Non-treatment decisions concerning demented patients are complex: in addition to issues concerning the health of patients, ethical and legal issues are involved. This paper describes a method for the development of a guideline that clarifies the steps to be taken in the decision making process whether to forgo curative treatment of pneumonia in psychogeriatric nursing home patients.The method of development consisted of seven steps. Step 1 was a literature study from which ethical, juridical and medical factors concerning the patient's health (...) and prognosis were identified. In step 2, a questionnaire was sent to 26 nursing home physicians to determine the relative importance of these factors in clinical practice. In a meeting of nine experienced physicians , the factors identified in step 2 were confirmed by most of these professionals. To prevent the final guideline being too directive, a concept guideline that included ethical and legal aspects was designed in the form of a “checklist of considerations” . Experts in the fields of nursing home medicine, ethics and law reviewed and commented on the concept guideline . The accordingly adapted “checklist of considerations” was tested in a pilot study , after which all experts endorsed the checklist .The resulting “checklist of considerations” structures the decision making process according to three primary domains: medical aspects, patient's autonomy, and patient's best interest. (shrink)

A diagnosis of dementia often comes with difficulties in understanding a conversational context and expressing how one feels. So far, research on how to facilitate advance care planning for people with dementia focused on defining relevant themes and topics for conversations, or on how to formalize decisions made by surrogate decision makers, e.g., family members. The aim of this review is to provide a better scope of the existing research on practical communication aspects related to dementia in ACP conversations. In (...) November 2020, seven databases were searched to select papers for inclusion. This search was updated in December 2021. The search strategy consisted of three tiers, intersected by using the Boolean term “AND,” and resulted in 787 studies. Two researchers followed explicit criteria for two sequential levels of screening, based on titles and abstracts and full papers. A total of 22 studies were included for data analysis. Seven topics emerged clustered around two themes. This scoping review provides practical suggestions for healthcare professionals to improve ACP communication and uncovered gaps in research on communication aspects related to dementia in ACP conversations, such as non-verbal behavior, timing and implementation, and personal preferences. (shrink)

When I was seven years old I discovered that I had been seeing the world differently from other people. My senses were joined. I was a synesthete. Over the years, I learned quite a bit about my synesthesia, but I was surprised in 2013 when I suddenly began to have another kind of vision, hypnagogic images. At first, I thought these new visions were part of my synesthesia, that I was seeing a new form, one I didn’t have a name (...) for. But synesthesia needs a trigger, a trigger that causes us to see what we see. This form did not have a trigger, and that concerned me. In this paper I will explore the visual similarities and differences between my synesthetic photisms and my hypnagogic visions. I will compare the triggers or lack thereof, where I see the images, the ways in which the shapes I see appear, their colors, and their commonalities. I will discuss how the hypnagogic visions have changed, along with the fact that now both synesthetic and hypnagogic visions occur during the same experience, and that I have found other synesthetes who also have both synesthesia and hypnagogia. À l’âge de sept ans j’ai découvert que je voyais le monde différemment des autres. Mes sens étaient reliés. J’étais une synesthète. Avec les années, j’ai beaucoup appris sur ma synesthésie mais j’ai été surprise en 2013 quand soudain j’ai commencé à voir une autre sorte de vision, des images hypnagogiques. Au début j’ai pensé que ces nouvelles visions faisaient partie de ma synesthésie, que j’en voyais une nouvelle forme, dont j’ignorais le nom. J’ai commencé à être préoccupée par cette forme qui n’avait pas de déclencheur. Dans cet article j’explorerai les similarités visuelles et les différences entre mes photismes synesthétiques et mes visions hypnagogiques. Je comparerai les déclencheurs ou leur absence, les espaces où je vois les images et de quelles manières apparaissent les formes que je vois, leurs couleurs et leurs points communs. J’examinerai comment changeaient les visions hypnagogiques et le fait que je vois des visions à la fois synesthésiques et hypnagogiques se produire dans la même expérience, et que j’ai trouvé d’autres synesthètes qui eux aussi ont à la fois la synesthésie et l’hypnagogie. (shrink)

