With the passage by virtually every state legislature of healthcare proxy laws, the medical profession increasingly can expect to rely on the participation of surrogates in making decisions on behalf of incompetent patients. Several concerns about the legitimacy of proxy decision making have been discussed in the ethical and general medical literature: the lack of concordance between the views of patients and their surrogates have been documented on multiple occasions, and cases of abuse by proxies or potential conflict of interest (...) have been reported. Another dilemma that deserves discussion arises when proxies demand withdrawal of treatment that physicians and nurses regard as essential to the wellbeing of the patient. The following case highlights this dilemma. (shrink)

Developing a reasonable approach to the medical care of older people with dementia will be essential in the coming decades. Physicians are the locus of decision making for persons with dementia. It is the responsibility of the physician to assure that the surrogate understands the nature and trajectory of the disease and then to elicit the desired goal of care. Physicians need to ascertain whether any advance directives are available, and if so, whether they apply to the situation of advanced (...) dementia. Finally, physicians should help surrogates understand how the goals of care are best translated into practice. When the goal is comfort, this is achieved by assuring dignity, minimizing suffering, and promoting caring. In general, comfort should be the default goal of care, best implemented through palliative care or hospice. (shrink)

America is aging. But even more striking than the rise in the proportion of the population over age 65 is the unprecedented number of individuals who are living into their eighties and nineties. While many people remain robust well into advanced age, the dramatic increase in the number of the oldest old has brought with it an epidemic of Alzheimer’s disease and other dementias. Dementia is a highly prevalent condition — currently 5.4 million Americans have Alzheimer’s disease, a number which (...) may rise to 16 million by 2050 if there is no breakthrough in the prevention or treatment of the disease — but it disproportionately affects those over age 85, striking between one-third and one-half of this cohort. Developing a reasonable approach to the medical care of older people with dementia will be essential in the coming decades. (shrink)

Several religious traditions are widely believed to advocate the use of life-sustaining treatment in all circumstances. Hence, many believe that these faiths would require the use of a feeding tube in patients with advanced dementia who have lost interest in or the capacity to swallow food. This article explores whether one such tradition—halachic Judaism—in fact demands the use of artificial nutrition and hydration in this setting. Traditional arguments have been advanced holding that treatment can be withheld in persons who are (...) dying, in individuals whose condition causes great suffering, or in the event that the treatment would produce suffering. Individuals with advanced dementia can be considered to be dying, often suffer as a result of their dementia, and are likely to suffer from the use of a feeding tube. Given these observations and the absence of a compelling case for distinguishing between tube feeding and other forms of medical treatment, traditional Judaism appears compatible with withholding artificial nutrition for individuals with advanced dementia. (shrink)

In light of the central role that medications play in medical progress, the declining rate of new drug development over the past decade is cause for concern . Without important breakthroughs in drug discovery, the future will not be auspicious for the many people suffering from chronic and incurable illnesses. The sluggish pace of pharmaceutical innovation has been particularly characteristic of the largest drug manufacturers, which have generally focused their energies on potential blockbuster medications, those that can generate over $1 (...) billion in annual revenue . Given Pharma’s struggles, the success of the country’s largest drug manufacturer in bringing the .. (shrink)

With great fanfare, the first baby boomer turned 65 on January 1, 2011, ushering in the new, gray society. We—I'm one of the 76 million baby boomers—were expected to transform aging: better educated, healthier, reared in an era of unprecedented prosperity, committed to individual autonomy, we would singlehandedly turn retirement from a time of decline, disability, and despair into a period of travel, adventure, and personal growth. If we did become ill, despite regular exercise, a wholesome diet, and a goodly (...) dose of vitamins, we would demand, and receive, the fruits of American technological ingenuity, vanquishing disease and perhaps even death. Concurrent with the designation of age 70 as "the new 40," we have... (shrink)

Modern gerontology has debunked the myth of old age as a period of inevitable decline. But what science has not been able to change is the reality that old age often is a time of illness and disability, particularly for the oldest old—those over age 85. The vaunted compression of morbidity hasn't happened; while the period of decline before death may have shrunk, it hasn't vanished. The trajectory in the last phase of life is rarely a precipice, with older people (...) living healthy lives until, abruptly, they fall off a cliff. Rather, it typically takes the form of a series of dips that return to an ever-lowering baseline or a slow fade.The... (shrink)

