Some health care organizations allow physicians to withhold cardiopulmonary resuscitation from a patient, despite patient or surrogate requests that it be provided, when they believe it will be more harmful than beneficial. Such cases usually involve patients with terminal diagnoses whose medical teams argue that aggressive treatments are medically inappropriate or likely to be harmful. Although there is state-to-state variability and a considerable judicial gray area about the conditions and mechanisms for refusals to perform CPR, medical teams typically follow a (...) set of clearly defined procedures for these decisions. The procedures are based on the principle of nonmaleficence and typically include consultation with hospital ethics committees, reflecting the guidelines of relevant professional associations. Ethical debates about when CPR can and should be limited tend to rely more on discussions of theory, principles, and case studies than systematic empirical study of the situations in which such limitations are applied. Sociologists of bioethics call for empirical study, arguing that what ethicists and health professionals believe they are doing when they draft policies or invoke principles does not always mirror what is happening on the ground. In this article, we begin the task of modeling the empirical analyses sociologists call for, focusing on a cohort at Massachusetts General Hospital. We inductively analyzed ethics committee notes and medical records of nineteen patients whose surrogates did not accept the decision to withhold CPR. (shrink)

Civic Republicanism is a valuable critical introduction to one of the most important topics in political philosophy. In this book, Iseult Honohan presents an authoritative and accessible account of civic republicanism, its origins and its problems. The book examines all the central themes of this political theory. In the first part of the book, Honohan explores the notion of historical tradition, which is a defining aspect of civic republicanism, its value and whether a continued tradition is sustainable. She also (...) discusses the central concepts of republicanism, how they have evolved, in what circumstances civic republicanism can be applied and its patterns of re-emergence. In the second part of the book, contemporary interpretation of republican political theory is explored and question of civic virtue and participation are raised. What is the nature of the common good? What does it mean to put public before private interests and what does freedom mean in a republican state? Honohan explores these as well as other questions about the sustainability of republican thought in the kind of diverse societies we live in today. Civic Republicanism will be essential reading for students of politics and philosophy. (shrink)

Freedom as non-domination provides a distinctive criterion for assessing the justifiability of migration controls, different from both freedom of movement and autonomy. Migration controls are dominating insofar as they threaten to coerce potential migrants. Both the general right of states to control migration, and the wide range of discretionary procedures prevalent in migration controls, render outsiders vulnerable to arbitrary power. While the extent and intensity of domination varies, it is sufficient under contemporary conditions of globalization to warrant limits on states’ (...) discretion with respect to admission. Reducing domination requires, rather than removing all immigration restrictions or democratically justifying them to all, that there be certain constraints on states’ freedom to control migration: giving migrants a publicly secured status somewhat analogous to that enjoyed by citizens, subjecting migration controls to higher legal regulation, and making immigration policies and decision contestable by those who are subject to them. (shrink)

Recent claims that civic republicanism can better address contemporary political problems than either liberalism or communitarianism are generating an intense debate. This is a sharp insight into this debate, confronting normative theory with historical and comparative analysis. It examines whether republican theory can address contemporary political problems in ways that are both valuable and significantly different in practice from liberalism. These expert authors offer contrasting perspectives on issues raised by the contemporary revival of republicanism and adopt a variety of methodological (...) approaches to address the practical implications of republican thought within a coherent thematic framework. This book also *clarifies core themes and contested areas of republican thought, especially the notion of liberty, the specific political institutions needed to realize it, and the nature of solidarity among citizens. * shows how republicanism continued to influence the development of liberal thought in nineteenth century Britain * examines the development of alternative republican discourses, including the established political practice and ideology of the French republican tradition * applies republican perspectives to contemporary political concerns such as the creation of social trust and the expansion of public accountability * explores the implications of republican theory for policy areas including houses, education and marriage in diverse multicultural societies This book will be of great interest to researchers and students studying republicanism in political science history, social policy and education. In addition, it is a valuable resource for those concerned with citizenship, democratic theory, multiculturalism, nationalism and patriotism, and politics beyond the nation-state. (shrink)

In Europe and other regions of the world public debate concerning how many immigrants should be admitted, which rights those admitted should have, and which conditions can be required for access to citizenship is intense and enduring, and these have increasingly become central electoral issues. On the one hand, the harsh treatment of migrants is often a matter of public criticism; on the other hand, states are concerned about problems of welfare, security and social unrest that they have come to (...) associate with large-scale migration. At its most fundamental level, this debate concerns the question of how best to balance particularist principles of democratic self-determination and state sovereignty and universalist principles of individual freedom and human rights. The articles in this special issue examine whether the concept of domination can cast a distinctive light on the normative issues arising in this tension between state sovereignty and universal principles with respect to migration and the position of non-citizens in contemporary liberal democratic states. These issues arise both externally insofar as foreigners are subject to migration controls, and internally insofar as migrants live in states of which they are not full members. The issue thus examines the potential of domination as a concept to bring to bear on issues of migration controls, differential residence statuses and access to membership. (shrink)

