Abstract Context: Established in 1997, Summa Health System’s Medical Ethics Committee (EC) serves as an educational, supportive, and consultative resource to patients/families and providers, and serves to analyze, clarify, and ameliorate dilemmas in clinical care. In 2009 the EC conducted its 100th consult. In 2002 a Palliative Care Consult Service (PCCS) was established to provide supportive services for patients/families facing advanced illness; enhance clinical decision-making during crisis; and improve pain/symptom management. How these services affect one another has thus far been (...) unclear. Objectives: This study describes EC consults: types, reasons, recommendations and utilization, and investigates the impact the PCCS may have on EC consult requests or recommendations. Methods: Retrospective reviews of 100 EC records explored trends and changes in types of consults, reasons for consults, and EC recommendations and utilization. Results: There were 50 EC consults each in the 6 years pre- and post-PCCS. Differences found include: (1) a decrease in number of reasons for consult requests (133–62); (2) changes in top two reasons for EC consult requests from ‘Family opposed to withdrawing life-sustaining treatment (LST)’ and ‘Patient capacity in question’ to ‘Futility’ and ‘Physician opposed to providing LST’; (3) changes in top two recommendations given by the EC from ‘Emotional Support for Patient/Family’ and ‘Initiate DNR Order’ to ‘Comfort Care’ and ‘Withdraw Treatment.’ Overall, 88% of recommendations were followed. Conclusion: PCCS availability and growth throughout the hospital may have influenced EC consult requests. EC consults regarding family opposition to withdrawing LST and EC recommendations for patient/family support declined. Content Type Journal Article Pages 1-16 DOI 10.1007/s10730-011-9170-9 Authors Jessica Richmond Moeller, Department of Psychiatry and Behavioral Sciences, Akron General Medical Center, 400 Wabash Ave, Akron, OH 44307, USA Teresa H. Albanese, Health Services Research and Education Institute, Summa Health System and Northeast Ohio Medical University, 55 Arch St., Suite 1A, Akron, OH 44304, USA Kimberly Garchar, Kent State University, 6000 Frank Ave., N.W, North Canton, OH 44720, USA Julie M. Aultman, Department of Family and Community Medicine, Northeast Ohio Medical University, P.O. Box 95, Rootstown, OH 44272, USA StevenRadwany, Palliative Care and Hospice Services, Summa Health System and Northeast Ohio Medical University, 55 Arch St., Suite 1A, Akron, OH 44304, USA Dean Frate, Internal Medicine, Palliative Care and Hospice Services, Summa Health System and Northeast Ohio Medical University, 55 Arch St., Suite 1A, Akron, OH 44304, USA Journal HEC Forum Online ISSN 1572-8498 Print ISSN 0956-2737. (shrink)
Steven French and Décio Krause have written what bids fair to be, for years to come, the definitive philosophical treatment of the problem of the individuality of elementary particles in quantum mechanics and quantum field theory. The book begins with a long and dense argument for the view that elementary particles are most helpfully regarded as non-individuals, and it concludes with an earnest attempt to develop a formal apparatus for describing such non-individual entities better suited to the task than (...) our customary set theory. Along the way one is treated to a compendious philosophical history of quantum statistics and a well-nigh exhaustive (I’m tempted to say, “exhausting”) analytical history of philosophical responses to the quantum theory’s prima facie challenge to classical notions of particle individuality. The book is also a salvo from the headquarters artillery company of the “pro” side in the contemporary structuralism wars, and an essay in metaphysical naturalism. Whew! There are too many places where the friendly critic wants to engage the argument, and few where the authors have not already anticipated such engagement. I take this as my excuse, then, for offering not any systematic response to the whole project, but just some questions and observations about several points that caught my attention. (shrink)
Aspects of an example of simulated shared subjectivity can be used both to support Steven Lehar's remarks on embodied percipients and to triangulate in a novel way the so-called “hard problem” of consciousness which Lehar wishes to “sidestep,” but which, given his other contentions regarding emergent holism, raises questions about whether he has been able or willing to do so.
