Since the Vietnam War, graphic novels about war have shifted from simply representing it to portraying avenues for survivors to establish psychological wellness in their lives following traumatic events. While modern diagnostic medicine often looks to science, technology, and medications to treat the psychosomatic damage produced by trauma, my article examines the therapeutic potential of the comics medium with close attention to war comics. Graphic novels draw trauma in a different light: because of the medium’s particular combination of words and (...) images in sequence, war comics represent that which is typically unrepresentable, and these books serve as useful tools to promote healing among the psychologically wounded. Graphic narratives, both fictional and non-fictional, illuminate the ways that the unseen wounds of traumatic experience affect public health by compromising the ability of communities, individuals, and survivors to create and maintain meaningful relationships with others. (shrink)

Background: The quality of care in maternity facilities significantly influences women’s autonomy and their right to make decisions about their bodies. Obstetric violence, a form of gender-based violence during childbirth, poses serious threats to women’s rights and health worldwide. Aim: The research aimed to examine women’s experiences and perceptions of obstetric violence using the micro-level constructivist grounded theory strategies of Mena-Tudela et al. (2023). Research design and methods: This study used a phenomenological qualitative research design. Data were collected from 17 (...) eligible women using a Participant Information Form and a Semi-Structured Interview Form, applying maximum variation sampling to ensure a wide range of sociodemographic characteristics and diverse views and experiences. The data were analyzed using the seven-step phenomenological analysis method. Participants and research context: A total of 17 women who had vaginal labor at least 6 months ago were interviewed. Ethical considerations: The study was approved by the University Ethics Board for Non-Interventional Clinical Studies. Ethical considerations were closely aligned with the principles of respecting women’s rights, ensuring that participants’ autonomy and consent were central throughout the research process. Results: Five themes and 13 subthemes were extracted from the data analysis, including “Ignoring women in care,” “The commodification of women,” “Are the healthcare professionals the only authority?”, “Ineffective childbirth management and its effects on women’s health-seeking behavior,” and “Types of obstetric violence.” Conclusions: This study underscores the urgent need to address obstetric violence, recognizing its detrimental impact on women’s rights, and well-being during childbirth. Protecting women’s rights by prioritizing individual-centered care, informed consent, and respectful treatment is essential to uphold ethical standards and ensure dignified childbirth experiences for all women. (shrink)

In 2015, the Israeli Knesset passed the force-feeding act that permits the director of the Israeli prison authority to appeal to the district court with a request to force-feed a prisoner against his expressed will. A recent position paper by top Israeli clinicians and bioethicists, published in Hebrew, advocates for force-feeding by medical professionals and presents several arguments that this would be appropriate. Here, we first posit three interrelated questions: 1. Do prisoners have a right to hunger-strike? 2. Should governing (...) institutions force-feed prisoners and/or is it ethical to force-feed prisoners? 3. Should healthcare professionals force-feed prisoners? We then focus on the first and third questions. We first briefly provide several arguments to support the right of prisoners to refuse treatment. Next, we critically review the arguments presented in the Israeli position paper, demonstrating that they are all misguided at best. Lastly, we briefly present arguments against force-feeding by medical professionals. We conclude that healthcare providers should not participate in the force-feeding of prisoners. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:God’s Wounds: Hermeneutic of the Christian Symbol of Divine Suffering. Vol. 1 of Divine Vulnerability and Creation (Princeton Theological Monograph Series, 100)Raymond Kemp AndersonGod’s Wounds: Hermeneutic of the Christian Symbol of Divine Suffering. Vol. 1 of Divine Vulnerability and Creation (Princeton Theological Monograph Series, 100) Jeff B. Pool Eugene, OR: Wipf and Stock, 2009. 358 pp. $38.00One should not be put off by a negative-sounding title. (...) Jeff Pool’s exhaustive study could as well be titled more positively as “God’s Passion” for the “passio” root-meaning linked to our concept of suffering describes in large part what [End Page 224] he is about. But we must reluctantly concede that Pool’s treatment barely glimmers where we might expect to find light-hearted joy in the passion-resurrection and eschatological promise that he does acknowledge is at the heart of the Christian gospel.In his effort to follow methodological strictures consonant with his Chicago schooling with Langdon Gilkey and others, Pool is at pains to keep his academic back to the wall. So the first part of this two-part volume simply rehearses the enormous plurality of “Christian attestations” to the theme of divine suffering (and patripassianism). Attestations of every stripe rub shoulders here and seem to acquire almost equal footing. Yet by calling his topic a “symbol,” Pool does not mean to question the believed ontological actuality of “divine suffering.” In his view, this suffering is not just a symbol but describes for Christian faith an actuality that corners into the meaning and purpose of our very existence. So, as it turns out, he offers us much more than a history-of-religions compilation of diverse “attestations”; he is intent on reworking a tenable systematic theology and theological ethic as these intersect with his theme.Pool’s criteria for ranking some “attestations” over others remain obscure, and we might think him to be arguing rationalistically from personal preferences, until finally (217 pages into his text) he slips in what he calls “an additional epistemological interlude” that divulges what apparently has been an underlying hermeneutic basis all along: his own Messianic secret, as it were, a Christological-revelational criterion and final norm based on the apostolic tradition.Pool’s proclivity for rational analysis may become self-deceptive. At points he does include disclaimers, explaining that his “analyses” of living realities are only mental abstractions describing aspects of personal wholes that in fact cannot be split apart. Yet he forgets himself here, I think, and attempts to subject both divine and human personhood to scholastic “analysis.” For example, his descriptive categories of different “human capacities to love” (along the lines of Nygren’s three loves) become so reified in his “analysis” that he begins to refer to them as if they were schizoid entities that modify, block, and limit each other in our psyche and even in God’s (as if we could strap down the mystery of holistic love and dissect it). Nevertheless, theologians may find Pool’s analytic endeavors quite challenging.This book is definitely not for your introductory ethics course. Pool’s language is labored and presupposes a wide command of the field. His treatment is original, in some respects idiosyncratic, and intentionally revisionist. Written in a neoscholastic vein, this study will give you far more about God’s suffering than you thought anyone ever wanted or needed to know. Yet it promises you a substantial theological workout, offering something provocative and worth considering on nearly every page. Its greatest strength is its perceptive bibliographical annotations, both in the text and in the wealth of footnotes that compose between a third and half of the book. The bibliography [End Page 225] itself, however, which masses together more than a thousand titles, may be too exhaustive to provide much selective guidance.Raymond Kemp AndersonWilson CollegeCopyright © 2012 The Society of Christian Ethics... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Clinical Anecdotes: A Painful Lack of WoundsChristopher Bailey (bio)Keywordsdepression, post-traumatic stress disorder (PTSD), evolution, fight-or-flight, veteran (treatment of)Colin came to me complaining of depression, which started after he got back from Iraq in 2005. Although he had served in the National Guard, he volunteered absolutely nothing about his time in Iraq as we spoke, instead focusing on other factors, like problems at his job and a family history (...) of depression.Colin's depression seemed serious but not severe. He had been functioning fairly well at work and was not suicidal, although his home life had begun to suffer. As the interview proceeded, I myself fell into Colin's blind spot, all but forgetting his tour of duty as I forged ahead with my list of questions. My avoidance was conscious at first, a deliberate reluctance to come across as one more morbidly curious onlooker recklessly inflaming the wounds of war.When Colin complained of irritability, however, and being kept awake by sinister, shadowy “flashes” at night, I knew I had to ask about Iraq. He was probably suffering from post-traumatic stress disorder, I decided, and was thus trying to avoid the very memories that were haunting and hunting him. And for fear of retraumatizing him (if not suffering second-hand trauma myself), I had colluded in his denial.So when I finally got around to asking about Iraq, I fully expected to hear horror stories, half-articulated perhaps, but all the more grisly for the graininess of their images. Instead, Colin surprised me. He had not experienced anything he considered traumatic. No bombs, bloodshed, or shattered bodies. And in fact, he felt like a “wimp” for having been assigned to a noncombat detail where he missed what might have been his last, best chance “to be a hero.”Most of us would consider this a good thing, but in Colin's case, it had left him feeling somehow uninitiated, like he had not done his part or proven his manhood. Contrary to my assumption, it was the lack of trauma that seemed to trigger his depression upon returning from Iraq. In a relatively safe homeland, rife with middle-class comforts and lacking all but metaphorical rites of passage, perhaps we all feel this way at some level.I pointed out to Colin that people have been dying everywhere in Iraq and under all different circumstances, not just combat. From my stateside perspective, just being there is brave. Although I meant to honor him, he seemed to take my offering as more evidence of his failure, reassuring me that nothing he did could ever compare with the unspeakable horrors endured by veterans of Viet Nam and World War II.Now, as a civilian, he questions whether or not he would respond with sufficient ferocity if, say, he had to defend his family against an attacker. Although powerfully built, Colin (to his credit) has never been a brawler or a bully. Nonetheless, [End Page 223] I have no doubt he could do whatever it took to protect his family. What concerns me more is the opposite: That in trying to prove himself, he might unwittingly put himself and his family in harm's way, if not hurt someone who was never really a threat to begin with.With a new family member, I too feel the burden of hypervigilance. But although terrorists, serial killers, and gangs grab headlines, activating our visceral alarm systems, data from the Centers for Disease Control and Prevention suggest that a sedentary lifestyle still exacts a higher death toll among white American men, like Colin and myself. Although the effect of inertia on the body has been discussed extensively, its impact on mental health has received relatively little attention. Maybe for a creature who evolved on the African savannah, competing over territory and trying not to get eaten, the absence of a visceral challenge can be as debilitating as too much of one.Colin seemed receptive to my concerns, which I took to be a good sign. Although insecure men are quick to fear emasculation, Colin did not seem to be the least bit threatened when I suggested a course... (shrink)

