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Beauty, Ugliness, and Black Theology: A Theological Aesthetics for Black Experience
In this paper, I argue that theological aesthetics speaks powerfully to black experience in light of this very situation. It does so, I find, through the Beauty of the Cross. While the Beauty of the Cross constitutes its own tradition developed through art, architecture, liturgics, and devotion, I use it to gesture broadly to the cruciform character of beauty in theology. The Beauty of the Cross shows how a theological account of beauty necessarily encompasses ugliness. I draw out the implications of this dynamic with regard to three doctrinal areas and related debates in black theology: theological anthropology, soteriology, and eschatology. I aim to show the utility of theological aesthetics for black experience, and center it as a vital resource for black theology
A Problem-based Curriculum to Conceptually Develop the Multiplication Principle for Counting
Counting exercises are difficult (e.g., Batanero et al., 1997; Hadar & Hadass, 1981). As a case in point, although multiplication is a relatively simple concept, students often use multiplication incorrectly on counting problems (Batanero et al., 1997). To address this issue, this paper develops a problem-based curriculum to help students learn about the multiplication principle (MP) for counting. In this paper, we outline the important mathematical issues and nuances associated with the MP in our proposed exercise set, and discuss how mathematics educators could implement this sequence of exercises to develop students’ conceptual understanding of the MP. We conclude by discussing how our exercise set aligns with a broader theory of learning – variation theory
Creating Opportunities Through Career and Technical Education: A Case Study of Brooklyn STEAM Center
Creating Opportunities Through Career and Technical Education: A Case Study of Brooklyn STEAM Cente
Letter from the Editor
Dear Reader,
We are deeply honored to announce the publication of The Columbia University Journal of Global Health Spring 2024 Issue. In the face of global health crises spanning from the Democratic Republic of the Congo, Sudan, and Palestine as well as restrictions to free speech on our campus, we as a journal remain steadfast in our belief that the exchange of knowledge from all corners of the globe holds immense power. Our goal has always been to center diverse perspectives and communities that have been marginalized, which is especially pertinent in the present. In our Spring 2024 issue you will find four manuscripts that investigate the pitfalls and untapped potential of health systems in Latin America, Africa, or Asia to maintain the well-being of vulnerable populations and ecosystems. We hope that as you delve into the state of child malnutrition in Dhaka or Ugandan perspectives on preventing malaria during pregnancy, you are able to recognize universal themes concerning access and multi sectoral approaches for ensuring health equity globally.
We are immensely proud of the range and depth of topics investigated by our online team, who have been able to highlight the work of global health professionals such as Professor Bill Bower, MPH, who serves as a Senior Lecturer at the Heilbrunn Department of Population and Family Health, and whose interview centered on Tuberculosis and the training of lay health workers. Related to the topic of global pandemics, we published a blog post about the current state of Covid-19, which continues to shape the landscape of global health. Our online team has also served as a space for students to share their unique experiences. We have enjoyed the thoughtful perspectives of our online team members on a blog post about the modern increase in allergen reactivity, as well as a podcast that discusses what this allergen sensitivity looks like in practice, with a student interview about living with dietary restrictions in college. We hope to continue to provide spaces for our members to explore their interests and share their perspectives.
We are immensely proud of the range and depth of topics investigated by our online team, who have been able to highlight the work of global health professionals such as Professor Bill Bower, MPH, who serves as a Senior Lecturer at the Heilbrunn Department of Population and Family Health, and whose interview centered on Tuberculosis and the training of lay health workers. Related to the topic of global pandemics, we published a blog post about the current state of Covid-19, which continues to shape the landscape of global health. Our online team has also served as a space for students to share their unique experiences. We have enjoyed the thoughtful perspectives of our online team members on a blog post about the modern increase in allergen reactivity, as well as a podcast that discusses what this allergen sensitivity looks like in practice, with a student interview about living with dietary restrictions in college. We hope to continue to provide spaces for our members to explore their interests and share their perspectives.
In a climate that has left many of our members feeling unsettled and anxious for the future, we would like to extend the utmost gratitude to our incredible team. Their fortitude and resilience has been inspiring to witness and it is not lost upon us the crucial role that each member plays in making our journal a reality. We are additionally thankful for the support of our faculty advisors, Esther Jackson, Dr. Julianna A. Bol, PhD, and Dr. Ana Navas-Acien, MD, PhD, MPH whose guidance has been invaluable. Thank you to our peer reviewers and the authors for their insightful comments and pieces, respectively. Lastly, we give a special thanks to our readers and listeners for their continuous engagement with our issues, blogs, and podcasts. You hold a special place within The Columbia University Journal of Global Health.
