An informed consent and voluntary assent in biomedical research with adolescents is contingent on a variety of factors, including adolescent and parent perceptions of research risk, benefit, and decision-making autonomy. Thirty-seven adolescents with asthma and their parents evaluated a high or low aversion form of a pediatric asthma research vignette and provided an enrollment decision; their perceptions of family influence over the participation decision; and evaluations of risk, aversion, benefit, and burden of study procedures. Adolescents and their parents agreed on (...) research participation decisions 74% of the time, yet both claimed ultimate responsibility for the participation decision. Both rated most study procedures as significantly more aversive than risky. Parents were more likely to rate aspects of the hypothetical study as beneficial and to provide higher risk ratings for procedures. Disagreements concerning research participation decisions and decision-making autonomy have implications for the exercise of voluntary assent in biomedical research. (shrink)

This issue investigates the meaning of photographic image for contemporary art. In Malraux' dream, photography offers the ultimate guarantee for a coherent presentation of art. However, as Douglas Crimp has stated, the appearance and enhancement of photography as a form of art among other art forms disrupted the center of the art world. What does this mean for art and philosophy in our time? Various artists and theorists will delve into that question: Christian Boltanski, Benjamin H.D. Buchloh, Jean-François Chevrier, Douglas (...) Crimp, Jos de Mul, Mirjam de Zeeuw, Rineke Dijkstra, Michael Gibbs, Rodney Graham, Gerald van der Kaap, Karen Knorr, Zoe Leonard, Ken Lum, Hermann Pitz, Liza-May Post, John Roberts, Allan Sekula, Andres Serrano, Jan Simons, Beat Streuli, John M. Swinnen, Renée van de Vall, Hilde van Gelder, Hripsimé Visser, Jeff Wall, Ian Wallace and Herta Wolf. (shrink)

In the first argumentative section of Book 1, Lucretius establishes the existence of matter and void , and in the second identifies matter as the atoms and defines their properties . In the third section, following Epicurean tradition, he attempts to refute a representative selection of Presocratic philosophers – Heraclitus , Empedocles and Anaxagoras – whose explanations of basic matter are potential rivals to the atomist theory which he has just outlined. The climax to this section is reached in Lucretius' (...) triumphant personal claim to be an original poet and health-bringing purveyor of truth . His foregoing criticism of the Presocratics as writers and thinkers is deeply coloured by the values he openly professes here. The introductory passages to each philosopher, in particular, are highly revealing of Lucretius' personal inclinations as a poet and exhibit a virtuoso command of several styles and techniques. (shrink)

_A moving meditation on recent geopolitical crises, viewed through the lens of ancient and modern tragedy__ “Spare, elegant and poignant.... If there is a single contemporary book that should be pressed into the hands of those who decide issues of war and peace, this is it.”—John Gray, _New Statesman_ “It is tragic that Robert D. Kaplan’s luminous _The Tragic Mind_ is so urgently needed.”—George F. Will_ Some books emerge from a lifetime of hard-won knowledge. Robert D. Kaplan has (...) learned, from a career spent reporting on wars, revolutions, and international politics in Europe, the Middle East, and East Asia, that the essence of geopolitics is tragedy. In _The Tragic Mind_, he employs the works of ancient Greek dramatists, Shakespeare, German philosophers, and the modern classics to explore the central subjects of international politics: order, disorder, rebellion, ambition, loyalty to family and state, violence, and the mistakes of power. The great dilemmas of international politics, he argues, are not posed by good versus evil—a clear and easy choice—but by contests of good versus good, where the choices are often searing, incompatible, and fraught with consequences. A deeply learned and deeply felt meditation on the importance of lived experience in conducting international relations, this is a book for everyone who wants a profound understanding of the tragic politics of our time. (shrink)

The Covid-19 pandemic has led to severe shortages of many essential goods and services, from hand sanitizers and N-95 masks to ICU beds and ventilators. Although rationing is not unprecedented, never before has the American public been faced with the prospect of having to ration medical goods and services on this scale.

