Two potentially lifesaving protocols, emergency preservation and resuscitation and uncontrolled donation after circulatory determination of death, currently implemented in some U.S. emergency departments, have similar eligibility criteria and initial technical procedures, but critically different goals. Both follow unsuccessful cardiopulmonary resuscitation and induce hypothermia to “buy time”: one in trauma patients suffering cardiac arrest, to enable surgical repair, and the other in patients who unexpectedly die in the ED, to enable organ donation. This article argues that to fulfill patient-focused fiduciary obligations (...) and maintain community trust, institutions implementing both protocols should adopt and publicize policies to guide ED physicians to utilize either protocol for particular patients, in order to address the appearance of conflict of interest arising from the protocols' similarities. It concludes by analyzing ethical implications of incentives that may influence institutions to develop the expertise required for uDCDD but not EPR. (shrink)

In the mid 1980s it was apparent that the need for organ donors exceeded those willing to donate. Some University of Pittsburgh Medical Center (UPMC) physicians initiated discussion of possible new organ donor categories including individuals pronounced dead by traditional cardiac criteria. However, they reached no conclusion and dropped the discussion. In the late 1980s and the early 1990s, four cases arose in which dying patients or their families requested organ donation following the elective removal of mechanical ventilation. Controversy surrounding (...) these cases precipitated open discussion of the use of organ donors pronounced dead on the basis of cardiac criteria. Prolonged deliberations by many committees in the absence of precedent ultimately resulted in what is, to our knowledge, the country's first policy for organ donation following elective removal of life support. The policy is intricate and conservative. Care was taken to include as many interested parties as possible in an effort to achieve representative and broad based support. This paper describes the development of the UPMC policy on non-heart-beating organ donation. (shrink)

When successful solid organ transplantation was initiated almost 40 years ago, its current success rate was not anticipated. But continuous efforts were undertaken to overcome the two major obstacles to success: injury caused by interrupting nutrient supply to the organ and rejection of the implanted organ by normal host defense mechanisms. Solutions have resulted from technologic medical advances, but also from using organs from different sources. Each potential solution has raised ethical concerns and has variably resulted in societal acclaim, censure, (...) and apathy. Transplant surgery is now well accepted, and the list of transplant candidates has grown far quicker than the availability of organs. More than 30,000 patients were awaiting organs for transplantation at the end of March 1993. While most organs came from donors declared dead by brain criteria, the increasing shortage of donated organs has prompted a reexamination of prior restrictions of donor groups. Recently, organ procurement from donors with cardiac death has been reintroduced in the United States. This practice had been mostly abandoned by the U.S. and some, though not all, other countries. Transplantation has been more successful using organs procured from heart-beating, "brain dead" cadavers than organs from non-heart-beating cadavers. However, recent advances have led to success rates with organs from non-heart-beating donors that may portend large increases in organ donation and procurement from this source. (shrink)

Physicians are taught that the foundation of the physician-patient relationship is trust, and trust is based in part on truthfulness. While drawing important Òlines in the sandÓ regarding whether and why to tell the truth, ethics codes promulgating honesty fail to provide clinicians with guidance regarding what is the truth, as well as when and how to disclose it. These issues may be at the core of why an adverse event is left undisclosed. Consistently being truthful in the setting of (...) an error is particularly difficult and requires overcoming a number of institutional and personal barriers. The article concludes that if delivering Òthe truthÓ is important, then articulation of criteria for determining what should be told, by whom, and when is essential. A policy that considers the practical issues and provides guidance may be useful. (shrink)

