When the COVID-19 surge hit New York City hospitals, the Division of Medical Ethics at Weill Cornell Medical College, and our affiliated ethics consultation services, faced waves of ethical issues sweeping forward with intensity and urgency. In this article, we describe our experience over an eight-week period (16 March through 10 May 2020), and describe three types of services: clinical ethics consultation (CEC); service practice communications/interventions (SPCI); and organizational ethics advisement (OEA). We tell this narrative through the prism of time, (...) describing the evolution of ethical issues and trends as the pandemic unfolded. We delineate three phases: anticipation and preparation, crisis management, and reflection and adjustment. The first phase focused predominantly on ways to address impending resource shortages and to plan for remote ethics consultation, and CECs focused on code status discussions with surrogates. The second phase was characterized by the dramatic convergence of a rapid increase in the number of critically ill patients, a growing scarcity of resources, and the reassignment/ redeployment of staff outside their specialty areas. The third phase was characterized by the recognition that while the worst of the crisis was waning, its medium- and long-term consequences continued to pose immense challenges. We note that there were times during the crisis that serving in the role of clinical ethics consultant created a sense of dis-ease as novel as the coronavirus itself. In retrospect we learned that our activities far exceeded the familiar terrain of clinical ethics consultation and extended into other spheres of organizational life in novel ways that were unanticipated before this pandemic. To that end, we defined and categorized a middle level of ethics consultation, which we have termed service practice communication intervention (SPCI). This is an underappreciated dimension of the work that ethics consult services are capable of in times of crisis. We believe that the pandemic has revealed the many enduring ways that ethics consultation services can more robustly contribute to the ethical life of their institutions moving forward. (shrink)

What solutions can we find in the research literature for preventing sexual violence, and what psychological theories have guided these efforts? We gather all primary prevention efforts to reduce sexual violence from 1985 to 2018 and provide a bird’s-eye view of the literature. We first review predominant theoretical approaches to sexual-violence perpetration prevention by highlighting three interventions that exemplify the zeitgeist of primary prevention efforts at various points during this time period. We find a throughline in primary prevention interventions: They (...) aim to change attitudes, beliefs, and knowledge (i.e., ideas) to reduce sexual-violence perpetration and victimization. Our meta-analysis of these studies tests the efficacy of this approach directly and finds that although many interventions are successful at changing ideas, behavior change does not follow. There is little to no relationship between changing attitudes, beliefs, and knowledge and reducing victimization or perpetration. We also observe trends over time, including a shift from targeting a reduction in perpetration to targeting an increase in bystander intervention. We conclude by highlighting promising new strategies for measuring victimization and perpetration and calling for interventions that are informed by theories of behavior change and that center sexually violent behavior as the key outcome of interest. (shrink)

This collection of essays, offered in honor of the distinguished career of prominent political philosophy professor Clifford Orwin, brings together internationally renowned scholars to provide a wide context and discuss various aspects of the virtue of “humanity” through the history of political philosophy.

