What is conscientious objection? -- Should conscientious objectors be accommodated? -- Assessing objectors' beliefs and reasons -- Accommodation and conscientious provision.

Historically associated with military service, conscientious objection has become a significant phenomenon in health care. Mark Wicclair offers a comprehensive ethical analysis of conscientious objection in three representative health care professions: medicine, nursing and pharmacy. He critically examines two extreme positions: the 'incompatibility thesis', that it is contrary to the professional obligations of practitioners to refuse provision of any service within the scope of their professional competence; and 'conscience absolutism', that they should be exempted from performing any action contrary (...) to their conscience. He argues for a compromise approach that accommodates conscience-based refusals within the limits of specified ethical constraints. He also explores conscientious objection by students in each of the three professions, discusses conscience protection legislation and conscience-based refusals by pharmacies and hospitals, and analyzes several cases. His book is a valuable resource for scholars, professionals, trainees, students, and anyone interested in this increasingly important aspect of health care. (shrink)

The coronavirus disease-2019 (COVID-19) has caused shortages of life-sustaining medical resources, and future waves of the virus may cause further scarcity. The Yale New Haven Health System developed a triage protocol to allocate scarce medical resources during the COVID-19 pandemic, with the primary goal of saving the most lives possible, and a secondary goal of making triage assessments and decisions consistent, transparent, and fair. We outline the process of developing the protocol, summarize the protocol, and discuss the major ethical challenges (...) encountered, along with our answers to the challenges. These challenges include (1) the role of age and chronic comorbidities; (2) evaluating children and pregnant patients; (3) racial, ethnic, and socioeconomic disparities in health; (4) prioritization of healthcare workers; and (5) balancing clinical judgment versus protocolized assessments.We conclude with a review of the limitations of our protocol and the lessons learned. We hope that a robust public discussion of such protocols and the ethical challenges they raise will result in the fairest possible processes, less need for triage, and more lives saved during future waves of the pandemic and similar public health emergencies. (shrink)

Typically, a refusal to provide a medical service is an instance of conscientious objection only when the medical service is legal, professionally accepted, and clinically appropriate. That is, conscientious objection typically occurs only when practitioners reject prevailing norms or practices. Insofar as refusing to provide antibiotics for a viral infection does not violate prevailing clinical norms, there is no need for the physician in Case 1 to justify his refusal to provide antibiotics by appealing to his conscience.1 By contrast, insofar (...) as emergency contraception is legal and does not violate prevailing norms of good medical practice, the physician in Case 6 cannot justify his refusal to provide EC by... (shrink)

In a provocative 1974 article entitled “Harvesting the Dead,” Willard Gaylin explored potential uses of “neomorts,” or what are currently referred to as “heart-beating cadavers”—that is, humans determined to be dead by neurological criteria and whose cardiopulmonary function is medically maintained by ventilators, vasopressors, and so forth. Medical research was one of the potential uses Gaylin identified. He pointed out that tests of drugs and medical procedures that would have unacceptable health risks if performed on living human subjects could be (...) performed on neomorts without any health risks. According to Gaylin, the potential benefits of such research could be enormous, including not subjecting patients to ineffective or harmful medical procedures and eliminating delays in providing effective therapies to dying patients. (shrink)

In “Disentangling Conscience Protections,” in this issue of the Hastings Center Report, Nadia Sawicki offers a taxonomy of conscience protection laws (conscience clauses) that highlights the expansive protections they can offer to health professionals who refuse to provide a medical service for reasons of conscience. Conscience clauses can protect health professionals from adverse actions by public actors (such as administrative agencies, prosecutors, and government funders) or private actors (such as employers, private professional associations, and injured patients), and they can also (...) protect health professionals from being subject to adverse actions for their beliefs, their conduct, or harm that results from their conduct. This taxonomy provides an accurate description of the broad range of protections conscience clauses can offer and thereby is a valuable contribution to the scholarly literature on conscientious objection in health care. But it remains to consider whether the distinctions Sawicki identifies disentangle conscience protections beyond merely providing a taxonomy. In particular, does the taxonomy identify relevant distinctions in relation to determining whether a conscience clause is justified? (shrink)

In 2017, Partridge et al. published remarkable experimental results concerning the use of a new artificial womb technology (AWT) with lambs, developed at Children’s Hospital of Philadelphia, called...

