While a significant literature has appeared discussing theoretical ethical concerns regarding COVID-19, particularly regarding resource prioritization, as well as a number of personal reflections on providing patient care during the early stages of the pandemic, systematic analysis of the actual ethical issues involving patient care during this time is limited. This single-center retrospective cohort mixed methods study of ethics consultations during the first surge of the COVID 19 pandemic in Massachusetts between March 15, 2020 through June 15, 2020 aim to (...) fill this gap. Results indicate that there was no significant difference in the median number of monthly consultation cases during the first COVID-19 surge compared to the same period the year prior and that the characteristics of the ethics consults during the COVID-19 surge and same period the year prior were also similar. Through inductive analysis, we identified four themes related to ethics consults during the first COVID-19 surge including (1) prognostic difficulty for COVID-19 positive patients, (2) challenges related to visitor restrictions, (3) end of life scenarios, and (4) family members who were also positive for COVID-19. Cases were complex and often aligned with multiple themes. These patient case-related sources of ethical issues were managed against the backdrop of intense systemic ethical issues and a near lockdown of daily life. Healthcare ethics consultants can learn from this experience to enhance training to be ready for future disasters. (shrink)

In recent years the writings of Ludwig Wittgenstein have received much attention from philosophers in general and especially from philosophers interested in religion; and there is no doubt that Wittgenstein's legacy of thought is both highly suggestive and highly problematical. It seems likely, however, that the vogue which Wittgenstein now enjoys owes not a little to his peculiar place in the development of modern philosophy and, in particular, of that empiricist tradition in philosophy which stems from what has been called (...) the revolution in philosophy in the early decades of the present century. (shrink)

Modern ethics has been chiefly concerned with the analysis of the conditions and principles of morality; and, in particular, one of its most important achievements has been the further elucidation of the Kantian dictum that “I ought” implies that I can. On the face of it Kant's contention seems perfectly straightforward, but, on examination, it becomes apparent that the simple word “can” covers a somewhat complicated ambiguity. When it is said that I ought to do act A, it may rightly (...) be taken that I can do act A; but the question arises whether or not this in turn involves that I am aware that I can do act A. There is clearly some significance in the assertion that I can do many acts which, however, never occur to me, either because I am ignorant of certain facts or because I have a mistaken opinion about the facts. On the other hand, it may quite properly be said that I cannot perform any act of the possibility of which I am unaware. The problem then is to determine and examine the sense of the word “can” which is a pre-condition of moral obligation. (shrink)

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)

There was a deep continuity in Wollheim’s thought from his book on F. H. Bradley onward. His notion of the concept of art as deeply interiorized was inextricable from his sense of the psychological unity of the mind and the historical continuity of artistic tradition, seen on analogy with an inherited language. His study of pictorial representation pivoted on the innate psychological capacity of ‘seeing-in’, perceiving the represented subject in a surface from which it was seen as distinct but to (...) which it could be related. The expressiveness of depiction he explained through a psychoanalytic concept of projection in which we come to see a piece of the external world as corresponding to an inward state of mind. He reserved the use of the term ‘imagination’ for the artist’s elaboration of ‘seeing-in’. This he exemplified in accounts of painting by Manet, Friedrich, Titian, and Ingres among others. His critical stance has a close affinity with certain essays by Pater. (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 paper criticizes criminal law scholarship for helping to construct and failing to expose analytic structures that falsely claim a higher level of rationality and coherence than current criminal law theory deserves. It offers illustrations of three such illusions of rationality. First, it is common in criminal law discourse for scholars and judges to cite any of the standard litany of "the purposes of punishment" -- just deserts, deterrence, incapacitation of the dangerous, rehabilitation, and sometimes other purposes -- as a (...) justification for one or another liability rule or sentencing practice. The cited "purpose" gives the rules an aura of rationality, but one that is, in large part, illusory. Without a principle defining the interrelation of the "purposes," nearly any rule can be justified by some "purpose of punishment." Thus, a decision maker can switch among distributive principles as needed to provide an apparent rationale for whichever rule the person prefers, even if that preference is not based on rational criteria. A second example is found in a central mechanism for determining an offenderâs blameworthiness: the use of an individualized objective standard. The widely used mechanism avoids the problems acknowledged to attend a strictly objective standard. A person's situation and capacities are central to an assessment of whether a person can be fairly blamed for a violation, and the individualized objective standard allows the decision maker to take these into account. At the same time, the mechanism avoids reversion to a completely subjective standard, which might exempt many blameworthy cases from liability. In reality, however, the mechanism only shifts the form of the problem. Codes that use the individualized objective standard fail to provide a principle by which one can determine those characteristics of an offender with which the objective standard ought to be individualized and those with which it ought not. Without a governing principle, the issue again is left to the discretion of decision makers, with no guidance as to how that discretion is to be exercised. A final illusion obscures whether the criminal justice system is, in fact, in the business of "doing justice." The "criminal justice" system imposes "punishment" and encourages moral condemnation of those found "guilty" of "crimes." But while the system cultivates its doing-justice image, it increasingly shifts to a system of essentially preventive detention, where a violator's sanction is derived more from what is needed to incapacitate him from committing future offenses than to punish him for a past offense. There are great advantages to the deception, but also serious costs and inefficiencies. The paper discusses why some illusions are more objectionable than others and what the existence of such illusions says about modern criminal law scholarship. (shrink)

In his article ‘Professor Bartley's Theory of Rationality and Religious Belief’ Mr W. D. Hudson has brought considerable clarification to the rather confused situation occasioned by Professor W. W. Bartley's book The Retreat to Commitment and its subsequent discussion; but the process can, I think, be carried still further.

