From computerized medical records to databases of pharmacological interactions and automated provisional EKG readings, the emergence of information technology has significantly altered the practice of medicine. Information technology has been widely used to enhance diagnosis and treatment and to improve communication between providers. The advent of the Internet also brings far-reaching implications for patient–physician communication, challenging physicians, patients, and policymakers to consider its impact on the delivery of medical care and the therapeutic relationship. A new set of practices by patients (...) and physicians is unfolding in cyberspace, ranging from the use of e-mail to communicate between physicians and patients in an existing relationship to one-to-one consultations with an anonymous physician and ongoing online treatment, such as psychotherapy. These practices are emerging in both the for-profit and not-for-profit spheres. (shrink)

This paper is a critical analysis of David Rayfield's attempt to distinguish true from correct descriptions of human actions (Inquiry, Vol. 13 [1970], Nos. 1?2). It is argued that the analysis fails to do the job required of it for two reasons. First, the analysis of true descriptions is circular insofar as it turns on the notion of an ?unbound action?. Secondly, and independent of the charge of circularity, it is shown that the basis upon which Rayfield draws the true?correct (...) distinction leads to certain unacceptable consequences for action theory. (shrink)

As the title indicates, This paper represents an examination of the relationships obtaining among the concepts of foresight, Intention, And responsibility. It begins with a critical analysis of the legal and quasi-Moral principle of the resumption of intentionality (i.E., An agent is presumed to have intended the "foreseeable" consequences of her intentional actions). It is shown that, While legally indispensable, It will simply not withstand philosophical scrutiny for purposes of ascribing moral responsibility. I proceed eventually to an evaluation of a (...) proposal which would make foresight itself a sufficient--Though not a necessary--Condition for the ascription of responsibility. The strengths and weaknesses of such a proposal are assessed within both legal and moral contexts. Having distinguished between what I term the "hard-Liners" vs. The "soft-Liners" to the debate, I give my reasons for aligning myself with the hard-Liners (i.E., Those who might be sympathetically inclined to my alternate proposal). (shrink)

This paper discusses a problem arising from the way in which John Searle marks the distinction between intentional and unintentional action (Inquiry, Vol. 22, pp. 253?80), namely, that of adequately distinguishing those events which we regard as unintentional actions on the part of an agent from those other events occasioned by or brought about as a result of his action which we (correctly) do not countenance as actions of any sort ? unintentional or otherwise. Searle's attempt to distinguish them in (...) terms of the ?proximity of the contents of intentions? is examined and rejected, and an alternative account which exploits the anthropocentric character of our action vocabulary is proposed and defended. The discussion ends with a brief indication of some other difficulties engendered by Searle's analysis. (shrink)

This paper is a critical discussion of Robert T. Hall's recent attempt to construct a "minimal" definition of 'civil disobedience.' It is shown that the analysis, if applied consistently, results in a definition which is too minimal in including far too much under the rubric of 'civil disobedience.’ Furthermore, it is argued that Hall himself is not consistent in his treatment, the result being a definition which is too restrictive insofar as it excludes certain clear cases of civilly disobedient action. (...) It is shown that the inadequacies in Hall's minimal definition stem from an underlying confusion in his understanding of civil disobedience, the nature of which is indicated by examining his treatment of one of the features commonly held to be essential to acts of civil disobedience, namely, the publicity attending their performance. Finally, my argument is intended to demonstrate that any proposed definition of 'civil disobedience' which does not include reference to a publicity condition is bound to fail to do the job required of it. (shrink)

Arthur Miller is one of the most important and enduring playwrights of the last fifty years. This new edition of The Theater Essays has been expanded by nearly fifty percent to include his most significant articles and interviews since the book's initial publication in 1978. Within these pages Miller discusses the roots of modern drama, the nature of tragedy, and the state of contemporary theater; offers illuminating observations on Ibsen, Strindberg, Chekhov, O'Neill, and Williams; probes the different (...) approaches and attitudes toward theater in Russia, China, and at home; and, of course, provides valuable insights into his own vast dramatic corpus. For this edition the literary chronology and cast and production information have been updated, and an extensive new bibliography has been added. The Theater Essays confirms Arthur Miller's standing as a brilliant, eloquent commentator on drama and culture. No one interested in theater should be without this definitive collection. (shrink)

Physicians generally recommend that patients resuscitated with naloxone after opioid overdose stay in the emergency department for a period of observation in order to prevent harm from delayed sequelae of opioid toxicity. Patients frequently refuse this period of observation despiteenefit to risk. Healthcare providers are thus confronted with the challenge of how best to protect the patient’s interests while also respecting autonomy, including assessing whether the patient is making an autonomous choice to refuse care. Previous studies have shown that physicians (...) have widely divergent approaches to navigating these conflicts. This paper reviews what is known about the effects of opioid use disorder on decision-making, and argues that some subset of these refusals are non-autonomous choices, even when patients appear to have decision making capacity. This conclusion has several implications for how physicians assess and respond to patients refusing medical recommendations after naloxone resuscitation. (shrink)

What term is most appropriate in describing the limits of medicine? That depends on who determines the limits and the bases on which those limits are delineated and communicated. Schneiderman, Jecker, and Jonsen critique two recent policy statements by critical care providers—Bosslet et al. and Nates et al. —for their rejection of the use of the term futile for treatment. Both statements recommend using the adjective inappropriate for the problematic treatment, rather than futile, based on the lack of consensus of (...) just what constitutes futility. Schneiderman, Jecker, and Jonsen also assert that, despite a lack of consensus about the determination of futility, the definitions they have... (shrink)

The Wisconsin Supreme Court, after adopting the doctrine of the objective patient standard, expanded it in bold and innovative ways over nearly four decades, until the Wisconsin legislative and executive branches drastically reversed this course. The saga has implications for other jurisdictions considering adoption or expansion of the objective patient standard doctrine.

