Abstract:Respect for persons protects patients regarding their own healthcare decisions. Patient informed choice for altruism (PICA) is a proposed means for a fully autonomous patient with decisionmaking capacity to limit his or her own treatment for altruistic reasons. An altruistic decision could bond the patient with others at the end of life. We contend that PICA can also be an advance directive option. The proxy, family, and physicians must be reminded that a patient’s altruistic treatment refusal should be respected.

There is a wind of change about to affect the training of all house officers in the United States. The Accreditation Council of Graduate Medical Education has promulgated a set of general competencies for all U.S.-trained residents, with a major thrust focused on bioethics and professionalism that will likely catch residency directors unaware. The ACGME's General Competencies document globally addresses many relationship-based ethical roles and responsibilities of house officers in healthcare. Of note, this document contains a specific section on professionalism. (...) However, the entire document is woven with a sustained thread of medical ethics throughout its other sections. The intent is to imbue each physician with those skills, rules, and aspects of character that will be a foundation for humane, ethical, professional conduct. Professionalism does indeed go beyond ethical principles, accounting for competency and commitment to excellence and, most of all, implying a virtue ethics account of medical practice. The need to address the central place of virtue ethics in house-staff education is apparent, and we now have the right tool for the job—the ACGME General Competencies. (shrink)

The physician-patient relationship has changed over the last several decades, requiring a systematic reevaluation of the competing demands of patients, physicians, and families. In the era of genetic testing, using a model of patient care known as the family covenant may prove effective in accounting for these demands. The family covenant articulates the roles of the physician, patient, and the family prior to genetic testing, as the participants consensually define them. The initial agreement defines the boundaries of autonomy and benefit (...) for all participating family members. The physician may then serve as a facilitator in the relationship, working with all parties in resolving potential conflicts regarding genetic information. The family covenant promotes a fuller discussion of the competing ethical claims that may come to bear after genetic test results are received. (shrink)

The emergence of the ethics consultation as a means to resolve moral crises in clinical medicine has revealed the need for a worksheet that would facilitate intake and analysis. The author developed the Bioethics Consultation Form as an attempt to remedy this need. The form is arranged in an outline format and is a useful asset to ethics committee discussions and record keeping. The first section covers basic intake data concerning the patient's medical and personal information, advance directives, and values, (...) as well as the values of the physician and family. After the intake section is completed with the above data, the ethics consultant then turns to the analysis section. This second section allows for (1) the discussion of conflicting values, (2) the identification of priorities, and (3) the elucidation of ethical norms relevant to the case.The Bioethics Consultation Form was adopted by the Patient Care Advisory committee of the Franklin Square Hospital Center in Baltimore, Maryland in 1986. The methodology in the use of the form will be discussed. Further, the potential spectrum of consultative cases that can be analyzed using the form will be highlighted. (shrink)

Physicians and families need to interact more meaningfully to clarify the values and preferences at stake in advance care planning. The current use of advance directives fails to respect patient autonomy. This paper proposes using the family covenant as a preventive ethics process designed to improve end-of-life planning by incorporating other family members—as agreed to by the patient and those family members—into the medical care dialogue. The family covenant formulates advance directives in conversation with family members and with the assistance (...) of a physician, thereby making advance directives more acceptable to the family, and more intelligible to other physicians. It adds the moral force of a promise to the obligation of respecting a patient’s preferences about end-of-life care. These negotiations between patient, family, and physician, from early planning phases through implementation, should greatly reduce the incidence of family disagreements on what the patient would have wanted. The family covenant ensures advance directive discussions within the family, promotes and respects the autonomy of other family members, and might even spur others in the family to complete advance directives through additional covenants. The family covenant holds the potential to transform moral quagmires into meaningful moral conversation. J Am Geriatr Soc 51:1155–1158, 2003. (shrink)

The development of the Values History instrument for use in advance directive decision making has raised the question of the importance of values in eliciting advance directives. This pilot study examines the relationship between the domains of values and advance directives drawn from the Values History in three generation intrafamily triads. Significant correlations between values and advance directives were found primarily within the youngest generation. Results reveal a relatively high familiarity by the participants of the various established forms of advance (...) directives. Also, a significant percentage of parents and grand- parents was found to have signed some form of advance directive. (shrink)

While I concur that the conclusions reached in the target article by Burger and Kass (2009) in this issue are essentially on target, the authors glossed over an important consideration in ethics an...

