Copyright © 2015 by the Society of Criti. Objective: Global lung stress varies considerably with low tidal volume ventilation for acute respiratory distress syndrome. High stress despite low tidal volumes may worsen lung injury and increase risk of death. No widely available parameter exists to assess global lung stress. We aimed to determine whether the volume delivered during a recruitment maneuver is inversely associated with lung stress and mortality in acute respiratory distress syndrome. Design: Substudy of an acute respiratory distress (...) syndrome clinical trial on esophageal pressure-guided positive end-expiratory pressure titration. Setting: U.S. academic medical center. Patients: Forty-two patients with acute respiratory distress syndrome in whom airflow, airway pressure, and esophageal pressure were recorded during the recruitment maneuver. Interventions: A single recruitment maneuver was performed before initiating protocol-directed ventilator management. Recruitment maneuvers consisted of a 30-second breath hold at 40 cm H2O airway pressure under heavy sedation or paralysis. VRM was calculated by integrating the flow-time waveform during the maneuver. End-inspiratory stress was defined as the transpulmonary pressure during end-inspiratory pause of a tidal breath and tidal stress as the transpulmonary pressure difference between end-inspiratory and end-expiratory pauses. Measurements and Main Results: VRM ranged between 7.4 and 34.7 mL/kg predicted body weight. Lower VRM predicted high end-inspiratory and tidal lung stress. After adjusting for Pao2/Fio2 and either driving pressure, tidal volume, or plateau pressure and positive end-expiratory pressure, VRM remained independently associated with both end-inspiratory and tidal stress. In unadjusted analysis, low VRM predicted increased risk of death. VRM remained significantly associated with mortality after adjusting for study arm. Conclusions: Low VRM independently predicts high lung stress and may predict risk of death in patients with acute respiratory distress syndrome. (shrink)

The US neutrino community gathered at the Workshop on the Intermediate Neutrino Program at Brookhaven National Laboratory February 4-6, 2015 to explore opportunities in neutrino physics over the next five to ten years. Scientists from particle, astroparticle and nuclear physics participated in the workshop. The workshop examined promising opportunities for neutrino physics in the intermediate term, including possible new small to mid-scale experiments, US contributions to large experiments, upgrades to existing experiments, R&D plans and theory. The workshop was organized into (...) two sets of parallel working group sessions, divided by physics topics and technology. Physics working groups covered topics on Sterile Neutrinos, Neutrino Mixing, Neutrino Interactions, Neutrino Properties and Astrophysical Neutrinos. Technology sessions were organized into Theory, Short-Baseline Accelerator Neutrinos, Reactor Neutrinos, Detector R&D and Source, Cyclotron and Meson Decay at Rest sessions.This report summarizes discussion and conclusions from the workshop. (shrink)

The spectacular development of medical knowledge over the last two centuries has brought intrusive advances in the capabilities of medical technology. These advances have been remarkable over the last century, but especially over the last few decades, culminating in such high technology interventions as heart transplants and renal dialysis. These increases in medical powers have attracted societal interest in acquiring more such knowledge. They have also spawned concerns regarding the use of human subjects in research and regarding the byproducts of (...) basic research as in the recent recombinant DNA debate. As a consequence of the development of new biomedical knowledge, physicians and biomedical scientists have been placed in positions of new power and responsibility. The emergence of this group of powerful and knowledgeable experts has occasioned debates regarding the accountability of physicians and biomedical scientists. But beyond that, the very investment of resources in the acquisition of new knowledge has been questioned. Societies must decide whether finite resources would not be better invested at this juncture, or in general, in the alleviation of the problems of hunger or in raising general health standards through interventions which are less dependent on the intensive use of high technology. To put issues in this fashion touches on philosophical notions concerning the claims of distributive justice and the ownership of biomedical knowledge. (shrink)

Proceedings of the eighth trans-disciplinary symposium on philosophy and medicine held at Farmington, Connecticut, November 9-11,1978.

The concept 'health' is ambiguous [18,9, 11]. The concept 'mental health' is even more so. 'Health' compasses senses of well-being, wholeness, and sound ness that mean more than the simple freedom from illness - a fact appreci ated in the World Health Organization's definition of health as more than the absence of disease or infirmity [7]. The wide range of viewpoints of the con tributors to this volume attests to the scope of issues placed under the rubric 'mental health. ' (...) These papers, presented at the Fourth Symposium on Philos ophy and Medicine, were written and discussed within a broad context of interests concerning mental health. Moreover, in their diversity these papers point to the many descriptive, evaluative, and, in fact, performative functions of statements concerning mental health. Before introducing the substance of these papers in any detail, I want to indicate the profound commerce between philosophical and psychological ideas in theories of mental health and disease. This will be done in part by a consideration of some conceptual developments in the history of psychiatry, as well as through an analysis of some of the functions of the notions of mental illness and health. 'Mental health' lays a special stress on the wholeness of human intuition, emotion, thought, and action. (shrink)