INTRODUCTION BY NANCY FUMERO What is a translation that stalls comprehension? That, when read, parsed, obfuscates comprehension through any language – English, Portuguese. It is inevitable that readers expect fidelity from translations. That language mirror with a sort of precision that enables the reader to become of another location, condition, to grasp in English in a similar vein as readers of Portuguese might from João Guimarães Rosa’s GRANDE SERTÃO: VEREDAS. There is the expectation that translations enable mobility. That what was (...) written in one language be accessible in another. And that a translator is to serve as a mediator, acting ultimately in service to ideas within the source text. To disperse them. However, this notion of translation is partly antithetical to the ideas in Rosa’s work. Or, alternately, to convey the despair of terrain slipping beneath one’s feet, and to encounter the heightened suspense of magic, the translation, as part of its strategy, cannot devotedly rely on its original language, not as its source text. The work undertaken by Felipe W.Martinez is a new form of translation that risks everything in order to encounter the same treacherous knowing Rosa had traversed. And it takes its risks by not taking risks: by being, almost word for word, a literal translation. This is an approach that reductively converts, as opposed to translates. The idiomatic differences between English and Portuguese are not accented. The syntax is not finessed. Liberties are not assumed on account of improving readability. What stands, resoundingly amid such absences, is the awakened challenge of reading. The genuine peril of not knowing. That is, this translation, one that purports to know nothing, creates access into the guileful world Rosa had created in Portuguese. But not by translating. If anything, GRANDE SERTÃO: VEREDAS is speaking a cosmic language through a linguistic one. And W.Martinez does us the service of recognizing this, as what configures the shapes of words and sentences is not as simple as neologisms, portmanteaus, and digressions, but as terrifying as the path the fool traverses: all paths. As such, this translation doesn’t speak English, just as the original does not speak Portuguese. It is the assemblage of paradox as a new logic that can be navigated, if only one could suspend the comfort of readability, of expectation. If one could descend a mountain in the pitch dark of night, each step shocking the body, unable to acclimate to the unleveled heights. Without a doubt, the translation is incongruous to the Portuguese. Taking a small excerpt to compare: Eh, well, thereafter, the rest the Sir provide: comes the bread, comes the hand, comes the god, comes the dog. What is striking is the interplay between “god” and “dog”. To most English speakers, this anagram is a familiar one. But in Portuguese the words god (“deus”) and dog (“cão”) are not so closely linked. In fact, there is no direct mention of “deus” in Rosa’s text: Eh, pois, empós, o resto o senhor prove: vem o pão, vem a mão, vem o são, vem o cão. Both are fascinating. In Rosa’s excerpt, the rhythm is unmistakable and precise, despite, of course, the indices of hesitation: the commas, the Eh, the uncomfortable way of searching through prolongation and wait. This is the sort of paradox Rosa can engage within a sentence. W.Martinez’s does this as well, at a scale that reverberates beyond the sentence, and with one noticeable addition: deus. What may appear to be an overstep, to add such a weighted word that draws out wordplay but is, nevertheless, not in the source text, is exemplary of risk. The translation buzzes because of it. This is because throughout the text we encounter dogs frequently, as some primal beast on par with humans. The dog is one that masters and can be mastered. A creature that is at times its face, and at others a mask. It is a powerful presence. For the translator to be attuned to the reverent undercurrent attributed to this animal, and create within the translation such charged play in English from what was only an implication in Portuguese, is in tribute to the grand beauty within dissonance. What aberrant modes of writing and translation can teach us most assuredly, is that things, words, are not in states of rightness or wrongness, but of oscillation. This isn’t so different from what Rosa says himself: The Sir look…see: the most important and beautiful, of the world, is this: that the people are not always same, still were not completed — but that they go always shifting. They tune or detune. We find this so readily in W.Martinez’s translation, this tuning and detuning. Nancy Fumero Los Angeles GRAND SERTÃO: VEREDAS BY JOÃO GUIMARÃES ROSA TRANSLATED FROM THE PORTUGUESE BY FELIPE W.MARTINEZ Nonothing. Shots that the Sir heard were man brawling not, God be. Bleach white sights on the tree in the backyard, down in the river. By my right. I do this every day, I like; from the bad of boyhood. Thereof they came to call on me. Case of a calf: a white calf, errorful, eyes of to not be—saw selves—; and with a mask of a dog! They told me; I didn’t want to catch a sight. Same that, by the defects of birth, upturned lips, looked to be a laughing man. Folkface, dogface: they determined—it was the devil. Bananas. Killed it. Do not know who owned it. They came to borrow my guns. I caved. I’ve no power to impose. Oh, sir, you laugh certain laughs…Look: when it’s a true shot, first the dogs begin to bark, instantly—after, then, you see who’s handed death. Sir, endure, this is the Sertão. Some want that it is not: that situated Sertão is in and out of those general fields, they say, end of the road, highlands, the other Urucuia. Toleima. For those of Cortino and of Curvelo, then, isn’t here said Sertão? Ah! That there’s more! To place the Sertão it’s told: it’s where the pastures lack latches; where one can tear off ten, fifteen leagues without running into a houseinhabitant; where criminalousness lives out its christ jesus. Sifted out from the tightening grip of the law. The Urcuia comes from the western mountains. But today, its banks, give all—farmlands of farms, pastures of meadows of good yield, low tides, cultures that go kill for kill, until these virgins there are. The general fields run round. These general fields are without size. Ultimately, whichever one one approves, the Sir knows: bread or breads, it’s a question of heads…the Sertão is everywhere. Of the devi? No comment. Sir ask the dwellers. Falsely I fear they unspeak that name of his—only say: whatsitcalled. Volt! no… Whosoever over avoids it, lives with it. In the sentence of one Aristides—who exists in the first palm grove on the right hand side, called Vereda-of-Cow-Calm-of-Saint-Rita—everyone believes: he can't pass in three designated places: then can be heard the tiny cry, behind, a little voice warning:— "Here I come! Here I come!... "— that is the Capirote, the whatsitcalled... And one Jise Simplicio—who anyone from here will swear he keeps an imp in house, a little satanite, imprisoned and obliged to help in all greedful deeds; reason that Simplicio emprises en route to complete riches. As such, for this they say too that his beast bristles and refuses, denying his banner, unyielding, when he wishes to mount... Superstition. Jise Simplicio and Aristides, continue getting fatter, thence unheard or heard. Still the Sir study: right now, in these days of time, you have people purporting that the devil proper stopped, mid-passage, in Andrequice. A boy out of there, to whom'd appeared, and there lauded that, to get here—normally, by horse, a day-n-half—he was capable of such with only some twenty minutes enough... by coasting the River of Chico by the headwaters! Or, too, who knows—sans offense—will not have been, for example, even yourself the Sir who announced such, when you passed by there, for fun run funny? Thereof, not my given crime, I know that wasn't. And evil I wanted not. Only that one question, in hours, at times, brightens peaceful reason. But, the Sir understand: if such a boy, there was, he wanted to dupe. Because, hey, that, to cut the river off by the springs, would be the same thing as one redoubling in the internals of this our state of ours, costant of a journey of some three months... Then? Whatsitcalled? Dodo. The fantastication. And, the respect of giving him such these names of delicacy, is what it is for one to want to invoke that he form of form, with his presence! Not that is. I, personally, almost that have lost in him the creed, deserving to Deus; is the that to the Sir I say, to pure-secret. I know that it is well established, that it greases our Saintly-Gospels. On occasion, I conversed with a young seminarian, super suitable, conferring in the book of prayers and coated in vestments, with a stick of black-sage in hand—prosed that he went auxilitator to the father, to extract the Cujo, from the body living of an oldwoman, in Waterfalls-of-Bulls, he went with the vicar of Field-Round... I conceive. The Sir not is as I? I didn't believe a single thing. Compadre mine Quelemem describes that that which reveals effect are the low spirits meager, of third, adoing in the worst darkness and with anxieties of connecting selves with the livers—they give support. Compadre mine Quelemem is who much me consoles—Quelemem of Goias. But he has to live far from here, in Jijuja, Vereda of Buriti Dark... Ahrr, I leave myself there, that in enevildemonment or with support—the Sir too must have had known diverse, men, women. As not yes? For me, umpteen I've seen, that I've learned. Ma-Neigh, Blood-o'Other, or Legion-Lips, or Tear-em-Down, Cold-Cutter, or Sissy-Goat, one Treciziano, or Verdigris... or Hermogenes... o'them, pileload. If I could forget so many names... I'm not a man for calming horses! And, same, whom of yes of to be jagunço self enters, yea is for some competence entrant of demonion. Will it not? Will it? From first, I made and mixed, and to think not I thought. I didn't have the deadlines. I lived pulling difficult from difficult, fish alive on griddle: who lives asp'rously, no fantasies. But, now, fete of fate to me comes, and sans little disquietudes, I'm from creaky net. And myself invented in this like, of to speculate ideas. The devil exists and nonexists? I say the saying. Opennouncement. These melancholies. The Sir sees: exists waterfall; and since? But waterfall is gulch of ground, and water so pouring from it, retumbling; the Sir consume that water, or undo that bankment, remainder waterfall any? To live is negotiation much perilous. I explain to the Sir: the devil vigors inside of human, the wrinkles of human— or is the human ruin, or the human of adversess. I free, per se, citizen, is that not has devil notone. Notone!— is the that I say. The Sir approve? Me declares total, frank— is high merit that me make: and to beg might, increased. This case— by rashtravagance that me they see— is of mine certain importance. God grant not was... But, not say that the Sir, awised and instructed, that agrees in people of them?! Not? You I appreciate! Your high opinion composes my value. Yea I knew, waited for it— yea the field! Ah, a we, in oldness, we lack of to have plowing of rest. You I appreciate. Is devil notone. Nor esprit. Never I've seen. Someone ought to see, then was I myself, this your servant. Was I you to tell... Well, the devil regulate his state black, ins creatures, ins womens, ins humans. E'en: ins childrens— I declaim. Since not is said: "boy—trainee of the devil"? And ins thes uses, ins plants, ins waters, in terra, in wind... Manures. …The devil in the street, in the middle of the vortex... Hey? Hey? Ah. Figuration mine, of worse by back, the certain memories. Mal-make me! I suffer pain of to tell not…Meliorate, if chillingly: well, in a ground and with equal format of branches and leaves, not give to cassava-calm, that is eaten common, and the cassava-mad that kills? Now, the Sir yea saw a strangeness? A cassava-sweet can rapidly to turn agonizing— motives not I know, at times is said that is for replanted in the terrain always, with mutations then, of caules—go embittering, of s’much in s’much, of its self takes poisons. And, well look: the other, the cassava-mad, too is that at times can fix calm, the estimate, of is to eat sans notone mal. And what this is? Eh, the Sir yea saw, for to see, the ugliness of hate pleated, facetorqued, on the faces of one cobrarattlesnake? Observed the porker fat, capita day more felicity brute, capable of, could, snort and engulf for its own dirty coziness the world total? And sparrowhawk, blackbird, some, the features of they yea represent the need of cleave for before, rend and shred by beak, appears a knife much fine for ruin I desire. Total. Has even twisted races of stone, horrorous, venomous— that spoil mortal the aquas, if they are buried beneath of well; the devil inside of them sleeps: they are the devil. Is known? And the demon— that is only thus the significance of one mercury malign— have order of to follow the path of him, have license to brag?! Arr, he is variegated in all! What the what wastes, goes spending the devil of inside of the people, by itttybits, is the reasonable to suffer. And the delight of love—compadre mine Quelemem says. Family. Really? Is, and not is. The Sir think and not think. Total is and not is… Almost all more grave criminous ferocity, always is much good husband, good son, good father, and is good-friend-of-your-friends! I know of those. Solo that have the afters— and Deus, joined. I spy many nimbi. But, in veracity, son, too, softens. Look: one called Aleixo, resident a league from Step-of-Sour, in Of-Sand, was the man of major badness calm that yea you saw. Me agreed that near the house of his had a weir, amidst the palms, with traíras, for souls of enormous, desenormous, to the real, that received fame; the Aleixo gave of to eat to them, in hours just, they self accustomed to if assuch of lunacies, in order to gobble, seemed to be fishes instructed. One day, solo for grace rustic, he killed an oldman who by there passed, destitute begging alms. The Sir not doubt—have people, in this bored world, that kill solo in order to see someone make grimace… Eh, well, thereafter, the rest the Sir provide: comes the bread, comes the hand, comes the god, comes the dog. This Aleixo was man afamilied, had children small; they were the love of his, total, absurdity. Gave good, that not even a year there passed, of to killed the oldman poor, and the children of Aleixo there they asickened. Smallepidemic of measles, they said, but complex; they never heal. When, then, they healed. But the eyes of theirs vermillionized high in an inflame of spraining to rebellion; and nexthing— the that not I know is if they went of at once, or one later and later other and other— they remained blind. Blind, sans remission of one sweet of light of this Ours! The Sir imagine: stairset— three boys and one girl— all blind. Sans remediable. The Aleixo not lost the judgment, but he changed; ah, mutated complete— now lives of band of Deus, sweating to be good and charitous in all his hours of night and of day. Appears even that he fixed the felicity, that before not was. He himself says he was a man of luck, because Deus wanted to have pity of him, to transform for there the route of his soul. That I heard, and me it gave rage. Reason of the children. If being castigated, what culpa of the let-there-bes of Aleixo those little children had?! Compadre mine Quelemem reproved my uncertainties. That, for certain, inother life returnaound, the children too had been the most wicked, of the mass and part of the father, demons of the same kettle of place. Sir the what thinks? And the oldman, assassinated? — I know the Sir goes to discuss. Well, too. In order that he had a sin of crime, in the body, by to pay. If the people— conforming compadre mine Quelemem is who says— if the people turn to to incarnate renovated, I contemplate even that enemy of death can come as son of the enemy. Look see: if to myself I say, has a subject Pedro Pindo, neighbor of here more six leagues, man of good for all in all, he and the woman of his, always been good, of goodness. They have a son of some ten years called Valtei—name modern, is the that the population of here now appreciates, the Sir knows. Well this-little-thing, thislet, since that some understanding illuminated in him, deed demonstrated the that is: petition stepfather, acid burner, likeful of ruin of inside of the profundity of the species of its nature. In which that torments, to the slowly, of all beasts or raisinglings little that quarrel; one time he found a creole woman hooched foolish sleeping, he arranged a shard of bottle, lashed at three points on the stern of the legs of hers. The what this boy drooled seeing, is bleeding hen or to knife pig.— “I enjoy of to kill…”— one occasion he teeny me told. He opened in me a fright; because: birdy that self leans over— the flight yea is ready! Well the Sir oversee: the pa, Pedro Pindo, mode of to correct this, and the ma, they give in him, misery and mast—they cast the boy sans to eat, they tied to trees in the yard, he nude, unplumed, even in June cold, they tilled the bittybody of his with the trammel and with the goblet, after they cleansed the skin of the sanguine, with bottle gourd brine. The people know, spy, fix wasted. The boy yea relowered of thinness, the eyes entering, caress of bones, enskulled, and tuberculated, the time total hacking, coughness of the that draw parched pectorals. Arr, that now, visible, the Pindo and the woman self habituated of on him hit, of little bit in little they were creating in this a pleasure ugly of diversion— as they regulate the canings in hours certain comfortable, until they call people to see the example good. I think that boy not endure, yea there is in the ta-da, not arrive for the lent to come… Ooee-ooee, then?! Not being as compadre mine Quelemem to want, that explication is that the Sir bestowed? That boy had to be a man. He should, in swing, terrible perversities. Soul of his was in the pitch. Demonstrated. And, now, paid. Ah, but, happens, when he’s crying and paining, he suffers equal that as was as a boy good… Bird, I saw all, in this world! Yea I saw even horse with hiccups… —the that the thing most costous that is. Good, but the Sir may say, should of: and in the start— for offenses and arts, the people— as for that was that s’much amended was started? Ey, ey, ey all collided. Compadre mine Quelemem, too. Am solo a sertanite, in these high ideas I navigate mal. Am much poor poor-thing. Envy my pedigree and of ones conform the Sir, with total reading and doctoration. Not is that I be illiterate. I spelt, years and middle, midly speller, memory and palmer. I had master, Master Lucas, in the Curralinho, he memorized grammar, the operations, rule-of-three, even geography and study patria. On leaves great of paper, with caprice I traced handsome maps. Ah, not is for to speak: but, since of the start, me they thought sophisticated of side. And that I merited of to go to course latin, in Lesson Waterlily—that too they said. Time nostalgic! Going today, I appreciate a good book, despaced. On the farm The Lilittlelemon, of one mine friend Vito Soziano, so sign of this almanac thick, of logoglyphs and conundrums and other divided matters, all year come. In s’much, I place primacy is in the reading advantageous, life of saints, virtues and examples— missionary astute engambling the Indians, or Saint Francis of Assis, Saint Anthony, Saint Gerald… I like much of moral. To ratiocinate, exhort the others for the good way, to acounsel to just. Mine woman, that the Sir knows, vigils for me: much prayer. She is a blessable. Compadre mine Quelemem always says that I may to aquiet my fears on conscience, that being well-attended, terrible good-esprits me protect. Eep! With like… As is of saint effect, I help with mine to want to accredit. But not even always can I. The Sir knew: I total the mine life I thought for me, lining, I am born different. I am and I same. I divert of total the world… I almost that nothing not I know. But I disconfide of many things. The Sir, conceding, I say: in order to think long, I am dog master— the Sir loose in mine front an idea ease and I research that by profundity of total the backwoods, amen! Look: the should of to have, was of so reunited-selves the wise, politicos, constitutions graded, closed the definitive the notion— to proclaim for one time, art assemblies, that not have devil notone, not exists, not possible. Valor of law! Solo assuch, they gave tranquility good to the people. Because the government not cares?! Ah, I know that not is possible. Not me settled the Sir for philistine. One this is to place ideas arranged, other is to deal with country of people, of flesh and sanguine, of thousand-and-many miseries… S’many people—gives scare of to know—and notone so calms: All nascenting, crescendoing, so wedding, wanting collocation of employment, consumables, health, abundance, to be important, wanting rain and affairs good… Of luck that lacks of so to choose: or we t’weave of to live in the salacious common, or care solo of religion solo. I could to be: father clergyman, if not chief of jagunços; for other things not was I birthed. But mine oldness yea principaled I erred of total account. And the rheumatism… There as whom says: in the primers. Ahem. Hey? Hey? The that more I think, I testify and explain: all-the-world is mad. The Sir, I, we, the people all. For this is that so lacks principally of religion: in order to desendodorize, to disdodoate. Pray is that heals of lunacy. In the general. This is that is the salvation-of-the-soul…Much religion your servant! I here, not I lose occasion of religion. I profit of all. I drink water of all rivers… One solo, for me is little, maybe not me arrives. I pray christian, catholic, I burrow the certain; and I accept the prayers of compadre mine Quelemem, doctrine of he, of Kardec. But, when I can, I go in the Mindubim, where one Matias is believer, methodist: the people so accuse of sinner, reads high the bible, and why, singing hymns beautiful of his. Total me quiets, me suspends. Whatever small shade me refreshes. But is solo much provisory. I wanted to pray— the time total. Many people not me approve, they think that law of Deus is privileges, invariable. And I! Doof! I Detest! The what I am? — the what I do, that want, much curia. And in face of total I face, executed. I? —not I trammel. Look: I have a black girl, Maria Leoncia, long from here not she lives, the prayers of her afame much virtue of power. Well to her I pay, every month— ordering of to pray for me one third, every saint day, and, on the Sundays, a rosary. Value, so values. Mine woman not sees mal in this. And I am, yea mandated word for an other, of the voyage-voyage, a Izina Calanga, in order to come here, I heard of that prayer too with grand mermermerits, I go to effect with she treatment equal. I want handful of those, me defending in Deus, reunited of me in volta… Cuts of Christ! To live is much perilous… To want the good with too much force, of incertain way, can yea to be being so wanting the mal, per to initiate. These humans! All they pull the world for itself, for the to concert amended. But capita one solo sees and understands the things of one his world. Amountain, the most supro, most serious was Mediero Vaz. That one man ancient… his Joaozy Ben-Ben, the most brave of all, no-one never can decipher how he by inside consisted. Joca Ramiro— grand man prince!— was politico. Zé Bebelo wanted to be politico, but had and not had luck: fox that lingered. So Candelario so demonized, by to think that was with illness mal. Titao Passos was the by the appreciation of friends: solo per via of them, of his same amities, were that such high so ajagunçoed. Antonio Do— severe bandit. But by half, grand majority half that be. Andalecio, in the profound, a good man-of-good, being raving in his total justice. Ricardao, same, wanted was to be rich in peace: for this he warred. Solo the Hermogenes was that born formed tiger, and assassinite. And the “Ofidios White”? Ah, not me speak. Ah this… joyless mischeivious, that was— that was a poor boy of the destiny… So good, congruous. The Sir heard, I you told: the ruin with the ruin, they terminate by the spine-bushes so to crack— Deus awaits that spendance. Boy!: Deus is patience. The contrary, is the devil. So consumes. The Sir file knife on knife— and file— that so they scrape. Even the rocks of the profound, one of in the other, they go-so aroundabounding even, that the rivulet rolls. Per enquantity, that I think, total as hath, in this world, is because so merits and lacks. Afterly precise. Deus not so reports with rifle, not garrotes the regulation. For what? Quit: goof with goof—one day, some illumination and learn: smart. Solo that, at times, for most auxiliar, Deus begets, in the middle, a pinch of pepper… Therebe? Well, for example: some time, I went of train, there in Seven-Lagoons, for parts of to consult a medical, of name me indicated. He went vested well, and in car of first, by via of the doubts, not me they shadowed for jagunço ancient. It goes and happens, that, close same of me, enfront, he took aseat, returning from the wild North, a mac Jazevedao, delegate professionale. Came with a capanga of his, an undercover, and I well knew the two, of that s’much a was ruin, as the other ruin was. The veracity to say, first I had the strict of me to surpasss for one lonng, to mutate of my place. Judgement me told, meliorate stay. Well, looking, I looked. And— you I tell: never I saw face of man furnished of brutez or malady more, of the them in that. As that was ogre, trussed of thickset, relustered of crude in the eyes small, and armed a chin of stone, toweringbrow; not of mid nor forehead. Not laughed, not so laughed not even one time; but, speaking or silent, the people appeared always to him some teeth, prey pointed of canids. Arr, and blustered, an ittybit. Solo growled curt, low, the mid-words grizzled. He came relooking, historicizing the documents— one by one the leaves with portraits and with the blacks of the digits of jagunços, lifters of horses and criminouses of death. That application of work, in one thing of those, generated the ire in the people. The undercover, busybodyguard, total close, seated joined, attending, excelling of to be dog. Me made a dread, but solo in the goof of the corpus, not in the intern of the courages. One hour, one of those reports fell— and I bent quickly, I knew there precisely by why, not I wanted, not I thought— even today I raise shame of this— I picked the paper of the ground, and delivered to him. Thereof, I say: I had more rage, because I did that; but there yea it was done. The man not even me looked, not even said notone thankfulment. Event he soles of the shoes of his— solo looking— that soles rough thick, bent of enormous, appearing iron bronzed. Because I knew: This Jazevedao, when he apprehended someone, the primary quiet thing that proceeded was that he came entering, sans to have to to say, feigning some hurry, and go stepping on the top of the feet of the poorthings. And that on these occasions he gave laughters, gave… Well, geck! I delivered to him the leaf of paper, and went leaving of there, by to have hand on me of not to destroy by shots that subject. Meat that much they weigh… And umbilicated beginning of belly pot bellied, that me created will… With my lightness, joyful that I’d kill. But, the barbarities that this delegate made and happened, the Sir not even has callus in heart to be able me to hear. He achieved of many men and women to cry blood, for the simple universolo ours here. Sertão. The Sir knows: sertão is where mandates who is strong, with the guile. And bullet is a tidbit of metal… S’much, I say: Jazevedao— one assuch, should of to have, needed? Ah, need. Leather ruined is that calls goad of point. That there be that, after— business particular of he— in the life or in the other, each Jazevedao, accomplished the that he has, desclimbs in his time of pain, too, until to pay the that he gave— compadre mine Quelemem is there, in order to fiscalize. The Sir knows: the peril that is to live… But solo of the mode, of these, by ugly instrument, was that the jagunsaga so finished. Sir thinks that Antonio Do or Olivino Oliviano were going to fix goodies by pure spelling of itself, or by begging of the infelicitous, or by always to hear sermon of father? You I think! In the aims… Of jagunço comported active in order so to repent in the middle of his jagunsagas, solo I lay of one: called Joe Cazuzo— was in smashing of one shotshow, for on the summit of the place Sierra New, district of river rusted, on the stream Traçadal. We made mal minority small, and they closed in order summit of us the personnel of one Coronel Adalvino, forted politico, with many soldiers uniformed in the center, commanding of the Lieutenant Epiphany Helm, that after fixed captain. We lasted hour more hour, and yea gave almost of encircled. There, of misslip, that Joe Cazuzo— man much valiant— so kneeled turned on the ground of the thick, lifted the arms that not even shoots of Jatoba dry, and solo yell, howl clear and howl deaf:— “I saw the Virgin Ours, in the resplendor of the Heavens, with her children of angels!... ” He screamed not touched. — “I saw the Virgin!... ” He ensouled? We desequaled. Bolt for my horse—that I thought— I leaped in mal seat, noteven I knew in which rupture-time I unfastened the halter, of tied up it foot of timber. I flew, arrived. Bullet come. The pasture roared. In the brush, the fear of the people so goes to the whole, one fear intentional. I could to lash out, fated burro brute, giv-that, giv-that. Some two or three