Many people have been enraged lately by the enormous increases in certain generic prescription drugs. But free marketeers defend these prices by arguing that they simply represent what the market will bear, and in a capitalist society there is accordingly nothing wrong with charging them. This paper argues that such a defense is actually contrary to the very principles that free marketeers claim to embrace. These prices are not only unjust and exploitative, but government interference with them would not render (...) the market less free, at least if what it means for a market to be “free” is properly understood. Everyone, even free marketeers with a libertarian or neoliberal bent, should accordingly be against this kind of profiteering. (shrink)

While the importance of mechanisms in determining causality in medicine is currently the subject of active debate, the role of mechanistic reasoning in clinical practice has received far less attention. In this paper we look at this question in the context of the treatment of a particular individual, and argue that evidence of mechanisms is indeed key to various aspects of clinical practice, including assessing population-level research reports, diagnostic as well as therapeutic decision making, and the assessment of treatment effects. (...) We use the pulmonary condition bronchiectasis as a source of examples of the importance of mechanistic reasoning to clinical practice. (shrink)

In Liberalism with Excellence, Matthew Kramer makes an argument for how excellence may enter in into liberalism, despite liberalism’s strong commitment to neutrality. Kramer seeks to challenge not only the uncompromising rejection of this position by liberals such a Jonathan Quong, but also the so-called “blended” approach of “soft-perfectionist” scholars such as Joseph Raz and George Sher. In this essay, I do not so much challenge Kramer’s approach as offer an alternative for accomplishing the same thing. Under my proposal, certain (...) forms of excellence and neutrality can both be accommodated as long as state support for the form of excellence at issue is proportional to the support for such a form of excellence within the relevant polity, competing forms of excellence are non-rivalrous, and no one is forced to embrace a form of excellence with which they disagree. My proposal is therefore not what Ronald Dworkin derogatively characterized as “a checkerboard solution.” Rather than allowing the state to support contrary moral positions at one and the same time, it is a solution that takes morally compatible but nevertheless competing conceptions of excellence seriously, and exhibits neutrality by giving them proportional rather than full support. This neither forces anyone to pursue the particular forms of excellence the state supports nor prevents them from pursuing some other form of excellence entirely or, if they wish, no form of excellence at all. (shrink)

Introduction -- Undermining the hermeneutics of suspicion -- The historical emergence of psychological man -- The "religious" therapeutics -- Rieff on Jung's "language of faith" -- Rieff and the hermeneutics of suspicion -- An alternative hermeneutic -- Applying this hermeneutic to depth psychology -- Concluding remarks -- The historical sources of Jung's psychology -- The young metaphysician -- Tempering metaphysical inclinations with a pragmatic standpoint -- The resurgence of metaphysics in Jung's psychology -- Jung's subjectivist argument -- The influence of (...) vitalism -- Individuation and the prospective method -- From the prospective method to a metaphysics of archetypes -- Jung and the Paracelsian theory of knowledge -- The persistence of metaphysical questions -- Hermeneutics and Jung's psychology -- The re-discovery of the psychogenic -- Towards a more adequate understanding of the psychogenic -- The methodological problems facing depth psychology -- The symbolic life -- The "realism of the East" -- The symbol of the self -- The "two kinds of thinking" -- "The transcendent function" -- From signs to symbols -- The practice of the transcendent function -- Definitions from psychological types (1921) -- The symbolic attitude -- Transcendent presence -- Alignment with the self -- Projective psychology and divine transcendence -- The relevance of the dispute between Jung and Buber -- The still point -- The beyond -- Contemporary psychoanalysis and the still point -- Ogden on potential space. (shrink)

Historically, conscientious objection has been associated with military service. Currently, however, it does not occur exclusively in response to compulsory military service. With increasing frequency, health care professionals, including those who practice in institutional settings such as hospitals and long-term care facilities, conscientiously object to providing specific medical services. This chapter provides a framework for managing conscientious objection within institutional settings. Criteria are provided for determining when refusals to provide medical services are conscientious objections. Reasons are offered for accommodating conscientious (...) objectors and for denying or limiting accommodation. A reasonable accommodation approach, which consists in five requirements, is explained and defended: (1) Conscience-based refusals will be accommodated only if a requested accommodation will not impede a patient’s/surrogate’s timely access to information, counseling, and referral. (2) Conscience-based refusals will be accommodated only if a requested accommodation will not impede a patient’s timely access to health care services offered within the institution. (3) Conscience-based refusals will be accommodated only if the accommodation will not impose excessive burdens on other clinicians, supervisors, department heads, or the institution. (4) Whenever feasible, health professionals should provide advance notification to department heads or supervisors. (5) Conscience-based refusals will be accommodated only if it will not enable invidious discrimination. (shrink)