The language of “participant-driven research,” “crowdsourcing” and “citizen science” is increasingly being used to encourage the public to become involved in research ventures as both subjects and scientists. Originally, these labels were invoked by volunteer research efforts propelled by amateurs outside of traditional research institutions and aimed at appealing to those looking for more “democratic,” “patient-centric,” or “lay” alternatives to the professional science establishment. As mainstream translational biomedical research requires increasingly larger participant pools, however, corporate, academic and governmental research programs (...) are embracing this populist rhetoric to encourage wider public participation. We examine the ethical and social implications of this recruitment strategy. We begin by surveying examples of “citizen science” outside of biomedicine, as paradigmatic of the aspirations this democratizing rhetoric was originally meant to embody. Next, we discuss the ways these aspirations become articulated in the biomedical context, with a view to drawing out the multiple and potentially conflicting meanings of “public engagement” when citizens are also the subjects of the science. We then illustrate two uses of public engagement rhetoric to gain public support for national biomedical research efforts: its post-hoc use in the “care.data” project of the National Health Service in England, and its proactive uses in the “Precision Medicine Initiative” of the United States White House. These examples will serve as the basis for a normative analysis, discussing the potential ethical and social ramifications of this rhetoric. We pay particular attention to the implications of government strategies that cultivate the idea that members of the public have a civic duty to participate in government-sponsored research initiatives. We argue that such initiatives should draw from policy frameworks that support normative analysis of the role of citizenry. And, we conclude it is imperative to make visible and clear the full spectrum of meanings of “citizen science,” the contexts in which it is used, and its demands with respect to participation, engagement, and governance. (shrink)

It has been a common assumption that words are substances that instantiate or have properties. In this paper, I question the assumption that our ontology of words requires posting substances by outlining a bundle theory of words, wherein words are bundles of various sorts of properties (such as semantic, phonetic, orthographic, and grammatical properties). I argue that this view can better account for certain phenomena than substance theories, is ontologically more parsimonious, and coheres with claims in linguistics.

What are words? What makes two token words tokens of the same word-type? Are words abstract entities, or are they (merely) collections of tokens? The ontology of words tries to provide answers to these, and related questions. This article provides an overview of some of the most prominent views proposed in the literature, with a particular focus on the debate between type-realist, nominalist, and eliminativist ontologies of words.

It has been widely argued that words are analogous to species such that words, like species, are natural kinds. In this paper, I consider the metaphysics of word-kinds. After arguing against an essentialist approach, I argue that word-kinds are homeostatic property clusters, in line with the dominant approach to other biological and psychological kinds.

ABSTRACT The idea that two words can be instances of the same word is a central intuition in our conception of language. This fact underlies many of the claims that we make about how we communicate, and how we understand each other. Given this, irrespective of what we think words are, it is common to think that any putative ontology of words, must be able to explain this feature of language. That is, we need to provide criteria of identity for (...) word-types which allow us to individuate words such that it can be the case that two particular word-instances are instances of the same word-type. One solution, recently further developed by Irmak, holds that words are individuated by their history. In this paper, I argue that this view either fails to account for our intuitions about word identity, or is too vague to be a plausible answer to the problem of word individuation. (shrink)

The role of probability is one of the most contested issues in the interpretation of contemporary physics. In this paper, I’ll be reevaluating some widely held assumptions about where and how probabilities arise. Larry Sklar voices the conventional wisdom about probability in classical physics in a piece in the Stanford Online Encyclopedia of Philosophy, when he writes that “Statistical mechanics was the first foundational physical theory in which probabilistic concepts and probabilistic explanation played a fundamental role.” And the conventional wisdom (...) about quantum probabilities is that they are basic, not reducible to the types of probabilities we see in statistical mechanics. In the first section of this paper, I’ll argue that in fact classical physics was steeped in probability long before statistical mechanics came on the scene, specifically, that an objective measure over phase space is an indispensable component of any informative physical theory. In the next section, I’ll argue that this objective measure is the fundamental form of physical probability and that quantum probabilities can be defined in terms of it. In the last, I’ll raise some questions about the metaphysical status of the fundamental measure. (shrink)

The natural name theory, recently discussed by Johnson (2018), is proposed as an explanation of pure quotation where the quoted term(s) refers to a linguistic object such as in the sentence ‘In the above, ‘bank’ is ambiguous’. After outlining the theory, I raise a problem for the natural name theory. I argue that positing a resemblance relation between the name and the linguistic object it names does not allow us to rule out cases where the natural name fails to resemble (...) the linguistic object it names. I argue that to avoid this problem, we can combine the natural name theory with a type-realist metaphysics of language, and hold that the name is natural because the name is an instance of the kind that it names. I conclude by reflecting on the importance of the metaphysics of language for questions in the philosophy of language. (shrink)

