BackgroundTo help inform the development of more accessible, acceptable, and effective ethics consultation (EC) training programs, we conducted an EC training needs assessment, exploring ethics practitioners’ opinions on: the relative importance of various EC practitioner competencies; the potential market for EC training (that is, how many individuals would benefit and how much individuals and hospitals would be willing to pay); and the preferred content, format, and characteristics of EC training.MethodsAs part of a multipart study, we surveyed “best informants” who self-identified (...) as the person most actively involved in EC or healthcare ethics in a random sample of 600 U.S. general hospitals, stratified for bed size.ResultsThe competency that was ranked most important for a lead or solo ethics consultant was knowledge of ethics, while common sense was ranked least important. The median estimated number of individuals at each hospital who would benefit from EC training was six at the basic level, three at the advanced level, and two for EC management training. In 19.1 percent of hospitals, respondents thought their hospital would not be willing to pay anything for EC training within the next two years. Respondents thought potential trainees would be likely to participate in EC training on multiple different topics. Opinions varied widely on preferred formats. Most respondents thought it very important to be able to interact with instructors and with other trainees, practice EC skills, receive a certificate for completing EC training, and complete EC training during work hours.ConclusionsThese findings provide U.S. population data that may be useful to healthcare educators and bioethics leaders in their efforts to develop EC training programs and products that match trainees’ preferences and needs. (shrink)

Imperfect efficiency in healthcare delivery is sometimes given as a justification for refusing to ration or even discuss how to pursue fair rationing. This paper aims to clarify the relationship between inefficiency and rationing, and the conditions under which bedside rationing can be justified despite coexisting inefficiency. This paper first clarifies several assumptions that underlie the classification of a clinical practice as being inefficient. We then suggest that rationing is difficult to justify in circumstances where the rationing agent is or (...) should be aware of and contributes to clinical inefficiency. We further explain the different ethical implications of this suggestion for rationing decisions made by clinicians. We argue that rationing is more legitimate when sufficient efforts are undertaken to decrease inefficiency in parallel with efforts to pursue unavoidable but fair rationing. While the qualifier ‘sufficient’ is crucial here, we explain why ‘sufficient efforts’ should be translated into ‘benchmarks of efficiency’ that address specific healthcare activities where clinical inefficiency can be decreased. Referring to recent consensus papers, we consider some examples of specific clinical situations where improving clinical inefficiency has been recommended and consider how benchmarks for efficiency might apply. These benchmarks should state explicitly how much inefficiency shall be reduced in a reasonable time range and why these efforts are ‘sufficient’. Possible strategies for adherence to benchmarks are offered to address the possibility of non-compliance. (shrink)

In recent decades, changes in climate have caused impacts on natural and human systems on all continents and across the oceans. Impacts are due to observed climate change, irrespective of its cause...

: The essay theorizes the logic of masculinist protection as an apparently benign form of male domination. It then argues that authoritarian government is often justified through a logic of masculinist protection, and that this is the form of justification for the security regime that has emerged in the United States since September 11, 2001. I argue that those who live under a security regime live within an oppressive protection racket. The paper ends by cautioning feminists not ourselves to adopt (...) a stance of protector toward women in so-called less developed societies. (shrink)

We introduce a natural generalization of Borel's Conjecture. For each infinite cardinal number $\kappa$, let ${\sf BC}_{\kappa}$ denote this generalization. Then ${\sf BC}_{\aleph_0}$ is equivalent to the classical Borel conjecture. Assuming the classical Borel conjecture, $\neg{\sf BC}_{\aleph_1}$ is equivalent to the existence of a Kurepa tree of height $\aleph_1$. Using the connection of ${\sf BC}_{\kappa}$ with a generalization of Kurepa's Hypothesis, we obtain the following consistency results: 1. If it is consistent that there is a 1-inaccessible cardinal then it is (...) consistent that ${\sf BC}_{\aleph_1}$.2. If it is consistent that ${\sf BC}_{\aleph_1}$, then it is consistent that there is an inaccessible cardinal.3. If it is consistent that there is a 1-inaccessible cardinal with $\omega$ inaccessible cardinals above it, then $\neg{\sf BC}_{\aleph_{\omega}} + (\forall n < \omega){\sf BC}_{\aleph_n}$ is consistent.4. If it is consistent that there is a 2-huge cardinal, then it is consistent that ${\sf BC}_{\aleph_{\omega}}$.5. If it is consistent that there is a 3-huge cardinal, then it is consistent that ${\sf BC}_{\kappa}$ for a proper class of cardinals $\kappa$ of countable cofinality. (shrink)

