Systematic study of the intersection of ethics consultation services and solid organ transplants and recipients can identify and illustrate ethical issues that arise in the clinical care of these patients, including challenges beyond resource allocation. This was a single-centre, retrospective cohort study of all adult ethics consultations between January 1, 2007, and December 31, 2017, at a large academic medical centre in the north-eastern United States. Of the 880 ethics consultations, sixty (6.8 per cent ) involved solid organ transplant, thirty-nine (...) (65.0 per cent) for candidates and twenty-one (35.0 per cent ) for recipients. Ethics consultations were requested for 4.3 per cent of heart, 4.9 per cent of lung, 0.3 per cent of liver, and 0.3 per cent of kidney transplant recipients over the study period. Nurses were more likely to request ethics consultations for recipients than physicians (80.0 per cent vs 20.0 per cent, p = 0.006). The most common reason for consultation among transplant candidates was discussion about intensity of treatment or goals of care after the patient was not or was no longer a transplant candidate. The most common reason for ethics consultation among transplant recipients was disagreement between transplant providers and patients/families/non-transplant healthcare professionals over the appropriate intensity of treatment for recipients. Very few consultations involved questions about appropriate resource allocation. Ethics consultants involved in these cases most often navigated communication challenges between transplant and non-transplant healthcare professionals and patients and families. (shrink)

Critical care society guidelines recommend that ethics committees mediate intractable conflict over potentially inappropriate treatment, including Do Not Resuscitate status. There are, however, limited data on cases and circumstances in which ethics consultants recommend not offering cardiopulmonary resuscitation despite patient or surrogate requests and whether physicians follow these recommendations. This was a retrospective cohort of all adult patients at a large academic medical center for whom an ethics consult was requested for disagreement over DNR status. Patient demographic predictors of ethics (...) consult outcomes were analyzed. In 42 of the 116 cases, the patient or surrogate agreed to the clinician recommended DNR order following ethics consultation. In 72 of 74 of the remaining cases, ethics consultants recommended not offering CPR. Physicians went on to write a DNR order without patient/surrogate consent in 57 of those cases. There were no significant differences in age, race/ethnicity, country of origin, or functional status between patients where a DNR order was and was not placed without consent. Physicians were more likely to place a DNR order for patients believed to be imminently dying. The median time from DNR order to death was 4 days with a 90-day mortality of 88.2%. In this single-center cohort study, there was no evidence that patient demographic factors affected ethics consultants’ recommendation to withhold CPR despite patient/surrogate requests. Physicians were most likely to place a DNR order without consent for imminently dying patients. (shrink)

Among your closest associates is a certain human animal – a living, breathing, organism. You see it when you look in the mirror. When it is sick, you don't feel too well. Where it goes, you go. And, one thinks, where you go, it must follow. Indeed, you can make it move through sheer force of will. You bear, in short, an important and intimate relation to this, your animal. So too rest of us with our animals. Animalism says that (...) this relation is nothing short of identity. According to animalists, we do not only coincide with or constitute or inhabit or otherwise hang out with these close associates, our animals: we are them. In this article, I offer an opinionated take on what animalism might be and situate it against contemporary rivals. Then, I outline a simple case for animalism. Finally, I sketch non-standard routes for animalists to take in light of standard challenges. My goal in all of this is to open up some new avenues of animalist thinking. (shrink)

There are predicates and subjects. It is thus tempting to think that there are properties on the one hand, and things that have them on the other. I have no quarrel with this thought; it is a fine place to begin a theory of properties and property-having. But in this paper, I argue that one such theory—bare particularism—is false. I pose a dilemma. Either bare particulars instantiate the properties of their host substances or they do not. If they do not, (...) then bare particularism is both unmotivated and false. If they do, then the view faces a problematic—and, I shall argue, false—crowding consequence. (shrink)

Materialists about human persons think that we are material through and through—wholly material beings. Those who endorse materialism more widely think that everything is material through and through. But what is it to be wholly material? In this article, I answer that question. I identify and defend a definition or analysis of ‘wholly material’.

I introduce and argue for a Priority Principle, according to which we exemplify certain of our mental properties in the primary or non-derivative sense. I then apply this principle to several debates in the metaphysics and philosophy of mind.

