Abstract Context: Established in 1997, Summa Health System’s Medical Ethics Committee (EC) serves as an educational, supportive, and consultative resource to patients/families and providers, and serves to analyze, clarify, and ameliorate dilemmas in clinical care. In 2009 the EC conducted its 100th consult. In 2002 a Palliative Care Consult Service (PCCS) was established to provide supportive services for patients/families facing advanced illness; enhance clinical decision-making during crisis; and improve pain/symptom management. How these services affect one another has thus far been (...) unclear. Objectives: This study describes EC consults: types, reasons, recommendations and utilization, and investigates the impact the PCCS may have on EC consult requests or recommendations. Methods: Retrospective reviews of 100 EC records explored trends and changes in types of consults, reasons for consults, and EC recommendations and utilization. Results: There were 50 EC consults each in the 6 years pre- and post-PCCS. Differences found include: (1) a decrease in number of reasons for consult requests (133–62); (2) changes in top two reasons for EC consult requests from ‘Family opposed to withdrawing life-sustaining treatment (LST)’ and ‘Patient capacity in question’ to ‘Futility’ and ‘Physician opposed to providing LST’; (3) changes in top two recommendations given by the EC from ‘Emotional Support for Patient/Family’ and ‘Initiate DNR Order’ to ‘Comfort Care’ and ‘Withdraw Treatment.’ Overall, 88% of recommendations were followed. Conclusion: PCCS availability and growth throughout the hospital may have influenced EC consult requests. EC consults regarding family opposition to withdrawing LST and EC recommendations for patient/family support declined. Content Type Journal Article Pages 1-16 DOI 10.1007/s10730-011-9170-9 Authors JessicaRichmondMoeller, Department of Psychiatry and Behavioral Sciences, Akron General Medical Center, 400 Wabash Ave, Akron, OH 44307, USA Teresa H. Albanese, Health Services Research and Education Institute, Summa Health System and Northeast Ohio Medical University, 55 Arch St., Suite 1A, Akron, OH 44304, USA Kimberly Garchar, Kent State University, 6000 Frank Ave., N.W, North Canton, OH 44720, USA Julie M. Aultman, Department of Family and Community Medicine, Northeast Ohio Medical University, P.O. Box 95, Rootstown, OH 44272, USA Steven Radwany, Palliative Care and Hospice Services, Summa Health System and Northeast Ohio Medical University, 55 Arch St., Suite 1A, Akron, OH 44304, USA Dean Frate, Internal Medicine, Palliative Care and Hospice Services, Summa Health System and Northeast Ohio Medical University, 55 Arch St., Suite 1A, Akron, OH 44304, USA Journal HEC Forum Online ISSN 1572-8498 Print ISSN 0956-2737. (shrink)
Following on from Nick Bostrom's discussion of the Doomsday argument, Alasdair Richmond considers how anthropic reasoning can lead from Doomsday to some odd conclusions about computation and our place in reality.
Justice, equality, and righteousnessthese are some of our greatest moral convictions. Yet in times of social conflict, morals can become rigid, making religious war, ethnic cleansing, and political purges possible. Morality, therefore, can be viewed as pathology-a rhetorical, psychological, and social tool that is used and abused as a weapon. An expert on Eastern philosophies and social systems theory, Hans-Georg Moeller questions the perceived goodness of morality and those who claim morality is inherently positive. Critiquing the ethical "fanaticism" of (...) Western moralists, such as Immanuel Kant, Lawrence Kohlberg, John Rawls, and the utilitarians, Moeller points to the absurd fundamentalisms and impracticable prescriptions arising from definitions of good. Instead he advances a theory of "moral foolishness," or moral asceticism, extracted from the "amoral" philosophers of East Asia and such thinkers as Ludwig Wittgenstein and Niklas Luhmann. The moral fool doesn't understand why ethics are necessarily good, and he isn't convinced that the moral perspective is always positive. In this way he is like most people, and Moeller defends this foolishness against ethical pathologies that support the death penalty, just wars, and even Jerry Springer's crude moral theater. Comparing and contrasting the religious philosophies of Christianity, Daoism, and Zen Buddhism, Moeller presents a persuasive argument in favor of amorality. (shrink)
Recent findings indicate that the constituting digits of multi-digit numbers are processed, decomposed into units, tens, and so on, rather than integrated into one entity. This is suggested by interfering effects of unit digit processing on two-digit number comparison. In the present study, we extended the computational model for two-digit number magnitude comparison of Moeller, Huber, Nuerk, and Willmes (2011a) to the case of three-digit number comparison (e.g., 371_826). In a second step, we evaluated how hundred-decade and hundred-unit compatibility (...) effects were moderated by varying the percentage of within-hundred (e.g., 539_582) and within-hundred-and-decade filler items (e.g., 483_489). From the results we predict that numerical distance as well as compatibility effects should indeed be modulated by the relevance of tens and units in three-digit number magnitude comparison: While in particular the hundred distance effect should decrease, we predict hundred-decade and hundred-unit compatibility effects to increase with the relevance of tens and units. (shrink)