bullets so drovein the pad of the mine saddle, they perforated of to tear away almost much the kapok of the filling. Horse trembled in pro, in middle of gallop, I know: thinks in the owner. I not fit of to be more well shrunken. Bulleted came to the sack that I had on the back, with few mine things. And other, of fusil, in ricochet decreed, heated my thigh, sans me wound, the Sir see: bullet does the what to want—so pierced impressed, between in me and the harness! Times crazy… Burumbum!: the horse so kneeled in the fall, dead perhaps, and I yea falling for front, embraced in foliage full, branched and linias, that me swayed and skewered, done I was pendulating in web of spider… Whither? I traversed that life total… Of fear of anxiety, I ruptured to read with mine corpus that forest, I know there — and me fell world below, rolled for the hollow of a grotto closed of shrubs, always me grasped— rolled same assuch: after: after, when I saw mine hands, total on they that not was withdrawn sanguine, was smeared green, on the digits, of leaves living that I pulled and mashed… I landed on the sedge of the profound— and a beast dark gave a releap, with a sneeze, too mad of fright: that was a papa-mel, that I descried; in order to flee, this is solely. Bigger being I, me doused mine overcoat; I spigotted total. And of one bit of thought: if that beast irara lying there then there not had cobra. I took the place of his. Existed cobra notone. I could me to lose. I was solo spineless, softness, but that not deadened, inside, the collisions of the heart. I gasped. I conceived that they came, me kill. Not even did mal, me mattered not. Assuch, some moments, at least I guarded the license of term in order me to rest. Conforming I thought in Diadorim. Solo I thought was in he. One joão-congo sang. I wanted to die thinking in my friend Diadorim, hand-o-bro, who was on the Sierra of WoodO’Bow, almost on the border baiana, with our other half of the so-candelarios… With my friend Diadorim me embraced, sentiment my went-flew right for he… Ay, arr, but: that this mine mouth not has order notone. I am accounting outside, things divagated. In the Sir me confide? Til-that, til-that. Say the angel-of-the-guard… But, conforming I came: after so knew, that same the soldiers of the Lieutenant and the goats of Coronel Adalvino remitted of to respect the blast of that Joe Cazuzo. And that this ended being the man most pacificious of the world, fabricator of oil and sacristan, in the Saint Sundays White. Times! For total, cleaned revelation, I fix thinking. I like. Meliorate, for the idea if well to open, is travelling in train-of-iron. Could, lived to top and to bottom, inside of it. Information that I ask: same in the Heavens, end of end, how is that the soul wins so to forget s’much sufferments and maladies, in the received and in the given? The how? The Sir knows: are things of hideous ofmuch, have. Pain of corpus and pain of idea mark forted, that forted as the total love and rage of hate. Goes, sea… Of luck that, then, the Firmiano, by appellationed Louse-of-Snake, so leoprosized with the leg disconformed, thickening, of that disease that not so cures; and not discern almost more, constant the branchials in the eyes, of the cataracts. Of before, years, had to of so disarray of the jagunsaga. Well, one occasion, some was on the ranch of his, on the High Jeuitai, after accounted—that, turns time, comes subject, he would say: “Me give yearning is of to seize a soldier, and such, for one good flay, with knife blind… But, first, to castrate…” The Sir conceive? Who has more dose of demon in self is Indian, any race of brusque. Folk see nation ofthese, for there profound of the generals of Goias, theofwhere has vagarous grand rivers, of aquas always so clear pleasantly, running of down crystal rosed… Louse-of-Snake gave of sanguine of heathen. Sir me will say: but that he pronounced that out of mouth, manner of to represent that yet not was old decadent. Opus of to oppose, for fear of to be tame, and cause in order so to see respected. Total listened for such rule: palavered of ruins, for more so valued, because we to the environs is hard durability. The worst, but, is that they finish, through the same ford, given of one day to execute the declared, in the real. I saw s’much crudity! Pain not pays to account; if I go, I collide. And me dedrip, three that me sicken, this total. Me convokes that the personnel, today in day, is good of heart. This is, good in the trivial. Malices wildwants, and perversities, always have some, but scarcities. Generation mine, true, was not assuch. Ah, goes to turn a time, in which not is used more to kill people… I yea am old. Good, I was saying: question, this that me excavates… Ah, I formed that question, for compadre mine Quelemem. That me responded: that, for close to heaven, we so amplified so, that total the uglies past so exhaled of not to be—fated sans-modus from time of youngster, mal-arts. As we not lack of to have remorse of the which divulged in the pulsation of his nightmares of one night. Assuch that: fleeced-so, flourished-so! Ahem. For this said, is that the journey to the Heavens is delayed. I confide with compadre mine Quelemem, the Sir knows: reason of creed same that has—that, for total the mal, that so does, one day so repays, the exact. Subject assuch rises three times, in ante of to want to facilitate in any minutia reprehensible… Compadre mine Quelemem never speaks vacant, not subtreats. Solo that this to he not I go to expose. We never should have to declare that accept entire the alien—that is what is the rule of the king! The Sir look…see: the most important and beautiful, of the world, is this: that the people are not always same, still were not completed — but that they go always shifting. They tune or detune. Truth major. Is the that the life me taught. This that me animates, mound. And, other thing: the devil and the brutes; but Deus is treacherous! Ah, a beauty of treacherous— gives like! The force of his, when he wants— boy!— me gives the fear dread! Deus comes coming: no one not sees. He does in the law of gentle— assuch is the miracle. And Deus attacks beautiful, so amusing, so economizes. The well: one day in a tannery, the little knife mine I had dropped inside of a tank, solo soup of bark of tan, stryphnodendron adstringens, angico, there I know. —“Tomorrow I try…”— I said, withmyself. Because it was of night, light notone I not disputed. Ah, then, I found: on the other day, early, the knife, the iron of it, had been gnawed, almost by half, by that aqua dark, total quiet. I left, for more to see. Crack, fuse! Know the what was? Well, in that same of afternoon, there: of the little knife solo so found the handle… The handle, for not to be of cold metal, but of horn of deer. There is: Deus… Good, the Sir heard knows, the that knows me understands… We sum, not think that religion fractures. Sir think the contrary. Visible that, those other times, I painted—belief that the neoglaziovia variegata lifts the flower. Ah, good my joy… Boyhood. But boyhood is task for more later so to deny. Too, I of that of to think in vague in s’much, lost mine hand-of-man for the management hot, in the middle of all. But, today, that I ratiocinated, and think the endeavor, not nor for this not I give for low my competence, in a fire-and-iron. The to see. Would approach would come here with war on me, with bad parts, with other laws, or with excessive looks, and I even draw to ignite this zone, ay, if, if! Is in the mouth of the blunderbuss: is in the rete-te-tem… And lonelyonly not I am, there-of-the. For not this, I was I placed encircle my mine people. Look the Sir: here, close, vereda below, the Paspe — cropper my — is mine. More league, if that, have the Herpetotheres, and have the compadre Ciril, him and three children, I know that they serve. Band of that hand, the Alaripe: knew the Sir the that is that so boasts, in rifleation and by the knife, one cearense did this! After more: the João Innatal, the Quipes, Lophiosilurus-of-claws. And the Fafafa— this gave fights high, all side with me, in the combat old of the Anteater-such: we cleaned the wind of whom not had order of to respirate, and ante these we desencompassed… The Fafafa has a mass of mares. He raises horses good. Even a little more distant, on the ped-of-sierra, of band mine was the Sesfred, Jesualdo, the Nelson, and João Concliz. Some others. The Triol… And not I go valuing? I leave terra with them, of theirs the what is mine is, we close that we not even brothers. For what I want to gather richness? They are there, of arms aireated. Enemy to come, we cross called, gathering: is hour of one good shotshowerment in peace, they exp’riment to see. I say this to the Sir, of confidence. Too, not go to think in double. We want is to work, propose tranquility. Of me, person, I live for mine woman, that total mode-meliorate merits, and for the devotion. Well-to want of mine woman was that me assisted, prayers of hers, graces. Love comes of love. I say. In Diadorim, I think too— but Diadorim is the mine nebulina… Now, well: not I wanted to touch on this more— of the Tineaous; arrive. But has a nevertheless: I ask: the Sir believe, think trust of truth in that parlance, of with the demon so to able to deal with pact? No, no is no? I knew that not there. I spoke of favas. But I like of total good confirmation. To vend you proper soul… Inventionate false! And, soul, the what is? Soul of has to be thing internal supremed, much more of the of inside, and is solo, of the that one if thought: ah, soul sheer! Decision of to vend soul is fearless moll, fantasied of moment, has not the obedience legal. Can I to vend those good terras, thereof of between the Veredas-Four— that are of one Mr. Admiral, who resides in the capital federal? Can I some? Then, if one boy boy is, and for this not so authorizes of to negotiate… And we, this I know, at times is solo fated boy. Mal that in mine life I prepared, I was in a certain infancy in dreams — total runs and arrives so swift —; will be that if hath flame of responsibilities? If dream; yea so did… I gave rapadura to the chump! Ahem. Well. If his soul, and has, it is of Deus established, not even that the person want or not want. Not is vendible. The Sir not thinks? Me declare, frank, I beg. Ah, you I appreciate. You so see that the Sir knows much, in idea firm, beyond of to have letter of doctor. You I appreciate, for much. Your company me gives high pleasures. In terms, I liked that I would live here, or close, was a help. Here not so has conviviation that to instruct. Sertão. Knows the Sir: sertão is where the thought of the people so forms more forted of the than power of the place. To live is much perilous… Eh, that you so go? Yeayea? Is that not. Today, no. Tomorrow, no. Not I consense. The Sir me forgive, but in endeavor of mine friendship accept: the Sir stay. After fifth of-morning-early, the Sir wanting to go, then goes, same me leaves feeling your absence. But, today or tomorrow, no. Visit, here in house, with me, is for three days! But, the Sir really intends to trespass the field this sea of territotires, for sortment of to confer the what exists? You have your motives. Now— I say for me — the Sir comes, came late, Times were, the customs mutate. Almost that, of legitimate loyal, little surplus, not even no excess more nothing. The bands good of valientoughs they reparted their end; many who were jagunço, by ouch pain, beg alms. Same as the herdsmen they doubt of to come in the commerce vested of clothes entire of leather, they think that garb of jerkin is ugly and boor. And even the herd in the shrubbed pasture goes waning less mad, more educated: casted of zebu, dissee with the rest of corralers and captiveborns. Always, in the generals is to the poverty, to the sadness. A sadness that even gladdens. But, then, for a crop reasonable of bizzarancies, I recounsel of the Sir to entest journey more dilated. Not were my desmight, by acids and rheumatism, there I went. I guided the Sir till total. March 2013 San Diego, CA ORIGINAL TEXT NONADA. TIROS QUE O SENHOR ouviu foram de briga de homem não, Deus esteja. Alvejei mira em árvores no quintal, no baixo do córrego. Por meu acerto. Todo dia isso faço, gosto; desde mal em minha mocidade. Daí, vieram me chamar. Causa dumbezerro: um bezerro branco, erroso, os olhos de nem ser – se viu –; e com máscara de cachorro. Me disseram; eu não quis avistar. Mesmo que, por defeito como nasceu, arrebitado de beiços, esse figurava rindo feito pessoa. Cara de gente, cara de cão: determinaram – era o demo. Povo prascóvio. Mataram. Dono dele nem sei quem for. Vieram emprestar minhas armas, cedi. Não tenho abusões. O senhor ri certas risadas... Olhe: quando é tiro de verdade, primeiro a cachorrada pega a latir, instantaneamente – depois, então, se vai ver se deu mortos. O senhor tolere, isto é o sertão. Uns querem que não seja: que situado sertão é por os campos-gerais a fora a dentro, eles dizem, fim de rumo, terras altas, demais do Urucuia. Toleima. Para os de Corinto e do Curvelo, então, o aqui não é dito sertão? Ah, que tem maior! Lugar sertão se divulga: é onde os pastos carecem de fechos; onde um pode torar dez, quinze léguas, sem topar com casa de morador; e onde criminoso vive seu cristo-jesus, arredado do arrocho de autoridade. O Urucuia vem dos montões oestes. Mas, hoje, que na beira dele, tudo dá – fazendões de fazendas, almargem de vargens de bom render, as vazantes; culturas que vão de mata em mata, madeiras de grossura, até ainda virgens dessas lá há. O gerais corre em volta. Esses gerais são sem tamanho. Enfim, cada um o que quer aprova, o senhor sabe: pão ou pães, é questão de opiniães... O sertão está em toda a parte. Do demo? Não gloso. Senhor pergunte aos moradores. Em falso receio, desfalam no nome dele – dizem só: o Que-Diga. Vote! não... Quem muito se evita, se convive. Sentença num Aristides – o que existe no buritizal primeiro desta minha mão direita, chamado a Vereda-da-Vaca-Mansa-deSanta-Rita – todo o mundo crê: ele não pode passar em três lugares, designados: porque então a gente escuta um chorinho, atrás, e uma vozinha que avisando: – “Eu já vou! Eu já vou!...” – que é o capiroto, o que-diga... E um José Simpilício – quem qualquer daqui jura ele tem um capeta em casa, miúdo satanazim, preso obrigado a ajudar em toda ganância que executa; razão que o Simpilício se empresa em vias de completar de rico. Apre, por isso dizem também que a besta pra ele rupeia, nega de banda, não deixando, quando ele quer amontar... Superstição. José Simpilício e Aristides, mesmo estão se engordando, de assim nãoouvir ou ouvir. Ainda o senhor estude: agora mesmo, nestes dias de época, tem gente porfalando que o Diabo próprio parou, de passagem, no Andrequicé. Um Moço de fora, teria aparecido, e lá se louvou que, para aqui vir – normal, a cavalo, dum dia-e-meio – ele era capaz que só com uns vinte minutos bastava... porque costeava o Rio do Chico pelas cabeceiras! Ou, também, quem sabe – sem ofensas – não terá sido, por um exemplo, até mesmo o senhor quem se anunciou assim, quando passou por lá, por prazido divertimento engraçado? Há-de, não me dê crime, sei que não foi. E mal eu não quis. Só que uma pergunta, em hora, às vezes, clareia razão de paz. Mas, o senhor entenda: o tal moço, se há, quis mangar. Pois, hem, que, despontar o Rio pelas nascentes, será a mesma coisa que um se redobrar nos internos deste nosso Estado nosso, custante viagem de uns três meses... Então? Que-Diga? Doideira. A fantasiação. E, o respeito de dar a ele assim esses nomes de rebuço, é que é mesmo um querer invocar que ele forme forma, com as presenças! Não seja. Eu, pessoalmente, quase que já perdi nele a crença, mercês a Deus; é o que ao senhor lhe digo, à puridade. Sei que é bem estabelecido, que grassa nos Santos- Evangelhos. Em ocasião, conversei com um rapaz seminarista, muito condizente, conferindo no livro de rezas e revestido de paramenta, com uma vara de maria-preta na mão – proseou que ia adjutorar o padre, para extraírem o Cujo, do corpo vivo de uma velha, na Cachoeira-dos-Bois, ele ia com o vigário do Campo-Redondo... Me concebo. O senhor não é como eu? Não acreditei patavim. Compadre meu Quelemém descreve que o que revela efeito são os baixos espíritos descarnados, de terceira, fuzuando nas piores trevas e com ânsias de se travarem com os viventes – dão encosto. Compadre meu Quelemém é quem muito me consola – Quelemém de Góis. Mas ele tem de morar longe daqui, na Jijujã, Vereda do Buriti Pardo... Arres, me deixe lá, que – em endemoninhamento ou com encosto – o senhor mesmo deverá de ter conhecido diversos, homens, mulheres. Pois não sim? Por mim, tantos vi, que aprendi. Rincha- Mãe, Sangued’Outro, o Muitos-Beiços, o Rasgaem-Baixo, Faca-Fria, o Fancho-Bode, um Treciziano, o Azinhavre... o Hermógenes... Deles, punhadão. Se eu pudesse esquecer tantos nomes... Não sou amansador de cavalos! E, mesmo, quem de si de ser jagunço se entrete, já é por alguma competência entrante do demônio. Será não? Será? De primeiro, eu fazia e mexia, e pensar não pensava. Não possuía os prazos. Vivi puxando difícil de dificel, peixe vivo no moquém: quem mói no asp’ro, não fantaseia. Mas, agora, feita a folga que me vem, e sem pequenos dessossegos, estou de range rede. E me inventei neste gosto, de especular idéia. O diabo existe e não existe? Dou o dito. Abrenúncio. Essas melancolias. O senhor vê: existe cachoeira; e pois? Mas cachoeira é barranco de chão, e água se caindo por ele, retombando; o senhor consome essa água, ou desfaz o barranco, sobra cachoeira alguma? Viver é negócio muito perigoso... Explico ao senhor: o diabo vige dentro do homem, os crespos do homem – ou é o homem arruinado, ou o homem dos avessos. Solto, por si, cidadão, é que não tem diabo nenhum. Nenhum! – é o que digo. O senhor aprova? Me declare tudo, franco – é alta mercê que me faz: e pedir posso, encarecido. Este caso – por estúrdio que me vejam – é de minha certa importância. Tomara não fosse... Mas, não diga que o senhor, assisado e instruído, que acredita na pessoa dele?! Não? Lhe agradeço! Sua alta opinião compõe minha valia. Já sabia, esperava por ela-já o campo! Ah, a gente, na velhice, carece de ter sua aragem de descanso. Lhe agradeço. Tem diabo nenhum. Nem espírito. Nunca vi. Alguém devia de ver, então era eu mesmo, este vosso servidor. Fosse lhe contar... Bem, o diabo regula seu estado preto, nas criaturas, nas mulheres, nos homens. Até: nas crianças – eu digo. Pois não é ditado: “menino – trem do diabo”? E nos usos, nas plantas, nas águas, na terra, no vento... Estrumes. ... O diabo na rua, no meio do redemunho... Hem? Hem? Ah. Figuração minha, de pior pra trás, as certas lembranças. Mal hajame! Sofro pena de contar não... Melhor, se arrepare: pois, num chão, e com igual formato de ramos e folhas, não dá a mandioca mansa, que se come comum, e a mandioca-brava, que mata? Agora, o senhor já viu uma estranhez? A mandioca-doce pode de repente virar azangada – motivos não sei; às vezes se diz que é por replantada no terreno sempre, com mudas seguidas, de manaíbas – vai em amargando, de tanto em tanto, de si mesma toma peçonhas. E, ora veja: a outra, a mandiocabrava, também é que às vezes pode ficar mansa, a esmo, de se comer sem nenhum mal. E que isso é? Eh, o senhor já viu, por ver, a feiúra de ódio franzido, carantonho, nas faces duma cobra cascavel? Observou o porco gordo, cada dia mais feliz bruto, capaz de, pudesse, roncar e engolir por sua suja comodidade o mundo todo? E gavião, corvo, alguns, as feições deles já representam a precisão de talhar para adiante, rasgar e estraçalhar a bico, parece uma quicé muito afiada por ruim desejo. Tudo. Tem até tortas raças de pedras, horrorosas, venenosas – que estragam mortal a água, se estão jazendo em fundo de poço; o diabo dentro delas dorme: são o demo. Se sabe? E o demo – que é só assim o significado dum azougue maligno – tem ordem de seguir o caminho dele, tem licença para campear?! Arre, ele está misturado em tudo. Que o que gasta, vai gastando o diabo de dentro da gente, aos pouquinhos, é o razoável sofrer. E a alegria de amor – compadre meu Quelemém, diz. Família. Deveras? É, e não é. O senhor ache e não ache. Tudo é e não é... Quase todo mais grave criminoso feroz, sempre é muito bom marido, bom filho, bom pai, e é bom amigo-de-seus-amigos! Sei desses. Só que tem os depois – e Deus, junto. Vi muitas nuvens. Mas, em verdade, filho, também, abranda. Olhe: um chamado Aleixo, residente a légua do Passo do Pubo, no da-Areia, era o homem de maiores ruindades calmas que já se viu. Me agradou que perto da casa dele tinha um açudinho, entre as palmeiras, com traíras, pra-almas de enormes, desenormes, ao real, que receberam fama; o Aleixo dava de comer a elas, em horas justas, elas se acostumaram a se assim das locas, para papar, semelhavam ser peixes ensinados. Um dia, só por graça rústica, ele matou um velhinho que por lá passou, desvalido rogando esmola. O senhor não duvide – tem gente, neste aborrecido mundo, que matam só para ver alguém fazer careta... Eh, pois, empós, o resto o senhor prove: vem o pão, vem a mão, vem o são, vem o cão. Esse Aleixo era homem afamilhado, tinha filhos pequenos; aqueles eram o amor dele, todo, despropósito. Dê bem, que não nem um ano estava passado, de se matar o velhinho pobre, e os meninos do Aleixo aí adoeceram. Andaço de sarampão, se disse, mas complicado; eles nunca saravam. Quando, então, sararam. Mas os olhos deles vermelhavam altos, numa inflama de sapiranga à rebelde; e susseguinte – o que não sei é se foram todos duma vez, ou um logo e logo outro e outro – eles restaram cegos. Cegos, sem remissão dum favinho de luz dessa nossa! O senhor imagine: uma escadinha – três meninos e uma menina – todos cegados. Sem remediável. O Aleixo não perdeu o juizo; mas mudou: ah, demudou completo – agora vive da banda de Deus, suando para ser bom e caridoso em todas suas horas da noite e do dia. Parece até que ficou o feliz, que antes não era. Ele mesmo diz que foi um homem de sorte, porque Deus quis ter pena dele, transformar para lá o rumo de sua alma. Isso eu ouvi, e me deu raiva. Razão das crianças. Se sendo castigo, que culpa das hajas do Aleixo aqueles meninozinhos tinham?! Compadre meu Quelemém reprovou minhas incertezas. Que, por certo, noutra vida revirada, os meninos também tinham sido os mais malvados, da massa e peça do pai, demônios do mesmo caldeirão de lugar. Senhor o que acha? E o velhinho assassinado? – eu sei que o senhor vai discutir. Pois, também. Em ordem que ele tinha um pecado de crime, no corpo, por pagar. Se a gente – conforme compadre meu Quelemém é quem diz – se a gente torna a encarnar renovado, eu cismo até que inimigo de morte pode vir como filho do inimigo. Mire veja: se me digo, tem um sujeito Pedro Pindó, vizinho daqui mais seis léguas, homem de bem por tudo em tudo, ele e a mulher dele, sempre sidos bons, de bem. Eles têm um filho duns dez anos, chamado Valtei – nome moderno, é o que o povo daqui agora apreceia, o senhor sabe. Pois essezinho, essezim, desde que algum entendimento alumiou nele, feito mostrou o que é: pedido madrasto, azedo queimador, gostoso de ruim de dentro do fundo das espécies de sua natureza. Em qual que judia, ao devagar, de todo bicho ou criaçãozinha pequena que pega; uma vez, encontrou uma crioula bentabêbada dormindo, arranjou um caco de garrafa, lanhou em três pontos a popa da perna dela. O que esse menino babeja vendo, é sangrarem galinha ou esfaquear porco. – “Eu gosto de matar...” – uma ocasião ele pequenino me disse. Abriu em mim um susto; porque: passarinho que se debruça – o vôo já está pronto! Pois, o senhor vigie: o pai, Pedro Pindó, modo de corrigir isso, e a mãe, dão nele, de miséria e mastro – botam o menino sem comer, amarram em árvores no terreiro, ele nu nuelo, mesmo em junho frio, lavram o corpinho dele na peia e na taca, depois limpam a pele do sangue, com cuia de salmoura. A gente sabe, espia, fica gasturado. O menino já rebaixou de magreza, os olhos entrando, carinha de ossos, encaveirada, e entisicou, o tempo todo tosse, tossura da que puxa secos peitos. Arre, que agora, visível, o Pindó e a mulher se habituaram de nele bater, de pouquinho em pouquim foram criando nisso um prazer feio de diversão – como regulam as sovas em horas certas confortáveis, até chamam gente para ver o exemplo bom. Acho que esse menino não dura, já está no blimbilim, não chega para a quaresma que vem... Uê-uê, então?!Não sendo como compadre meu Quelemém quer, que explicação é que o senhor dava? Aquele menino tinha sido homem. Devia, em balanço, terríveis perversidades. Alma dele estava no breu. Mostrava. E, agora, pagava. Ah, mas, acontece, quando está chorando e penando, ele sofre igual que se fosse um menino bonzinho... Ave, vi de tudo, neste mundo! lá vi até cavalo com soluço... – o que é a coisa mais custosa que há. Bem, mas o senhor dirá, deve de: e no começo – para pecados e artes, as pessoas – como por que foi que tanto emendado se começou? Ei, ei, aí todos esbarram. Compadre meu Quelemém, também. Sou só um sertanejo, nessas altas idéias navego mal. Sou muito pobre coitado. Inveja minha pura é de uns conforme o senhor, com toda leitura e suma doutoração. Não é que eu esteja analfabeto. Soletrei, anos e meio, meante cartilha, memória e palmatória. Tive mestre, Mestre Lucas, no Curralinho, decorei gramática, as operações, regra-de-três, até geografia e estudo pátrio. Em folhas grandes de papel, com capricho tracei bonitos mapas. Ah, não é por falar: mas, desde o começo, me achavam sofismado de ladino. E que eu merecia de ir para cursar latim, em Aula Régia – que também diziam. Tempo saudoso! Inda hoje, apreceio um bom livro, despaçado. Na fazenda O Limãozinho, de um meu amigo Vito Soziano, se assina desse almanaque grosso, de logogrifos e charadas e outras divididas matérias, todo ano vem. Em tanto, ponho primazia é na leitura proveitosa, vida de santo, virtudes e exemplos – missionário esperto engambelando os índios, ou São Francisco de Assis, Santo Antônio, São Geraldo... Eu gosto muito de moral. Raciocinar, exortar os outros para o bom caminho, aconselhar a justo. Minha mulher, que o senhor sabe, zela por mim: muito reza. Ela é uma abençoável. Compadre meu Quelemém sempre diz que eu posso aquietar meu temer de consciência, que sendo bem-assistido, terríveis bons-espíritos me protegem. Ipe! Com gosto... Como é de são efeito, ajudo com meu querer acreditar. Mas nem sempre posso. O senhor saiba: eu toda a minha vida pensei por mim, forro, sou nascido diferente. Eu sou é eu mesmo. Diverjo de todo o mundo... Eu quase que nada não sei. Mas desconfio de muita coisa. O senhor concedendo, eu digo: para pensar longe, sou cão mestre – o senhor solte em minha frente uma idéia ligeira, e eu rastreio essa por fundo de todos os matos, amém! Olhe: o que devia de haver, era de se reunirem-se os sábios, políticos, constituições gradas, fecharem o definitivo a noção – proclamar por uma vez, artes assembléias, que não tem diabo nenhum, não existe, não pode. Valor de lei! Só assim, davam tranqüilidade boa à gente. Por que o Governo não cuida?! Ah, eu sei que não é possível. Não me assente o senhor por beócio. Uma coisa é pôr idéias arranjadas, outra é lidar com país de pessoas, de carne e sangue, de mil-e-tantas misérias... Tanta gente – dá susto de saber – e nenhum se sossega: todos nascendo, crescendo, se casando, querendo colocação de emprego, comida, saúde, riqueza, ser importante, querendo chuva e negócios bons... De sorte que carece de se escolher: ou a gente se tece de viver no safado comum, ou cuida só de religião só. Eu podia ser: padre sacerdote, se não chefe de jagunços; para outras coisas não fui parido. Mas minha velhice já principiou, errei de toda conta. E o reumatismo... Lá como quem diz: nas escorvas. Ahã. Hem? Hem? O que mais penso, testo e explico: todo-omundo é louco. O senhor, eu, nós, as pessoas todas. Por isso é que se carece principalmente de religião: para se desendoidecer, desdoidar. Reza é que sara da loucura. No geral. Isso é que é a salvaçãoda- alma... Muita religião, seu moço! Eu cá, não perco ocasião de religião. Aproveito de todas. Bebo água de todo rio... Uma só, para mim é pouca, talvez não me chegue. Rezo cristão, católico, embrenho a certo; e aceito as preces de compadre meu Quelemém, doutrina dele, de Cardéque. Mas, quando posso, vou no Mindubim, onde um Matias é crente, metodista: a gente se acusa de pecador, lê alto a Bíblia, e ora, cantando hinos belos deles. Tudo me quieta, me suspende. Qualquer sombrinha me refresca. Mas é só muito provisório. Eu queria rezar – o tempo todo. Muita gente não me aprova, acham que lei de Deus é privilégios, invariável. E eu! Bofe! Detesto! O que sou? – o que faço, que quero, muito curial. E em cara de todos faço, executado. Eu não tresmalho! Olhe: tem uma preta, Maria Leôncia, longe daqui não mora, as rezas dela afamam muita virtude de poder. Pois a ela pago, todo mês – encomenda de rezar por mim um terço, todo santo dia, e, nos domingos, um rosário. Vale, se vale. Minha mulher não vê mal nisso. E estou, já mandei recado para uma outra, do Vau-Vau, uma Izina Calanga, para vir aqui, ouvi de que reza também com grandes meremerências, vou efetuar com ela trato igual. Quero punhado dessas, me defendendo em Deus, reunidas de mim em volta... Chagas de Cristo! Viver é muito perigoso... Querer o bem com demais força, de incerto jeito, pode já estar sendo se querendo o mal, por principiar. Esses homens! Todos puxavam o mundo para si, para o concertar consertado. Mas cada um só vê e entende as coisas dum seu modo. Montante, o mais supro, mais sério – foi Medeiro Vaz. Que um homem antigo... Seu Joãozinho Bem-Bem, o mais bravo de todos, ninguém nunca pôde decifrar como ele por dentro consistia. Joca Ramiro – grande homem príncipe! – era político. Zé- Bebelo quis ser político. (shrink)

