The most recent work dealing expressly with adoption in Greece is Wentzel's article in Hermes lxv , 167–76, ‘Studien über die Adoption in Griechen-land’. Her article ranges widely over the whole subject and includes a list of all the inscriptions known to her which refer to adoptions, as well as a list of the adoptive formulae found in these inscriptions. In the present article I shall deal more fully with these formulae.

The most recent work dealing expressly with adoption in Greece is Wentzel's article in Hermes lxv, 167–76, ‘Studien über die Adoption in Griechen-land’. Her article ranges widely over the whole subject and includes a list of all the inscriptions known to her which refer to adoptions, as well as a list of the adoptive formulae found in these inscriptions. In the present article I shall deal more fully with these formulae.

My concern in this paper is with the claim that knowledge is a mental state – a claim that Williamson places front and centre in Knowledge and Its Limits. While I am not by any means convinced that the claim is false, I do think it carries certain costs that have not been widely appreciated. One source of resistance to this claim derives from internalism about the mental – the view, roughly speaking, that one’s mental states are determined by one’s (...) internal physical state. In order to know that something is the case it is not, in general, enough for one’s internal physical state to be a certain way – the wider world must also be a certain way. If we accept that knowledge is a mental state, we must give up internalism. One might think that this is no cost, since much recent work in the philosophy of mind has, in any case, converged on the view that internalism is false. This thought, though, is too quick. As I will argue here, the claim that knowledge is a mental state would take us to a view much further from internalism than anything philosophers of mind have converged upon. (shrink)

While outcomes for children with T-cell acute lymphoblastic leukemia have improved dramatically, survival rates for patients with relapsed/refractory disease remain dismal. Prior studies indicate that glucocorticoid resistance is more common than resistance to other chemotherapies at relapse. In addition, failure to clear peripheral blasts during a prednisone prophase correlates with an elevated risk of relapse in newly diagnosed patients. Here we show that intrinsic GC resistance is present at diagnosis in early thymic precursor T-ALLs as well as in a subset (...) of non-ETP T-ALLs. GC-resistant non-ETP T-ALLs are characterized by strong induction of JAK/STAT signaling in response to interleukin-7 stimulation. Removing IL7 or inhibiting JAK/STAT signaling sensitizes these T-ALLs, and a subset of ETP T-ALLs, to GCs. The combination of the GC dexamethasone and the JAK1/2 inhibitor ruxolitinib altered the balance between pro- and anti-apoptotic factors in samples with IL7-dependent GC resistance, but not in samples with IL7-independent GC resistance. Together, these data suggest that the addition of ruxolitinib or other inhibitors of IL7 receptor/JAK/STAT signaling may enhance the efficacy of GCs in a biologically defined subset of T-ALL.Leukemia advance online publication, 30 May 2017; doi:10.1038/leu.2017.136. (shrink)

This book explores a question central to philosophy--namely, what does it take for a belief to be justified or rational? According to a widespread view, whether one has justification for believing a proposition is determined by how probable that proposition is, given one's evidence. In this book this view is rejected and replaced with another: in order for one to have justification for believing a proposition, one's evidence must normically support it--roughly, one's evidence must make the falsity of that proposition (...) abnormal in the sense of calling for special, independent explanation. This conception of justification bears upon a range of topics in epistemology and beyond. Ultimately, this way of looking at justification guides us to a new, unfamiliar picture of how we should respond to our evidence and manage our own fallibility. This picture is developed here. (shrink)

Tom Stoppard’s “Rosencrantz and Guildenstern Are Dead” opens with a puzzling scene in which the title characters are betting on coin throws and observe a seemingly astonishing run of 92 heads in a row. Guildenstern grows uneasy and proposes a number of unsettling explanations for what is occurring. Then, in a sudden change of heart, he appears to suggest that there is nothing surprising about what they are witnessing, and nothing that needs any explanation. He says ‘…each individual coin spun (...) individually is as likely to come down heads as tails and therefore should cause no surprise each time it does.’ In this article I argue that Guildenstern is right – there is nothing surprising about throwing 92 heads in a row. I go on to consider the relationship between surprise, probability and belief. (shrink)

One of the most intriguing claims in Sven Rosenkranz’s Justification as Ignorance is that Timothy Williamson’s celebrated anti-luminosity argument can be resisted when it comes to the condition ~K~KP—the condition that one is in no position to know that one is in no position to know P. In this paper, I critically assess this claim.