Does cross-cultural philosophy stand in need of a hermeneutical expansion? In engaging with this question, the symposium focuses upon methodological issues salient to cross-cultural inquiry. Douglas L. Berger lays out the ground for the debate by arguing for a methodological approach, which is able to rectify the discipline’s colonial legacies and bridge the hermeneutical distance with its objects of study. From their own perspectives, Hans-Georg Moeller, Paul Roth and A. Raghuramaraju analyze whether such a processual and hermeneutically-sensitive approach can (...) indeed open up new hermeneutic horizons. Their responses shed light upon cross-cultural philosophy’s continued embedment in Euroamerican professional philosophy and how the locality of its knowledge-seeking endeavors may indeed have repercussions on attempts to bridge temporal and spatial distances. (shrink)
Health-related Quality of Life measures have recently been attacked from two directions, both of which criticize the preference-based method of evaluating health states they typically incorporate. One attack, based on work by Daniel Kahneman and others, argues that ‘experience’ is a better basis for evaluation. The other, inspired by Amartya Sen, argues that ‘capability’ should be the guiding concept. In addition, opinion differs as to whether health evaluation measures are best derived from consultations with the general public, with patients, or (...) with health professionals. And there is disagreement about whether these opinions should be solicited individually and aggregated, or derived instead from a process of collective deliberation. These distinctions yield a wide variety of possible approaches, with potentially differing policy implications. We consider some areas of disagreement between some of these approaches. We show that many of the perspectives seem to capture something important, such that it may be a mistake to reject any of them. Instead we suggest that some of the existing ‘instruments’ designed to measure HR QoLs may in fact successfully already combine these attributes, and with further refinement such instruments may be able to provide a reasonable reconciliation between the perspectives. (shrink)
In the early years of Mendelism, 1900-1910, William Bateson established a productive research group consisting of women and men studying biology at Cambridge. The empirical evidence they provided through investigating the patterns of hereditary in many different species helped confirm the validity of the Mendelian laws of heredity. What has not previously been well recognized is that owing to the lack of sufficient institutional support, the group primarily relied on domestic resources to carry out their work. Members of the group (...) formed a kind of extended family unit, centered on the Batesons' home in Grantchester and the grounds of Newnham College. This case illustrates the continuing role that domestic environments played in supporting scientific research in the early 20th century. (shrink)
Muriel Wheldale, a distinguished graduate of Newnham College, Cambridge, was a member of William Bateson's school of genetics at Cambridge University from 1903. Her investigation of flower color inheritance in snapdragons (Antirrhinum), a topic of particular interest to botanists, contributed to establishing Mendelism as a powerful new tool in studying heredity. Her understanding of the genetics of pigment formation led her to do cutting-edge work in biochemistry, culminating in the publication of her landmark work, The Anthocyanin Pigments of Plants (1916). (...) In 1915, she joined Frederick Gowland Hopkin's Department of Biochemistry as assistant and in 1926 became one of the first women to be appointed university lecturer. In 1919 she married the biochemist Huia Onslow, with whom she collaborated until his death in 1922. This paper examines Wheldale's work in genetics and especially focuses on the early linkage of Mendelian methdology with new techniques in biochemistry that eventually led to the founding of biochemical genetics. It highlights significant issues in the early history of women in genetics, including the critical role of mentors, funding opportunities, and career strategies. (shrink)
In 1853, the young Thomas Henry Huxley published a long review of German cell theory in which he roundly criticized the basic tenets of the Schleiden-Schwann model of the cell. Although historians of cytology have dismissed Huxley's criticism as based on an erroneous interpretation of cell physiology, the review is better understood as a contribution to embryology. "The Cell-theory" presents Huxley's "epigenetic" interpretation of histological organization emerging from changes in the protoplasm to replace the "preformationist" cell theory of Schleiden and (...) Schwann (as modified by Albert von Kölliker), which posited the nucleus as the seat of organic vitality. Huxley's views influenced a number of British biologists, who continued to oppose German cell theory well into the twentieth century. Yet Huxley was pivotal in introducing the new German program of "scientific zoology" to Britain in the early 1850s, championing its empiricist methodology as a means to enact broad disciplinary and institutional reforms in British natural history. (shrink)
Various passages in the Laozi and the Zhuangzi, the two most important texts of “philosophical Daoism,” critically mock Confucian sacrificial rites. Perhaps the best known of these criticisms refers to a practice involving straw dogs. This article will attempt to expose the philosophical dimensions of these passages that show, in my reading, how Daoist philosophy looks at such sacrificial rituals as a sort of evidence of the Confucian misconceptions of time, of death and life, and of cosmic and social order.
