RationaleSurrogates of critically ill patients often have inaccurate expectations about prognosis. Yet there is little research on how intensive care unit clinicians should discuss prognosis, and existing expert opinion-based recommendations give only general guidance that has not been validated with surrogate decision makers.ObjectiveTo determine the perspectives of key stakeholders regarding how prognostic information should be conveyed in critical illness.MethodsThis was a multicenter study at three academic medical centers in California, Pennsylvania, and Washington. One hundred eighteen key stakeholders completed in-depth semistructured (...) interviews. Participants included 47 surrogates of adult patients with acute respiratory distress syndrome; 45 clinicians working in study ICUs, including physicians, nurses, social workers, and spiritual care providers; and 26 experts in health communication, decision science, ethics, family-centered care, geriatrics, healthcare disparities, palliative care, psychology, psychiatry, and critical care.Measurements and main resultsThere was broad support among surrogates for existing expert recommendations, including truthful prognostic disclosure, emotional support, tailoring the disclosure strategy to each family's needs, and checking for understanding. In addition, stakeholders offered suggestions that add specificity to existing recommendations, including: In addition to conveying prognostic estimates, clinicians should help families "see the prognosis for themselves" by showing families radiographic images and explaining the clinical significance of physical manifestations of severe disease at the bedside. Many physicians did not support using numeric estimates to convey prognosis to families, whereas many surrogates, clinicians from other disciplines, and experts believed numbers could be helpful. Clinicians should conceptualize prognostic communication as an iterative process that begins with a preliminary mention of the possibility of death early in the ICU stay and becomes more detailed as the clinical situation develops. Although prognostic information should be initially disclosed by physicians, other members of the multidisciplinary team-nurses, social workers, and spiritual care providers-should be given explicit role responsibilities to reinforce physicians' prognostications and help families process a poor prognosis emotionally.ConclusionsFamily members, clinicians, and experts identified specific communication behaviors that clinicians should use to discuss prognosis in the critical care setting. These findings extend existing opinion-based recommendations and should guide interventions to improve communication about prognosis in ICUs. (shrink)

Social robots have limited social competences. This leads us to view them as depictions of social agents rather than actual social agents. However, people also have limited social competences. We argue that all social interaction involves the depiction of social roles and that they originate in, and are defined by, their function in accounting for failures of social competence.

Empirical evidence from dialogue, both corpus and experimental, highlights the importance of interaction in language use – and this raises some questions for Christiansen & Chater's proposals. We endorse C&C's call for an integrated framework but argue that their emphasis on local, individual production and comprehension makes it difficult to accommodate the ubiquitous, interactive, and defeasible processes of clarification and repair in conversation.

Book Information Frege. An Introduction to the Founder of Modern Analytic Philosophy. By Anthony Kenny. Blackwell Publishers. Oxford. 2000. Pp. xi + 223. Paperback, £12.99.

At the end of ‘The Age of the World Picture,’ Heidegger offers a brief sentence, ‘Keiner stirbt für blosse Werte’ (No one dies for mere values.). This sentence underscores one of the central themes of Heidegger’s later essays, the nihilism that results from living in an economy of value. This way of life is lived by a certain kind of human being, one who treats a culture’s embedded habits and practices as value systems to be exploited and exhausted. A more (...) difficult problem presents itself: what is it like to be a person who has mastered this economy of value? This paper sets out to examine this question, and to propose another perspective: no one dies for mere values, but how does Heidegger’s rendition of the Übermensch manage to live? How does one live for mere values? I argue that Heidegger’s technological examples (e.g., the hydroelectric plant) have two salient features: each is ‘infectious’ and ‘exhaustible,’ features that are not consonant with the appropriative use of our habits and practices. I will focus on the condition Heidegger describes, and the person who makes this condition manifest, and conclude with a proposal for a ‘Nietzschean corrective.’. (shrink)

We present empirical evidence from dialogue that challenges some of the key assumptions in the Pickering & Garrod (P&G) model of speaker-hearer coordination in dialogue. The P&G model also invokes an unnecessarily complex set of mechanisms. We show that a computational implementation, currently in development and based on a simpler model, can account for more of this type of dialogue data.

