Unrepresented patients lack the capacity to make medical decisions for themselves, have no clear documentation of preferences for medical treatment, and have no surrogate decision maker or obvious candidate for that role. There is no consensus about who should serve as the decision maker for these patients, particularly regarding whether to continue or to limit life-sustaining treatment. Several authors have argued that ethics committees should play this role rather than the patient's treating physician, a common current default. We argue that (...) concerns about the adequacy of physicians as surrogates are either empirically unfounded or apply equally to ethics committees. We suggest that physicians should be the primary decision maker for the unrepresented because of their fiduciary duties toward their patients. As part of the process of fulfilling these duties, they should seek the advice of third parties such as ethic committees; but final end-of-life decision-making for the unrepresented should rest with the treating physician. (shrink)

In June 2015, the major North American and European critical care societies released new joint guidelines that delineate a process-based approach to resolving intractable conflicts over the appropriateness of providing or continuing LST.2 This article frames the new guidelines within the history, ethical arguments, legal landscape, and empirical evidence regarding limitation of LST without surrogate consent in cases of intractable conflict.

Systematic study of the intersection of ethics consultation services and solid organ transplants and recipients can identify and illustrate ethical issues that arise in the clinical care of these patients, including challenges beyond resource allocation. This was a single-centre, retrospective cohort study of all adult ethics consultations between January 1, 2007, and December 31, 2017, at a large academic medical centre in the north-eastern United States. Of the 880 ethics consultations, sixty (6.8 per cent ) involved solid organ transplant, thirty-nine (...) (65.0 per cent) for candidates and twenty-one (35.0 per cent ) for recipients. Ethics consultations were requested for 4.3 per cent of heart, 4.9 per cent of lung, 0.3 per cent of liver, and 0.3 per cent of kidney transplant recipients over the study period. Nurses were more likely to request ethics consultations for recipients than physicians (80.0 per cent vs 20.0 per cent, p = 0.006). The most common reason for consultation among transplant candidates was discussion about intensity of treatment or goals of care after the patient was not or was no longer a transplant candidate. The most common reason for ethics consultation among transplant recipients was disagreement between transplant providers and patients/families/non-transplant healthcare professionals over the appropriate intensity of treatment for recipients. Very few consultations involved questions about appropriate resource allocation. Ethics consultants involved in these cases most often navigated communication challenges between transplant and non-transplant healthcare professionals and patients and families. (shrink)

Critical care society guidelines recommend that ethics committees mediate intractable conflict over potentially inappropriate treatment, including Do Not Resuscitate status. There are, however, limited data on cases and circumstances in which ethics consultants recommend not offering cardiopulmonary resuscitation despite patient or surrogate requests and whether physicians follow these recommendations. This was a retrospective cohort of all adult patients at a large academic medical center for whom an ethics consult was requested for disagreement over DNR status. Patient demographic predictors of ethics (...) consult outcomes were analyzed. In 42 of the 116 cases, the patient or surrogate agreed to the clinician recommended DNR order following ethics consultation. In 72 of 74 of the remaining cases, ethics consultants recommended not offering CPR. Physicians went on to write a DNR order without patient/surrogate consent in 57 of those cases. There were no significant differences in age, race/ethnicity, country of origin, or functional status between patients where a DNR order was and was not placed without consent. Physicians were more likely to place a DNR order for patients believed to be imminently dying. The median time from DNR order to death was 4 days with a 90-day mortality of 88.2%. In this single-center cohort study, there was no evidence that patient demographic factors affected ethics consultants’ recommendation to withhold CPR despite patient/surrogate requests. Physicians were most likely to place a DNR order without consent for imminently dying patients. (shrink)

The lung allocation score system in the United States and several European countries gives more weight to risk of death without transplantation than to survival following transplantation. As a result, centers transplant sicker patients, leading to increased length of initial hospitalization. The care of patients who have accumulated functional deficits or additional organ dysfunction during their prolonged stay can be ethically complex. Disagreement occurs between the transplant team, patients and families, and non-transplant health care professionals over the burdens of ongoing (...) intensive intervention. These cases highlight important ethical issues in organ transplantation, including the nature and requirements of transplant informed consent, the limits of physician prognostication, patient autonomy and decision-making capacity following transplant, obligations to organ donors and to other potential recipients, and the impact of program metrics on individualized recipient care. We outline general ethical principles for the care of lung transplant recipients with prolonged hospitalization and give regulatory, research, and patient-centered recommendations for these cases. (shrink)

Adorno: A Critical Reader presents a collection of new essays by many of the world's top critics that examine Adorno's lasting impact on the arts, politics, history, philosophy, psychoanalysis, and sociology.