International Humanitarian Law mandates that all wounded in war, no matter which party they belong to, shall receive aid in accordance with their medical condition, and that “there shall be no distinction among them founded on any grounds other than medical ones.” This principle of impartiality is endorsed by various other military and civilian institutions worldwide to include the ICRC, the US Department of Defense, and the American Medical Association. In this essay, I argue that in some cases, we ought, (...) morally speaking, to triage based on factors beyond one’s medical condition. More specifically, I argue that in these cases, we ought to triage, at least partly, based on one’s moral responsibility for one’s current medical predicament. I call this view Triage by Moral Responsibility (TMR). I support my argument for TMR by demonstrating its plausibility when applied to cases of medical treatment and disaster relief, and by drawing parallels between these situations and those considered in the ethics of defensive harming. I conclude by discussing the practicality of my moral conclusion for the practice of medical triage in pandemics and war. (shrink)

Proposes that postmodernist inquiries regarding power and authority have contributed to the adoption by some psychologists of discursive stances that are fundamentally ethical. Two of the most important schools defined by their employment of an ethical logic are feminist psychology and multicultural therapy, both of which offer "ethico-therapeutic" treatment modalities to clients perceived to be suffering from psychological wounds caused by some kind of power inequity. Essential to the success of such therapy for clients is the demand by (...) psychologists for changes not only from clients, but from the general society. The authors conclude that the continued development of ethical discourses within psychology may help to meet many of the challenges to psychological well-being in the postmodern era. 2012 APA, all rights reserved). (shrink)

Sinologists as Translators in the Seventeenth to Nineteenth Centuries. Edited by Lawrence Wangchi Wong and Bernhard Fuehrer. Hong Kong: Research Centre for Translation, Chinese University Press, 2015. Pp. xx + 440. $52.

