In the face of mounting criticism against advance directives, we describe how a novel, computer-based decision aid addresses some of these important concerns. This decision aid, Making Your Wishes Known: Planning Your Medical Future , translates an individual's values and goals into a meaningful advance directive that explicitly reflects their healthcare wishes and outlines a plan for how they wish to be treated. It does this by (1) educating users about advance care planning; (2) helping individuals identify, clarify, and prioritize (...) factors that influence their decision-making about future medical conditions; (3) explaining common end-of-life medical conditions and life-sustaining treatment; (4) helping users articulate a coherent set of wishes with regard to advance care planning—in the form of an advance directive readily interpretable by physicians; and (5) helping individuals both choose a spokesperson, and prepare to engage family, friends, and health care providers in discussions about advance care planning. (shrink)

PurposeAdvance directives have been criticized for failing to help physicians make decisions consistent with patients’ wishes. This pilot study sought to determine if an interactive, computer-based decision aid that generates an advance directive can help physicians accurately translate patients’ wishes into treatment decisions.MethodsWe recruited 19 patient-participants who had each previously created an advance directive using a computer-based decision aid, and 14 physicians who had no prior knowledge of the patient-participants. For each advance directive, three physicians were randomly assigned to review (...) the advance directive and make five to six treatment decisions for each of six (potentially) end-of-life clinical scenarios.From the three individual physicians’ responses, a “consensus physician response” was generated for each treatment decision (total decisions = 32). This consensus response was shared with the patient whose advance directive had been reviewed, and she/he was then asked to indicate how well the physician translated his/her wishes into clinical decisions.ResultsPatient-participants agreed with the consensus physician responses 84 percent (508/608) of the time, including 82 percent agreement on whether to provide mechanical ventilation, and 75 percent on decisions about cardiopulmonary resuscitation (CPR).Across the six vignettes, patient-participants’ rating of how well physicians translated their advance directive into medical decisions was 8.4 (range = 6.5-10, where 1 = extremely poorly, and 10 = extremely well). Physicians’ overall rating of their confidence at accurately translating patients’ wishes into clinical decisions was 7.8 (range = 6.1-9.3, 1 = not at all confident, 10 = extremely confident).ConclusionFor simulated cases, a computer-based decision aid for advance care planning can help physicians more confidently make end-of-life decisions that patients will endorse. (shrink)

The adage “an ounce of prevention is worth a pound of cure” is widely used in healthcare settings and can be applied to the work of institutional clinical ethics committees. The model of clinical ethics consultation, however, is inherently reactive: a crisis or question emerges, and ethics experts are called to help. In an effort to employ a proactive component to the model of clinical ethics consultation (as well as to standardize our educational interventions), we developed ethics pocket cards. The (...) purpose of this article is to: (1) describe the rationale for using ethics pocket cards, (2) provide examples of our cards, and (3) begin a dialogue about the potential uses of ethics pocket cards. In doing so, we hope to explore how such portable, economical devices can advance the goals of ethics consultation as well as the educational aims of ethics committees. (shrink)

Mr. Galanas, an eighty‐six‐year‐old man, intentionally shot himself in the chest and abdomen. Surprisingly, the bullet damaged only his distal pancreas and part of his colon, requiring a diverting colostomy to prevent leakage of bowel fluids into his abdomen. After being admitted, he lies intubated in the intensive care unit awaiting surgery to repair his colon. He is responsive but does not demonstrate clear decision‐making capacity. He grudgingly accepts pain medications but refuses antibiotics and antidepressants. He has a living will (...) that gives his wife durable power of attorney and also explicitly states a desire to refuse all medical interventions if he is permanently unconscious or in an end‐stage condition. Mrs. Galanas reports frequent conversations in which her husband said he would not want to be sustained on life support. She also says that he often mentioned he would not want an ostomy bag—a likely, albeit temporary, outcome of the proposed surgery. His physicians are nervous about withholding medical interventions when Mr. Galanas's injury is the result of a suicide attempt and his prognosis is good. Should the care team surgically repair his injured colon, regardless of the patient's capacity, his advance directive, and his wife's statement that he would not want surgery or other life‐sustaining treatment? (shrink)

We report the identification of a recurrent, 520-kb 16p12.1 microdeletion associated with childhood developmental delay. The microdeletion was detected in 20 of 11,873 cases compared with 2 of 8,540 controls and replicated in a second series of 22 of 9,254 cases compared with 6 of 6,299 controls. Most deletions were inherited, with carrier parents likely to manifest neuropsychiatric phenotypes compared to non-carrier parents. Probands were more likely to carry an additional large copy-number variant when compared to matched controls. The clinical (...) features of individuals with two mutations were distinct from and/or more severe than those of individuals carrying only the co-occurring mutation. Our data support a two-hit model in which the 16p12.1 microdeletion both predisposes to neuropsychiatric phenotypes as a single event and exacerbates neurodevelopmental phenotypes in association with other large deletions or duplications. Analysis of other microdeletions with variable expressivity indicates that this two-hit model might be more generally applicable to neuropsychiatric disease. © 2010 Nature America, Inc. All rights reserved. (shrink)

Christopher Caudwell’s The Crisis in Physics is a stylish and readable analysis of the lines of connection between scientific theories and economic realities. Caudwell provides a trenchant critique of mechanism and positivism. In the words of J.B.S. Haldane, The Crisis in Physics offers a “quarry of ideas” for future philosophers: a wealth of insights and arguments that demands continuing critical reflection.

