State governments provide preprinted advance directive forms to the general public. However, many adults in the United States (US) lack the skills necessary to read and comprehend health care-related materials. In this study, we sought to determine the readability of state government-sponsored advance directive forms.

: Dr. Smith is an internist in private practice who works at an inner city clinic affiliated with a university hospital. He is also a member of the university faculty. Many of Dr. Smith’s patients have type 2 diabetes mellitus and struggle with health care and other costs. Thinking about opportunities to better serve his patients and advance his career, Dr. Smith considers conducting clinical research in his office. ACME is a respected pharmaceutical company that for decades has engaged in (...) research, development, and production of widely used drugs. Several of ACME’s oral agents for type 2 diabetes will soon go off patent. In an effort to retain its market share in this class of drugs, ACME wants to complete clinical trials expeditiously and obtain approval for its new oral hypoglycemic medicine. The company approaches Dr. Smith to be a coinvestigator in its multicenter clinical trial. (shrink)

Volume 20, Issue 2, February 2020, Page 49-50.

Background Following passage of the Patient Self Determination Act in 1990, health care institutions that receive Medicare and Medicaid funding are required to inform patients of their right to make their health care preferences known through execution of a living will and/or to appoint a surrogate-decision maker. We evaluated the impact of external factors and perceived patient preferences on physicians’ decisions to honor or forgo previously established advance directives (ADs). In addition, physician views regarding legal risk, patients’ ability to comprehend (...) complexities involved with their care, and impact of medical costs related to end-of-life care decisions were explored. Methods Attendees of two Mayo Clinic continuing medical education courses were surveyed. Three scenarios based in part on previously court-litigated matters assessed impact of external factors and perceived patient preferences on physician compliance with patient-articulated wishes regarding resuscitation. General questions measured respondents’ perception of legal risk, concerns over patient knowledge of idiosyncrasies involved with their care, and impact medical costs may have on compliance with patient preferences. Responses indicating strength of agreement or disagreement with statements were treated as ordinal data and analyzed using the Cochran Armitage trend test. Results Three hundred eighty-eight of 951 surveys were completed (41% response rate). Eighty percent reported they were likely to honor a patient’s AD despite its 5 year age. Fewer than half (41%) would honor the AD of a patient in ventricular fibrillation who had expressed a desire to “pass away in peace.” Few (17%) would forgo an AD following a family’s request for continued resuscitative treatment. A majority (52%) considered risk of liability to be lower when maintaining someone alive against their wishes than mistakenly failing to provide resuscitative efforts. A large percentage (74%) disagreed that patients could not appreciate complexities surrounding their care while 69% agreed that costs should never impact a physician’s decision as to whether to comply with a patient’s AD. Conclusions Our findings highlight the impact, albeit small, external factors have on physician AD compliance. Most respondents based their decision on the clinical situation at hand and interpretation of the patient’s initial wishes and preferences expressed by the AD. (shrink)