Organ transplantation is an accepted therapy for major organ failure, but it depends on the availability of viable organs. Most organs transplanted in the U.S. come from either "brain-dead" or living related donors. Recently organ procurement from patients pronounced dead using cardiopulmonary criteria, so-called "non-heart-beating cadaver donors" (NHBCDs), has been reconsidered. In May 1992, the University of Pittsburgh Medical Center (UPMC) enacted a new, complicated policy for procuring organs from NHBCDs after the elective removal of life support. Seventeen months later (...) only one patient has become a NHBCD. This article describes her case and the results of interviews with the health care team and the patient's family. The case and interviews are discussed in relation to several of the ethical concerns previously raised about the policy, including potential conflicts of interest, the definition of cardiopulmonary death, and a possible net decrease in organ donation. The conclusion is reached that organ procurement from non-heart-beating cadavers is feasible and may be desirable both for the patient's family and the health care providers. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 11.2 (2001) 115-116 [Access article in PDF] The Ethics of Medical Mistakes: Historical, Legal, and Institutional Perspectives Introduction In late 1999, the Institute of Medicine (IOM) released its report on medical errors, To Err is Human: Building a Safer Health System. The report estimated almost 50,000 deaths per year nationally due to medical mistakes, making it a leading cause of death. IOM speculated that (...) more than half of the deaths related to medical error are preventable. The IOM report shocked the public and medical professionals alike, sparking a national discussion of how to make the health care system safer. This multifaceted issue has profound implications for all aspects of health care, from the very personal--e.g., the relationship of caregiver and patient--to the societal--e.g., a nation's responsibility to its citizens.On 15 May 2000, the University of Pittsburgh Medical Center hosted an ethics conference devoted to the topic of medical mistakes. The goal was to bring together experts from various disciplines, before an audience of both providers and patients, to discuss medical mistakes and their implications. In this issue of the Kennedy Institute of Ethics Journal, we present selected papers resulting from that conference. These papers reflect not only the original oral presentations, but also much of the discussion those presentations generated. Three key perspectives on the ethics of medical mistakes are offered: historical, legal, and institutional.Rosa Lynn Pinkus offers a revealing historical perspective on the ethics of medical mistakes. In analyzing the history of mistake reporting in neurosurgery, she shows how the notion of a mistake developed only as the notion of a standard of practice emerged. Although much of managed care is directed toward systematically fostering a standard of care, this pursuit is relatively new in health care. One might speculate that as more standards are created, mistakes--defined as deviations from standard practice--must increase. If deviation from standard practice is overly castigated, however, then needed innovation in practice may be stifled. Interestingly, as Pinkus discusses, medical malpractice suits quickly followed the emergence of practice standards, driving the initial open reporting of mistakes underground. [End Page 115]Taking up the issue of medical malpractice, Thomas May and Mark Aulisio consider the ramifications of the current malpractice system for mistake prevention. The current system, they argue, while failing to adequately achieve its purported goals of deterring medical mistakes and compensating victims, itself creates a climate that deters the open reporting of mistakes by engendering fear and shame in clinicians. According to May and Aulisio, this failure to report medical mistakes openly has serious ramifications. Chief among these is the inability to do root cause analysis of mistakes, and then, where possible, to implement safeguards to minimize the occurrence of future mistakes. Ultimately, both the prevention of medical mistakes and the goals of malpractice litigation itself will be better served if substantial malpractice reform is undertaken.Andy Thurman argues that even in the current climate institutions ought to have a policy (and practice) of admitting to and openly reporting medical mistakes. Thurman argues that doing so not only is the right thing to do, but is also in the interest of institutions. Interestingly, he contends that failing to admit and openly report mistakes is both at odds with the mission of health care institutions and puts them at higher risk of litigation, and liability. In light of this, Thurman then suggests an institutional process for handling medical mistakes.Michael DeVita concedes that disclosing mistakes is widely supported by the health professionals' principles of ethics, but argues that there are a number of factors that conspire to make doing so a very difficult task. In analyzing an index case, DeVita contends that platitudes about being honest are not nearly enough to foster honest behavior and that policies that offer specific guidance on handling unfavorable events are needed in health care institutions.Finally, we conclude with the policy on disclosure of unfavorable events (this terminology is chosen because it includes both iatrogenic and natural diseases and conditions) that resulted from... (shrink)

In 1991, the University of Pittsburgh Medical Center implemented a policy that permitted the recovery of organs from cadavers pronounced dead using standardized cardiac criteria. This policy allowed families that had made a decision to forgo life sustaining treatment to then request organ donation. This entailed taking the patient to the operating room, discontinuing therapy, and after the patient is pronounced dead, procuring organs.