In 2015, the major critical care societies issued guidelines outlining a procedural approach to resolving intractable conflict between healthcare professionals and surrogates over life-sustaining treatments (LST). We report our experience with a resolving conflict procedure. This was a retrospective, single-centre cohort study of ethics consultations involving intractable conflict over LST. The resolving conflict process was initiated eleven times for ten patients over 2,015 ethics consultations from 2000 to 2020. In all cases, the ethics committee recommended withdrawal of the contested LST. (...) In seven cases, the patient died or was transferred or a legal injunction was obtained before completion of the process. In the four cases in which LST was withdrawn, the time from ethics consultation to withdrawal of LST was 24.8 ± 12.2 days. Healthcare provider and surrogate were often distressed during the process, sometimes resulting in escalation of conflict and legal action. In some cases, however, surrogates appeared relieved that they did not have to make the final decision regarding LST. Challenges regarding implementation included the time needed for process completion and limited usefulness in emergent situations. Although it is feasible to implement a due process approach to conflict over LST, there are factors that limit the procedure’s usefulness. (shrink)

In Democracy and the Claims of Nature, the leading thinkers in the fields of environmental, political, and social theory come together to discuss the tensions and sympathies of democratic ideals and environmental values. The prominent contributors reflect upon where we stand in our understanding of the relationship between democracy and the claims of nature. Democracy and the Claims of Nature bridges the gap between the often competing ideals of the two fields, leading to a greater understanding of each for the (...) other. (shrink)

During multiple testing, researchers often adjust their alpha level to control the familywise error rate for a statistical inference about a joint union alternative hypothesis (e.g., “H1,1 or H1,2”). However, in some cases, they do not make this inference. Instead, they make separate inferences about each of the individual hypotheses that comprise the joint hypothesis (e.g., H1,1 and H1,2). For example, a researcher might use a Bonferroni correction to adjust their alpha level from the conventional level of 0.050 to 0.025 (...) when testing H1,1 and H1,2, find a significant result for H1,1 (p < 0.025) and not for H1,2 (p > .0.025), and so claim support for H1,1 and not for H1,2. However, these separate individual inferences do not require an alpha adjustment. Only a statistical inference about the union alternative hypothesis “H1,1 or H1,2” requires an alpha adjustment because it is based on “at least one” significant result among the two tests, and so it refers to the familywise error rate. Hence, an inconsistent correction occurs when a researcher corrects their alpha level during multiple testing but does not make an inference about a union alternative hypothesis. In the present article, I discuss this inconsistent correction problem, including its reduction in statistical power for tests of individual hypotheses and its potential causes vis-à-vis error rate confusions and the alpha adjustment ritual. I also provide three illustrations of inconsistent corrections from recent psychology studies. I conclude that inconsistent corrections represent a symptom of statisticism, and I call for a more nuanced inference-based approach to multiple testing corrections. (shrink)

Terence Horgan and Mark Timmons? Moral Twin Earth thought experiment shows that realist ethical naturalism entails a kind of conceptual relativism about moral predicates. This conceptual relativism implies, further, that Earthlings and Twin Earthlings do not express substantive disagreement with one another. Because this latter implication clashes with considered linguistic intuitions, Horgan and Timmons conclude that we should reject realist ethical naturalism. Against this, several critics recommend that realists ?bite the bullet? with respect to Moral Twin Earth: despite our intuitions, (...) we should accept that the speakers do not disagree. These critics argue that the intuitions elicited by the thought experiment are either the result of a failure on the part of readers to appreciate hidden details of the Moral Twin Earth case, or else they are mere artifacts of readers? epistemic limitations. In this paper, I show that the Moral Twin Earth argument prevails against this line of attack. (shrink)

莊子為什麼不屬於道家？ 如果他不是道家人物，他的思想如何定位？ 一個新的莊子圖像對於我們今日了解儒家及中國哲學， 能夠提供什麼樣的新視野？ 莊子道家說始於漢代，但這種學派歸屬在歷代常受到修正，楊儒賓最新論著《儒門內的莊子》可視為第三波修正運動中的一環。繼承晚明王夫之、方以智的莊子觀，透過重新解讀莊子的語言、隱喻、技術、身體、氣化諸概念，主 張莊子提供一種新的主體範式，這種新的主體範式奠定了非定命論的氣化世界觀。本書指出，莊子和孔子有特殊的地理風土與文化風土的淵源，孔子是《莊子》內篇的典範人物，兩人在中國文化史上的軸心時代，有另類的人文精 神的傳承關係。.

