James E. O. Hughes

The Path of Altruism: A Reflection on the Nature of a Gift and Its Consequences in Leading to Entitlement or Enhancement

The author offers an instructive distinction between a gift and a transfer. A gift enhances the human and intellectual development of another; a transfer might initiate the downhill slide of another into the state of victimhood known as entitlement. Every act we perform toward another, whether individually or through our social capital as philanthropists, has these two possible outcomes. The author then distinguishes between three possible meanings for the concept of obligation: a duty, a responsibility, or compassion and gratitude. He proposes that any act toward another that begins as a duty will likely lead to dependence and reduction of the human spirit. An action that creates in another a state of “being entitled” carries with it, for that person, a significant risk of becoming, in his or her own eyes, a victim with an ever-deepening loss of self-awareness and personal freedom. When that obligation is viewed with a sense of responsibility, an important positive step is achieved in that giving responsibly requires of the donor active caring about whether the gift will harm another. Finally, when obligation is manifested through gratitude as compassion, it leads to the enhancement of one’s own spirit and to the enhancement of the spirits of those it touches. It is the practice of love for one’s fellow man. It is the essence of philosanthropos and thus of philanthropy.

Surgery of the Infected Spine and Spinal Cord Function

The surgical treatment of spinal infections has taught us a great deal about the pathophysiology of the spinal cord. In the past 15 years at St. Luke’s—Roosevelt, we have operated on 23 patients with various forms of Pott’s paraplegia and done 61 anterior explorations for pyogenic infections in 57 patients (cervical 24, thoracic 14, lumbar 23). During the same period, we have done more than 250 anterior explorations of the spine for tumor. Successful surgery required adequate decompression and maintenance of bony stability. Surgical cases in our series of spinal infections presented a myriad of combinations of cord compression and spinal instability. In my discussion of the cases presented, we will point out that the blood supply of the spinal cord does not appear to be precarious. Cord infarction from the anterior transthoracic surgery does not appear to be a problem. We believe that the deleterious effects of infection arise from mechanical compression, not from “arteritis or phlebitis,” and that it is rare in spinal surgery to have a vascular spinal cord complication except in the vigorous correction of scoliosis.