This reply examines to what extent Claes’s qualitative research on volunteers, meaningfulness and citizenship mirrors dimensions of republican citizenship. Republican citizenship brings together the idea of freedom as membership of a self-governing community and the ideal of commitment of those members to the common good of the community. According to the author, the idea of republican citizenship that emerges from the interviews is connected with An experience of meaningfulness that is self-fulfilling, but at the same time places life in a (...) larger context, A deeper inner side of civic engagement, A notion of civic virtue that is not too demanding due to its inner link with self-discovery through active citizenship, A strong awareness of the plurality of ways of living a human life, and not a passive identification with an abstract, homogeneous social whole. (shrink)

Does the concept of domination cast new light on issues that arise in the context of migration and citizenship? If citizenship is a status that provides protection from domination, understood as subjection to arbitrary interference, are non-citizens - whether outside or inside the state - necessarily subject to domination by virtue of being non-citizens? Does domination provide a useful basis for considering the harms that migrants suffer? If non-domination is a value to be promoted in politics, what are the implications (...) for the treatment of migrants and resident non-citizens? This book addresses issues of migration and citizenship within the frame of freedom, in terms of domination, understood as being subject to the threat of arbitrary interference. Coming from a variety of perspectives, the chapters examine the issues of migration controls, differential resident statuses, including temporary workers, refugees and long-term residents, and the conditions for access to citizenship in the light of these concerns. This book was published as a special issue of the Critical Review of International Social and Political Philosophy. (shrink)

¿Tiene la teoría política republicana algún recurso que ofrecer a la democracia contemporánea? Dos objeciones son abordadas: que se pone en tela de juicio demasiado internamente que la teoría republicana contemporánea pueda ofrecer una propuesta coherente, y que ninguna idea susceptible de ser valorada es distinguible de la teoría liberal. Mantengo que, a pesar de que hay ciertos lugares comunes entre los republicanos y los liberales, su compromiso para con la democracia muestra diferentes enfoques, tensiones y acuerdos. El republicanismo tiene (...) una subyacente perspectiva coherente y ofrece un enfoque distintivo para fundamentar y concebir la democracia. Su énfasis en la deliberación entre ciudadanos en múltiples esferas públicas, antes que en una soberanía popular unitaria, puede contribuir potencialmente a tratar los problemas que conlleva la compresión y la realización de la democracia a nivel transnacional y global. (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)

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)

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)

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)

We describe the structure, operation, and experience of the Massachusetts General Hospital ethics committee, formally called the Edwin H. Cassem Optimum Care Committee, from January 2007 through December 2013. Founded in 1974 as one of the nation’s first hospital ethics committees, this committee has primarily focused on the optimum use of life-sustaining treatments. We outline specific sociodemographic and clinical characteristics of consult patients during this period, demographic differences between the adult inpatient population and patients for whom the ethics committee was (...) consulted, and salient features of the consults themselves. We include three case studies that illustrate important consult themes during this period. Our findings expand knowledge about the structure and workings of hospital ethics committees and illustrate how one ethics committee has developed and utilized policies on end-of-life care. More generally, we model a sociological approach to the study of clinical ethics consultation that could be utilized to contextualize institutional practices over time. (shrink)

A growing body of research has demonstrated significant heterogeneity of hospital ethics committee (HEC) size, membership and training requirements, length of appointment, institutional support, clinical and policy roles, and predictors of self identified success. Because these studies have focused on HECs at a single point in time, however, little is known about how the composition of HECs changes over time and what impact these changes have on committee utilization. The current study presents 20 years of data on the evolution of (...) the Massachusetts General Hospital HEC. Between 1993 and 2012, the average number of committee members per year was 38 ± 3 and the average length of membership was 4.8 ± 0.4 years. During that time, the committee performed 934 consults, averaging 47 ± 3 per year. Attendance rates fell from 61.5 to 23.8 % over the study period and were inversely correlated with the total number of members. Between 1993 and 2012, the committee saw substantial growth in the diversity of the professional backgrounds of its members. Multivariate analysis, however, suggests that substantial changes in committee composition did not impact its utilization and that other factors are more likely to explain fluctuations in consultation volume. (shrink)

In response to the environmental and political crisis that we currently face, new ways of thinking and acting that provide alternatives to the current operation of liberal democracy and capitalism...