The first reported successful kidney transplantation occurred in 1954, between twins. Since then, organ donation and transplantation has become less a medical marvel than a common expectation of patients with a variety of diseases resulting in organ failure. Those expectations have caused demand for organs to skyrocket far beyond available supply, fueling an organ shortage and resulting in over 60,000 patients on transplant waiting lists. In this special issue, our contributors attempt to shed new light on some of the many (...) old ethical questions raised by transplant in the contemporary context of extreme scarcity. (shrink)

In the preceding commentary, Campbell and Weber raise two valid and important issues concerning non-heart-beating organ donation (NHBOD). First, because the procedure links withdrawal of life support and the potential for subsequent organ donation, the desire for organs may create a situation in which care of the dying individual has relatively less importance and the dying may receive suboptimal care. Second, even if concerns about care of the dying were dealt with adequately, there will not be enough non-heart-beating donors to (...) significantly decrease the organ shortage that exists, making the procedure not worth the risk. We agree that attention to the important details of caring for the dying are, and must be, the primary concern of all health care workers caring for those individuals. Ensuring the patients' comfort, dignity, and autonomy, and providing for family and social support are the mainstays of this care. All policies for NHBOD should clearly support and mandate these concepts. Regarding the second concern, we agree that NHBOD is currently rare; however, evidence is increasing that this type of donation has great potential. Continued growth of the practice in this country will depend largely on public acceptance, which we believe will be directly influenced by whether the public perceives that care of the dying is not compromised by this procedure. (shrink)

: Research involving the dead, especially heart-beating cadavers, may facilitate the testing of potentially revolutionary and life-saving medical treatments. However, to ensure that such research is conducted ethically, it is essential to: (1) identify appropriate standards for this research and (2) assign institutional responsibility and a mechanism for oversight. Protocols for research involving the dead should be reviewed by a special committee and assessed according to nine standards intended to ensure scientific merit, to protect deceased patients and their families, and (...) to promote institutional integrity and responsibility. Federal regulation of research involving the dead will foster appropriate standards and, equally importantly, help establish the acceptability of such research. (shrink)

One way of increasing the supply of vital organs without violating the dead donor rule is to declare death on cardiopulmonary criteria after withdrawing life support. The question then is how quickly death may be declared.

One way of increasing the supply of vital organs without violating the dead donor rule is to declare death on cardiopulmonary criteria after withdrawing life support. The question then is how quickly death may be declared.

This book defends a form of ethical intuitionism, according to which (i) there are objective moral truths; (ii) we know some of these truths through a kind of immediate, intellectual awareness, or "intuition"; and (iii) our knowledge of moral truths gives us reasons for action independent of our desires. The author rebuts all the major objections to this theory and shows that the alternative theories about the nature of ethics all face grave difficulties.

The first edition of The Scientific Background to Modern Philosophy took the dialogue of science and philosophy from Aristotle through to Newton. This second edition adds eight chapters, taking the dialogue through the Enlightenment and up to Darwin. This anthology is an attempt to help bridge the gap between the history of science and the history of philosophy.

Part I: The representation of life -- Can life be given a real definition? -- The representation of the living individual -- The representation of the life-form itself -- Part II: Naive action theory -- Types of practical explanation -- Naive explanation of action -- Action and time -- Part III: Practical generality -- Two tendencies in practical philosophy -- Practices and dispositions as sources of the goodness of individual actions -- Practice and disposition as sources of individual action.