Cet article s’inscrit dans le cadre d’une recherche doctorale portant sur les représentations de la séparation chez des enfants placés en Protection de l’enfance. Il s’intéresse ici spécifiquement au dessin de la famille de deux enfants d’âge de latence placés en foyer. L’article analyse chaque dessin en profondeur puis tente de dégager les éléments saillants communs aux enfants rencontrés, tout en les mettant en lien avec les mouvements transféro-contretransférentiels à l’œuvre dans ces rencontres-séparations. Ces dessins montrent de grandes difficultés de (...) représentation, les personnes dessinées sont peu différenciées. Cette indistinction pourrait être mise en lien avec le concept de mentalisation qui aurait été mis à mal par les traumatismes vécus par ces enfants. Mais ce trouble de la mentalisation semble aussi fonctionner comme un mécanisme de défense contre les reviviscences traumatiques et des mouvements pulsionnels agressifs. (shrink)

Die Krisenerfahrungen der Moderne führen zum Rückgriff auf vormoderne Ordnungsvorstellungen, die jene Legitimationsdefizite kompensieren sollen, die im Zuge einer Dialektik der Aufklärung entstanden sind: die emanzipatorische Kraft der Vernunft scheint sich in eine Instanz neuer Herrschaft zu verkehren, als deren Organ die als repressiv erfahrenen Ordnungsleistungen des Staates begriffen werden. Diese Situation begünstigt die Suche nach Kräften, die menschlichem Eingriff entzogen sind, und kommt der Rehabilitierung von Naturvorstellungen entgegen, die sich der Welt des Menschen als normative Ordnungsquelle anbieten. Inwieweit sich (...) gerade die Geschlechterbeziehungen als Ausdruck solch natürlicher Ordnung verstehen lassen, ist eine der zentralen Fragen einer kritischen feministischen Philosophie. Die Untersuchungen, die die AutorInnen dieses Bandes vorlegen, bewegen sich im thematischen Umkreis dieser Fragestellung: in der Art eines Kompendiums werden in Interpretationen von Texten der politischen Philosophie, die in der Epoche von 1600-1850 entstanden sind, paradigmatische Legitimationsfiguren herausgearbeitet und der feministischen Ideologiekritik zugänglich gemacht. (shrink)

BackgroundFrench military doctors are currently deployed in the Sahel to support the armed forces of Operation Barkhane, in medical or surgical units. As well as supporting French soldiers, their other missions are diverse and complex: medical assistance to civilians and persons under control (PUC), advice to commanding officers. These tasks can create ethical dilemmas when decisions are forced upon doctors that may be in conflict with medical values or fundamental principles. Little is known about the specific dilemmas experienced by French (...) military doctors in overseas operations. We therefore conducted a qualitative study among doctors and surgeons recently deployed to the Sahel to explore and better understand this question.MethodSemi-structured, face-to-face interviews were conducted with 20 French military doctors or surgeons deployed since January 2016 in medical or surgical facilities in Mali and Chad.ResultsAll interviewed doctors reported having faced several ethical dilemmas during missions. All reported dilemmas involved the treatment of civilians (while delivering community medical assistance) or of PUC. The dilemmas involved choices as to which patients to treat, the use of care as a means to an end by military authorities, and the level of care attainable in the absence of any possible hospital follow-up. Questions of delivering care at the risk of their own safety or the mission’s and of treating openly hostile patients were also brought up. Several dilemmas stemmed from the dual loyalty problem, namely the conflict between military doctors’ duty of care to patients and to the military institution, but this was not the only factor involved. Contextual factors (restricted resources and security constraints) and psychological factors (especially hostility towards the enemy) were also associated with many of the reported dilemmas.ConclusionThis is the first reported study focusing on the ethical dilemmas encountered by French military doctors in overseas operations. It provides unique insights into their ethical experiences and should prove useful in improving operational training for healthcare personnel deployed on overseas missions. (shrink)

Fifty-seven outstanding black-and-white photographs from the central California coast and Sierra reflect the author's special relationship with the coastline of California, as well as capture vivid images from the deserts of California and the Southwest.

