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)

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)

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 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)

The first edition was awarded the '2005 Textbook Award of the Association of University Professors of Management (Verband der Hochschullehrer fur ...

"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.

"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.

How should politicians act? When should they try to lead public opinion and when should they follow it? Should politicians see themselves as experts, whose opinions have greater authority than other people's, or as participants in a common dialogue with ordinary citizens? When do virtues like toleration and willingness to compromise deteriorate into moral weakness? In this innovative work, Andrew Sabl answers these questions by exploring what a democratic polity needs from its leaders. He concludes that there are systematic, (...) principled reasons for the holders of divergent political offices or roles to act differently. Sabl argues that the morally committed civil rights activist, the elected representative pursuing legislative results, and the grassroots organizer determined to empower ordinary citizens all have crucial democratic functions. But they are different functions, calling for different practices and different qualities of political character. To make this case, he draws on political theory, moral philosophy, leadership studies, and biographical examples ranging from Everett Dirksen to Ella Baker, Frances Willard to Stokely Carmichael, Martin Luther King Jr. to Joe McCarthy. Ruling Passions asks democratic theorists to pay more attention to the "governing pluralism" that characterizes a diverse, complex democracy. It challenges moral philosophy to adapt its prescriptions to the real requirements of democratic life, to pay more attention to the virtues of political compromise and the varieties of human character. And it calls on all democratic citizens to appreciate "democratic constancy": the limited yet serious standard of ethical character to which imperfect democratic citizens may rightly hold their leaders--and themselves. (shrink)

We all face death, but how many of us are actually ready for it? Whether our own death or that of a loved one comes first, how prepared are we, spiritually or practically? In Preparing to Die, Andrew Holecek presents a wide array of resources to help the reader address this unfinished business. Part One shows how to prepare one's mind and how to help others, before, during, and after death. The author explains how spiritual preparation for death can (...) completely transform our relationship to the end of life, dissolving our fear and helping us to feel open and receptive to letting go in the dying process. Daily meditation practices, the stages of dying and how to work with them, and after-death experiences are all detailed in ways that will be particularly helpful for those with an interest in Tibetan Buddhism and in Tibetan approaches to conscious dying. Part Two addresses the practical issues that surround death. Experts in grief, hospice, the funeral business, and the medical and legal issues of death contribute chapters to prepare the reader for every practical concern, including advance directives, green funerals, the signs of death, warnings about the funeral industry, the stages of grief, and practical care for the dying. Part Three contains heart-advice from twenty of the best-known Tibetan Buddhist masters now teaching in the West. These brief interviews provide words of solace and wisdom to guide the dying and their caregivers during this challenging time. Preparing to Die is for anyone interested in learning how to prepare for death from a Buddhist perspective, both spiritually and practically. It is also for those who want to learn how to help someone else who is dying, both during the time of illness and death as well as after death. (shrink)

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)

In recent years, firms have greatly increased the amount of resources allocated to activities classified as Corporate Social Responsibility (CSR). While an increase in CSR expenditure may be consistent with firm value maximization if it is a response to changes in stakeholders' preferences, we argue that a firm's insiders (managers and large blockholders) may seek to overinvest in CSR for their private benefit to the extent that doing so improves their reputations as good global citizens and has a "warm-glow" effect. (...) We test this hypothesis by investigating the relation between firms' CSR ratings and their ownership and capital structures. Employing a unique data set that categorizes the largest 3000 U. S. corporations as either socially responsible (SR) or socially irresponsible (SI), we find that on average, insiders' ownership and leverage are negatively related to the firm's social rating, while institutional ownership is uncorrelated with it. Assuming that higher CSR ratings is associated with higher CSR expenditure level, these results support our hypothesis that insiders induce firms to over-invest in CSR when they bear little of the cost of doing so. (shrink)

A satisfactory theory of linguistic communication must explain how it is that, through the interpersonal exchange of auditory, visual, and tactile stimuli, the communicative preconditions for the acquisition of testimonial knowledge regularly come to be satisfied. Without an account of knowledge-yielding communication this success condition for linguistic theorizing is left opaque, and we are left with an incomplete understanding of testimony, and communication more generally, as a source of knowledge. This paper argues that knowledge-yielding communication should be modelled on knowledge (...) itself. It is argued that knowledge-yielding communication occurs iff interlocutors coordinate on truth values in a non-lucky and non-deviant way. This account is able to do significant explanatory work: it sheds light on the nature of referential communication, and it allows us to capture, in an informative way, the sense in which interlocutors must entertain similar propositions in order to communicate successfully. (shrink)

In this paper I argue that the enkratic principle in its classic formulation may not be a requirement of rationality. The investigation of whether it is leads to some important methodological insights into the study of rationality. I also consider the possibility that we should consider rational requirements as a subset of a broader category of agential requirements.

