Objective Futile treatment, which by definition cannot benefit a patient, is undesirable. This research investigated why doctors believe that treatment that they consider to be futile is sometimes provided at the end of a patient9s life. Design Semistructured in-depth interviews. Setting Three large tertiary public hospitals in Brisbane, Australia. Participants 96 doctors from emergency, intensive care, palliative care, oncology, renal medicine, internal medicine, respiratory medicine, surgery, cardiology, geriatric medicine and medical administration departments. Participants were recruited using purposive maximum variation sampling. (...) Results Doctors attributed the provision of futile treatment to a wide range of inter-related factors. One was the characteristics of treating doctors, including their orientation towards curative treatment, discomfort or inexperience with death and dying, concerns about legal risk and poor communication skills. Second, the attributes of the patient and family, including their requests or demands for further treatment, prognostic uncertainty and lack of information about patient wishes. Third, there were hospital factors including a high degree of specialisation, the availability of routine tests and interventions, and organisational barriers to diverting a patient from a curative to a palliative pathway. Doctors nominated family or patient request and doctors being locked into a curative role as the _main_ reasons for futile care. Conclusions Doctors believe that a range of factors contribute to the provision of futile treatment. A combination of strategies is necessary to reduce futile treatment, including better training for doctors who treat patients at the end of life, educating the community about the limits of medicine and the need to plan for death and dying, and structural reform at the hospital level. (shrink)

ObjectiveTo increase knowledge of how doctors perceive futile treatments and scarcity of resources at the end of life. In particular, their perceptions about whether and how resource limitations influence end-of-life decision making. This study builds on previous work that found some doctors include resource limitations in their understanding of the concept of futility.SettingThree tertiary hospitals in metropolitan Brisbane, Australia.DesignQualitative study using in-depth, semistructured, face-to-face interviews. Ninety-six doctors were interviewed in 11 medical specialties. Transcripts of the interviews were analysed using thematic (...) analysis.ResultsDoctors’ perceptions of whether resource limitations were relevant to their practice varied, and doctors were more comfortable with explicit rather than implicit rationing. Several doctors incorporated resource limitations into their definition of futility. For some, availability of resources was one factor of many in assessing futility, secondary to patient considerations, but a few doctors indicated that the concept of futility concealed rationing. Doctors experienced moral distress due to the resource implications of providing futile treatment and the lack of administrative supports for bedside rationing.ConclusionsDoctors’ ability to distinguish between futility and rationing would be enhanced through regulatory support for explicit rationing and strategies to support doctors’ role in rationing at the bedside. Medical policies should address the distinction between resource limitations and futility to promote legitimacy in end-of-life decision making. (shrink)

Traditionally, this puzzle has been solved in various ways. Aristotle, for example, distinguished between “accidental” and “essential” changes. Accidental changes are ones that don't result in a change in an objects' identity after the change, such as when a house is painted, or one's hair turns gray, etc. Aristotle thought of these as changes in the accidental properties of a thing. Essential changes, by contrast, are those which don't preserve the identity of the object when it changes, such as when (...) a house burns to the ground and becomes ashes, or when someone dies. Armed with these distinctions, Aristotle would then say that, in the case of accidental changes, (1) and (2) are both false—a changing thing can really change one of its “accidental properties” and yet literally remain one and the same thing before and after the change. (shrink)

[Stephen Yablo] The usual charge against Carnap's internal/external distinction is one of 'guilt by association with analytic/synthetic'. But it can be freed of this association, to become the distinction between statements made within make-believe games and those made outside them-or, rather, a special case of it with some claim to be called the metaphorical/literal distinction. Not even Quine considers figurative speech committal, so this turns the tables somewhat. To determine our ontological commitments, we have to ferret out all traces of (...) nonliterality in our assertions; if there is no sensible project of doing that, there is no sensible project of Quinean ontology. /// [Andre Gallois] I discuss Steve Yablo's defence of Carnap's distinction between internal and external questions. In the first section I set out what I take that distinction, as Carnap draws it, to be, and spell out a central motivation Carnap has for invoking it. In the second section I endorse, and augment, Yablo's response to Quine's arguments against Carnap. In the third section I say why Carnap's application of the distinction between internal and external questions runs into trouble. In the fourth section I spell out what I take to be Yablo's version of Carnap. In the last I say why that version is especially vulnerable to the objection raised in the second. (shrink)

