Mental health chatbots (MHCBs) designed to support individuals in coping with mental health issues are rapidly advancing. Currently, these MHCBs are predominantly used in commercial rather than clinical contexts, but this might change soon. The question is whether this use is ethically desirable. This paper addresses a critical yet understudied concern: assuming that MHCBs cannot have genuine emotions, how this assumption may affect psychotherapy, and consequently the quality of treatment outcomes. We argue that if MHCBs lack emotions, they cannot have (...) genuine (affective) empathy or utilise countertransference. Consequently, this gives reason to worry that MHCBs are (a) more liable to harm and (b) less likely to benefit patients than human therapists. We discuss some responses to this worry and conclude that further empirical research is necessary to determine whether these worries are valid. We conclude that, even if these worries are valid, it does not mean that we should never use MHCBs. By discussing the broader ethical debate on the clinical use of chatbots, we point towards how further research can help us establish ethical boundaries for how we should use mental health chatbots. (shrink)

Public health ethicists face two difficult questions. First, what makes something a matter of public health? While protecting citizens from outbreaks of communicable diseases is clearly a matter of public health, is the same true of policies that aim to reduce obesity, gun violence or political corruption? Second, what should the scope of the government’s authority be in promoting public health? May government enact public health policies some citizens reasonably object to or policies that are paternalistic? Recently, some theorists have (...) attempted to address these questions by arguing that something is a matter of public health if and only if it involves a health-related public good, such as clean water or herd immunity. Relatedly, they have argued that appeals to the promotion of public health should only be used to justify the provision of health-related public goods. This public goods conception of public health (PGC) is meant to enjoy advantages over its rivals in three respects: it provides a better definition of public health than rival views, it respects moral disagreement, and it avoids licensing objectionably paternalistic public health policies. We argue, however, that the PGC does just as poorly, or worse, than its rivals in all three respects. (shrink)

In a recent paper in this journal, Jason Brennan correctly notes that libertarians struggle to justify a policy of compulsory vaccination. The most straightforward argument that justifies compulsory vaccination is that such a policy promotes welfare. But libertarians cannot make this argument because they claim that the state is justified only in protecting negative rights, not in promoting welfare. I consider two representative libertarian attempts to justify compulsory vaccination, and I argue that such arguments are unsuccessful. They either fail to (...) show that the state is justified in implementing the policy or overgeneralise. I suggest that Brennan's solution is especially well motivated insofar as it addresses the shortcomings of these arguments. Brennan argues that we violate the rights of others by participating in an activity that imposes an unacceptable collective risk of harm. Going unvaccinated is an activity that imposes an unacceptable collective risk of harm, and thus amounts to a rights violation. So, the state can implement a policy of compulsory vaccination I object, however, that Brennan's delineation of acceptable and unacceptable risk implicitly rests on classical liberal rather than libertarian principles; he justifies compulsory vaccination on the grounds that it promotes welfare. I also object that Brennan's argument would entail significant departures from libertarian institutional arrangements. This leaves libertarians with a choice: they can develop new arguments to demonstrate that their position is compatible with compulsory vaccination, or they can accept that their view entails the impermissibility of compulsory vaccination, and argue that this is not an unpalatable implication of their view. (shrink)

This article proposes a novel defense of vaccine mandates: such policies are justifiable because they protect the capabilities of individuals who cannot cultivate individual immunity against infection. We begin by considering a nearby argument that has recently enjoyed popularity, which claims individuals have an enforceable obligation to get vaccinated because they have benefited from community protection (often referred to as ‘herd immunity’), and thus they ought to do their fair share in sustaining that public good by getting vaccinated. We object, (...) however, that this kind of argument misstates the ethical basis for vaccine mandates because community protection primarily protects unvaccinated people. We contend that the duty to vaccinate is not fundamentally an obligation to make a fair contribution to a public good from which vaccinated people benefit, but a duty to protect the wellbeing of otherwise vulnerable third parties. We flesh out our view by drawing on Martha Nussbaum's capabilities approach. (shrink)