For years now, unionization has been under vigorous attack. Membership has been steadily declining, and with it union bargaining power. As a result, unions may soon lose their ability to protect workers from economic and personal abuse, as well as their significance as a political force. In the Name of Liberty responds to this worrying state of affairs by presenting a new argument for unionization, one that derives an argument for universal unionization in both the private and public sector from (...) concepts of liberty that we already accept. In short, In the Name of Liberty reclaims the argument for liberty from the political right, and shows how liberty not only requires the unionization of every workplace as a matter of background justice, but also supports a wide variety of other progressive policies. (shrink)

Unfortunately, many people today see the regulation of lies, disinformation, hate speech, and fake news as an infringement of free speech, at least when such speech is ‘political,’ despite the damage that such speech can do. But this very protective attitude toward speech rests on a mistaken understanding of the role of free speech in a liberal society. The right to free speech is based on the liberal value of freedom, and as such can be no broader than freedom itself. (...) And freedom has always been subject to reasonable limits in a liberal society. Indeed, while the principles of toleration and neutrality are often cited as supporting a broad interpretation of the right to free speech, they also tell us that certain limits apply to that right. We need not tolerate speech that encourages intolerance, and while government should be neutral between reasonable conceptions of the good, it need not be neutral between reasonable and unreasonable conceptions. These ideas form the framework of liberal society, and as I shall show, also provide a guide for understanding what kind of speech is protected in a liberal society and what it is not. (shrink)

The reality of resource limitation during the Coronavirus Disease 2019 pandemic has deeply challenged established approaches to healthcare system emergency response. Early preparation du...

Unemployment has been at historically high rates for an extended period, and while it has recently improved in certain countries, the unemployment that remains may be becoming structural. Aside from inequality, unemployment is accordingly the problem that is most likely to put critical pressure on our political institutions, disrupt the social fabric of our way of life, and even threaten the continuation of liberalism itself. Despite the obvious importance of the problem of unemployment, however, there has been a curious lack (...) of attention paid to this issue by contemporary non-Marxist political philosophers. Non-Marxists typically view unemployment as a technical matter, and doing something about it a question of means not ends, with the solution to this question depending on the kind of empirical determinations about what causes what that are best left to economists, not political philosophers. But I think this is a mistake. Because work is a major part of our social life, as well as something that for a great many people grounds their sense of who they are and provides the basis of their sense of self-respect, those unable to find work are missing out on a great deal of what makes for a meaningful life, and not just the economic benefits that social cooperation has to offer. Those who are unemployed accordingly have something to complain about, even if we do not let them starve, and the rest of us (or at least the institutions that represent us) may have some sort of moral obligation to take action to increase the number of employment opportunities currently available regardless of any uncertainty surrounding the effects that any actions open to us might have. The nature and extent of this moral obligation is what On Unemployment is dedicated to exploring. (shrink)

Those who provide medical care for infants born extremely prematurely, at what is often referred to as borderline viability, have long grown accustomed to working with the parent(s) to reach a deci...