Breastfeeding remains an understudied topic in research and theorizing about reproductive experience and women's bodies. This article reports on women's experiences of breastfeeding in public as revealed through in-depth interviews with 51 women. The current construction of the good maternal body requires women to carefully manage the performance of breastfeeding in specific ways and with particular attention to the dominant notion of a sexualized rather than nurturing breast. Women accommodate to, and resist, the perceived boundaries of the good maternal body (...) through their breastfeeding behaviors. (shrink)

According to an externalist theory of content the content of an individual’s thoughts and the meaning of her words need not supervene on her intrinsic history. Two individuals may be intrinsically exactly alike yet entertain different thoughts, and attach different meanings to the words they use. ETC, which has been most notably defended by Saul Kripke, Hilary Putnam and Tyler Burge, has attained the status of current orthodoxy. Nevertheless, some maintain that combining ETC with the premisses that we have privileged (...) access to our intentional states yields a surprising conclusion. It yields the conclusion that we can have a priori knowledge of features of the external world that seem only accessible to empirical investigation. Call the argument from ETC and privileged access to this conclusion the main argument. Some take the main argument to be a reductio of ETC. Since we have privileged access to our intentional states, and lack the a priori knowledge attributed by the main argument, ETC is false. Some take the main argument to refute the premisses that we have privileged access to those intentional states falling within the scope of ETC. Others see the main argument as a refutation of external world scepticism. We will show that the main argument does not support any of these interesting conclusions. We will show that the main argument does not threaten to restrict privileged access, refute external world scepticism, or constitute a reductio of ETC. More exactly, we will show that the most defensible version of ETC, even when combined with the premiss that we have unrestricted privileged access to our intentional states, yields no a priori knowledge of the external world. (shrink)

As a number of philosophers have observed, our knowledge of what is passing through our own minds appears to be quite different to our knowledge of other things. I do not, it seems, need to accumulate evidence in order to know what psychological states I am in. 1 Without relying on evidence I am able to effortlessly attribute to myself beliefs, desires, intentions, hopes, fears, and a host of other psychological states. The distinctive knowledge we have of our own psychological (...) states is sometimes labeled privileged access. If ’privileged access’ means knowledge that is not evidentially based we certainly seem to have privileged access to some psychological states including those exhibiting intentionality.2 Nevertheless, some have questioned whether we do enjoy privileged access to our intentional states. One reason for doing so derives from the findings of psychologists. The time honored thesis that we have privileged access to our own psychological states is threatened by such findings (see especially Nesbitt and Wilson, 1977). Moreover, there is threat to privileged access from a different direction. It comes from a philosophical thesis commonly referred to as externalism. Externalism is the view that the content of an intentional state such as a belief is fixed by the environment external to the believer. Some externalists deny that externalism conflicts with privileged access. Donald Davidson and Tyler Bürge in particular have developed what might be called a minimalist account of privileged access which, they would claim, reconciles privileged access with externalism. An interesting feature of their account is that it suggests a defense of privileged access in the light of the psychological findings mentioned above. However, that is a topic for another paper. Here I will confine myself to assessing the Davidson Burge account of privileged access, and its implications for the relationship between privileged access and externalism. (shrink)

The child protection system in France has gradually changed along the lines of the laws enacted in 2002 and 2007 that reasserted the importance of the role played by the parents. Far from condemning the family, it henceforth seeks to provide it with accompaniment so as to ensure the child’s future reintegration. Grounded in psychoanalytical group and family theories, the article investigates the psychic function of the institution and (with case studies to support it) discusses what has to be done (...) to make arrangements within the therapeutic framework for families to make progress and maintain ties despite the absence of direct relations. For it is only after a real period of separation that work on the young person’s psychic group experience will enable the family to move forward. (shrink)