in a scientific way, and takes the patient and his family into his confidence. Thus he learns something from the sufferer, and at the same time instructs the invalid to the best of his power. He does not give his prescriptions until he has won the patient's support, and when he has done so, he steadilY aims at producing complete restoration to health by persuading the sufferer in to compliance (Laws 4. 720 b-e, [28]). This passage shows the perennial nature (...) of the problems of treating the patient as a person. It shows as well the historical'depth of philosophical interest in medicine. The history of philosophy includes more reflections upon medical ethics than the casual reader might suspect. Many of these reflections are pertinent to contemporary issues such as abortion and population control. Plato, for example, recommends abortion in cases of incest (Republic 5. 461c); and Aristotle argues for letting seriously deformed children die, while forbidding infanticide as a means of popUlation control, suggesting instead the use of early abortions. 'As to the exposure in rearing of children, let there be a law that no deformed child shall live, but that on the ground of an excess in the number of children... let abortion be procured before sense and life have begun; what mayor may not be lawfully done in these cases depends on the question of life and sensation' (Politics VII, 16,335 b20-26, [4]). (shrink)

Proceedings of the second trans-disciplinary symposium on philosophy and medicine held at Farmington, Connecticut, May 15-17, 1975.

This is the first book to offer the best essays, articles, and speeches on ethics and intelligence that demonstrate the complex moral dilemmas in intelligence collection, analysis, and operations. Some are recently declassified and never before published, and all are written by authors whose backgrounds are as varied as their insights, including Robert M. Gates, former Director of the Central Intelligence Agency; John P. Langan, the Joseph Cardinal Bernardin Professor of Catholic Social Thought at the Kennedy Institute of Ethics, Georgetown (...) University; and Loch K. Johnson, Regents Professor of Political Science at the University of Georgia and recipient of the Owens Award for contributions to the understanding of U.S. intelligence activities. Creating the foundation for the study of ethics and intelligence by filling in the gap between warfare and philosophy, this is a valuable collection of literature for building an ethical code that is not dependent on any specific agency, department, or country. (shrink)

The philosophy of medicine cum bioethics has become the socially recognized source for moral and epistemic direction in health-care decision-making. Over the last three decades, this field has been accepted politically as an authorized source of guidance for policy and law. The field's political actors have included the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, the Department of Health, Education, and Welfare, the President's Commission for the Study of Ethical Problems in Medicine and Biomedical (...) and Behavioral Research, the National Bioethics Advisory Commission, and the new Council on Bioethics; these groups and agencies have set forth rules on issues ranging from the role of humans in biomedical research to the production of human embryos for research, the definition of death, and the permissibility of human cloning. The members of the field are not just scholars and teachers in an academic realm directed to both theoretical and applied issues. They are, in addition, practitioners of a conceptual and moral trade that possesses a legal and political standing. This essay critically addresses the sudden emergence of bioethics as a societally recognized source of moral guidance, a source replete with authorized moral experts. Attention is directed to moral and conceptual assumptions that have led the philosophy of medicine, and especially bioethics, to acquire a quasi-juridical/political role in guiding clinical choices, framing health-care policy, and directing court holdings. (shrink)

Instead of benefitting from open meetings and public discussions, the Clintons drafted their health care plan in private and asked that it be accepted in haste. They advance an ideology that claims we can receive the best care for all without any increase in cost or rationing, and then they use "ethicists" to justify this ideology through a supposedly common morality. However, there is no such common morality. In the context of American pluralism, one must look to the actual consent (...) of the governed and recognize the limits on state authority. The result will be a two tiered system of health care, with a basic tier focusing on cost-effective care for the poor that eliminates suffering rather than equalizing inputs, and a space for collateral private insurance. Keywords: Clinton health plan, egalitarianism of envy, egalitarianism of altrusim, limited democracy, moral pluralism CiteULike Connotea Del.icio.us What's this? (shrink)

Sally Gadow influenced our work when we first began exploring the meaning of nursing philosophically. In this article, we discuss two major themes of Gadow's work that have influenced us: existential advocacy and treating the body objectively without reducing the patient to the moral status of an object. Our treatment of these issues is appreciative but not uncritical. We argue that existential advocacy makes an important contribution to the meaning of nursing but that it cannot be its essential meaning. We (...) contend that Gadow, by making self‐direction the essence of care, tends to diminish the intersubjective nature of care. Then we show how Gadow recovers the intersubjective nature of care by disclosing how nurses and patients both become subjects in personal relationships, even when tending to the body objectively. We show how hermeneutic phenomenology, which we favour, can contribute to Gadow's existential phenomenology by using examples from nursing practice to disclose the meaning of nursing. Gadow's major contribution to our work has been in the ways her work has evoked creative thought from us concerning the meaning of nursing. (shrink)