This paper addresses several questions related to the nature, production, and use of animal-human (a-h) chimeras. At the heart of the issue is whether certain types of a-h chimeras should be brought into existence, and, if they are, how we should treat such creatures. In our current research environment, we recognize a dichotomy between research involving nonhuman animal subjects and research involving human subjects, and the classification of a research protocol into one of these categories will trigger different ethical standards (...) as to the moral permissibility of the research in question. Are a-h chimeras entitled to the more restrictive and protective ethical standards applied to human research subjects? We elucidate an Aristotelian-Thomistic metaphysical framework in which to argue how such chimeras ought to be defined ontologically. We then examine when the creation of, and experimentation upon, certain types of a-h chimeras may be morally permissible. (shrink)

The article examines the surprising role of Rousseau in the revival of liberal and humanist thought in contemporary French political thought. The choice of Rousseau as an inspiration and source of humanism is an illuminating indication of a shift in French thought. The authors concentrate on the natural- rights republicanism of Luc Ferry and Alain Renaut and the critical humanism of Tzvetan Todorov. While these thinkers all appeal to Rousseau's definition of humanity in terms of freedom, they draw on different (...) aspects of his thought and his relationship to the philosophic tradition. Their different receptions of Rousseau reveal tensions in the humanist revival and provoke reflection on the relationships among republicanism, liberalism and humanism in contemporary France. (shrink)

Recent highly publicized privacy breaches in health care and genomics research have led many to question whether current standards of data protection are adequate. Improvements in de-identification techniques, combined with pervasive data sharing, have increased the likelihood that external parties can track individuals across multiple databases. This paper focuses on the communication of identifiability risks in the process of obtaining consent for donation and research. Most ethical discussions of identifiability risks have focused on the severity of the risk and how (...) it might be mitigated, and what precisely is at stake in pervasive data sharing. However, there has been little discussion of whether and how to communicate the risk to potential donors. We review the ethical arguments behind favoring different types of risk communication in the consent process, and outline how identifiability concerns can be incorporated into either a detailed or simplified method of communicating risks during the consent process. (shrink)

Minimally, metaphysical realists hold that there exist some mind-independent entities. Metaphysical realists also hold that we can speak meaningfully or truthfully about mind-independent entities. Those who reject metaphysical realism deny one or more of these commitments. This Element aims to introduce the reader to the core commitments of metaphysical realism and to illustrate how these commitments have changed over time by surveying some of the main families of views that realism has been contrasted with: such as scepticism, idealism, and anti-realism.

Recent advances in synthetic biology have made it possible to revive extinct species of animals, a process known as ‘de-extinction’. This paper examines two reasons for supporting de-extinction: the potential for de-extinct species to play useful roles in ecosystems; and human valuing of certain de-extinct species. I focus on the particular case of passenger pigeons to argue that the most critical challenge for de-extinction is that it entails significant suffering for sentient individual animals. I also provide reasons to take existence (...) value, or valuing the mere the fact that a species exists, into consideration in debates over de-extinction. (shrink)

In a paper recently published in this Review, I tried to show that part of the formal beauty of the Hercules Furens is due to a subtle treatment of the familiar doctrine that the tyrant's wealth and power are of trifling value compared with Sophrosune, the gain that is really gain. Perhaps some further notes on the dramatic use made by Euripides of these familiar ideas may be of interest. One object with which I started was to observe the use (...) of the word τúραννος in Greek drama. Though the poets frequently enough use it merely as a convenient equivalent for βασιλεúσetc., popular feeling made it easy to suggest the meaning ‘tyrant,’ ‘bad King,’ or ‘Usurper’; and the poets use the ambiguity with great subtlety and in a manner which enables them to obtain fine effects of irony and scorn. What is more important is the fact that the notion of a tyrant with which we are acquainted in later Greek literature was already common-place in the fifth century, and that many dramatic effects depend on the recognition by the audience of the commonplace as such. Indeed, it is often the adaptation by the poet of the familiar ideas that lends formal beauty to compositions which, if we think simply of the plot, appear at first sight jerky or ‘epeisodic.’. (shrink)

Let be a class of models with a notion of ‘strong’ submodel and of canonically prime model over an increasing chain. We show under appropriate set-theoretic hypotheses that if K is not smooth , then K has many models in certain cardinalities. On the other hand, if K is smooth, we show that in reasonable cardinalities K has a unique homogeneous-universal model. In this situation we introduce the notion of type and prove the equivalence of saturated with homogeneous-universal.

Something is wrong with current discussions about theory reduction. The question of whether higher level theories are reducible to lower level theories cannot be posed in a sensible way if methodological principles that are needed to evaluate scientific theories are disregarded. If this is recognized, the problem looses much of its alleged importance.