What is consciousness? How does the subjective character of consciousness fit into an objective world? How can there be a science of consciousness? In this sequel to his groundbreaking and controversial The Conscious Mind, David Chalmers develops a unified framework that addresses these questions and many others. Starting with a statement of the "hard problem" of consciousness, Chalmers builds a positive framework for the science of consciousness and a nonreductive vision of the metaphysics of consciousness. He replies to many (...) critics of The Conscious Mind, and then develops a positive theory in new directions. The book includes original accounts of how we think and know about consciousness, of the unity of consciousness, and of how consciousness relates to the external world. Along the way, Chalmers develops many provocative ideas: the " consciousness meter", the Garden of Eden as a model of perceptual experience, and The Matrix as a guide to the deepest philosophical problems about consciousness and the external world. This book will be required reading for anyone interested in the problems of mind, brain, consciousness, and reality. (shrink)

Advance directives are useful ways to express one's wishes about end of life care, but even now most people have not completed one of the documents. David Doukas and William Reichel strongly encourage planning for end of life care. Although Planning for Uncertainty is at times fairly abstract for the general reader, it does provide useful background and practical steps.

Inspired by Rudolf Carnap's Der Logische Aufbau Der Welt, David J. Chalmers argues that the world can be constructed from a few basic elements. He develops a scrutability thesis saying that all truths about the world can be derived from basic truths and ideal reasoning. This thesis leads to many philosophical consequences: a broadly Fregean approach to meaning, an internalist approach to the contents of thought, and a reply to W. V. Quine's arguments against the analytic and the a (...) priori. Chalmers also uses scrutability to analyze the unity of science, to defend a conceptual approach to metaphysics, and to mount a structuralist response to skepticism. Based on the 2010 John Locke lectures, Constructing the World opens up debate on central philosophical issues involving language, consciousness, knowledge, and reality. This major work by a leading philosopher will appeal to philosophers in all areas. This entry contains uncorrected proofs of front matter, chapter 1, and first excursus. (shrink)

What is the mind? Is consciousness a process in the brain? How do our minds represent the world? Philosophy of Mind: Classical and Contemporary Readings is a grand tour of writings on these and other perplexing questions about the nature of the mind. The most comprehensive collection of its kind, the book includes sixty-three selections that range from the classical contributions of Descartes to the leading edge of contemporary debates. Extensive sections cover foundational issues, the nature of consciousness, and the (...) nature of mental content. Three of the selections are published here for the first time, while many other articles have been revised especially for this volume. Each section opens with an introduction by the editor. Philosophy of Mind is suitable for students at all levels and also for general readers. (shrink)

The hypothesis that belief aims at the truth has been used to explain three features of belief: (1) the fact that correct beliefs are true beliefs, (2) the fact that rational beliefs are supported by the evidence and (3) the fact that we cannot form beliefs.

I examine some problems standing in the way of a successful `field interpretation' of quantum field theory. The most popular extant proposal depends on the Hilbert space of `wavefunctionals.' But since wavefunctional space is unitarily equivalent to many-particle Fock space, two of the most powerful arguments against particle interpretations also undermine this form of field interpretation. IntroductionField Interpretations and Field OperatorsThe Wavefunctional InterpretationFields and Inequivalent Representations 4.1. The Rindler representation 4.2. Spontaneous symmetry breaking 4.3. Coherent representations The Fate of Fields (...) in Interacting QFTConclusions. (shrink)

According to comparativist theories of quantities, their intrinsic values are not fundamental. Instead, all the quantity facts are grounded in scale-independent relations like "twice as massive as" or "more massive than." I show that this sort of scale independence is best understood as a sort of metaphysical symmetry--a principle about which transformations of the non-fundamental ontology leave the fundamental ontology unchanged. Determinism--a core scientific concept easily formulated in absolutist terms--is more difficult for the comparativist to define. After settling on the (...) most plausible comparativist understanding of determinism, I offer some examples of physical systems that the comparativist must count as indeterministic although the relevant physical theory gives deterministic predictions. Several morals are drawn. In particular: comparativism is metaphysically contingent if true, and it is most natural for a comparativist to accept an at-at theory of motion. (shrink)

The widely held picture of dynamical symmetry as surplus structure in a physical theory has many metaphysical applications. Here, I focus on its relevance to the question of which quantities in a theory represent fundamental natural properties.