The epistemological and sociological consequences of post-modernity include the inability to show moral strangers, in terms they can see as binding, the moral wrongness of activities such as abortion. Such activities can be perceived as morally disordered within a content-full moral narrative, but not outside of the context it brings. Though one can salvage something of the Enlightenment project of justifying a morality that can bind moral strangers, one is left with moral and metaphysical views that can be recognized as (...) impoverished and incomplete by those who live their lives within the embrace of a content-full moral narrative. The cardinal dualism of post-modemity is not that which separates mind from body, but the gulf between the morality binding moral strangers and that binding moral friends. Keywords: dualism, human embryo, personhood, post-modernity CiteULike Connotea Del.icio.us What's this? (shrink)

This chapter explores the view that religious claims have no legitimate place in the public forum. This exploration involves a critical re-examination of the public versus private distinction that would place religious commitments and grounds for action in a sphere isolated from that of public discourse and public choice. In the process, this chapter brings into question John Rawls's defense of a public discourse that seeks to marginalize religious commitments.

At the beginning of the twenty-first century, with vocations to the Christian religious orders of the West in marked decline, an authentic Christian presence in health care is threatened. There are no longer large numbers of women willing to offer their life labors bound in vows of poverty, chastity, and obedience, so as to provide a real preferential option for the poor through supporting an authentic Christian mission in health care. At the same time, the frequent earlier death of men (...) leaves a large number of widows, some in need of care and some able to provide care. Drawing on the role of widows sketched in I Timothy 2, one can envision Christian widows entering a life of prayer and service in health care settings. As female monastics, such widows could reintroduce a salient Christian presence in health care. How one ties this response to the message of I Timothy 2 will depend on one’s understanding of the status of Scripture, the significance of tradition, the nature of theological epistemology, the meaning of theology, the nature of the Church, and the ontology of gender. The position taken on these issues will define the character of a Christian bioethics of care. (shrink)

Rousseau argued forcefully for the superiority of a life lived in accordance with "the simplest impulses of nature," but his complex (some would say contradictory) understanding of the relationship between humans and "nature" is rarely cited as a source of inspiration by those seeking to reform the human relationship with the natural world. We argue that the complexities of Rousseau's political thought illuminate important connections between his works and the programs put forth by deep ecology. In Part One, we explore (...) the theoretical connections between Rousseau's account of the human fall from nature and major works of radical environmentalism. In Part Two, we offer suggestions for a reconsideration of Rousseau's work that may illuminate the paradoxical political requirements of deep ecology's recommendations for a more ecological human life. We hope to illustrate how a careful reading of Rousseau's work may serve as the basis for fruitful questioning of environmentalist thought. (shrink)

Once God is no longer recognized as the ground and the enforcer of morality, the character and force of morality undergoes a significant change, a point made by G.E.M. Anscombe in her observation that without God the significance of morality is changed, as the word criminal would be changed if there were no criminal law and criminal courts. There is no longer in principle a God's-eye perspective from which one can envisage setting moral pluralism aside. In addition, it becomes impossible (...) to show that morality should always trump concerns of prudence, concerns for one's own non-moral interests and the interests of those to whom one is close. Immanuel Kant's attempt to maintain the unity of morality and the force of moral obligation by invoking the idea of God and the postulates of pure practical reason are explored and assessed. Hegel's reconstruction of the status of moral obligation is also examined, given his attempt to eschew Kant's thing-in-itself, as well as Kant's at least possible transcendent God. Severed from any metaphysical anchor, morality gains a contingent content from socio-historical context and its enforcement from the state. Hegel's disengagement from a transcendent God marks a watershed in the place of God in philosophical reflections regarding the status of moral obligations on the European continent. Anscombe is vindicated. Absent the presence of God, there is an important change in the force of moral obligation. (shrink)

Where Friedrich Schleiermacher left off, Christopher Bruell has dared to set forth. Schleiermacher was the last thinker about Plato to present an order in which the dialogues should be read, on the assumption that an author as careful as Plato must have arranged his diverse works in an intentional order. In 1839 the philologist Karl Friedrich Hermann transformed Schleiermacher’s order of exposition, as intended by Plato, into an order of development of Plato’s thought. Ever since, Platonic scholars have expended more (...) effort in arguing about the order of the dialogues than in anything else. (shrink)

This is an analysis of the relation of green to nineteenth century thought. the author believes that green stands for three ideas. first, he is the major nineteenth century critic of utilitarianism. second, he is the main critic of laissez-faire individualism. third, he is the major critic of empiricism. green believed that experience is identical with thought; the real world is the intelligible world. the human mind, in knowing, establishes relations with the eternal mind. the author concludes that green is (...) both a platonist and an augustinian, eliminating particulars, or feelings, from philosophical importance. (staff). (shrink)