Johann Gottfried Herder (1744-1803) gilt weithin als Autor des literarischen Sturm und Drang bzw. der philosophischen und theologischen Spataufklarung. Dass er jedoch auf vielen Gebieten die Klassische Deutsche Philosophie massgeblich beeinflusste, wird eher selten in den Blick genommen. Der Band untersucht dieses sowohl kritische als auch affirmative Rezeptionsverhaltnis Kants, Schellings, Schlegels, Humboldts oder Hegels zu Herder auf den Gebieten der Geschichtsphilosophie, der Metaphysik, der Ethik und Politik sowie der Asthetik und Anthropologie. - Mit Beitragen von Andreas Arndt, Manfred Baum, Christoph (...) Binkelmann, Martin Bondeli, Nigel De Souza, Stefan Greif, Andree Hahmann, Cornelia Klinger, Christian Krijnen, Stephan Nachtsheim, Angelica Nuzzo, Ludger Roth, Gideon Stiening, Violetta Stolz und Gunter Zoller. (shrink)

Natural kinds is a widely used and pivotal concept in philosophy – the idea being that the classifications and taxonomies employed by science correspond to the real kinds in nature. Natural kinds are often opposed to the idea of kinds in the human and social sciences, which are typically seen as social constructions, characterised by changing norms and resisting scientific reduction. Yet human beings are also a subject of scientific study.Does this mean humans fall into corresponding kinds of their own? (...) In The Epistemology and Morality of Human Kinds Marion Godman defends the idea of human kinds. She first examines the scientific use and nature of human kinds, considering the arguments of key philosophers whose work bears upon human kinds, such as Ian Hacking, John Searle, Richard Boyd and Ruth Millikan. Using the examples of gender, ethnic minorities and Buddhism she then argues that human kinds are a result of ongoing historical reproduction, chiefly due to pre-existing cultural models and social learning. Her novel argument shifts the focus away from the reductionism characteristic of research about human kinds. Instead, she argues that they are “multiply projectable” and deserving of scientific study not in spite of, but because of their role in explaining our identity, injustice and the emergence of group rights. (shrink)

Iris Marion Young (1949-2006) was one of the most influential and innovative political theorists of her generation who had a significant impact on a wide range of topics such as democratic theory, feminist theory, and justice. She bridged many longstanding divides among political theorists, engaging in Continental and critical theory, but also insisting on the importance of normative argument: her corpus stands as a testament to the fruitfulness of engaging in both abstract theory and the 'real world' of everyday (...) politics. This volume spans the several decades of her work, illustrating her intellectual development over time through three major areas of innovation: Gender: Maintaining that gender is both conceptually and politically meaningful, Young theorized gender in terms of structures that, in combination, position different people we call "women" in different ways, such that some women have some structures in common, without all women sharing all gendered structures in common. Justice: Young's early writings on a critical theory of justice evolved in her later and posthumously published works where she developed an account of justice that brought together her theorization of structure with her concern to respond to contemporary claims of injustice. The Politics of Difference: Young rejected universal and abstract theories of justice and maintained that justice instead required attending to the experiences of people marked by difference. (shrink)

In the third book in the trilogy that includes Reduction and Givenness and Being Given. Marion renews his argument for a phenomenology of givenness, with penetrating analyses of the phenomena of event, idol, flesh, and icon. Turning explicitly to hermeneutical dimensions of the debate, Marion masterfully draws together issues emerging from his close reading of Descartes and Pascal, Husserl and Heidegger, Levinas and Henry. Concluding with a revised version of his response to Derrida, In the Name: How to (...) Avoid Speaking of It, Marion powerfully re-articulates the theological possibilities of phenomenology. (shrink)

The possible and revelation -- The saturated phenomenon -- Metaphysics and phenomenology: a relief for theology -- "Christian philosophy": hermeneutic or heuristic? -- Sketch of a phenomenological concept of the gift -- What cannot be said: Apophasis and the discourse of love -- The banality of saturation -- Faith and reason.

