Researchers tracking social trends have discovered a remarkable labor-saving device called the computer. They sit down before the instrument, call up a search engine, enter a key word that they believe represents the trend, and count the number of articles aroused by that key word. They track these numbers over a period of time and even graph them. Those who dislike a certain concept are happy to report the concept's rise and fall. Such has occurred with two articles, one of (...) which appeared in CQ, reporting the rise and fall of medical futility. We are impressed with the power of this research methodology, which seems capable of eliminating concepts, even when our own more labor-intensive yet apparently less perceptive daily experience finds evidence of their existence all around us. (shrink)

Previous studies have documented the fallibility of attempts by surrogates and physicians to act in a substituted judgment capacity and predict end-of-life treatment decisions on behalf of patients. We previously reported that physicians misperceive their patients' preferences and substitute their own preferences for those of their patients with respect to four treatments: cardiopulmonary resuscitation (CPR) in the event of cardiac arrest, ventilator for an indefinite period of time, medical nutrition and hydration for an indefinite period of time, and hospitalization in (...) the event of pneumonia. (shrink)

Previous studies have documented the fallibility of attempts by surrogates and physicians to act in a substituted judgment capacity and predict end-of-life treatment decisions on behalf of patients. We previously reported that physicians misperceive their patients' preferences and substitute their own preferences for those of their patients with respect to four treatments: cardiopulmonary resuscitation in the event of cardiac arrest, ventilator for an indefinite period of time, medical nutrition and hydration for an indefinite period of time, and hospitalization in the (...) event of pneumonia. (shrink)

Schneiderman, Teetzel, and Gilmer offer an amusing but misleading response to my article on medical futility. Although I did make note of the falloff in citations to medical futility in Medline and Bioethicsline after 1995, my analysis focused on the precipitous rise in professional publications on the concept in the period from 1988 to 1995—a trend confirmed by the authors' own search results. I certainly did not argue, either explicitly or implicitly, that the discussion of medical futility was over. (...) I made limited use of this citation survey—to raise a question about what sparked so much professional debate after 1988. This seems to me an entirely appropriate methodology. (shrink)

'Alain Badiou: Between Theology and Anti-theology' provides one of the first comprehensive analyses of the relationship between Badiou's philosophy and theology. Examining the full range of Badiou's writings, this provocative study explores how Badiou's philosophy relies on theology even if he claims otherwise and actively attempts to work against theology. Despite the complex questions discussed - ranging across ontology, the theory of truth and the subject, philosophy and its conditions, and anti-philosophy - this book presents a clear and accessible overview (...) of the theological, religious and biblical themes which animate Badiou's philosophy. (shrink)

Economics is probably the most subtle, precise and powerful of the social sciences and its theories have deep philosophical import. Yet the dominant alliance between economics and philosophy has long been cheerfully simple. This is the textbook alliance of neo-Classicism and Positivism, so crucial to the defence of orthodox economics against by now familiar objections. This is an unusual book and a deliberately controversial one. The authors cast doubt on assumptions which neo-Classicists often find too obvious to defend or, indeed, (...) to mention. They set out to disturb an influential concensus and to champion an unpopular cause. Although they go deeper into both philosophy and economics than is usual in interdisciplinary works, they start from first principles and the text is provokingly clear. This will be a stimulating book for all economic theorists and philosophers interested in the philosophy of science and social science. (shrink)

Losing an arm to rescue a child from a burning building is supererogatory. But is losing an arm to save two children more supererogatory than losing two arms to save a single child? What factors make one act more supererogatory than another? I provide an innovative account of how to compare which of two acts is more supererogatory, and show the superiority of this account to its chief rival.

Does it make sense to refer to bird song - a complex vocalization, full of repetitive and transformative patterns that are carefully calculated to woo a mate - as art? What about a pack of wolves howling in unison or the cacophony made by an entire rain forest? Redefining music as "the art of possibly animate things," Musical Vitalities charts a new path for music studies that blends musicological methods with perspectives drawn from the life sciences. In opposition to humanist (...) approaches that insist on a separation between culture and nature--approaches that appear increasingly untenable in an era defined by human-generated climate change--Musical Vitalities treats music as one example of the cultural practices and biotic arts of the animal kingdom rather than as a phenomenon categorically distinct from nonhuman forms of sonic expression. The book challenges the human exceptionalism that has allowed musicologists to overlook music's structural resemblances to the songs of nonhuman species, the intricacies of music's physiological impact on listeners, and the many analogues between music's formal processes and those of the dynamic natural world. Through close readings of Austro-German music and aesthetic writings that suggest wide-ranging analogies between music and nature, Musical Vitalities seeks to both rekindle the critical potential of nineteenth-century music and rejoin the humans at the center of the humanities with the nonhumans whose evolutionary endowments and planetary fates they share. (shrink)

