Background: Family members are often required to act as substitute decision-makers when health care or research participation decisions must be made for an incapacitated relative. Yet most families are unable to accurately predict older adult preferences regarding future health care and willingness to engage in research studies. Discussion and documentation of preferences could improve proxies' abilities to decide for their loved ones. This trial assesses the efficacy of an advance planning intervention in improving the accuracy of substitute decision-making and increasing (...) the frequency of documented preferences for health care and research. It also investigates the financial impact on the healthcare system of improving substitute decision-making.Methods/DesignDyads (n = 240) comprising an older adult and his/her self-selected proxy are randomly allocated to the experimental or control group, after stratification for type of designated proxy and self-report of prior documentation of healthcare preferences. At baseline, clinical and research vignettes are used to elicit older adult preferences and assess the ability of their proxy to predict those preferences. Responses are elicited under four health states, ranging from the subject's current health state to severe dementia. For each state, we estimated the public costs of the healthcare services that would typically be provided to a patient under these scenarios. Experimental dyads are visited at home, twice, by a specially trained facilitator who communicates the dyad-specific results of the concordance assessment, helps older adults convey their wishes to their proxies, and offers assistance in completing a guide entitled My Preferences that we designed specifically for that purpose. In between these meetings, experimental dyads attend a group information session about My Preferences. Control dyads attend three monthly workshops aimed at promoting healthy behaviors. Concordance assessments are repeated at the end of the intervention and 6 months later to assess improvement in predictive accuracy and cost savings, if any. Copies of completed guides are made at the time of these assessments.DiscussionThis study will determine whether the tested intervention guides proxies in making decisions that concur with those of older adults, motivates the latter to record their wishes in writing, and yields savings for the healthcare system.Trial RegistrationISRCTN89993391. (shrink)
Gottlob Frege famously rejects the methodology for consistency and independence proofs offered by David Hilbert in the latter's Foundations of Geometry. The present essay defends against recent criticism the view that this rejection turns on Frege's understanding of logical entailment, on which the entailment relation is sensitive to the contents of non-logical terminology. The goals are (a) to clarify further Frege's understanding of logic and of the role of conceptual analysis in logical investigation, and (b) to point out the extent (...) to which his understanding of logic differs importantly from that of the model-theoretic tradition that grows out of Hilbert's work. (shrink)
This paper examines the connection between model-theoretic truth and necessary truth. It is argued that though the model-theoretic truths of some standard languages are demonstrably ''''necessary'''' (in a precise sense), the widespread view of model-theoretic truth as providing a general guarantee of necessity is mistaken. Several arguments to the contrary are criticized.
This paper defends the view that Frege's reduction of arithmetic to logic would, if successful, have shown that arithmetical knowledge is analytic in essentially Kant's sense.It is argued, as against Paul Benacerraf, that Frege's apparent acceptance of multiple reductions is compatible with this epistemological thesis.The importance of this defense is that (a) it clarifies the role of proof, definition, and analysis in Frege's logicist works; and (b) it demonstrates that the Fregean style of reduction is a valuable tool for those (...) who would investigate the nature of arithmetical knowledge. (shrink)
Peter Geach famously holds that there is no such thing as absolute identity. There are rather, as Geach sees it, a variety of relative identity relations, each essentially connected with a particular monadic predicate. Though we can strictly and meaningfully say that an individual a is the same man as the individual b, or that a is the same statue as b, we cannot, on this view, strictly and meaningfully say that the individual a simply is b. It is difficult (...) to find anything like a persuasive argument for this doctrine in Geach's work. But one claim made by Geach is that his account of identity is the account most naturally aligned with Frege's widely admired treatment of cardinality. And though this claim of an affinity between Frege's and Geach's doctrines has been challenged, the challenge has been resisted. William Alston and Jonathan Bennett, indeed, go further than Geach to argue that Frege's doctrine implies Geach's. If Alston and Bennett are right, then those who favor a broadly Fregean treatment of cardinality have no choice but to adopt Geach's doctrine of relative identity. And because contemporary set-theoretic accounts of cardinality are essentially Fregean in all respects relevant to this issue (see §11 below), it follows from Alston and Bennett's claim that virtually every standard modern treatment of cardinality requires a 'relativized' treatment of identity. The purpose of this paper is to argue against the implication claimed by Alston and Bennett. Despite some superficial similarities between Frege's treatment of cardinality and Geach's treatment of identity, the two doctrines are fundamentally opposed. Frege's account of cardinality, and its set-theoretic descendants, are all inconsistent with the claim that identity is 'relative' in Geach's sense. (shrink)
This essay addresses the question of the effect of Russell's paradox on Frege's distinctive brand of arithmetical realism. It is argued that the effect is not just to undermine Frege's specific account of numbers as extensions (courses of value) but more importantly to undermine his general means of explaining the object-directedness of arithmetical discourse. It is argued that contemporary neo-Fregean attempts to revive that explanation do not successfully avoid the central problem brought to light by the paradox. Along the way, (...) it is argued that the need to fend off an eliminative construal of arithmetic can help explain the so-called Caesar problem in the Grundlagen, and that the "syntactic priority thesis" is insufficient to establish the claim that numbers are objects. (shrink)
In the early years of the twentieth century, Gottlob Frege and David Hilbert, two titans of mathematical logic, engaged in a controversy regarding the correct understanding of the role of axioms in mathematical theories, and the correct way to demonstrate consistency and independence results for such axioms. The controversy touches on a number of difficult questions in logic and the philosophy of logic, and marks an important turning-point in the development of modern logic. This entry gives an overview of that (...) controversy and of its philosophical underpinnings. (shrink)
Pt. 1. The journey inward. Breaking into the intellectual scene -- Awakening to the divine light in human action -- The original philosophy of the supernatural -- The vocation to philosophy -- Discourse on method for philosophy of religion -- Crisis of modernity for Catholic apologetics -- The broader social involvement -- The philosopher of Aix -- The philosophical itinerary -- The question of a Catholic philosophy -- Pt. 2. The systematic summation. The question of thought -- The responsibilities of (...) thought -- Ontology of consolidation in being in, through, and of itself -- Action as cooperation with the first cause -- The original philosophy of action revisited -- The expanded philosophy of the supernatural -- Symbiosis of the human and the divine in history -- Christian spirit and historical civilization. (shrink)