With the passage by virtually every state legislature of healthcare proxy laws, the medical profession increasingly can expect to rely on the participation of surrogates in making decisions on behalf of incompetent patients. Several concerns about the legitimacy of proxy decision making have been discussed in the ethical and general medical literature: the lack of concordance between the views of patients and their surrogates have been documented on multiple occasions, and cases of abuse by proxies or potential conflict of interest (...) have been reported. Another dilemma that deserves discussion arises when proxies demand withdrawal of treatment that physicians and nurses regard as essential to the wellbeing of the patient. The following case highlights this dilemma. (shrink)

Some recent discussions of narrative structure consider the narrative as a sequence of events, and assume that the structure is what is manifested by the relation between any given event and the event 1, or perhaps the whole sequence from the first event up to the th event in the book. In the present discussion this approach will be modified in two ways. It will be modified, later on, by considering what would be happening if the writer were revising his (...) work into the final version, out of a penultimate version which was, as it were, a next-most complex version: one to which some final "complexifying" process had not yet been applied. The other way in which the present discussion will modify that approach is that it will consider narrative not as one sequence of events but as an interrelated set of sequences. · 1. E.g., R. Barthes, "Introduction à l'analyse structurale du récit," Communications, no. 8 , pp.1-27. John Holloway, professor of Modern English at the University of Cambridge, has written The Victorian Sage, The Charted Mirror, The Story of the Night, Blake: The Lyric Poetry, and five volumes of verse, such as New Poems. He is presently completing a book on poetic modes from Milton to Hardy and coediting a four-volume series on English and Irish street ballads. His other contribution to Critical Inquiry," Supposition and Supersession: A Model of Analysis for Narrative Structure" appeared in the Autumn 1976 issue. (shrink)

Clarifying the mission of the American high school / Ernest L. Boyer--Educational goals and curricular decisions in the new Carnegie Report / John Martin Rich--Essential schools : a first look / Theodore R. Sizer--Teaching and learning : the dilemma of the American high school / Chester E. Finn, Jr.--The paideia proposal : rediscovering the essence of education / Mortimer Adler--The paideia proposal : noble amibitions, false leads, and symbolic politics / Willis D. Hawley--Cultural literacy : let's get specific / E.D. (...) Hirsch, Jr.--Cultural literacy : what every educator needs to know / Thomas H. Estes, Carol J. Gutman, and Elise K. Harrison--A blueprint for public education / John E. Chubb--Should market forces control educational decision making / Jack Tweedie--Teachers as transformative intellectuals / Henry A. Giroux--Dilemma language / Colin Lacey--Rich schools, poor schools : the persistence of unequal education / Arthur E. Wise and Tamar Gendler--Partial privatization of publice school finance / Thomas G. Fox and John Riew--Quality and equality in American education : public and Catholic schools / James S. Coleman--Oranges plus apples, Dr. Coleman, give you oranges plus apples / James Rogers--Synthesis of research on school-based management / Jane L. David--Unfulfilled promises / Betty Malen, Rodney T. Ogawa, and Jennifer Kranz--Effective high schools--What are the common characteristics? / Joseph Murphy and Philip Hallinger--Effective schools : a friendly but cautionary note / Larry Cuban--In education, magnets attract controversy / Mary Haywood Metz--Schools of choice : a path to educational quality or 'Tiers of inequity'? / Kathleen Sylvester--Interesting times / Alan H. Jones--Making a difference in educational quality through teacher education / Carolyn M. Evertson, Willis D. Hawley, and Marilyn Zlotnik--Developing a career ladder : getting down to the basics / Thomas Deering--The career ladder and lattice : a new look at the teaching career / Timothy J.L. Chandler, Stacey L. Lane, Janice M. Bibik, and Bernard Oliver--Equity, quality, and effectiveness in bilingual education / George M. Blanco--Bilingual--No! / Muriel Paskin Carrison--Multiethnic education and the quest for equality / James A. Banks--The limits of pluralism / M. Donald Thomas--The case for keeping mentally retarded children in your regular classrooms / Martin Tonn--Mainstreaming : a formative consideration / Harry N. Chandler--Reflections on three decades of eduction of the gifted / A. Harry Passow--Equity vs. excellence : an eductional drama / James J. Gallagher. (shrink)

R.I.G. Hughes presents a series of eight philosophical essays on the theoretical practices of physics. The first two essays examine these practices as they appear in physicists' treatises and journal articles. By treating these publications as texts, Hughes casts the philosopher of science in the role of critic. This premise guides the following six essays which deal with various concerns of philosophy and physics such as laws, disunities, models and representation, computer simulation, explanation, and the discourse of physics.