With recent controversies surrounding the eligibility of athletes with disorders of sex development and hyperandrogenism, as well as continued discussion of the conditions transgender athletes must meet to compete in high-performance sport, a wide array of scholars representing a diverse range of disciplines have weighed in on both the appropriateness of classifying athletes into the female and male categories and the best practices of doing so. In response to cases of high-profile athletes’ sex being called into question, the International Olympic (...) Committee, the International Association of Athletics Federations, and the National Collegiate Athletics Association, among others, published or updated policies addressing who is eligible to compete in the women’s sport category and under what conditions. This paper addresses the areas in which philosophical reasoning and ethical analysis can contribute to reopened debates about the surveillance of the women’s category in sport. Emphasis is placed on determining where the onus of responsibility should fall for ensuring the new policies are followed. (shrink)

Throughout 2019, retired athletes Martina Navratilova, Sharron Davies, Kelly Holmes and Paula Radcliffe all spoke publically about what they perceive to b...

Twentieth century philosophers introduced the distinction between “objective rightness” and “subjective rightness” to achieve two primary goals. The first goal is to reduce the paradoxical tension between our judgments of what is best for an agent to do in light of the actual circumstances in which she acts and what is wisest for her to do in light of her mistaken or uncertain beliefs about her circumstances. The second goal is to provide moral guidance to an agent who may be (...) uncertain about the circumstances in which she acts, and hence is unable to use her standard moral principle directly in deciding what to do. This paper distinguishes two important senses of “moral guidance”; proposes criteria of adequacy for accounts of subjective rightness; canvasses existing definitions for “subjective rightness”; finds them all deficient; and proposes a new and more successful account. It argues that each comprehensive moral theory must include multiple principles of subjective rightness to address the epistemic situations of the full range of moral decision-makers, and shows that accounts of subjective rightness formulated in terms of what it would reasonable for the agent to believe cannot provide that guidance. (shrink)

Recently two distinct forms of rule-utilitarianism have been introduced that differ on how to measure the consequences of rules. Brad Hooker advocates fixed-rate rule-utilitarianism, while Michael Ridge advocates variable-rate rule-utilitarianism. I argue that both of these are inferior to a new proposal, optimum-rate rule-utilitarianism. According to optimum-rate rule-utilitarianism, an ideal code is the code whose optimum acceptance level is no lower than that of any alternative code. I then argue that all three forms of rule-utilitarianism fall prey to two fatal (...) problems that leave us without any viable form of rule-utilitarianism. (shrink)

An exploration of YouTube as a platform for remix, reuse, and sampling.

It's commonly understood within the academy that the terms "man," "woman," and "other" are socially constructed, and that their meanings are maintained by the current political order. But few thinkers have attempted to reconcile that knowledge - which is rooted in Marxism - with queer theory. The few who have, meanwhile, usually attempt to do so through issues of libidinal desire and sexual expression. In the Politics of Everybody, Holly Lewis argues powerfully that the emphasis on desire, though seemingly (...) innocuous, is actually symptomatic of neoliberal habits of thought, and consequently, is responsible for a continued focus on the limited politics of identity. Instead, Lewis shows, we should look to the arena of body production, categorization, and exclusion; only through such a reorientation can we create a politics of liberation that is truly inclusive and grounded in lived experience."-- Provided by publisher. (shrink)

Twentieth century philosophers introduced the distinction between “objective rightness” and “subjective rightness” to achieve two primary goals. The first goal is to reduce the paradoxical tension between our judgments of (i) what is best for an agent to do in light of the actual circumstances in which she acts and (ii) what is wisest for her to do in light of her mistaken or uncertain beliefs about her circumstances. The second goal is to provide moral guidance to an agent who (...) may be uncertain about the circumstances in which she acts, and hence is unable to use her standard moral principle directly in deciding what to do. This paper distinguishes two important senses of “moral guidance”; proposes criteria of adequacy for accounts of subjective rightness; canvasses existing definitions for “subjective rightness”; finds them all deficient; and proposes a new and more successful account. It argues that each comprehensive moral theory must include multiple principles of subjective rightness to address the epistemic situations of the full range of moral decision-makers, and shows that accounts of subjective rightness formulated in terms of what it would reasonable for the agent to believe cannot provide that guidance. -/- . (shrink)

