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)

The corporatization of U.S. health care has directed cost containment efforts toward scrutinizing the clinical decisions of physicians. This stimulated a variety of new utilization management interventions, particularly in hospital and managed care settings. Recent changes in fee-for-service medicine and physicians' traditional agency relationships with patients, purchasers, and insurers are examined here. New information systems monitoring of physician ordering behavior has already begun to impact on physician autonomy and the relationship of physicians to provider organizations in both for-profit and not-for-profit (...) sectors. As managed care practice settings proliferate, serious ethical questions will be raised about agency relationships with patients.This article examines health system dynamics altering the historical agency relationship between the physician and patient and eroding the traditional autonomy of the medical profession in the United States. The corporatization of medicine and the accompanying information systems monitoring of physician productivity is seen to account of such change, now posing serious ethical dilemmas. (shrink)

The existential analysis -- The death of dasein -- The timeliness of dasein -- The derivation of time -- The time of being.

In On the Origin of Species, Charles Darwin put forward his theory of natural selection. Conventionally, Darwin's argument for this theory has been understood as based on an analogy with artificial selection. But there has been no consensus on how, exactly, this analogical argument is supposed to work – and some suspicion too that analogical arguments on the whole are embarrassingly weak. Drawing on new insights into the history of analogical argumentation from the ancient Greeks onward, as well as on (...) in-depth studies of Darwin's public and private writings, this book offers an original perspective on Darwin's argument, restoring to view the intellectual traditions which Darwin took for granted in arguing as he did. From this perspective come new appreciations not only of Darwin's argument but of the metaphors based on it, the range of wider traditions the argument touched upon, and its legacies for science after the Origin. (shrink)

The sudden emergence of the COVID-19 pandemic brought global disruption to every aspect of society including healthcare, supply chain, the economy, and social interaction. Among the many emergent considerations were the safety and public health of the public, patients, essential workers, and healthcare professionals. In certain locations, clinical research was halted—or terminated—in deference to the immediate needs of patient care, and clinical trials focusing on the treatment and prevention of coronavirus infection were prioritized over studies focusing on other diseases. Difficult (...) decisions were made rapidly; flexibility and reconsideration were necessary not only because the intensity and severity of infection varied over time and by locale but also because knowledge of the disease and understanding of its treatment grew. Here we discuss the ethical challenges in decision-making and competing ethical tensions during the pandemic in an effort to advance future preparedness. (shrink)

Foundations of Economic Personalism is a series of three book-length monographs, each closely examining a significant dimension of the Center for Economic Personalism's unique synthesis of Christian personalism and free-economic market theory. In the aftermath of the momentous geo-political and economic changes of the late 1980s, a small group of Christian social ethicists began to converse with free-market economists over the morality of market activity. This interdisciplinary exchange eventually led to the founding of a new academic subdiscipline under the rubric (...) of economic personalism. These scholars attempt to integrate economic theory, history, and methodology with Christian personalism's stress upon human dignity, humane social structures, and social justice. This second volume in the series surveys the anthropological foundations to the disciplines of economics and moral theology. The first part of the book presents an overview of the German, French, and Polish branches of personalist thought. Particular attention is given to theological anthropology, especially as it is developed by such thinkers as Emmanuel Mounier, Max Scheler, Gabriel Marcel, Karol Wojtyla, and Emil Brunner. Part two surveys models of human nature that have been espoused by various schools of free-market thought—including mainstream neoclassical economics. In conclusion, the authors demonstrate how an expanded understanding of human nature can augment the ability of economic science to model and predict human behavior. (shrink)

Hare used his thesis of universalizability to generate specific normative results and a defense of utilitarianism. To accomplish the latter task, he enjoined that one consider oneself in various roles in a given situation, and that the concluding judgment must be one that is affirmable in any of the various roles. In effect this means that one must, says Hare, give equal weight to the interests of all involved parties, an axiom of utilitarianism. The paper argues that he did not (...) succeed. (shrink)