This paper argues that individuals in many high-income countries typically have moral reasons to limit their beef consumption and consume plant-based protein instead, given the negative effects of beef production and consumption. Beef production is a significant source of agricultural greenhouse gas emissions and other environmental impacts, high levels of beef consumption are associated with health risks, and some cattle production systems raise animal welfare concerns. These negative effects matter, from a variety of moral perspectives, and give us collective moral (...) reasons to reduce beef production and consumption. But, as some ethicists have argued, we cannot draw a straight line from the ethics of production to the ethics of consumption: even if a production system is morally impermissible, this does not mean that any given individual has moral reasons to stop consuming the products of that system, given how miniscule one individual’s contributions are. This paper considers how to connect those dots. We consider three distinct lines of argument in support of the conclusion that individuals have moral reasons to limit their beef consumption and shift to plant-based protein, and we consider objections to each argument. This argument applies to individuals in high beef-consuming and high greenhouse gas-emitting high-income countries, though we make this argument with a specific focus on the United States. (shrink)

Paternalism has attracted new defenders in recent years. Such defenders typically either downplay the normative significance of autonomy or deny that we are sufficiently rational for paternalistic interventions to be objectionable.1 Both of these argumentative strategies constitute challenges to John Stuart Mill’s influential anti-paternalistic ‘harm principle’, which states that coercive interference with the liberty of competent adults is justifiable only if such interference prevents harm to non-consenting third parties (Mill, p. 23).2 In this journal, Wilkinson has provided a novel, provocative (...) defence of paternalism in the medical context—one that (provisionally) accepts rather than challenges Mill’s harm principle.3 Wilkinson’s argument is complex. But he begins with Parfit’s influential account of personal identity.4 According to Parfit, Alice at T1 can be the same person as Alice at T2, but the extent to which Alice at T1 and Alice at T2 are similar depends on the extent to which there are ‘chains’ of strong psychological connections between Alice at T1 and Alice at T2. Strong psychological connections, in turn, are mental states such as intentions or beliefs, or psychological traits. For example, if Alice at T2 remembers very little about herself the day before, and the day before that, all the way to Alice at T1, Alice at T2 has completely different psychological traits than Alice at T1—for example, Alice at T1 was courageous, whereas Alice at T2 is cowardly—then Alice at T1 and Alice at T2 are distinct persons. If the harm principle is correct and Alice is autonomous, it is permissible to interfere with Alice’s liberty only if it prevents harm to some non-consenting third party. But if we accept Parfit’s view on personal identity, then a novel defence of paternalistic intervention emerges: Alice at T2 may well be a distinct person from Alice at T1. So, …. (shrink)

In recent years, cognitive neuroscientists have began to explore the process of how sensory information gains access to awareness. To further probe this process, event-related functional magnetic resonance imaging was used while testing subjects with a paradigm known as the “attentional blink.” In this paradigm, visually presented information sporadically fails to reach awareness. It was found that the magnitude and time course of activation within the anterior cingulate , medial prefrontal cortex , and frontopolar cortex predicted whether or not information (...) was consciously perceived during the critical period for the attentional blink. These results are discussed in light of a neural framework for conscious processing. (shrink)

This essay argues that in his Breviloquium Bonaventure expands the doctrine of trinitarian appropriation beyond its fixed scholastic frame; that he applies this expanded grammar of appropriation across the text both synchronically and diachronically, or formally in its literary structure and narratively throughout its account of salvation history; and that Bonaventure does so, or at least there are good reasons for so thinking, in response to the Joachite controversy that embattled the Franciscan Order of his time, to whose benefit he (...) composed the Breviloquium.1 This is, then, an essay whose central task it is to investigate how a highly technical idiom of the scholastic mastertext features within Bonaventure's... (shrink)

ABSTRACTThis article argues that new forms of conducting military information activities using the Internet require renewed consideration of the ethical frameworks in which conduct of such activities can be grounded: frameworks that require these operations to be considered on their own terms rather than as a subset of wider categories. In this online context the article explores the interlinked areas of proportionality and privacy, delineations between combatant and non-combatant, and limits to acceptable deceptive practices. The article argues that the “soft” (...) effects that online information activities promise may reduce destruction and loss of life in the pursuit of military objectives. This context creates new reference points from which necessity and proportionality tests are conducted: tests that justify collection of online data to support online military information activities, and the conduct of the actual activities. The article outlines the possibility that such activities may facilitate potenti... (shrink)