For a long time, economic growth has been seen as the most promising source of funds to use toward reducing economic inequality, as well as a necessity if we are aiming at achieving full employment. But one of the most troubling aspects of the recent exponential rise in economic inequality is that this rise has occurred despite continued economic growth. Increases in national income have gone almost exclusively to the super-rich, while real wages for almost everybody else have stagnated or (...) even declined. And while the unemployment rate dropped significantly before the coronavirus pandemic hit, good, permanent, high-wage jobs with benefits had by then often been replaced by temporary, part-time, low-wage jobs without benefits, leaving even the employed feeling economically insecure. And now, of course, unemployment is again skyrocketing, and it is unclear how long it might take to come down. As a result, we have now arrived at a point of reckoning: can we continue to believe that liberal capitalism is the most promising combination of economic and political ideologies for securing a prosperous and just future? If not, what might replace it? Is the problem capitalism, or is it liberalism? Are we up against economic forces that we cannot influence or control, or is it our political will and the liberal values we endorse that are being tested? This paper looks at all these questions, and suggests how we might think about the prospects for a liberal future. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:DESIRED POSSESSIONS: KARL POLANYI, RENÉ GIRARD, AND THE CRITIQUE OF THE MARKET ECONOMY Mark R. Anspach CREA, Paris! f '""phe most radical critique of liberal capitalism ever:" that is how JL Louis Dumont describes 7Ae Great Transformation, Karl Polanyi's classic work on the rise of the market system. But the French anthropologist goes on to observe that, when one confronts this same critique with the ethnography of tribal (...) societies, "one may ask whether Polanyi did not in fact come up short; having criticized the economy as an idea, he thought he could retain it as a thing..." (Dumont xiv, xvi). Is the economy indeed a "thing" that has always existed in some form everywhere, and if so, what manner of thing is it? In a word, what is an economyfor? Is there a particular aim that any economy must serve? A specific motive that it necessarily brings into play? We will begin by looking at Polanyi's answer to this question. "No human motive is per se economic," Polanyi tells us. "There is no such thing as a sui generis economic experience in the sense in which man may have a religious, aesthetic, or sexual experience." It is market society, with its dependence on a disembedded economic system, which fosters the illusion that the "economic" motives of hunger and gain necessarily underlie every economic system (1968, 63-4). In reality, however, "human beings will labor for a large variety of reasons as long as things are arranged accordingly." For example, "Monks traded for religious reasons... The KuIa trade ofthe Trobriand islanders... is mainly an aesthetic pursuit. Feudal economy was run on customary lines. With the Kwakiutl," industry appears to have been "a point of honor," and 1 82Mark R. Anspach so on (1968, 68). The trick, it seems, is to "arrange things accordingly." An economic system can be "run on noneconomic motives," Polanyi explains, without linking the process of production or distribution "to specific economic interests attached to the possession of goods," as long as "every single step in that process is geared to a number of social interests which eventually ensure that the required step be taken" (2001, 48). Now, there is a danger in this presentation. It could lead a reader to conclude that other societies arrange things cunningly so that all these social interests are harnessed to ensure the performance of the steps necessary to economic processes in a kind ofelaborate ruse—a ruse which the out-in-the-open operation ofthe economy in our society gives us the ability to see through. Very well, such a reader might acknowledge, the economy is an "instituted process," and, yes, the act of instituting it "shifts the place ofthe process in society" (Polanyi 1968, 148), but ifyou track it down to its hiding place and strip away the social contrivances in which it has been embedded, what you will find is still the economy as we know it—indeed, the economy which market society alone lays bare. In this reading, or rather misreading, the "real" economic aims that market society achieves directly are elsewhere accomplished only in the most cumbersomely indirect fashion. This kind of erroneous conclusion will likely be difficult to counter as long as one posits an opposition between multiple, variable and diffuse social interests, on the one hand, and the apparently straightforward individual interest in the possession of goods, on the other. Wherever the economy is submerged in social relationships, Polanyi says, a man "does not act so as to safeguard his individual interest in the possession ofmaterial goods; he acts so as to safeguard his social standing, his social claims, his social assets" (2001, 48). The problem with such an opposition between individual and social is that a market-minded theorist can overcome it simply by broadening the individual interest in the possession ofgoods to include the possession ofreified social goods. Once social interests are conceptualized as "social assets," to use Polanyi's own expression—or as "symbolic capital," to cite a more recent formulation—they lend themselves to "economizing" even in the formal sense, and Polanyi's carefully constructed distinction between the substantive and the formal collapses, apparently confirmingthe universality of the market... (shrink)

There are many different kinds of libertarianism. The first is right libertarianism, which received its most powerful expression in Robert Nozick’s Anarchy, State and Utopia (1974), a book that still sets the baseline for discussions of libertarianism today. The second, I will call faux libertarianism. For reasons I will explain in this paper, most ‘man-on-the-street’ libertarians and most politicians who claim to be libertarians are actually this kind of libertarian. And third, there is left libertarianism, which is what I shall (...) spend most of this paper explicating. But I will not simply be surveying the views of those who identify as left libertarians and put this forth as if I were engaged in an exegetical exercise. Instead, what I shall set forth is a kind of manifesto, a statement of why I consider myself a left libertarian, one that takes this approach to political morality well beyond where it was left around the end of the last century by the previous generation of left libertarians. My hope is to provide those who find certain left libertarian ideas attractive a guide by which they can explain and harmonise their own views, recognise left libertarianism as a distinct comprehensive political doctrine, and feel more open to identify themselves as left libertarian too. (shrink)

