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)

At the turn of the 21st century, Susan Leigh Anderson and Michael Anderson conceived and introduced the Machine Ethics research program, that aimed to highlight the requirements under which autonomous artificial intelligence systems could demonstrate ethical behavior guided by moral values, and at the same time to show that these values, as well as ethics in general, can be representable and computable. Today, the interaction between humans and AI entities is already part of our everyday lives; in the (...) near future it is expected to play a key role in scientific research, medical practice, public administration, education and other fields of civic life. In view of this, the debate over the ethical behavior of machines is more crucial than ever and the search for answers, directions and regulations is imperative at an academic, institutional as well as at a technical level. Our discussion with the two inspirers and originators of Machine Ethics highlights the epistemological, metaphysical and ethical questions arising by this project, as well as the realistic and pragmatic demands that dominate artificial intelligence and robotics research programs. Most of all, however, it sheds light upon the contribution of Susan and Michael Anderson regarding the introduction and undertaking of a main objective related to the creation of ethical autonomous agents, that will not be based on the “imperfect” patterns of human behavior, or on preloaded hierarchical laws and human-centric values. (shrink)

Many problems of inequality in developing countries resist treatment by formal egalitarian policies. To deal with these problems, we must shift from a distributive to a relational conception of equality, founded on opposition to social hierarchy. Yet the production of many goods requires the coordination of wills by means of commands. In these cases, egalitarians must seek to tame rather than abolish hierarchy. I argue that bureaucracy offers important constraints on command hierarchies that help promote the equality of workers in (...) bureaucratic organizations. Bureaucracy thus constitutes a vital if limited egalitarian tool applicable to developing and developed countries alike. (shrink)

What is the proper role of politics in higher education? Many policies and reforms in the academy, from affirmative action and a multicultural curriculum to racial and sexual harassment codes and movements to change pedagogical styles, seek justice for oppressed groups in society. They understand justice to require a comprehensive equality of membership: individuals belonging to different groups should have equal access to educational opportunities; their interests and cultures should be taken equally seriously as worthy subjects of study, their persons (...) treated with equal respect and concern in communicative interaction. Conservative critics of these egalitarian movements represent them as dangerous political meddling into the disinterested pursuit of knowledge. They cast the pursuit of equality as a threat to freedom of speech and academic standards. In response, some radical advocates of such programs agree that the quest for equality clashes with free speech, but view this as an argument for sacrificing freedom of speech. (shrink)

Many problems of inequality in developing countries resist treatment by formal egalitarian policies. To deal with these problems, we must shift from a distributive to a relational conception of equality, founded on opposition to social hierarchy. Yet the production of many goods requires the coordination of wills by means of commands. In these cases, egalitarians must seek to tame rather than abolish hierarchy. I argue that bureaucracy offers important constraints on command hierarchies that help promote the equality of workers in (...) bureaucratic organizations. Bureaucracy thus constitutes a vital if limited egalitarian tool applicable to developing and developed countries alike. (shrink)

A staff photographer for the Ketchikan Daily News, Hall Anderson counted among his early influences photographers like Robert Frank and Henri Cartier-Bresson, who understood the visual bounty to be found in photographing the candid side of life. For more than twenty-five years, Anderson has brought this perspective to his photographic endeavors, both personal and professional, in the small town of Ketchikan in southeast Alaska. Still Rainin' Still Dreamin' showcases one hundred of Anderson's prize-winning black-and-white images, which collectively (...) chronicle three decades of life in Ketchikan, spanning its transition from a timber- and fishing-based economy to one built on a booming tourism industry. From timber carnivals to election coverage to Fourth of July parades, Still Rainin' Still Dreamin' is a poignant celebration of the uncanny juxtapositions found in everyday life. (shrink)

Over time, according to popular and academic accounts, alternative trade initiatives [such as fair trade, organics, forest certification, and socially responsible investing ] almost invariably lose their oppositional stance and go mainstream. That is, they lose their alternative, usually peripheral, and often contrarian character. In this paper, I argue that this is not always the case and that the path to going mainstream is not always an unproblematic one. I observe that while scholars have documented various aspects of specific alternative (...) trade initiatives, little comparative work has been done to theorize their different trajectories. To advance the scholarship, I compare two alternative trade movements, fair trade and SRI, and develop three hypotheses—the relation motivations hypothesis, the material interests hypothesis, and the organization of credibility hypothesis—that explain why going mainstream has been so hotly contested in the fair trade movement but not the SRI movement. I articulate these hypotheses and evaluate their merits. (shrink)

A portrait of the influential western philosopher and writer is targeted to lay readers and seeks to clarify his ideas and influences, offering insight into the impact of his chronic ill health and insanity on his beliefs while challenging stereotypes that have been attributed to his character. 10,000 first printing.

In a recent articles David Mouton has argued that immortality is compatible with one sort of physicalism. I believe that he fails to establish this thesis and that, moreover, this article contains several misconceptions having to do with the topic of immortality.

Nelson Goodman (1906-2007) approached the arts and other kinds of knowledge as forms of symbolism. His principal aim in philosophy was to advance understanding and remove confusions by verbal analysis and logical constructions. Goodman's philosophical theories encompass nominalism, constructivism and a version of radical relativism. In his Languages of Art, Goodman sets forth distinctions among the various art according to differences in the forms of symbols employed. He contributed as well to arts education and to philosophy of the museum. His (...) performance work, "Hockey Seen: A Nightmare in Three Periods and Sudden Death embodies his aesthetic theories. (shrink)

Open peer commentary on the article “A Defence of Starmaking Constructivism: The Problem of Stuff” by Bin Liu. Abstract: I provide a brief account of key elements in Nelson Goodman’s starmaking constructivist philosophy and comment on Bin Liu’s defense of Goodman in the context of contemporary constructivist philosophy.

Presents a tribute to American philosopher Nelson Goodman who died on November 25, 1998 in Needham, Massachusetts. Contributions of Goodman to analytic philosophy; Career background; Range of interest from philosophy to art collecting; Major publications on the work of Goodman; Role of Goodman as a gallery director and private art collector.

Carlos Luna: Cuban Artist at the Crossroads is an essay appearing in the exhibition catalogue Pablo Picasso Ceramics, Carlos Luna Paintings for the exhibit of the same title installed at the Museum of Art/Fort Lauderdale from October 2, 2008 through February 23, 2009.