BackgroundAn analysis of the position statements of secular US medical and surgical professional societies on physician-assisted suicide (PAS) and euthanasia have not been published recently. Available statements were evaluated for position, content, and sentiment.MethodsIn order to create a comprehensive list of secular medical and surgical societies, the results of a systematic search using Google were cross-referenced with a list of societies that have a seat on the American Medical Association House of Delegates. Societies with position statements were identified. These statements (...) were divided into 5 categories: opposed to PAS and/or euthanasia, studied neutrality, supportive, acknowledgement without statement, and no statement. Linguistic analysis was performed using RapidMinder in order to determine word frequency and sentiment respective to individual statements. To ensure accuracy, only statements with word counts > 100 were analyzed. A 2-tailed independentttest was used to test for variance among sentiment scores of opposing and studied neutrality statements.ResultsOf 150 societies, only 12 (8%) have position statements on PAS and euthanasia: 11 for PAS (5 opposing and 4 studied neutrality) and 9 for euthanasia (6 opposing and 2 studied neutrality). Although the most popular words used in opposing and studied neutrality statements are similar, notable exceptions exist (suicide,medicine, andtreatmentappear frequently in opposing statements, but not in studied neutrality statements, whereaspsychologists,law, andindividualsappear frequently in studied neutrality statements, but not in opposing statements). Sentiment scores for opposing and studied neutrality statements do not differ (mean, 0.094 vs. 0.104;P = 0.90).ConclusionsFew US medical and surgical societies have position statements on PAS and euthanasia. Among them, opposing and studied neutrality statements share similar linguistic sentiment. Opposing and studied neutrality statements have clear differences, but share recommendations. Both opposing and studied neutrality statements cite potential risks of PAS legalization and suggest that good palliative care might diminish a patient’s desire for PAS. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Bibliography of Resources by and about André E. Hellegers*Compiled by Doris Mueller Goldstein (bio)This bibliography is derived from the holdings of the National Reference Center for Bioethics Literature and the BIOETHICSLINE© database (both of which are at the Kennedy Institute of Ethics and supported by the National Library of Medicine); the archives of Lauinger Library, Georgetown University; the Medline databases of the National Library of Medicine; the WorldCat database (...) of OCLC, Dublin, Ohio, and selected Internet sites.Primarily comprised of writings by Dr. Hellegers, the list also includes interviews and media programs in which he participated, as well as writings about him that were written following his death. The arrangement within each section is by date. The 231 authored pieces reflect the transition from Dr. Hellegers’s early career as a researcher in fetal physiology at Johns Hopkins Medical School, where he published his first research report at the age of 29, to the early years of the Kennedy Institute, where he produced so many provocative columns on bioethical issues that influenced the growth of the field.Due to the diversity of sources and the 40-year time span covered, there are some variations in bibliographic style. Time and availability constraints precluded verifying all of the citations with the original documents. Any additions or corrections should be submitted to the compiler.Works Authored by André E. HellegersNo Date Ethical Issues in Sterilization of the Retarded. Unpublished paper.1956Vitamin B12 Serum Level and Pregnancy. American Journal of Clinical Nutrition 4: 440+, 1956. [With Bacon F. Chow and Kunio Okuda] [End Page 89]1957Vitamin B12 Absorption in Pregnancy and in the Newborn. American Journal of Clinical Nutrition 5: 327+, 1957. [With Bacon F. Chow, Robert E. L. Nesbitt, Kunio Okuda, and David W. Smith]1958The Effects of Acute Hypoxia on the Osmotic Pressure of the Plasma. Quarterly Journal of Experimental Physiology 43: 197+, 1958. [With Donald H. Barron, Frederick C. Battaglia, and Giacomo Meschia]Studies on the Absorption of Vitamin B12 in Human Pregnancy with Especial Reference to the Effect of D-Sorbitol. American Journal of Obstetrics and Gynecology 76: 91+, 1958. [With Bacon F. Chow, Harry Prystowsky, and Vernon Wong]1959The Alveolar PCO2 and PO2 in Pregnant and Nonpregnant Women at Altitude. Proceedings of the Society for Clinical Investigation 38: 1010+, 1959. [With Donald Barron, William Huckabee, Giacomo Meschia, James Metcalfe, and Harry Prystowsky]A Comparison of the Oxygen Dissociation Curves of the Bloods of Maternal and Fetal Goats at Various pHs. Quarterly Journal of Experimental Physiology 44: 215–21, July 1959. [With Donald Barron, Giacomo Meschia, Harry Prystowsky, and A. Stark Wolkoff]Fetal Blood Studies. XII. On the Relationship Between the Position of the Oxygen Dissociation Curve of Human Fetal Blood and Adult Fetal Hemoglobin. American Journal of Obstetrics and Gynecology 77: 585+, 1959. [With Paul D. Bruns, Julian Cotter, and Harry Prystowsky]Fetal Blood Studies. XIV. A Comparative Study of the Oxygen Dissociation Curve of Nonpregnant, Pregnant and Fetal Human Blood. American Journal of Obstetrics and Gynecology 78: 489–93, September 1959. [With Paul D. Bruns and Harry Prystowsky]Fetal Blood Studies. XVI. On the Changes in Total Osmotic Pressure and Sodium and Potassium Concentration of Amniotic Fluid During the Course of Human Gestation. Surgery, Gynecology and Obstetrics 109: 509–12, October 1959. [With Frederick Battaglia, Paul D. Bruns, Harry Prystowsky, and Clayton Smisson]Further Observations on the Metabolism of Vitamin B12 in Human Pregnancy. American Journal of Obstetrics and Gynecology 77: 1+, 1959. [With Bacon F. Chow, Harry Prystowsky, Bruno Ranke, and Elma Ranke]The Oxygen Dissociation Curves of the Bloods of Adult and Fetal Llamas. Federation Proceedings 18, 1959. [With Donald Barron, William Huckabee, Giacomo Meschia, James Metcalfe, and Harry Prystowsky] [End Page 90]Transfer of Oxygen Across the Sheep Placenta at High Altitude. Federation Proceedings 18, 1959. [With Donald Barron, William Huckabee, Giacomo Meschia, and Harry Prystowsky]Uterine Blood Flow and Metabolism in Pregnant Sheep at High Altitude. Federation Proceedings 18, 1959. [With Donald Barron, William Huckabee, Giacomo Meschia, James Metcalfe, and Harry Prystowsky]Uterine Blood Flow and Metabolism in Unanesthetized Pregnant Sheep. Federation Proceedings 18, 1959. [With Donald Barron, William Huckabee, Giacomo... (shrink)