Animalism is the view that we are animals: living, breathing, wholly material beings. Despite its considerable appeal, animalism has come under fire. Other philosophers have had much to say about objections to animalism that stem from reflection on personal identity over time. But one promising objection (the `Elimination Argument') has been overlooked. In this paper, I remedy this situation and examine the Elimination Argument in some detail. I contend that the Elimination Argument is both unsound and unmotivated.

Animalism is at once a bold metaphysical theory and a pedestrian biological observation. For according to animalists, human persons are organisms; we are members of a certain biological species. In this article, I introduce some heretofore unnoticed data concerning the interlocking interests of human persons and human organisms. I then show that the data support animalism. The result is a novel and powerful argument for animalism. Bold or pedestrian, animalism is true.

There is a new objection to the Consequence Argument for incompatibilism. I argue that the objection is more wide-ranging than originally thought. In particular: if it tells against the Consequence Argument, it tells against other arguments for incompatibilism too. I survey a few ways of dealing with this objection and show the costs of each. I then present an argument for incompatibilism that is immune to the objection and that enjoys other advantages.

In this paper, I will examine John Smeaton’s contribution to the vis viva controversy in Britain, focusing on how the hybridization of science, technology, and industry helped to establish vis viva, or mechanic power, as a measure of motive force. Smeaton, embodying the ‘hybrid expert’ who combined theoretical knowledge and practical knowhow, demonstrated that the notion of vis viva possessed a greater explanatory power than momentum, because it could be used to explain the difference in efficiency between overshot and undershot (...) waterwheels. Smeaton’s conclusions were correct since waterwheel efficiency was already measured in terms that were proportional to vis viva, not momentum, as a result of the industrial applications of waterwheel technology, which favored measuring efficiency by the product of mass and vertical displacement. Toward the end of the eighteenth century, the loss of motive force in the inelastic collision driving the undershot wheel began to be seen as equivalent to the expenditure of labor in the manufacture of commodities, further underlining how strictly scientific conclusions about motive force could have their origin in industrial practices. (shrink)

Here's an interesting question: what are we? David Barnett has claimed that reflection on consciousness suggests an answer: we are simple. Barnett argues that the mereological simplicity of conscious beings best explains the Datum: that no pair of persons can itself be conscious. In this paper, I offer two alternative explanations of the Datum. If either is correct, Barnett's argument fails. First, there aren't any such things as pairs of persons. Second, consciousness is maximal; no conscious thing is a proper (...) part of another conscious thing. I conclude by showing how both moves comport with materialist theories of what we are and then apply them to another anti-materialist argument. (shrink)

According to the doctrine of animalism, we are animals in the primary and non-derivative sense. In this article, I introduce and defend a novel argument for the view.

Some strange cases have gripped philosophers of mind. They have been deployed against materialism about human persons, functionalism about mentality, the possibility of artificial intelligence, and more. In this paper, I cry “foul”. It’s not hard to think that there’s something wrong with the cases. But what? My proposal: their proponents ignore questions about composition. And ignoring composition is a mistake. Indeed, materialists about human persons, functionalists about mentality, and believers in the possibility of artificial intelligence can plausibly deploy moderate (...) theories of composition in defense of their views. And as it turns out, these strange cases are an interesting source of evidence for moderate theories of composition. (shrink)

According to theists, God is an immaterial thinking being. The main question of this article is whether theism supports the view that we are immaterial thinking beings too. I shall argue in the negative. Along the way, I will also explore some implications in the philosophy of mind following from the observation that, on theism, God’s mentality is in a certain respect magical.

Digital artifacts — humanly-constructed items that inhabit our computers and networks — suffer an unfortunate reputation as being virtual and therefore unreal, and all too easy to reproduce on the cheap. These features together prompt the question of this article: if digital artifacts can be reproduced for free, and if they are unreal, why do they have economic value at all? Using a focal case study of bitcoin — the most unreal digital artifact of them all, and one that has (...) been copied and pasted a thousand times over — I answer the question. Some digital artifacts can't be copied on the cheap, as it turns out, and they are real enough to be useful. (shrink)

Substance dualism is on the move. Though the view remains unfashionable, a growing and diverse group of philosophers endorse it on impressive empirical, religious, and purely metaphysical grounds. In this note, I develop and evaluate one conceptual argument for substance dualism. According to that argument, we may derive a conclusion about our nature from the mere fact that we have the concept of a spirit. The argument is intriguing and fruitful; but I shall contend that it is, nonetheless, unsound.