Background In end-of-life situations, the phrase “do everything” is sometimes invoked by physicians, patients, or substitute decision-makers, though its meaning is ambiguous. We examined instances of the phrase “do everything” in the archive of the Ontario Consent and Capacity Board in Canada, a tribunal with judicial authority to adjudicate physician–patient conflicts in order to explore its potential meanings. Methods We systematically searched the CCB’s online public archive from its inception to 2018 for any references to “do everything” in the context (...) of critical care medicine and end-of-life care. Two independent assessors reviewed decisions, collected characteristics, and identified key themes. Results Of 598 cases in the archive, 41 referred to “do everything” in end-of-life situations. The phrase was overwhelmingly invoked by SDMs, typically to advocate for life-prolonging measures that contradicted physician advice. Physicians generally related “doing everything” to describe the interventions they had already performed, using it to recommend focusing on patients’ quality of life. SDMs were generally reluctant to accept death, whereas physicians found prolonging life at all costs to be morally distressing. The CCB did not interpret appeals to “do everything” legally but followed existing laws by deferring to patients’ prior wishes whenever known, or to concepts of “best interests” when not. The CCB generally recommended against life-prolonging measures in these cases, focusing on patients’ “well-being” and “best interests.” Conclusions In this unique sample of cases involving conflict surrounding resuscitation and end-of-life care, references to “do everything” highlighted conflicts over quantity versus quality of life. These appeals were associated with signs of cognitive distress on the behalf of SDMs who were facing the prospect of a patient’s death, whereas physicians identified moral distress related to the prolongation of patients’ suffering through their use of life-sustaining interventions. This divergence in perspectives on death versus suffering was consistently the locus of conflict. These findings support the importance of tools such as the Serious Illness Conversation Guide that can be used by physicians to direct conversations on the patients’ goals, wishes, trade-offs, and to recommend a treatment plan that may include palliative care. Trial Registration Not applicable. (shrink)

The requirement that moral theories be usable for making decisions runs afoul of the fact that decision makers often lack sufficient information about their options to derive any accurate prescriptions from the standard theories. Many theorists attempt to solve this problem by adopting subjective moral theories—ones that ground obligations on the agent’s beliefs about the features of her options, rather than on the options’ actual features. I argue that subjective deontological theories suffer a fatal flaw, since they cannot appropriately require (...) agents to gather information before acting. (shrink)

Ellis argues that certain essential properties of objects in the world not only determine the nature of these objects but also how they will behave in any situation. In this paper I will critique Ellis's essentialism from the perspective of the philosophy of chemistry, arguing that our current knowledge of chemistry in fact does not lend itself to essentialist interpretations and that this seriously undercuts Ellis's project. In particular I will criticize two key distinctions Ellis draws between internal vs. external (...) properties and essential vs. accidental properties, showing that at the chemical level such distinctions are insupportable. If essential properties only exist at the level of sub-atomic physics, then Ellis's hopes that essentialism will provide a theoretical basis for a philosophy of chemistry are at best hopes for a very distant future, since the argument that chemical structure and dynamics can be explained at the quantum level derived is purely from analogy to much simpler systems than those chemists actually study. This suggests that we have very little scientific evidence that scientific essentialism is a viable ontology. †To contact the author, please write to: Department of Philosophy, University of Notre Dame, Notre Dame, IN 46556; e-mail: [email protected]. (shrink)

To prepare for potential human infection challenge studies involving SARS-CoV-2, we convened a multidisciplinary working group to address ethical questions regarding whether and how much SAR...

Although justice is a central principle in clinical ethics, work that centers social justice is often marginalized in clinical ethics. In addition to institutional barriers that may be preventing clinical ethicists from becoming the activists that Meyers argues we should be, we must also recognize the barriers embedded in the field of clinical ethics itself. As clinical ethicists, we have an opportunity to support anti‐racism work in particular by altering our own organizational structures to be more inclusive and reflective of (...) the Black, Indigenous, and other communities of color we serve, enhancing clinical ethics education and training by making critical theories foundational, and decolonizing our clinical ethics consultation tools and practices. (shrink)

What should we do if we cannot figure what morality requires of us? Holly M. Smith argues that the best moral codes solve this problem by offering two tiers, one of which tells us what makes acts right and wrong, and the other of which provides user-friendly decision guides. She opens a path towards resolving a deep problem of moral life.