The purpose of Plato’s investigation of justice in the ideal polis of the Republic is neither to formulate an abstract conception of justice in itself nor to work out a blueprint for the perfectly just state. Rather, through the contemplation of an ideal social/political order where justice might be found “writ large,” Plato intends to bring about the actualization of justice in the “polity” of the individual soul. It must be kept in mind, of course, that, while possessing a notion (...) of the individual, the Greeks lacked our modern, Cartesian conception of subjectivity, burdened as it is with the existential task of creating and sustaining a meaningful cosmos. But precisely for this reason the ancients had a clearer perspective of the synergistic and mutually determinative dialectic that conjoins the individual and the state, a conjunction grounded in the ethical. This can be seen, Hegel suggests, in terms of the “unwritten and infallible law” that Antigone takes to be the “law of the gods” which “is right because it is what is right,” placing the individual “within the ethical substance; and this substance is thus the essence of self-consciousness.”. (shrink)

Despite its familiarity and widespread acceptance, the concept of “brain death” remains incoherent in theory and confused in practice. Moreover, the only purpose served by the concept is to facilitate the procurement of transplantable organs. By abandoning the concept of brain death and adopting different criteria for organ procurement, we may be able to increase both the supply of transplantable organs and clarity in our understanding of death.

Robert Rupert argues against the view that human cognitive processes comprise elements beyond the boundary of the organism, developing a systems-based conception in place of this extended view. He also argues for a conciliatory understanding of the relation between the computational approach to cognition and the embedded and embodied views.

Stolorow and his collaborators' post-Cartesian psychoanalytic perspective – intersubjective-systems theory – is a phenomenological contextualism that illuminates worlds of emotional experience as they take form within relational contexts. After outlining the evolution and basic ideas of this framework, Stolorow shows both how post-Cartesian psychoanalysis finds enrichment and philosophical support in Heidegger's analysis of human existence, and how Heidegger's existential philosophy, in turn, can be enriched and expanded by an encounter with post-Cartesian psychoanalysis. In doing so, he creates an important psychological (...) bridge between post-Cartesian psychoanalysis and existential philosophy in the phenomenology of emotional trauma. (shrink)

We seek to change the conversation about brain death by highlighting the distinction between brain death as a biological concept versus brain death as a legal status. The fact that brain death does not cohere with any biologically plausible definition of death has been known for decades. Nevertheless, this fact has not threatened the acceptance of brain death as a legal status that permits individuals to be treated as if they are dead. The similarities between “legally dead” and “legally blind” (...) demonstrate how we may legitimately choose bright-line legal definitions that do not cohere with biological reality. Not only does this distinction bring conceptual coherence to the conversation about brain death, but it has practical implications as well. Once brain death is recognized as a social construction not grounded in biological reality, we create the possibility of changing the social construction in ways that may better serve both organ donors and recipients alike. (shrink)

Trauma and Human Existence effectively interweaves two themes central to emotional trauma--the first pertains to the contextuality of emotional life in general, and of the experience of emotional trauma in particular, and the second pertains to the recognition that the possibility of emotional trauma is built into the basic constitution of human existence. This volume traces how both themes interconnect, largely as they crystallize in the author’s personal experience of traumatic loss. As discussed in the book's final chapter, whether or (...) not this constitutive possibility will be brought lastingly into the foreground of our experiential world depends on the relational contexts in which we live. (shrink)

Savulescu and colleagues have provided interesting insights into how the UK public view the ‘best interests’ of children like Charlie Gard. But is best interests the right standard for evaluating these types of cases? In the USA, both clinical decisions and legal judgments tend to follow the ‘harm principle’, which holds that parental choices for their children should prevail unless their decisions subject the child to avoidable harm. The case of Charlie Gard, and others like it, show how the USA (...) and the UK have strikingly different approaches for making decisions about the treatment of severely disabled children. (shrink)

The concept of brain death was recently described as being “at once well settled and persistently unresolved.” Every day, in the United States and around the world, physicians diagnose patients as brain dead, and then proceed to transplant organs from these patients into others in need. Yet as well settled as this practice has become, brain death continues to be the focus of controversy, with two journals in bioethics dedicating major sections to the topic within the last two years.By way (...) of background, the Uniform Determination of Death Act states that “[a]n individual who has sustained either: irreversible cessation of circulatory and respiratory functions, or irreversible cessation of all functions of the entire brain, including the brain stem, is dead. A determination of death must be made in accordance with accepted medical standards.” In other words, death can be defined by either cardiorespiratory or neurological criteria, with “brain death” representing the loss of all brain function. This standard, or closely related variants, has become the accepted approach throughout the United States and in many parts of the world. (shrink)

