Recent contributions to the literature on the topic of futility have focused primarily on two areas: 1) definitions of the term and 2) the suggestion that cardiopulmonary resuscitation may be futile in certain patients. This suggestion is based on “scientific” measures and analyses of outcomes, describing the low probability of success of CPR in patients over age 70, those with cancer, those with multiorgan failure, etc. The research reported suggests that with such patients the physician need not get the patient's (...) consent to withhold resuscitation; the physician need only inform either the patient or the surrogate that CPR will not be Instituted in the event of an arrest. (shrink)

As noted In Part II of this series, perhaps the most critical elements to define in deciding when treatment Is futile are the goals of therapy from, both the physician's and the patient's point of view. A patient's personal goals are based upon value system., life goals, and personal definition of “quality of life.” These personal goals must then be interpreted and applied in a reasonable and realistic fashion against what the physician has previously described as the legitimate, objective, and (...) attainable therapeutic goals. As far as possible, both, parties must work together to eliminate the uncertainties in their discussion. The ideal situation includes a competent, alert patient and a prudent, caring physician who have had a long-term ongoing relationship. The key to collaboration is communication: a sincere interest in and professional concern for the patient; a willingness to be honest and open; a commitment to talk and to listen; an attempt to make one another feel comfortable in the collaboration; and an effort to recognize and to overcome barriers to communication, whether barriers are personal to either the patient or the physician or are professional, institutional, or societal. (shrink)

The patient was a woman in her 30s who, until the rapid progression of an ultimately fatal neurologic disease, had been a very successful professional, enjoying athletics and an active social life. In the 6 months of swift deterioration, she had gone from being extremely vibrant and energetic to being totally unable to care for her personal needs. There had been no loss of intellectual capacity. Her sister later recounted to Dr. J., the emergency department physician, that she had found (...) the patient unconscious and unresponsive at home and had immediately called the patient's neurologist in a neighboring city. He directed her to call the paramedics. (shrink)

A physician recently asked how to respond in the case of an 87-year-old patient with advanced Alzheimer's disease, who was unable to swallow or tolerate a nasogastric tube, when the family insisted a gastrostomy tube be inserted but the physician believed the intervention futile. That question encompasses some of the crucial issues in the concept of futility of the treatment goals of physician, patient, and family; the rights of patients and families to demand care; physician judgment; family values; and, to (...) the degree that it represents many similar dilemmas, justice. What are professionals saying when they pronounce treatment futile? What are patients' rights if they or their surrogates disagree?The word “futile” implies a precision about outcome probability that we do not have, and it ignores the wide range of treatments for a given diagnosis. Is futile the same as useless or the opposite of hope? Futile for what? Cure? Restora tion of function? Prolongation of life? Relief from pain? Relief from anxiety? Com fort? Reassurance? To satisfy or placate the patient or the family? The word “futile” is so imprecise that, rather than clarifying, it confuses and clutters the discussion. (shrink)

ABSTRACT This article proposes that Dorothy Dinnerstein’s philosophy can help us understand the problem of miseducation that places male-dominated and ‘masculine’ rapacity at the center of so many human endeavors, including capitalist economic exploitation and environmental exploitation. Dinnerstein argues that early childhood experiences of female domination lead to reactive and immature adult preferences for excessive, triumphing, rapacious, male rule. In Dinnerstein’s theory, the solution to this psychologically deep-rooted problem is for men to do half of the childcare work. This (...) article acknowledges and refutes arguments against Dinnerstein’s theory, and expounds its soundness and benefits. Dinnerstein’s thought can help us put a brake on the capitalist rapacity that threatens our very survival while increasing possibilities for human self-actualization. (shrink)

The playback experiment -- the playing back of recorded animal sounds to the animals in order to observe their responses -- has twice become central to celebrated researches on non-human primates. First, in the years around 1890, Richard Garner, an amateur scientist and evolutionary enthusiast, used the new wax cylinder phonograph to record and reproduce monkey utterances with the aim of translating them. Second, in the years around 1980, the ethologists Peter Marler, Robert Seyfarth, and Dorothy Cheney used tape (...) recorders in a broadly similar way to test whether the different predator calls of one monkey species, vervet monkeys, warn about different kinds of predator. This paper explores the circumstances leading to the ca. 1890 invention and the ca. 1980 reinvention of the primate playback experiment. In both instances, I show, the experiment served as a riposte to those arguing, on scientific grounds, that an unbridgeable gap divides human language from animal communication. I also consider how far progress in technology explains the timing of invention and reinvention. I conclude with some reflections on sifting contingent from inevitable aspects of the history of the primate playback experiment, and of scientific achievements more generally. (shrink)