This essay discusses the nature of collective responsibility and explores various controversies associated with its possibility and normative value.

Marked sharply by its time and place (Paris in the 1970s), this early theological text by Jean-Luc Marion nevertheless maintains a strikingly deep resonance with his most recent, groundbreaking, and ever more widely discussed phenomenology. And while Marion will want to insist on a clear distinction between the theological and phenomenological projects, to read each in light of the other can prove illuminating for both the theological and the philosophical reader - and perhaps above all for the reader (...) who wants to read in both directions at once, the reader concerned with those points of interplay and undecidability where theology and philosophy inform, provoke, and challenge one another in endlessly complex ways." "In both his theological and his phenomenological projects Marion's central effort to free the absolute or unconditional (be it theology's God or phenomenology's phenomenon) from the various limits and preconditions of human thought and language will imply a thoroughgoing critique of all metaphysics, and above all of the modern metaphysics centered on the active, spontaneous subject who occupies modern philosophy from Descartes through Hegel and Nietzsche. (shrink)

Marion Milner introduces this edited collection of her papers from 1942 to 1977 with a fascinating biographical account of her development in psychoanalysis. The collection includes her classic papers on symbolism.

Le bouddhisme tel que nous le concevons aujourd'hui est un produit de la sécularisation européenne. Depuis la seconde partie du XIXe siècle, des intellectuels anticléricaux ont cherché à remplacer l'héritage biblique de l'Europe par les anciennes doctrines de l'Inde, jugées plus rationnelles. L'enseignement du Bouddha semblait particulièrement indiqué. Sans Dieu, sans Sauveur, sans révélation écrite, il paraissait à même de réformer l'Occident en l'asseyant sur de nouvelles bases. L'anthropologue Marion Dapsance démontre comment le bouddhisme est devenu une nouvelle philosophie (...) progressiste dont le but est moins l'épanouissement des individus qu'une véritable réforme de notre monde. (shrink)

While humanists have pondered the subject of love to the point of obsessiveness, philosophers have steadfastly ignored it. One might wonder whether the discipline of philosophy even recognizes love. The word philosophy means “love of wisdom,” but the absence of love from philosophical discourse is curiously glaring. So where did the love go? In The Erotic Phenomenon, Jean-Luc Marion asks this fundamental question of philosophy, while reviving inquiry into the concept of love itself. Marion begins his profound and (...) personal book with a critique of Descartes’ equation of the ego’s ability to doubt with the certainty that one exists—“I think, therefore I am”—arguing that this is worse than vain. We encounter being, he says, when we first experience love: I am loved, therefore I am; and this love is the reason I care whether I exist or not. This philosophical base allows Marion to probe several manifestations of love and its variations, including carnal excitement, self-hate, lying and perversion, fidelity, the generation of children, and the love of God. Throughout, Marion stresses that all erotic phenomena, including sentimentality, pornography, and even boasts about one’s sexual conquests, stem not from the ego as popularly understood but instead from love. A thoroughly enlightening and captivating philosophical investigation of a strangely neglected subject, The Erotic Phenomenon is certain to initiate feverish new dialogue about the philosophical meanings of that most desirable and mysterious of all concepts—love. (shrink)

Does Descartes belong to metaphysics? What do we mean when we say "metaphysics"? These questions form the point of departure for Jean-Luc Marion's groundbreaking study of Cartesian thought. Analyses of Descartes' notion of the ego and his idea of God show that if Descartes represents the fullest example of metaphysics, he no less transgresses its limits. Writing as philosopher and historian of philosophy, Marion uses Heidegger's concept of metaphysics to interpret the Cartesian corpus--an interpretation strangely omitted from Heidegger's (...) own history of philosophy. This interpretation complicates and deepens the Heideggerian concept of metaphysics, a concept that has dominated twentieth-century philosophy. Examinations of Descartes' predecessors (Aristotle, Augustine, Aquinas, and Suarez) and his successors (Leibniz, Spinoza, and Hegel) clarify the meaning of the Cartesian revolution in philosophy. Expertly translated by Jeffrey Kosky, this work will appeal to historians of philosophy, students of religion, and anyone interested in the genealogy of contemporary thought and its contradictions. (shrink)