This paper argues that the dominance of linear models has led many sociologists to construe the social world in terms of a "general linear reality." This reality assumes (1) that the social world consists of fixed entities with variable attributes, (2) that cause cannot flow from "small" to "large" attributes/events, (3) that causal attributes have only one causal pattern at once, (4) that the sequence of events does not influence their outcome, (5) that the "careers" of entities are largely independent, (...) and (6) that causal attributes are generally independent of each other. The paper discusses examples of these assumptions in empirical work, consider standard and new methods addressing them, and briefly explores alternative models for reality that employ demographic, sequential, and network perspectives. (shrink)

A Physicalist Manifesto is a full treatment of the comprehensive physicalist view that, in some important sense, everything is physical. Andrew Melnyk argues that the view is best formulated by appeal to a carefully worked-out notion of realization, rather than supervenience; that, so formulated, physicalism must be importantly reductionist; that it need not repudiate causal and explanatory claims framed in non-physical language; and that it has the a posteriori epistemic status of a broad-scope scientific hypothesis. Two concluding chapters argue (...) in detail that contemporary science provides no significant empirical evidence against physicalism and some considerable evidence for it. Written in a brisk, candid and exceptionally clear style, this 2003 book should appeal to professionals and students in philosophy of mind, metaphysics and philosophy of science. (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.

This introduction to mathematical logic starts with propositional calculus and first-order logic. Topics covered include syntax, semantics, soundness, completeness, independence, normal forms, vertical paths through negation normal formulas, compactness, Smullyan's Unifying Principle, natural deduction, cut-elimination, semantic tableaux, Skolemization, Herbrand's Theorem, unification, duality, interpolation, and definability. The last three chapters of the book provide an introduction to type theory (higher-order logic). It is shown how various mathematical concepts can be formalized in this very expressive formal language. This expressive notation facilitates proofs (...) of the classical incompleteness and undecidability theorems which are very elegant and easy to understand. The discussion of semantics makes clear the important distinction between standard and nonstandard models which is so important in understanding puzzling phenomena such as the incompleteness theorems and Skolem's Paradox about countable models of set theory. Some of the numerous exercises require giving formal proofs. A computer program called ETPS which is available from the web facilitates doing and checking such exercises. Audience: This volume will be of interest to mathematicians, computer scientists, and philosophers in universities, as well as to computer scientists in industry who wish to use higher-order logic for hardware and software specification and verification. (shrink)

This book provides a critical media analysis of the COVID-19 pandemic, using the precision of a surgeon’s scalpel to reveal the deliberate practices of those that have weaponized a deadly, serious disease against the most vulnerable members of society.

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)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:An Exposition of The Divine Names, The Book of Blessed Dionysius by Thomas AquinasMichael J. Rubin, Elizabeth C. Shaw, and Staff*AQUINAS, Thomas. An Exposition of The Divine Names, The Book of Blessed Dionysius. Translated and edited with an introduction by Michael A. Augros. Merrimack, N.H.: Thomas More College Press, 2021. xxv + 549 pp. Cloth, $65.00The profound influence that Pseudo-Dionysius had on Aquinas’s thought, especially in his (...) metaphysics of participation and his apophatic theology, has been known for some time now, thanks to the excellent work of such scholars as Fran O’Rourke. One would therefore think that Aquinas’s Exposition of the Divine Names (his only commentary on the works of Pseudo-Dionysius) would have been translated a lot sooner. This delay is assuredly due not just to the difficulty of translating this work but also to a certain embarrassment felt by Thomists over Aquinas’s sincere belief that the “Dionysius” who wrote the Divine Names was the Areopagite whose conversion at the teaching of St. Paul is mentioned in the Acts of the Apostles. That the author calling himself “Dionysius” was in fact a theologian writing in the fifth or sixth centuries has been well established by modern scholarship. Hence, Thomists may have felt tempted to discount or at least pass over the influence of this author on Aquinas since it is discomfiting to think that the Church’s greatest theologian accorded such authority to an imposter.Michael Augros tackles these concerns head-on in the excellent introduction to his new translation of the Divine Names commentary. First, Augros points out that in past centuries a pseudonym was usually not an act of forgery but, rather, a way of concealing the author’s identity, which an early Christian theologian might well decide to do either out of humility or out of a desire “to avoid provoking certain prejudices” in those who disagreed with him in contemporary theological disputes. Moreover, it is likely that the work was never intended for the general public (who could easily mistake the pseudonym as genuine) but, rather, was written for those “already initiated in a particular Neoplatonic school of Christian theology,” who would recognize the author as being “one of their own” but without knowing his precise identity. Finally, in taking the particular name of “Dionysius,” the author of the Divine Names was indicating his intention for the work: Just as the biblical Dionysius was a Greek philosopher who converted to Christianity, so the works of Pseudo-Dionysius [End Page 345] are an attempt to reconcile Greek philosophy with the Christian faith.It therefore seems likely, as Augros observes, that Aquinas would still have accorded a great deal of respect to the Divine Names even if he had learned the truth of the author’s identity. The work would not have had the same deuterocanonical authority for him that comes with being written by a direct disciple of St. Paul himself, but “the inherent cogency, coherence, and beauty” of Pseudo-Dionysius’s theology would have been the same. Hence, Pseudo-Dionysius would surely have earned from Aquinas the “docile attitude” appropriate “for a philosopher and theologian of the first order, such as Boethius.”That Aquinas was right to see the author of the Divine Names as a master philosopher and theologian becomes evident when one dives into the text itself, in which Aquinas sees a truly dazzling order, both externally and internally. According to Aquinas, the Divine Names discusses those truths about God of which there are intelligible likenesses in creatures, such as goodness or wisdom, whereas the truths about God of which there are sensible likenesses (for example, “when God is called a lion, or a rock”) are treated by Pseudo-Dionysius in The Symbolic Theology; meanwhile, in the lost or fictional work The Divine Characteristics, Dionysius claims to have treated those truths about God (such as the Trinity) that cannot be known through any likenesses in creatures.Aquinas finds a still more intricate order within the Divine Names itself. Since this work is dedicated to “the divine names by which the processions of God to creatures are manifested,” the plan of the work... (shrink)