Information can be public among a group. Whether or not information is public matters, for example, for accounts of interdependent rational choice, of communication, and of joint intention. A standard analysis of public information identifies it with (some variant of) common belief. The latter notion is stipulatively defined as an infinite conjunction: for p to be commonly believed is for it to believed by all members of a group, for all members to believe that all members believe it, and so (...) forth. This analysis is often presupposed without much argument in philosophy. Theoretical entrenchment or intuitions about cases might give some traction on the question, but give little insight about why the identification holds, if it does. The strategy of this paper is to characterize a practical-normative role for information being public, and show that the only things that play that role are (variants of) common belief as stipulatively characterized. In more detail: a functional role for “taking a proposition for granted” in non-isolated decision making is characterized. I then present some minimal conditions under which such an attitude is correctly held. The key assumption links this attitude to beliefs about what is public. From minimal a priori principles, we can argue that a proposition being public among a group entails common commitment to believe among that group. Later sections explore partial converses to this result, the factivity of publicity and publicity from the perspective of outsiders to the group, and objections to the aprioricity of the result deriving from a posteriori existential presuppositions. (shrink)

Bazzocchi disposes the text of the Tractatus in a user-friendly manner, exactly as Wittgenstein's decimals advise. This discloses the logical form of the book by distinct reading units, linked into a fashioned hierarchical tree. The text becomes much clearer and every reader can enjoy, finally, its formal and literary qualities.

Knowledge of mechanisms is critical for causal reasoning. We contrasted two possible organizations of causal knowledge—an interconnected causal network, where events are causally connected without any boundaries delineating discrete mechanisms; or a set of disparate mechanisms—causal islands—such that events in different mechanisms are not thought to be related even when they belong to the same causal chain. To distinguish these possibilities, we tested whether people make transitive judgments about causal chains by inferring, given A causes B and B causes C, (...) that A causes C. Specifically, causal chains schematized as one chunk or mechanism in semantic memory led to transitive causal judgments. On the other hand, chains schematized as multiple chunks led to intransitive judgments despite strong intermediate links. Normative accounts of causal intransitivity could not explain these intransitive judgments. (shrink)

The AGI alignment problem has a bimodal distribution of outcomes with most outcomes clustering around the poles of total success and existential, catastrophic failure. Consequently, attempts to solve AGI alignment should, all else equal, prefer false negatives (ignoring research programs that would have been successful) to false positives (pursuing research programs that will unexpectedly fail). Thus, we propose adopting a policy of responding to points of philosophical and practical uncertainty associated with the alignment problem by limiting and choosing necessary assumptions (...) to reduce the risk of false positives. Herein we explore in detail two relevant points of uncertainty that AGI alignment research hinges on---meta-ethical uncertainty and uncertainty about mental phenomena---and show how to reduce false positives in response to them. (shrink)

In a recent article Duncan Purves, Ryan Jenkins, and B. J. Strawser argue that in order for a decision in war to be just, or indeed the decision to resort to war to be just, it must be the case that the decision is made for the right reasons. Furthermore, they argue that this requirement holds regardless of how much good is produced by said action. In this essay I argue that their argument is flawed, in that it mistakes what (...) makes an agent morally good for what makes an act morally good. I argue that the main thrust of Purves et al.’s argument in fact undermines the conclusion they wish to draw, and that the reasons for one’s action do not make an in principle difference to the morality of actions in war. I further argue that this position undermines the traditional ad bellum just war constraint of right intention, and that the morality of actions in war is, at core, only concerned with outcomes. I conclude by clarifying that one’s reasons for action do in fact matter when deciding to enter war or kill in war, but only because one’s reasons significantly impact the way in which one acts. The purpose of this paper is to clear the theoretical space by showing why intentions/reasons do not in principle matter when assessing the morality of war (or killing), but this should not be taken as an argument that we should ignore intentions/reasons altogether. (shrink)

In his article, a unified brain-based determination of death is described by James Bernat (2024) as a permanent cessation of systemic circulation causing a permanent cessation of brain circulation...

Response to commentaries on keynote article.

Includes bibliographical references and index.