Causal theories of mental content (CTs) ground certain aspects of a concept's meaning in the causal relations a concept bears to what it represents. Section 1 explains the problems CTs are meant to solve and introduces terminology commonly used to discuss these problems. Section 2 specifies criteria that any acceptable CT must satisfy. Sections 3, 4, and 5 critically survey various CTs, including those proposed by Fred Dretske, Jerry Fodor, Ruth Garrett Millikan, David Papineau, Dennis Stampe, Dan Ryder, and the (...) author himself. The final section considers general objections to the causal approach. (shrink)

The recent literature on mental causation has not been kind to nonreductive, materialist functionalism (‘functionalism’, hereafter, except where that term is otherwise qualified). The exclusion problem2 has done much of the damage, but the epiphenomenalist threat has taken other forms. Functionalism also faces what I will call the ‘problem of metaphysically necessary effects’ (Block, 1990, pp. 157-60, Antony and Levine, 1997, pp. 91-92, Pereboom, 2002, p. 515, Millikan, 1999, p. 47, Jackson, 1998, pp. 660-61). Functionalist mental properties are individuated partly (...) by their relation to the very effects those properties’ instantiations are thought to cause. Consequently, functionalist causal generalizations would seem to have the following problematical structure: The state of being, among other things, a cause of e (under such-andsuch conditions) causes e (under those conditions).3 The connection asserted lacks the contingency one would expect of a causal generalization. Mental states of the kind in question are, by metaphysical necessity, causes of e; any state that does not cause e is thereby a different kind of state. Yet, a mental state’s being the sort of state it is must play some causal role if functionalism is to account for mental causation.4 In what follows, I first articulate more fully the problem of metaphysically necessary effects. I then criticize three functionalist attempts to solve the problem directly. Given the failure of functionalist efforts to meet the problem head-on, I consider less direct strategies: these involve formulating functionalism or its causal claims in such a way that they appear not to generate the problem of metaphysically necessary effects. I argue against these indirect solutions, in each case concluding either that the problem still arises or that avoiding it requires the adoption of an unorthodox form of functionalism (itself a surprising result). In the final.. (shrink)

Over the past several decades, medical ethics has gained a solid foothold in medical education and is now a required course in most medical schools. Although the field of medical ethics is by nature eclectic, moral philosophy has played a dominant role in defining both the content of what is taught and the methodology for reasoning about ethical dilemmas. Most educators largely rely on the case‐based method for teaching ethics, grounding the ethical reasoning in an amalgam of theories drawn from (...) moral philosophy, including consequentialism, deontology, and principlism.In this article we hope to make a case for augmenting the focus of education in medical ethics. We propose complementing the traditional approach to medical ethics with a more embedded approach, one that has been described by others as “microethics,” the ethics of everyday clinical practice. (shrink)

forthcoming in R. Menary (ed.), The Extended Mind.

This essay joins Wilhelm Dilthey’s conception of the metaphysical impulse as a flight from the tragedy of human finitude with Ludwig Wittgenstein’s understanding of how language bewitches intelligence. We contend that there are features of the phenomenology of language that play a constitutive and pervasive role in the formation of metaphysical illusion.

This special report is published in commemoration of the fiftieth anniversary of the “Report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death,” a landmark document that proposed a new way to define death, with implications that advanced the field of organ transplantation. This remarkable success notwithstanding, the concept has raised lasting questions about what it means to be dead. Is death defined in terms of the biological failure of the organism to (...) maintain integrated functioning? Can death be declared on the basis of severe neurological injury even when biological functions remain intact? Is death essentially a social construct that can be defined in different ways, based on human judgment? These issues, and more, are discussed and debated in this report by leading experts in the field, many of whom have been engaged with this topic for decades. (shrink)