"Dr. Rubin has brought cognitive psychology into a wholly unprecedented dialogue with studies in oral tradition. The result is a truly new perspective on memory and the processes of oral tradition." --John Miles Foley, University of Missouri.

This paper examines the idea of objective phenomenology, or a way of understanding the phenomenal character of conscious experiences that doesn’t require one to have had the kinds of experiences under consideration. My central thesis is that structural facts about experience—facts that characterize purely how conscious experiences are structured—are objective phenomenal facts. I begin by precisifying the idea of objective phenomenology and diagnosing what makes any given phenomenal fact subjective. Then I defend the view that structural facts about experience are (...) objective. I also argue that structural facts about experience, despite being objective, nevertheless still give rise to an explanatory gap. (shrink)

"Dr. Rubin has brought cognitive psychology into a wholly unprecedented dialogue with studies in oral tradition. The result is a truly new perspective on memory and the processes of oral tradition." --John Miles Foley, University of Missouri.

There is increasing interest in determining what impact having women in management positions may have on corporate social responsibility initiatives. Various authors suggest that gender equality practices should be factored into the broader framework of CSR. This paper examines how the presence of women on corporate boards, in top and middle management and as heads of CSR departments, influences gender equality practices in the field of CSR. Using information collected from companies that have signed up to Women's Empowerment Principles in (...) Spain, we show that the presence of women in the aforesaid posts has a positive impact on CSR activities with gender equality objectives. We thus supplement the justice, business and moral arguments with further arguments in support of the incorporation of women into not only corporate boards but all management positions. Finally, we provide a view of how gender equality can be included in the broader framework of CSR. (shrink)

Yoga 365 presents a year's worth of daily readings that invite yoga lovers of every skill level to bring the inspiration they experience on their mats into their everyday lives. Each entry explores a mind-body theme such as balance, strength, and resilience in a short, illuminating paragraph that can be enjoyed in the morning or at bedtime, incorporated into a yoga session, or read on the go. Featuring a serenely beautiful hardcover and a spacious, color-washed interior, the package is as (...) calming in the hand as the readings are to the eye. Yogis will find it to be a motivating tool for personal growth and a lighthearted, gift-worthy way to share the joys of their practice with others. (shrink)

We present some techniques in c.c.c. forcing, and apply them to prove consistency results concerning the isomorphism and embeddability relations on the family of ℵ 1 -dense sets of real numbers. In this direction we continue the work of Baumgartner [2] who proved the axiom BA stating that every two ℵ 1 -dense subsets of R are isomorphic, is consistent. We e.g. prove Con). Let K H, be the set of order types of ℵ 1 -dense homogeneous subsets of R (...) with the relation of embeddability. We prove that for every finite model L, : Con iff L is a distributive lattice. We prove that it is consistent that the Magidor-Malitz language is not countably compact. We deal with the consistency of certain topological partition theorems. E.g. We prove that MA is consistent with the axiom OCA which says: “If X is a second countable space of power ℵ 1, and { U 0,\h.;, U n−1 } is a cover of D ▪ X x X -} x,x> ¦ x ϵ X } consisting of symmetric open sets, then X can be partitioned into { X i \brvbar; i ϵ ω } such that for every i ϵ ω there is l such that D ⊇ U l ”. We also prove that MA+OCA [xrArr] 2 ℵ 0 = ℵ 2. (shrink)

Tomorrow has never looked better. Breakthroughs in fields like genetic engineering and nanotechnology promise to give us unprecedented power to redesign our bodies and our world. Futurists and activists tell us that we are drawing ever closer to a day when we will be as smart as computers, will be able to link our minds telepathically, and will live for centuries--or maybe forever. The perfection of a "posthuman" future awaits us. Or so the story goes. In reality, the rush toward (...) a posthuman destiny amounts to an ideology of human extinction, an ideology that sees little of value in humanity except the raw material for producing whatever might come next. In Eclipse of Man, Charles T. Rubin traces the intellectual origins of the movement to perfect and replace the human race. He shows how today's advocates of radical enhancement are--like their forebears--deeply dissatisfied with given human nature and fixated on grand visions of a future shaped by technological progress. Moreover, Rubin argues that this myopic vision of the future is not confined to charlatans and cheerleaders promoting this or that technology: it also runs through much of modern science and contemporary progressivism. By exploring and criticizing the dreams of post humanity, Rubin defends a more modest vision of the future, one that takes seriously both the limitations and the inherent dignity of our given nature. (shrink)