Recent studies reported the development of psychological distress symptoms in patients who recovered from COVID-19. However, evidence is still scarce and new data are needed to define the exact risk and protective factors that can explain the variability in symptoms manifestation. In this study, we enrolled 257 patients who recovered from COVID-19 and we evaluated the levels of psychological distress through the Symptoms Checklist-90-R scale. Data concerning illness-related variables were collected from medical records, while the presence of subjective cognitive difficulties, (...) both before and after the illness, as well as the level of the cognitive reserve, were assessed over a clinical interview. Results revealed that being female and reporting the presence of subjective cognitive difficulties after COVID-19 were associated with higher levels of psychological distress. At the same time, being admitted to the hospital and having a high CR were protective factors. Adding new information to this emerging research field, our results highlight the importance of a complete psychological and cognitive assessment in patients with COVID-19. (shrink)

Virtually all philosophers agree that for a belief to be epistemically justified, it must satisfy certain conditions. Perhaps it must be supported by evidence. Or perhaps it must be reliably formed. Or perhaps there are some other "good-making" features it must have. But does a belief's justification also require some sort of awareness of its good-making features? The answer to this question has been hotly contested in contemporary epistemology, creating a deep divide among its practitioners. Internalists, who tend to focus (...) on scientific or theoretical beliefs as the ideal, insist that such awareness is required for justification. Externalists, who think children's ordinary beliefs in obvious facts are paradigm cases of justified belief, say it isn't required. Michael Bergmann's book offers a decisive refutation of internalism and a sustained defense of externalism. (shrink)

Externalist theories of justification create the possibility of cases in which everything appears to one relevantly similar with respect to two propositions, yet one proposition is justified while the other is not. Internalists find this difficult to accept, because it seems irrational in such a case to affirm one proposition and not the other. The underlying internalist intuition supports a specific internalist theory, Phenomenal Conservatism, on which epistemic justification is conferred by appearances.

At the University of Sheffield during 2011 and 2012, a leading group of philosophers, psychologists, and others gathered to explore the nature and significance of implicit bias. The two volumes of Implicit Bias and Philosophy emerge from these workshops. Each volume philosophically examines core areas of psychological research on implicit bias as well as the ramifications of implicit bias for core areas of philosophy. Volume I: Metaphysics and Epistemology is comprised of two parts: “The Nature of Implicit Attitudes, Implicit Bias, (...) and Stereotype Threat,” and “Skepticism, Social Knowledge, and Rationality.” The first part contains chapters examining the relationship between implicit attitudes and “dual process” models of the mind; the role of affect in the formation and change of implicit associations; the unity (or disunity) of implicit attitudes; whether implicit biases are mental states at all; and whether performances on stereotype-relevant tasks are automatic and unconscious or intentional and strategic. The second part contains chapters examining implicit bias and skepticism; the effects of implicit bias on scientific research; the accessibility of social stereotypes in epistemic environments; the effects of implicit bias on the self-perception of members of stigmatized social groups as rational agents; the role of gender stereotypes in philosophy; and the role of heuristics in biased reasoning. (shrink)

In this engaging and spirited text, Michael Lynch argues that truth does matter, in both our personal and political lives. He explains that the growing cynicism over truth stems in large part from our confusion over what truth is.

Dignity plays a central role in current thinking about law and human rights, but there is sharp disagreement about its meaning. Combining conceptual precision with a broad historical background, Michael Rosen puts these controversies in context and offers a novel, constructive proposal. “Penetrating and sprightly...Rosen rightly emphasizes the centrality of Catholicism in the modern history of human dignity. His command of the history is impressive...Rosen is a wonderful guide to the recent German constitutional thinking about human dignity...[Rosen] is in (...) general an urbane and witty companion, achieving his aim of accessibly written philosophy.” —Samuel Moyn, The Nation “[An] elegant, interesting and lucid exploration of the concept of dignity...Drawing on classical, liberal and Catholic traditions, Rosen hopes to rehabilitate dignity to its rightful place near the centre of moral thought...Rosen's admirable book deserves wide attention from political theorists, jurisprudes and political philosophers.” —Simon Blackburn, Times Higher Education “Dignity deserves to be widely read, not only for its intrinsic interest, but also as a corrective to the habit of discussing such topics in abstraction from their social context. Whether or not one agrees with Rosen's arguments, there can be no doubt he has widened our horizons.” —Rae Langton, Times Literary Supplement. (shrink)

edition (unseen), $12.95. traditions, bringing into being new modes of understanding. Paper Anthropology, and particularly ethnography, is torn between two quests, one to capture the diversity of social life and the other to discover universal principles structuring that diversity. Jackson examines these quests within the context of ethnographic fieldwork, focusing on the relationship between ethnographers and the people they study. He is concerned with defining the anthropological project as something more than the projection of the anthropologist's traditions and concerns onto (...) an alien culture. Rather, he would have the project open a genuine dialogue between people from different cultures or Annotation copyrighted by Book News, Inc., Portland, OR. (shrink)