This paper explores in detail an argument for epistemic expressivism, what we call the Argument from Motivation. While the Argument from Motivation has sometimes been anticipated, it has never been set out in detail. The argument has three premises, roughly, that certain judgments expressed in attributions of knowledge are intrinsically motivating in a distinct way (P1); that motivation for action requires desire-like states or conative attitudes (HTM); and that the semantic content of knowledge attributions cannot be specified without reference to (...) the intrinsically motivating judgments that such attributions express (P2). We argue that these premises entail a version of ecumenical expressivism. Since the argument from motivation has not been explicitly stated before, there is no current discussion of the argument. In this paper we therefore consider and reject various objections that one might propose to the argument, including some that stem from the idea that knowledge is factive, or that knowledge involves evidence that rules out relevant alternatives. Other objections to (P1) specifically might be derived from cases of apparent lack of epistemic motivation considered in in Kvanvig (The value of knowledge and the pursuit of understanding, 2003) and Brown (Nous 42(2):167–189, 2008), as well as from general forms of externalism about epistemic motivation. We consider these and find them wanting. Finally, the paper offers some critical remarks about the prospect of denying (P2). (shrink)
Recently, an associative learning account of cognitive control has been suggested (Verguts & Notebaert, 2009). In this so-called adaptation by binding theory, Hebbian learning of stimulus–stimulus and stimulus–response associations is assumed to drive the adaptation of human behavior. In this study, we evaluated the validity of the adaptation-by-binding account for the case of implicit learning of regularities within a stimulus set (i.e., the frequency of specific unit digit combinations in a two-digit number magnitude comparison task) and their association with a (...) particular response. Our data indicated that participants indeed learned these regularities and adapted their behavior accordingly. In particular, influences of cognitive control were even able to override the numerical distance effect—one of the most robust effects in numerical cognition research. Thus, the general cognitive processes involved in two-digit number magnitude comparison seem much more complex than previously assumed. Multi-digit number magnitude comparison may not be automatic and inflexible but influenced by processes of cognitive control being highly adaptive to stimulus set properties and task demands on multiple levels. (shrink)
Combining time travel with certain kinds of supertask, this paper proposes a novel model for Hell. Temporally-closed spacetimes allow otherwise impossible opportunities for material kinds of damnation and reveal surprising limitations on metaphysical objections to Hell. Prima facie, eternal damnation requires either infinite amounts of time or time for the damned to speed-up arbitrarily. However, spatiotemporally finite ‘time travel’ universes can host unending personal torment for infinitely many physical beings, while keeping fixed finite limits on rates of temporal passage. Such (...) ‘Hilbert's Inferno’ spacetimes suggest neither materialism nor the finitude of time and space need forbid Hell. A material Hell can be spatiotemporally finite yet eternal for its inhabitants. Hilbert's Inferno also sheds light on Hell's location and accessibility, and shows that some spacetimes are intrinsically better suited to punishment than reward. (shrink)
Nelson Goodman has constructed two theories of simplicity: one of predicates; one of hypotheses. I offer a simpler theory by generalization and abstraction from his. Generalization comes by dropping special conditions Goodman imposes on which unexcluded extensions count as complicating and which excluded extensions count as simplifying. Abstraction is achieved by counting only nonisomorphic models and subinterpretations. The new theory takes into account all the hypotheses of a theory in assessing its complexity, whether they were projected prior to, or result (...) from, projection of a given hypothesis. It assigns simplicity post-projection priority over simplicity pre-projection. It better orders compound conditionals than does the theory of simplicity of hypotheses, and it does not inherit an anomaly of the theory of simplicity of predicates — its failure to order the ordering relations. Drop Goodman's special conditions, and the problems fall away with them. (shrink)