Even though the evidence‐based medicine movement (EBM) labels mechanisms a low quality form of evidence, consideration of the mechanisms on which medicine relies, and the distinct roles that mechanisms might play in clinical practice, offers a number of insights into EBM itself. In this paper, I examine the connections between EBM and mechanisms from several angles. I diagnose what went wrong in two examples where mechanistic reasoning failed to generate accurate predictions for how a dysfunctional mechanism would respond to intervention. (...) I then use these examples to explain why we should expect this kind of mechanistic reasoning to fail in systematic ways, by situating these failures in terms of evolved complexity of the causal system(s) in question. I argue that there is still a different role in which mechanisms continue to figure as evidence in EBM: namely, in guiding the application of population‐level recommendations to individual patients. Thus, even though the evidence‐based movement rejects one role in which mechanistic reasoning serves as evidence, there are other evidentiary roles for mechanistic reasoning. This renders plausible the claims of some critics of evidencebased medicine who point to the ineliminable role of clinical experience. Clearly specifying the ways in which mechanisms and mechanistic reasoning can be involved in clinical practice frames the discussion about EBM and clinical experience in more fruitful terms. (shrink)

In this paper, I discuss the nature and consequences of confabulation about political opinions and behaviours. When people confabulate, they give reasons for their choices or behaviour which are ill-grounded and do not capture what really brought the behaviour about, but they do this with no intention to deceive and endorse their own accounts. I suggest that this can happen when people are asked why they voted a certain way, or support certain campaigns, and so on. Confabulating in these political (...) contexts seems bad because we do not get a fully truthful account of why some political choice was made, and so the reasoning behind the choice is under-scrutinised. However, I argue that if people have a virtue of self-regulation, confabulation in political contexts can actually be part of the process of coming to better understand our political choices and embody more consistently the political values which we ascribe to. (shrink)

This paper explores the degree of privacy athletes can expect and demand in the era of genetic technology in sport. Detecting genetic enhancements in sport, and consequently doping violations, using genetic tests is problematic because testing requires access to athletes' genetic information, and accessing genetic information creates many potential privacy issues and concerns throughout the world. Whether it is morally acceptable to subject athletes to the tests used to detect genetic modifications in sport is taken up in this paper, and (...) I argue that the elite sport movement faces an ethical dilemma since rules prohibit athletes from utilising certain substances, methods and procedures, but the testing methods needed to ensure compliance with the rules are controversial and at odds with a reasonable expectation of privacy. (shrink)

In this field guide, I distinguish five separate senses with which the term ‘mechanism’ is used in contemporary philosophy of science. Many of these senses have overlapping areas of application but involve distinct philosophical claims and characterize the target mechanisms in relevantly different ways. This field guide will clarify the key features of each sense and introduce some main debates, distinguishing those that transpire within a given sense from those that are best understood as concerning distinct senses. The ‘new mechanisms’ (...) sense is at the center of most of these contemporary debates and will be treated at greater length; subsequent senses of mechanism will be primarily distinguished from this one. In part I of this paper, I distinguish two senses of the term ‘mechanism’, both of which are explicitly hierarchical and nested in character, such that any given mechanism is comprised of smaller sub-mechanisms, in turn comprised of yet smaller sub-sub-mechanisms and so on. While both of the senses discussed here are anti-reductive, they differ in their focus on scientific practice versus metaphysics, in the degree of regularity they attribute to mechanisms, and in terms of their relationships to the discussions of mechanisms in the history of philosophy and science. (shrink)

A finer-grained delineation of a given explanandum reveals a nexus of closely related causal and non- causal explanations, complementing one another in ways that yield further explanatory traction on the phenomenon in question. By taking a narrower construal of what counts as a causal explanation, a new class of distinctively mathematical explanations pops into focus; Lange’s characterization of distinctively mathematical explanations can be extended to cover these. This new class of distinctively mathematical explanations is illustrated with the Lotka-Volterra equations. There (...) are at least two distinct ways those equations might hold of a system, one of which yields straightforwardly causal explanations, but the other of which yields explanations that are distinctively mathematical in terms of nomological strength. In the first, one first picks out a system or class of systems, finds that the equations hold in a causal -explanatory way; in the second, one starts with the equations and explanations that must apply to any system of which the equations hold, and only then turns to the world to see of what, if any, systems it does in fact hold. Using this new way in which a model might hold of a system, I highlight four specific avenues by which causal and non- causal explanations can complement one another. (shrink)

After witnessing extraordinary scientific and regulatory efforts to speed development of and access to new COVID-19 interventions, patients facing other serious diseases have begun to ask “where’s...

This paper articulates an account of causation as a collection of information-theoretic relationships between patterns instantiated in the causal nexus. I draw on Dennett’s account of real patterns to characterize potential causal relata as patterns with specific identification criteria and noise tolerance levels, and actual causal relata as those patterns instantiated at some spatiotemporal location in the rich causal nexus as originally developed by Salmon. I develop a representation framework using phase space to precisely characterize causal relata, including their degree (...) of counterfactual robustness, causal profiles, causal connectivity, and privileged grain size. By doing so, I show how the philosophical notion of causation can be rendered in a format that is amenable for direct application of mathematical techniques from information theory such that the resulting informational measures are causal informational measures. This account provides a metaphysics of causation that supports interventionist semantics and causal modeling and discovery techniques. (shrink)