We describe and analyze 13 cases handled by our ethics consultation service (ECS) in which families requested continuation of physiological support for loved ones after death by neurological criteria (DNC) had been declared. These ethics consultations took place between 2005 and 2013. Patients’ ages ranged from 14 to 85. Continued mechanical ventilation was the focal intervention sought by all families. The ECS’s advice and recommendations generally promoted “reasonable accommodation” of the requests, balancing compassion for grieving families with other ethical and (...) moral concerns such as stewardship of resources, professional integrity, and moral distress. In cases we characterized as finitegoal accommodation, a “reasonable accommodation” strategy proved effective in balancing stakeholders’ interests and goals, enabling steady progress toward resolution. When a family objected outright to a declaration of DNC and asked for an indefinite accommodation, the “reasonable accommodation” approach offered clinicians little practical direction, and resolution required definitive action by either the family or the clinical team. Based on our analysis and reflections on these 13 cases, we propose ethically justified and practical guidelines to assist healthcare professionals, administrators, and ECSs faced with similar cases. (shrink)

In this paper I respond to Marcello Di Bello’s criticisms of the ‘normic account’ of the criminal standard of proof. In so doing, I further elaborate on what the normic account predicts about certain significant legal categories of evidence, including DNA and fingerprint evidence and eyewitness identifications.

In this paper I draw attention to a peculiar epistemic feature exhibited by certain deductively valid inferences. Certain deductively valid inferences are unable to enhance the reliability of one's belief that the conclusion is true—in a sense that will be fully explained. As I shall show, this feature is demonstrably present in certain philosophically significant inferences—such as GE Moore's notorious 'proof' of the existence of the external world. I suggest that this peculiar epistemic feature might be correlated with the much (...) discussed phenomenon that Crispin Wright and Martin Davies have called 'transmission failure'—the apparent failure, on the part of some deductively valid inferences to transmit one's justification for believing the premises. (shrink)

The notion of risk plays a central role in economics, finance, health, psychology, law and elsewhere, and is prevalent in managing challenges and resources in day-to-day life. In recent work, Duncan Pritchard (2015, 2016) has argued against the orthodox probabilistic conception of risk on which the risk of a hypothetical scenario is determined by how probable it is, and in favour of a modal conception on which the risk of a hypothetical scenario is determined by how modally close it is. (...) In this article, we use Pritchard’s discussion as a springboard for a more wide-ranging discussion of the notion of risk. We introduce three different conceptions of risk: the standard probabilistic conception, Pritchard’s modal conception, and a normalcy conception that is new (though it has some precursors in the psychological literature on risk perception). Ultimately, we argue that the modal conception is ill-suited to the roles that a notion of risk is required to play and explore the prospects for a form of pluralism about risk, embracing both the probabilistic and the normalcy conceptions. (shrink)

Many epistemologists have responded to the lottery paradox by proposing formal rules according to which high probability defeasibly warrants acceptance. Douven and Williamson present an ingenious argument purporting to show that such rules invariably trivialise, in that they reduce to the claim that a probability of 1 warrants acceptance. Douven and Williamson’s argument does, however, rest upon significant assumptions – amongst them a relatively strong structural assumption to the effect that the underlying probability space is both finite and uniform. In (...) this paper, I will show that something very like Douven and Williamson’s argument can in fact survive with much weaker structural assumptions – and, in particular, can apply to infinite probability spaces. (shrink)

In this paper, we present the results of two surveys that investigate subjects’ judgments about what can be known or justifiably believed about lottery outcomes on the basis of statistical evidence, testimonial evidence, and “mixed” evidence, while considering possible anchoring and priming effects. We discuss these results in light of seven distinct hypotheses that capture various claims made by philosophers about lay people’s lottery judgments. We conclude by summarizing the main findings, pointing to future research, and comparing our findings to (...) recent studies by Turri and Friedman. (shrink)

The _Principle of Indifference_ was once regarded as a linchpin of probabilistic reasoning, but has now fallen into disrepute as a result of the so-called _problem of multiple of partitions_. In ‘Evidential symmetry and mushy credence’ Roger White suggests that we have been too quick to jettison this principle and argues that the problem of multiple partitions rests on a mistake. In this paper I will criticise White’s attempt to revive POI. In so doing, I will argue that what underlies (...) the problem of multiple partitions is a fundamental tension between POI and the very idea of _evidential incomparability_. (shrink)

In this paper I defend the claim that justification is closed under conjunction, and confront its most alarming consequence — that one can have justification for believing propositions that are unlikely to be true, given one's evidence.