Sincerely,
Kairaluchi Oraedu & Ann Thanh Phan
Co-Editors-in-Chief,
The Columbia University Journal of Global Healt
Battlefield Triage: A Resolvable Moral Tragedy
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 v
Using Creatures of Flight to Explore the Mind-Body Relationship and Transcendence in Emily Dickinson’s Poetry
Emily Dickinson is recognized as one of the most illustrious American poets of all time, famous for her explorations of profound concepts surrounding the mind and body life and death and. Yet in doing so, she does not simply paint binary understandings of the universe, but also makes evident that these dualities are not to be simply reconciled either. This literary and philosophical approach is captured in various symbolic forms throughout Dickinson’s poetry, and I chose to focus on the recurring appearance of flying creatures, namely birds, bees, and angels. By first sitting down and reading hundreds of her poems in order to take a top-down approach that was thus less biased in its analysis, I pieced together what I thought were notable themes and consistencies amongst each distinct category of creature in order to weave a greater, transcendent image of how Dickinson views the world
Taking Personhood Seriously
This Article takes the recent Twitter merger litigation, along with other high-profile legal developments, as an opportunity to re-examine one of the most important, and misunderstood, concepts in the modern social landscape: legal personhood. The Article makes three main contributions to the literature: first, it originally connects several key stages in personhood’s historical development, from the common law, through the hurdles of legal realism and the early law and economics movement, to the recent revival of substantive personhood, both in scholarship and following the Supreme Court’s decisions on corporate constitutional rights. It then integrates this history with an analysis of the legal scene where personhood achieved its most profound impact, from the 1980s takeover era to the Twitter story: Delaware corporate law. Finally, this Article builds upon these insights to offer a new theoretical account of personhood as a legal degree of freedom, which holds the capacity to generate a practically unlimited range of situational outcomes. So far, scholars have tended to discuss personhood in a limited, context-specific manner. This Article brings personhood front and center in its own right, illustrating for the first time how personhood can be a no less, and often more, significant fact of legal life than contract, property, or public law, and why we should place it at the start of the analysis, prior to delving into the policy discussion of the day
Miller in a Cashless Society: Financial Surveillance and the Fourth Amendment
In United States v. Miller, the Supreme Court declared that the Fourth Amendment does not protect Americans’ bank records because there is no reasonable expectation of privacy in the data. More recently, while limiting the third-party doctrine in Carpenter v. United States, the Court expressly left Miller standing by distinguishing the checks and deposit slips in Miller from the cell site location information in Carpenter. The Carpenter majority described the bank records in Miller as containing “limited types of personal information,” but the continued use of that distinction relies on an outdated picture of financial technology and consumer habits. Financial records have evolved significantly since Miller was decided in 1976, and ever-increasing reporting and retention requirements have created massive financial databases. In an increasingly cashless society, financial records can reveal intimate and comprehensive information about nearly every American. Still, this Note recognizes that courts are unlikely to find them worthy of constitutional protection, and it does not argue that all searches of them should be subject to a warrant requirement. This Note instead aims to highlight our vast financial surveillance infrastructure, consider its costs and benefits, and advocate for Congressional narrowing of the procedures for access to and use of financial records by government agents
La khuṭba d’Abū Ḥamza al-Shārī : soulèvement ibāḍite et rhétorique de la contestation en péninsule Arabique au second siècle de l’Islam. Traduction commentée d’une version inédite du sermon
The present paper investigates the famous khuṭba attributed to Abū Ḥamza al-Shārī, an Ibāḍī warlord on behalf of ʿAbd Allāh b. Yaḥyā. In the middle of the 2nd/8th century, he seized Mecca and Medina as the outcome of an Ibāḍī rebellion that had begun in the remote region of Ḥaḍramawt. The khuṭba has been well-known for decades, as fragments are scattered throughout various Sunnī and Shīʿī sources. However, few studies have addressed the broader context of the sermon so far, or offered a comprehensive translation of it. This article is divided into two parts. The first part is devoted to the history of Ibāḍism in the Arabian Peninsula during the 2nd/8th century. We propose explanatory hypotheses to understand the various reasons that led ʿAbd Allāh b. Yaḥyā to rebel against the Umayyad dynasty. We also offer a commentary on the khuṭba to help in its reading. The second part contains an extensive translation based on a longer version of the khuṭba found in a little-known eighteenth-century Ibāḍī source, the Kashf al-ghumma al-jāmiʿ li-akhbār al-umma, drafted in Oman and attributed to Ibn Sirḥān al-Izkawī