PurposeAdvance directives have been criticized for failing to help physicians make decisions consistent with patients’ wishes. This pilot study sought to determine if an interactive, computer-based decision aid that generates an advance directive can help physicians accurately translate patients’ wishes into treatment decisions.MethodsWe recruited 19 patient-participants who had each previously created an advance directive using a computer-based decision aid, and 14 physicians who had no prior knowledge of the patient-participants. For each advance directive, three physicians were randomly assigned to review (...) the advance directive and make five to six treatment decisions for each of six (potentially) end-of-life clinical scenarios.From the three individual physicians’ responses, a “consensus physician response” was generated for each treatment decision (total decisions = 32). This consensus response was shared with the patient whose advance directive had been reviewed, and she/he was then asked to indicate how well the physician translated his/her wishes into clinical decisions.ResultsPatient-participants agreed with the consensus physician responses 84 percent (508/608) of the time, including 82 percent agreement on whether to provide mechanical ventilation, and 75 percent on decisions about cardiopulmonary resuscitation (CPR).Across the six vignettes, patient-participants’ rating of how well physicians translated their advance directive into medical decisions was 8.4 (range = 6.5-10, where 1 = extremely poorly, and 10 = extremely well). Physicians’ overall rating of their confidence at accurately translating patients’ wishes into clinical decisions was 7.8 (range = 6.1-9.3, 1 = not at all confident, 10 = extremely confident).ConclusionFor simulated cases, a computer-based decision aid for advance care planning can help physicians more confidently make end-of-life decisions that patients will endorse. (shrink)

We describe the educational character and leadership development processes used by the United States Air Force Academy that other educational institutions may find useful. Our processes include an integrated educational curriculum designed to complement and integrate the experiential learning that results in achieving specific organizational outcomes, co-curricular activities in cadet living, and a specific focus on the ethical development of leaders’ respect for human dignity and cultural competency as well as the mechanisms to assess and refine our processes.

In lieu of an abstract, here is a brief excerpt of the content: Canti VI, Bruto Minore GIACOMO LEOPARDI (Translated by Steven J. Willett) To Peter Green After Italian Valor, lying in Thracian dust an immense ruin, had been uprooted, then in the valleys of green Hesperia, on Tiber’s shore, Fate prepares the tramp of barbarian horse, and from naked forests oppressed by the freezing Bear, calls forth the Gothic swords to overthrow Rome’s renowned walls; sitting alone, (...) soaked in brothers’ blood, through black night in a desolate site, Brutus is determined to die, and the implacable gods and Hell itself he accuses with savage cries and strikes the somnambulant air in vain. Fatuous Valor, the empty mists, the fields of unquiet phantoms are your schools, and behind you strides remorse. To you, marmoreal gods, (whether you reside in Phlegethon or the clouds), to you a laughingstock and mockery is the miserable race from whom you extort temples and a fraudulent law insulting to mortals. Is heaven’s wrath, then, so provoked by terrestrial piety? and do you then sit, Jove, impiety’s protector? and when storm clouds exult through the air, and when arion 27.1 spring/summer 2019 you hurl the swift thunderbolt, do you cast the sacred fire on the just and faithful? Invincible destiny and iron necessity crush the sickly slaves of death: and if nothing avails to end their indignities, the common man takes comfort in their necessity. Is the evil without cure less harsh? Does he feel no grief who’s stripped naked of hope? War to the death, eternal, o ignoble fate, the valorous man wages, incapable of surrender; and your tyrannical right hand, victorious as it bears him down, indomitable he shrugs off with a valiant show, when in his noble side the bitter blade runs with blood, and malignly he smiles at the darkening shadows. He displeases the gods who violently breaks into Tartarus. No such courage could be found in their feeble, eternal breasts. Perhaps our torments, perhaps our bitter accidents and wretched passions heaven created as a pleasing spectacle for their idle hours? Not between calamities and crimes, but free in the forests and pure Nature appointed us, once our queen and goddess. But since on earth impious custom has destroyed the blessed realms and subjected our miserable life to other laws; when a virile soul rejects his luckless days does Nature return, and accuse the arrow that’s not hers? 166 CANTI VI, bruto minore Ignorant of guilt and their own misfortunes are the fortunate beasts; serene old age guides them to an unforeseen passage. But if they dash their foreheads on rough tree-trunks or from a mountain cliff cast bodies headlong to the winds, moved by their anguish, against that miserable desire would stand no arcane law or shadowy conception. You alone, among the numerous progeny that heaven created, alone among all, children of Prometheus, regret life. Alone o wretched ones, to you Jove bans, if sluggish fate delays, the shores of death. And you, from the sea stained by our blood, you rise bright moon, and explore the unquiet night and the deadly battlefield of Italian Valor. The victor tramples on kinsmen’s breasts, the hills shudder, from her highest summits ancient Rome collapses— and are you so placid? You saw the birth of Lavinia’s offspring, and their years of happiness, and the memorable victories; and on the mountain peaks you pour your immutable silent light when, in the wreck of the servile Italian name, this solitary place will echo beneath the barbarian tramp. Giacomo Leopardi 167 Here among naked rocks or on green boughs, beast and bird, breasts heavy with their habitual oblivion, ignore the profound ruin and the altered destiny of the world: and as the rooftop of the industrious peasant first glows red, with its morning song the one will wake the valleys, while through high slopes the other will startle the helpless multitude of smaller creatures. Oh destiny! oh insensate race! we are an abject part of things; neither the bloodstained soil nor the howling caves has our calamity ever perturbed, and no human cares stain the stars. Neither to Olympus’ or Cocytus’ deaf kings, or to the unworthy earth, and... (shrink)