Some have it that wholes are, somehow, identical to their parts. This doctrine is as alluring as it is puzzling. But in this paper, I show that the doctrine is inconsistent with two widely accepted theses. Something has to go.

Making room for agency in a physical world is no easy task. Can it be done at all? In this article, I consider and reject an argument in the negative.

Materialists about human persons say that we are, and must be, wholly material beings. Substance dualists say that we are, and must be, wholly immaterial. In this paper, I take issue with the “and must be” bits. Both materialists and substance dualists would do well to reject modal extensions of their views and instead opt for contingent doctrines, or doctrines that are silent about those modal extensions. Or so I argue.

In this article, I focus on internal dimensions of moral responsibility. I argue that if such dimensions are real -- and it seems they are -- then moral responsibility is compatible with determinism.

Warrant is what fills the gap between mere true belief and knowledge. But a problem arises. Is there just one condition that satisfies this description? Suppose there isn’t: can anything interesting be said about warrant after all? Call this the uniqueness problem. In this paper, I solve the problem. I examine one plausible argument that there is no one condition filling the gap between mere true belief and knowledge. I then motivate and formulate revisions of the standard analysis of warrant. (...) Given these revisions, I argue that there is, after all, exactly one warrant condition. (shrink)

The continental tradition in philosophy has gotten more "materialistic" over the last two hundred years. This has resulted from a combination of some very specific moves with regard to the epistemological parameters of understanding and the assertion that ideas may have material force in history. Therefore, the materialism within the continental tradition is not a materiality of being, but a materiality of understanding and action. Such an inquiry opens up space between the activities of sensation and the mental faculty of (...) cognition. 'I think, therefore I am,' is not an empirical statement, but a statement of cognition. It is assumed that this distinction is at the core of continental philosophy. Cognition is always interpretive. Experience is the start of cognition, but not its final product. Our cognitions cannot be separated from our experience of the physical, social, and cultural environment around us. The symbolic nature of language reinforces the interpretive nature of our thoughts and ideas. Our language is, therefore, always projecting an implicit image of the world. Language is, therefore, always political. The materiality of these cognitive world-views is manifested in two ways. First, in their formation. They are the products of sensual contact with the world. Second, in their effects. They move people. It is a picture of the world which serves to shape the content and character of human behavior. Whether we want to call these phantoms of the mind, world-view, ideas, thoughts, cognitions, or any other term, the dual character of their materiality is secure. This work examines the threads of materialist ideas running through the efforts of some major authors in the continental tradition in philosophy. A model of materialism is constructed in Chapter One and used to assess the materialist elements in works from Kant, Marx, Weber, Nietzsche, and contemporary poststructuralism. The work demonstrates the evolution of materialist thinking within the tradition and asserts an evolving and developing articulation of materialism in relation to the thoughts and activities of human beings." -- Publisher's description. (shrink)

Recent research in epidemiology has identified a number of factors beyond access to medical care that contribute to health disparities. Among the so-called socioeconomic determinants of health are income, education, and the distribution of social capital. One factor that has been overlooked in this discussion is the effect that stigmatization can have on health. In this paper, I identify two ways that social stigma can create health disparities: directly by impacting health-care seeking behaviour and indirectly through the internalization of negative (...) interpersonal judgments. I then argue that social arrangements that foster self-respect can reduce the impact of stigmatization on health disparities. I conclude by showing how John Rawls' conception of justice can be used to address the intersection of stigma, health, and self-respect, in contrast to critics of his position, who have seen him as excessively focused on the allocation of material goods. (shrink)

Research indicates that emotions are predictive of sports performance. The application of emotion research to practice is that intervention strategies can be used to change emotions to enhance performance. The present study examined emotional profiles associated with successful performance. A review of studies indicate that there are general trends, that is, high activation emotions such as excitement and vigor tend to associate with good performance and low activation unpleasant emotions such as depression and dejection tend to associate with poor performance. (...) Studies show mixed results for high activation unpleasant emotions. Athletes like to feel emotions that can be functional, and so some athletes will seek to increase or sustain relatively high levels of anger or anxiety if they believe they are helpful for performance. It is proposed that practitioners identify individual emotion-performance relationships and examine underlying beliefs associated with each emotion. (shrink)

I raise a puzzle concerning Destinism -- the view that that the only things we can do are those things we in fact do.