While philosophers hold that it is patently absurd to blame robots or hold them morally responsible [1], a series of recent empirical studies suggest that people do ascribe blame to AI systems and robots in certain contexts [2]. This is disconcerting: Blame might be shifted from the owners, users or designers of AI systems to the systems themselves, leading to the diminished accountability of the responsible human agents [3]. In this paper, we explore one of the potential underlying reasons for (...) robot blame, namely the folk's willingness to ascribe inculpating mental states or "mens rea" to robots. In a vignette-based experiment (N=513), we presented participants with a situation in which an agent knowingly runs the risk of bringing about substantial harm. We manipulated agent type (human v. group agent v. AI-driven robot) and outcome (neutral v. bad), and measured both moral judgment (wrongness of the action and blameworthiness of the agent) and mental states attributed to the agent (recklessness and the desire to inflict harm). We found that (i) judgments of wrongness and blame were relatively similar across agent types, possibly because (ii) attributions of mental states were, as suspected, similar across agent types. This raised the question - also explored in the experiment - whether people attribute knowledge and desire to robots in a merely metaphorical way (e.g., the robot "knew" rather than really knew). However, (iii), according to our data people were unwilling to downgrade to mens rea in a merely metaphorical sense when given the chance. Finally, (iv), we report a surprising and novel finding, which we call the inverse outcome effect on robot blame: People were less willing to blame artificial agents for bad outcomes than for neutral outcomes. This suggests that they are implicitly aware of the dangers of overattributing blame to robots when harm comes to pass, such as inappropriately letting the responsible human agent off the moral hook. (shrink)

At the heart of ethics reside the concepts of good and bad; they are at work when we assess whether a person is virtuous or vicious, an act right or wrong, a decision defensible or indefensible, a goal desirable or undesirable. But there are many varieties of goodness and badness. At their core lie intrinsic goodness and badness, the sort of value that something has for its own sake. It is in virtue of intrinsic value that other types of value (...) may be understood, and hence that we can begin to come to terms with questions of virtue and vice, right and wrong, and so on. This book investigates the nature of intrinsic value: just what it is for something to be valuable for its own sake, just what sort of thing can have such value, just how such a value is to be computed. In the final chapter, the fruits of this investigation are applied to a discussion of pleasure, pain, and displeasure and also of moral virtue and vice, in order to determine just what value lies within these phenomena. (shrink)

In previous work I have argued against internalism by means of a dilemma intended to force all internalists to accept one of two undesirable options: either their internalism is unmotivated or it is saddled with vicious regress problems. Recently it has been argued that Phenomenal Conservatism—a theory of justification according to which justification depends on seemings—is a kind of internalism that can escape this dilemma. In this paper, I argue that Phenomenal Conservatism cannot escape my dilemma for internalism. In order (...) to do this, it is helpful to get clear on what Phenomenal Conservatism is saying, and for that reason I begin, in section I, by examining in some detail what seemings are. I then argue, in the remainder of the paper, that, whichever horn of the dilemma for internalism they take, Phenomenal Conservatives are in trouble. (shrink)

Can an ugly experiment be a good experiment? Philosophers have identified many beautiful experiments and explored ways in which their beauty might be connected to their epistemic value. In contrast, the present chapter seeks out (and celebrates) ugly experiments. Among the ugliest are those being designed by AI algorithms. Interestingly, in the contexts where such experiments tend to be deployed, low aesthetic value correlates with high epistemic value. In other words, ugly experiments can be good. Given this, we should conclude (...) that beauty is not generally necessary or sufficient for epistemic value, and increasing beauty will not generally tend to increase epistemic value. (shrink)