This collection of essays, offered in honor of the distinguished career of prominent political philosophy professor Clifford Orwin, brings together internationally renowned scholars to provide a wide context and discuss various aspects of the virtue of “humanity” through the history of political philosophy.

In lieu of an abstract, here is a brief excerpt of the content:Open Letter to the Enemy:Jean Genet's Holy WarSteven Miller (bio)J.G. seeks, or is searching for, or would like to discover, never to uncover him, the delicious enemy, quite disarmed, whose equilibrium is unstable, profile uncertain, face inadmissible, the enemy broken by a breath of air, the already humiliated slave, ready to throw himself out the window at the least sign, the defeated enemy: blind, deaf, mute. With no arms, (...) no legs, no stomach, no heart, no sex, no head, all told a complete enemy, already bearing all the marks of my bestiality that now need never be used (too lazy anyway). I want the total enemy, with immeasurable and spontaneous hatred for me, but also the subjugated enemy, defeated by me before he even knows me. Not to be reconciled with me, in any case. No friends. Above all, no friends: a declared enemy, but not a tortured one. Clean, faultless. What are his colors? From a green as tender as a cherry to an effervescent violet. His size? Between the two of us, he presents himself to me man to man. No friends. I seek an inadequate enemy, one who comes to capitulate. I will come at him with all that I can muster: whacks, slaps, kicks, I will feed him to starving foxes, make him eat English food, attend the House of Lords, be received at Buckingham Palace, fuck Prince Phillip, and be fucked by him, live for a month in London, dress like me, sleep in place of me, live in place of me: I seek the declared enemy.This brief text was not published until 1991. It was almost published in 1975 in a book of homages to William Burroughs and Brion Gysin, and was to have been preceded with the following explanation of its origins, written by Gysin:In Tangiers in 1970, Jean Genet asked me what ever happened to the English underground newspaper The International Times. When I responded that the editors were having trouble with the law in England because of the newspaper's ads for "special friendships" [amitiés particulières], he exclaimed: "Why friends? Personally, I am looking for a suitable enemy [un ennemi à ma taille]." He then wrote the following text...[qtd. in Genet, ED 9]Hence the anecdotal reason for the form of the personal advertisement. In 1991 the text was published—according to Genet's wishes—as the first page of the posthumous collection of his political writings and interviews, L'ennemi déclaré.1 Such a placement demands more than an anecdotal explanation. What is a personal ad doing as the preface to a collection of political writings? Albert Dichy, the editor of the collection, notes that this text has the status of an exception: "the text that opens the collection does not belong to the group of writings that make up the book as a whole" [ED 331]. Each of the other texts emerges from Genet's involvement in specific political events (the [End Page 85] 1968 Chicago Democratic National Convention, the Chatila massacre) or with named political figures and groups (the Palestinians, the Black Panthers, the Baader-Meinhof group, George Jackson, Angela Davis), whereas the form of the ad that he wrote for Gysin seems to number it among his literary works. Nonetheless, this eccentric text remains the first in the collection—"en tête de l'ouvrage," is Dichy's phrase—and gives the book its title. Rather than serving as an introduction to the other texts, this text, by virtue of its exceptional form, is a challenge addressed directly to the public. Dichy himself is the first to accept this challenge. His editorial notice passes quickly from anecdote to interpretation:The fact that Genet wished to see the publication of his political articles preceded by this precise text has an unavoidable impact, not only on the identity of the author, now partially assimilable to a fictional character ("J.G. cherche, ou recherche..."), but also on the way in which we read the different texts in the collection, now that we have been given the general tone and the note of secrecy.[ED 331]These suggestions are apt enough... (shrink)

