Withholding or withdrawing life-saving ventilators can become necessary when resources are insufficient. In the USA, such rationing has unique social justice dimensions. Structural elements of dominant allocation frameworks simultaneously advantage white communities, and disadvantage Black communities—who already experience a disproportionate burden of COVID-19-related job losses, hospitalisations and mortality. Using the example of New Jersey’s Crisis Standard of Care policy, we describe how dominant rationing guidance compounds for many Black patients prior unfair structural disadvantage, chiefly due to the way creatinine and (...) life expectancy are typically considered.We outline six possible policy options towards a more just approach: improving diversity in decision processes, adjusting creatinine scores, replacing creatinine, dropping creatinine, finding alternative measures, adding equity weights and rejecting the dominant model altogether. We also contrast these options with making no changes, which is not a neutral default, but in separate need of justification, despite a prominent claim that it is simply based on ‘objective medical knowledge’. In the regrettable absence of fair federal guidance, hospital and state-level policymakers should reflect on which of these, or further options, seem feasible and justifiable.Irrespective of which approach is taken, all guidance should be supplemented with a monitoring and reporting requirement on possible disparate impacts. The hope that we will be able to continue to avoid rationing ventilators must not stand in the way of revising guidance in a way that better promotes health equity and racial justice, both to be prepared, and given the significant expressive value of ventilator guidance. (shrink)

We respond to recent comments on our proposal to improve justice in ventilator triage, in which we used as an example New Jersey’s publicly available and legally binding Directive Number 2020-03. We agree with Bernard Lo and Doug White that equity implications of triage frameworks should be continually reassessed, which is why we offered six concrete options for improvement, and called for monitoring the consequences of adopted triage models. We disagree with their assessment that we mis-characterised their Model Guidance, as (...) included in the NJ Directive, in ways that undermine our conclusions. They suggest we erroneously described their model as a two-criterion allocation framework; that recognising other operant criterion reveals it ‘likely mitigate[s] rather than exacerbate[s] racial disparities during triage’, and allege that concerns about inequitable outcomes are ‘without evidence’. We highlight two major studies robustly demonstrating why concerns about disparate outcomes are justified. We also show that White and Lo seek to retrospectively—and counterfactually—correct the version of the Model Guideline included in the NJ Directive. However, as our facsimile reproductions show, neither the alleged four-criteria form, nor other key changes, such as dropping the Sequential Organ Failure Assessment score, are found in the Directive. These points matter because our conclusions hence stand, because the public version of the Model Guidance had not been updated to reduce the risk of inequitable outcomes until June 2021 and NJ’s Directive still does not reflect these revisions, and, hence, represents a less equitable version, as acknowledged by its authors. We comment on broader policy implications and call for ways of ensuring accurate, transparent and timely updates for users of high-stakes guidelines. (shrink)

The paper examines the relationship between praxeology and Schutzian phenomenology. It does so by tracing and comparing the conceptualizations of sense and sensemaking in both approaches. In a first step the phenomenological concept of mental and subjective sense and meaning is discerned. Subsequently, different disengagements from this concept within interpretative sociologies are reconstructed. It is argued that those disengagements, which seek to replace the understanding of sense and meaning as private,,inner’ entities with notions of the,publicness’ of practical social sensemaking are (...) crucial for advancing a praxeological perspective in social theory. (shrink)

This article outlines a culture-analytical alternative in, and to, decision science. In contrast to the predominant individualistic and mentalistic conceptions of decision making an empirical and praxeological perspective is proposed. Beginning with empirical processes and situated practices of decision-making, this perspective aims to decenter the decision-making subject. The author revisits Harold Garfinkel’s analyses of actual decision-making behavior amongst jurors in court proceedings and Ludwig Wittgenstein’s reflections on rule-following to develop this critical perspective on decision-making necessities in contemporary culture and everyday (...) life. (shrink)