For most observers of economics from both inside and outside the science, the term ‘economics’ is synonymous with neoclassical economics. It is the methodology of neoclassical economics that defines the discipline of economics. ‘Mainstream economics’ is neoclassical economics and anyone entering the discipline today who wishes to obtain an appointment at one of the leading universities of the world is well advised to master its techniques. The fact that virtually every winner of a Nobel prize from Paul Samuelson up (...) to his student Joseph Stiglitz has been a practitioner of neoclassical economics is ample proof of the methodology’s triumph. Despite the dominance of this methodology, however, neoclassical economics has been subject to a steady stream of criticisms and proposals for alternative methodological approaches throughout its life. This article focuses on two relatively recent challenges to the neoclassical orthodoxy that seem to have taken hold of a non-negligible minority of the profession, some of whom can be found at leading universities. These two challenges come from behavioural economics and evolutionary economics. The article describes the strengths and weaknesses of both of these methodological approaches and contrasts them with that of neoclassical economics. It concludes that all three methodologies have something positive to contribute to the study of human behaviour. Key Words: neoclassical economics • behavioural economics • evolutionary economics. (shrink)

Quine claims that holism (i.e., the Quine-Duhem thesis) prevents us from defining synonymy and analyticity (section 2). In Word and Object, he dismisses a notion of synonymy which works well even if holism is true. The notion goes back to a proposal from Grice and Strawson and runs thus: R and S are synonymous iff for all sentences T we have that the logical conjunction of R and T is stimulus-synonymous to that of S and T. Whereas Grice and Strawson (...) did not attempt to defend this definition, I try to show that it indeed gives us a satisfactory account of synonymy. Contrary to Quine, the notion is tighter than stimulus-synonymy – particularly when applied to sentences with less than critical semantic mass (section 3). Now according to Quine, analyticity could be defined in terms of synonymy, if synonymy were to make sense: A sentence is analytic iff synonymous to self-conditionals. This leads us to the following notion of analyticity: S is analytic iff, for all sentences T, the logical conjunction of S and T is stimulus-synonymous to T; an analytic sentence does not change the semantic mass of any theory to which it may be conjoined (section 4). This notion is tighter than Quine's stimulus-analyticity; unlike stimulus-analyticity, it does not apply to those sentences from the very center of our theories which can be assented to come what may, even though they are not synthetic in the intuitive sense (section 5). Conclusion: We can have well-defined notions of synonymy and analyticity even if we embrace Quine's holism, naturalism, behaviorism, and radical translation. Quine's meaning skepticism is to be repudiated on Quinean grounds. (shrink)