Some accounts of moral responsibility hold that an agent's responsibility is completely determined by some aspect of the agent's mental life at the time of action. For example, some hold that an agent is responsible if and only if there is an appropriate mesh among the agent's particular psychological elements. It is often objected that the particular features of the agent's mental life to which these theorists appeal (such as a particular structure or mesh) are not necessary for responsibility. This (...) is because there appear to be cases in which an agent acts at an earlier time which causes her to lack the appropriate psychological features at some later time and yet, intuitively, she is responsible at that later .. (shrink)

A structure has a (finite-string) automatic presentation if the elements of its domain can be named by finite strings in such a way that the coded domain and the coded atomic operations are recognised by synchronous multitape automata. Consequently, every structure with an automatic presentation has a decidable first-order theory. The problems surveyed here include the classification of classes of structures with automatic presentations, the complexity of the isomorphism problem, and the relationship between definability and recognisability.

Perception is riddled with cases of reliable misperception. These are cases in which a perceptual state is tokened inaccurately any time it is tokened under normal conditions. On the face of it, this fact causes trouble for theories that provide an analysis of perceptual content in non-semantic, non-intentional, and non-phenomenal terms, such as those found in Millikan (1984), Fodor (1990), Neander (2017), and Schellenberg (2018). I show how such theories can be extended so that they cover such cases without giving (...) up their core commitments. (shrink)

本書為漢語世界第一部探討「自然」概念在中國文化史上流變的著作， 從概念史角度出發，探究「自然」概念的多重淵源與多元脈絡。 「自然」是當代漢語學術詞彙中語義極多源也極多元的重要概念。自《老子》提出「道法自然」以來，「自然」概念的流變始終與中國思想史的發展脈絡並行，而如同「道」、「太極」、「涅槃」一般，是極為重要的理論概念， 在中國文化史各領域亦扮演關鍵性的角色。 本書是漢語世界第一部從概念史的觀點出發，探討「自然」概念在中國文化史上流變的著作。全書由十二個單元組成，撰述的角度是對「自然」一詞的後設反省，內容跨越的年代由先秦直至20世紀，作者分別來自臺灣、香港、 美國的人文學者，議題新穎，觀點多元，一編在手，可大致瀏覽「自然」在中國文化史上的流變過程。.

We are all familiar with the phenomenon of a proposition seeming true. Many think that these seeming states can yield justified beliefs. Very few have seriously explored what these seeming states are. I argue that seeming states are not plausibly analyzed in terms of beliefs, partial beliefs, attractions to believe, or inclinations to believe. Given that the main candidates for analyzing seeming states are unsatisfactory, I argue for a brute view of seemings that treats seeming states as irreducible propositional attitudes.

At last, Russia has begun to speak in a truly original voice." So said Anatoly Vaneev, a Soviet dissident who became Karsavin's disciple in the Siberian gulag where the philosopher spent his last two years. The book traces the unusual trajectory of this inspiring voice: Karsavin started his career as Russia's brightest historian of Catholic mysticism; however, his radical methods - which were far ahead of their time - shocked his conservative colleagues. The shock continued when Karsavin turned to philosophy, (...) writing flamboyant and dense essays in a polyphonic style, which both Marxists and religious traditionalists found provocative. There was no let-up after he was expelled by Lenin from Soviet Russia: in exile, he became a leading theorist in the Eurasian political movement, combining Orthodox theology with a left-wing political orientation. (shrink)

This is a discussion of the state of discussion on pragmatic reasons for belief.

This book brings together an international group of scholars to discuss the ramifications of Heidegger's Black Notebooks for philosophy and the humanities. In contrast to both those who seek to exonerate Heidegger and those who simply condemn him, they urge careful reading and rereading of his work to turn Heideggerian thought against itself.