Rambam Medical Center, the only tertiary care center and largest hospital in northern Israel, was subjected to continuous rocket attacks in 2006. This extreme situation posed serious and unprecedented ethical dilemmas to the hospital management. An ambiguous situation arose that required routine patient care in a tertiary modern hospital together with implementation of emergency measures while under direct fire. The physicians responsible for hospital management at that time share some of the moral dilemmas faced, the policy they chose to follow, (...) and offer a retrospective critical reflection in this paper. The hospital’s first priority was defined as delivery of emergency surgical and medical services to the wounded from the battlefields and home front, while concomitantly providing the civilian population with all elective medical and surgical services. The need for acute medical service was even more apparent as the situation of conflict led to closure of many ambulatory clinics, while urgent or planned medical care such as open heart surgery and chemotherapy continued. The hospital management took actions to minimize risks to patients, staff, and visitors during the ongoing attacks. Wards were relocated to unused underground spaces and corridors. However due to the shortage of shielded spaces, not all wards and patients could be relocated to safer areas. Modern warfare will most likely continue to involve civilian populations and institutes, blurring the division between peaceful high-tech medicine and the rough battlefront. Hospitals in high war-risk areas must be prepared to function and deliver treatment while under fire or facing similar threats. (shrink)

In the Philosophy of Right, Hegel claims that crime is a negation of right and punishment is the “negation of the negation.” Punishment, for Hegel, “annuls” the criminal act. Many take it that Hegel endorses a form of retributivism—the theory that criminal offenders should be subject to harsh treatment in response and in proportion to their wrongdoing. Here I argue that restorative criminal justice is consistent with Hegel's remarks on punishment and his overall philosophical system. This is true, in (...) part, because restorative justice integrates Hegel's instructive discussion of confession and forgiveness in the Phenomenology of Spirit. Hegel claims that true moral relationships allow space for persons to confess their moral shortcomings and forgive the shortcomings of others. Restorative criminal justice brings the perpetrators and victims of crime together to offer confessions and forgiveness and to work to heal the various wounds caused by crime. I do not claim that Hegel must be read as advocating restorative justice. While Hegel tells us what punishment does, he does not commit himself to any form of punishment. What I offer here is a rational, progressive reconstruction and extension of Hegel's conception of crime and punishment. (shrink)

Seriously engaging with the needs, hardships, and aspirations of future generations is an emotional experience as much as an intellectual endeavor. In this essay we describe a guided visualization exercise used to overcome the emotional barriers that often prevent us from dealing effectively with intergenerational decisions. The meditation and dreaming technique was applied to a diverse group of researchers who engaged in a visualized encounter with future generations. Following the exercise, we concluded that a serious analysis of intergenerational conflict requires (...) us to confront our own mortality. Also, somewhat surprisingly to workshop participants, our desire to become stewards of the planet was driven by our fear of death as well as our egoist yearning for immortality. We posit that imagining the unknown with visioning practices might increase our emotional resilience, and hence improve our ability to confront the burdens of intergenerational responsibility. (shrink)

Mitchell et al. contend that there is no need to posit a contribution based on the formation of associative links to human learning. In order to sustain this argument, they have ignored evidence which is difficult to explain with propositional accounts; and they have mischaracterised the evidence they do cite by neglecting features of these experiments that contradict a propositional account.

Little is known about employee reactions in the form of un/ethical behavior to perceived acts of unfairness toward their peers perpetrated by the supervisor. Based on prior work suggesting that third parties also make fairness judgments and respond to the way employees are treated, this study first suggests that perceptions of interactional justice for peers (IJP) lead employees to two different responses to injustice at work: deviant workplace behaviors (DWBs) and organizational citizenship behaviors (OCBs). Second, based on prior literature pointing (...) to supervisors as among the most important sources of moral guidance at work, a mediating role is proposed for ethical leadership. The article suggests that supervisors who inflict acts of injustice on staff will be perceived as unethical leaders, and that these perceptions would explain why employees react to IJP in the form of deviance (DWBs) and citizenship (OCBs). Data were collected from 204 hotel employees. Results of structural equation modeling demonstrate that DWBs and OCBs are substantive reactions to IJP, whereas ethical leadership significantly mediates reactions in the form of DWBs and OCBs. Behavioral ethics and managerial implications are discussed. (shrink)

Neurosurgery for psychiatric disorders, also sometimes referred to as psychosurgery, is rapidly evolving, with new techniques and indications being investigated actively. Many within the field have suggested that some form of guidelines or regulations are needed to help ensure that a promising field develops safely. Multiple countries have enacted specific laws regulating NPD. This article reviews NPD-specific laws drawn from North and South America, Asia and Europe, in order to identify the typical form and contents of these laws and to (...) set the groundwork for the design of an optimal regulation for the field. Key challenges for this design that are revealed by the review are how to define the scope of the law, what types of regulations are required, and how to approach international harmonization given the potential migration of researchers and patients. (shrink)

The discovery of penicillin by Alexander Fleming in 1928 revolutionized the way infections were treated. In the context of World War II, the government of the United States politicized the production and use of penicillin as yet another weapon to win the war. It was carefully rationed on the home front, while being used with reckless abandon in the treatment battle wounds and venereal diseases on the battlefield. Penicillin was described as a miracle drug that would be able (...) to cure everyone, when in reality it was only being used to benefit the military and the American war effort, at the expense of civilian lives. (shrink)

The aim of the study was to determine how the health of people living with Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) is affected by social and structural factors conducive to non-adherence to antiretroviral treatment. In a qualitative study conducted at Victoria Hospital in Alice, a town in the Eastern Cape, South Africa, 23 isiXhosa-speaking participants (including both men and women) between the ages of 18 and 60 years were interviewed. Guided by the social-ecological framework of Bronfenbrenner (...) (1979), which is based on the notion that the health-seeking behaviour of people living with HIV/AIDS (PLWHA) is influenced by their social, institutional and physical environments, the analysis of the data identified the following themes conducive to non-adherence to antiretroviral treatment: food insecurity, financial constraints, poor service from health workers, unfair dismissal, fear of the consequences of disclosure, and rejection by church members. Based on these findings, and given that there is no single model of best practice that can appropriately address the various social and structural factors complicating the treatment of HIV/AIDS and hence the containing of the pandemic, the study suggests the need for not only supportive community initiatives, but a collaborative approach at both local and national level, and particularly in impoverished communities, by the appropriate departments of state to promote adherence to anti-retroviral treatment by making treatment and counselling facilities more accessible to PLWHA and educating communities about the implications and prevention of the disease. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:From Parnassus to EdenChristopher McDonoughFor Rebekah SmithIn these pages some seven years ago, Robert Renehan (1992) discussed the passage from book 19 of the Odyssey in which the young Odysseus’ cousins sing a healing incantation over his wound in the wilderness of Mount Parnassus. 1 Renehan was specifically interested in bringing to light the Old Irish comparanda, so as to display the Indo-European roots of this particular form of (...) magical healing; he was clear in stating, nonetheless, that such practices are found in many other parts of the world. To encounter this custom, however, it is not necessary to study ancient Ireland or Greece, as I discovered by surprise in class one day.When lecturing on the Odyssey in the past, I have always enjoyed lingering over this particular scene, presenting to students Erich Auerbach’s ideas on mimesis as well as more general folkloric material. 2 In addition to the Irish evidence adduced by Renehan, I have usually mentioned anecdotes about the brauchers (wizards) of the Pennsylvania Dutch, some of whom could still blood by chanting—even over the telephone (see Dorson 1964, 115). Thus it was, in the fall of 1995, that I was giving a guest lecture on book 19 for a classical mythology class at the University of North Carolina at Greensboro. I had just finished reciting some of the stories above, when a student raised his hand to ask, “Is that anything like talking out fire?” Before I could respond, another student also spoke up. “I was thinking that, too,” she said.A few others were nodding their heads in recognition, though the majority of the class looked perplexed. I certainly was, since I had no idea what they were talking about. The first student explained that he [End Page 297] was from Eden, North Carolina, a Piedmont town near the Virginia border; that, in this area, there were old women who could talk out fire; that, if a person had been burned, such a woman could be hired to speak to the fire and convince it to leave the body; that his own grandmother was such a woman; and that he himself as a child had had a burn talked out of his hand, which hand—the very hand he had raised!—he now raised again as dramatic testimony of the treatment. A few other students said that they too were familiar with the custom, though none had quite so intimate a familiarity as he.In the days that followed I did a little research on the topic, fearing that I may have been hoodwinked by some true son of crafty Autolykos. But his story checked out: the phenomenon of “talking the fire out of a burn” is well attested in North Carolina and throughout the South. 3 While folklorists have collected many accounts of this type of healing, perhaps the most vivid description is given by Southern writer Harry Crews. In A Childhood: The Biography of a Place (1978 = 1993, 17–170), a memoir of his upbringing in Depression-era rural Georgia, the author relates that, while playing as a boy, he had fallen into a cast-iron tub filled with boiling water for skinning hogs; over two-thirds of his body was scalded and, he recalls, the skin of his left hand came off “like a wet glove.” His family was too remote and too poor for a hospital trip, and had to rely on some makeshift arrangements set up by the local doctor. Shortly thereafter, however, they were visited by a rough character named Hollis Toomey, known throughout the area for his ability to talk out fire. Crews recounts what happened next:Hollis Toomey’s voice was low like the quiet rasping of a file on metal. I couldn’t hear most of what he had to say, but that was all right because I stopped burning before he ever started talking. He talked to the fire like an old and respected adversary, but one he had beaten consistently and had come to beat again. I don’t remember him once looking at my face while he explained: “Fire, this boy is mine. This bed is mine... (shrink)

In this short commentary, I reflect on the new definition of disease proposed by Powell and Scarffe. I suggest that the method they appeal to as objective, namely, rational justification, is open to several criticisms, which I outline and discuss.

This monograph consists of five parts: (1) introductory material including a conference overview; (2) papers presented at an international symposium on the topic of ethical issues in disability and rehabilitation as a section of the Annual Conference of the Society for Disability Studies; (3) responses to the symposium, prepared by four of the participants; (4) selected additional papers which offer views from perspectives or cultures not represented at the Denver conference; and (5) an annotated international bibliography. Representatives from 10 countries (...) discussed ethical issues and decision making in disability and rehabilitation. Conference papers include: "Genetic Engineering--The New Eugenics? Evolving Medical Attitudes towards the Quality of Life" (Hugh Gallagher);"Description of the Decision-Making Project" (Daryl Evans); "Treatment and Nontreatment Decisions with Respect to Extremely Premature, Very Low Birthweight Infants (500-750g)" (Ernle Young); "Allocation of Resources and Distributive Justice" (John Mather); "Quality Assurance as an Aid to Ethical Decision Making in Disability Management: Lessons from Recent Ethical Issues Involving Disadvantaged Groups in New Zealand" (Peter Gow); "Disability and Ethical Issues: A Point of View from the Netherlands" (Yolan Koster-Dreese); "Who Shall Live or How Shall They Live? Consumer and Professional Perspectives on Treatment/Non-Treatment Decisions" (Joseph Kaufert and Patricia Kaufert); and "Debates across Social Movements on Reproductive Technologies, Genetic Engineering, and Eugenics" (Theresia Degener). Conference commentaries include: "The Meeting of Disability and Bioethics: A Beginning Rapprochement" (Adrienne Asch); "A Plea for More Dialogue: Commentary on Ethics Conference" (Robert Slater); "Healing Our Wounds" (Martha Lentz Walker); "Theories and Values: Ethics and Contrasting Perspectives on Disability" (Harlan Hahn); and "Current Example of Ethical Dilemma" (Susan Lacetti). Selected additional papers include: "High-tech Medicine Is Basic Care" (Frederick Abrams); "Prevention of Disabilities as a Medical Question" (G. Schioler); "The Ethics of Disability Prevention: A Parent's Point of View" (Mrs. J. Baker); "A Reference Matrix for Issues of Life and Personhood" (Mike Miles); "Nazi Scientists and Ethics of Today" (Isabel Wilkerson); "Ethical and Policy Issues in Rehabilitation Medicine (Hastings Center Report)" (Arthur Caplan et al.); and "Differing Approaches to Prevention of Disability and Treatment of Impaired Infants Creates Controversies Worldwide" (Barbara Duncan). (JDD). (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Nature of Proof in PsychiatryPaul Lieberman (bio)Keywordspsychotherapy process, knowledge and psychiatry, externalism, WittgensteinThis vivid clinical report illustrates recognizably, and provocatively, a number of routine, but often unexamined, clinical questions. In its few paragraphs, it depicts challenges that each practitioner confronts, and, in the flux of clinical work, addresses, however implicitly and imperfectly, every day: From what data, and by what processes, does a clinical formulation, or way of (...) understanding, come into being? How do we appraise its accuracy and adequacy? Of what value is even a well-substantiated understanding, in the mind of the therapist, to the patient? What is the power of empathy as a treatment tool? How do we assess someone's status as a “good candidate for therapy?” When, typically, only the outlines of a problem are visible, and its origins and implications are largely hidden, by what right do we recommend psychotherapy, and with what conception, at what level of detail, of what its outcome will be? These are among the questions that Dr. Bailey's story challenges us to address.They are clinical questions, of course, because they deal with empirical matters of fact—psychological processes, outcomes studies, and evidence. But they are also philosophical because, as Freud insisted and Dr. Bailey shows, information obtained in the clinical situation often has power and authority that lead us to believe we understand what is going on, understand the other person, even in the absence of scientifically tested hypotheses, or the clear application of research-based evidence. Interactions between people—including clinical interactions—have a life and ability to engage us. Their meanings can seem so transparent and convincing that no doubt or questioning may seem cogent. At their most powerful, such experiences can reawaken us to important realms of experience and feeling which we might, otherwise, forget, ignore, suppress, deny, or in other ways keep out of awareness; they have the potential to arouse us and reconnect us with truths that, once revived, can seem both valid and important—perhaps the kind of experience that we may derive from works of art or literature (in fact, Dr. Bailey's account could be seen as a clinical parable—meant to be neither true nor false, but instructive). But even less dramatic examples are commonplace: we do routinely claim to know and be able to interpret and understand the actions of other people from our everyday interactions with and observations of them.What is less clear is how to account for these convictions and how to appraise their value, because they do not derive from established scientific procedures. Clinical intuition has a role throughout medicine, but we usually expect it to be subjected later to more rigorous tests to establish the correct diagnosis. Yet, as Dr. Bailey's case illustrates, clinical intuition in the psychiatric encounter seems somehow different. When Colin [End Page 225] leads Dr. Bailey to the conclusion that a “painful lack of wounds” has made him depressed, we find this credible. It seems similarly credible that Dr. Bailey might be anxious about his own capacity to defend his young family, because he says he is, that he perceives Colin as testing his manhood or sincerity, because that seems to fit Colin's temperament, that being accurately understood is helpful, because most of us have had that experience and valued it, and that, most generally, an absence of challenge or of activity could be depressing. But suppose a patient believed that a painful lack of wounds produced diabetes instead of depression, or suppose he had developed epilepsy and attributed that to an absence of combat experience. We might see these as ‘pre-scientific’ or ‘hypothesis-generating’ (or worse). By contrast, it seems timid to consider psychiatric formulations to be always and only provisional or hypothetical.In what ways and to what extent should we expect psychiatry to be different, and why? Several considerations suggest that psychiatry's reasons are not, always and everywhere, the same as those of general medicine, nor are its objectives.In general medicine, we distinguish between signs and symptoms, on the one hand, and “underlying” disease processes, on the other. But in psychiatry, this distinction can be... (shrink)