Occasions of Identity is an exploration of timeless philosophical issues about persistence, change, time, and sameness. Andre Gallois offers a critical survey of various rival views about the nature of identity and change, and puts forward his own original theory. He supports the idea of occasional identities, arguing that it is coherent and helpful to suppose that things can be identical at one time but distinct at another. Gallois defends this view, demonstrating how it can solve puzzles about (...) persistence dating back to the Ancient Greeks, and investigates the metaphysical consequences of rejecting the necessity and eternity of identities. (shrink)

In a recent paper, Michael Levin argues that both statements reporting causal relations and causal explanatory statements are extensional. We show that his argument for the extensionality of causal explanatory statements fails to establish that conclusion. His claim that certain 'because' statements are elliptical for statements of what he terms the 'causal explanatory' form is unsubstantiated. The argument for the referential transparency of the allegedly explanatory form, regardless of whether it is a distinct explanatory form, fails because of scope problems. (...) Finally, we argue that the apparent referential opacity of explanations, the attribution of certain kinds of properties to explanations, and our satisfaction with explanations in what appear to be disparate forms are best accounted for, not by the assumption of ellipticality of statements in various forms for statements in some inherently explanatory form, but rather by an account of explanation as a speech act, the success or failure of which may be affected by which of several co-referring expressions is employed. (shrink)

Background Current requirements for ethical research in Canada, specifically the standard of active or signed parental consent, can leave Indigenous children and youth with inequitable access to research opportunities or health screening. Our objective was to examine the literature to identify culturally safe research consent processes that respect the rights of Indigenous children, the rights and responsibilities of parents or caregivers, and community protocols. Methods We followed PRISMA guidelines and Arksey and O’Malley’s approach for charting and synthesizing evidence. We searched (...) MEDLINE, PsycINFO, ERIC, CINAHL, Google Scholar, Web of Science, Informit Indigenous Collection, Bibliography of Native North Americans, and Sociological Abstracts. We included peer-reviewed primary and theoretical research articles written in English from January 1, 2000, to March 31, 2022, examining Indigenous approaches for obtaining informed consent from parents, families, children, or youth. Eligible records were uploaded to Covidence for title and abstract screening. We appraised the findings using a Two-Eyed Seeing approach. These findings were inductively coded using NVivo 12 and analyzed thematically. Results We identified 2,984 records and 11 eligible studies were included after screening. Three key recommendations emerged: addressing tensions in the ethics of consent, embracing wise practices, and using relational approaches to consent. Tensions in consent concerned Research Ethics Board consent requirements that fall short of protecting Indigenous children and communities when culturally incongruent. Wise practices included allowing parents and children to consent together, land-based consenting, and involving communities in decision-making. Using relational approaches to consent embodied community engagement and relationship building while acknowledging consent for Indigenous children cannot be obtained in isolation from family and community. Conclusions Very few studies discussed obtaining child consent in Indigenous communities. While Indigenous communities are not a monolith, the literature identified a need for community-driven, decolonized consent processes prioritizing Indigenous values and protocols. Further research is needed to examine nuances of Indigenized consent processes and determine how to operationalize them, enabling culturally appropriate, equitable access to research and services for all Indigenous children. (shrink)

Zaller's model of public-opinion formation portrays the average citizen as an automaton who responds unthinkingly to elite cues. That is, once people have received information from political elites, they tend to abide by whatever their respective cue-givers dictate, since rejecting information is more cognitively costly than simply accepting it. Empirical research in psychology on priming supports this view of the citizen as a passive receiver of information. For example, people are likely to be unconsciously influenced by subtle cues and they (...) tend to base their opinions on the accessibility of information in memory. However, some citizens, under certain conditions, may be ?active processors? of information: actively interpreting it, elaborating on its implications, and negotiating its meaning. Whether or not Zaller's model is an accurate representation of the process of public-opinion formation depends substantially upon the inclusiveness of the researcher's views about what constitutes public opinion and how to study its determinants. (shrink)