Within the Anglo-American world, economic liberalism is generally viewed as having only one progenitor—Adam Smith—and one offspring—neoliberalism. But it actually has two. The work of G. W. F. Hegel was also very influential on the development of economic liberalism, at least in the German-speaking world, and the most powerful contemporary instantiation of economic liberalism within that world is not neoliberlaism, but ordoliberalism, although this is generally unknown and certainly unacknowledged outside of Continental Europe. Accordingly, what I am going to be (...) doing in this piece is trying to bring ordoliberalism more directly into the light—I will argue that by comparing and contrasting the views of Smith and Hegel or at least between how Smith and Hegel tend to be currently (mis)understood, we can better understand both the roots and the nature of these two contemporary incarnations of economic liberalism, and the light this sheds, in turn, brings some interesting and important features of these two contemporary theories into view. From Smith, for example, neoliberals took the idea of the invisible hand, although I am going to argue that contemporary advocates of invisible hand theory have largely misconstrued or at the very least overstated the significance of this metaphor. From Hegel, in contrast, ordoliberals took the idea of the civil society, and I will argue that the civil society is a much better metaphor not only for Hegel's but also for Smith's views. Indeed, I will argue that ordoliberalism, not neoliberalism, is a better and more coherent instantiation of economic liberalism than neoliberalism could ever be. (shrink)

A US Department of Health and Human Services Final Rule, Protecting Statutory Conscience Rights in Health Care, and a proposed bill in the British House of Lords, the Conscientious Objection Bill, may well warrant a concern that—to borrow a phrase Daniel Callahan applied to self-determination—conscientious objection in health care has “run amok.” Insofar as there are no significant constraints or limitations on accommodation, both rules endorse an approach that is aptly designated “conscience absolutism.” There are two common strategies to counter (...) conscience absolutism and prevent conscientious objection in medicine from running amok. One, non-toleration, is to decline to accommodate physicians who refuse to provide legal, professionally accepted, clinically appropriate medical services within the scope of their clinical competence. The other, compromise or reasonable accommodation, is to impose constraints on accommodation. Several arguments for non-toleration are critically analyzed, and I argue that none warrants its acceptance. I maintain that non-toleration is an excessively blunt instrument to prevent conscientious objection in medicine from running amok. Instead, I defend a more nuanced contextual approach that includes constraints on accommodation. (shrink)

Physicians are expected to engage patients as partners in identifying the possible benefits and harms associated with treatment options and selecting from among medically appropriate treatment options, rather than simply dictating what treatments patients will and will not receive. This collaborative model reflects the recognition that citizens in multicultural societies have diverse values and are likely to have different views about whether the possible benefits of a medical intervention outweigh the possible harms. However, there are circumstances in which the collaborative (...) process breaks down due to irresolvable disagreement. Especially challenging are cases in which patients are expected to die if they do not receive a treatment and either the patients or their surrogates insist on the treatment despite the physician's belief that providing it is ill advised. The source of disagreement is often differing appraisals of the risks and potential benefits. In such cases, physicians generally judge that there is insufficient likelihood or magnitude of benefit to justify the burdens or expense of treatment, while patients or surrogates believe that the small chance of preventing the patient's death is sufficient to justify the costs and potential burdens to the patient.There is a perception that surgeons enjoy considerable discretion in deciding when the risks of a procedure outweigh the expected benefits. An important contrast can be drawn between surgeons and intensivists—physicians who specialize in the medical management of critically ill patients. We will argue that there are good reasons for subjecting the decisions of both surgeons and intensivists to some oversight. We begin by showing that, for many cases, major professional society guidelines for intensivists recommend oversight via a procedural mechanism rather than unilateral decision‐making by individual clinicians. Next, we present reasons for adopting a procedural approach to dispute resolution, and we argue that these reasons apply to situations in which intensivists believe that patients or surrogates are requesting inappropriate life support as well as to many disagreements between surgeons and surrogates. Finally, we present and respond to several objections. (shrink)

This special issue of HEC Forum includes articles on a wide range of specific topics that make significant contributions to conscientious objection scholarship. In this commentary, it is not feasible to provide a comprehensive analysis of each of the articles; and I have not attempted to do so. Instead, for each article, I have selected specific issues and arguments on which to comment.

Within the evidence-based medicine construct, clinical expertise is acknowledged to be both derived from primary experience and necessary for optimal medical practice. Primary experience in medical practice, however, remains undervalued. Clinicians’ primary experience tends to be dismissed by EBM as unsystematic or anecdotal, a source of bias rather than knowledge, never serving as the “best” evidence to support a clinical decision. The position that clinical expertise is necessary but that primary experience is untrustworthy in clinical decision-making is epistemically incoherent. Here (...) we argue for the value and utility of knowledge gained from primary experience for the practice of medicine. Primary experience provides knowledge necessary to diagnose, treat, and assess response in individual patients. Hierarchies of evidence, when advanced as guides for clinical decisions, mistake the relationship between propositional and experiential knowledge. We argue that primary experience represents a kind of medical knowledge distinct from the propositional knowledge produced by clinical research, both of which are crucial to determining the best diagnosis and course of action for particular patients. (shrink)

Volume 20, Issue 7, July 2020, Page 122-124.