An introductory exploration on the nature of emotions, and examination of some of the critical issues surrounding the emotional life of God as they relate to happiness, empathy, love, and moral judgments. Covering the different criteria used in the debate between impassibility and passibility, readers can begin to think about which emotions can be predicated of God and which cannot.

PREFACE The first three of these lectures, or rather an abbreviated version of them, were first given as the Lindsay Memorial Lectures at the University of ...

The book is written for anyone seriously interested in Plato's thought and in the history of literary theory or of rhetoric. No knowledge of Greek is required. The focus of this account is on how the resources both of persuasive myth and of formal argument, for all that Plato sets them in strong contrast, nevertheless complement and reinforce each other in his philosophy.

This book aims to provide an introduction to Aristotle's Politics, highlighting the major themes and arguments offered in the scholar's work. It begins with a discussion on what Aristotle perceives as human good, which he had described as the ethical purpose of political science, and how he views the political community, or the polis, as a community of persons formed with a view to some good purpose and a supreme entity in the sense that it is not just one aspect (...) of city-state society but is the whole of that society. The book also discusses Aristotle's arguments against the abolition of the household for the ruling class and the communism of families and property, which Plato advocates, and highlights certain inconsistencies and vulnerabilities in his arguments supporting natural slavery and on how the husband should rule over his wife and children. The book presents Aristotle's account of the relative merits of six different types of constitution and his views on the best possible constitution that will help in the realization of the polis' true purpose of achieving the good life. It ends with a discussion on Aristotle's view of political science in relation to the protection of particular constitutions against constitutional change and political disorder. (shrink)

The 1973 archeological discovery of important documents of classical thought known as the Huang-Lao Boshu coupled with advancements in contemporary jurisprudence make possible a reassessment of the philosophies of pre-Qin and early Han China. This study attempts to elucidate the importance of the Huang-Lao school within the intellectual tradition of China through a comparison of the Boshu's philosophical position, particularly its understanding of the relation between law and morality, with the respective views of major thinkers of the period--Confucius, Han Fei, (...) Lao Zi, Zhuang Zi, and to a lesser extent, Shen Dao, Shen Buhai and the authors of the Guan Zi and He Guan Zi. So doing reveals Huang-Lao to be a unique and sophisticated social and political philosophy which, until its expulsion from court by Emperor Wu and subsequent adoption by Daoist religion, served as the ideological foundation for the post-Qin reforms of the early Han. (shrink)

The argument of the Transcendental Deduction of the Categories in the Critique of Pure Reason is the deepest and most far-reaching in philosophy. In his new book, Robert Howell interprets main themes of the Deduction using ideas from contemporary philosophy and intensional logic, thereby providing a keener grasp of Kant's many subtleties than has hitherto been available. No other work pursues Kant's argument through every twist and turn with the careful, logically detailed attention maintained here. Surprising new accounts of apperception, (...) the concept of an object, the logical functions of thought, the role of the Metaphysical Deduction, and Kant's relations to his Aristotelian-Cartesian background are developed. Howell makes a precise contribution to the discussion of most of the disputed issues in the history of Deduction interpretation. Controversial in its conclusions, this book demands the attention of all who take seriously the task of understanding Kant's work and evaluating it dispassionately. (shrink)

There are many problems about business ethics. What I want to deal with is only part of the problem: I want to consider just what can properly be expected of business in general terms by way of ethical behaviour and, along with that, what is special about business ethics and how it is related to the personal morality we are all expected to exhibit in our day-to-day lives; I want to consider how it is that ethical confusions arise from people's (...) mistaking the relationship between personal morality and business ethics; and I want to consider what can be done by way of education in business ethics to raise the standards and just what role philosophical ethics can play in that. (shrink)

The essays in The Philosophy of Spirituality address spirituality as a subject of philosophical interest independent of religion and respecting diverse spiritual traditions: African, atheist, Indigenous, Indian, Stoic, and Sufic perspectives, as well as Western analytic and continental views.

Paper read at the 32nd Conference on Value Inquiry: Reason and Evaluation, 8-10/4, 2005, Louisiana State University, Baton Rouge.