Cutting a cake, dividing up the property in an estate, determining the borders in an international dispute - such problems of fair division are ubiquitous. Fair Division treats all these problems and many more through a rigorous analysis of a variety of procedures for allocating goods, or deciding who wins on what issues, when there are disputes. Starting with an analysis of the well-known cake-cutting procedure, 'I cut, you choose', the authors show how it has been adapted in a number (...) of fields and then analyze fair-division procedures applicable to situations in which there are more than two parties, or there is more than one good to be divided. In particular they focus on procedures which provide 'envy-free' allocations, in which everybody thinks he or she has received the largest portion and hence does not envy anybody else. They also discuss the fairness of different auction and election procedures. (shrink)

This report outlines the findings from a Delphi study designed to establish consensus on the definitions of cognitive style and learning style amongst an international style researcher community. The study yields long-needed definitions for each construct that reflect high levels of agreement. In a field that has been criticised for a bewildering array of definitions and a proliferation of terms and concepts, this study represents an important step to address confusion in the meaning of the two terms. New researchers interested (...) in styles are encouraged to draw on these definitions when developing new research agendas aimed at deepening our understanding of style as a core construct in educational psychology. (shrink)

1. Introduction The policy of deterrence, at least to avert nuclear war between the superpowers, has been a controversial one. The main controversy arises from the threat of each side to visit destruction on the other in response to an initial attack. This threat would seem irrational if carrying it out would lead to a nuclear holocaust – the worst outcome for both sides. Instead, it would seem better for the side attacked to suffer some destruction rather than to retaliate (...) in kind and, in the process of devastating the other side, seal its own doom in an all-out nuclear exchange. Yet, the superpowers persist in their adherence to deterrence, by which we mean a policy of threatening to retaliate to an attack by the other side in order to deter such an attack in the first place. To be sure, nuclear doctrine for implementing deterrence has evolved over the years, with such appellations as “massive retaliation,” “flexible response,” “mutual assured destruction”, and “counterforce” giving some flavor of the changes in United States strategic thinking. All such doctrines, however, entail some kind of response to a Soviet nuclear attack. They are operationalized in terms of preselected targets to be hit, depending on the perceived nature and magnitude of the attack. Thus, whether U.S. strategic policy at any time stresses a retaliatory attack on cities and industrial centers or on weapons systems and armed forces, the certainty of a response of some kind to an attack is not the issue. (shrink)

The leading models of disability struggle to fully encompass all aspects of “disability.” This difficulty arises, the author argues, because the models fundamentally misunderstand the nature of disability. Current theoretical approaches to disability can be understood as “nounal,” in that they understand disability as a thing that is caused or embodied. In contrast, this paper presents an adverbial perspective on disability, which shows that disability is experienced as a personally irremediable impediment to daily-living tasks or goals-like-ours. The picture theory of (...) disability technically constitutes a species of relational approach because its analysis references the interplay between an individual and their environment; it differs from other relational accounts, however, by interpreting disability as a certain kind of negative experience—rather than a function of that relationship. This purely descriptive theory makes no normative claims about disability and operates as both a mechanism for the evaluation of the experience of disability and a heuristic device for the proper interpretation of disability. When disability is reframed in this way, the theory offers a particularist perspective which shows if, when, where, and how disability is experienced. (shrink)

While cognitive style congruence has been highlighted as a potentially important variable influencing performance outcomes in work-related contexts, studies of its influence are scarce. This paper examines the influence of leader-follower cognitive style similarity on followers’ organizational citizenship behaviors. Data from 430 leader-follower dyads were analyzed using polynomial regression and response surface analysis. Results demonstrate that congruence of leader/follower cognitive style is a predictor of follower organizational citizenship behaviors. Organizations may therefore benefit from considering issues of similarity of cognitive styles (...) in their attempts to develop effective leader-follower partnerships leading to increased organizational citizenship behaviorsand concomitant improvements in both individual and organizational level success. (shrink)

