Objectives: The objective of this study is to estimate the proportion of different types of end‐of‐life decisions (ELDs) of physicians in the city of Hasselt (Flanders, Belgium). The question is addressed to what degree these ELD meet legal constraints and the ethical requirements for prudent practice. Methodology: All physicians of the city of Hasselt who signed at least one death certificate in 1996 (N=166) received an anonymous self‐administered mail questionnaire per death case (max. 5/doctor) Results: the response rate was 55% (...) (N=269). In 37.3% of all cases at least one ELD was made (16.5% non‐treatment decisions; 16% potential life‐shortening by intensifying the treatment of pain and symptoms; 4.8% administration, supply or prescription of lethal drugs). In 59.5% of the cases were an ELD was made that decision was legally questionable. Patient characteristics were clearly related to the type of ELD. There was no influence of physician characteristics, except for commitment to life‐stance. In 71.3% of the cases the ELD was in no way discussed with the patient. 8.1% of the ELD‐cases were in response to a direct request from the patient Conclusions: The incidences of ELDs in Hasselt are consistent with earlier findings. The study shows that religious commitment influences the behaviour of physicians at the end of their patients' life. The patient's and her family's entitlements to participation in the decision making process were rather poorly respected. (shrink)

International Rules brings together exemplary works from the most prominent approaches to international rules of International Law and International Relations disciplines. Included are chapters on Natural Law, Legal Positivism, Classical Realism, the New Haven School, Institutionalism, Structural Realism, the New Stream, and Feminist Voices. Each of the eight chapters begins with a brief overview, offers a representative work or works, and concludes with a selected bibliography. From Hugo Grotius to David Kennedy, from George Kennan to Robert Keohane, the featured (...) authors provide valuable insights into their common subject: international rules. Despite divergent methods and objectives, they address fundamentally the same questions: What is the nature of such rules? What is their purpose? How do they originate? What role, if any, do they play in politics? Framing the selections assembled are two original chapter-length essays. The first chapter of this volume assesses the prospects for interdisciplinary collaboration; the final one suggests a direction for future research. (shrink)

Rationale In Belgium, several policies regulating reimbursement of acid suppressant drugs and evidence-based recommendations for clinical practice were issued in a short period of time, creating a unique opportunity to observe their effect on prescribing. Aims and objectives To describe the evolution of prescriptions for acid suppressants and explore the interaction of policies and practice recommendations with prescribing patterns. Method Monthly claims-based data for proton pump inhibitors (PPIs) and H-2-antihistamines by general practitioners, internists and "astroenterologists were obtained from the Belgian (...) national health insurance database (1997-2005). The evolution of reimbursed defined daily doses and expenses after introduction of reimbursement regulations and dissemination of practice recommendations was explored. Results Recommendations had no impact on prescribing. All changes can be related to concomitant policies. Lifting reimbursement restrictions for cheaper products did not control growth or save costs in the Iona term. Only restricting reimbursement of all PPIs managed to curb the growth. We observed an unintended increase of non-omeprazole PPIs by gastroenterologists. Conclusions Reimbursement policies influence prescribing, but their effect can be unintended. A dialogue between policymakers and guideline developers, and evidence-based policies that are linked to clinical guidelines, could be an effective way to pursue both cost-containment and quality of care. (shrink)

Objectives: The objective of this study is to estimate the proportion of different types of end‐of‐life decisions (ELDs) of physicians in the city of Hasselt (Flanders, Belgium). The question is addressed to what degree these ELD meet legal constraints and the ethical requirements for prudent practice.Methodology: All physicians of the city of Hasselt who signed at least one death certificate in 1996 (N=166) received an anonymous self‐administered mail questionnaire per death case (max. 5/doctor)Results: the response rate was 55% (N=269). In (...) 37.3% of all cases at least one ELD was made (16.5% non‐treatment decisions; 16% potential life‐shortening by intensifying the treatment of pain and symptoms; 4.8% administration, supply or prescription of lethal drugs). In 59.5% of the cases were an ELD was made that decision was legally questionable. Patient characteristics were clearly related to the type of ELD. There was no influence of physician characteristics, except for commitment to life‐stance. In 71.3% of the cases the ELD was in no way discussed with the patient. 8.1% of the ELD‐cases were in response to a direct request from the patientConclusions: The incidences of ELDs in Hasselt are consistent with earlier findings. The study shows that religious commitment influences the behaviour of physicians at the end of their patients' life. The patient's and her family's entitlements to participation in the decision making process were rather poorly respected. (shrink)