Recently, Kenneth Westphal has presented a highly interesting and innovative reading of Kant's critical philosophy.2 This reading continues a tradition of Kantscholarship of which, e.g., Paul Guyer's work is representative, and in which the antiidealistic potential of Kant's critical philosophy is pitted against its idealistic selfunderstanding. Much of the work in this tradition leaves matters at observing the tensions this introduces in Kant's work. But Westphal's proposed interpretation goes farther. Its attractiveness derives for the most part from the promise (...) that it permits an internal critique of Kant's transcendental idealism (TI), that is, a critique that is based on the very resources of Kantian transcendental philosophy.3 In contrast to these resources, which currently seem to go through a sort of revival in an enormous array of fields, TI is notorious for dismaying even sympathetic interpreters. How attractive and needed such an internal critique of TI would be becomes all the more patent when we place such a promise in the context of some of the contemporary discussions about TI after Allison's famous defense of it. Before directly engaging with Westphal's interpretation, I would therefore like to quickly sketch on what background it acquires its force (I). After characterizing the main features of Westphal's view (II), and supporting it in more detail by an account of Kant's theory of cognitive significance (III), I then want to review the extent of its success to present Kant as issuing an anti-skeptical argument (IV.1), or semantic views that are incompatible with TI (IV.2), or a 'proof of not merely empirical realism' (IV.3). I agree that purely idealist readings of Kant are mistaken. Westphal's... (shrink)

Introduction to sensory psychology, by C. Mueller.--Some reflections on brain and mind, by R. Brain.--In search of the engram, by K. Lashly.--Cerebral organization and behavior, by R. W. Sperry.--Relations between the central nervous system and the peripheral organs, by E. von Holst.--Effects of the Gestalt revolution, by J. E. Hochberg.--Seeing in depth, by R. L. Gregory.--The stimulus variables for visual depth perception, by J. J. Gibson.--The elaboration of the universe, by J. Piaget.--Visual perception approached by the method of stabilized images, (...) by R. M. Pritchard, W. Heron, and D. O. Hebb.--Philosophy as rigorous science, by E. Husserl.--The "sensation" as a unit of experience, by M. Merleau-Ponty.--The phenomenology of perception: perceptual implications, by A. Gurwitsch.--The expression of thinking, by E. W. Straus.--The concept of group and the theory of perception, by E. Cassirer.--Norm and pathology of I-world relations, by E. W. Straus.--The metaphysical in man, by M. Merleau-Ponty.--Cultural differences in the perception of geometric illusions, by M. H. Segall, D. T. Campbell, and M. J. Herskovits.--The interpretive cortex, by W. Penfield.--Recovery from early blindness: a case study, by R. L. Gregory and J. G. Wallace.--Visual disturbances after perceptual isolation, by W. Heron, B. K. Doane, and T. H. Scott. (shrink)

This self-contained treatise, originally published in 1947 by Holt, Rinehart and Winston, examines fundamental features of nature in order to lay the groundwork for providing a solution to the major problems of ethics.

v. 1. 1955-1960.--v. 2. 1960-1964.--v. 3. March-November 1964.--v. 4. November 26, 1964-September 2, 1965.--v. 5. September 3, 1965-August 27, 1968.--v. 6. August 28, 1968-May 22, 1971.--v. 7. April 13, 1975-June 21, 1976.--v. 7, pt. 2. September 17, 1977-February 26, 1978.--v. 8. April 28, 1978-July 28, 1980 -- v. 9. August 16, 1980-March 15, 1984 -- v. 11. January 19, 1986-May 27, 1987.

The options in a decision problem generally have outcomes with common features. Putting aside the common features simplifies deliberations, but the simplification requires a philosophical justification that this book provides.

In 1873, within two years of the publication of The Descent of Man, Friedrich Max Mueller wrote: There is one difficulty which Mr Darwin has not sufficiently appreciated … There is between the whole animal kingdom on the one side, and man, even in his lowest state, on the other, a barrier which no animal has ever crossed, and that barrier is – Language … If anything has a right to the name of specific difference, it is language, as we (...) find it in man, and in man only … If we removed the name of specific difference from our philosophic dictionaries, I should still hold that nothing deserves the name of man except what is able to speak … a speaking elephant or an elephantine speaker could never be called an elephant.' and ‘If a pig were ever to say to me, “I am a pig” it would ipso facto cease to be a pig’. (shrink)

ArgumentIn 1877, a young mathematician named Joseph Boussinesq presented amémoireto theAcadémiedes sciences which demonstrated that some differential equations may have more than one solution. Boussinesq linked this fact to indeterminism and to a possible solution to the free will versus determinism debate. Boussinesq's main interest was to reconcile his philosophical and religious views with science by showing that matter and motion do not suffice to explain all there is in the world. His argument received mixed criticism that addressed both his (...) philosophical views and the scientific content of his work, pointing to the physical “realisticness” of multiple solutions. While Boussinesq proved to be able to face the philosophical criticism, the scientific objections became a serious problem, thus slowly moving the focus of the debate from the philosophical plane to the scientific one. This change of perspective implied a wide discussion on topics such as instability, the sensitivity to initial conditions, and the conservation of energy. The Boussinesq debate is an example of a philosophically motivated debate that transforms into a scientific one, an example of the influence of philosophy on the development of science. (shrink)

Feyerabrend argues that intellectual progress relies on the creativity of the scientist, against the authority of science.