This book develops an “idiomatic” foundational theory of the self and its moral obligations. It then employs this theory to answer a variety of questions about legal obligation, political authority, community, and international justice. It argues that we ought to obey a particular community’s laws and government commands, so long as our government restricts itself to protecting classical liberty and individual property rights under the rule of law. It further argues that people today should ideally live in confederated, legally sovereign (...) nation-states or nation-unions. Finally, it suggests that we have greater obligations to our compatriots than we do to foreign citizens, although we will often have pressing moral reasons to obey foreign laws while abroad, grant citizenship to outsiders who wish to join us, and help relieve foreign people’s misery. (shrink)

This book offers an original theory of adjudication focused on the ethics of judging in courts of law, and proposes two main theses. One is the good faith thesis, which defends the possibility of lawful judicial decisions even when judges exercise discretion. The other is the permissible discretion thesis, which defends the compatibility of judicial discretion and legal indeterminacy with the legitimacy of adjudication in a constitutional democracy. Together these two theses oppose both conservative theories that would restrict the scope (...) of adjudication unduly, and leftist critical theories that would liberate judges from the rule of law. (shrink)

Suppose two players wish to divide a finite set of indivisible items, over which each distributes a specified number of points. Assuming the utility of a player’s bundle is the sum of the points it assigns to the items it contains, we analyze what divisions are fair. We show that if there is an envy-free (EF) allocation of the items, two other desirable properties—Pareto-optimality (PO) and Maximinality (MM)—can also be satisfied, rendering these three properties compatible. But there may be no (...) EF division, in which case some division must satisfy a modification of Bentham’s (1789/2017) “greatest satisfaction of the greatest number” property, called maximum Nash welfare (MNW), that satisfies PO. However, an MNF division may be neither MM nor EFX, which is a weaker form of EF. We conjecture that there is always an EFX allocation that satisfies MM, ensuring that an allocation is maximin, precisely the property that Rawls (1971/1999) championed. We discuss four broader philosophical implications of our more technical analysis. (shrink)

Oliver Wendell Holmes, Jr. is, arguably, the most important American jurist of the twentieth century, and his essay The Path of the Law, first published in 1898, is the seminal work in American legal theory. In it, Holmes detailed his radical break with legal formalism and created the foundation for the leading contemporary schools of American legal thought. He was the dominant source of inspiration for the school of legal realism, and his insistence on a practical approach to law and (...) legal analysis laid the basis for the realists' later concentration upon the pragmatic and empirical aspects of law and legal procedures. This volume brings together some of the most distinguished legal scholars from the United States and Canada to examine competing understandings of The Path of the Law and its implications for contemporary American jurisprudence. For the reader's convenience, the essay is republished in an Appendix. (shrink)

The concepts of omniscience and omnipotence are defined in 2 ? 2 ordinal games, and implications for the optimal play of these games, when one player is omniscient or omnipotent and the other player is aware of his omniscience or omnipotence, are derived. Intuitively, omniscience allows a player to predict the strategy choice of an opponent in advance of play, and omnipotence allows a player, after initial strategy choices are made, to continue to move after the other player is forced (...) to stop. Omniscience and its awareness by an opponent may hurt both players, but this problem can always be rectified if the other player is omniscient. This pathology can also be rectified if at least one of the two players is omnipotent, which can override the effects of omniscience. In some games, one player's omnipotence ? versus the other's ? helps him, whereas in other games the outcome induced does not depend on which player is omnipotent. Deducing whether a player is superior (omniscient or omnipotent) from the nature of his game playing alone raises several problems, however, suggesting the difficulty of devising tests for detecting superior ability in games. (shrink)

This paper analyzes criteria of fair division of a set of indivisible items among people whose revealed preferences are limited to rankings of the items and for whom no side payments are allowed. The criteria include refinements of Pareto optimality and envy-freeness as well as dominance-freeness, evenness of shares, and two criteria based on equally-spaced surrogate utilities, referred to as maxsum and equimax. Maxsum maximizes a measure of aggregate utility or welfare, whereas equimax lexicographically maximizes persons' utilities from smallest to (...) largest. The paper analyzes conflicts among the criteria along with possibilities and pitfalls of achieving fair division in a variety of circumstances. (shrink)

The American Journal of Bioethics, Volume 11, Issue 12, Page 57-59, December 2011.