Eleanor Knox has argued that our concept of spacetime applies to whichever structure plays a certain functional role in the laws (the role of determining local inertial structure). I raise two complications for this approach. First, our spacetime concept seems to have the structure of a cluster concept, which means that Knox's inertial criteria for spacetime cannot succeed with complete generality. Second, the notion of metaphysical fundamentality may feature in the spacetime concept, in which case spacetime functionalism may be uninformative (...) in the absence of answers to fundamental metaphysical questions like the substantivalist/relationist debate. (shrink)

The nature of antimatter is examined in the context of algebraic quantum field theory. It is shown that the notion of antimatter is more general than that of antiparticles. Properly speaking, then, antimatter is not matter made up of antiparticles—rather, antiparticles are particles made up of antimatter. We go on to discuss whether the notion of antimatter is itself completely general in quantum field theory. Does the matter–antimatter distinction apply to all field theoretic systems? The answer depends on which of (...) several possible criteria we should impose on the space of physical states. (shrink)

Eleanor Knox has argued that our concept of spacetime applies to whichever structure plays a certain functional role in the laws. I raise two objections to this inertial functionalism. First, it depends on a prior assumption about which coordinate systems defined in a theory are reference frames, and hence on assumptions about which geometric structures are spatiotemporal. This makes Knox’s account circular. Second, her account is vulnerable to several counterexamples, giving the wrong result when applied to topological quantum field theories (...) and parity- and time-asymmetric theories. I advance an alternative account on which our spacetime concept is a cluster concept. On this view, the notion of metaphysical fundamentality may feature in the cluster, in which case spacetime functionalism may be uninformative in the absence of answers to fundamental metaphysical questions like the substantivalist/relationist debate. (shrink)

Eleanor Knox has argued that our concept of spacetime applies to whichever structure plays a certain functional role in the laws. I raise two objections to this inertial functionalism. First, it depends on a prior assumption about which coordinate systems defined in a theory are reference frames, and hence on assumptions about which geometric structures are spatiotemporal. This makes Knox’s account circular. Second, her account is vulnerable to several counterexamples, giving the wrong result when applied to topological quantum field theories (...) and parity- and time-asymmetric theories. I advance an alternative account on which our spacetime concept is a cluster concept. On this view, the notion of metaphysical fundamentality may feature in the cluster, in which case spacetime functionalism may be uninformative in the absence of answers to fundamental metaphysical questions like the substantivalist/relationist debate. (shrink)

The phenomenon of broken spacetime symmetry in the quantum theory of infinite systems forces us to adopt an unorthodox ontology. We must abandon the standard conception of the physical meaning of these symmetries, or else deny the attractive “liberal” notion of which physical quantities are significant. A third option, more attractive but less well understood, is to abandon the existing (Halvorson-Clifton) notion of intertranslatability for quantum theories.

Medical school curricula, although traditionally and historically dominated by science, have generally accepted, appreciated, and welcomed the inclusion of literature over the past several decades. Recent concerns about medical professional formation have led to discussions about the specific role and contribution of literature and stories. In this article, we demonstrate how professionalism and the study of literature can be brought into relationship through critical and interrogative interactions based in the literary skill of close reading. Literature in medicine can question the (...) meaning of “professionalism” itself, thereby resisting standardization in favor of diversity method and of outcome. Literature can also actively engage learners with questions about the human condition, providing a larger context within which to consider professional identity formation. Our fundamental contention is that, within a medical education framework, literature is highly suited to assist learners in questioning conventional thinking and assumptions about various dimensions of professionalism. (shrink)

If we divide our physical theories into theories of matter and theories of spacetime, quantum field theory is our most fundamental empirically successful theory of matter. As such, it has attracted increasing attention from philosophers over the past two decades, beginning to eclipse its predecessor theory of quantum mechanics in the philosophical literature. Here I survey some central philosophical puzzles about the theory's foundations.