I consider backtracking reasoning: that is, reasoning from backtracking counterfactuals such as if Hitler had won the war, he would have invaded Russia six weeks earlier. Backtracking counterfactuals often strike us as true. Despite that, reasoning from them just as often strikes us as illegitimate. A number of diagnoses have been offered of the illegitimacy of such backtracking reasoning which invoke the fixity of the past, or the direction of causation. I argue against such diagnoses, and in favor of one (...) that invokes a principle I call the fixity of reasons. Backtracking reasoning violates the fixity of reasons. But, the fixity of reasons is a principle that must be observed in order to engage in practical reasoning at all. (shrink)

Over the past decade AIDS research has turned toward the use of pharmacology in HIV prevention, including pre-exposure prophylaxis (PrEP): the use of HIV medication as a means of preventing HIV acquisition in those who do not have it. This paper explores the contradictory reasons offered in support of PrEP—to empower women, to provide another risk-reduction option for gay men—as the context for understanding the social meaning of the experimental trials that appear to show that PrEP works in gay men (...) and heterosexual couples but not single women. The PrEP debates reveal the different ideas about “demedicalization” in the earlier gay health and women’s health movements and highlight the relationship between health activism and critique of research ethics in the context of a global pharmaceutical market. (shrink)

In this challenging study, André Gallois proposes and defends a thesis about the character of our knowledge of our own intentional states. Taking up issues at the centre of attention in contemporary analytic philosophy of mind and epistemology, he examines accounts of self-knowledge by such philosophers as Donald Davidson, Tyler Burge and Crispin Wright, and advances his own view that, without relying on observation, we are able justifiably to attribute to ourselves propositional attitudes, such as belief, that we consciously (...) hold. His study will be of wide interest to philosophers concerned with questions about self-knowledge. (shrink)

Cultural narratives shape how we think about the world, including how we decide when the end of life begins. Hospice care has become an integral part of the end‐of‐life care in the United States, but as it has grown, its policies and practices have also imposed cultural narratives, like those associated with the “six‐month rule” that the majority of the end of life takes place in the final six months of life. This idea is embedded in policies for a range (...) of care practices and reimbursement processes, even though six months is not always a meaningful marker. In the case of people living with advanced dementia, six months is both too early in the trajectory to facilitate conversations and too late in the trajectory to ensure decision‐making capacity. This essay encourages scholars and policy‐makers to consider how cultural narratives may limit what they think is possible in care for people living with dementia. (shrink)

It has come to be widely accepted that jus post bellum includes responsibilities to rebuild. Consequently, duties to establish a sustainable peace are increasingly defined in terms of duties to protect and promote international human rights, including duties to effectively investigate human rights violations, to ensure access to effective remedy, and to transform institutional and legal contexts that have facilitated or sustained human abuse. But what are investigations by transitional bodies seeking when they take on these tasks? Often, investigators present (...) themselves as seeking the truth and claim value for their findings based on having produced a better description or explanation than was antecedently available. But is truth worth pursuing for its own sake in transitions from conflict or must it contribute to some other goal to be valuable? In what follows I argue that the value of truth in transitions from conflict lies in the role of truth in ascribing knowledge. The connection between truth and knowledge makes it important to preserve distinctively epistemological grounds for accepting and rejecting claims and narratives. These distinctively epistemological grounds explain how, if it is conceived of as adequate responsiveness to experience, truth is a legitimate and important goal in transitions from violence that is worth pursuing for its own sake. In particular, I argue that there is value in insisting that adequate responsiveness to experience serve as an arbiter in the reception of claims and narratives because when responsiveness to experience plays an arbitral role it becomes possible for bodies such as truth commissions to serve as vehicles by which groups may attain or ascribe knowledge. (shrink)

This chapter contains sections titled: Character of Claus Christmas Crowd Civic Claus Symbol of Supremacy? Common Claus.

