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)

J. L. Ackrill; VIII*—Aristotle's Definitions of Psuche, Proceedings of the Aristotelian Society, Volume 73, Issue 1, 1 June 1973, Pages 119–134, https://doi.org.

Aristotle is widely regarded as the greatest of all philosophers; indeed, he is traditionally referred to simply as `the philosopher'. Today, after more than two millennia, his arguments and ideas continue to stimulate philosophers and provoke them to controversy. In this book J.L. Ackrill conveys the force and excitement of Aristotle's philosophical investigations, thereby showing why contemporary philosophers still draw from him and return to him. He quotes extensively from Aristotle's works in his own notably clear English translation, and a (...) picture emerges of a lucid, lively, subtle and tough-minded thinker of astonishing range and penetration. Professor Ackrill identifies many striking connections between Aristotle's ideas and ideas in recent philosophy; he also raises philosophical questions of his own, and exemplifies the way in which Aristotle can still be argued with and learned from. (shrink)

According to reductive intellectualists about knowledge-how :147–190, 2008; Philos Phenomenol Res 78:439–467, 2009) knowledge-how is a kind of knowledge-that. To the extent that this is right, then insofar as we might conceive of ways knowledge could be extended with reference to active externalist :7–19, 1998; Clark in Supersizing the mind: embodiment, action, and cognitive extension: embodiment, action, and cognitive extension. Oxford University Press, Oxford, 2008) approaches in the philosophy of mind, we should expect no interesting difference between the two. However, (...) insofar as anti-intellectualist approaches to knowledge-how are a viable option, there is an overlooked issue of how knowledge-how might be extended, via active externalism, in ways very differently from knowledge-that. This paper explores this overlooked space, and in doing so, illustrates how a novel form of extended knowledge-how emerges from a pairing of active externalism in the philosophy of mind with anti-intellectualism in the theory of knowledge. Crucial to our argument will be a new way of thinking about the extended mind thesis, as it pertains to the kinds of state one is in when one knows how to do something, and how this state connects with non-accidentally successful performance. (shrink)

While structural equations modeling is increasingly used in philosophical theorizing about causation, it remains unclear what it takes for a particular structural equations model to be correct. To the extent that this issue has been addressed, the consensus appears to be that it takes a certain family of causal counterfactuals being true. I argue that this account faces difficulties in securing the independent manipulability of the structural determination relations represented in a correct structural equations model. I then offer an alternate (...) understanding of structural determination, and I demonstrate that this theory guarantees that structural determination relations are independently manipulable. The account provides a straightforward way of understanding hypothetical interventions, as well as a criterion for distinguishing hypothetical changes in the values of variables which constitute interventions from those which do not. It additionally affords a semantics for causal counterfactual conditionals which is able to yield a clean solution to a problem case for the standard ‘closest possible world’ semantics. (shrink)

Pascal Engel (2008) has insisted that a number of notable strategies for rejecting the knowledge norm of assertion are put forward on the basis of the wrong kinds of reasons. A central aim of this paper will be to establish the contrast point: I argue that one very familiar strategy for defending the knowledge norm of assertion—viz., that it is claimed to do better in various respects than its competitors (e.g. the justification and the truth norms)— relies on a presupposition (...) that is shown to be ultimately under motivated. That presupposition is the uniqueness thesis—that there is a unique epistemic rule for assertion, and that such a rule will govern assertions uniformly. In particular, the strategy I shall take here will be to challenge the sufficiency leg of the knowledge norm in a way that at the same time counts against Williamson’s (2000) own rationale for the uniqueness thesis. However, rather than to challenge the sufficiency leg of the knowledge norm via the familiar style of ‘expert opinion’ and, more generally, ‘second-hand knowledge’ cases (e.g. Lackey (2008)), a strategy that has recently been called into question by Benton (2014), I’ll instead advance a very different line of argument against the sufficiency thesis, one which turns on a phenomenon I call epistemic hypocrisy. (shrink)

In a recent paper in this journal, we proposed two novel puzzles associated with the precautionary principle. Both are puzzles that materialise, we argue, once we investigate the principle through an epistemological lens, and each constitutes a philosophical hurdle for any proponent of a plausible version of the precautionary principle. Steglich-Petersen claims, also in this journal, that he has resolved our puzzles. In this short note, we explain why we remain skeptical.

