideway Reflections . London: Profile Books, 2009. p.39. What is killing us is the notion that Breivik’s act is beyond reason, beyond knowing, outside understanding itself. This is why Boris Johnson’s plea was for us to ignore Breivik as a madman. But to do so, Johnson conflates the notion of the act and the person; the singular and the universal. This is exactly the same gesture as insisting on his sanity: the ‘madman’ is merely the absolute other, one that we are not. Avital Ronell. The Telephone Book: Technology, Schizophrenia, Electric Speech . Lincoln: University of Nebraska Press, 1989: 380. Christopher Fynsk. Infant Figures: The Death of the Infans and Other Scenes of Origin . Stanford, CA: Stanford University Press, 2000.  . (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Ethics for a Layered SelfLaughter, Reciprocity, Generosity, HomeCynthia WillettI can imagine no better way to respond to these insightful readings than to turn the spotlight on the important books that Ann Murphy and Megan Craig have written on affect and ethics! Craig’s book, Levinas and James: Toward a Pragmatic Phenomenology, weaves radical empiricism into phenomenology as only a philosopher who is also an artist could. Her evocative queries on (...) prereflective affects, perception, and ethical attunement shed light on the role of moods for unsettling rigid ego boundaries, ethical subjectivity, the feeling of being alive, the audible dimension of ethical encounters, life beyond a struggle to survive, temporality, and ethical ambiguity. These themes are compelling for any postmoral ethics that operates beyond or below the register of modern moral theory’s abstract laws and transparent cogitos. Her work balances an ethical concern for vulnerability with a vital regard for the vibrancy of living creatures and landscapes.Ann Murphy’s Violence and the Philosophical Imaginary illuminates philosophical questions with an abiding lucidity that does not weaken but amplifies the complexity and difficulty of ethics. Murphy’s work exposes how tropes of violence saturate philosophical discourses of both identity formation and of political and historical transformation, and how this violence, embedded in norms, denies sympathetic concern to those outside the limits of cultural intelligibility. Building upon recent work by Judith Butler, Adriana Caverero, and others, Murphy addresses the ambiguities arising from the multiple responses that exposure to vulnerability provokes. These responses can signal care but [End Page 70] they can also manifest violence. Even as she acknowledges the complex underside of cultural intelligibility, Murphy affirms sympathy and generous concern as paradigmatic virtues to be cultivated in response to various forms of violence. She probes the significance of shame and guilt for collective responsibility, ever alert to alterity and difference. With attentive care to the singular contributions of a broad range of philosophers and critical traditions, she argues compellingly for a corporeal ethics grounded on the ontological fact of vulnerability.Through their work, Murphy and Craig pose astute questions for my project, and, in fact, for any endeavor to conceptualize an ethics attentive to an embodied sociality. I describe the multifaceted approach I contribute toward this task as a call and response ethics for a layered self. Craig wonders if the more basic feature before any “call” is contact, touch, or immersion. She notes my concern that “any purported gap or abyss between humans and animals has less to do with unique human capacities than with the rise of urban centers and the loss of contact with other species.” Harm arises from a loss of contact. This is so true. Ethics as contact calls attention to the poetry of proximity, to erotic waves that transmit through the sound or feel of the other’s breath, the heat of the body, and the smell of the skin. This intense proximity serves as a compelling source for ethical sociality, resonating in some respects with what Merleau-Ponty explores as the sense of flesh and touch and, as Murphy suggests, a transcendental eros. This contact is as primal and ordinary as the skin-to-skin contact of caregiver and infant or, perhaps, the skin-to-hair contact of a terrier and her human companion, lost for a moment in inexplicable laughter. From these observations, Craig asks if “call and response” as a locution or central designation adequately captures the intimacy and intensity of these engagements.Craig’s remarks raise the further question of what is at stake in designations or phrasings. An ethics of call and response, designated as such, emerges from phenomenological but also crucially Africana and critical theory traditions. As a relational ethics, this ethics of call and response highlights social relations and expectations, opening a path outside of what Murphy characterizes as the trifecta of virtue ethics, deontology, and utilitarianism. It attends to desire (eros) beneath, in between, and above the prescriptive rules of moral reason or the interests of individuals. At its center are social bonds (friendship and companionship, community and domination, love, hate, and other social emotions, belonging and alienation, and the conflicts of groups and reconciliation) rather... (shrink)