Two humanist, critical approaches—those of Dorothy Dinnerstein and Immanuel Kant—are summarized, compared, and employed to critique gender bias in science education. The value of Dinnerstein’s approach lies in her way of seeing conventional “masculinity” and conventional “femininity” as developing in relation to each other from early childhood. Because of women’s dominance of early childcare and adults’ enduring, sexist resentment of that dominance, women become inhumanely associated with the non-adult qualities of immaturity, dependence, and childish vulnerability and punish-ability; and male (...) human beings—to whom woman-resenting convention assigns the impossible task of absolutely triumphing over “the feminine,” childhood experience, and all human vulnerability—become inhumanely held to unachievable standards of super-hero invulnerability and god-like mental and practical infallibility. The value of Kant’s approach lies in his insistence that our sense of what is right and necessary for social progress must arise in a practically engaged and experientially full manner, rather than (1) from concepts (such as rigid ideological prescriptions) conceived as being detached from sense experience and as arising from an otherworldly, divine or quasi-divine realm of moral infallibility (such concepts being conventionally associated with “masculine” authority and leadership), or (2) from a sense of being trapped in what—in a given historical, cultural, or experiential moment—may appear as an absolute and unchangeable reality of embodied human experience (an anti-critical, anti-intellectual, and anti-progressive sense of things often associated with disempowered “feminine” experience). I demonstrate that critique integrating these approaches is useful in a science education setting. (shrink)

"This reviewer had to be restrained from stopping people in the street to urge them to read it: They would learn something of the way science is done,...

Book synopsis: Vagueness is currently the subject of vigorous debate in the philosophy of logic and language. Vague terms-such as "tall", "red", "bald", and "tadpole"—have borderline cases ; and they lack well-defined extensions. The phenomenon of vagueness poses a fundamental challenge to classical logic and semantics, which assumes that propositions are either true or false and that extensions are determinate. Another striking problem to which vagueness gives rise is the sorites paradox. If you remove one grain from a heap of (...) sand, surely you must be left with a heap. Yet apply this principle repeatedly as you remove grains one by one, and you end up, absurdly, with a solitary grain that counts as a heap. This anthology collects papers in the field. After an introduction that surveys the field, the essays form four groups, starting with some historically notable pieces. The 1970s saw an explosion of interest in vagueness, and the second group of essays reprints classic papers from this period. The following group of papers represent current work on the logic and semantics of vagueness. The essays in the final group are contributions to the continuing debate about vague objects and vague identity. (shrink)

This important book provides a theory about the nature of fiction, and about the relation between the author, the reader and the fictional text. The approach is philosophical: that is to say, the author offers an account of key concepts such as fictional truth, fictional characters, and fiction itself. The book argues that the concept of fiction can be explained partly in terms of communicative intentions, partly in terms of a condition which excludes relations of counterfactual dependence between the world (...) and the text. This communicative model is then applied to the following problems: how can something be 'true in the story' without being explicitly stated in the text? In what ways does interpreting a fictional story depend upon grasping its author's intentions? Is there always a unique best interpretation of a fictional text? What is the correct semantics for fictional names? What is the nature of our emotional response to a fictional work? In answering these questions the author explores the complex interaction between author, reader, and text. This interaction requires the reader to construct a 'fictional author' - a character in the story whose personality, beliefs and emotional states must be interpreted if the reader is to grasp the meaning of the work. (shrink)

Conditional judgements—judgements employing ‘if’—are essential to practical reasoning about what to do, as well as to much reasoning about what is the case. We handle them well enough from an early...

Landini discusses the second edition of Principia Mathematica, to show Russella (TM)s intellectual relationship with Wittgenstein and Ramsey.

In Complicity and Moral Accountability, Gregory Mellema presents a philosophical approach to the moral issues involved in complicity. Starting with a taxonomy of Thomas Aquinas, according to whom there are nine ways for one to become complicit in the wrongdoing of another, Mellema analyzes each kind of complicity and examines the moral status of someone complicit in each of these ways. Mellema's central argument is that one must perform a contributing action to qualify as an accomplice, and that it (...) is always morally blameworthy to perform such an action. Additionally, he argues that an accomplice frequently bears moral responsibility for the outcome of the other's wrongdoing, but he distinguishes this case from cases in which the accomplice is tainted by the wrongdoing of the principal actor. He further distinguishes between enabling, facilitating, and condoning harm, and introduces the concept of indirect complicity. Mellema tackles issues that are clearly important to any case of collective and shared responsibility, yet rarely discussed in depth, always presenting his arguments clearly, concisely, and engagingly. His account of the nonmoral as well as moral qualities of complicity in wrongdoing--especially of the many and varied ways in which principles and accomplices can interact--is highly illuminating. Liberally sprinkled with helpful and nuanced examples, Complicity and Moral Accountability vividly illustrates the many ways in which one may be complicit in wrongdoing. "In Complicity and Moral Accountability, Gregory Mellema has made an immensely important contribution to the discussion of group morality and collective responsibility both within and far beyond professional academic philosophy. His clearly written book will be essential reading." --Fergus Kerr, Honorary Fellow, University of Edinburgh. (shrink)

Putnam discusses each of the fifteen odes found in the book, studying the work both as a whole and as a series of interactive units.