This article argues that governments in countries that currently permit intensive animal agriculture - especially but not exclusively high-income countries - are, in principle, morally justified in taking steps to restrict or even eliminate intensive animal agriculture to protect public health from the risk of zoonotic pandemics. Unlike many extant arguments for restricting, curtailing, or even eliminating intensive animal agriculture which focus on environmental harms, animal welfare, or the link between animal source food (ASF) consumption and noncommunicable disease, the argument (...) in this article appeals to the value of protecting populations from future global health emergencies and their broad social, economic, and health impacts, taking the SARS-CoV-2 virus as a particularly salient example. The article begins by identifying how intensive animal agriculture contributes to the outbreak (and risk of future outbreaks) of zoonotic diseases. Next, we explore three specific policy options: 1. Incentivizing plant-based and cell-based ASF alternatives through government subsidies; 2. Disincentivizing intensive ASF production through the adoption of a “zoonotic tax”; and 3. Eliminating intensive ASF production through a total ban. We argue that all three of these measures are permissible, although we remain agnostic as to whether these measures are obligatory. We argue for this conclusion on the grounds that each measure is justified by the same sorts of considerations that justify other widely accepted public health interventions, and each is compatible with a variety of theories of justice. We then address potential objections. Finally, we discuss how our novel argument relates to extant ethical arguments in favor or curtailing ASF production and consumption. (shrink)

This is the first scholarly study of Atlas Shrugged, covering in detail the historical, literary, and philosophical aspects of Ayn Rand's magnum opus. Topics explored in depth include the history behind the novel's creation, publication, and reception; its nature as a romantic novel; and its presentation of a radical new philosophy.

The essays in this collection treat historical, literary, and philosophical topics related to Ayn Rand's Anthem, an anti-utopia fantasy set in the future. The first book-length study on Anthem, this collection covers subjects such as free will, political freedom, and the connection between freedom and individual thought and privacy.

Ayn Rand's first novel, We the Living, offers an early form of the author's nascent philosophy—the philosophy Rand later called Objectivism. Robert Mayhew's collection of entirely new essays brings together pre-eminent scholars of Rand's writing. In part a history of We the Living, from its earliest drafts to the Italian film later based upon it, Mayhew's collection goes on to explore the enduring significance of Rand's first novel as a work both of philosophy and of literature.

This encyclopedia entry provides an overview of the field of public health ethics. It focuses on what distinguishes public health ethics from other nearby subfields—especially biomedical ethics. It also frames the problems of public health ethics in terms of the concepts of justice and political legitimacy.

Spitale et al. (2024) address a public health ethics question of great importance: How should governments communicate with the public during public health emergencies? The article highlights severa...

Many of us believe that we can and do have individual obligations to refrain from contributing to massive collective harms – say, from producing luxury greenhouse gas (GHG) emissions; however, our individual actions are so small as to be practically meaningless. Can we then, justify the intuition that we ought to refrain? In this paper, we argue that this debate may have been mis-framed. Rather than investigating whether or not we have obligations to refrain from contributing to collective action, perhaps (...) we should ask whether we have reason to do so. However, this framing brings challenges of its own, and so we close by asking what problems are generated if we focus on these questions of ‘contributory ethics’. (shrink)

Most liberals agree that governments should protect certain basic liberties, such as freedom of speech, freedom of religion and freedom of the person. Liberals disagree, however, about whether free market rights should also be protected. By “free market rights,” we mean those rights typically associated with laissez-faire economic systems such as freedom of contract, a right to market returns, and claims to privately own the means of production.We do not use the phrase “economic liberties,” as Tomasi does, because it does (...) not distinguish between the “economic rights” defended by classical liberal and those defended by socialists. Those on the right often see such freedoms as core liberal commitments, while those on the left argue that an economic system should be organized to protect the interests of the less advantaged members of society. If free market rights should be protected, then most existing societies are unjust. These societies fail the liberal standard in the same ways as th .. (shrink)

Some parents take advantage of legal exemptions for the measles-mumps-rubella vaccine. While there are a variety of reasons parents do so—including having children with medical conditions that make vaccination medically unsafe—some parents appear to be driven, at least in part, by beliefs that vaccines cause a variety of diseases or conditions, such as autism. Those who delay or refuse the MMR vaccine because of false beliefs about its side effects elicit a strikingly strong response from many who endorse MMR vaccine (...) mandates. Accusations of moral wrongdoing, expressions of anger, indignation, resentment, or disgust frequently appear in social... (shrink)