For Kant, knowledge involves certainty. If “certainty” requires that the grounds for a given propositional attitude guarantee its truth, then this is an infallibilist view of epistemic justification. Such a view says you can’t have epistemic justification for an attitude unless the attitude is also true. Here I want to defend an alternative fallibilist interpretation. Even if a subject has grounds that would be sufficient for knowledge if the proposition were true, the proposition might not be true. And so there (...) is sometimes still rational room for doubt. The goal of this paper is to present four different models of what “certainty” amounts to, for Kant, each of which is compatible with fallibilism. (shrink)

In his 1978 paper “Mathematical Explanation”, Mark Steiner attempts to modernize the Aristotelian idea that to explain a mathematical statement is to deduce it from the essence of entities figuring in the statement, by replacing talk of essences with talk of “characterizing properties”. The language Steiner uses is reminiscent of language used for proofs deemed “pure”, such as Selberg and Erdős’ elementary proofs of the prime number theorem avoiding the complex analysis of earlier proofs. Hilbert characterized pure proofs as those (...) that use only “means that are suggested by the content of the theorem”, a characterization we have elsewhere called “topical purity”. In this paper we will examine the connection between Steiner’s account of mathematical explanation and topical purity. Are Steiner-explanatory proofs necessarily topically pure? Are topically pure proofs necessarily Steiner-explanatory? Answers to these questions will shed light on the general question of the relation between purity and explanatory power. (shrink)

The aim of the Analytic of Concepts is to derive and deduce a set of pure concepts of the understanding, the categories, which play a central role in Kant’s explanation of the possibility of synthetic a priori cognition and judgment. This chapter is structured around two questions. First, what is a pure concept of the understanding? Second, what is involved in a deduction of a pure concept of the understanding? In answering the first, we focus on how the categories differ (...) from the pure forms of sensibility and examine whether they are known only to be the pure forms of human thinking or rather the forms of discursive cognition as such. In answering the second, we draw a distinction between the application and the exemplification of the categories and use it to identify different ways of understanding Kant’s project in the Transcendental Deduction of the Categories. These questions connect because the answer to the first determines how we should understand the kind of entitlement which is to be established in the Deduction. (shrink)

While many aspects of cognition have been shown to be shared between humans and non-human animals, there remains controversy regarding whether the capacity to mentally time travel is a uniquely human one. In this paper, we argue that there are four ways of representing when some event happened: four kinds of temporal representation. Distinguishing these four kinds of temporal representation has five benefits. First, it puts us in a position to determine the particular benefits these distinct temporal representations afford an (...) organism. Second, it provides the conceptual resources to foster a discussion about which of these representations is necessary for an organism to count as having the capacity to mentally time travel. Third, it enables us to distinguish stricter from more liberal views of mental time travel that differ regarding which kind(s) of temporal representation is taken to be necessary for mental time travel. Fourth, it allows us to determine the benefits of taking a stricter or more liberal view of mental time travel. Finally, it ensures that disagreement about whether some species can mentally time travel is not merely the product of unrecognised disagreement about which temporal representation is necessary for mental time travel. We argue for a more liberal view, on the grounds that it allows us to view mental time travel as an evolutionarily continuous phenomenon, and to recognise that differences in the ways that organisms mentally time travel might reflect different temporal representations, or combinations thereof, that they employ. Our ultimate aim, however, is to create the conceptual framework for further discussion regarding what sorts of temporal representations are required for mental time travel. (shrink)

The fallacy fallacy is either the misdiagnosis of fallacy or the supposition that the conclusion of a fallacy must be a falsehood. This paper explores the relevance of these and related errors of reasoning for the appraisal of arguments, especially within virtue theories of argumentation. In particular, the fallacy fallacy exemplifies the Owl of Minerva problem, whereby tools devised to understand a norm make possible new ways of violating the norm. Fallacies are such tools and so are vices. Hence a (...) similar problem arises with argumentative vices. Fortunately, both instances of the problem have a common remedy. (shrink)

This chapter addresses an ambiguity in some of the literature on rational peer disagreement about the use of the term 'rational'. In the literature 'rational' is used to describe a variety of normative statuses related to reasons, justification, and reasoning. This chapter focuses most closely on the upshot of peer disagreement for what is rationally required of parties to a peer disagreement. This follows recent work in theoretical reason which treats rationality as a system of requirements among an agent's mental (...) states. It is argued that peer disagreement has either no, or a very limited, affect on what rationality requires of an agent in a given circumstance. This is in part because of difficulties generated by a novel example of evidence of evidence of p being evidence against p. This example calls into question the mechanisms whereby peer disagreement might affect what is rationally required of an agent. The chapter also reevaluates the importance of actual peer disagreement against the backdrop of prior expectations about whether disagreement is believed to be likely, arguing that peer disagreement is most likely to change what is rationally required of an agent when it is believed to be unlikely. (shrink)