This essay investigates an underappreciated way in which trust and testimonial injustice are closely connected. Credibility deficit and credibility excess cases both (in their own distinctive ways) contribute to a speaker’s being harmed in her capacity a knower. But moreover, as we will show—by using the tools of a performance-theoretic framework—both credibility deficit and credibility excess cases also feature incompetent trusting on the part of the hearer. That is, credibility deficit and excess cases are shown to manifest qualities of thinkers (...) that are inconducive to trust’s being reliably fulfilled. What this implies is an interesting result about testimonial injustice: to the extent that we want to mitigate against testimonial injustice—one promising way to do so will be to target incompetent trusting of the sort that underlies it. We conclude by outlining and defending what we take to be a promising substantive version of such a mitigation strategy, one which is centred around the cultivation of higher-order trusting competences. (shrink)

An interesting aspect of Ernest Sosa’s (2017) recent thinking is that enhanced performances (e.g., the performance of an athlete under the influence of a performance-enhancing drug) fall short of aptness, and this is because such enhanced performances do not issue from genuine competences on the part of the agent. In this paper, I explore in some detail the implications of such thinking in Sosa’s wider virtue epistemology, with a focus on cases of cognitive enhancement. A certain puzzle is then highlighted, (...) and the solution proposed draws from both the recent moral responsibility literature on guidance control (e.g., Fischer and Ravizza 1998; Fischer 2012) as well as from work on cognitive integration in the philosophy of mind and cognitive science (e.g., Clark and Chalmers 1998; Clark 2008; Pritchard 2010; Palermos 2014; Carter 2017). (shrink)

He that is to govern a whole nation, must read in himself, not this, or that particular man; but mankind. Leviathan is both a magnificent literary achievement and the greatest work of political philosophy in the English language. Permanently challenging, it has found new applications and new refutations in every generation. This new edition reproduces the first printed text, retaining the original punctuation but modernizing the spelling. It offers the most useful annotation available, an introduction that guides the reader through (...) the complexities of Hobbes's arguments, and a substantial index. (shrink)

The degrees of formality into which speech can be graded are in no sphere more obvious than in expressions of address and third-person reference. Methods of naming vary according to many factors: the formality of the circumstances in which naming takes place, the nature of the subject under discussion, and the ages, sex, and relative status of the speaker and addressee. Conventions of naming sometimes reflect the rigidity or otherwise of social divisions. In some societies or circles address between superior (...) and subordinate is non-reciprocal: the speaker with the greater prestige will adopt one form of address, the subordinate another. In other societies when unequals address each other both may use the same formal method of address: the difference of prestige is not explicitly acknowledged. (shrink)

Recent work in the philosophy of mind and cognitive science (e.g., Clark and Chalmers 1998; Clark 2010a; Clark 2010b; Palermos 2014) can help to explain why certain kinds of assertions—made on the basis of information stored in our gadgets rather than in biological memory—are properly criticisable in light of misleading implicatures, while others are not.

J. M. Shorter; X*—Personal Identity, Personal Relationships, and Criteria, Proceedings of the Aristotelian Society, Volume 71, Issue 1, 1 June 1971, Pages 165–1.

International array of contributors, bringing together both traditional and more recent approaches to provide valuable insights into the poets’ use of language.Covers authors from Lucilius to Juvenal.Of the peoples of ancient Italy, only the Romans committed newly composed poems to writing, and for 250 years Latin-speakers developed an impressive verse literature.The language had traditional resources of high style, e.g., alliteration, lexical and morphological archaism or grecism, and of course metaphor and word order; and there were also less obvious resources in (...) the technical vocabularies of law, philosophy and medicine.The essays in this volume show how the poets in the classical period combined these elements, and so created a poetic medium that could comprehend satire, invective, erotic elegy, drama, lyric, and the grandest heroic epos. (shrink)

The Perceptions of Conscience Questionnaire (PCQ) and the Stress of Conscience Questionnaire (SCQ) have previously been developed and validated within the ‘Stress of Conscience Study’. The aim was to revalidate these two questionnaires, including two additional, theoretically and empirically significant items, on a sample of healthcare personnel working in direct contact with patients. The sample consisted of 503 healthcare personnel. To test variation and distribution among the answers, descriptive statistics, item analysis and principal component analysis (PCA) were used to examine (...) the underlying factor structure of the questionnaires. Support for adding the new item to the PCQ was found. No support was found for adding the new item to the SCQ. Both questionnaires can be regarded as valid for Swedish settings but can be improved by rephrasing some of the PCQ items and by adding items about private life to the SCQ. (shrink)