Background A team-based approach has been advocated for advance care planning in nursing homes. While nurses are often put forward to take the lead, it is not clear to what extent other professions could be involved as well. Objectives To examine to what extent engagement in advance care planning practices, knowledge and self-efficacy differ between nurses, care assistants and allied care staff in nursing homes. Design Survey study. Participants/setting The study involved a purposive sample of 14 nursing homes in Flanders, (...) Belgium. Nurses, care assistants and allied care staff completed a survey. Ethical considerations The study was approved by the University Hospital of Brussels, as part of a cluster randomized controlled trial. Results One hundred ninety-six nurses, 319 care assistants and 169 allied staff participated. After adjusting for confounders, nurses were significantly more likely than care assistants to have carried out advance care planning conversations and documented advance care planning ; differences not found between allied staff and care assistants. Advance care planning knowledge total scores differed significantly, with nurses ; 95% confidence interval 0.08–0.17; p < 0.001) and allied staff scoring higher than care assistants. We found no significant differences regarding self-efficacy. Discussion While nursing home nurses conducted more advance care planning conversations and documentation than allied care staff and care assistants, these two professional groups may be a valuable support to nurses in conducting advance care planning, if provided with additional training. Conclusions Allied care staff and care assistants, if trained appropriately, can be involved more strongly in advance care planning to enhance relational and individual autonomy of nursing home residents, alongside nurses. Future research to improve and implement advance care planning should consider this finding at the intervention development stage. (shrink)

Nozick analyzes fundamental issues, such as the identity of the self, knowledge and skepticism, free will, the foundations of ethics, and the meaning of life.

Several themes of David Lewis's theory of counterfactuals, especially their sensitivity to context, pave the way for a viable theory of non-trivial counterpossibles. If Lewis was successful in defending his account against the early objections, a semantics of counterpossibles can be defended from similar objections in the same way. The resulting theory will be extended to address 'might' counterfactuals and questions about the relative "nearness" of impossible worlds.

Perfect for students with no background in logic or philosophy, Simple Formal Logic provides a full system of logic adequate to handle everyday and philosophical reasoning. By keeping out artificial techniques that aren’t natural to our everyday thinking process, Simple Formal Logic trains students to think through formal logical arguments for themselves, ingraining in them the habits of sound reasoning. Simple Formal Logic features: a companion website with abundant exercise worksheets, study supplements (including flashcards for symbolizations and for deduction rules), (...) and instructor’s manual two levels of exercises for beginning and more advanced students a glossary of terms, abbreviations and symbols. This book arose out of a popular course that the author has taught to all types of undergraduate students at Loyola University Chicago. He teaches formal logic without the artificial methods–methods that often seek to solve farfetched logical problems without any connection to everyday and philosophical argumentation. The result is a book that teaches easy and more intuitive ways of grappling with formal logic–and is intended as a rigorous yet easy-to-follow first course in logical thinking for philosophy majors and non-philosophy majors alike. (shrink)

INTRODUCTION: REASON AND THE PASSIONS i. Philosophy? This same philosophy is a good horse in the stable, but an arrant jade on a journey. ...