Bob Solomon used to inveigh against William James’ theory of emotions, but he eventually arrived at a rapprochement with James and James’s recent successors. In particular, James suggested that emotions are initiated by the “automatic, instinctive” appraisals that register important information in the body and are recorded by body-mapping brain areas. In recent work Solomon describes the judgments he thinks constitute emotions as felt bodily appraisals in similar fashion.

In this paper I hope to show that a particular modern approach to Aristotle's philosophy of mind is untenable and, out of that negative discussion, develop some tentative suggestions concerning the interpretation of two famous and puzzling Aristotelian maxims. These maxims are, first, that the soul is the form of the body and, second, that perception is the reception of form without matter. The fashionable interpretation of Aristotle which I wish to criticize is the attempt to assimilate him to certain (...) modern philosophies of mind by making him into a functionalist. I shall therefore begin by explaining this modern term of art. (shrink)

It is easy to understand the apparent appeal of strict liability to policymakers and legal reformers seeking to reduce crime: if the criminal law can do away with its traditional culpability requirement, it can increase the likelihood of conviction and punishment of those who engage in prohibited conduct or bring about prohibited harm or evil. And such an increase in punishment rate can enhance the crime-control effectiveness of a system built upon general deterrence or incapacitation of the dangerous. Similar arguments (...) support the use of criminal liability for regulatory offenses. Greater punishment rates suggest greater compliance. But this analysis fails to appreciate the crime-control costs of strict liability. By explicitly providing for punishment in the absence of moral blameworthiness, the law undermines its moral credibility with the community and thereby provokes subversion and resistance instead of the cooperation and acquiescence it needs for effective crime control. More importantly, the system’s lost moral credibility undermines the law’s ability to harness the powerful forces of stigmatization, social influence, and internalized norms. Given the serious limitations inherent in the real-world application of general deterrence and preventive detention programs, the most effective crime-control strategy is to build the criminal law’s reputation for being just, which means avoiding the use of strict liability. (shrink)

Because they track the Model Penal Code, current criminal law formulations of risk offenses typically fail to distinguish the rule of conduct question—What risks does the criminal law prohibit?—from the adjudication question — When is a particular violator’s conscious disregard of, or his inattentiveness to, a risk in a particular situation sufficiently condemnable to deserve criminal liability? Instead, the formulations address only the second question — through their definition of reckless and negligent culpability — and fail to provide a rule (...) of conduct provision to define a prohibited risk. This reliance upon culpability definitions as the core of risk-creation offense definitions is problematic because it fails to announce a useable conduct rule that describes those risks the law prohibits. Instead, this approach subjectivizes the definition of prohibited risks. What may be held "reckless" or "negligent" for one person may not be "reckless" or "negligent" for another person in the identical situation — an effect that strips case adjudications of their value in educating the community as to risks that the rules of conduct prohibit. Current risk-creation offenses also are problematic because they make results — including the creation of a prohibited risk — irrelevant to criminal liability. While this is consistent with the Model Code’s view that resulting harm is insignificant, that only culpable state of mind ought to affect liability, it is inconsistent with the view of most state code drafters. Thus, while the Model Code grades offenses without regard to whether a prohibited risk in fact is created, most state codes logically would want to grade lower in the absence of a prohibited risk. These two fundamental problems—the failure to distinguish conduct rules and adjudication rules and the confusion over the significance of results — are related. The Model Penal Code’s general failure to distinguish conduct and adjudication rules made it less likely that state code drafters would notice what they would have seen as the Code’s inappropriate subjectivization of risk and risk offenses. If the Model Code had systematically segregated conduct and adjudication rules, it would have been more obvious to state code drafters that the Code’s formulation of risk-creation offenses was one that they could not accept. (shrink)

It has long been held that humans need government to impose social order on a chaotic, dangerous world. How, then, did early humans survive on the Serengeti Plain, surrounded by faster, stronger, and bigger predators in a harsh and forbidding environment? Pirates, Prisoners, and Lepers examines an array of natural experiments and accidents of human history to explore the fundamental nature of how human beings act when beyond the scope of the law. Pirates of the 1700s, the leper colony on (...) Molokai Island, prisoners of the Nazis, hippie communes of the 1970s, shipwreck and plane crash survivors, and many more diverse groups--all existed in the absence of formal rules, punishments, and hierarchies. Paul and Sarah Robinson draw on these real-life stories to suggest that humans are predisposed to be cooperative within limits. What these "communities" did and how they managed have dramatic implications for shaping our modern institutions. Should today's criminal justice system build on people's shared intuitions about justice? Or are we better off acknowledging this aspect of human nature but using law to temper it? Knowing the true nature of our human character and our innate ideas about justice offers a roadmap to a better society. (shrink)