In this paper I explore some ideas inspired by Federico Picinali’s Justice In-Between: A Study of Intermediate Criminal Verdicts. Picinali makes a case for the introduction of intermediate options in criminal trials – verdicts with consequences that are harsher than an acquittal, but not so harsh as a conviction. From a certain perspective, the absence of intermediate options in criminal trials is puzzling – out of kilter with much of our everyday decision-making and, perhaps, with the recommendations of expected utility (...) theory. I will argue, however, that the lack of intermediate options is much less puzzling when put in the context of our ordinary practices of blame and non-legal punishment. (shrink)

In ‘Single premise deduction and risk’ (2008) Maria Lasonen-Aarnio argues that there is a kind of epistemically threatening risk that can accumulate over the course of drawing single premise deductive inferences. As a result, we have a new reason for denying that knowledge is closed under single premise deduction—one that mirrors a familiar reason for denying that knowledge is closed under multiple premise deduction. This sentiment has more recently been echoed by others (see Schechter 2011). In this paper, I will (...) argue that, although there is a kind of risk that can accumulate over the course of drawing single premise deductive inferences, it is importantly different to the kind of risk that multiple premise deductive inferences can introduce. Having distinguished these two kinds of risk, I shall offer some reasons for thinking that the kind associated with single premise deductions is, in fact, epistemically benign—it poses no threat, in and of itself, to the knowledge status of a belief. If this is right, then Lasonen-Aarnio’s argument against single premise closure is unsuccessful. (shrink)

Mistakes and errors happen in most spheres of human life and activity, including in medicine. A mistake can be as simple and benign as the collection of an extra and unnecessary urine sample. Or a mistake can cause serious but reversible harm, such as an overdose of insulin in a patient with diabetes, resulting in hypoglycemia, seizures, and coma. Or a mistake can result in serious and permanent damage for the patient, such as the failure to consider epiglottitis in an (...) initial differential diagnosis, resulting in a chronic vegetative state for a seven-year-old boy. Or a mistake can be an error in judgment that leads to a patient's death. (shrink)

The standard of proof applied in civil trials is the preponderance of evidence, often said to be met when a proposition is shown to be more than 50% likely to be true. A number of theorists have argued that this 50%+ standard is too weak – there are circumstances in which a court should find that the defendant is not liable, even though the evidence presented makes it more than 50% likely that the plaintiff’s claim is true. In this paper, (...) I will recapitulate the familiar arguments for this thesis, before defending a more radical one: The 50%+ standard is also too strong – there are circumstances in which a court should find that a defendant is liable, even though the evidence presented makes it less than 50% likely that the plaintiff’s claim is true. I will argue that the latter thesis follows naturally from the former once we accept that the parties in a civil trial are to be treated equally. I will conclude by sketching an alternative interpretation of the civil standard of proof. (shrink)