This essay investigates the way in which dying and dead bodies resist poetic incorporation and the way in which such bodies can be fugitively attested to through fictive prose. It examines Heidegger's treatment of dead and dying bodies from Being and Time to his later work on poetry and language, and it offers as a counterpoint another mode of addressing these bodies found in the fiction of Poe. It also shows how even the poetry of Trakl, heralded by Heidegger (...) as an exemplar of poetic address, can be fruitfully understood in prosaic terms, terms which more faithfully reveal both the content of his poetry itself as well as the true nature of the wounds of dying life. (shrink)

La guérison prouve-t-elle l’effectivité d’une théorie médicale ? Après avoir suivi un traitement médical, suffit-il d’« aller mieux » pour conclure que le médicament a été efficace ? En posant un regard épistémologique sur l’histoire de la cure à distance des blessures par l’unguentum armarium, nous analysons la manière dont la médecine philosophique des XVIe et XVIIe siècles a traité ces questions. Chez Andrea Libavius la réflexion concernant les pouvoirs de l’imagination sur le corps et sur les mécanismes naturels d’autoguérison (...) s’avère être particulièrement féconde à ce sujet. Elle souligne la différence entre les plans physiologique et fictionnel d’un traitement, tout en admettant leur complémentarité.Does the healing prove the effectiveness of a medical theory ? After completing a medical treatment, may we conclude that the remedy was effective just because we « get better » ? An epistemological approach upon the history of the magnetic treatment of wounds by the weapon salve shows how some doctors and philosophers of the 16th and the 17th centuries deal with these issues. Andrea Libavius’ reflection on the powers of imagination on the body and on the natural mechanisms of healing is particularly fruitful in this regard. It stresses the difference between the physiological and fictional plans of a treatment, while acknowledging their complementarity. (shrink)

In lieu of an abstract, here is a brief excerpt of the content: -/- I gathered it in my hands as it fell from my hair-brush, too saturated to hold anymore. It felt as if I were inside a movie and waiting for someone to yell “Cut!” but no call came. It continued to fall, feather-like onto the ground, individual strands glinting in the light of the bathroom window. My hair, nearly all of it, was gone. Between the time of (...) my heart transplant and the moment my hair began to fall out, I arguably had suffered enough. Transplant brought four open-heart surgeries, ten days on ECMO, an intra-aortic balloon pump, delirium, necrotizing pneumonia, and so much muscular atrophy that I had to re-learn how to walk. CPR, broken ribs, and the scar of a tricuspid clip from a botched biopsy: it was not the miracle I was hoping for. The internal trauma had certainly taken its toll. I no longer knew how I really felt, thanks to copious pain meds that altered my mind and body. Each limb was foreign as I re-acclimated to how one grabs hold of a cup, signs their name, touches their legs. Externally, I was a mess: covered in deep purple bruises across my torso from the diabetes treatments, dead skin pooling in unwashed pores, my ankles swollen and indiscernible from my legs. But lacking a good mirror (or the desire to find one), I still felt like “myself” during my forty-five day hospital stay. I could feel my cheekbones protruding from thinning skin, saw through unfocused eyes from the tempestuous blood sugars, and my hair sat in a rat’s nest atop my head; but I was still me. -/- Arriving home, I felt like a newborn being brought into the real world for the first time. I needed help with everything—showers, sitting up, putting on shoes, even going to the bathroom. At age twenty-four, I felt I had regressed to the point of no return as I relied on others to do the simplest tasks. In addition, I was quarantined inside for three months, due to the risk of obtaining a fungal infection from the outside. Caged, and alone in my body, I a trapped and wounded tiger: angry, hurting, and scared. [End Page 109]When I had been prepared for transplant—and I use “prepared” loosely because the information packet I was handed was insulting at best—I knew to expect the scars. I had no issue with that, having been cut open at my throat and chest for previous surgeries. I knew to expect a 12-inch line from neck to navel: the most evident sign I would now carry that I was disabled. -/- What I did not expect were the bullet holes— the sealed entrances of thick chest tubes that now dotted my lower torso. I did not anticipate the bruises on my arms and groin from arterial pokes. I felt violated as if I had walked into some kind of abduction and was rolled out, beaten, bruised, and, worst, touched. But it wasn’t the physical trauma that hurt the most. It was that no one seemed surprised. Immediately after transplant, the team’s focus is purely on survival. Survive the 30 days post-surgery. Survive the year. Metrics, uncomfortably tied to transplant center success statistics, funding, and clout have little to do with the patients themselves. What did I care to only survive a year? I wanted years. I wanted decades. It felt I wanted more than anyone was willing to pay attention to. -/- The conversation was narrowed to high-risk issues: infection, rejection, or other life-threatening conditions. While this makes sense on a clinical level, what constitutes a major event for a clinician may not be of the same emotional value to the patient. In my case, I was less occupied by how the steroids were working and more obsessed with their side effects, such as how much weight I was rapidly gaining. I walked into the clinic one day with the beginnings of stretch marks and a week later had claw-like ripples down my sides. My mood swings were explosive... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Jacob Burckhardt, Religion, and the Historiography of “Crisis” and “Transition”Thomas Albert Howard*A great historical subject, the representation of which should be the high point of a historian’s life, must cohere sympathetically and mysteriously to the author’s innermost being.Jacob Burckhardt 1If you are to venture to interpret the past you can do so only out of the fullest exertion of the vigor of the present: only when you can put (...) forth your... qualities in all their strength will you divine what is worth knowing and preserving in the past.Friedrich Nietzsche 2The renowned nineteenth-century Swiss-German historian Jacob Burckhardt (1818–97) was a masterful historian of crises and transitional periods. Two of his major works, The Age of Constantine the Great (1852) and The Civilization of the Renaissance in Italy (1860), bear out this claim. In his Constantine Burckhardt deals with the transition from late pagan antiquity to the early Christian Middle Ages, and in his more famous Renaissance he deals with the transition from the late Middle Ages to the beginnings of secular modernity. In the [End Page 149] latter, as is well known, he established one of the most compelling and creative theses in the history of modern historiography, virtually creating the “idea of the Renaissance” that has long influenced both scholarly and popular conceptions of that period. 3What elicited Burckhardt’s interest in crises and transitions in general and in these two periods of crisis and transition in particular? In this article, I shall argue that there is a strong relationship between Burckhardt’s own historical experience in the early and mid-nineteenth century and his choice of subject and mode of analysis in these two monumental works. In theoretical terms one observes a “dialectical” form of objectivity in the execution of Burckhardt’s historiographical tasks: a structural affinity or kinship between subject (Burckhardt, his historical experience) and object (late antiquity, Renaissance) predisposes Burckhardt to his theme/argument and thus provides a key to understanding the genesis and the character of insights that he offers in these two works. 4 To establish this point I shall focus on the category of religion, on Burckhardt’s own experience of questions of religious truth and skepticism in the nineteenth century, and on his treatment of religion in these two works.The Young Jacob Burckhardt and ReligionReligion is a crucial but often neglected aspect of Jacob Burckhardt’s thought. 5 Like a number of nineteenth-century German intellectuals, Burckhardt was a Pfarrersohn, a “pastor’s son.” 6 He grew up in a profoundly conservative Protestant environment in Basel, nicknamed “pious Basel” for its dogged resistance to the “ideas of 1789” and for its earlier heritage of Reformation and pietist religiosity. During Burckhardt’s youth in fact, his father was a children’s minister and head-deacon (Obersthelfer) before becoming in 1838 the city cathedral’s Antistes, the highest and most prestigious ecclesiastical office in Basel. In short, as his biographer Werner Kaegi has noted, Burckhardt’s early [End Page 150] upbringing and education were strongly shaped by the world of his father, a world of “old Protestant piety.” 7Following his father’s example, Burckhardt started out on the clerical track, studying theology at the University of Basel. However, during his Theologie-studium (1837–39) he experienced a profound crisis of faith brought on by an encounter with German historical biblical criticism and liberal theology represented in the person of W. M. L. de Wette (1780–1848). A radical theologian and biblical scholar, de Wette had wound up in Basel in 1822 after being dismissed from the University of Berlin for holding views considered heterodox and politically threatening by the conservative Prussian government. 8 In a letter to his friend Johannes Riggenbach written in August 1838 Burckhardt tells how de Wette’s critical theology had unseated his faith. “In my eyes,” Burckhardt wrote,de Wette’s system grows in stature every day; one simply must follow him, there is no alternative; but every day a part of our traditional church doctrine melts away under his hand. Today, finally, I realized that he regards the birth of Christ simply as a myth... (shrink)

An alternative to objectifying approaches to understanding Post-traumatic Stress Disorder grounded in hermeneutic phenomenology is presented. Nurses who provided care for soldiers injured in the Iraq and Afghanistan wars, and sixty-seven wounded male servicemen in the rehabilitation phase of their recovery were interviewed. PTSD is the one major psychiatric diagnosis where social causation is established, yet PTSD is predominantly viewed in terms of the usual neuro-physiological causal models with traumatic social events viewed as pathogens with dose related effects. Biologic models (...) of causation are applied reductively to both predisposing personal vulnerabilities and strengths that prevent PTSD, such as resiliency. However, framing PTSD as an objective disease state separates it from narrative historical details of the trauma. Personal stories and cultural meanings of the traumatic events are seen as epiphenomenal, unrelated to the understanding of, and ultimately, the therapeutic treatment of PTSD. Most wounded service members described classic symptoms of PTSD: flashbacks, insomnia, anxiety etc. All experienced disturbance in their sense of time and place. Rather than see the occurrence of these symptoms as decontextualized mechanistic reverberations of war, we consider how these symptoms meaningfully reflect actual war experiences and sense of displacement experienced by service members. (shrink)

In their environment, plants are continuously submitted to natural stimuli such as wind, rain, temperature changes, wounding, etc. These signals induce a cascade of events which lead to metabolic and morphogenetic responses. In this paper the different steps are described and discussed starting from the reception of the signal by a plant organ to the final morphogenetic response. In our laboratory two plants are studied: Bryonia dioica for which rubbing the internode results in reduced elongation and enhanced radial expansion and (...) Bidens pilosa for which the response occurs at distance, hence pricking the cotyledon of a plantlet induces the growth inhibition of both the hypocotyl and the axillary bud of the pricked cotyledon. Reception of the signal and transmission of the message. In Bryonia the signal is received by epidermal cells while in Bidens they are the cells adjacent to the midrib of the cotyledon which receive the mechanical signal. In both plants the message is transmitted via a wave of electric depolarization. This latter is composed of an action potential associated with a slow wave whose transmission rates are respectively 1cm s−1 and 1 mm s−1. Recent results have shown the involvement of Ca2+ in the triggering of the slow wave and the role of the H+ pump during the slow wave. Transient and fast biochemical responses. An entry of extraceilular Ca2+ into the cells and a transient increase in IP3 occur within seconds following the mechanical stimulus. At the same time, the membrane becomes more fluid, correlated with qualitative changes in phospholipids. The rapid increase in the concentration of peroxidated lipids may be correlated with ethylene biosynthesis which is stimulated after rubbing. Other parameters such as cytoplasmic pH, relative water content, hydric potential, membrane potential and modifications of K+, Mg2+-ATPase and Ca2+-ATPase activities, play a key role in the early responses induced by the traumatisms. Irreversible-biochemical responses. The mechanical stimulus performed on a Bryonia internode induces an acceleration of: i) enzymatic activities related to the lignification, ii) esterification of phenolic acids in the cell wall. Consequently the lignification process is accelerated. Storage of the information. After being received by the target cells the information can be stored during several days before being expressed. At the level of cotyledonary bud, the first message, previously stored, can be expressed or not by a second treatment. Bidens thus behaves as if it was able to “store” and to “retrieve” morphogenetic messages, using a sort of rudimentary memory. The nuclei of the bud cells of the pricked cotyledon show that these cells, initially in G2 phase, divide and then remain in the G1 phase. In Bryonia, calli derived from young stimulated internodes, keep thigmomorphogenetic characteristics during several weeks. In the last part of this paper the particularity of our plant model which permits a study of the transmission and storage of the message, is underlined. The links between the different steps induced by the stimulus are discussed. Special attention is devoted to second messengers and to the amplification of the message. (shrink)

How biological form is generated remains one of the most fascinating but elusive challenges for science. Moreover, it is widely documented in contemporary literature that development is tightly coordinated. The idea that such development is governed by a coordinating field of force, the morphogenetic field, and its position in embryology research paradigms, is traced in this article. Empirical evidences for field phenomena are described, ranging from bioelectromagnetic effects, morphology, transplantation, regeneration, and other data. Applications of medical potential including treatment (...) of cancer, birth defects, and wound healing are highlighted. The article hypothesizes that distinct morphological forms may have distinct field parameters. Experimentally tractable field parameters may thus provide an exciting research program for probing morphogenesis and phylogenetic diversity. (shrink)

Military Medical Ethics for the 21st Century is the first full length, broad-based treatment of this important subject. Written by an international team of practitioners and academics, this book provides interdisciplinary insights into the major issues facing military-medical decision makers and critically examines the tensions and dilemmas inherent in the military and medical professions. In this book the authors explore the practice of battlefield bioethics, medical neutrality and treatment of the wounded, enhancement technologies for war fighters, the potential (...) risks of dual-use biotechnologies, patient rights for active duty personnel, military medical research and military medical ethics education in the 21st Century. (shrink)

The men and women who serve in the armed forces, in the words of Major General Joseph Caravalho, “sign a blank check, co-signed by their families, payable to the Army, Navy, Air Force, or Marines, up to and including their lives.” It is human nature to consider such a pact in polarized terms; the pact concludes in either a celebratory homecoming or funereal mourning. But in reality, surviving catastrophic injury may incur the greatest debt. The small but real possibility of (...) losing the ability to bear biological children due to genitourinary combat injury has been a topic of discussion in hushed tones, behind closed doors. But as policy changes move the conversation into the open, we must be fully aware of the far-reaching and long-term impacts of decisions on those who have sustained genitourinary injury. In January 2016, Secretary of Defense Ashton Carter outlined a set of reforms that would improve the quality of life for military families by recognizing the importance of maintaining fertility, even in the face of severe injury. This first promising step could build a solid foundation of insuring fertility preservation for wounded service members with genitourinary injury, and it could set a precedent beyond the military for insuring treatment for people who have lost their reproductive capacity. Thus, the ethical challenges raised by the new policy require careful analysis. (shrink)

During asymmetric war, state armies must care for their local allies, detainees and the civilian population in two contexts: acute care for those wounded during military operations and medical care for the general population as required by the Geneva Conventions. Constrained by scarce resources, state armies face a number of moral dilemmas that affect care on the ground.Triage. As they deploy, state armies allocate in-theater medical resources to care for their soldiers. In-theater care does not provide for long-term treatment. (...) Its purpose is to return warfighters to active duty or to quickly evacuate them to the US or Europe for comprehensive medical care. Limited beds and personnel make it impossible to provide the local population with the level of care that Western soldiers receive. As a result, the US and other armies develop complex and often arbitrary rules to treat civilians. The inability to provide high-level care to all, creates tensions with local civilians and host country allies.Ensuring local medical care. The Geneva Conventions require occupying armies to “ensure the medical needs of the civilian population.” Specifying these needs is a medical and moral challenge. What level satisfies this requirement? How much aid should the occupying power provide? How best to distribute existing resources? How should state armies protect NGOs that provide significant medical care and often find themselves under attack by insurgents?Medical Diplomacy. While the purpose of medical care is to treat the sick and injured, medical care also serves security needs. Medical care is a long-established tool to win the hearts and minds of the local population. Since the Vietnam War, however, critics have charged that medical diplomacy subverts the purpose of medicine, places medical personnel in the service of war and provides poor medical care. (shrink)