The present paper is a survey of the economics of survival, a branch of ecological economics that stresses the preservation of the opportunities of future generations over an extended time horizon. It outlines the main analytical foundation of the branch – in which the concept of entropy is a major building block –, and its analysis of the interaction between the economic system and the environment. Regarding its outlook of the future, we see that the founders of the branch were (...) mainly concerned with the consequences of a serious depletion of natural resources – particularly the energetic capital of the earth. More recently, however, emphasis is being placed on problems that stem from the fragility of the global ecosystem in face of the disturbances caused by the entropic acceleration imposed by mankind. It is feared that the ongoing expansion of the scale of the economy may bring about irreversible damages to vital environmental functions, such as protection against undesirable consequences of solar radiation, maintenance of temperature within a range that will support life, and preservation of ecosystem resiliency. (shrink)

Zusammenfassungen der Referate in französischer Sprache.

In the first part of this paper some general theses concerning the difference between logic and mathematics are defended. In the second part four different views for a possible demarcation between logic and mathematics are stated.

An agent often does not have precise probabilities or utilities to guide resolution of a decision problem. I advance a principle of rationality for making decisions in such cases. To begin, I represent the doxastic and conative state of an agent with a set of pairs of a probability assignment and a utility assignment. Then I support a decision principle that allows any act that maximizes expected utility according to some pair of assignments in the set. Assuming that computation of (...) an option's expected utility uses comprehensive possible outcomes that include the option's risk, no consideration supports a stricter requirement. (shrink)

Schelling und Hegel benutzen in ihren philosophischen Texten mathematische und naturwissenschaftliche Modelle wie Unendlichkeit oder Gleichgewicht. Die Strukturen dieser Begriffe liefern einen Massstab fur den Vergleich der Positionen Schellings und Hegels, der fur Schellings Identitatsphilosophie und Hegels erste Jenaer Schriften durchgefuhrt wird. Als wichtigstes Resultat kann eine grundlegende Differenz zwischen beiden Positionen bereits um 1801 nachgewiesen und gezeigt werden, dass diese auf einer unterschiedlichen Auffassung der Rolle des Absoluten beruht.

This paper contributes to the (re-)conceptualisation of responsible innovation by proposing an evolutionary economic approach that focuses on the role of consumers in the innovation process. After a discussion of the philosophical foundations and ethical implications of this approach, which bears an explanatory potential that has not been adequately considered in previous discussions of responsible innovation, we present a first step towards capturing the important but often neglected role of consumers in innovation processes (including responsible innovation): We propose an agent-based (...) model that incorporates a multidimensional space of characteristics in which new products or services are represented by more than the mere aspect of price and quality. Instead, innovations are denoted by a large set of characteristics, including also negative or harmful ones. The model is used to illustrate that consumers’ heterogeneity and bounded rationality – even if considered in a simple manner – indeed play a crucial role in the creation and diffusion of responsible innovation which can and should be used for further work in this field and for possible extensions of the model. (shrink)

Die MISCELLANEA MEDIAEVALIA präsentieren seit ihrer Gründung durch Paul Wilpert im Jahre 1962 Arbeiten des Thomas-Instituts der Universität zu Köln. Das Kernstück der Publikationsreihe bilden die Akten der im zweijährigen Rhythmus stattfindenden Kölner Mediaevistentagungen, die vor über 50 Jahren von Josef Koch, dem Gründungsdirektor des Instituts, ins Leben gerufen wurden. Der interdisziplinäre Charakter dieser Kongresse prägt auch die Tagungsakten: Die MISCELLANEA MEDIAEVALIA versammeln Beiträge aus allen mediävistischen Disziplinen - die mittelalterliche Geschichte, die Philosophie, die Theologie sowie die Kunst- und (...) Literaturwissenschaften sind Teile einer Gesamtbetrachtung des Mittelalters. (shrink)