The target article's critique of the integrated information theory of consciousness is misguided on several fronts, which I hope are addressed in other comments, but here I focus on the connection between IIT and rigorous phenomenology, and IIT's connection to the psychophysics of perception.

The principles whereby the reason operates in ethically complicated situations has been subject to long-standing debates in Catholic Philosophy. A classic text which exemplifies this is Aquinas’s consideration of self-defensive killing. In this paper I clarify two central issues in double-effect reasoning debates surrounding this text. Both issues are connected to the seemingly simple but actually complex task of accounting for the “chosen means” of self-defense. The first issue is whether the “chosen means” are also able to be considered a (...) “proximate end,” to which the intention is directed. The second is determining whether the assailant’s death is related to the “chosen means” per se and therefore to the rest of the moral action. Resolving these issues will provide grounds for answering the broader question implicit in the situation of self-defensive killing: what is to be done when human actions would inevitably entail that some evil is instrumentally tied to realizing some good? (shrink)

The principles whereby the reason operates in ethically complicated situations has been subject to long-standing debates in Catholic Philosophy. A classic text which exemplifies this is Aquinas’s consideration of self-defensive killing. In this paper I clarify two central issues in double-effect reasoning debates surrounding this text. Both issues are connected to the seemingly simple but actually complex task of accounting for the “chosen means” of self-defense. The first issue is whether the “chosen means” are also able to be considered a (...) “proximate end,” to which the intention is directed. The second is determining whether the assailant’s death is related to the “chosen means” per se and therefore to the rest of the moral action. Resolving these issues will provide grounds for answering the broader question implicit in the situation of self-defensive killing: what is to be done when human actions would inevitably entail that some evil is instrumentally tied to realizing some good? (shrink)

The principles whereby the reason operates in ethically complicated situations has been subject to long-standing debates in Catholic Philosophy. A classic text which exemplifies this is Aquinas’s consideration of self-defensive killing. In this paper I clarify two central issues in double-effect reasoning debates surrounding this text. Both issues are connected to the seemingly simple but actually complex task of accounting for the “chosen means” of self-defense. The first issue is whether the “chosen means” are also able to be considered a (...) “proximate end,” to which the intention is directed. The second is determining whether the assailant’s death is related to the “chosen means” per se and therefore to the rest of the moral action. Resolving these issues will provide grounds for answering the broader question implicit in the situation of self-defensive killing: what is to be done when human actions would inevitably entail that some evil is instrumentally tied to realizing some good? (shrink)

Rustin Cohle, or Rust, is identifiable as being one character by looking at the script of True Detective and seeing the lines of text that only Rust will say. It would appear that the brute physicalist account is not sufficient for understanding how there are three different Rusts while each possesses many of the same physical characteristics as the others. In fact, one identifies at least three distinct non‐identical Rusts namely: Taxman, Belligerent, and Patient. Since they are mental instantiations and (...) not physical bodies, it is possible to have all three Rusts existing in the same body and, oddly, at the same time. By appealing to the psychological account, there is no restriction on how many Rusts there can be in a single body at any moment. Rust continues to be Rust so long as he has the same body, which can be identified as the body with the bird tattoo on the right arm. (shrink)

What might be called the “common approach” to teaching incorporates traditional retrieval exercises, such as tests and quizzes, as tools for evaluating retention. Given our course goals, many educators would recognize that the emphasis on retention is problematic. In addition to understanding information in the short-term, long-term understanding is also desirable. In this paper, I advocate for a new use of quizzes in philosophy courses that is intentionally designed to enhance long-term understanding of course material as well as to develop (...) skills that are applicable outside academic settings. These skills include learning to confront problems that do not have obvious solutions and revise beliefs in light of new information. I will specifically consider three iterations involved in developing this method. (shrink)