Owing to its grappling with a motley of intricate socioeconomic, as well as medico-legal, crises, Haiti has found itself bereft of some of its people, many of whom have had to leave the Caribbean country in search of improved lives elsewhere. Receiving some of the Haitian refugees fleeing abject poverty, unemployment, and other harms and barriers has been the United States, one of Haiti's northern neighbors and a country that has played an outcome-determinative, if not outsized, role in steering the (...) country toward its presently hobbled state. Drawing on the U.S.’s recent treatment of Haitian refugees, this paper argues that U.S. reception of Haitian immigrants rubs salt in the wound of a long history of dehumanizing and oppressive abuses endured by Haitians. Furthermore, and more importantly, this paper posits that U.S. failure to wholly embrace its legal obligation to accept Haitian refugees under international law needs to be understood in the light of the specific horrors inflicted by science, in pre-independence Haiti, on non-consenting, Afro-Haitian experimental subjects. And by extension, such a contextually-nuanced understanding is crucial in shaping the delivery of healthcare services to Haitian refugees fortunate enough to remain in the U.S. —as an awareness and appreciation of the socio-historical context of patients' lived experiences, i.e., their complete social history, can furnish important clues vis-à-vis the presence and etiologies of disease, influence the foci of physical exams, and generally pave the way for the provision of cost-efficient and evidence-based care. (shrink)

Fragile states have been raising increasing concern among donors since the mid-2000s. The policies of the Global Fund to fight HIV/AIDS, Malaria, and Tuberculosis have not excluded fragile states, and this source has provided financing for these countries according to standardized procedures. They represent interesting cases for exploring the meaning and role of measurement in a globalized context. Measurement in the field of HIV/AIDS and its treatment has given rise to a private outsourcing of expertise and auditing, thereby creating (...) a new form of value based on the social process of registration and the creation of realities produced by the intervention itself. These “scriptural economies” must be questioned in terms of the production of knowledge, but also in terms of social justice. Governing HIV/AIDS treatments by numbers in a fragile state is explored in this article through the experience of the Central African Republic in terms of epidemiology and access to antiretroviral drugs. The unexpected effects of performance-based programs in this context underline the need for global health governance to be re-embedded into a social justice framework. (shrink)

The patient we call Danny was a mildly mentally retarded male in his mid-thirties who adamantly refused kidney dialysis when it was offered as the only therapeutic option for his progressive kidney failure. It was uncertain how fully Danny understood the implications of his refusal. To complicate the case still further, several “advocates” emerged to speak on Danny's behalf — each with a somewhat different interpretation of the situation and different sets of value presuppositions and ethical principles to apply to (...) the choice. We chronicle the development of this situation through a series of scenes; and in each scene we also attempt to clarify the ethical and medico-legal issues involved at that point. Danny was finally permitted to make this decision for himself — though more by default than by an agreement by all parties to honor his autonomy. Our hope is that this presentation will lead to further discussion and clarification of these important issues. (shrink)

Photo ID 222412412 © US Navy Medicine | Dreamstime.com ABSTRACT In a non-military setting, the answer is clear: it would be unethical to treat someone based on non-medical considerations such as nationality. We argue that Battlefield Triage is a moral tragedy, meaning that it is a situation in which there is no morally blameless decision and that the demands of justice cannot be satisfied. INTRODUCTION Medical resources in an austere environment without quick recourse for resupply or casualty evacuation are often (...) limited. The shortage extends not only to supplies like blood products and drugs, but physicians and other medical personnel. In the midst of a mass casualty scenario, such as a battle that includes intense ground fighting, the medical staff will stretch scarce resources and triage casualties according to specific criteria. Typically, they proceed by providing care for the most severely wounded first, referred to here as conventional triage. At times, though, the staff may reverse the triage so that soldiers with minor wounds can return to the fight. In a mass casualty situation, when medical personnel apply conventional triage and treat casualties from opposing forces, a dilemma may arise. We argue that it can be permissible for military physicians to prioritize their own soldiers over enemy combatants in a mass casualty triage, where reverse triage does not apply. The case we will focus on is as follows: Battlefield Triage: During combat operations on a remote island in the Pacific Ocean, a compatriot soldier and an enemy combatant arrive at the compatriot soldier country’s medical treatment facility. Both have similar gunshot wounds to the abdomen, and they arrive with similar conditions. Both have low oxygen saturation and excessive blood loss. The sole physician only has enough time to stabilize one person. The scenario is brief, and we are aware that medical rules of eligibility will most often dictate how the physician proceeds,[1] but this scenario is useful in setting up the question we focus on in this paper: would it be wrong to favor the stabilization of a soldier just because the soldier is the physician’s compatriot? In other words, can nationality serve as an ethically justified tiebreaker in a situation such as Battlefield Triage?[2] In a non-military setting, the answer is clear: it would be unethical to treat someone based on non-medical considerations such as nationality. The AMA’s Code of Medical Ethics asserts that physicians have “ethical obligations to place patients’ welfare above their self-interest and above obligations to other groups.”[3] The World Medical Association’s Declaration of Tokyo affirms that “no motive, whether personal, collective or political, shall prevail against this higher purpose” of alleviating distress.[4] Physicians are taught early on that triage decisions must be medically indicated and made without consideration of factors such as race, ethnicity, religion, social status, and nationality. They are taught that public trust and obligations of justice grounded in equality demand that only medical indications be considered. But military physicians in a military setting are beholden to obligations, duties, and responsibilities as members of the military, and when these obligations, duties, and responsibilities conflict, as they do in Battlefield Triage, which loyalties win out and why?[5] Critics of partiality on national grounds argue that partiality undermines public trust in medicine and justice because everyone should be treated equally regardless of nationality.[6] Proponents of partiality argue that military obligations supersede equality and that justice requires partiality in such cases.[7] Despite the critics’ disagreement, both agree that there is a morally right, perhaps even blameless, course of action. Drawing on insights from virtue ethics, we argue that Battlefield Triage is a moral tragedy in which justice is unattainable and there is no action without moral cost. The assumption that there is a morally right choice is flawed. We argue that while no decision in this scenario is free from moral blame, there are reasons to favor treating one’s soldiers over enemy combatants. I. The Case Against Partiality There is a common assumption that there is a morally right or just decision in Battlefield Triage. A number of organizations and scholars claim that it is wrong for military physicians to favor their own soldiers on the grounds of nationality or some form of ‘group membership.’ (In a conflict involving service members from multiple nations working as a coalition, a soldier from an allied country may receive the same priority as the US service member due to ‘group membership.’) The World Medical Association’s WMA Declaration of Lisbon on the Rights of the Patient, which was reaffirmed in 2015, posits that, “[i]n circumstances where a choice must be made between potential patients for a particular treatment that is in limited supply, all such patients are entitled to a fair selection procedure for that treatment. That choice must be based on medical criteria and made without discrimination.”[8] This echoes what was set forth in Article 12 of the Geneva Conventions, which states that “[o]nly urgent medical reasons will authorize priority in the order of treatment to be administered.”[9] The argument for impartiality in Battlefield Triage is that every person is morally equal, and equality entails that medical distribution is, “based on a combination of medical need and urgency.”[10] This is in keeping with the bioethical principles that are generally applied.[11] II. The Case for Partiality On the other side, there are arguments that favoritism is the ethically right decision in Battlefield Triage.[12] The argument asserts that members of the military form a morally significant community of friends and participation in these relationships demands partiality. Just as parents have strong ethical duties to their children and not just any children, military personnel have ethical duties to their group, a group that involves an affirmation of mutual aid and support. Some have termed these ‘associative duties. According to Michael Gross, obligations of friendship, care, and solidarity “leave very little room for generally applicable principles of justice that would obligate a medic to treat enemy or non-compatriot wounded ahead of their compatriots.”[13] This is true in Battlefield Triage, but it may also be true even if the enemy’s soldier were more seriously wounded: “the ethics of small group cohesion, largely an ethics of care, mostly replaces the demands of impartial justice.”[14] In a more recent article, Gross explains that preferential treatment is ethically justified based on fighting capability and “the special obligations people owe friends, family, and, no less, comrades-in-arms.”[15] To not show partiality to the US soldier would be morally wrong on the grounds of friendship and mutual care.[16] III. The Moral Tragedy of Battlefield Triage Defenders and critics of Battlefield Triage favoritism based on nationality both frame their position as just or fair. For example, Justin List argues that physicians are “bound to practice medical neutrality,”[17] Marcus Adams denies that physicians “possess special ethical obligations” to enemy combatants because of their profession.[18] These perspectives assume that there is a morally right decision and that justice is attainable. The assumption that there is or can be a morally right Battlefield Triage decision, and we need to put our heads together to figure it out, remains strongly entrenched. However, the facts of the situation should give us pause; there are too many people and too few resources, and this demands a decision-making process that determines who will receive scarce resources. By its very nature, a battlefield triage decision has to be made based on some characteristic or value, a characteristic or value that will inevitably favor some at the expense of others. This is precisely why competing analyses “in the military context struggle to resolve these conflicts satisfactorily.”[19] Drawing on the insights of virtue ethics, we suggest that Battlefield Triage is a moral tragedy. Virtue ethics suggests that morality is about acting virtuously, which is to say that we should do what a virtuous person would do in the situation. Ethics is about figuring out how a just, wise, compassionate, loving, and fair person would act, and then doing that, as one grows in virtue. But life is not always clear cut, and it is possible that virtuous people may find themselves in a moral tragedy, a situation in which, through no fault of one’s own, a person must make a morally objectionable decision. After the action the virtuous person “emerges having done a terrible thing, the very sort of thing that the callous, dishonest, unjust, or in general vicious agent would characteristically do.”[20] Stated differently, a moral tragedy presents a virtuous person with two or more courses of action, all of which have a moral cost.[21] In Battlefield Triage, no matter how the physician goes about deciding, there is going to be defensible concern from those not saved. The fact that there are more people than can be helped fosters competing values in battlefield triage: maximize lives saved, treat people equally, treat the worse off, and support the war effort. Treating people equally may create tension between treating the worse off, maximizing lives saved, and supporting the war effort. Reverse triage is a case in point, as supporting the war effort conflicts with treating the worse off first, as is a fair lottery system since deploying a lottery may not maximize lives saved or support the war effort. There can be reasons why one person is selected over another, to be sure. Yet, there are reasons for making a decision, and that the decision is subject to legitimate moral concern is another. To recognize the moral tragedy of Battlefield Triage is to recognize the impossibility of acting blamelessly in the situation. In this situation, the virtuous military physician is going to have to sacrifice important values such as justice, compassion, and respect for others, even with a defensible criterion in hand. The physician will grieve this sacrifice accordingly. The physician may find her decision difficult or stressful, and rightly so, because of what her circumstances require of her. This kind of moral tragedy results “in actions which betray and violate the rights of persons to whom there may be a strong duty of care. When this happens, it properly triggers an appropriate moral emotion since our moral integrity has been violated and this affects how we think of ourselves and what we have become.”[22] Rather than view her triage decision as the morally superior choice, the virtuous military physician will view her decisions in these circumstances in a different light: it is the least bad option in a terrible situation, and she did something ethically problematic, something that is contrary to her moral character. She deeply regrets the circumstances in which she had to act. IV. Virtue Ethics A virtue ethicist has insight into how one should go about deciding what to do in a moral tragedy, although virtue ethics may not be as helpful as one may hope. The goal of the virtuous military physician in Battlefield Triage is to adopt the best course of action or the action that she feels she ought to do, all things considered. This does not make her choice devoid of serious wrongdoing—a decision must be made, but that does not make it just. The virtuous military physician will approach the situation with courage, responsibility, and insight. She will think about the decision carefully, wisely, and conscientiously; she will weigh the goods and harms of the choices before her, in conjunction with a proper conception of the good life, human worth, and understanding of her obligations to others—including chain of command, fellow soldiers, and the medical community. She is attuned to the value of human life and has a reasonable idea of the various ways her decisions will affect others. She recognizes that she is in this non-ideal situation through no fault of her own: she is not the one fighting in battles; she is serving her country as a physician, whose job it is to save lives, treat everyone justly, and promote military objectives. She regrets the decision she is forced to make in battlefield triage, acting “with immense regret and pain,” Hursthouse explains, “instead of indifferently or gladly.”[23] This is because, no matter what decision is made, the virtuous military physician “does something terrible or horrible,” something she otherwise would not do and is contrary to her values.[24] V. A Resolvable Moral Tragedy Instead of asking whether there is a morally right decision, in which a decision is morally blameless and above reproach, the virtue ethicist asks whether there is a decision with a convincing rationale, knowing that a decision can have a clear rationale but still be morally tragic. It is perfectly reasonable to think that different virtuous persons will arrive at different courses of action: “two virtuous agents, in the same situation,” Hursthouse writes, “may act differently” in irresolvable moral tragedies, in cases in which there is no clear course of action.[25] Because a person must act in a moral tragedy, one goal is to identify reasons for choosing the chosen action. Some decisions are clearly indefensible—treating neither the compatriot soldier nor the enemy combatant in Battlefield Triage would be wrong—and some decisions are more problematic than others. If the military physician selects to treat the soldier because she does not like the enemy combatant’s skin color, such a reason would be deeply problematic. But much of the debate over how to act in a moral tragedy is not over clearly indefensible or problematic criteria. Instead, the literature is largely about different standards or implementations of justice. Some scholars defend nation-impartial triage as right, while others defend nation-aware triage as right, and each argues that the other side is promoting an unjust or otherwise wrong solution to Battlefield Triage. We suggest that Battlefield Triage is a resolvable moral tragedy and that virtue ethics offers convincing reasons to prefer the treatment of the compatriot soldier rather than the enemy combatant on the grounds of national identity. Virtues are integral to living a good life, a flourishing life, but as Aristotle observed long ago, human beings are inherently social, interdependent and interconnected in profound ways.[26] This goes beyond the obvious fact that we need each other to survive day to day (one person makes clothes, another farms, and another makes tools); the claim is that a good or flourishing life depends in large part on one’s social network or community. This is why many of Aristotle’s moral virtues are other facing: justice, friendship, generosity, and magnanimity, to name a few. Courage, a typically self-facing virtue, is understood by Aristotle to be the virtue that regards one’s fear of death in battle, a battle fought on behalf of one’s city.[27] All of this remains true today. Namely, there is an important sense in which our community matters to our lives: it is easier to live a good, flourishing life if one is part of a good, flourishing community. Our community is made up of smaller groups, and it is more accurate to say that we are simultaneous members of different groups within a broader community. A person may be part of a family, friend group, research team, large state university, city, state, and nation. Groups can function well or not, as we all have experienced, and this suggests that there are virtues or excellences that groups can instantiate. Good groups are unified in purpose, with each member doing their duty alongside others for the attainment of that purpose. Good groups manifest solidarity among their members. Although Aristotle does not list solidarity as a virtue, a number of modern-day virtue ethicists have begun examining how group solidarity can be a virtue that contributes to a good or flourishing life.[28] Solidarity is not conceptualized as an individual virtue, a virtue possessed by a person in isolation of others; instead, it is a collective virtue, a virtue that is shared among members of a defined group with particular ends.[29] “A group has solidarity to the extent that its members are disposed to: (1) share values, aims, or goals; (2) care about those values, aims, or goals; (3) act in accordance with those values, aims, or goals; (4) trust the testimony of other group members with respect to those values, aims, and goals; and (5) feel a sense of belonging to the group.”[30] The virtue of collective or group solidarity involves individuals having special concern for each other, shared aims and values, trust, loyalty, and a sense of belonging with these specific others. There is a oneness to the group in the pursuit of a definite goal or purpose, involving mutual support and affirmation of each member. As such, the group has ends and goods above and beyond the good of each individual person. Sometimes solidarity requires personal sacrifice for the collective (for example, a father sacrificing food so his child can eat). The virtue of collective or group solidarity is important to the military and medical community at every level, and for clear reasons. In the military, there is a clear hierarchy of command, unity of purpose and end, mutual trust and support in complex settings, and so on. Soldiers need to know they can count on one another, and solidarity grounds a soldier’s ability to trust others and be assured of mutual aid. In medicine, solidarity maintains self-regulation of the profession, shared values and goals, as well as public support, not to mention that day-to-day operations require physician trust, engagement, and effort toward the ends of clinical care. Physicians need to work together, along with others, in pursuit of health, and disunity is sowed when there is mistrust, selfishness, or disengagement among the healthcare team and organization. Importantly, just as we are all members of various groups and hence may manifest group solidarity in different settings, the virtuous military physician instantiates collective solidarity with both the medical profession and the military. Her dual loyalty contributes to the moral difficulty of acting in Battlefield Triage. The military physician has competing obligations to distinct groups and cannot satisfy all obligations in Battlefield Triage. Solidarity with the military supports the consideration of favoring the soldier for reasons of national identity, whereas solidarity with the medical community does not. Something has to give, which is why it is a moral tragedy. The virtuous military physician, therefore, must weigh the costs of each course of action. To fulfill her obligations to the medical community would require that she does not use nationality and other non-medical considerations in Battlefield Triage. Since the soldier and enemy combatant are equally injured, justice would demand a random process, perhaps a flip of the coin. Although this may satisfy obligations the military physician has to the medical community, this would be costly to the physician’s military group. If word gets out that the physician decides who to treat based on a coin toss, soldiers, families, and citizens may become frustrated and angry. Soldier morale may go down if it becomes known that a coin flip led to the preventable death of a soldier and the saving of an enemy combatant who had killed (or attempted to kill) other soldiers. As Gross highlights, military solidarity involves a mutual aid promise that military personnel promise to help one another.[31] A military physician is part of the military and, as such, is part of the mutual aid promise, which would appear to be violated if the physician flips a coin. Treating a member of one’s own team may be psychologically more beneficial than treating an enemy combatant and may lead to less moral distress.[32] Finally, treating soldiers rather than enemy combatants promotes broader military and social aims, including returning soldiers to health, maintaining unity of purpose, and minimizing community suffering from a soldier’s death. Favoring members of one’s group, that is, triage based on nationality in Battlefield Triage, would fulfill obligations of military group loyalty, which is contrary to the values and duties of medicine. It does not seem as though showing favoritism in this particular situation is very costly to the medical community or general public, but this is because there is recognition that the physician is in the military. Medicine is impartial to non-medical indications partly because of fairness and to promote public trust in medicine. However, Battlefield Triage is unique, as medicine is being practiced in a non-public, wartime setting. In ordinary circumstances, a patient’s identity is irrelevant, and physicians ought not play favorites. Since Battlefield Triage is not an ordinary circumstance, decisions based on patient identity may not undermine public trust in medicine. In addition, it is contestable that fairness in Battlefield Triage requires that no consideration be paid to one’s nationality. Fairness is about giving each person their due, what is owed to them, and the case can be made that soldiers who place themselves in danger for the sake of the common good or a just cause are owed special attention when they suffer harm in the line of duty. In other words, soldiers voluntarily undergo risk to themselves for the greater good, and society owes them for this sacrifice. This plausibly includes preferential treatment in a situation such as Battlefield Triage. So, while the medical community affirms justice demands non-preferential treatment, the military community can affirm the opposite. The demands of fairness are unclear at best or in conflict in this situation: demands of physician justice decry favoritism, while demands of military justice support favoritism. Triage not based on nationality is arguably unfair and triage based on nationality may not undermine public trust, after all. All things considered, there is a clear rationale for favoring nationality-based preferential treatment in Battlefield Triage. Adopting a nationality-based preference in this situation is more defensible than not. This does not make such a decision ethically right or just. Preference based on nationality is the least bad decision, but it is not morally blameless. It involves one in a serious moral wrong, a wrong otherwise avoided and contrary to one’s character. The virtuous military physician is in a situation in which obligations conflict, and we disagree with Gross, who posits that care of fellow soldiers “is important to the near exclusion of all else.”[33] Gross fails to appreciate the collective virtue of solidarity as applied to those in medicine. The military physician has duties to fellow soldiers but also to fellow physicians, to the medical community, and humanity. To favor a soldier on grounds of nationality violates her duties and responsibilities to this latter group. She is involved in a moral tragedy and can only seek the most just action given the circumstances, yet, at least in virtue ethics, the action remains far from blameless. CONCLUSION We argue that Battlefield Triage is a moral tragedy, meaning that it is a situation in which there is no morally blameless decision and that the demands of justice cannot be satisfied. As such, the virtuous military physician incurs a moral cost to acting as she does—there is a moral residue. However, despite being a moral tragedy, there are clear reasons to act in favor of treating one’s own, considering group solidarity. As such, these kinds of tragedies are resolvable: virtuous military physicians should favor treatment of their own, although they would do so with sorrow. - [1] Militaries set forth medical rules of eligibility or guidelines used to determine whether a person qualifies for specific medical interventions or treatments in certain circumstances, and these guidelines are binding for a military physician. For example, despite opposition from medical organizations, militaries have adopted reverse triage guidelines for military physicians to follow. For ethical discussion, see Falzone, Elisabeth, P. Pasquier, C. Hoffmann, O. Barbier, M. Boutonnet, A. Salvadori, A. Jarrassier, J. Renner, B. Malgras, and S. Mérat. "Triage in military settings." Anaesthesia Critical Care & Pain Medicine 36, no. 1 (2017): 43-51. https://doi.org/10.1016/j.accpm.2016.05.004 [2] There are issues that are related to this, including the triage of civilians and allied soldiers. We set related issues aside for purposes of this paper [3] American Medical Association, Code of Medical Ethics: Current Opinions with Annotations, 2004–2005 ed. (Chicago, IL: AMA, 2004), 300. [4] American Medical Association, Code of Medical Ethics: Current Opinions with Annotations, 2004–2005 ed. (Chicago, IL: AMA, 2004), 300. [5] This is termed the “dual loyalty” dilemma in military medicine and has been described at length elsewhere: Institute of Medicine (US) Board on Health Sciences Policy. Military Medical Ethics: Issues regarding Dual Loyalties: Workshop Summary. Washington (DC): National Academies Press (US); 2008. Toward a Framework for Resolving Dual Loyalties. Available from: https://www.ncbi.nlm.nih.gov/books/NBK214853/ [6] See Kenneth G. Swan and K.G. Swan, Jr., “Triage: The Past Revisited,” Military Medicine 161:8 (1996): 448–452. https://doi.org/10.1093/milmed/161.8.448; Jerome A. Singh, “American Physicians and dual loyalty obligations in the ‘war on terror,’” BMC Medical Ethics 4.4 (2003): 1–10. https://doi.org/10.1186/1472-6939-4-4; Beam, Thomas E. "Medical Ethics on the Battlefield." Military Medical Ethics: Sect. IV. Medical ethics in the military. Medical ethics on the battlefield: the crucible of military medical ethics 2 (2003): 369-402; Hereth, Blake. "Health justice for unjust combatants." Journal of Military Ethics 20, no. 1 (2021): 67-81. https://doi.org/10.1080/15027570.2021.1949782. [7] See Adams, Marcus P. "Triage priorities and military physicians." In Physicians at war: The dual-loyalties challenge, pp. 215-236. Dordrecht: Springer Netherlands, 2008. Gross, Michael L. "Comradery, community, and care in military medical ethics." Theoretical medicine and bioethics 32 (2011): 337-350. https://doi.org/10.1007/s11017-011-9189-6. Gross, Michael L. "The limits of impartial medical treatment during armed conflict." In Military medical ethics for the 21st century, pp. 71-84. Routledge, 2016. [8] World Medical Association, WMA Declaration of Lisbon on the Rights of the Patient. 5 December 2022, https://www.wma.net/policies-post/wma-declaration-of-lisbon-on-the-rights-of-the-patient/ [9] Geneva Convention for the Amelioration of the Condition of Wounded, Sick in Armed Forces in the Field. 12 August 1949. https://www.un.org/en/genocideprevention/documents/atrocity-crimes/Doc.30_GC-I-EN.pdf. [10] List, Justin M. "Medical neutrality and political activism: physicians' roles in conflict situations." In Physicians at war: The dual-loyalties challenge, pp. 237-253. Dordrecht: Springer Netherlands, 2008. 240 [11] Beauchamp, T., and J. Childress. 2013. Principles of Biomedical Ethics, 7th ed. Oxford, United Kingdom: Oxford University Press. [12] Adams, Marcus P. "Triage priorities and military physicians." In Physicians at war: The dual-loyalties challenge, pp. 215-236. Dordrecht: Springer Netherlands, 2008. [13] Gross, "Comradery, community, and care in military medical ethics," 347. [14] Gross, “Comradery, community, and care in military medical ethics,” 349. [15] Gross, Michael L. "When medical ethics and military ethics collide." Narrative inquiry in bioethics 13, no. 3 (2023): 199-204. 202 https://dx.doi.org/10.1353/nib.2023.a924191 [16] Our argument draws on virtue ethics, from which care ethics derives, and it is worth clarifying how our argument relates to Gross’s. We do not think that the virtue of friendship grounds triage decisions, for we think it is unlikely that the physician and wounded soldier are friends. Instead, as explained below, we think the collective virtue of group solidarity better captures the moral significance of group loyalty and that Gross would agree with us. But since military physicians are part of distinct groups, with competing obligations, the military physician will be forced to sacrifice a value in battlefield triage cases. In other words, we think Gross downplays the dual group membership of a military physician. [17] List,”Medical neutrality and political activism,” 250. [18] Adams,”Triage priorities and military physicians,” 235. [19] London, Leslie, Leonard S. Rubenstein, Laurel Baldwin-Ragaven, and Adriaan Van Es. "Dual loyalty among military health professionals: human rights and ethics in times of armed conflict." Cambridge Quarterly of Healthcare Ethics 15, no. 4 (2006): 381-391. 383. [20] Hursthouse, R. On Virtue Ethics. OUP 1999. 74 [21] Nussbaum, Martha C. "The costs of tragedy: Some moral limits of cost-benefit analysis." The Journal of Legal Studies 29, no. S2 (2000): 1005-1036, 1007. [22] De Wijze, S. (2005). Tragic-remorse–the anguish of dirty hands. Ethical theory and moral practice, 7(5), 453-471, 457. https://doi.org/10.1007/s10677-005-6836-x [23] Hursthouse, 73 [24] Hursthouse, 81 [25] Hursthouse, 72 [26] Aristotle, Politics 1253a8. Reeve, C. D. C., Indianapolis: Hackett Publishing Co., 2017 [27] Aristotle, Nicomachean Ethics. III.6.114a, 34-35. 2002, Nicomachean Ethics, Christopher Rowe (trans.), Oxford: Oxford University Press [28] Byerly, T. Ryan, and Meghan Byerly. "Collective virtue." The Journal of Value Inquiry 50, no. 1 (2016): 33-50. https://doi.org/10.1007/s10790-015-9484-y; Federico, Veronica. "Conclusion: solidarity as a public virtue." Solidarity as a Public Virtue (2018): 495-542. https://doi.org/10.5771/9783845290058. Rehg, William. "Solidarity and the common good: An analytic framework." Journal of Social Philosophy 38, no. 1 (2007): 7-21. https://doi.org/10.1111/j.1467-9833.2007.00363.x [29] Byerly and Byerly. "Collective virtue." 43 [30] Battaly, Heather. "Solidarity: Virtue or vice?." In Social virtue epistemology, pp. 303-324. Routledge, 2022. 304 [31] Ibid., 2011: 341 [32] It might be thought that displaying altruism by helping an enemy combatant at the expense of one’s fellow soldier may be psychologically satisfiying. For evidence that military physicians find it difficult to treat enemy combatants, see Lundberg, Kristina, Sofia Kjellström, Anders Jonsson, and Lars Sandman. "Experiences of Swedish military medical personnel in combat zones: adapting to competing loyalties." Military medicine 179, no. 8 (2014): 821-826. https://doi.org/10.7205/MILMED-D-14-00038. Lamblin, Antoine, Clément Derkenne, Marion Trousselard, and Marie-Ange Einaudi. "Ethical challenges faced by French military doctors deployed in the Sahel (Operation Barkhane): a qualitative study." BMC Medical Ethics 22 (2021): 1-13. https://doi.org/10.1186/s12910-021-00723-2 [33] Ibid., 2011: 344. (shrink)

