Volume 20, Issue 3, March 2020, Page 85-87.

Governments standardly deploy a distinction between goods and services in assessing economic health and tracking national income statistics, of which medical goods and services carry significant importance. In what follows we draw on Basic Formal Ontology (BFO) to introduce a third kind of entity called patterns, which help capture the various ways in which goods and services are intertwined and help also to show how many services generate a new kind of non-goods-related products. Patterns are an overlooked yet essential features (...) of many economic sectors including medicine. Studying patterns offers new insights into various components of economic analysis, including outcomes-oriented evaluations of medical services and the value of human capital in the medical sphere. (shrink)

The authors work in a variety of clinical ethics consultation services (CECSs) that employ a range of methods and approaches. This article discusses the approach to ethics consultation at the Center for Medical Ethics and Health Policy at Baylor College of Medicine and describes the development and transformation of the authors’ CECSs. It discusses how one CECS shifted from a nascent program with only fifty consultations a year to a vibrant, heavily staffed service with five hundred ethics consultations a year.

In “Three Kinds of Decision-Making Capacity for Refusing Medical Interventions,” Navin et al. (2022) propose two additional kinds of decision-making capacity that ought to be recognized in cases of...

Volume 20, Issue 8, August 2020, Page 96-98.

In clinical ethics, there remains a great deal of uncertainty regarding the appropriateness of attempting cardiopulmonary resuscitation (CPR) for certain patients. Although the issue continues to receive ample attention and various frameworks have been proposed for navigating such cases, most discussions draw heavily on the notion of harm as a central consideration. In the following, I use emerging philosophical literature on the notion of harm to argue that the ambiguities and disagreement about harm create important and oft-overlooked challenges for the (...) ethics of CPR. I begin by elucidating the standard account of harm, called the Counterfactual Comparative Account (CCA). I then show that three challenges to the CCA—preemptive harms, the harm of death, and non-experiential harms—are particularly salient when assessing potential harms for candidates of CPR and likely impact-related decision-making and communication. I extend this argument to explore how the ambiguities of harm might extend to other realms of clinical decision-making, such as the use and limitations of life-sustaining treatments. To address these challenges, I propose two strategies for identifying and minimizing the impact of such uncertainty: first, clinicians and ethicists ought to promote pluralistic conversations that account for different understandings of harm; second, they ought to invoke harm-independent considerations when discussing the ethics of CPR in order to reflect the nuances of such conversations. These strategies, coupled with a richer philosophical understanding of harm, promise to help clinicians and ethicists navigate the prevalent and difficult cases involving patient resuscitation and many other harm-based decisions in the clinical setting. (shrink)

Although shared decision-making is a standard in medical care, unilateral decisions through process-based conflict resolution policies have been defended in certain cases. In patients who do not stand to receive proportional clinical benefits, the harms involved in interventions such as cardiopulmonary resuscitation seem to run contrary to the principle of non-maleficence, and provision of such interventions may cause clinicians significant moral distress. However, because the application of these policies involves taking choices out of the domain of shared decision-making, they face (...) important ethical and legal problems, including a recent challenge to their constitutionality. In light of these concerns, we suggest a re-conceptualization of informed non-dissent as an alternative approach in cases where the application of process-based policies is being considered. This clinician-directed communication model still preserves what is valuable in such policies and salvages professional integrity, while minimising ethical and legal challenges. (shrink)

The use of decision-making capacity assessments in clinical medicine is an underdeveloped yet quickly growing practice. Despite the ethical and clinical importance of these assessments as a means of protecting patient autonomy, clinicians, philosophers, and ethicists have identified a number of practical and theoretical hurdles which remain unresolved. One ethically important yet largely unaddressed issue is whether, and to what extent physicians ought to inform and obtain consent from patients prior to initiating a capacity assessment. In what follows, I address (...) the following question: Must, or should, physicians obtain consent for capacity assessments? I argue that physicians have an ethical obligation to obtain express patient consent for capacity assessments, and in doing so, I challenge the predominant view which requires physicians to merely inform patients without obtaining consent. I then identify an underlying philosophical paradox that complicates the clinician's duty to obtain consent: in short, consent is needed for an assessment of one's ability to consent. Finally, I recommend a practical solution to this paradox of consent for capacity assessments by proposing a model of double consent from both the patient and health care representative. (shrink)

In this paper I will provide a hylomorphic critique of Jeff McMahan’s “An Alternative to Brain Death.” I will evaluate three puzzles—the dicephalus, the braintransplant, and the split-brain phenomenon—proposed by McMahan which allow him to deny that a human being is identical to an organism. I will contend thatMcMahan’s solution entails counterintuitive consequences that pose problems to organ transplant cases. A Thomistic hylomorphic metaphysics not only avoids these unwelcome consequences and provides solutions to the three puzzles but in doing so (...) allows for an alternative definition of death. Since McMahan has constructed his definition of death around his own metaphysics, alternative metaphysics, in this case a hylomorphic metaphysics, allow for an alternative definition of death. (shrink)