Strengthening the abilities of smallholder farmers in developing countries, particularly women farmers, to produce for both home and the market is currently a development priority. In many contexts, ownership of assets is strongly gendered, reflecting existing gender norms and limiting women’s ability to invest in more profitable livelihood strategies such as market-oriented agriculture. Yet the intersection between women’s asset endowments and their ability to participate in and benefit from agricultural interventions receives minimal attention. This paper explores changes in gender relations (...) and women’s assets in four agricultural interventions that promoted high value agriculture with different degrees of market-orientation. Findings suggest that these dairy and horticulture projects can successfully involve women and increase production, income and the stock of household assets. In some cases, women were able to increase their control over production, income and assets; however in most cases men’s incomes increased more than women’s and the gender-asset gap did not decrease. Gender- and asset-based barriers to participation in projects as well as gender norms that limit women’s ability to accumulate and retain control over assets both contributed to the results. Comparing experiences across the four projects, especially where projects implemented adaptive measures to encourage gender-equitable outcomes, provides lessons for gender-responsive projects targeting existing and emerging value chains for high value products. Other targeted support to women farmers may also be needed to promote their acquisition of the physical assets required to expand production or enter other nodes of the value chain. (shrink)

Kant holds that in order to have knowledge of an object, a subject must be able to “prove” that the object is really possible—i.e., prove that there is neither logical inconsistency nor “real repugnance” between its properties. This is (usually) easy to do with respect to empirical objects, but (usually) impossible to do with respect to particular things-in-themselves. In the first section of the paper I argue that an important predecessor of Kant’s account of our ignorance of real possibility can (...) be found in Locke’s Essay Concerning Human Understanding. In the middle sections I discuss the way in which our inability to prove the real possibility of things-in-themselves motivates Kant’s famous prohibition on certain kinds of knowledge-claims about them. In the final section I examine Hegel’s attempts to dissolve this problem of real repugnance and thereby remove an inherited obstacle to speculative knowledge of the supersensible. -/- . (shrink)

Empirical work has lately confirmed what many philosophers have taken to be true: people are ‘biased toward the future’. All else being equal, we usually prefer to have positive experiences in the future, and negative experiences in the past. According to one hypothesis, the temporal metaphysics hypothesis, future-bias is explained either by our beliefs about temporal metaphysics—the temporal belief hypothesis—or alternatively by our temporal phenomenology—the temporal phenomenology hypothesis. We empirically investigate a particular version of the temporal belief hypothesis according to (...) which future-bias is explained by the belief that time robustly passes. Our results do not match the apparent predictions of this hypothesis, and so provide evidence against it. But we also find that people give more future-biased responses when asked to simulate a belief in robust passage. We take this to suggest that the phenomenology that attends simulation of that belief may be partially responsible for future-bias, and we examine the implications of these results for debates about the rationality of future-bias. (shrink)

Empirical evidence suggests that a majority of people believe that time robustly passes, and that many also report that it seems to them, in experience, as though time robustly passes. Non-dynamists deny that time robustly passes, and many contemporary non-dynamists—deflationists—even deny that it seems to us as though time robustly passes. Non-dynamists, then, face the dual challenge of explaining why people have such beliefs and make such reports about their experiences. Several philosophers have suggested the stable-self explanation, according to which (...) what partly explains one or both of the explananda is that people believe themselves to have a stable persisting self which is imagined either as moving through time, or as being stationary, with time moving around it. This paper empirically investigates this explanation. We found, however, no evidential support for the stable-self explanation, leaving the non-dynamist but also, we will argue, the dynamist, with an extant explanatory challenge. (shrink)

The biological world is full of phenomena that seem to run counter to Darwin's insight that natural selection can lead to the appearance of design. For instance, why do organisms in some species divide reproductive labor? The existence of non-reproducing organisms in such 'eusocial' species looks to be at odds with an evolutionary theory which posits traits exist because they help organisms survive and reproduce. What is the evolutionary advantage of an insect being distasteful to its predators? The distastefulness appears (...) designed to deter predators, but can only affect the predator's actions when the insect is eaten; it is hard to see how such a trait could be passed on. This Element will cover the shared foundations of evolutionary explanations for these and other seemingly puzzling phenomena, focusing on the concepts of inclusive fitness and kin selection. (shrink)

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