"This book is very valuable. Today, there are too many books on the Work that are either deliberately impersonal and as a result are just a re-explaining of basic ideas which are already there in Ouspensky.

We often ascribe possibility to the scenes that are displayed by mental or nonmental sensory images. The paper presents a novel argument for thinking that we are prima facie justified in ascribing metaphysical possibility to what is displayed by suitable visual images, and it argues that many of our imagery‐based ascriptions of metaphysical possibility are therefore prima facie justified. Some potential objections to the arguments are discussed, and some potential extensions of them, to cover nonvisual forms of imagery and nonmetaphysical (...) forms of possibility, are endorsed. (shrink)

There has been a long debate on whether demonstratives are directly referential as Kaplan originally argued, or indirectly referential like a definite description. I propose a new analysis of demonstratives that combines intuitions from both direct and indirect approaches. The demonstrative is analyzed as an indirectly referential expression with a binary maximality operator that takes two arguments, where the second argument can be a deictic pointing, an anaphoric index, or a relative clause. Direct reference is encoded not in the meaning (...) of the demonstrative but in the meaning contributed by the pointing gesture, thus capturing both direct and indirect uses. I further propose that some pronouns in English function as demonstratives, realizing the binary structure and competing with the demonstrative. The main advantages of this proposal include (a) deriving the distribution of pronominal and adnominal demonstratives systematically; (b) capturing the unique interaction that demonstratives have with a pointing gesture; and (c) locating English demonstratives against a larger, cross-linguistic picture. (shrink)

A re-issue of Gregory Bateson's classic work. It summarizes Bateson's thinking on the subject of the patterns that connect living beings to each other and to their environment.

This introduction to modern work in analytic philosophy uses the example of the proper name to give a clear explanation of the logical theories of Gottlob Frege, and explain the application of his ideas to ordinary language. McCulloch then shows how meaning is rooted in the philosophy of mind and the question of intentionality, and looks at the ways in which thought can be "about" individual material objects.

Using Sartre is an introduction to the philosophy of Jean-Paul Sartre which promotes Sartrean views but adopts a consistently analytical approach to him. Concentrating on his early philosophy, up to and including Sartre's masterwork Being and Nothingness, Gregory McCulloch demonstrates how much analytical philosophers miss when they neglect Sartre and the continental tradition in philosophy. In the classic spirit of analytical philosophy, Using Sartre is a clear and pithy exposition of Sartre's early work. Written specifically for beginners and non-specialists, (...) the book is sure to spark new interest in Sartre and the existentialists while also making a significant contribution to the analytical philosophy of mind. It indicates how the analytical and continental approaches to philosophy may be brought into closer relation to one another. (shrink)

Context Conflicts over treatment decisions have been linked to physicians' emotional states. Objective To measure the prevalence of emotional exhaustion and conflicts over treatment decisions among US obstetrician/gynaecologists (ob/gyns), and to examine the relationship between the two and the physician characteristics that predict each. Methods Mailed survey of a stratified random sample of 1800 US ob/gyn physicians. Criterion variables were levels of emotional exhaustion and frequency of conflict with colleagues and patients. Predictors included physicians' religious characteristics and self-perceived empathy. Results (...) Response rate among eligible physicians was 66% (1154/1760). 36% of ob/gyns reported high levels of emotional exhaustion, and majorities reported conflict with colleagues (59%) and patients (61%). Those reporting conflict were much more likely to report emotional exhaustion (58% vs 29% who never conflict, OR, 95% CI 2.8, 1.6 to 4.8 for conflict with colleagues; 55% versus 26%, OR, 95% CI 2.2, 1.4 to 3.5 for conflict with patients). Physicians with lower self-perceived empathy were more likely to report physician-patient conflicts (65% vs 58% with higher empathy, OR, 95% CI 1.4, 1.0 to 1.9), as were female ob/gyns (66% vs 57% of males, OR, 95% CI 1.5, 1.1 to 2.0). Foreign-born physicians were less likely to report such conflicts (47% vs 64% of US born, OR, 95% CI 0.5, 0.4 to 0.8). Physicians' religious characteristics were not significantly associated with reporting conflict. Conclusions Conflicts over treatment decisions are associated with physicians' empathy, gender, immigration history and level of emotional exhaustion. With respect to the latter, conflict in the clinical encounter may represent an overlooked source or sign of burnout among ob/gyns. (shrink)

Visualizings, the simplest imaginings which employ visual imagery, have certain characteristic features; they are perspectival, for instance. Also, it seems that some but not all of our visualizings are imaginings of seeings. But it has been forcefully argued, for example by M.G.F. Martin and Christopher Peacocke, that all visualizings are imaginings of visual sensations. I block these arguments by providing an account of visualizings which allows for their perspectival nature and other features they typically have, but which also explains how (...) we can visualize things without thereby imagining visual sensations. (shrink)

Composed of a substantial introduction, twelve original essays produced for this volume, and a new English translation of a personal, intriguing, and little ...