A paradigm-shifting work that revolutionizes our understanding of the origins and structure of science. Captivatingly written, interwoven with tantalizing illustrations and historical vignettes ranging from Newton's alchemy to quantum mechanics to the storm surge of Hurricane Sandy, Michael Strevens's wholly original investigation of science asks two fundamental questions: Why is science so powerful? And why did it take so long, two thousand years after the invention of philosophy and mathematics, for the human race to start using science to learn (...) the secrets of nature? The Knowledge Machine's radical answer is that science calls on its practitioners to do something irrational: by willfully ignoring religion, theoretical beauty, and, especially, philosophy-essentially stripping away all previous knowledge-scientists embrace an unnaturally narrow method of inquiry, channeling unprecedented energy into observation and experimentation. Like Yuval Harari's Sapiens or Thomas Kuhn's 1962 classic, The Structure of Scientific Revolutions, The Knowledge Machine overturns much of what we thought we knew about the origins of the modern world. (shrink)

Radical skepticism endorses the extreme claim that large swaths of our ordinary beliefs, such as those produced by perception or memory, are irrational. The best arguments for such skepticism are, in their essentials, as familiar as a popular science fiction movie and yet even seasoned epistemologists continue to find them strangely seductive. Moreover, although most contemporary philosophers dismiss radical skepticism, they cannot agree on how best to respond to the challenge it presents. In the tradition of the 18th century Scottish (...) philosopher, Thomas Reid, Radical Skepticism and Epistemic Intuition joins this discussion by taking up four main tasks. First, it identifies the strongest arguments for radical skepticism, namely, underdetermination arguments, which emphasize the gap between our evidence and our ordinary beliefs based on that evidence. Second, it rejects all inferential or argument-based responses to radical skepticism, which aim to lay out good noncircular reasoning from the evidence on which we base our ordinary beliefs to the conclusion that those beliefs are probably true. Third, it develops a commonsense noninferential response to radical skepticism with two distinctive features: it consciously and extensively relies on epistemic intuitions, which are seemings about epistemic goods, such as knowledge and rationality, and it can be endorsed without difficulty by both internalists and externalists in epistemology. Fourth, and finally, it defends this commonsense epistemic-intuition-based response to radical skepticism against a variety of objections, including those connected with underdetermination worries, epistemic circularity, disagreement problems, experimental philosophy, and concerns about whether it engages skepticism in a sufficiently serious way. (shrink)

Imagination is important for many things in science: solving problems, interpreting data, designing studies, etc. Philosophers of imagination typically account for the productive role played by imagination in science by focusing on how imagination is constrained, e.g., by using self-imposed rules to infer logically, or model events accurately. But the constraints offered by these philosophers either constrain too much, or not enough, and they can never account for uses of imagination that are needed to break today’s constraints in order to (...) make progress tomorrow. Thus, epistemology of imagination needs to make room for an element of epistemological anarchy. (shrink)

Metaphysics: Contemporary Readings is a comprehensive anthology that draws together leading philosophers writing on the major themes in Metaphysics. Chapters appear under the headings: Universals Particulars Modality and Possible Worlds Causation Time Persistence Realism and Anti-Realism Each section is prefaced by an introductory essay by the editor which guides students gently into each topic. Articles by the following leading philosophers are included: Allaire, Anscombe, Armstrong, Black, Broad, Casullo, Dummett, Ewing, Heller, Hume, Kripke, Lewis, Mackie, McTaggart, Mellor, Merricks , Parfit, Plantinga, (...) Price, Prior, Putnam, Quine, Russell, Smart, Swinburne, Taylor , Van Cleve, van Inwagen, Williams Featuring a new section on causation, this new edition is highly accessible and provides a broad-ranging exploration of the subject. Ideal for any philosophy student, this reader will prove essential reading for any metaphysics course. The sections and selections of readings have been updated to complement Michael Loux's textbook Metaphysics: A Contemporary Introduction , third edition. (shrink)