Philosophical and political discussions of health inequalities have largely focused on questions of justice. The general strategy employed by philosophers like Norman Daniels is to identify a certain state of affairs—in his case, equality of opportunity—and then argue that health disparities limiting an individual's or group's access to that condition are unjust, demanding intervention. Recent work in epidemiology, however, has highlighted the importance of socioeconomic status in creating health inequalities. I explore the ways in which theories of justice have been (...) expanded in light of this data, suggesting that more work is required if such theories are to provide an adequate framework for addressing health disparities. I conclude by sketching an alternative possibility for thinking about health disparities outside of the context of justice. (shrink)

Philosophical and political discussions of health inequalities have largely focused on questions of justice. The general strategy employed by philosophers like Norman Daniels is to identify a certain state of affairs—in his case, equality of opportunity—and then argue that health disparities limiting an individual's or group's access to that condition are unjust, demanding intervention. Recent work in epidemiology, however, has highlighted the importance of socioeconomic status in creating health inequalities. I explore the ways in which theories of justice have been (...) expanded in light of this data, suggesting that more work is required if such theories are to provide an adequate framework for addressing health disparities. I conclude by sketching an alternative possibility for thinking about health disparities outside of the context of justice. (shrink)

This chapter contains sections titled: A Philosophical Gaze into the Writings of the Zodiac Killer Who is the Zodiac Killer? Peek‐A‐Boo: You Are Doomed! This is the Zodiac Speaking Conclusion.

In this commentary on Denis Noble’s “The Illusions of the Modern Synthesis,” I discuss three illusions he argues exist within the Modern Synthesis. These illusions have the common theme of attempting to identify the correct way of understanding and describing biological systems. I agree with much of Noble’s claims, but offer the language of developmental systems theory as a friendly tool for moving the project forward.

In this paper I consider the thought of two Jewish existentialists from the first half of the 20th century, showing how their critique of pantheistic and panentheistic thinking grounded novel ideas about politics, history and human thought. In place of a concept of history directed towards a teleological redemption of suffering in the future, Lev Shestov (1866–1938) and Benjamin Fondane (1898–1944) abandoned notions of philosophical rationality in order to avow a ‘reversal’ of history according to which historical suffering could be (...) expiated through the unforeseeable powers of the divine. From here, I look at the work of a contemporaneous philosopher – Walter Benjamin (1892–1940) – for the way in which his own conception of history as ‘rescuing’ the past provides an alternative panentheism, one according to which political responsibility derives from a need to redeem God whose existence has been exiled throughout the mundane world. (shrink)

Despite the efforts of Bosanquet, Muirhead, Basch, and many others, it is still frequently stated or implied, in both popular and scholarly literature, that Hegel constructed his philosophy of the State with an eye to pleasing the reactionary and conservative rulers of Prussia in his day, and condoned, supported, and, through his teaching, became partly responsible for some of the most criticized features in “Prussianism” and even of present-day National-Socialism.5 Ijn this article I propose to give reasons for denying that (...) Hegel the man is justly accused of servility to the Prussian Government, and that there is any warrant in the text of his Philosophie des Rechts for the charge that Hegel the philosopher was an exponent of “Prussianism” and “ frightfulness.”. (shrink)

Microbiologists are transitioning from the study and characterization of individual strains or species to the profiling of whole microbiomes and microbial ecology. Equipped with high-throughput methods for studying the taxonomic and functional characteristics of diverse samples, they are just beginning to encounter the conceptual, theoretical, and experimental problems of comparing taxonomy to function, and extracting useful measures from such comparisons. Although still unresolved, these problems are well studied in macro-ecology and are reiterated here as an historical precautionary for microbial ecologists. (...) Beyond expected and unresolved terminological vagueness, we argue that assessments and comparisons of taxonomic and functional profiles in micro-ecology suffer from theoretically unresolvable arbitrariness and ambiguities. We divide these into problems of scale, individuation, and commensurability. We argue that there is no technically/theoretically “correct” scale, individuation, or comparison of taxonomy and function, but there are nonetheless better and worse methodologies for profiling. (shrink)