We propose a definition of capability as a class intermediate between function and disposition as the latter are defined in Basic Formal Ontology (BFO). A disposition inheres in a material entity and is realized in a certain kind of process. An example is the disposition of a glass to break when struck, which is realized when it shatters. A function is a disposition which is (simply put) the rationale for the existence of its bearer. To say for example that a (...) water pump has the function to pump water is to say that the pump exists because something was needed that would pump water. Capabilities are a special sort of disposition in that that, like functions, they can be evaluated on the basis of how well they are realized. They differ from functions in that their realizations are not the rationale – not the primary reason – for the existence of their bearers. Thus, a water pump may have many capabilities, including to be weatherproof, to run without lubricant, and so forth, but only one function. All functions are capabilities on the view we defend, but not all capabilities are functions. We develop a series of axioms to distinguish capabilities formally from both dispositions and functions and provide examples of the use of ‘capability’ in a variety of domains. (shrink)

When governments collect data relating to economic activity they commonly employ a distinction between goods and services. Both goods and services have economic value. Goods (cars, houses, bottles of milk) are, very roughly, independent continuants which can be alienated (sold, gifted, rented, and so forth). Services (hairdressing, gardening, teaching) are, again very roughly, occurrents. They are occurrents which are further often said to be marked by the fact that production and consumption coincide. Social services under both headings typically involve combinations (...) of service provision. The patterns in question are primarily those of the family (where the patterns to be maintained or restored are, roughly, those characteristic of a healthy family life) and of the child (patterns characteristic of healthy development, provided by child protective services, who work to prevent child abuse). (shrink)

In this paper I will provide a hylomorphic critique of Jeff McMahan’s “An Alternative to Brain Death.” I will evaluate three puzzles—the dicephalus, the braintransplant, and the split-brain phenomenon—proposed by McMahan which allow him to deny that a human being is identical to an organism. I will contend thatMcMahan’s solution entails counterintuitive consequences that pose problems to organ transplant cases. A Thomistic hylomorphic metaphysics not only avoids these unwelcome consequences and provides solutions to the three puzzles but in doing so (...) allows for an alternative definition of death. Since McMahan has constructed his definition of death around his own metaphysics, alternative metaphysics, in this case a hylomorphic metaphysics, allow for an alternative definition of death. (shrink)

In this paper I will provide a hylomorphic critique of Jeff McMahan’s “An Alternative to Brain Death.” I will evaluate three puzzles—the dicephalus, the braintransplant, and the split-brain phenomenon—proposed by McMahan which allow him to deny that a human being is identical to an organism. I will contend thatMcMahan’s solution entails counterintuitive consequences that pose problems to organ transplant cases. A Thomistic hylomorphic metaphysics not only avoids these unwelcome consequences and provides solutions to the three puzzles but in doing so (...) allows for an alternative definition of death. Since McMahan has constructed his definition of death around his own metaphysics, alternative metaphysics, in this case a hylomorphic metaphysics, allow for an alternative definition of death. (shrink)

Contains revised papers from a September 1996 symposium which provided a forum for synchronically and diachronically oriented scholars to exchange ideas and for ...

One might imagine that this remark of James was too obvious to be denied, but in fact current philosophical orthodoxy runs against it. Since the renewal of interest in the emotions produced by Anthony Kenny's Action Emotion and Will in 1963, philosophers have focussed primarily on the cognitive aspects of emotions—the judgments, evaluations, beliefs, presuppositions which they contain. Bodily feelings have been, on the whole, slighted. Sometimes they are dismissed outright, as by Robert Solomon: “feelings no more constitute or define (...) the emotion than an army of fleas constitutes a homeless dog. … Feeling is the ornamentation of emotion, not its essence.”; more often, as in Jerome Neu, given only rather slight attention because “thoughts are of greater importance than feelings in the classification and discrimination of emotional states”. (shrink)

Dieser Sammelband zeigt anhand von Problemen der Lexik und Grammatik romanischer Sprachen sowie der linguistischen Metasprache, daß die onomasiologische und die semasiologische Perspektive in ihrer Komplementarität unabdingbare Bezugspunkte einer sich als 'kognitiv' verstehenden Sprachwissenschaft sein sollten. Mit im Detail unterschiedlicher Perspektivierung werden Fragen der synchronischen und diachronischen Lexikologie und Grammatik diskutiert, ausgewählte Konzept- bzw. Funktionsbereiche im Detail analysiert und Probleme der Grammatikographie und der Konzeptualisierung von Sprache beleuchtet.

Ray splitting is a universal phenomenon that occurs with appreciable amplitude in all wave systems when the properties of the system change on a scale smaller than the wave length. We study the quantum implications of ray splitting theoretically and experimentally with the help of ray-splitting billiards in one and two dimensions. We show that Gutzwiller's trace formula works even in the context of ray-splitting systems provided reflection and transmission of waves at ray-splitting boundaries is properly included.

In “Harmful Choices, the case of C, and decision making competence,” Pickering et al. offer a thought-provoking interpretation of the relationship between harm and capacity assessments by an...