A central theme in the scholarly literature on Enlightenment Europe concerns the increased focus on the role of reason in the development of European thought, especially in the development of the new science by the natural philosophers. As a consequence, there is a tendency in both philosophical scholarship and teaching to bind philosophy and science tightly together. While there is certainly much that is correct in this approach, one motivation for pluralizing philosophy’s past is that this story leaves out a (...) great deal that is important in Enlightenment views of reason. We argue, using as an example the work of figures like Margaret Cavendish, that reason was significantly broader in scope—and that developments in science were paralleled by equally important advances in music, art, literature, medicine, philosophy, and other areas. In recognizing the lack of a sharp boundary between these areas, an inclusive canon of Enlightenment philosophy gives us this richer notion of reason. Integrating figures such as Cavendish into the canon helps us to see that the narrow focus on the scientific version of reason within Enlightenment scholarship creates a false distinction between science and the humanities and misses out on the humanistic ends for which we engage in philosophy. (shrink)

To incorporate medical ethics into clinical practice, it must first be understood and valued by health care professionals. The recognition of this principle led to an expanding and continuing educational effort by the ethics committee of the Vancouver General Hospital. This paper reviews this venture, including some pitfalls and failures, as well as successes. Although we began with consultants, it quickly became apparent that education in medical ethics must reach all health care professionals—and medical students as well. Our greatest successes (...) came in the formative years of a medical career (ie, in medical school and residency training programmes), but other efforts were not wasted, particularly among nurses and other health care professionals.Although this is a personal review of the experience in one institution, the lessons learnt in Vancouver are applicable to the further development of medical ethics in the UK. (shrink)

This article explores children’s narrative identity formation and the impact of adult–child relationships on shaping a child’s narrative. The formation of identity in all children is vulnerable to a culture of ‘adultism’, wherein the authority wielded by adults can potentially subject children to abuse and neglect. Consequently, adultism has the aptitude to hinder the constructive development of a life-affirming identity in children. The primary objective of this article is to develop a childist narrative theology of praxis methodology, aimed at raising (...) consciousness and educating adults on both life-denying and life-giving ways of engaging in the process of children’s narrative identity formation.To achieve this goal, the methodology is developed by adapting Denise Ackermann’s ‘feminist theology of praxis’ to focus specifically on children. The application of feminist theory principles is deemed relevant to the social standing of children as it aligns with the broader goal of liberating oppressed groups, whether women or children. Additionally, John Wall’s work is employed to elucidate the terms ‘childist’ and ‘childism’ as interpretive frameworks. Positioned within the scientific domain of Practical Theology, this study seeks to transform conditions that impede human flourishing into opportunities for positive change.The research objectives determine that a literature review will be suitable to gather essential information for the formulation of a childist narrative theology of praxis. This review, characterised as explorative and descriptive, is conducted within the field of Practical Theology.Contribution: The significance of this study is underscored by its exploration and description of the pastoral functions of consciousness, awareness-raising, and education concerning adult–child relations. By scrutinising these pastoral functions, the emphasis is placed on the proactive, preventive, and universal aspects of pastoral care in the context of children, thereby contributing valuable insights to the discourse. (shrink)

The adjective ἱερός is a central term in Greek religion and is used in various contexts. Generally translated ‘sacred’, it indicates that an object has been conceded to the gods and is now in relation with them (relation of belonging, protection, etc.). It appears frequently in Greek inscriptions in the expression τὰ ἱερά, to designate sacred objects or, in a more abstract meaning, sacred matters.

This interview deals with the major themes in the work of Ruth Millikan. Her most fundamental idea is that the intentionality of inner and outer representations can be understood in analogy to biological functions. Another innovative feature is the view that thought and language stand parallel to each other. Thirdly, the basic ideas concerning the ontology and the epistemology of concepts are explained. Millikan aims at clarifying her position by contrasting it with Dretske, Fodor, Sellars, and Brandom. Finally, the interview (...) addresses topics that pose problems for her account as well as questions she does not treat in her work. (shrink)

Name der Zeitschrift: Semiotica Jahrgang: 2015 Heft: 205 Seiten: 261-276.