Much of the discourse in the bioethics literature on what is often called “cesarean delivery on maternal request” has focused on balancing respect for patient autonomy with attention to the short- and long-term risks of this procedure to maternal and neonatal well-being. And while there has been some analysis of the social and economic costs inherent in performing cesareans, much of the clinical and ethical analysis has concluded that, given the degree of risk to the mother and neonate from a (...) primary or single repeat cesarean delivery, there is sufficient justification for pregnant women to request and obtain this procedure from obstetricians willing to meet such requests. However, these same analyses often caution that physicians should not offer these elective cesareans to all women, but only to those who initiate the request. This paper analyzes recommendations that do not promote universal access to these procedures and concludes that such a policy is ethically unjustifiable, as it treats women who do not inquire about such procedures differently. Depriving appropriate candidates—for example, healthy women who are good surgical candidates and desire only one or two children—of information about elective cesarean delivery is a form of undue influence on women's decision-making. (shrink)

By executive order—later passed into law—President Obama closed legal loopholes used to justify torture by his predecessor. Less often discussed, his administration also instituted scientific research into the most effective interrogation techniques. This dual-track approach already demands the use of two different methods to properly discuss the policy, and in this article, a third is put forward for a fuller interdisciplinary view. That is to say, although there are notable shortcomings, scientific and legal developments will be explored to illuminate how (...) he also clarified a moral stance for the nation. Put all together, this article will show that Obama indeed achieved laudable steps towards preventing the reintroduction of torture. (shrink)

Issues that arise in using game theory to model national security problems are discussed, including positing nation-states as players, assuming that their decision makers act rationally and possess complete information, and modeling certain conflicts as two-person games. A generic two-person game called the Conflict Game, which captures strategic features of such variable-sum games as Chicken and Prisoners'' Dilemma, is then analyzed. Unlike these classical games, however, the Conflict Game is a two-stage game in which each player can threaten to retaliate (...) — and carry out this threat in the second stage — if its opponent chose noncooperation in the first stage.Conditions for the existence of different pure-strategy Nash equilibria, or stable outcomes, are found, and these results are extended to situations in which the players can select mixed strategies (i.e., make probabilistic threats or choices). Although the Conflict Game sheds light on the rational foundations underlying arms races, nuclear deterrence, and other strategic situations, more detailed assumptions are required to tie this generic game to specific conflicts. (shrink)

1. Introduction The policy of deterrence, at least to avert nuclear war between the superpowers, has been a controversial one. The main controversy arises from the threat of each side to visit destruction on the other in response to an initial attack. This threat would seem irrational if carrying it out would lead to a nuclear holocaust – the worst outcome for both sides. Instead, it would seem better for the side attacked to suffer some destruction rather than to retaliate (...) in kind and, in the process of devastating the other side, seal its own doom in an all-out nuclear exchange. Yet, the superpowers persist in their adherence to deterrence, by which we mean a policy of threatening to retaliate to an attack by the other side in order to deter such an attack in the first place. To be sure, nuclear doctrine for implementing deterrence has evolved over the years, with such appellations as “massive retaliation,” “flexible response,” “mutual assured destruction”, and “counterforce” giving some flavor of the changes in United States strategic thinking. All such doctrines, however, entail some kind of response to a Soviet nuclear attack. They are operationalized in terms of preselected targets to be hit, depending on the perceived nature and magnitude of the attack. Thus, whether U.S. strategic policy at any time stresses a retaliatory attack on cities and industrial centers or on weapons systems and armed forces, the certainty of a response of some kind to an attack is not the issue. (shrink)

This paper reports on the design and implementation of a multi-phase interactive process among a set of scientists, policy makers, land managers, and community representatives, so as to facilitate communication, mutual understanding, and participative decision making. This was part of the Ecosystem Services Project in Australia. The project sought to broaden public understanding about the natural ecosystems in Australia. The study reported here pertains to one of the project sites--the Goulburn Broken catchment, a highly productive agricultural watershed in the south-east (...) of Australia. The paper demonstrates how, starting from a condition of diversity of ideas and interests among the participants, systematic dialogue and mutual learning could be generated, leading to identification of options for more sustainable land management practices. The concept of "ecosystem services" was used as an integrative tool across disciplines and community perspectives. The concept of scenarios was used to encourage future-focussed thinking among the participants. The idea of "stakeholder jury" was used to promote deliberation. A process of multi-criteria evaluation was used to facilitate convergence of viewpoints, through informed trade-offs and compromises. This experience led to the development of a process for integration research, which helped in harmonising across diverse understandings and values in a transparent and structured manner. (shrink)

Naturalism - the thesis that all facts are natural facts, that is the facts that can be recognised and explained by a natural science - plays a central role in contemporary analytical philosophy. Yet many philosophers reject the claims of naturalism. The essays in this anthology explore the difficulties of naturalism by revealing the ambiguities surrounding it, as well as the tensions that exist among its critics.