Jahi McMath's case has raised challenging uncertainties about one of the most profound existential questions that we can ask: how do we know whether someone is alive or dead? The case is striking in at least two ways. First, how can it be that a person diagnosed as dead by qualified physicians continued to live, at least in a biological sense, more than four years after a death certificate was issued? Second, the diagnosis of brain death has been considered irreversible; (...) in fact, there has never been a case of a person correctly diagnosed as brain‐dead who improved to the point that the person no longer fulfilled the diagnostic criteria. If the neurologist Alan Shewmon is correct that, prior to her cardiac arrest in June 2018, McMath no longer met the criteria for brain death and was actually in a minimally conscious state, this case could have momentous implications for how we think about this diagnosis going forward. In this essay, I will offer a hypothesis that could, perhaps, explain both these aspects of the case. The hypothesis is based on differences in how we distinguish between biological and legal categories. The law tends to prefer to draw bright‐line distinctions between categories, whereas biological categories tend to fall along a spectrum, without sharp distinctions. (shrink)

Recent debates over adults' theory of mind use have been fueled by surprising failures of perspective-taking in communication, suggesting that perspective-taking may be relatively effortful. Yet adults routinely engage in effortful processes when needed. How, then, should speakers and listeners allocate their resources to achieve successful communication? We begin with the observation that the shared goal of communication induces a natural division of labor: The resources one agent chooses to allocate toward perspective-taking should depend on their expectations about the other's (...) allocation. We formalize this idea in a resource-rational model augmenting recent probabilistic weighting accounts with a mechanism for (costly) control over the degree of perspective-taking. In a series of simulations, we first derive an intermediate degree of perspective weighting as an optimal trade-off between expected costs and benefits of perspective-taking. We then present two behavioral experiments testing novel predictions of our model. In Experiment 1, we manipulated the presence or absence of occlusions in a director–matcher task. We found that speakers spontaneously modulated the informativeness of their descriptions to account for “known unknowns” in their partner's private view, reflecting a higher degree of speaker perspective-taking than previously acknowledged. In Experiment 2, we then compared the scripted utterances used by confederates in prior work with those produced in interactions with unscripted directors. We found that confederates were systematically less informative than listeners would initially expect given the presence of occlusions, but listeners used violations to adaptively make fewer errors over time. Taken together, our work suggests that people are not simply “mindblind”; they use contextually appropriate expectations to navigate the division of labor with their partner. We discuss how a resource-rational framework may provide a more deeply explanatory foundation for understanding flexible perspective-taking under processing constraints. (shrink)

This paper engages critically with anti-representationalist arguments pressed by prominent enactivists and their allies. The arguments in question are meant to show that the “as-such” and “job-description” problems constitute insurmountable challenges to causal-informational theories of mental content. In response to these challenges, a positive account of what makes a physical or computational structure a mental representation is proposed; the positive account is inspired partly by Dretske’s views about content and partly by the role of mental representations in contemporary cognitive scientific (...) modeling. (shrink)

Historically, the practice of medicine has been a physically intimate endeavor. Physicians have used their hands to palpate and reveal the secrets hidden within the body. Smelling the breath for the ketosis of diabetes or tasting the skin for the saltiness of cystic fibrosis were among the physician's essential practices. Today, perhaps the most defining characteristic of a brilliant clinician is the ability to synthesize many images—from electrocardiograms, ultrasounds, CT scans, and so forth—into a coherent picture that can guide our (...) diagnosis and treatment. Yet this is rapidly becoming a Sisyphean task. Just as we are about to drown in a deluge of data, AI is throwing us a life preserver, to save not only our patients but ourselves. But where will AI take us? (shrink)

Ethik-Komitees gehören zum festen Bestandteil des Ethikmanagements und der Organisationsethik in klinischen Einrichtungen des Gesundheitswesens. Entsprechende Ethikstrukturen und die damit verbundenen Angebote stoßen hinsichtlich ihrer Wirksamkeit allerdings an ihre Grenzen. Ihre Arbeitsweisen sind häufig reaktiv und eine Verankerung in den entsprechenden Organisationsebenen fehlt. Ausgehend von diesen Limitationen der klinischen Ethikberatung hat sich die multiprofessionelle „Arbeitsgruppe Ethik“ am Universitätsklinikum Tübingen um die Konzeption und Implementierung eines neuen Ansatzes zur nachhaltigen Integration von ethischen Reflexions- und Entscheidungsprozessen auf den Stationen des UKT bemüht. (...) Mit dem Tübinger Modell der Ethikbeauftragten der Station verfolgt sie ein Pilotprojekt, das speziell geschulte Pflegekräfte aus allen Stationen des UKT als AnsprechpartnerInnen für ethische Fragen einsetzt. Damit stellen die Ethikbeauftragten eine Erweiterung zu etablierten Strukturen der Ethikberatung dar und ergänzen vorhandene Top-Down-Strategien. Der vorliegende Beitrag stellt die Zielsetzungen des Tübinger Modells dar und schildert erste Erfahrungen in der Umsetzung. Neben der Einbettung in organisationale Strukturen der Ethikberatung werden die stationsinternen und stationsübergreifenden Aufgaben der Ethikbeauftragten dargestellt. Zudem wird das Qualifikationsprogramm für Ethikbeauftragte sowie ein Train-the-Trainer-Konzept vorgestellt, welche eine vertiefende Entwicklung von pflege- und medizinethischer Kompetenzen unterstützen und Sicherheit in den stationsbezogenen Reflexions- und Entscheidungsprozessen vermitteln. (shrink)