From Greek antiquity to the latest theories, this historical survey of political philosophy not only covers the major thinkers in the field but also explores the theme of how political philosophy relates to the nature of man. It illustrates how the great political thinkers have always grounded their political thought in what the author terms a "normative anthropology," which typically has not only ethical but metaphysical and/or theological components. Starting with the ancient Greek Sophists, author Michael J. White examines how (...) thinkers over the centuries have approached such political and philosophical concerns as justice, morality, and human flourishing, offering substantial studies of--among others--Plato, Aristotle, Cicero, Locke, Hobbes, Rousseau, Marx, and J. S. Mill. White highlights the impact of Christianity on political philosophy, illustrating the diversity of that impact by studies of Augustine, Aquinas, and Marsilius of Padua. Concluding with an in-depth analysis of John Rawls and contemporary liberal political philosophy, this text blends insight and information in a refreshing and useful manner. A brief Epilogue considers both the value and the limitations of political philosophy and its study. (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)

Numerical studies of the Hubbard model and its strong-coupling form, the t-J model, show evidence for antiferromagnetic, $d_{x^{\text{2}} - y^2 } $ -pairing and stripe correlations which remind one of phenomena seen in the layered cuprate materials. Here, we ask what these numerical results imply about various scenarios for the pairing mechanism.

According to a natural view of instrumental normativity, if you ought to do φ, and doing ψ is a necessary means for you to do φ, then you ought to do ψ. In “Instrumental Normativity: In Defense of the Transmission Principle,” Benjamin Kiesewetter defends this principle against certain actualist-inspired counterexamples. In this article I argue that Kiesewetter’s defense of the transmission principle fails. His arguments rely on certain principles—Joint Satisfiability and Reason Transmission—which we should not accept in the unqualified forms (...) needed to establish his conclusion. (shrink)

Working parents in are struggling to balance the demands of their occupation with those of childcare and homeschooling during the COVID-19 pandemic. Moreover, studies show that women are shouldering more of the burden and reporting greater levels of psychological distress, anxiety, and depression relative to men. However, research has yet to show that increases in psychological symptoms are linked to changes in stress during the pandemic. Herein, we conduct a small-N study to explore the associations between stress and psychological symptoms (...) during the pandemic among mothers using structural equation modeling, namely latent change score models. Thirty-three mothers completed questionnaires reporting current anxious and depressive symptoms, as well as stressful life experiences prior to-versus during the pandemic. Women endorsed significantly more stressful events during the pandemic, relative to the pre-pandemic period. Additionally, 58% of mothers scored as moderate-to-high risk for developing a stress-related physical illness in the near future because of their pandemic-level stress. Depressive symptoms were associated with the degree of change in life stress, whereas anxiety symptoms were more related to pre-pandemic levels of stress. The present study preliminarily sheds light on the nuanced antecedents to mothers’ experiences of anxious and depressive symptoms during the COVID-19 pandemic. Although further work is needed in larger, more diverse samples of mothers, this study highlights the potential need for appropriate policies, and prevention and intervention programs to ameliorate the effects of pandemics on mothers’ mental health. (shrink)

This paper proposes to reorient the philosophical debate about peer disagreement. The problem of peer disagreement is normally seen as a problem about the extent to which disagreement provides one with evidence against one's own conclusions. It is thus regarded as a problem for individual inquiry. But things look different in more collaborative contexts. Ethical norms relevant to those contexts make a difference to the epistemology. In particular, we argue that a norm of mutual answerability applies to us when we (...) engage in shared inquiry with others, and precludes us from treating one another's conflicting judgments as evidence relevant to the dispute. From this it follows that standard philosophical accounts of peer disagreement—e.g., the Equal Weight View and the Total Evidence View—presuppose that the disagreeing parties are in a sense alienated from one another. It's doubtful that such forms of alienated disagreement should be treated as the central case. (shrink)

Are predictions about how one will freely and intentionally behave in the future ever relevant to how one ought to behave? There is good reason to think they are. As imperfect agents, we have responsibilities of self-management, which seem to require that we take account of the predictable ways we're liable to go wrong. I defend this conclusion against certain objections to the effect that incorporating predictions concerning one's voluntary conduct into one's practical reasoning amounts to evading responsibility for that (...) conduct. There is, however, some truth to this sort of objection. To understand the legitimate role of self-prediction in practical reasoning, we need to distinguish instances of coping responsibly with an anticipated failure to behave as one ought, on the one hand, from mere acquiescence in one's flaws, on the other. I argue that, to draw this distinction, we must recognize certain limits on the use of self-prediction as a ground of choice. (shrink)

By introducing the concept of “mental data,” Palermos (2023) highlights an underappreciated aspect of data ethics that policymakers would do well to heed. Sweeping artificial intelligence (AI) legi...