Conflicts of interest. None to report. Despite widespread acceptance in the United States of neurological criteria to determine death, clinicians encounter families who object, often on religious grounds, to the categorization of their loved ones as “brain dead.” The concept of “reasonable accommodation” of objections to brain death, promulgated in both state statutes and the bioethics literature, suggests the possibility of compromise between the family’s deeply held beliefs and the legal, professional and moral values otherwise directing clinicians to withdraw medical (...) interventions. Relying on narrative to convey the experience of a family and clinical caregivers embroiled in this complex dilemma, the case analyzed here explores the practical challenges and moral ambiguities presented by the concept of reasonable accommodation. Clarifying the term’s meaning and boundaries, and identifying guidelines for its clinical implementation, could help to reduce uncertainty for both health care professionals and families and, thereby, the incremental moral distress such uncertainty creates. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Setting the Stage for a Dialogue:Aesthetics in Drama and Theatre EducationAlistair Martin-Smith (bio)For us, education signifies an initiation into new ways of seeing, hearing, feeling, moving. It signifies the nurture of a special kind of reflectiveness and expressiveness, a reaching out for meanings, a learning to learn.—Maxine Greene, Variations on a Blue Guitar1Examining the aesthetics of the complementary fields of educational drama and theatre is like looking (...) through a kaleidoscope. If you turn it one way, you see one colorful pattern; if you turn it the other way, you see yet another. The multiplicity of approaches to drama and theatre education, each with its own aesthetic pattern, often obscures the common ground they all share. As a result, in its unique emphasis on art, pedagogy, and society, each may have its own aesthetic pattern; yet only by looking closely at each distinct pattern can we understand more of the power of drama and theatre to develop human consciousness.In Western education, aesthetic learning seems incidental to the assessment of learning. How did this happen? For Descartes, whose Cartesian philosophy dissociated mind from body, aesthetic feelings are irrational, since they originate in the body's senses rather than in the mind. Theories of education focused on the primacy of cognition, denying feelings in the erroneous belief that learning is independent of its context. Conversely, aesthetic education is concerned with the quality of experience, how it is felt. Dewey believed that "learning by doing" was a "consummatory" experience for the learner; it was dramatic, dialogic, and felt. The confusion between subjective and objective aspects of the aesthetic experience makes aesthetic evaluation difficult, and this may be why cognitively dominated education has steered clear of aesthetics. Richard Courtney recognized that there is an important distinction to be made between aesthetic symbols and [End Page 3] artistic symbols: "Aesthetic symbols emphasize feeling; artistic symbols are context-dependent—they only have meaning in the context of art."2David Best argues that "the failure to recognise the distinction between the aesthetic and the artistic contributes largely to the trivialisation of the potential of the arts in education."3 He points out that "... it may often be necessary to take into account, at least implicitly, wider factors... in order to judge whether [an] appraisal was aesthetic or artistic."4 What are these wider factors, and how can audiences attend to them? As Christopher Havell reminds us,There is increasing pressure on drama teachers to use their teaching expertise purely for the development of social and life-skills training. This instrumental work may, at times, closely resemble the drama process, but the intentions will be confined to an experience that simulates or resembles those "real-life situations" that it is expected students will encounter. The aesthetic search for the "universal" at the centre of the particular will not be a relevant aim in any vocational training! One can only hope that the emerging interest in the aesthetic nature of drama and its place in a coherent arts education will encourage teachers and students to reflect on the final inadequacy of any instrumental view.5I believe that it is through the power of aesthetic education that audiences for drama and theatre will come to appreciate the artistic.In Caravaggio's painting David with the Head of Goliath (1606-10), the viewer is confronted with three time periods simultaneously. In his depiction of David, Caravaggio paints the shepherd-king of the Old Testament who prefigures Christ, but he is also modeled on Caravaggio's lover. David holds the severed head of Goliath down low in such a way as to engage the private viewer rather than to evoke the public spectacle.6 As I understood that the head of Goliath was actually a self-portrait of the painter not long before his death, I experienced a moment of instantaneity that shocked me into a new awareness of my own mortality, my relation to life and death. As it is Caravaggio's last journey, so is it our own. While Caravaggio's penultimate painting is recognized in terms of its artistic achievement, the moment of self-recognition on the part of the... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Journal of Aesthetic Education 39.4 (2005) 1-2 [Access article in PDF] A Personal Tribute to Nellie McCaslin: 20 August 1914–28 February 2005 Nellie McCaslin, pioneer in creative drama and educational theatre, passed away earlier this year in New York City at age 90. Having obtained a bachelor's degree from Western Reserve University in 1936 and a master's degree in 1937, she went on to study improvisation with Maria (...) Ouspenskaya, of the Moscow Art Theatre, in California. In 1957, she received a Ph.D. from the School of Education at New York University (NYU). A longtime Greenwich Village resident, she became associate dean at the Gallatin School of Individualized Study and for over thirty years was an adjunct faculty member at NYU's Program in Educational Theatre.Her publications include Theatre for Children in the United States: A History (1971), Children and Drama (1975), Theatre for Young Audiences (1978), and Creative Drama in the Classroom and Beyond (2006), forthcoming in its eighth edition. She will be fondly remembered by her colleagues and friends for her keynote speeches delivered at conferences and events from Canada to Switzerland, from Israel to Taiwan. Throughout her career, she enthusiastically encouraged imagination and creativity through creative drama and the arts. In 1977, she was elected to the American College of Fellows. She received an honorary Doctor of Humanities from Ferrum College, Virginia, in 1986. Nellie's outstanding contribution to educational theatre was recognized with a Lifetime Achievement Award from the American Alliance of Theatre and Education in 1996 and with a Medallion Award from the Children's Theatre Foundation in 2001.At the Program in Educational Theatre at NYU, she taught courses in Theatre for Young Audiences and Creative Drama. She would also invite [End Page 1] friends and acquaintances to attend seminars at her church, First Presbyterian in the Village, and afterwards we might return to her apartment on 10th Street, where she would introduce us to fellow artists. Nellie found time to volunteer at church and at the local animal shelter, Bide-A-Wee. Her tireless energy and compassion were expressions of her love of living. She had begun to act again and each summer would travel south to take part in the Blue Ridge Dinner Theatre. Artistic Director Rex Stephenson said recently, "She's the only person that could cash a check from New York in Rocky Mount, Virginia, because everybody knew who she was."1 People were drawn to Nellie, as if by her luminous presence; she always had time to listen. Active to the end, she wrote the article that appears in this issue of the Journal of Aesthetic Education. Before she died, Nellie was working with NYU students to create a new play. At St. Vincent's in Manhattan, she was rehearsing her lines by telephone from her hospital bed. She will be deeply missed. Alistair Martin-Smith Endnote 1. Margalit Fox, "Nellie McCaslin, Professor and Children's Theater Authority, Dies at 90," New York Times, 12 March 2005.Photo by Maya Ishiura... (shrink)