Why do we tend to ascribe possibility to what we can imagine? One strategy for answering that question involves the thought that, just as sensory episodes often involve its seeming to us as though the world is certain ways, so imaginings involve its seeming to us that what we have imagined is possible. This chapter argues that while some imaginings do feature appearances of possibility, very many others do not; and it explores the broader relevance of its conclusions for modal (...) epistemology. (shrink)

After a period of relative exhaustion, French phenomenology has experienced a powerful revival in the last ten years, with the emer-gence of a “cosmological” paradigm in phenomenology. While this situation is obviously to be welcomed, it also presents contemporary phenomenologists with the challenge of acquiring a compass that will enable them to find their bearings in this rapidly reconfiguring philosophical landscape, and according to principles that still partly elude those who are committed to them. In so doing, the aim of (...) this study is twofold: firstly, to put forward a series of hypotheses as to the way in which it is being structured - and thus to elaborate a typology of contemporary French phenomenologies; and secondly, to attempt to determine the stakes and also the presuppositions of this new philosophical “deal” which, perhaps, remains transitory and, as such, rich in a future that, for the time being, it is only possible to presage. (shrink)

Now in its twentieth year of publication, this rich collection, popular among teachers and students alike, provides an in-depth look at major cases that have shaped the field of medical ethics. The book presents each famous (or infamous) case using extensive historical and contextual background, and then proceeds to illuminate it by careful discussion of pertinent philosophical theories and legal and ethical issues.

[This is an edited and improved version of "You Are Not Your Brain: Against 'Teaching to the Brain'" previously published in *Review of Higher Education and Self-Learning* 5(15), Summer 2012.] Since educators are always looking for ways to improve their practice, and since empirical science is now accepted in our worldview as the final arbiter of truth, it is no surprise they have been lured toward cognitive neuroscience in hopes that discovering how the brain learns will provide a nutshell explanation (...) for student learning in general. I argue that identifying the person with the brain is scientism (not science), that the brain is not the person, and that it is the person who learns. In fact the brain only responds to the learning of embodied experience within the extra-neural network of intersubjective communications. Learning is a dynamic, cultural activity, not a neural program. Brain-based learning is unnecessary for educators and may be dangerous in that a culturally narrow ontology is taken for granted, thus restricting our creativity and imagination, and narrowing the human community. (shrink)

Background and objectives Conscientious refusal of abortion has been discussed widely by medical ethicists but little information on practitioners' opinions exists. The American College of Obstetricians and Gynecologists (ACOG) issued recommendations about conscientious refusal. We used a vignette experiment to examine obstetrician-gynecologists' (OB/GYN) support for the recommendations. Design A national survey of OB/GYN physicians contained a vignette experiment in which an OB/GYN doctor refused a requested elective abortion. The vignette varied two issues recently addressed by the ACOG ethics committee—whether the (...) doctor referred and whether the doctor disclosed their objection to the abortion. Participants and setting 1800 OB/GYN randomly selected physicians were asked to complete a mail survey containing the vignette. The response rate was 66% (n=1154) after excluding 40 ineligible cases. Measurement Physicians indicated their approval for the vignette doctor's decision. Main results Overall, 43% of OB/GYN physicians responded that the conscientious refusal exercised by the vignette physician was appropriate. 70% rated the vignette doctor as acting appropriately when a referral was made. This dropped to 51% when the doctor disclosed objections to the patient, and to 12% when the doctor disclosed objections and refused to make a referral. Consistent with previous research, males were more likely to support disclosure and refusal to refer. Highly religious physicians supported non-referral but not disclosure. Conclusion OB/GYN physicians are less likely to support conscientious refusal of abortion if physicians disclose their objections to patients. This is at odds with ACOG recommendations and with some models of the doctor–patient relationship. (shrink)

This chapter provides the background to the American women philosophers’ works that are introduced and collected in Knowledge, Mind and Reality: An Introduction by Early Twentieth-Century American Women Philosophers. We describe the institutional context which made these works possible and their methodological and theoretical background. We also provide biographies for their authors.