The concept of “site” is at the center of current debates in theories of social practices as well as in cultural anthropology. It is unclear, however, how to assess the associated methodological assumption that overriding social structures or cultural formations can manifest themselves in sites. The article draws on the conception of social practices and introduces the notion of “publicness” in order to explicate how and why sociality and social structures can be accessed through “siting”. Sites as well as social (...) practices, it is claimed, have to be conceptualized as essentially public and thus principally observable phenomena. This assumption of publicness implicit to both site ontology and theories of social practices is unfolded on the basis of a praxeological reformulation of the paradigm of joint attention elaborated in developmental psychology. To avoid presentist misinterpretations, we then conceptualize sociality as chains of practices across time and space, drawing on the works of Theodore Schatzki, Ludwig Wittgenstein, Anthony Giddens and Bruno Latour. The public carriers of practices (artifacts, symbols, media, bodies) and the translocal structures they establish acquire particular significance in these approaches. In a further step, we present some methodological consequences of the “publicness assumption” and support our arguments by referring to Pierre Bourdieu's study on Distinction. (shrink)

We discuss the astronomical underpinning of the improved calendar of 1700. Starting from the astronomical motivation of the Gregorian calendar of 1582 and the rejection of this reform in Protestant states in Europe, we describe how the astronomical Easter reckoning based on Kepler’s Rudolphine tables led to the foundation of Berlin Observatory and enabled the founding of the Electoral Brandenburg Society of Sciences, which had to finance itself through a calendar monopoly.

Zusammenfassung Der Beitrag beschäftigt sich in einer praxeologischen Perspektive mit den Wirkungen, die compu­ter- und videogestützte Spielanalysen im professionellen Fußball entfalten können. Es werden Wis­senspraktiken skizziert, die sich mit dem Einsatz von Spielanalysesoftware herausgebildet haben und es werden daran anknüpfend konzeptionelle Überlegungen präsentiert, die in zwei Richtungen weitergeführt werden: Zum einen werden sie auf zentrale Grundannahmen der Praxeologie bezo­gen. Dabei zeigt sich, dass die Analyse der Wirkungen und Potentiale reflexiver Wissens- und Kön­nensformen in Praktiken ein Desiderat der praxissoziologischen Perspektive darstellt. (...) Zum anderen werden aus den konzeptionellen Überlegungen zum softwaregestützten accounting Ideen zu den damit induzierten Veränderungen des Fußballspiels und des professionellen Fußballs entwickelt. (shrink)

Roland Allen’s emphasis on the ministry in missionary churches opens the door to a number of ways in which the church can work to change society, and he makes some very important connections between the promises of the prophets, Jesus announcement of the coming kingdom, and Paul’s missionary methods. In doing so, he again invites the church to bring the good news of the Kingdom of God to the modern world.

Loren Eiseley is known both as a scientist and an essayist/poet. The disillusionment with science and technology among many in the late 1950s and the search for new values in the 1960s help account for Eiseley's significance as a writer. He appears to offer a solution to mankind's contemporary disillusionment by reminding that science has limits and that intuitive, nonscientific insight is valid, especially when it is complementary to scientific knowledge. The thesis of this essay is that in content (...) and style Eiseley writes as a religious writer in the sense that he reaffirms what is necessary for humankind to be happy and even to be “saved.”. (shrink)

The Anthropology of Sport and Human Movement represents a collection of work that reveals and explores the often times dramatic relationship of our biology and culture that is inextricably woven into a tapestry of movement patterns. It explores the underpinning of human movement, reflected in play, sport, games and human culture from an evolutionary perspective and contemporary expression of sport and human movement.