S.R.L. Clark is a prominent defender of environmental holism and an advocate of the better treatment of other species. Not coincidentally, he is also a defender of a Neoplatonic Theism which holds that the presuppositions of reason have theistic implications and the point of the world is to exemplify beauty, or all the forms of beauty. Here I examine certain aspects of his view. I do so because I’m drawn to his main holist conclusion: we should live according to those (...) rules that will allow as many creatures as possible, of as many kinds, their best chance of living a satisfactory life according to their kind. However, I express doubts about his general route to the principle. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Style and the Mole: Domestic Aesthetics in The Wind in the WillowsSeth Lerer (bio)Writing to her husband’s first illustrator, Graham Robertson, in 1931, Elspeth Grahame thanked him for the gift of his recently published memoirs. She called them “entrancing” and goes on to note: “The touch is so light yet so sure that whatever the subject the reading of it would be full of pleasure to any lover of (...) English style.”1 Lovers of English style would have been long familiar with Kenneth Grahame’s Wind in the Willows, originally published in 1908 and, by 1931, available in four different editions (a new one, illustrated by Ernest Shepard would soon appear in that year).2 A. A. Milne’s stage adaptation, Toad of Toad Hall, played to welcoming audiences in 1929, and Sir Arthur Quiller-Couch, perhaps that era’s greatest arbiter of English style, had ensconced Grahame with two selections in his Oxford Book of English Prose, published in 1925.3While The Wind in the Willows is about many things—the nature of friendship, the loss of English pastoral security, the temptations of fashion and fad—it is, first and foremost, an essay in aesthetics. Style governs each and every creature of its woods and mansions, from Mole’s quiet, gentlemanly domesticity to Toad’s manic, aristocratic shows. Style governs, too, the progress of its narrative, and throughout this book, Grahame explores techniques of pictorial description and devices of characterization that would come to epitomize what Elspeth could evoke as “English style.”4Though voiced decades after her husband’s major work had been completed, Elspeth’s judgment chimes with the ideals of the Edwardian aesthetic codified in Quiller-Couch’s anthology.5 Central to that aesthetic was a kind of effortless esprit, as well as an essential “Englishness” that rooted that esprit in local landscape and personal reminiscence. There remains something sweetly nostalgic about the Edwardian idiom, and Quiller-Couch makes clear that, even though his book may brim with “purple patches,” there is nonetheless a “subdued and hallowed emotion” to its selections: “a sense of wonderful history written silently in books and buildings, all [End Page 51] persuading that we are heirs of more spiritual wealth than, may be, we have surmised or hitherto begun to divine.”6 Some of those selections, he claims, hold “the core of true English gentility.” Others are, he reflects, full of “out-of-door matter.”7 He goes on to note that, when Wolfe crossed the St. Lawrence, he is reputed to have “murmured a stanza or two from Gray’s Elegy,” and Quiller-Couch himself has drawn on writers who, he claims, evoked “this imperishable land of ours revived.”8 Such sentiments could not have been far from the mind of Elspeth Grahame, who invites Graham Robertson to their home in the country in her letter of thanks:Do you ever go caring—or if by train we are within an hour of Paddington, and 5 minutes walk from the station here—in an old cottage next the church with a round village lock-up in the garden—so if you would ever propose yourself to come down & see us we should be so glad—and used as you are in Surrey to beauty-spots the river & trees are beautiful in summer-time, that is of course when there is any summer about which has not been the case this year.9The Grahames lived by what Quiller-Couch calls that “green and English country churchyard,” and in his anthology he calls attention to a selection from Charles Reade, “The English Skylark in Australia.” There, in an amazing, paragraph-long sentence, Reade epitomizes the ideals of local pastoralism, and his style—though readers today may find it overwrought—would provide a model for the criticism of Elspeth as well as the writing of her husband:Every time he checked his song to think of its theme, the green meadows, the quiet stealing streams, the clover he first soared from and the Spring he sang so well, a loud sigh from many a rough bosom, many a wild and wicked heart, told how tight the listeners had... (shrink)

This collection of original essays, by some of the best known contemporary criminal law theorists, tackles a range of issues about the criminal law's 'special part' - the part of the criminal law that defines specific offences. One of its aims is to show the importance, for theory as well as for practice, of focusing on the special part as well as on the general part which usually receives much more theoretical attention. Some of the issues covered concern the proper (...) scope of the criminal law, for example how far should it include offences of possession, or endangerment? If it should punish only wrongful conduct, how can it justly include so-called 'mala prohibita', which are often said to involve conduct that is not wrongful prior to its legal prohibition? Other issues concern the ways in which crimes should be classified. Can we make plausible sense, for instance, of the orthodox distinction between crimes of basic and general intent? Should domestic violence be defined as a distinct offence, distinguished from other kinds of personal violence? Also examined are the ways in which specific offences should be defined, to what extent those definitions should identify distinctive types of wrongs, and the light that such definitional questions throw on the grounds and structures of criminal liability. Such issues are discussed in relation not only to such crimes as murder, rape, theft and other property offences, but also in relation to offences such as bribery, endangerment and possession that have not traditionally been subjects for in depth theoretical analysis. (shrink)

Excessive prescribing of pain medications after surgery has contributed to the epidemic of opioid misuse and diversion in the United States. Pain specialists may be particularly well situated to address these issues. We describe an attempt to reverse the trend at an orthopedic surgical hospital by implementing a peri-operative assessment and treatment service which minimizes preoperative opioid use, when necessary implements addiction treatment, and encourages early tapering from opioids.