This important book charts the development of philosophical thinking about history over the past 250 years, combining extracts from key texts with new explanatory and critical discussion. The book is designed to make the work of thinkers such as Hume, Herder, Hegel, Dilthey, Nietzsche, Heidegger and Foucault accessible to students with no prior knowledge of Western philosophy. An introductory section is followed by nine further chapters exploring contrasting schools of thought. The volume reveals the origins of contemporary trends in the (...) discipline and relates wider philosophical reflections to the study of history itself. It also points to connections between philosophy of history and literary and cultural theory which have developed in recent decades. (shrink)

Plausibly, no agent ever performs an action without some desire to perform that action. If so, a regress argument shows that, given incompatibilism, we are only rarely free. The argument sidesteps recent objections to this thesis.

Against the historically widespread view that divine conservation is a continuation of the act of creation, William Lane Craig argues that conservation is a different kind of act since, unlike creation ex nihilo, it is diachronic and it acts on a patient. Timothy Miller poses a timing objection against Craig's view, arguing that on such a view either the existence of a conserved entity is discontinuous, or the conserving activity overdetermines its effect, or the conserving activity is not continuous. The (...) present paper explores the options that remain for a diachronic, agent-patient account of conservation. It includes several models of conservation on which divine activity is continuous but not overdetermined since its effect at each time is something less specific than the existence of a created being at a time. (shrink)

Winner of the 1975 National Book Award, this brilliant and widely acclaimed book is a powerful philosophical challenge to the most widely held political and social positions of our age--liberal, socialist, and conservative.

Theories of discourse bring to realism new ideas about how knowledge develops and how representations of reality are influenced. We gain an understanding of the conceptual aspect of social life and the processes by which meaning is produced. This collection reflects the growing interest realist critics have shown towards forms of discourse theory and deconstruction. The diverse range of contributions address such issues as the work of Derrida and deconstruction, discourse theory, Eurocentrism and poststructuralism. What unites all of the contributions (...) is a sense that it is essential to provide a realist alternative to the hitherto dominance of social constructionism, hermeneutics and postmodernism, over many of the issues discussed. By developing a realist perspective the different authors attempt to embed discourse within the structured nature of the reality of the world. Realism can situate language, discourse and ideology within context specific, or 'causally efficacious' circumstances. Realism can help to uncover issues of power, representation, and subjectivity and how discursive and other social practices produce real effects. This can help us understand the manner in which social structures are reproduced through various forms of ideology and discourse. And by knowing this, we can start to address questions concerning human emancipation and how the world is to be transformed. (shrink)

A recently advanced argument for purgatory hinges on the need for complete sanctification before one can enter heaven. The argument has a modal gap.The gap can be exploited to fashion a competing account of how sanctification occurs in the afterlife according to which it is in part a heavenly process.The competing account usefully complicates the overall case for purgatory and raises questions about how the notion ought to be understood.

The best arguments for possible worlds as states of affairs furnish us with equally good arguments for impossible worlds of the same sort. I argue for a theory of impossible worlds on which the impossible worlds correspond to maximal inconsistent classes of propositions. Three objections are rejected. In the final part of the paper, I present a menu of impossible worlds and explore some of their interesting formal properties.

Offering a unique and wide-ranging examination of the theory of knowledge, the new edition of this comprehensive collection deftly blends readings from the foremost classical sources with the work of important contemporary philosophical thinkers. Human Knowledge: Classical and Contemporary Approaches, 3/e, offers philosophical examinations of epistemology from ancient Greek and Roman philosophy (Plato, Aristotle, Sextus Empiricus); medieval philosophy (Augustine, Aquinas); early modern philosophy (Descartes, Locke, Leibniz, Berkeley, Hume, Reid, Kant); classical pragmatism and Anglo-American empiricism (James, Russell, Ayer, Lewis, Carnap, Quine, (...) Rorty); and other influential Anglo-American philosophers (Chisholm, Kripke, Moore, Wittgenstein, Strawson, Putnam). Organized chronologically and thematically, Human Knowledge, 3/e, features exceptionally broad coverage and nontechnical selections that are easily accessible to students. An ideal text for both undergraduate and graduate courses in epistemology, it is enhanced by the editors' substantial general introduction, section overviews, and up-to-date bibliographies. The third edition offers expanded selections on contemporary epistemology and adds selections by Thomas Reid, Richard Rorty, David B. Annis, Richard Feldman and Earl Conee, Ernest Sosa, Barry Stroud, and Louise M. Antony. Human Knowledge, 3/e, offers an unparalleled introduction to our ancient struggle to understand our own intellectual experience. (shrink)