In lieu of an abstract, here is a brief excerpt of the content:Melancholy and the Therapeutic Language of Moral Philosophy in Seventeenth-Century ThoughtJeremy SchmidtThe concept of melancholy comprehended a wide range of characteristics and conditions in seventeenth-century European culture, from the brooding introspection of the genius and the scholar to a condition of delirious and delusory madness.1 Its central and most immediately identifiable characteristic, however, was the excessive and unreasonable nature of its symptomologically defining emotions of fear and sorrow. As (...) Robert Burton noted out in The Anatomy of Melancholy (1621), the melancholic condition was commonly taken to be "a kind of dotage without fever, having for his ordinary companions fear and sadness, without any apparent occasion."2 The presence of a pervasive and unreasonable sense of fear and sorrow invariably solicited the melancholic label. Indeed, melancholic emotions were the primary substance of melancholic dotage; the ravings of the melancholically mad and their frequent obsession with a single idea were often driven by an overwhelming feeling of fear and sorrow.3The concept of melancholy as a mental disorder involving these specific emotions had coalesced under the gaze of medical observation in ancient Greece, and the melancholic condition was thought by many medical theorists of classical [End Page 583] antiquity to be caused by a physiological surfeit of black bile, the Greek word for which was melancholia.4 Western medicine, profoundly influenced by the Greek medical tradition, continued to diagnose and treat melancholic disturbance as a physical distemper well into the nineteenth century. Yet the kind of mental anguish which early medical observers labeled melancholic bore a striking resemblance to forms of emotional disorder whose point of origin was thought to be the mind itself. Various traditions of classical moral philosophy sought to treat disorders of the mind that unchecked emotion could create primarily by directing, ordering, and correcting the thought of the sufferer. Where the melancholic condition displayed qualities of the emotions as these were represented and analyzed by moral philosophers it was viewed as susceptible to philosophical treatment and insight.5Early modern English writers, no less than classical writers, thought it appropriate to apply to cases of melancholy therapies derived from the philosophic endeavor to define and achieve peace of mind. Burton argued explicitly in The Anatomy of Melancholy for the rightful authority of the philosophical "physician of the soul" in the treatment of melancholy; and the conceptual similarity of melancholy to moral diseases of the soul which provided the basis for this authority is evidenced in the works of several seventeenth-century moralists, as well as in the writings of the influential seventeenth-century physician and natural philosopher Thomas Willis on melancholy and the passions. Willis noted that melancholic emotions were structured and caused by the judgments of the mind rather than by the force of physiological dysfunction alone. His recognition of the importance of the mental aspects of melancholy provided the basis for his prescription of moral therapies for the government of the mind in addition to therapies for the body. Moreover, his writing on the passion of grief displays the ability of moral philosophical language to represent melancholic-like states as problems of the moral life, to be engaged through rational meditation and control.The importance of moral philosophy in understanding and treating melancholy has been largely ignored in current scholarship in the history of psychiatry and madness, which has concentrated on early modern medical concepts of mental disorder that traced its origins to the body. The historian of psychiatry and "madness" Roy Porter has, for instance, referred to Willis's medical writings as evidence for the "thoroughgoing somatic grounding of disorders of thought, feeling and behavior" that he alleged to have dominated the era's medical [End Page 584] conceptualization and treatment of madness.6 While Michel Foucault insightfully noted that Willis's ostensibly chemical account of the nature of melancholy was in fact "a phenomenology of the melancholic experience," he dismissed out of hand the relevance of classical moral philosophical language to the early modern treatment of madness, asserting the complete absence of moral treatments of madness until the end of the eighteenth century.7 In analyzing Willis's writing he thus failed to note the broader moral philosophical... (shrink)

A translation based on the Latin text of the Leonine edition. The Quaestiones Disputatae de Veritate constitutes Aquinas's most extended treatment of any single topic. Volume I discusses the nature of truth and divine and angelic intellects. Volume II deals with truth and human intellect. Volume III investigates the operation of the will.