The dispute over the exact nature and status of possible worlds in Leibniz’s philosophy has proven difficult to resolve. The standard view, that there is one unique actual world and that possible worlds exist solely as ideas within God’s understanding, sits in tension with important metaphysical and theological components of Leibniz’s system. For example, Leibniz takes possible individuals to have some “essence or reality” in themselves and to strive for existence, which allows him to ground counterfactual claims and to overcome (...) necessitarianism. However, scholars have long seen these claims as being at odds with God’s creation of one unique actual world. Catherine Wilson (2000) challenges the standard view’s claim that possible worlds are substantially different from the actual world, arguing instead that Leibniz’s metaphysical commitments are consistent with there being more than one actual world and that Leibniz has no way to block the claim that God would generate more than one such world. In this paper, I expand on Wilson’s account and argue, contrary to the standard view, that the key theses at the heart of Leibniz’s philosophical system entail modal realism—for Leibniz, there can be no ontological difference between possible and actual worlds. (shrink)

Specialists and primary care physicians play an integral role in treating the twin epidemics of pain and addiction. But inadequate access to specialists causes much of the treatment burden to fall on primary physicians. This article chronicles the differences between treatment contexts for both pain and addiction — in the specialty and primary care contexts — and derives a series of reforms that would empower primary care physicians and better leverage specialists.

Nostalgia, a sentimental longing for one’s past, can serve as a resource for individuals coping with discomforting experiences. The experience of bereavement poses psychological and physical risks....

While the literature in business ethics abounds with philosophical analyses, perspectives from religious thinkers are curiously underrepresented. What religious analysis has occured has often been moralistic in tone, more fit to the pulpit than the classroom or the boardroom. In the three essays that follow, presented originally at a panel at the Annual Meeting of the American Academy of Religion in 1989, ethicists from the Protestant, Roman Catholic, and Jewish traditions analyze a case study familiar to many who teach and (...) research in business ethics — the Consolidated Foods Case. Each author shows how a particular religious tradition might react to the case. The authors show how insights from their traditions would affect corporation's moral deliberations about policy. Specific policy recommendations are offered to CEO John Bryan. (shrink)

In Book 2 of The Peloponnesian War, the ancient Greek historian Thucydides describes the Plague of Athens which killed an estimated 75,000 people in 430 BC, the second year of the war. Thucydides i...

25 leading contemporary theorists of criminal law tackle a range of foundational issues about the proper aims and structure of the criminal law in a liberal democracy. The challenges facing criminal law are many. There are crises of over-criminalization and over-imprisonment; penal policy has become so politicized that it is difficult to find any clear consensus on what aims the criminal law can properly serve; governments seeking to protect their citizens in the face of a range of perceived threats have (...) pushed the outer limits of criminal law and blurred its boundaries. To think clearly about the future of criminal law, and its role in a liberal society, foundational questions about its proper scope, structure, and operations must be re-examined. What kinds of conduct should be criminalized? What are the principles of criminal responsibility? How should offences and defences be defined? The criminal process and the criminal trial need to be studied closely, and the purposes and modes of punishment should be scrutinized. Such a re-examination must draw on the resources of various disciplines-notably law, political and moral philosophy, criminology and history; it must examine both the inner logic of criminal law and its place in a larger legal and political structure; it must attend to the growing field of international criminal law, it must consider how the criminal law can respond to the challenges of a changing world.Topics covered in this volume include the question of criminalization and the proper scope of the criminal law; the grounds of criminal responsibility; the ways in which offences and defences should be defined; the criminal process and its values; criminal punishment; the relationship between international criminal law and domestic criminal law. Together, the essays provide a picture of the exciting state of criminal law theory today, and the basis for further research and debate in the coming years. (shrink)

The Central Bank of China is testing its Digital Currency Electronic Payment (DCEP) in the cities of Shenzhen, Suzhou, Chengdu and Xunan with the involvement of four large state-owned banks in the...