Childress and coauthors present a case considering ECMO withdrawal over the objection of the conscious patient who is no longer a candidate for transplantation or other definitive therapeutic inter...

In this issue, Raphael Cohen-Almagor reviews some of the terms used in the discussion of bioethical issues at the end of a patient's life; he argues that they are “valueladen” and serve “primarily the physicians, at times at the expense of the patients’ best interest.” Each of the following terms comes under scrutiny: “death with dignity,” “persistent vegetative state,” “futility,” “double effect,” and “brain death.” He argues that these concepts, developed in recent decades, “have generated an unhealthy atmosphere for patients, (...) which might lead to undesirable actions at the end of patients’ lives.” He issues a plea to discontinue the use of the term “persistent vegetative state” because it is dehumanizing, to explain “double effect” and “futility” in detail and with sincerity, and to clarify the motivation for using these terms and others. He warns physicians not to use terminology that is offensive to patients and loved ones or that weakens their patients’ will to live. (shrink)

In this issue, Raphael Cohen-Almagor reviews some of the terms used in the discussion of bioethical issues at the end of a patient's life; he argues that they are “valueladen” and serve “primarily the physicians, at times at the expense of the patients’ best interest.” Each of the following terms comes under scrutiny: “death with dignity,” “persistent vegetative state,” “futility,” “double effect,” and “brain death.” He argues that these concepts, developed in recent decades, “have generated an unhealthy atmosphere for patients, (...) which might lead to undesirable actions at the end of patients’ lives.” He issues a plea to discontinue the use of the term “persistent vegetative state” because it is dehumanizing, to explain “double effect” and “futility” in detail and with sincerity, and to clarify the motivation for using these terms and others. He warns physicians not to use terminology that is offensive to patients and loved ones or that weakens their patients’ will to live. (shrink)

The problem of decision-making capacity in patients with dementia, such as those with early stage Alzheimer's, can be vexing, especially when these patients refuse life-sustaining medical treatments. However, these patients should not be presumed to lack decision-making capacity. Instead, an analysis of the patient's decision-making capacity should be made. Patients who have some degree of decision-making capacity may be able to make a choice about life-sustaining medical treatment and may, in many cases, choose to forgo treatment.

It is now a default obligation to provide cardiopulmonary resuscitation (CPR), in the absence of knowledge of a patient’s or surrogate’s wishes to the contrary. We submit that it is time to reevaluate this position. Attempting CPR should be subject to the same scrutiny demanded of other medical interventions that involve balancing a great benefit against grievous harms.

There is a remarkable trend in contemporary environmentalism that emphasizes ‘accepting responsibility’ for the natural world in contrast to outdated preservationist thinking that shirks such responsibility. This approach is often explained and justified by reference to the anthropocene: this fundamentally new epoch—defined by human domination—requires active human intervention to avert planetary catastrophe. However, in this paper, I suggest this rhetoric encourages a flight from history. This often jubilant, sometimes anxious, yearning for unprecedented human innovation and—ultimately—control in our new millennia mirrors (...) the Futurist movement that took off near the beginning of the last century. Despite the significant differences in the details of how academics have defended this twenty-first-century environmental outlook, they all represent the true flight from history; they too quickly jettison the ideas of historical environmentalists and so misunderstand the environmental values at the heart of preservation that are more salient than ever. (shrink)

Soil is fragile and nonrenewable but the most basic of natural resources. It has a capacity to tolerate continuous use but only with proper management. Improper soil management and indiscriminate use of chemicals have contributed to some severe global environmental issues, e.g., volatilization losses and contamination of natural waters by sediments and agricultural fertilizers and pesticides. The increasing substitution of energy for labor and other cultural inputs in agriculture is another issue. Fertilizers and chemicals account for about 25% of the (...) production energy investment in agriculture. An additional 60% is accounted for by machinery, gasoline, electricity, and power-related inputs. Fertilizer additions to cropland are not utilized fully and significant amounts, depending on conditions, are either lost in surface runoff or leached into the ground water. The annual discharge of dissolved solids from agricultural lands to the waterways in the USA is substantial. The increasing use of herbicides in agriculture is a threat to the quality of surface and ground water, although this threat is dependent upon both the chemistry of the compound and the ecosystem in which it is used. Especially within the Third World, development of an environmental ethic and environmental laws have not kept pace with the increase in pesticide use. Above all is the severe and global problem of soil degradation currently occurring at the rate of five to seven million hectares per year. The policy and moral aspects of these issues are discussed. (shrink)