On the basis of knowledge prior to 1988, Ashbrook pointed out that whereas most men are primarily dependent on the left cerebral hemisphere (“dominant hemisphere”) for verbally related functions, women show a greater hemispheric balance in this respect. For men, he argues, their possession of a “speaking” and a “non‐speaking hemisphere” results in a positive‐negative, bipolar way of thinking that may be characterized as dualistic and dialectically hierarchical. In contrast, the greater balance of hemispheric function in women appears to promote (...) greater generalization and synthesis in their thinking.In this article I cite more recent neuroanatomical and brain imaging studies that provide further evidence of disparities in structure and function of the brains of men and women. As background for an attempt to explain these differences, I give a brief review of the triune evolution of the mammalian brain leading up to the human cerebrum. It is of major significance that the female has played a central role in mammalian evolution for more than 180 million years and that the evolutionary transition from reptilian therapsids to mammals is characterized by the develoment of (1) nursing conjoined with maternal care; (2) audiovocal communication or aiding mother‐offspring contact; and (3) play. In human beings, the infant‐carrying hypothesis suggests one means by which, over generations, certain parts of a woman's right hemisphere could undergo functional and eventual anatomical expansion. The mother‐infant communication of basic mammalian sounds with vowel and consonant components suggests a basis for the origination of speech.Finally, in an expansion of Ashbrook's original thesis, we arrive at the rovocative consideration that, unlike men, with their dialectical reasoning, women, with their more balanced brain, are provided with a trialectial ladder for climbing to achieve knowledge. In terms of quantum mechanics, the particle and wave would correspond to the substance and strength of the sides of the ladder, and the derived psychic information (which is neither matter nor energy) would compare to the rungs in between. (shrink)

There are no egalitarians in a pandemic. The scale of the challenge for health systems and public policy means that there is an ineluctable need to prioritize the needs of the many. It is impossible to treat all citizens equally, and a failure to carefully consider the consequences of actions could lead to massive preventable loss of life. In a pandemic there is a strong ethical need to consider how to do most good overall. Utilitarianism is an influential moral theory (...) that states that the right action is the action that is expected to produce the greatest good. It offers clear operationalizable principles. In this paper we provide a summary of how utilitarianism could inform two challenging questions that have been important in the early phase of the pandemic: (a) Triage: which patients should receive access to a ventilator if there is overwhelming demand outstripping supply? (b) Lockdown: how should countries decide when to implement stringent social restrictions, balancing preventing deaths from COVID‐19 with causing deaths and reductions in well‐being from other causes? Our aim is not to argue that utilitarianism is the only relevant ethical theory, or in favour of a purely utilitarian approach. However, clearly considering which options will do the most good overall will help societies identify and consider the necessary cost of other values. Societies may choose either to embrace or not to embrace the utilitarian course, but with a clear understanding of the values involved and the price they are willing to pay. (shrink)

This article examines the foundations of social experience from a psychoanalytic perspective. In current developmental psychology, social cognition debate, and phenomenology of empathy, it is widely assumed that the self and the other are differentiated from the outset, and the basic challenge is accordingly taken to consist in explaining how the gap between the self and the other can be bridged. By contrast, in the psychoanalytic tradition, the central task is considered to lie in explaining how such a gap is (...) established in the first place. My article develops this latter idea. I focus on the infant’s early experience of care, show how the presence of the caregiver can be interpreted in terms of an interoceptive experience, illustrate the gradual self/other differentiation from this perspective, and thus argue that the other is granted ‘otherness’ gradually. By emphasising this graduality, I challenge the assumption that self/other differentiation dominates the infant’s life from the outset. In this manner, I show how the psychoanalytic theory may be used in contesting one of the cornerstones of the current research paradigm. (shrink)