CAMBRIDGE, Mass. -- What will English be like a hundred years from now? No one has ever observed what happens when a language is used for a century in a global village. Will MTV and CNN infiltrate every yurt and houseboat and drive out all other languages? Will regional accents go extinct, leaving everyone sounding like a Midwestern newscaster? Some language lovers worry that e-mail and chat rooms will influence writing & F2F (face-to-face) lang. & leadd it 2 loose it's (...) grammer spllng etc. :-(. (shrink)
Should a theory of meaning state what sentences mean, and can a Davidsonian theory of meaning in particular do so? Max Ko¨lbel answers both questions affirmatively. I argue, however, that the phenomena of non-homophony, non-truth-conditional aspects of meaning, semantic mood, and context-sensitivity provide prima facie obstacles for extending Davidsonian truth-theories to yield meaning-stating theorems. Assessing some natural moves in reply requires a more fully developed conception of the task of such theories than Ko¨lbel provides. A more developed conception is also (...) required to defend his positive answer to the first question above. I argue that, however Ko¨lbel might elaborate his position, it can’t be by embracing the sort of cognitivist account of Davidsonian semantics to which he sometimes alludes. (shrink)
Steven Pinker's How the mind works (HTMW) marks in my opinion an historic point in the history of humankind's attempt to understand itself. Socrates delivered his "know thyself" imperative rather long ago, and now, finally, in this behemoth of a book, published at the dawn of a new millennium, Pinker steps up to have psychology tell us what we are: computers crafted by evolution - end of story; mystery solved; and the poor philosophers, having never managed to obey Socrates' (...) command, are left alone to wander in the labyrinth of their benighted speculation forever. Unfortunately, though HTMW is to this point the crowning attempt of psychology to make systematic sense of persons by integrating everything relevant science knows, the book fails - and it fails so fundamentally and irremediably that we would do well to wonder anew whether we should supplant the basic view it promotes with what I call the super-mind hypothesis: the view that though mere animals are evolved computers, persons are more. (shrink)
The significance of historical advances in human development has been widely debated within cognitive science. Steven Mithen's recent book, The prehistory of mind (London: Thames & Hudson, 1996), presents an archeologist's attempt to explain the details of cognitive development within the framework of modern anthropology and cognitive psychology. We argue that Mithen's attempt fails for a number of different reasons. The relationship between the archeological evidence he considers and his conclusions is problematic. We maintain that it is difficult to (...) draw biological conclusions from strictly behavioral artifactual evidence. To buttress his claims, Mithen borrows heavily from the very cognitive science literature to which he hopes to contribute. As a consequence, his analysis of the archeological evidence cannot promote a particular cognitive theory, since his interpretation is only as strong as those theories from which he borrows. We are also concerned that the specific details of Mithen's program are equally problematic. Mithen's claim that modular intelligences did not exist outside of hominid evolution is likely false and unwarranted. As a consequence, we argue that the central component of his claim that the uniquely human feature of our development, the move from modular to fluid minds, depends on poorly defined distinctions between a wide range of mental processes. Whether we can accept Mithen's characterization of these claims will depend, we argue, on how he chooses to clarify these terms. We suggest that the various choices will be difficult to reconcile with his theory. Moreover, we suggest that the phenomena that Mithen hopes to explain in human development cannot be explained strictly in terms of analogical reasoning. We nevertheless find Mithen's attempt at answering these questions to be both a constructive and fascinating foray into what is an under-explored topic. (shrink)
A review of Steven Shaviro´s Without Criteria: Kant, Whitehead, Deleuze, and Aesthetics (Cambridge, MA: MIT Press, 2009, xvi + 174 pp. ISBN 978-0-262-19576-8).
Lifelines by Steven Rose is supposed to present a new perspective on biology replacing an emphasis on genes with one on organisms. However, much of the book is a highly biased critique of sociobiology and behavior genetics. Some of the flaws in Rose's description and depiction of these fields are presented and refuted. Also, it would appear that these aspects of the book and many others are, in fact, related more to Rose's perennial concern for the ideology, social origins (...) or social consequences of behavioral biology. These concerns are, I believe based, in part, upon Rose's misunderstandings and misinterpretations of genetics, behavior genetics, and sociobiology. (shrink)
According to Steven Pinker and his associates the cooperative model of human communication fails, because evolutionary biology teaches us that most social relationships, including talk-exchange, involve combinations of cooperation and conflict. In particular, the phenomenon of the strategic speaker who uses indirect speech in order to be able to deny what he meant by a speech act (deniability of conversational implicatures) challenges the model. In reply I point out that interlocutors can aim at understanding each other (cooperation), while being (...) in conflict. Furthermore, Pinker’s strategic speaker relies on the Cooperative Principle when conveying a conversational implicature, and so non-cooperative behaviour (denial) only emerges as a response to a negative reaction from the audience. It is also doubtful in the cases Pinker presents whether a denial will successfully cancel the conversational implicature –change the audience’s interpretation of speaker’s meaning. I also argue that a strategic speaker might choose indirect speech due to the ignorability of conversational implicatures, in which case the strategic speaker can be highly cooperative. (shrink)
According to Steven Pinker and his associates the cooperative model of human communication fails, because evolutionary biology teaches us that most social relationships, including talk-exchange, involve combinations of cooperation and conflict. In particular, the phenomenon of the strategic speaker who uses indirect speech in order to be able to deny what he meant by a speech act (deniability of conversational implicatures) challenges the model. In reply I point out that interlocutors can aim at understanding each other (cooperation), while being (...) in conflict. Furthermore, Pinker’s strategic speaker relies on the Cooperative Principle when conveying a conversational implicature, and so non-cooperative behaviour (denial) only emerges as a response to a negative reaction from the audience. It is also doubtful in the cases Pinker presents whether a denial will successfully cancel the conversational implicature –change the audience’s interpretation of speaker’s meaning. I also argue that a strategic speaker might choose indirect speech due to the ignorability of conversational implicatures, in which case the strategic speaker can be highly cooperative. (shrink)
Steven Hales constructs a novel argument against the possibility of presentist time travel called the suicide machine argument. Hales argues that if presentism were true, then time travel would result in the annihilation of the time traveler. But such a consequence is not time travel, therefore presentism cannot allow for the possibility of time travel. This paper argues that in order for the suicide machine argument to succeed, it must make (at least) one of two assumptions, each of which (...) beg the question. The argument must either assume that the sequence of moments is invariant, or that time travel requires distinct, co-instantiated moments. Because the former disjunct assumes that presentist time travel is impossible and the latter assumes that presentism is impossible, the suicide machine argument fails. (shrink)