Although the metaphysics of words remains a relatively understudied domain, one of the more discussed topics has been the question of how to account for the apparent sameness of words. Put one way, the question concerns what it is that makes two word- instances (or tokens) instances of the same word. In this paper, I argue that the existing solutions to the problems all fail as they take the problem of sameness of word to be a problem about how one (...) object relates to another. I propose an alternative solution to the problem of sameness of word which is instead focused on the intrinsic nature of the properties possessed by words. The result is a more thoroughgoing version of nominalism than is currently defended in the literature. (shrink)

Like any other group of philosophers, scholastic thinkers from the Middle Ages disagreed about even the most fundamental of concepts. With their characteristic style of rigorous semantic and logical analysis, they produced a wide variety of diverse theories about a huge number of topics. The Routledge Companion to Medieval Philosophy offers readers an outstanding survey of many of these diverse theories, on a wide array of subjects. Its 35 chapters, all written exclusively for this Companion by leading international scholars, are (...) organized into seven parts: I Language and Logic II Metaphysics III Cosmology and Physics IV Psychology V Cognition VI Ethics and Moral Philosophy VII Political Philosophy In addition to shedding new light on the most well-known philosophical debates and problems of the medieval era, the Companion brings to the fore topics that may not traditionally be associated with scholastic philosophy, but were in fact a veritable part of the tradition. These include chapters covering scholastic theories about propositions, atomism, consciousness, and democracy and representation. The Routledge Companion to Medieval Philosophy is a helpful, comprehensive introduction to the field for undergraduate students and other newcomers as well as a unique and valuable resource for researchers in all areas of philosophy. (shrink)

On a common view of evolution, natural selection is the major force that produces evolutionary change. Selection is thought to operate on different types (genotypes or phenotypes) in populations so as to generate differential reproductive survival of these types. This should engender changes in population composition. The conception of selection as a "force" should be considered as a convenient shorthand that easily misleads us. Selection is not a factor over and above items such as temperature regimes, predators, and so forth. (...) These items do causal work in evolutionary processes. The term "selection" is merely an abstract placeholder for them. Differential reproductive survival thus appears to depend on particular environmental items that influence different types in different ways. Such items are properly regarded as the selective agents. On the face of it, selection processes must always be due to the operation of such agents. I argue that this is a mistaken assumption. Processes of selection may well occur in the absence of selective agents. That is because environmental factors may contribute to differential reproductive survival even if they do not affect different genotypes or phenotypes in different ways. Considering the role of the environment in selection, we should distinguish between selective agents and contributive agents. (shrink)

Optimality theory, particularly optimal foraging theory (OFT), has spurned controversy over decades. I argue that the controversy results from conceptual pitfalls. The focus in this article is on pitfalls underlying the concept of constraint. Constraints in OFT models are a means to distinguish between possible and impossible behaviours. I argue that the seemingly innocuous notion of (im)possibility is tricky. It is indeed linked here with troublesome philosophical problems concerning free will. To steer away from such problems in OFT, we need (...) to distinguish between hard and soft constraints. Such a distinction is necessarily context-dependent. This implies that OFT, to a large extent, should take the form of natural history rather than general theory. (shrink)

The overt oviposition rhythm ofLymnaea stagnalis should be regarded as an endogenous one. Despite considerable deviations of its period from 24 hrs, entrainment by 24 hr. external periodicities is possible. Possibly, entrainment is effectuated via a second — covert — internal rhythm. The fact that similar rhythms have not been established before, is probably connected with the nature of the phenomena to which previous studies have generally been limited.

Sober and Brandon et al. disagree about the role of screening-off in the appraisal of theories of natural selection. Some problems disregarded by them are unearthed in this discussion note.

Peter Wenz has recently distinguished various forms of moral pluralism in an effort to dissolve the controversy over monism and pluralism. I argue that the distinctions are not really helpful once the methodology and the substance of science are brought to bear on ethics. Theories in ethics and science alike are subject to context-dependent methodological trade-offs. Hence, the category of theories should be heterogeneous. Monism and pluralism are at cross-purposes since they endorse different unanalyzed notions of theory. Awareness of heterogeneity (...) among theories is helpful in dismissing the controversy. (shrink)

This paper addresses the ontological status of the ontological categories as defended within E.J. Lowe’s four-category ontology (kinds, objects, properties/relations, and modes). I consider the arguments in Griffith (2015. “Do Ontological Categories Exist?” Metaphysica 16 (1):25–35) against Lowe’s claim that ontological categories do not exist, and argue that Griffith’s objections to Lowe do not work once we fully take advantage of ontological resources available within Lowe’s four-category ontology. I then argue that the claim that ontological categories do not exist has (...) no undesirable consequences for Lowe’s brand of realism. (shrink)