Robert Stern investigates how scepticism can be countered by using transcendental arguments concerning the necessary conditions for the possibility of experience, language, or thought. He shows that the most damaging sceptical questions concern neither the certainty of our beliefs nor the reliability of our belief-forming methods, but rather how we can justify our beliefs.

A revised edition of an undergraduate text for students in history of psychology courses. Designed for one semester, covers: the history of psychology in ancient philosophy, structuralism, neurophysiology, functionalism, behaviorism, psychoanalysis, and gestalt theories. The new edition has expanded.

This paper develops a view of the content of perceptual states that reflects the cognitive significance those states have for the subject. Perhaps the most important datum for such a theory is the intuition that experiences are ‘transparent’, an intuition promoted by philosophers as diverse as Sartre and Dretske. This paper distinguishes several different transparency theses, and considers which ones are truly supported by the phenomenological data. It is argued that the only thesis supported by the data is much weaker (...) than those typically considered in the literature, and has no obvious implications for the existence of sensory intermediaries. It does, however, have implications for the content of perceptual experience. It is argued that combining the first personal project with the transparency intuition yields an error theory of perception. The counterintuitive implications of this error theory are mitigated, however, by an account of perceptual beliefs which allows for them to be true even if the perceptual states are non-veridical. (shrink)

This chapter focuses on one of the common fallacies in Western philosophy called “adverse consequences”. The argument from adverse consequences can be seen as an argument that is intended to be pragmatic ‐ about what we should do, not about what is true ‐ but then comes to the wrong kind of conclusion. In many genuinely pragmatic arguments, however, adverse consequences are relevant to the conclusion and no fallacy is committed. So it is important to notice exactly what the conclusion (...) of the argument is. (shrink)

This entry provides a brief exposition and formal reconstruction of the argument for possible worlds in David Lewis's _Counterfactuals_.

The theory of possible worlds has permeated analytic philosophy in recent decades, and its best versions have a consequence which has gone largely unnoticed: in addition to the panoply of possible worlds, there are a great many impossible worlds. A uniform ontological method alone should bring the friends of possible worlds to adopt impossible worlds, I argue, but the theory's applications also provide strong incentives. In particular, the theory facilitates an account of counterfactuals which avoids several of the implausible results (...) of David Lewis's account, and it paves the way for the analogues of Kripkean semantics for epistemic and relevant logics. On the theories of possible worlds as abstract objects, worlds bear a strong resemblance to propositions. I contend that if there are distinct necessarily false propositions, then there are likewise distinct impossible worlds. However, one who regards possible worlds as concrete objects must not recognize impossible worlds, in part because concrete worlds cannot misrepresent certain features of reality, as some impossible worlds must. Accordingly, I defend and develop a theory of impossible worlds as maximal impossible states of affairs. Impossible worlds perform admirably in the analysis of counterfactuals with impossible antecedents. I argue that, contrary to standard accounts, not all counterpossibles are trivially true, and I develop a Lewis-style semantics which allows this result. The point is crucial, since many views presuppose that some counterpossibles are substantive philosophical truths. Finally, I show that impossible worlds hold great promise for doxastic and relevant logics. Epistemic logic needs a domain of propositions which is not closed under strict implication to avoid the problem of logical omniscience, and relevant logic needs such a domain to avoid the famous paradoxes of implication. In sum, impossible world theory promises natural, elegant solutions to philosophical problems in numerous areas where possible worlds alone flounder. These solutions come to most possible world theorists at no cost, since the existence of impossible worlds is entailed by theses they already hold. (shrink)