It is sometimes claimed that string theory posits a fundamental ontology including extended mereological simples, either in the form of minimum-sized regions of space or of the strings themselves. But there is very little in the actual theory to support this claim, and much that suggests it is false. Extant string theories treat space as a continuum, and strings do not behave like simples.

This paper is devoted to the investigation of term-definable connexive implications in substructural logics with exchange and, on the semantical perspective, in sub-varieties of commutative residuated lattices (FL ${}_{\scriptsize\mbox{e}}$ -algebras). In particular, we inquire into sufficient and necessary conditions under which generalizations of the connexive implication-like operation defined in [6] for Heyting algebras still satisfy connexive theses. It will turn out that, in most cases, connexive principles are equivalent to the equational Glivenko property with respect to Boolean algebras. Furthermore, we (...) provide some philosophical upshots like, e.g., a discussion on the relevance of the above operation in relationship with G. Polya’s logic of plausible inference, and some characterization results on weak and strong connexivity. (shrink)

We pose and resolve a puzzle about spontaneous symmetry breaking in the quantum theory of infinite systems. For a symmetry to be spontaneously broken, it must not be implementable by a unitary operator in a ground state's GNS representation. But Wigner's theorem guarantees that any symmetry's action on states is given by a unitary operator. How can this unitary operator fail to implement the symmetry in the GNS representation? We show how it is possible for a unitary operator of this (...) sort to connect the folia of unitarily inequivalent representations. This result undermines interpretations of quantum theory that hold unitary equivalence to be necessary for physical equivalence. (shrink)

For centuries, the processes of social differentiation associated with Modernity have often been thought to intensify the need for site-specific forms of role training and knowledge production, threatening the university’s survival either through fragmentation or through failure to adapt. Other lines of argument emphasize the extent to which the Modern system creates and relies on an integrated knowledge system, but most of the literature stresses functional differentiation and putative threats to the university. And yet over this period the university has (...) flourished. In our view, this seeming paradox is explained by the fact that modern society rests as much on universalistic cosmological bases as it does on differentiation. The university expands over recent centuries because – as it has from its religious origins – it casts cultural and human materials in universalistic terms. Our view helps explain empirical phenomena that confound standard accounts: the university’s extraordinary expansion and global diffusion, its curricular and structural isomorphism, and its relatively unified structure. All of this holds increasingly true after World War II, as national state societies made up of citizens are increasingly embedded in a world society constituted of empowered individuals. The redefinition of society in global and individual terms reduces nationally bounded models of nature and culture, extends the pool of university beneficiaries and investigators, and empowers the human persons who are understood to root it all. The changes intensify universalization and the university’s rate of worldwide growth. For the university’s knowledge and “knowers,” and for the pedagogy that joins them together, the implications are many. The emerging societal context intensifies longstanding processes of cultural rationalization and ontological elaboration, yielding great expansions in what can and should be known, and in who can and should know. These changes in turn alter the menu of approved techniques for joining knowledge and knower as one. The “knowledge society” that results is distinguished by the extraordinary degree to which the university is linked to society. But it is also distinguished by the degree to which society is organized around the university’s abstracted and universalized understandings of the world and its degree-certified graduates. (shrink)

The permutation symmetry of quantum mechanics is widely thought to imply a sort of metaphysical underdetermination about the identity of particles. Despite claims to the contrary, this implication does not hold in the more fundamental quantum field theory, where an ontology of particles is not generally available. Although permutations are often defined as acting on particles, a more general account of permutation symmetry can be formulated using superselection theory. As a result, permutation symmetry applies even in field theories with no (...) particle interpretation. The quantum mechanical account of permutations acting on particles is recovered as a special case. (shrink)