Les rédacteurs du Code pénal, lorsqu'ils ont décrit l'élément matériel des crimes et des délits, ont pris grand soin de distinguer entre l'omission et la commission punissables, et les juges s'interdisent scrupuleusement de les confondre, même quand elles ont le même résultat dommageable. Pourtant, les personnes investies d'une autorité publique ou privée sont, par la jurisprudence, rendues responsables d'un grand nombre de délits commis sous leur autorité, par le seul motif qu'elles n'ont pas mis tout en oeuvre pour les empêcher. (...) Cet article explique l'origine historique de ce paradoxe. La responsabilité des décideurs était primitivement confinée à la matière des contraventions, conçues comme des violations de règles de police administrative, et sanctionnées de peines faibles précisément dites "de police". Les lois modernes ont peu à peu détruit la spécificité des contraventions et leur lien avec la police administrative. Le mode d'imputation jadis caractéristique des contraventions est passé dans la matière des délits et concerne tous ceux dont l'élément moral est fait d'une intention faiblement caractérisée ou d'une imprudence. (shrink)

L'interprétation de l'eschatologie paulinienne est dominée par la question de son rapport avec l'apocalyptique juive. Les points communs, soulignés par J.C. Beker à la suite de E. Käsemann, ne sont pas contestables, mais ne doivent pas occulter des différences notables, qui tiennent à la prééminence du Christ dans la vision paulinienne des événements de la fin. Ni l'attente ni le retard de la parousie ne semblent avoir eu, quoi qu'on en dise, d'influence décisive sur la pensée de l'Apôtre, mais bien (...) plutôt la réconciliation avec Dieu par la Croix et l'inauguration d'une humanité nouvelle dans la résurrection du Christ.Les lettres deutéropauliniennes ne rnodifient pas fondamentalement cette eschatologie, si ce n'est qu'elles accentuent encore l'emprise de la christologie sur la vision de la fin : à ceux qui attendent les ascensions célestes promises par la littérature apocalyptique, Paul répond qu'ils possèdent déjà leur être ressuscité avec le Christ, qui trône bien au-dessus de tous les être célestes. Ses idées sur le jugement dernier et la rétribution finale sont parfois dépendantes de celles du judaïsme, souvent imprécises et limitées, mais c'est toujours sa connaissance du Ressuscité, second Adam, qui conduit sa réflexion et l'aide à déchiffrer le destin final de l'humanité dans le Christ. The interpretation of pauline eschatology is dominated by the question of its rapport with Jewish apocalypse. The common points, underlined by J.C. Beker following E. Käsemann, cannot be contested, but should not hide the notable differences, which are based on the pre-eminence of Christ in the Pauline vision of the final events. Neither the expectation nor the delay of the Parousia does not seem to have had, despite what is said, a decisive influence on the Apostle’s thinking. He was concerned more about reconciliation with God through the cross and the inauguration of a new humanity by the resurrection of Christ.The deuteropauline letters do not fundamentally modify this eschatology, except in so far as they accentuate the dominance of Christology on the vision of the end. For those who await the celestial ascensions promised by apocalyptic literature, Paul answers that they already possess their resurrected being with Christ, who sits well above are celestial beings. These ideas on the Last Judgement and the final retribution are sometimes dependent on those of Judaism, often imprecise and limited, but it is always Paul's knowledge of the Resurrected, the second Adam, which directs his reflection and helps to decipher the final destiny of humanity in Christ. (shrink)

This volume is dedicated to Mario Bunge in honor of his sixtieth birthday. Mario Bunge is a philosopher of great repute, whose enormous output includes dozens of books in several languages, which will culminate with his Treatise on Basic Philosophy projected in seven volumes, four of which have already appeared [Reidel, I 974ff. ]. He is known for his works on research methods, the foundations of physics, biology, the social sciences, the diverse applications of mathematical methods and of systems analysis, (...) and more. Bunge stands for exact philosophy, classical liberal social philosophy, rationalism and enlightenment. He is brave, even relentless, in his attacks on subjectivism, mentalism, and spiritualism, as well as on positivism, mechanism, and dialectics. He believes in logic and clarity, in science and open-mindedness - not as the philosopher's equivalent to the poli tician's rhetoric of motherhood and apple pie, but as a matter of everyday practice, as qualities to cultivate daily in our pursuit of the life worth living. Bunge's philosophy often has the quality of Columbus's egg, and he is prone to come to swift and decisive conclusions on the basis of argu ments which seem to him valid; he will not be perturbed by the fact that most of the advanced thinkers in the field hold different views. (shrink)