The dynamics of knowledge transmission and acquisition, or how different aspects of culture are passed from one individual to another and how they are acquired and embodied by individuals, are central to understanding cultural evolution. In small-scale societies, cultural knowledge is largely acquired early in life through observation, imitation, and other forms of social learning embedded in daily experiences. However, little is known about the pathways through which such knowledge is transmitted, especially during middle childhood and adolescence. This study presents (...) new empirical data on cultural knowledge transmission during childhood. Data were collected among the Baka, a forager-farmer society in southeastern Cameroon. We conducted structured interviews with children between 5 and 16 years of age about group composition during subsistence activities. Children’s groups were generally diverse, although children tended to perform subsistence activities primarily without adults and with same-sex companions. Group composition varied from one subsistence activity to another, which suggests that the flow of knowledge might also vary according to the activity performed. Analysis of the social composition of children’s subsistence groups shows that vertical and oblique transmission of subsistence-related knowledge might not be predominant during middle childhood and adolescence. Rather, horizontal transmission appears to be the most common knowledge transmission strategy used by Baka children during middle childhood and adolescence, highlighting the importance of other children in the transmission of knowledge. (shrink)

[P]layers line up in a long line and hold hands. The player at the front of the line is the ‘head’ and the player at the end of the line is the ‘tail’.… The game begins when the head begins to run wildly in any direction, making sharp turns and quick double-backs.… The force created by the twists and turns will often send the tail of the whip flying.… It may be best for the tail to hold on with both (...) hands to keep from flying off the end. Sometimes, however, the tail will go flying no matter how hard they hold on... Be prepared to get dirty if you play this game!--"Crack the Whip: Party Game CentralIf the evolution of American health policy is compared to the children’s game of Crack the Whip, then there is no question that the Medicaid program is the tail of the line. When those at the head of the line start to move. Medicaid receives whatever shocks and unintended consequences result, and when the line “begins to run wildly in any direction,” it receives them faster and harder than the players at the center.Shocks also come from other sources. When the economy slumps, an epidemic arises, or a path in another part of the system becomes a cul-de-sac, new twists and turns occur, with Medicaid absorbing much of the change. (shrink)

André Gallois’s Occasions of Identity is a detailed, well-written presentation and defense of one attempt to solve many of the recently much discussed puzzles in the metaphysics of material objects. It is engaging not only for Gallois’s ingenious attempt to defend his view that objects can be “occasionally identical”—identical at one time but not another —but for his discussion throughout of the puzzles and of alternative solutions. Gallois does a fine job of keeping the motivations for a (...) position, whether his own or others’, in view while working out details and responding to objections. Even where one disagrees, there is excellent food for thought and discussion here. (shrink)

By examining an exemplar sample of mental health nursing educational policies and related legislation, in this article, we trace the discursive production of madness as an “othered” identity category. We engage in a critical discourse analysis of mental health nursing education in Canada, drawing on provincial and federal policies and legislation as the main sources of data. Theoretically framed by critical posthumanism and mad studies, this article outlines how the mad subjectivity becomes decontextualized out of its identity‐based understanding and recontextualized (...) as an inferior category of “the human,” circulating within discourses of pedagogy, economics, law, and psychiatry. The article maps the intertextual nexus of the discourse of mental health nursing education, making visible the complex, the arbitrary, and the sometimes‐contradictory nature of the discipline's grappling with identity‐based mental health concepts. We close with several implications for nursing policy, education, and practice. (shrink)

La conceptualización del saber artesanal es compleja y requiere del reconocimiento epistemológico dentro del contexto sociocultural y económico en el que opera lo artesanal, donde es necesario resaltar el valor ancestral, pues, dentro del aprendizaje hay una transferencia de conocimiento tradicional cuando no hay una ruptura en la producción de sentido que se constituye.Por ello, esta investigación busca, por medio de un documental, visibilizar la labor que cumplen los artesanos y cesteros del municipio de Tocaima, Cundinamarca, logrando construir un espacio (...) de integración y capacitación donde sean los cesteros quienes se beneficien y logren transmitir los saberes de la cestería. (shrink)

This paper involves a case study of physicians working in an urban Midwestern region. It raises questions surrounding how physicians adapted to, encouraged and resisted the increasing presence of managed care in their work lives. The patterning of physician accommodation to managed care and the failure of physicians to mount any effective organized resistance in Metro has some important implications for theories about professional dominance and decline.