Nature seems to be such that we can describe it accurately with quantum theories of bosons and fermions alone, without resort to parastatistics. This has been seen as a deep mystery: paraparticles make perfect physical sense, so why don’t we see them in nature? We consider one potential answer: every paraparticle theory is physically equivalent to some theory of bosons or fermions, making the absence of paraparticles in our theories a matter of convention rather than a mysterious empirical discovery. We (...) argue that this equivalence thesis holds in all physically admissible quantum field theories falling under the domain of the rigorous Doplicher–Haag–Roberts approach to superselection rules. Inadmissible parastatistical theories are ruled out by a locality-inspired principle we call charge recombination. 1 Introduction2 Paraparticles in Quantum Theory3 Theoretical Equivalence3.1 Field systems in algebraic quantum field theory3.2 Equivalence of field systems4 A Brief History of the Equivalence Thesis4.1 The Green decomposition4.2 Klein transformations4.3 The argument of Drühl, Haag, and Roberts4.4 The Doplicher–Roberts reconstruction theorem5 Sharpening the Thesis6 Discussion6.1 Interpretations of Quantum Mechanics6.2 Structuralism and haecceities6.3 Paraquark theories. (shrink)

In Section I, I clarify turning point issues in the Phillips and Block debate about whether there is unconscious perception. These include questions about whether uptake of certain visual information is an individual or person level accomplishment, as required for genuine unconscious _perceiving_. Section II takes up a recent reorientation proposed in Block ( 2017 ) towards the question of whether there is unconscious perceiving, where we are to look for the pervasive role of unconscious perceiving in, perhaps especially, the (...) online control of everyday reaching and grasping. I point out that while this may well be a helpfully different approach to explore, it does not evade the central questions and challenges familiar from the prior debate between Phillips and Block. Section III reviews an approach summarized in Dehaene ( 2014 ), drawing from a range of measures of neural activity. Dehaene provides evidence of quite rich non-conscious perceptual system responses, some arguably individual or person level. But in a fairly thin or fragile way, absent taking up, in higher level assessment, the information encoded in initial visual response. Or that is the interpretation I argue for, in relating the Dehaene account to the Phillips and Block debate, in a way that illuminates the Phillips and Block discussions. An Appendix provides an overview of debates in the literature about the Goodale and Milner Two Visual Systems Hypothesis, that Block ( 2017 ) makes central appeal to. (shrink)

A collection of personal narratives and essays, Living Professionalism is designed to help medical students and residents understand and internalize various aspects of professionalism. These essays are meant for personal reflection and above all, for thoughtful discussion with mentors, with peers, with others throughout the health care provider community who care about acting professionally.

A new argument is given for the thesis that only symmetry-invariant physical quantities are real. Non-invariant quantities are dynamically epiphenomenal in that they have no effect on the evolution of invariant quantities, and it is a significant theoretical vice to posit epiphenomenal quantities.

I advance a stipulational account of symmetry-to-reality inference, according to which symmetries are part of the content of theories. For a theory to have a certain symmetry is for the theory to stipulate that models related by the symmetry represent the same possibility. I show that the stipulational account compares positively with alternatives, including Dasgupta’s epistemic account of symmetry, Møller-Nielsen’s motivational account, and so-called formal and ontic accounts. In particular, the stipulational account avoids the problems Belot and Dasgupta have raised (...) against formal and ontic accounts of symmetry while retaining many of the advantages of these otherwise-attractive frameworks. (shrink)

In the paper of Brown and Priest 2004, the authors developed the chunk and permeate method, which they described as a ?paraconsistent reasoning strategy?. There it is suggested that the method of chunk and permeate could apply to the historical infinitesimal calculus. However, no attempt was made to look at actual historical examples. In this paper, I show that the method of chunk and permeate can indeed apply, as a rational reconstruction, to certain of Isaac Newton's arguments that use infinitesimals. (...) This rational reconstruction maintains and uses, rather than sidesteps, the apparent contradictions in Newton's arguments. The applicability of chunk and permeate to other historical arguments, e.g. of Leibniz/L'Hospital and Fermat, has also been investigated and will be communicated in future publications. (shrink)

Comparativism--the view that comparative relations like mass ratios are fundamental and intrinsic values of quantities are not--faces a challenge from physics. In its standard form, comparativism predicts indeterminism in physical theories that are ordinarily understood as deterministic. I explore an option for saving comparativism from this objection: the introduction of "mixed" relations that compare values of unlike quantities. Although tenable, this revised version of comparativism lacks some of the theoretical virtues of the standard version.

