Peter Durno Murray

Decisions for patients in the neonatal intensive care unit (NICU) are made under the auspices of the shared decision-making model, which uses the best interests standard as a guide. Decisions made regarding the withdrawal of life-sustaining measures (WLSM) are also made using the shared decision-making model with attention to either physiological parameters indicative of survival or the potential for disability. The two dominant frameworks for considering disability are the medical and social models. At its core, the medical model views disability as something broken within the person, something in need of being fixed. On the other hand, the social model of disability asserts that disability is a socially constructed process consisting of a multitude of barriers encountered by people with various impairments. The social and medical models of disability fail to represent disability in the NICU accurately. The former neglects the biological aspect, as a neonate in the NICU is primarily a physiological being. In contrast, the latter overlooks the possibility that the neonate may not yet be impacted by their impairment and, therefore, would technically not be considered disabled per specific criteria outlined in the medical model. An alternative framework that incorporates the neonate’s current medical requirements in conjunction with the prognostication of disability as a method by which parents might make decisions regarding WLSM is desperately needed.

Background Moral distress, or the inability to carry out what one believes to be ethically appropriate because of constraints or barriers, is understudied in obstetrics and gynecology. We sought to characterize moral distress among Maternal-Fetal Medicine (MFM) fellows using a standardized survey. Methods We disseminated a national anonymized survey study of MFM fellows electronically regarding moral distress using a validated questionnaire with supplemental questions pertaining to specific challenges within MFM clinical care. Multivariable linear regression modeling was used to examine the association between abortion restrictions, maternal mortality, and moral distress, controlling for demographic variables. Thematic analysis was performed for the free text responses elaborating upon moral distress and grouped by thematic elements. We hypothesized that training in states with more abortion restrictions and higher maternal mortality would be associated with higher moral distress scores. Results Among 245 total responses (61% response rate), 177 complete responses (44% complete response rate) were included for analysis. Most of our respondents identified as female (78.5%), White (71.8%), and training in urban programs (83.1%). 37.9% of respondents reported training in the Northeast, with the remainder of respondents evenly distributed across the United States. The mean score for the validated questions was 85.9 ± 48.8, with female gender identity associated with higher measures of moral distress on the validated portion of the questionnaire as compared to male gender identity (90.1 ± 49.2 vs. 70.4 ± 44.7, p < 0.05), whereas more advanced training was associated with higher measures of moral distress on the supplemental questions as compared to those less advanced in training (20.9 ± 11.8 vs. 28.5 ± 15.9 vs. 25.9 ± 15.6 for PGY-5 vs. PGY-6 vs. PGY-7 and PGY-8 combined, respectively, p < 0.05). After adjustment, higher measure of moral distress on the validated questionnaire was associated with training in states designated “Abortion restrictive” as compared to “Abortion most protective” (beta estimate 27.80 and p < 0.01). Of 34 free responses, 65% referred to limitations on abortion access and reproductive justice as causes of significant moral distress. Conclusion MFM fellows who identify as female reported higher measures of moral distress, as well as those training in states with more abortion restrictions. Among free text respondents, abortion restrictions underlie a significant proportion of moral distress.

The passages composed by Nietzsche around the time he spent at Sorrento reflect an engagement with the anarcho-utopian socialist milieu into which he had been introduced by Malwida von Meysenbug. The “Sorrentino politics” that appear in Human, All Too Human I and II and later works need to be understood in the context of an affirmative form of political thought that could remedy the pessimism and nihilism that he finds in the politics of all sides. Nietzsche argues that the monarchical state, modern industrialism, and the restricted ownership of capital and property all undermine the goal of creating a life-affirming culture for Europe. He also provides a criticism of a utopian teleology of equality in the future – whether religious or socialist – that imposes an objective notion of purpose. Nietzsche rejects the Schopenhauerian pessimism of resignation while affirmatively engaging with the thought of Alexander Herzen and Guiseppe Mazzini.

After meeting in Zurich, Nikos Kazantzakis and Elli Lambridi undertook a number of Nietzsche pilgrimages in Switzerland together in 1918, beginning with a trip to Silvaplana. At the time, Kazantzakis had written a thesis on Nietzsche and had translated The Birth of Tragedy (1872) and Thus Spoke Zarathustra (1883–85) into Greek, while Elli Lambridi was enrolled in a PhD in philosophy at the University of Zurich writing on Aristotle. They continually debated the nature of the philosopher-type in relation to Nietzsche and Dionysianism, and this philosophical engagement is the central topic of this paper. Lambridi envisaged a Dionysian philosopher fully engaged in an ethical and natural life within a community of others and also envisaged a derived politics of affirmative communal responsibility. Kazantzakis considered that the philosopher should take a much more Apolline, spiritually focused and solitary path, continually ascending toward heroic self-redemption. As well as examining their recorded exchanges, this paper also addresses the fictional resumption of their relationship in The New People, a novel which Lambridi wrote some time after Kazantzakis’ death. In the novel, they resume their discussion of the philosopher-type in 2118, in an eternal recurrence event. In the end, the male character, Petros, learns that the grounding event of a Dionysian Nietzscheanism is an instinctive promise of responsibility for the future of others.

This book argues that Nietzsche bases his affirmative morality on the model of individual responsiveness to otherness which he takes from the mythology of Dionysus. The subject is not free to choose to avoid such responding to the demands of the other. Nietzsche finds that the basic mode of responding is pleasure. This feeling, as a basis for morality, underlies the morality which is true to the earth and the major concepts of "will to power", "eternal return", and "amor fati". The priority of otherness makes all thought ethical and not only aesthetic. The basis of all meanings combines the fundamental impulse of responding outwards with an immediate complement in the individual interpretation-world. This is specifically ethical because the recognition of our own historical specificity arises as a result of the refusal of others to become mere differences within our notion of the Same, and through their demand that we "become who we are" in the recognition of their separate existence.