1 Evidence-based policy requires researchers to provide the answers to ecological questions that are of interest to policy makers. To find out what those questions are in the UK, representatives from 28 organizations involved in policy, together with scientists from 10 academic institutions, were asked to generate a list of questions from their organizations. 2 During a 2-day workshop the initial list of 1003 questions generated from consulting at least 654 policy makers and academics was used as a basis for (...) generating a short list of 100 questions of significant policy relevance. Short-listing was decided on the basis of the preferences of the representatives from the policy-led organizations. 3 The areas covered included most major issues of environmental concern in the UK, including agriculture, marine fisheries, climate change, ecosystem function and land management. 4 The most striking outcome was the preference for general questions rather than narrow ones. The reason is that policy is driven by broad issues rather than specific ones. In contrast, scientists are frequently best equipped to answer specific questions. This means that it may be necessary to extract the underpinning specific question before researchers can proceed. 5 Synthesis and applications. Greater communication between policy makers and scientists is required in order to ensure that applied ecologists are dealing with issues in a way that can feed into policy. It is particularly important that applied ecologists emphasize the generic value of their work wherever possible. (shrink)

One of the best-known bits—perhaps the best-known bit—of the inscription of Diogenes of Oinoanda is frs. 2–3, in which the author explains what motivated him to display Epicurean doctrines in epigraphical form.

In this paper I will compare two competing accounts of assertion: the knowledge account and the justified belief account. When it comes to the evidence that is typically used to assess accounts of assertion – including the evidence from lottery propositions, the evidence from Moore’s paradoxical propositions and the evidence from conversational patterns – I will argue that the justified belief account has at least as much explanatory power as its rival. I will argue, finally, that a close look at (...) the ways in which assertions can be challenged and retracted reveals a certain advantage for the justified belief account. The paper will touch upon a number of further topics along the way, including the logical interaction between knowledge and justified belief, the nature of defeat, and the hypothesis that knowledge and justified belief are normatively coincident goals. (shrink)

This introduction to the Common Knowledge symposium titled “Comparative Relativism” outlines a variety of intellectual contexts where placing the unlikely companion terms comparison and relativism in conjunction offers analytical purchase. If comparison, in the most general sense, involves the investigation of discrete contexts in order to elucidate their similarities and differences, then relativism, as a tendency, stance, or working method, usually involves the assumption that contexts exhibit, or may exhibit, radically different, incomparable, or incommensurable traits. Comparative studies are required to (...) treat their objects as alike, at least in some crucial respects; relativism indicates the limits of this practice. Jensen argues that this seeming paradox is productive, as he moves across contexts, from Lévi-Strauss's analysis of comparison as an anthropological method to Peter Galison's history of physics, and on to the anthropological, philosophical, and historical examples offered in symposium contributions by Barbara Herrnstein Smith, Eduardo Viveiros de Castro, Marilyn Strathern, and Isabelle Stengers. Comparative relativism is understood by some to imply that relativism comes in various kinds and that these have multiple uses, functions, and effects, varying widely in different personal, historical, and institutional contexts that can be compared and contrasted. Comparative relativism is taken by others to encourage a “comparison of comparisons,” in order to relativize what different peoples—say, Western academics and Amerindian shamans—compare things “for.” Jensen concludes that what is compared and relativized in this symposium are the methods of comparison and relativization themselves. He ventures that the contributors all hope that treating these terms in juxtaposition may allow for new configurations of inquiry. (shrink)