Background: Discussions about medical errors facilitate professional learning for physicians and may provide emotional support after an error, but little is known about physicians’ attitudes and practices regarding error discussions with colleagues.Methods: Survey of faculty and resident physicians in generalist specialties in Midwest, Mid-Atlantic and Northeast regions of the US to investigate attitudes and practices regarding error discussions, likelihood of discussing hypothetical errors, experience role-modelling error discussions and demographic variables.Results: Responses were received from 338 participants . In all, 73% of (...) respondents indicated they usually discuss their mistakes with colleagues, 70% believed discussing mistakes strengthens professional relationships and 89% knew at least one colleague who would be a supportive listener. Motivations for error discussions included wanting to learn whether a colleague would have made the same decision , wanting colleagues to learn from the mistake and wanting to receive support . Given hypothetical scenarios, most respondents indicated they would likely discuss an error resulting in no harm , minor harm or major harm . Fifty-seven percent of physicians had tried to serve as a role model by discussing an error and role-modelling was more likely among those who had previously observed an error discussion .Conclusions: Most generalist physicians in teaching hospitals report that they usually discuss their errors with colleagues, and more than half have tried to role-model discussions. However, a significant number of these physicians report that they do not usually discuss their errors and some do not know colleagues who would be supportive listeners. (shrink)

In this paper I take Hempel’s raven paradox as the claim that statements of the form ‘∼Ru v Bu’, ‘u is not a raven or u is black,’ confirm the hypothesis h ‘(x)(Rx → Bx)’, ‘All ravens are black.’ Although Hempel discusses this using a criterion of confirmation expressed wholly in terms of deductive logic (see 1965, pp. 35-9), it has become more common to articulate criteria of confirmation using concepts of probability and, in particular, to employ the positive relevance (...) criterion of confirmation which says that, given background knowledge k, (i) e confirms h if and only if P(h/e.k)>P(h/k); (ii) e disconfirms h if and only if P(h/e.k)shrink)

On April 26, 1995, the United States Supreme Court limited the reach of the preemption provision of ERISA in New York State Conference of Blue Cross & Blue Shield Plans v. Tavelers Insurance Co. ). In Travelers, the Supreme Court upheld the validity of a New York statute requiring hospitals to collect surcharges from patients covered by commercial insurers and requiring health maintenance organizations to pay a surcharge to the state's general fund that varies depending on the number of Medicaid-eligible (...) HMO members enrolled. Neither patients insured by Blue Cross/Blue Shield plans nor the plans themselves are similarly charged under the statute. Several commercial insurers and HMOs claimed the surcharges should be preempted under ERISA because they are levied on patients whose insurance or HMO membership premiums are purchased by an ERISA plan.The ERISA preemption clause means that federal regulation, or lack thereof, supersedes state regulation that is related to employee pension and benefit plans. This preemption clause prevents states from changing health care and benefit law for a significant portion of state residents. (shrink)

"Every word, like a sacred object, has its place. No _précis_ is possible. This extraordinary book must be read."—Edmund Carpenter, _New York Times Book Review _ "No outline is possible; I can only say that reading this book is a most exciting intellectual exercise in which dialectic, wit, and imagination combine to stimulate and provoke at every page."—Edmund Leach, _Man _ "Lévi-Strauss's books are tough: very scholarly, very dense, very rapid in argument. But once you have mastered him, human history (...) can never be the same, nor indeed can one's view of contemporary society. And his latest book, _The Savage Mind_, is his most comprehensive and certainly his most profound. Everyone interested in the history of ideas _must_ read it; everyone interested in human institutions _should _read it."—J. H. Plumb, _Saturday Review_ "A constantly stimulating, informative and suggestive intellectual challenge."—Geoffrey Gorer, _The Observer_, London. (shrink)

In the end of the 1960s France witnessed the response of the younger generation of philosophers to the leftist ideologies of 1968, as well as to the "intellectual models" of that time: Sartre, Lévi-Strauss, Lacan etc. It was from this response that the so called "new philosophy" raised. Among them also B.-H. Lévy, who later, as a mature philosopher , in spite of having suppressed his model J.-P. Sartre returned to him in his remarkable biography. The question than is: Which (...) Sartre - then there were more than one Sartre: Sartre as the author of Nausea is not identical with Sartre as a follower of Stalinism - and how could he substantiate the whole century, which was a century of seething of ideas, events mostly tragic, challenges, defeats, which all are constitutive of our modernity? (shrink)