In this paper I hope to show that a particular modern approach to Aristotle's philosophy of mind is untenable and, out of that negative discussion, develop some tentative suggestions concerning the interpretation of two famous and puzzling Aristotelian maxims. These maxims are, first, that the soul is the form of the body and, second, that perception is the reception of form without matter. The fashionable interpretation of Aristotle which I wish to criticize is the attempt to assimilate him to certain (...) modern philosophies of mind by making him into a functionalist. I shall therefore begin by explaining this modern term of art. (shrink)

Aim: Participation in classroom physical activity breaks may improve children’s cognition, but few studies have involved adolescents. The primary aim of this study was to examine the effects of classroom-based resistance training with and without cognitive training on adolescents’ cognitive function.Methods: Participants were 97 secondary school students. Four-year 10 classes from one school were included in this four-arm cluster randomized controlled trial. Classes were randomly assigned to the following groups: sedentary control with no cognitive training, sedentary with cognitive training, resistance (...) training without cognitive training, and resistance training with cognitive training. Sessions varied in levels of both cognitive demand and resistance training and were administered three times per week for 4 weeks. Inhibition, cognitive flexibility, episodic memory, on-task behavior, and muscular fitness were assessed at baseline and post-test. Linear mixed models were used to examine changes within and between groups.Results: In comparison with the control group, episodic memory improved significantly in the resistance training without cognitive training group. There were no group-by-time effects for inhibition or cognitive flexibility. Classroom activity breaks both with and without cognitive demand improved participants’ on-task behavior in comparison with the control and sedentary group. The resistance training programs did not lead to improvements in muscular fitness.Conclusion: Participation in body weight resistance training without cognitive training led to selective improvements in episodic memory. No training effects were found for inhibition or cognitive flexibility. A longer study period may be necessary to induce improvements in muscular fitness and associated changes in inhibition and cognitive flexibility.Clinical Trial Registration:https://www.anzctr.org.au/ACTRN12621001341819.aspx, Australian New Zealand Clinical Trials Registry—ACTRN12621001341819. (shrink)

What is our nature? : What does government do for us, and to us? -- Cooperation : lepers & pirates -- Punishment : Drop City & the utopian communes -- Justice : 1850's San Francisco & the California gold rush -- Injustice : the Attica uprising & the Batavia shipwreck -- Survival : the Inuits of King William Land & the mutineers on Pitcairn Island -- Subversion : hellships & prison camps -- Credibility : America's prohibition -- Excess : committing (...) felony murder while asleep in bed & life in prison for an air-conditioning fraud -- Failure : getting away with murder beyond a reasonable doubt -- Collapse : Escobar's Colombia -- Taking justice seriously five proposals -- Epilogue : what are they doing now? (shrink)

The natural experiments of history present an opportunity to test Hobbes' view of government and law as the wellspring of social order. Groups have found themselves in a wide variety of situations in which no governmental law existed, from shipwrecks to gold mining camps to failed states. Yet the wide variety of situations show common patterns among the groups in their responses to their often difficult circumstances. Rather than survival of the fittest, a more common reaction is social cooperation and (...) a commitment to fairness and justice, although both can be subverted in certain predictable ways. The absent-law situations also illustrate the dependence of social order and cooperation on a group's commitment to justice. The insights from the absent-law situations have implication for several modern criminal justice issues, including the appropriate distributive principle for criminal liability and punishment, restorative justice programs, the movement to promote non-incarcerative sanctions, transitional justice and truth commissions, the use-of-force rules under international law, the procedures for fairness in criminal adjudication, and crime-control policies in fighting organized crime and terrorism. (shrink)

The authors use social science methodology to determine whether a doctrinal shift—from an objectivist view of criminality in the common law to a subjectivist view in modem criminal codes—is consistent with lay intuitions of the principles of justice. Commentators have suggested that lay perceptions of criminality have shifted in a way reflected in the doctrinal change, but the study results suggest a more nuanced conclusion: that the modern lay view agrees with the subjectivist view of modern codes in defining the (...) minimum requirements of criminality, but prefers the common law's objectivist view of grading the punishment deserved. The authors argue that there is practical value in having criminal law track shared community intuitions of the proper rules for assigning liability and punishment. For that reason, the study results support the often criticized subjectivist view of modern codes in setting the minimum requirements of liability, but disapprove of the modern codes' shift away from the common law's objectivist view of grading. (shrink)

The author considers two arguments concerning the nature of space which occur in Berkeley and which he thinks are not sufficiently discussed. The first one concerns the phenomenology of space, the second the physics of space. The first one is the “mite” argument, while the second draws from Newton’s two thought experiments concerning absolute space: the “bucket” experiment and the “balls” experiment. The author’s aim is to support the idealist approach to space.

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)