What is right in the corporation is not what is right in a man's home or in his church," a former vice-president of a large firm observes. "What is right in the corporation is what the guy above you wants from you." Such sentiments pervade American society, from corporate boardrooms to the basement of the White House. In Moral Mazes, Robert Jackall offers an eye-opening account of how corporate managers think the world works, and of how big organizations shape (...) moral consciousnss. Based on extensive interviews with managers at every level of two industrial firms and of a large public relations agency, Moral Mazes takes the reader inside the intricate world of the corporation. It is a world where hard work does not necessarily lead to success, but where sharp talk, self-promotion, powerful patrons, and sheer luck might; where intense competition is masked by cheerfully bland public faces; where intentions are cloaked and frankness is simply one of many guises; and where words are always provisional and accountability often depends on the ability to outrun mistakes. In this topsy-turvy world, managers must bring often unforgiving technology and always difficult people together to make money, an uncompromising task demanding continual compromises with conventional verities. Moral issues are translated into practical concerns and into issues of public relations. Sooner or later, managrs ask themselves: How does one act in such a world and maintain a sense of personal integrity? Moral Mazes is a brilliant, sometimes disturbing, often wildly funny study of corporate thinking, decision-making, and morality. It is an analytical work of great importance, one filled with compelling real life stories of the men and women charged with running the business of America. It is a book for anyone interested in how big organizations actually function, or who is concerned with the current moral malaise in our public life. (shrink)

Many theorists claim that if an agent benefits from an action that harms others, that agent has a moral duty to compensate those who are harmed, even if the agent did not cause the harm herself. In the debate on climate justice, this idea is commonly referred to as the beneficiary-pays principle . This paper argues that the BPP is implausible, both in the context of climate change and as a normative principle more generally. It should therefore be rejected.

Many theorists claim that if an agent benefits from an action that harms others, that agent has a moral duty to compensate those who are harmed, even if the agent did not cause the harm herself. In the debate on climate justice, this idea is commonly referred to as the beneficiary-pays principle. This paper argues that the BPP is implausible, both in the context of climate change and as a normative principle more generally. It should therefore be rejected.

Permissivism says that for some propositions and bodies of evidence, there is more than one rationally permissible doxastic attitude that can be taken towards that proposition given the evidence. Some critics of this view argue that it condones, as rationally acceptable, sets of attitudes that manifest an untenable kind of arbitrariness. I begin by providing a new and more detailed explication of what this alleged arbitrariness consists in. I then explain why Miriam Schoenfield’s prima facie promising attempt to answer the (...) Arbitrariness Objection, by appealing to the role of epistemic standards in rational belief formation, fails to resolve the problem. Schoenfield’s strategy is, however, a useful one, and I go on to explain how an alternative form of the standards-based approach to Permissivism – one that emphasizes the significance of the relationship between people’s cognitive abilities and the epistemic standards that they employ – can respond to the arbitrariness objection. (shrink)

This book is a small handbook designed to give Institutional Review Board (IRB) members the information they need to protect the rights and welfare of research subjects in a way that is both effective and efficient. The chapters of this book are short and to the point. Topic-specific chapters list the criteria IRB members should use to determine how to vote on specific kinds of studies and offer practical advice on what IRB members should do before and during full-committee meetings.

This is a paradigmatic work of contemporary philosophy.

This is the most important book on Hegel to have appeared in the past ten years. Robert Pippin offers a completely new interpretation of Hegel's idealism, which focuses on Hegel's appropriation and development of kant's theoretical project. Hegel is presented neither as a precritical metaphysician nor as a social theorist, but as a critical philosopher whose disagreements with Kant, especially on the issue of intuitions, enrich the idealist arguments against empiricism, realism and naturalism. In the face of the dismissal (...) of absolute idealism as either unintelligible or implausible, Pippin explains and defends an original account of the philosophical basis for Hegel's claims about the historical and social nature of selfconsciousness, and so of knowledge itself. (shrink)