In response to the environmental and political crisis that we currently face, new ways of thinking and acting that provide alternatives to the current operation of liberal democracy and capitalism...

The book presents the most relevant theories of truth (correspondence, semantic, deflational, pragmaticist, coherentist, constructivist, evidential), with the emphasis of analytical approaches. The author develops a version of the realist correspondence concept of truth while distinguishing various criteria of truth. He is skeptical in regard of any, complete or certain truth but he does not accept epistemic skepticism either, but argues for a moderate realism where objective orientation towards truth suffices as catching (ever) more truth than falsity.

Comment devient-on philosophe? Par quel sursaut un Aristoclès se fait-il Platon, jusqu'à s'imposer dans la liste des " auteurs philo " Il faut enquêter, non pas sur la vie privée, mais sur la vie intime : rumination intellectuelle, ton sur lequel on parle, motivations amoureuses... Ce qui fait un philosophe, c'est un immense travail sur soi, et la rencontre d'autres philosophes, vivants, de leurs problématiques. Mémoire sémantique + obsession métaphysique, voilà le code génétique du philosophe. Il débute par un attentat (...) religieux, puisqu'il commence sa carrière en niant tel ou tel sacré. Bien sûr, il vaut mieux être mâle, communiquer par les livres adopter la langue dominante, écrire quand on est célibataire. Comment gagner sa vie? Pas forcément en étant enseignant, comme c'est le cas aujourd'hui. Le profil du philosophe nous le révèle orphelin, vivant à l'étranger, souvent laid, jamais fou, et serial thinker, prêt à changer de philosophie pourvu qu'il reste, lui, à menacer le monde donnera ou donnera pas du sens à notre vie? Le philosophe est l'être inquiet qui pense inquiéter l'Être par deux trois mots bien aiguisés. (shrink)

While there are numerous doubts, controversies and lack of consensus on alternative definitions of human death, it is argued that it is more ethical to allow people to choose either cessation of cardio-respiratory function or loss of entire brain function as the definition of death based on their own views. This paper presents the law of organ transplantation in Japan, which allows people to decide whether brain death can be used to determine their death in agreement with their family. Arguably, (...) Japan could become a unique example of individual choice in the definition of death if the law is revised to allow individuals choose definition of death independently of their family. It suggests that such an approach is one of the reasonable policy options a country can adopt for legislation on issues related to the definition of death. (shrink)

Extraterrestrial Altruism examines a basic assumption of the Search for Extraterrestrial Intelligence (SETI): that extraterrestrials will be transmitting messages to us for our benefit. This question of whether extraterrestrials will be altruistic has become increasingly important in recent years as SETI scientists have begun contemplating transmissions from Earth to make contact. Technological civilizations that transmit signals for the benefit of others, but with no immediate gain for themselves, certainly seem to be altruistic. But does this make biological sense? Should we (...) expect altruism to evolve throughout the cosmos, or is this only wishful thinking? Is it dangerous to send messages to other worlds, as Stephen Hawking has suggested, or might humankind benefit from an exchange with intelligence elsewhere in the galaxy? Would extraterrestrial societies be based on different ethical principles, or would we see commonalities with Earthly notions of morality? Extraterrestrial Altruism explores these and related questions about the motivations of civilizations beyond Earth, providing new insights that are critical for SETI. Chapters are authored by leading scholars from diverse disciplines—anthropology, astronomy, biology, chemistry, computer science, cosmology, engineering, history of science, law, philosophy, psychology, public policy, and sociology. The book is carefully edited by Douglas Vakoch, Director of Interstellar Message Composition at the SETI Institute and professor of clinical psychology at the California Institute of Integral Studies. The Foreword is by Frank Drake. This interdisciplinary book will benefit everybody trying to understand whether evolution and ethics are unique to Earth, or whether they are built into the fabric of the universe. (shrink)

How (Not) to Be Secular is what Jamie Smith calls "your hitchhiker's guide to the present" -- it is both a reading guide to Charles Taylor's monumental work A Secular Age and philosophical guidance on how we might learn to live in our times. Taylor's landmark book A Secular Age (2007) provides a monumental, incisive analysis of what it means to live in the post-Christian present -- a pluralist world of competing beliefs and growing unbelief. Jamie Smith's book is a (...) compact field guide to Taylor's insightful study of the secular, making that very significant but daunting work accessible to a wide array of readers. Even more, though, Smith's How (Not) to Be Secular is a practical philosophical guidebook, a kind of how-to manual on how to live in our secular age. It ultimately offers us an adventure in self-understanding and maps out a way to get our bearings in today's secular culture, no matter who "we" are -- whether believers or skeptics, devout or doubting, self-assured or puzzled and confused. This is a book for any thinking person to chew on. (shrink)