Mammalian sperm undergo discharge of a single, anterior secretory granule following their attachment to the zona pellucida surrounding the oocyte. This secretory discharge is known for historical reasons as the acrosome reaction. It fulfils a number of purposes and without it, sperm are unable to penetrate the zona pellucida and fuse with the oocyte. In this review, we focus on the role of the acrosome reaction in the development of fusion competence in sperm. Any naturally occurring membrane fusion has two (...) major sequential steps: a docking or adhesion step, in which two membranes adhere, and a fusion step, in which their lipid bilayers are destabilized and merged and a cellular compartment is either created or destroyed. Recent evidence suggests that there is an important role for oocyte integrins and sperm‐bound disintegrins in mammalian sperm/oocyte adhesion and fusion. The fusion mechanism employed by sperm remains poorly understood, however, and circumstantial evidence suggests it is more complex than the interaction between a single protein species and its target. Sperm/oocyte fusion is probably the most accessible eukaryotic model for intercellular fusion currently available, partly because it is temporally separated from gene expression. Elucidation of the mechanism of sperm/oocyte fusion may throw light on the mechanism of other intercellular fusions such as myoblast fusion, and the evolutionary relationship of intercellular membrane fusion to intracellular membrane fusion. (shrink)

Drawing from both theoretical and empirical research, the literature on basic income (BI) is now voluminous, pronouncing both its merits and its limitations. Burgeoning research documents the impacts of un/conditional cash transfers and negative income tax programs, with many studies highlighting the effectiveness of these programs in reducing poverty, and improving a host of social, economic and health outcomes. We consider possible avenues for BI architecture to be adopted within Canada’s existing constellation of income security programs, to the benefit of (...) disadvantaged groups in society. Identifying key federal and provincial (i.e., Ontario) transfer and tax benefit programs, we highlight which programs might best be maintained or converted to a BI. While opponents decry the (alleged) exorbitant costs of BI schemes, we suggest that the existing approach not only produces an ineffective system—which actually engenders poverty and the health and social problems that accompany it—but an excessively costly one. (shrink)

Michael A. Peters Beijing Normal UniversityDeclinism is back in fashion again. It is now a common and persistent source of historical reflection that has been a constant theme since the first Chris...

In three studies, we examined food as an elicitor of nostalgia. Study 1 participants visualised eating either a nostalgic or regularly consumed food. Study 2 participants visualised consuming 12 foods. Study 3 participants consumed 12 flavour samples. Following their food experiences, all participants responded to questions regarding the profile of food-evoked nostalgia (i.e. autobiographical relevance, arousal, familiarity, positive and negative emotions) and several psychological functions (i.e. positive affect, self-esteem, social connectedness, meaning in life). Study 2 and 3 participants also reported (...) their state nostalgia. Results revealed that food is a powerful elicitor of nostalgia. Food-evoked nostalgia has a similar contextual profile to previously examined elicitors, but is a predominantly positive emotional experience. Food-evoked nostalgia served multiple psychological functions and predicted greater state nostalgia. (shrink)

Brain-computer interfaces (BCIs) have been successfully used by adults, but little information is available on BCI use by children, especially children with severe multiple impairments who may need technology to facilitate communication. Here we discuss the challenges of using non-invasive BCI with children, especially children who do not have another established method of communication with unfamiliar partners. Strategies to manage these challenges require consideration of multiple factors related to accessibility, cognition, and participation. These factors include decisions regarding where (home, clinic, (...) or lab) participation will take place, the number of sessions involved, and the degree of participation necessary for success. A strategic approach to addressing the unique challenges inherent in BCI use by children with disabilities will increase the potential for successful BCI calibration and adoption of BCI as a valuable access method for children with the most significant impairments in movement and communication. (shrink)

Anticipated nostalgia is a new construct that has received limited empirical attention. It concerns the anticipation of having nostalgic feelings for one’s present and future experiences. In three...