How should we respond to injuries done to us and to the hurts that we inflict on others? In this thoughtful book, Wounds Not Healed By Time, Solomon Schimmel guides us through the meanings of justice, forgiveness, repentance, and reconciliation. In doing so, he probes to the core of the human encounter with evil, drawing on religious traditions, psychology, philosophy, and the personal experiences of both perpetrators and of victims.

The aim of this study was to investigate patients' experiences of not being treated well in medical health care in Stockholm County, Sweden. The study was conducted by implementing qualitative content analysis using categorization of empirical material for 2006 and 2007 provided by the Patients' Advisory Committee (Patientnämnden) in Stockholm. Complaints about not being treated well accounted for 13% of all complaints to the Patients' Advisory Committee. A sample of those who complained about their medical treatment shows that about (...) 30% of these complaints also involved experiences of being badly received. Categorization of the complaints about being badly treated resulted in the following 11 categories: (1) rude, aggressive or arrogant behaviour; (2) being ignored; (3) being denied examinations or treatments; (4) lack of empathy among personnel; (5) lack of respect for personal integrity; (6) lack of time/waiting time; (7) personnel not separating private issues from their professional role; (8) injustice and discrimination; (9) sexual harassment; (10) coercion and violence and (11) unspecified bad treatment. In relation to the total number of patients, women were over-represented in all categories. In conclusion, what patients react most strongly against is when health-care personnel treat them disrespectfully by not abiding by established social norms. The results indicate that the combination of failure in medical treatment and not receiving an apology often leads patients to complain to the Patients' Advisory Committee. (shrink)

One of the urgent tasks facing Christian educators at the present time is how they might encourage the spiritual growth of their students. This paper invites reflection on this central question by discussing the role aesthetics might play with particular focus on its relationship to the ‘spiritual senses’, a theme which has been strikingly absent from recent publications on religion and Christian education. Paying particular attention to the work of the contemporary French phenomenologist, Jean-Louis Chrétien, I shall argue that art (...) invites us to listen to as well as to see the power of beauty. Educators should not ignore this capacity of art to engage the spiritual senses within a contemplative ethos of silence. But I go further than simply pointing to these seminal ideas about Christian formation, by discussing the ‘wound’ that beauty inevitably inflicts. I illustrate this suggestion by referring to Pope Benedict XVI's essay ‘Wounded by the Arrow of the Beautiful’ and to two visualizations of religion: Delacroix's painting Fight between Jacob and the Angel and Beauvois' film Of Gods and Men. (shrink)

This book challenges the World Medical Associationâ (TM)s (WMA) International Code of Ethics statement in 2004, which declared that â ~medical ethics in armed conflict is identical to medical ethics in times of peaceâ (TM). This is achieved by examining the professional, ethical, and legal conflicts in British Military healthcare practice that occur in three distinct military environments. These are (i) the battlefield, (ii) the operational environment and (iii) the non-operational environment. As this conflict is exacerbated by the need to (...) achieve Operational Effectiveness, this book also explores the dual loyalty conflict that Military Health Care Professionals (MHCPs) encounter between following military orders and professional codes of practice. The method used to challenge the WMAâ (TM)s statement and explore these conflicts is the use of real-life problem-solving vignettes, which mirror actual ethical and professional conflicts and dilemmas that may occur in the three environments. The areas of law analysed similarly reflect the difficulties that MHCPs face when caring for the sick and wounded in violent locations when under attack. In particular, the book questions whether it is right for a MHCP to owe their patients a duty of care in hostile environments. This leads on to questioning if any MHCP could be protected by combat immunity where no duty of care is owed to fellow soldiers in the battlefield. The book also questions whether the standard of care should be variable in hostile environments. It also explores the dual loyalty conflict of a wounded senior officer refusing treatment from a junior officer. In addition, it examines the difficulties of a doctor maintaining patient confidentiality when a soldier refuses treatment for a psychological injury but wishes to redeploy to the battlefield. The book successfully challenges the WMAâ (TM)s statement. It also concludes by suggesting that neither a military-focused approach nor a professional healthcare-focused approach towards military healthcare is the best way to solve the dual loyalty conflict. (shrink)

This article, originally presented as a keynote address at the 2019 McCain conference, proposes that we must take seriously the “moral” component of moral injury. In addition to psychological treatment, wounded warriors suffering moral injury require atonement for genuine transgressions, and insight when the conduct they regard as transgression actually is not. The article defines the dimensions of moral injury as parallel to those of physical injury: pain, loss of functionality, and (in some cases) disfigurement. It then asks how (...) atonement can be achieved, turning to an unusual source for inspiration: the laws of atonement set out by the medieval Jewish philosopher Moses Maimonides. Maimonides proposes four requirements: verbal confession, repentance, reparation, and apology. The article explains their meaning in the context of contemporary wounded warriors. Finally, it argues that Judaism’s unique tradition of collective atonement offers an important model for the armed services. (shrink)