This article is situated within the framework of schema therapy and offers a comprehensive and clinically useful list of schema modes that have been identified as being relevant to conceptualizing complex psychological problems, such as those posed by personality disorders, and, in particular, the way that those problems are perpetuated. Drawing on the schema therapy literature, as well as other literature including that of cognitive behavior therapy and metacognitive therapy, over eighty modes are identified altogether, categorized under the widely accepted (...) broad headings of Healthy Adult, Child modes, Parent modes and coping modes which are, in turn, divided into Surrender, Detached/Avoidant, and Overcompensator. An additional category is included: Repetitive Unproductive Thinking. This draws attention to the recognition by metacognitive therapists that such covert behaviors play a significant role in amplifying distress and perpetuating a range of psychological problems and symptoms. In addition to the modes themselves, several concepts are defined that are directly relevant to working with modes in practice. These include: default modes, blended modes, mode suites and mode sequences. Attention is also drawn to the way in which Child modes may be hidden “backstage” behind coping modes, and to the dyadic relationship between Child modes and Parent modes. Also relevant to practice are: the recognition that Critic voices may have different sources and this has implications for treatment, the concept of complex modes in which several submodes work together, and the fact that in imagery work and image of a child may not represent a Vulnerable Child, but a Coping Child. The modes and mode processes described are directly relevant to clinical practice and, in addition to being grounded in the literature, have grown out of and proved to be of practical use in conceptualizing my own cases, and in supervising the cases of other clinicians working within the schema therapy framework. (shrink)

If the block universe view is correct, the future and the past have similar status and one would expect physical theories to involve final as well as initial boundary conditions. A plausible consistency condition between the initial and final boundary conditions in non-relativistic quantum mechanics leads to the idea that the properties of macroscopic quantum systems, relevantly measuring instruments, are uniquely determined by the boundary conditions. An important element in reaching that conclusion is that preparations and measurements belong in a (...) special class because they involve many subsystems, at least some of which do not form superpositions of their physical properties before the boundary conditions are imposed. It is suggested that the primary role of the formalism of standard quantum mechanics is to provide the consistency condition on the boundary conditions rather than the properties of quantum systems. Expressions are proposed for assigning a set of (unmeasured) physical properties to a quantum system at all times. The physical properties avoid the logical inconsistencies implied by the no-go theorems because they are assigned differently from standard quantum mechanics. Since measurement outcomes are determined by the boundary conditions, they help determine, rather than are determined by, the physical properties of quantum systems. (shrink)

In recent decades, the individual has become more and more central in both national and world cultural accounts of the operation of society. This continues a long historical process, intensified by the consolidation of a more global polity and the weakening of the primordial sovereignty of the national state. Increasingly, society is culturally rooted in the natural, historical, and spiritual worlds through the individual, rather than through corporate entities or groups. The shift has produced a proliferation and specification of individual (...) roles, accounting for what individuals do in society. It has also produced an expansion in recognized individual personhood, accounting for who individuals are in the extrasocial cosmos and fueling elaborated personal tastes and preferences. Where it has been contested, the shift to the individual has also produced a rise in specializing identities. These offer accounts of individuals' distinctive linkages to the cosmos, and they serve to bolster individual claims to standard roles and personhood. Over time, specializing identities tend to get absorbed into roles and personhood. And in turn, expanded roles and personhood provide further bases for specializing identity claims. Because many theorists mischaracterize the relationship of specializing identities to roles and personhood, the literature often overemphasizes the anomic character of the identity explosion and the closeness of the coupling between social roles and identity claims. On the contrary, specializing identities tend to be edited to remain within general rules of individual personhood and to be disconnected from the obligations involved in institutionalized roles. (shrink)

Supersymmetry in quantum physics is a mathematically simple phenomenon that raises deep foundational questions. To motivate these questions, I present a toy model, the supersymmetric harmonic oscillator, and its superspace representation, which adds extra anticommuting dimensions to spacetime. I then explain and comment on three foundational questions about this superspace formalism: whether superspace is a substance, whether it should count as spatiotemporal, and whether it is a necessary postulate if one wants to use the theory to unify bosons and fermions.

Comments and replies from the 2021 Eastern APA book symposium on Jill North's Physics, Structure, and Reality.