Abstrakt Der vorliegende Artikel befasst sich mit der Theorie des Schönen und der Schönheit im Denken des Johannes Scottus Eriugena, basierend auf seinem Hauptwerk Periphyseon, den ‚Aulae sidereae‘, einem Gedicht Eriugenas, und dem Kommentar zur Schrift ‚Über die himmlische Rangfolge‘ des Pseudo-Dionysius Areopagita. Dazu werden zunächst die metaphysischen Grundlagen für eine Theorie des Schönen im System des Eriugena, wie er sie im s.o. erarbeitet, kurz und prägnant vorgestellt: Für Eriugena ist das Seiende eine Erscheinung und Manifestation Gottes, des unsagbaren Prinzips, (...) des Einen. Danach wird aufgezeigt, wie Eriugena das Schöne als Konkretwerdung des Einen denkt, wobei zuerst die Schönheit der Natur besprochen wird, um dann einen Blick auf den Sonderfall der menschengemachten Kunst zu werfen. Das Ergebnis der Untersuchung ist, dass Eriugena die Kunst als eine reflexive Haltung des Menschen zur Welt und ihrem Ursprung versteht. (shrink)

Originally presented as the author's thesis (doctoral)--Eberhard Karls Universit'at T'ubingen, 2007. Cf. Page 9.

In the continuing debate about the role of the Clinical Ethics Consultant in performing clinical ethics consultations, it is often assumed that consultants should operate within ethical and legal standards. Recent scholarship has focused primarily on clarifying the consultant's role with respect to the ethical standards that serve as parameters of consulting. In the following, however, I wish to address the question of how the ethics consultant should weigh legal standards and, more broadly, how consultants might weigh authoritative directives, whether (...) legal, institutional, or professional, against other normative considerations. I argue that consultants should reject the view that authoritative directives carry exclusionary reason for actions and, further, ethicists should interpret directives as lacking any moral weight qua authoritative directive. I then identify both implications and limitations of this view with respect to the evolving role of the ethics consultant in an institutional setting, and in doing so propose the kinds of considerations the ethicist should weigh when presented with an authoritative directive. (shrink)

Artificial neural networks have weaknesses as models of cognition. A conventional neural network has limitations of computational power. The localist representation is at least equal to its competition. We contend that locally connected neural networks are perfectly capable of storing and retrieving the individual features, but the process of reconstruction must be otherwise explained. We support the localist position but propose a “hybrid” model that can begin to explain cognition in anatomically plausible terms.

Between-subject variability in cognitive performance has been related to inter-individual differences in functional brain networks. Targeting the dorsal attention network we questioned whether resting-state functional connectivity within the DAN can predict individual performance in spatial attention tasks and whether there is short-term adaptation of DAN-FC in response to task engagement. Twenty-seven participants first underwent resting-state fMRI, they subsequently performed different tasks of spatial attention [including visual search ] and immediately afterwards received another rs-fMRI. Intra- and inter-hemispheric FC between core hubs (...) of the DAN, bilateral intraparietal sulcus and frontal eye field, was analyzed and compared between PRE and POST. Furthermore, we investigated rs-fMRI-behavior correlations between the DAN-FC in PRE/POST and task performance parameters. The absolute DAN-FC did not change from PRE to POST. However, different significant rs-fMRI-behavior correlations were revealed for intra-/inter-hemispheric connections in the PRE and POST run. The stronger the FC between left FEF and IPS before task engagement, the better was the learning effect in VS. And the faster the VS, the stronger was the FC between right FEF and IPS after task engagement. To conclude, DAN-FC relates to the individual performance in spatial attention tasks supporting the view of functional brain networks as priors for cognitive ability. Despite a high inter- and intra-individual stability of DAN-FC, the change of FC-behavior correlations after task performance possibly indicates task-related adaptation of the DAN, underlining that behavioral experiences may shape intrinsic brain activity. However, spontaneous state fluctuations of the DAN-FC over time cannot be fully ruled out as an alternative explanation. (shrink)

In so far as the Tao Te Ching and the Chuang Tzu are life-philosophies, they are philosophies of solitude. My aim in the following pages is to explain and defend this claim, clarifying the distinctive kind of solitude that is taught by Lao Tzu and Chuang Tzu.

Source: Author: Eldar Sultanow, Sean Cox, Sebastian Homann, Philipp Koch, Olliver Franke Mass media initiated exhibitions of information and knowledge streams account for a significant factor of opinion-forming in modern digitalized nations and thus influence their country's political development. Within the framework of a globalized environment, this information has the ability to shape worldwide opinion and international policy decisions across geographical boundaries. Similarly, however, information and knowledge that does not flow freely has an impact on the behind the scenes decisions (...) of world affairs. Selective manipulation, consumed through hidden channels, is therefore a powerful tool for shaping both social and organizational environments. Currently no classification approaches exist in order to identify and evaluate this type of manipulation. Therefore, this article will discuss this type of manipulative communication and align each category into an assessment model. Forty-two varieties of manipulative arguments will be identified as well as classified along three-dimensions. A model has been developed which will serve as a tool to identify the degree and at which level manipulation was performed. ]]>. (shrink)