Modern accounts of Sicilian history in the late fifth century b.c.e. and its relations with Athens often follow Thucydides’ Athenocentric narrative closely, largely ignoring the Sicilian background. This article instead foregrounds the actions and concerns of two important Sicilian cities, Segesta and Leontini, whose perspectives Thucydides chose to leave out or downplay. In particular, Segesta was involved in the complex cross-cultural dynamics of western Sicily, while Leontini demonstrated resilience in its resistance to Syracusan imperialism. Both cities’ relations with Athens emerged (...) from their pre-existing policies and strategies. This article thus develops an alternate narrative of these events that complements Thucydides’ Athenocentric one. To accomplish this, it argues for a more nuanced approach to Thucydides’ narrative: reading it against the grain, supplementing it with data from Diodorus and epigraphy, and placing it in its Sicilian historical and cultural context. In this way, the article develops a new approach to the methodological issues involved in writing the history of poleis that are not emphasized in major extant narrative sources. Recognizing Segesta and Leontini as political actors with their own goals and agendas enables both a new reading of Thucydides and a less Athenocentric account of late fifth-century Sicilian history. (shrink)

As with other fields of applied ethics, philosophers engaged in business ethics struggle to carry out substantive philosophical reflection in a way that mirrors the practical reasoning that goes on within business management itself. One manifestation of the philosopher’s struggle is the field’s division into approaches that emphasize moral philosophy and those grounded in the methods of social science. I claim here that the task for those who come to business ethics with philosophical training is to avoid unintentionally widening the (...) gap between philosophical theory and business management by emphasizing the centrality of practical wisdom to both good managment and to the moral life. Distinguishing my own approach from recent emphases on phronesis in management literature, I draw on the concepts of social practice and of narrative to tie practical reasoning to a company’s unique story. Practical reason, social practices and narrative are employed together to give an account of the art of management at Patagonia. The essay hopes to both provide a way for philosophers engaged with business ethics to see family resemblances between their practices and those of business management and to offer a pedagogical example useful for those in any discipline interested in viewing businesses ethically. (shrink)

Process physics2 is, like all physics, a model of reality. However, unlike traditional substance-based versions, process physics implements many process philosophical concepts, perhaps most notably, the notion of internal relations. It argues that the universe can best be understood in terms of selfreferential semantic information that is remarkably similar to mathematical stochastic neural networks research in biology. It argues that information patterns generate new information through causal efficacy and, ultimately, internal integration, generating self-organising patterns of relationships. These patterns or relations (...) have an intrinsic value inherent in their self-actualisation and thereby experience a subjective unity in response to influences from the totality of their past. The result is an internally related self-organising stream of experiences that provides a defining essence objectively distinguishable in abstraction and as exhibiting all the characteristics of a quantum space and quantum matter. In process physics, therefore, quantum phenomena emerge where no prior assumption regarding their existence is made or prescribed at the start. Rather, they are internally generated as an inherent feature of an experientially becoming reality, growing in size over time and thus having an observable key feature — i.e. a ‘defining essence’ — of an expanding universe. Reality itself is now understood — and modeled — as having a primitive form of self awareness. By this we mean that it has, in the process philosopher Alfred North Whitehead’s words, prehensions of other actualities as objects in terms of their ‘provocation of some special activity within the subject’.3 In more biologically complex information systems these ultimately lead to experiential integration as conscious discrimination of contrasts in prior experiences. Reality is, ultimately, not about the identification of isolated individuals through externality, but related individuals through internality. The purpose of this paper is to arrive at a point whereby we might apply these ultimate principles of reality to management. To do this, we shall start by considering Whitehead’s own renderings of management issues, before turning to the use management studies has or has not made of his work. In the light of this discussion, we shall question the principle of deconstructive postmodernism that underpins this body of work. We shall then ask whether and to what extent Whiteheadian principles might help explain organisations as ‘event fields’ 4 within which ‘persons-in-communities’5 reside. This will then allow us to consider organisations in terms of a process reinterpretation of physics. In so doing, we shall uncover a final contradiction, between Whitehead’s understanding of organisation and his principles concerning the application of metaphysics, to which we shall at least indicate a solution. (shrink)