Summary of claims: (1) One of the most important relationships between the ontical and the ontological in Heidegger’s thought is the central, ontologically revelatory role that he gives to moods. (2) Heidegger uses the word “mood” as a term of art to refer to the whole range of disclosive affectivity. (3) Because of the role that Heidegger grants to mood as a primordial way of disclosing Being-in-the-world, and because it is impossible to think mood without also thinking the lived body, (...) Heidegger has placed the latter at the center of Dasein’s disclosedness. (4) Heidegger’s account of mood thus entails and highlights, rather than neglects, the ontological significance of the body. (shrink)

In her landmark book, Language, Thought, and Other Biological Categories (Millikan1984),1 Ruth Garrett Millikan utilizes the idea of a biological function to solve philosophical problems associated with the phenomena of language, thought, and meaning. Language and thought are activities of biological organisms, according to Millikan, and we should treat them as such when trying to answer related philosophical questions. Of special interest is Millikan’s treatment of intentionality. Here Millikan employs the notion of a biological function to explain what it is (...) for one thing in nature, a bee dance (43), for example, to be about another, in this case, the location of a nectar source. My concern in this paper is to understand whether Millikan’s account of intentionality adequately explains how humans achieve reference, in language or thought, to individuals and groups in their environment. In bringing her theory of intentional content to bear on human activities, Millikan focuses largely on natural language. Thus, in what follows, I begin by laying out the biology-based principles that underlie Millikan’s theory of content, then proceed with an explanation of how the theory is to apply to natural language. As it appears, Millikan’s account of how content is determined for natural language terms and sentences rests on the determinacy of intentional content at the psychological level. This leads me to take a careful look at what Millikan says about the content of mental representations, in hopes of finding a sufficient basis there for the application of Millikan’s theory of content to natural language. Ultimately, I conclude that Millikan’s theory faces a problem of vacuity. If we approach the theory as a theory of intentional content, intended to explain the nature of reference, the theory is lacking in an extremely important respect: Millikan explains how it could be one of the biological functions of a mental or natural language term to refer, without telling us precisely what in the natural order constitutes the reference relation.. (shrink)

Laws of nature seem to take two forms. Fundamental physics discovers laws that hold without exception, ‘strict laws’, as they are sometimes called; even if some laws of fundamental physics are irreducibly probabilistic, the probabilistic relation is thought not to waver. In the nonfundamental, or special, sciences, matters differ. Laws of such sciences as psychology and economics hold only ceteris paribus – that is, when other things are equal. Sometimes events accord with these ceteris paribus laws (c.p. laws, hereafter), but (...) sometimes the laws are not manifest, as if they have somehow been placed in abeyance: the regular relation indicative of natural law can fail in circumstances where an analogous outcome would effectively refute the assertion of strict law. Many authors have questioned the supposed distinction between strict laws and c.p. laws. The brief against it comprises various considerations: from the complaint that c.p. clauses are void of meaning to the claim that, although understood well enough, they should appear in all law-statements. These two concerns, among others, are addressed in due course, but first, I venture a positive proposal. I contend that there is an important contrast between strict laws and c.p. laws, one that rests on an independent distinction between combinatorial and noncombinatorial nomic principles.2 Instantiations of certain properties, e.g., mass and charge, nomically produce individual forces, or more generally, causal influences,3 in accordance with noncombinatorial.. (shrink)