Mark Coeckelbergh starts his book with a very powerful picture based on a real incident: On the 9th of January 2020, Robert Williams was wrongfully arrested by Detroit police officers in front of his two young daughters, wife and neighbors. For 18 hours the police would not disclose the grounds for his arrest (American Civil Liberties Union 2020; Hill 2020). The decision to arrest him was primarily based on a facial detection algorithm which matched Mr. Williams’ driving license photo (...) with the picture of a man who was suspected of watch theft two years earlier. Not only did the computer ‘get it wrong’ as one of the detectives said, when Mr. Williams made them aware that the picture of the suspect obviously wasn’t resembling him, the probably unreliable algorithm very likely contributed to racial discrimination (Hill 2020). It is well documented that many available facial detection algorithms at this time had significant problems (e.g. a comparably high false positive rate) with respect to black persons, like Mr. Williams (NIST 2019). Multiple causes may exist, such as unbalanced training datasets and insufficient optimization. Coeckelbergh compares the disturbing case of Mr. Williams with a political interpretation of Franz Kafka’s The Trial, where the protagonist, Josef K., is accused of an unspecified crime by an opaque, oppressive and absurd bureaucracy: “In the 21st-century United States, Josef K. is black and is falsely accused by an algorithm, without explanation” (p. 2). (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Is Bioethics Applied Ethics?Robert M. VeatchBioethics is often referred to as a kind of applied ethics. The term applied ethics can be controversial if it is taken to imply that ethical theory from philosophy or religious ethics has to be the starting point for ethical analysis of some practical field such as medicine or law or politics. The term can be understood as requiring some premises from an (...) ethical theory that are then "applied" to some problem area, as a "top down" way of doing the work of moral reflection in a way that axioms in geometry are applied to present proofs of mathematical claim.The publication of an important work in the history of medical ethics, A History of Medical Ethics, provides an opportunity to reflect more carefully on what applied ethics means. That massive multi-authored volume edited by Robert Baker and Laurence McCullough (2007) is scheduled for publication this fall. With the permission of the Press, we have asked Baker and McCullough to prepare an article-length version of one of the central essays in that work. Their paper challenges the idea that ethical theory should be "applied" to medicine or other fields, putting forth an alternative of the "appropriation" of an ethical theory by the formulation of concepts, principles, moral rules, or other specifications that may turn out to be unique or at least modified for the particular field in question.In this issue of the Kennedy Institute of Ethics Journal, we publish the Baker-McCullough article together with five critical commentaries. We include two medical historians who have a sustained commitment to studying the history of ethics in medicine, two systematic ethicists who have an unusual level of commitment to studying ethics historically, and a physician with unusual sensitivity to the history of medical ethics. Each comments on the Baker-McCullough thesis and offers an alternative view of the link between ethical theory and the field of biomedical ethics.Daniel Fox triggered some of the initial reflection on the history of medical ethics in the 1970s. His work is discussed by Baker and McCullough. Fox is sympathetic with the Baker-McCullough appropriation thesis, viewing their position as complementary to his own, although he [End Page 1] urges more attention to the political aspects of medicine, professional dominance, and professional control of medical resources.Ulf Schmidt, a specialist on the historical aspects of research during the Nazi era, focuses on Baker and McCullough's use of that historical example of the appropriation of medical ethics.The two ethicists who comment both have had many years experience with historical aspects of medical ethics, and both worked on the historically important Belmont Report of the National Commission for the Protection of Human Subjects. Both question whether Baker and McCullough overstate the problem of the relation between application and appropriation. Albert Jonsen, as a member of the National Commission, concentrates on the Belmont Report, showing how he sees the report appropriating philosophical ethics.Tom Beauchamp, who was the primary staff person responsible for the report, provides a somewhat different read on the report and particularly on the role of Kantian ethics in the report's discussion of autonomy. Beauchamp accuses Baker and McCullough of having too narrow an understanding of the meaning of the term "applied," claiming that no people doing medical ethics today would simply apply ethical theory in a deductivist manner.Finally, Jeremy Sugarman, the physician ethicist, is, in a somewhat surprising turn, the cautious defender of the application that Baker and McCullough challenge. Although he ends up sympathetic with the appropriation that implies going beyond straight-forward top-down application, he outlines the value of ethical theory for the practical analysis of ethical problems in fields such as medicine.ReferenceBaker, Robert, and McCullough, Laurence, eds. 2007. A History of Medical Ethics. New York: Cambridge University Press, in press. [End Page 2]Google ScholarCopyright © 2007 Johns Hopkins University Press... (shrink)