In lieu of an abstract, here is a brief excerpt of the content:358 HISTORY OF PHILOSOPHY und k6nnen es nur sein. Das Gleiche ist der Fall mit den Erfahrungstatsachen des wissenschaftlichen Versuches und im Grunde aller Wissenschaft gibt es nichts anderes und kann es nichts anderes geben. Mag ein gewandter Dialektiker die Voraussetzungen, yon denen er ausgeht, noch so sehr durcheinanderwirbeln, sie verbinden und zu Schliissen aufeinandertiirmen: Was er erhiilt, wird stets wieder eine Aussage sein. Niemals wird er zu einem (...) Gesetze gelangen, das lauten wiirde: Tue dies! oder Tue dies nicht! also zu einem Satze, der dem sittlichen Gesetze entsprechen oder ibm entgegenstehen kSnnte,r Kann Morscher dann noch immer behaupten, dass Poincar6 nur kategorische Syllogismen oder nur Schhssfolgerungen mit gerade Priimissen im Sinne hatte? Wir sind dem t3bersetzer eine Ehrenrettung schuldig: wenn er hier "syllogisme" mit "logischer Schluss" iibersetzt hat, hat er keinen Fehler begangen, es trifft ihn nicht der Tadel, durch eine scblechte Ubersetzung eine Legende hervorgerufen zu haben. Morscher soUte jedoch nicht, wenn er "syllogisme" liest, "kategorischer Syllogismus" verstehen, lind bei geistesgeschichtlichen Diskussionen immer den hermeneutisch relevanten Kontext beachten, d.h. wnigstens den Absatz, den er gerade analysiert, zu Ende lesen. Es liisst sich rticht daran zweifeln, dass Hare mit Recht [PR] Poincar6 zuschreibt. Nicht ganz sicher bin ich, ob Poincar6, wenn er sah und es ausdriicklich sagte, dass die iiblichen logischen Regeln fiir Imperativfolgerung nicht anwendbar sind, damit auch gleichzeitig die Entwicklung einer Imperativlogik (Normenlogik) forderte, oder ob er sich dieser programmatischen Konsequenz nicht ganz bewusst war. OTAWEINBERGER Universitiit Graz RUSSELL'S REALIST THEORY OF REMOTE MEMORY In a paper on Bertrand Russell's theory of memory1 David Pears undertakes to amend certain aspects of his version of Russell's theory of memory which he had presented in his Bertrand Russell and the British Tradition in Philosophy. ~ In that work Pears had attributed to Russell an extreme realist theory of memory from 1905 through 1918, i.e., a general theory of memory according to which the mind maintains direct contact by the dual relation of acquaintance with past sense-data. 3 This, he now believes, is historically incorrect in view of two of Russell's lesser known papers which have since come to his attention and which make it clear that in 1915 Russell held the extreme realist account only in connection with immediate memory--i.e., with memory within what is often called the specious present--and that as regards remote memory--i.e., memory of things not very recent and, so, outside the specious present--past sense-data 7 Poincare, Letzte Gedanken, aus dem FranzSsischen iibersetzt yon Karl Lichteneeker (Leipzig : Akademische Verlagsgesellschaft, 1913),pp. 226 f. 1 D. F. Pears, "Russell's Theories of Memory 1912-1921," in Bertrand Russell's Philosophy, ed. George Nakhnikian (New York: Harper and Row, 1974), pp. 117-137. The papers are from the Indiana University Russell centenary conference, 1972. 2 (London: Collins~I967), pp. 7I, 181-182. 3 Ibid. NOTES AND DISCUSSIONS 359 were knowable only by description and not by acquaintance.4 But Pears still argues, as against J. O. Urmson,5 that Russell did hold the realist theory of remote memory before 1915, although he was "changing his mind" in that year and, by 1917 ("The Philosophy of Logical Atomism"), had definitely abandoned the theory,e I believe that Pears is partly right about this matter: Russell almost certainly did hold a realist theory of remote memory before 1915. However, it can be shown, I think, that the theory was abandoned, not in 1915 or later, but in 1914. Pears shows beyond any reasonable doubt that Russell held a realist theory of remote memory in 1912. The strongest evidence may be found in a passage in Problems of Philosophy: There is some danger of confusion as to the nature of memory, owing to the fact that memory of an object is apt to be accompanied by an image of the object, and yet the image cannot be what constitutes memory. This is easily seen by merely noticing that the image is in the present, whereas what is remembered is known to be in the past. Moreover, we are certainly able to some extent to compare our image with the object remembered, so that we often know, within... (shrink)