In jurisdictions where voluntary assisted dying is legal, eligibility assessments, prescription and administration of a VAD substance are commonly performed by senior doctors. Junior doctors’ involvement is limited to a range of more peripheral aspects of patient care relating to VAD. In the Australian state of Victoria, where VAD has been legal since June 2019, all health professionals have a right under the legislation to conscientiously object to involvement in the VAD process, including provision of information about VAD. While this (...) protection appears categorical and straightforward, conscientious objection to VAD-related care is ethically complex for junior doctors for reasons that are specific to this group of clinicians. For junior doctors wishing to exercise a conscientious objection to VAD, their dependence on their senior colleagues for career progression creates unique risks and burdens. In a context where senior colleagues are supportive of VAD, the junior doctor’s subordinate position in the medical hierarchy exposes them to potential significant harms: compromising their moral integrity by participating, or compromising their career progression by objecting. In jurisdictions intending to provide all health professionals with meaningful conscientious objection protection in relation to VAD, strong specific support for junior doctors is needed through local institutional policies and culture. There are no data in this work. (shrink)

How, if at all, does one's intention to realize an end bear on the justification for taking the means to that end? Theories that allow that intending an end directly provides a reason to take the means are subject to a well-known "bootstrapping" objection. On the other hand, "anti-psychologistic" accounts—which seek to derive instrumental reasons directly from the reasons that support adopting the end itself—have unacceptable implications where an agent faces multiple rationally permissible options. An alternative, predictive, role for intention (...) in means-end reasoning is considered and rejected. A new proposal is then developed, according to which instrumental reasons are not merely reasons to perform an act necessary for a given end, but to perform the act for the sake of that end. (shrink)

The rubber hand paradigm is used to create the illusion of self-touch, by having the participant administer stimulation to a prosthetic hand while the Examiner, with an identical stimulus , administers stimulation to the participant’s hand. With synchronous stimulation, participants experience the compelling illusion that they are touching their own hand. In the current study, the robustness of this illusion was assessed using incongruent stimuli. The participant used the index finger of the right hand to administer stimulation to a prosthetic (...) hand while the Examiner used a paintbrush to administer stimulation to the participant’s left hand. The results indicate that this violation of tactile expectations does not diminish the illusion of self-touch. Participants experienced the illusion despite the use of incongruent stimuli, both when vision was precluded and when visual feedback provided clear evidence of the tactile mismatch. (shrink)

Supererogation has gained attention as a means of explaining the voluntary behaviours of individuals and organizations that are done for the benefit of others and which go above what is required of legislation and what may be expected by society. Whilst the emerging literature has made some significant headway in exploring supererogation as an ethical lens for the study of business there remain several important issues that require attention. These comprise, the lack of primary evidence upon which such examinations have (...) been made, attention has been given to only singular pro-social acts of organizations, and the focus has been upon the actions of large organizations. Furthermore, Heyd’s (Supererogation, Cambridge University Press, 1982) original taxonomy of six supererogatory acts, comprising Moral Heroism, Beneficence, Volunteering, Favour, Forgiveness and Forbearance, has been considered to be complete and other forms of supererogatory acts have not yet been explored. In order to address these gaps this study poses the research questions: First, it studies how a single, contemporary SME performs multiple supererogatory acts in its attempts to address its social and environmental goals that go beyond CSR. Second, it seeks to gain a deeper theoretical understanding of Heyd’s (Supererogation, Cambridge University Press, 1982) taxonomy of six forms of supererogation through the capture of primary data. This research makes a three-year case study examination of a single SME that has been formally recognized for its work in addressing social and environmental issues at local, national and global levels. Primary data are acquired of the supererogatory acts that it performs through a three-year participant observation case study, utilizing 61 interviews and 3 focus groups with internal and external stakeholders. In doing so, it addresses the empirical limitations of the extant research, substantiates each of the forms that supererogatory acts may take, and makes a contribution to the theory of supererogation by identifying a further class of act that is ‘Sharing’. (shrink)