What is the relation between ‘full’ or ‘outright’ belief and the various levels of confidence that agents can have in the propositions that concern them? This paper argues for a new answer to this question. Decision theory implies that in making decisions, rational agents must treat certain propositions as though they were completely certain; but on most forms of decision theory, these propositions are not ones for which any finite agent could have maximal justification – the agent will clearly have (...) less justification for these propositions than for elementary logical truths. Thus, every adequate model of a finite rational agent's belief‐system must involve two set of credences – theoretical credences and practical credences . A full or outright belief in p can be defined as the state of being stably disposed to assign a practical credence of 1 to p, for all normal practical purposes. This definition allows for a kind of reconciliation between the pragmatist and intellectualist approaches in epistemology. (shrink)

One of the best-known bits—perhaps the best-known bit—of the inscription of Diogenes of Oinoanda is frs. 2–3, in which the author explains what motivated him to display Epicurean doctrines in epigraphical form.

There are a number of apparent parallels between belief in God and belief in the existence of an external world beyond our experiences. Both beliefs would seem to condition one's overall view of reality and one's place within it – and yet it is difficult to see how either can be defended. Neither belief is likely to receive a purely a priori defence and any empirical evidence that one cites either in favour of the existence of God or the existence (...) of the external world would seem to blatantly beg the question against a doubter. I will explore just how far this parallel can be pushed by examining some strategies for resisting external world scepticism1. (shrink)

NOTE: This paper is a reworking of some aspects of an earlier paper – ‘What else justification could be’ and also an early draft of chapter 2 of Between Probability and Certainty. I'm leaving it online as it has a couple of citations and there is some material here which didn't make it into the book (and which I may yet try to develop elsewhere). My concern in this paper is with a certain, pervasive picture of epistemic justification. On this (...) picture, acquiring justification for believing something is essentially a matter of minimising one’s risk of error – so one is justified in believing something just in case it is sufficiently likely, given one’s evidence, to be true. This view is motivated by an admittedly natural thought: If we want to be fallibilists about justification then we shouldn’t demand that something be certain – that we completely eliminate error risk – before we can be justified in believing it. But if justification does not require the complete elimination of error risk, then what could it possibly require if not its minimisation? If justification does not require epistemic certainty then what could it possibly require if not epistemic likelihood? When all is said and done, I’m not sure that I can offer satisfactory answers to these questions – but I will attempt to trace out some possible answers here. The alternative picture that I’ll outline makes use of a notion of normalcy that I take to be irreducible to notions of statistical frequency or predominance. (shrink)

In Knowledge and Lotteries, John Hawthorne offers a diagnosis of our unwillingness to believe, of a given lottery ticket, that it will lose a fair lottery – no matter how many tickets are involved. According to Hawthorne, it is natural to employ parity reasoning when thinking about lottery outcomes: Put roughly, to believe that a given ticket will lose, no matter how likely that is, is to make an arbitrary choice between alternatives that are perfectly balanced given one’s evidence. It’s (...) natural to think that parity reasoning is only applicable to situations involving lotteries dice, spinners etc. – in short, situations in which we are reasoning about the outcomes of a putatively random process. As I shall argue in this paper, however, there are reasons for thinking that parity reasoning can be applied to any proposition that is less than certain given one’s evidence. To see this, we need only remind ourselves of a kind of argument employed by John Pollock and Keith Lehrer in the 1980s. If this argument works, then believing any uncertain proposition, no matter how likely it is, involves a (covert) arbitrary or capricious choice – an idea that contains an obvious sceptical threat. (shrink)

Our hospital’s policy and procedures for “Patients Without Surrogates” provides for gradated safeguards for managing patients’ treatment and care when they lack decision–making capacity, have no advance directives, and no surrogate decision makers are available. The safeguards increase as clinical decisions become more significant and have greater consequences for the patient. The policy also directs social workers to engage in “rigorous efforts” to search for surrogates who can potentially provide substituted judgments for such patients. We describe and illustrate the policy, (...) procedures, and kinds of expected rigorous efforts through our narration of an actual but disguised case for which we provided clinical ethics guidance and social work expertise. Our experience with and reflection on this case resulted in four recommendations we make for health care facilities and organizations that aim to provide quality care for their own patients without surrogates. (shrink)