Henri Bergson's philosophy, which Sartre studied as a student, had a profound but largely neglected influence on his thinking. In this paper I focus on the new light that recognition of this influence throws on Sartre's central argument about the relationship between negation and nothingness in his Being and Nothingness. Sartre's argument is in part a response to Bergson's dismissive, eliminativist account of nothingness in Creative Evolution (1907): the objections to the concept of nothingness with which Sartre engages are precisely (...) those raised by Bergson. Even if Sartre's account of nothingness in its entirety is found to be flawed, I argue that the points he makes specifically against Bergson are powerful. My discussion concludes with a brief examination of the wider philosophical background to Sartre's and Bergson's discussion of nothingness: here I point to some important aspects of Sartre's early philosophy, including some features of his conception of nothingness, that may testify to Bergson's positive influence on his thought. (shrink)
This article discusses New Confucian views on individuality and related philosophical problems. Special emphasis is given to the position of Tu Wei-Ming, a foremost living New Confucian thinker. It is pointed out that many New Confucian philosophers share a vision of a Confucian 'ideal' individuality or selfhood based on social integration - as opposed to a Western type of individuality sometimes portrayed as an individuality by isolation. These patterns of individuality are further examined on the basis of Niklas Luhmann's historical (...) analysis of the semantics of individuality and his categories of 'individuality by inclusion' and 'individuality by exclusion'. Finally, some parallels and differences between Confucian and the Luhmannian viewpoints are pointed out, and a suggestion on how a Luhmannian perspective might contribute to reformulations of New Confucian thought is attempted. (shrink)
This paper attempts three tasks in relation to Carter and Leslie's Doomsday Argument. First, it criticises Timothy Chambers' 'Ussherian Corollary', a striking but unsuccessful objection to standard Doomsday arguments. Second, it reformulates the Ussherian Corollary as an objection to Bradley Monton's variant Doomsday and Nick Bostrom's Simulation Argument. Finally, it tries to diagnose the epistemic/metaphysical problems facing Doomsday-related arguments.1.
Note on the text of the principles -- Context -- Biography -- Berkeley's philosophical background -- Overview of themes -- Teading the text -- The principles : introduction -- The principles : part one -- The objects and subject of knowledge : ideas and spirit -- Unperceived existence : a nicer strain of abstraction -- Problems for materialism -- A Cartesian dream argument -- The master argument -- From the inertness of ideas to the existence of God -- Philosophical objections (...) to immaterialism and replies -- Religious objections to immaterialism and replies -- Further advantages of immaterialism -- Great provinces of speculative science -- The attack on absolute space -- Mathematics -- Other minds -- The divine language of nature -- Reception and influence -- Guide to further reading. (shrink)
This article uses Hans Kelsen's theory of a legal system to take a fresh look at European Community law, and the relationship between the European Community, its Member States, and international law. It argues that the basis of the Community's legal legitimacy is indeterminate, and offers a model to accommodate that indeterminacy. This model is founded on a constructivist approach suggested to be particularly useful in the EC context. Using this approach, it is argued that the concepts of system, autonomy (...) and sovereignty in the Community can only be understood through the recognition of a plurality of viewpoints, and that it is crucial, in describing the Community, to distinguish between a concept per se and the choice to adopt that concept. (shrink)
Around 1998, internet postings began appearing under the alias ‘ Timetravel_0 ’. This alias was later replaced by ‘John Titor’, and it's as such I'll designate the posts' author. Remarkably, Titor claimed to have time-travelled from 2036 on a mission to retrieve an IBM 5100 in 1975. Titor refrained from public appearances and any evidence for his story remains web-bound but before closing shop c. March 24 th 2001, he described various future events, e.g.: Y2K is a disaster. Many people (...) die on the highways when they freeze to death trying to get to warmer weather. Cancellation of the Olympics after 2004 due to world conflict. America will soon be engaged in civil war with itself; a civil war that we'll see the beginnings of during 2004 and 2005, escalating until it is indisputable by 2008. This equivocal civil war fizzles until global nuclear war kills three billion people in 2015. (shrink)