According to Bikas Chakrabarti (2005, p. 225), the term econophysics was neologized in 1995 at the second Statphys-Kolkata conference in Kolkata (formerly Calcutta), India by the physicist H. Eugene Stanley, who was also the first to use it in print (Stanley, 1996). Mantegna and Stanley (2000, pp. viii-ix) define “the multidisciplinary field of econophysics” as “a neologism that denotes the activities of physicists who are working on economics problems to test a variety of new conceptual approaches deriving from the physical (...) sciences.” The list of such problems has included distributions of returns in financial markets (Mantegna, 1991; Levy and Solomon, 1997; Bouchaud and Cont, 1998; Gopakrishnan, Plerou, Amaral, Meyer, and Stanley, 1999; Sornette and Johansen, 2001; Farmer and Joshi, 2004) the distribution of income and wealth (Drăgulescu and Yakovenko, 2001; Bouchaud and Mézard, 2000; Chatterjee, Yarlagadda, and Charkrabarti, 2005), the distribution of economic shocks and growth rate variations (Bak, Chen, Scheinkman, and Woodford, 1993; Canning, Amaral, Lee, Meyer, and Stanley, 1998), the distribution of firm sizes and growth rates (Stanley, Amaral, Buldyrev, Havlin, Leschhorn, Maass, Salinger, and Stanley, 1996; Takayasu and Okuyama, 1998; Botazzi and Secchi, 2003), the distribution of city sizes (Rosser, 1994; Gabaix, 1999), and the distribution of scientific discoveries (Plerou, Amaral, Gopakrishnan, Meyer, and Stanley, 1999; Sornette 1 and Zajdenweber, 1999), among other problems, all of which are seen at times not to follow normal or Gaussian patterns that can be described fully by mean and variance. The main sources of conceptual approaches from physics used by the econophysicists have been from models of statistical mechanics (Spitzer, 1971), geophysical models of earthquakes (Sornette, 2003), and “sandpile” models of avalanches, the latter involving self-organized criticality (Bak, 1996). An early physicist to assert the essential identity of statistical methods used in physics and the social sciences was Majorana (1942). A common theme among those who identify themselves as econophysicists is that standard economic theory has been inadequate or insufficient to explain the non-Gaussian distributions empirically observed for various of these phenomena, such as “excessive” skewness and leptokurtotic “fat tails” (McCauley, 2004).. (shrink)

This article explores Presocratic epistemology, arguing that divine revelation is replaced as a warrant for knowledge with naturalistic accounts of how and what we humans can know; thus replacing earlier Greek pessimism about knowledge with a more optimistic outlook that allows for human discovery of the truth. A review of the relevant fragments and testimonia shows that Xenophanes, Alcmaeon, Heraclitus, and Parmenides—even Pythagoras and Empedocles—all moved some distance away from the older “god-oriented” view of knowledge toward a more secular and (...) optimistic outlook. But to get some sense of the dynamics at work in this transition this article begins, as virtually every account of early Greek thought must begin, with Homer and Hesiod. (shrink)

The contributions to this special collection concern issues and problems discussed in or related to the work of Wesley C. Salmon. Salmon has long been noted for his important work in the philosophy of science, which has included research on the interpretation of probability, the nature of explanation, the character of reasoning, the justification of induction, the structure of space/time and the paradoxes of Zeno, to mention only some of the most prominent. During a time of increasing preoccupation with historical (...) and sociological approaches to under standing science (which characterize scientific developments as though they could be adequately analysed from the perspective of political movements, even mistaking the phenomena of conversion for the rational appraisal of scientific theories), Salmon has remained stead fastly devoted to isolating and justifying those normative standards distinguishing science from non-science - especially through the vindi cation of general principles of scientific procedure and the validation of specific examples of scientific theories - without which science itself cannot be (even remotely) adequately understood. In this respect, Salmon exemplifies and strengthens a splendid tradi tion whose most remarkable representatives include Hans Reichenbach, Rudolf Carnap and Carl G. Hempel, all of whom exerted a profound influence upon his own development. (shrink)

This collection of essays is the definitive version of a widely discussed debate over the origins of the New Theory of Reference. In new articles, written especially for this volume, Quentin Smith and Scott Soames, the original participants in the debate, elaborate their positions on who was responsible for the ideas that Saul Kripke presented in his Naming and Necessity. They are joined by John Burgess, who weighs in on the side of Soames, while Smith adds a further dimension in (...) discussing the contributions of philosophers such as Follesdal, Geach, Hintikka, and Plantinga. Also included are lengthy excerpts from Follesdal's 1961 Harvard dissertation and a careful examination by Sten Lindstrom of the respective contributions of Kripke and Stig Kanger to the development of modal semantics. The collection will be essential reading for anyone acquainted with these influential ideas. (shrink)

This additional volume offers a revised edition of Lingua , Erasmus’ work on language, its possibilities and the dangers in its use, ending in a praise of the Word of God. Since it deals with the moral implications of language, Erasmus placed it in Ordo IV that comprises works on moral issues.