Reduced Environmental Stimulation Therapy (REST) alters the balance of sensory input to the nervous system by systematically attenuating sensory signals from visual, auditory, thermal, tactile, vestibular, and proprioceptive channels. Previous research from our group has shown that REST via floatation acutely reduces anxiety and blood pressure while simultaneously heightening interoceptive awareness in clinically anxious populations. Anorexia nervosa (AN) is an eating disorder characterized by elevated anxiety, distorted body representation, and abnormal interoception, raising the question of whether REST might positively impact (...) these symptoms. However, this approach has never been studied in eating disorders and it is unknown whether exposure to REST might worsen AN symptoms. To examine these possibilities we conducted an open-label study to investigate the safety and tolerability of REST in AN. We also explored the impact of REST on affective symptoms, body image disturbance, and interoception. Twenty-one partially weight-restored AN outpatients completed a protocol involving four sequential sessions of REST: reclining in a zero-gravity chair, floating in an open pool, and two sessions of floating in an enclosed pool. All sessions were 90 minutes, approximately one week apart. We measured orthostatic blood pressure before and immediately after each session (primary outcome), in addition to collecting blood pressure readings every 10 minutes during the session using a wireless waterproof system as a secondary outcome measure. Each participant's affective state, awareness of interoceptive sensations, and body image was assessed before and after every session (exploratory outcomes). There was no evidence of orthostatic hypotension following floating, and no adverse events (primary outcome). Secondary analyses revealed that REST induced statistically significant reductions in blood pressure, anxiety and negative affect, heightened awareness of cardiorespiratory but not gastrointestinal sensations, and reduced body image dissatisfaction. The findings from this initial trial suggest that individuals with AN can safely tolerate the physical effects of REST via floatation. Future randomized controlled trials will need to investigate whether these initial observations of improved anxiety, interoception, and body image disturbance can be effectively extended to acutely ill AN populations. (shrink)

Journal of Social Philosophy, EarlyView.

An emerging topic in robot design and scholarly research is socially assistive robots for senior citizens. Compared to robots in other sectors, SARs can augment their assistive-utilitarian functions by offering social, emotional, and cognitive support to seniors. This study draws upon interviews with 45 senior citizens to understand this group’s expectations for human-robot interactions and their anticipated needs for robots. Our grounded theory analysis suggests that senior citizens expect robots to meet three types of needs: physical, informational, and interactional. Furthermore, (...) they seek assurances that they will have complete control over interactions with robots. Findings show that seniors’ mental models about robots are shaped by their recent experiences with advanced communications technologies and mediated representations of robots in popular culture. Findings are discussed in light of practical design considerations and two theoretical perspectives. (shrink)

An emerging topic in robot design and scholarly research is socially assistive robots for senior citizens. Compared to robots in other sectors, SARs can augment their assistive-utilitarian functions by offering social, emotional, and cognitive support to seniors. This study draws upon interviews with 45 senior citizens to understand this group’s expectations for human-robot interactions and their anticipated needs for robots. Our grounded theory analysis suggests that senior citizens expect robots to meet three types of needs: physical, informational, and interactional. Furthermore, (...) they seek assurances that they will have complete control over interactions with robots. Findings show that seniors’ mental models about robots are shaped by their recent experiences with advanced communications technologies and mediated representations of robots in popular culture. Findings are discussed in light of practical design considerations and two theoretical perspectives. (shrink)

An emerging topic in robot design and scholarly research is socially assistive robots for senior citizens. Compared to robots in other sectors, SARs can augment their assistive-utilitarian functions by offering social, emotional, and cognitive support to seniors. This study draws upon interviews with 45 senior citizens to understand this group’s expectations for human-robot interactions and their anticipated needs for robots. Our grounded theory analysis suggests that senior citizens expect robots to meet three types of needs: physical, informational, and interactional. Furthermore, (...) they seek assurances that they will have complete control over interactions with robots. Findings show that seniors’ mental models about robots are shaped by their recent experiences with advanced communications technologies and mediated representations of robots in popular culture. Findings are discussed in light of practical design considerations and two theoretical perspectives. (shrink)

Contingencies of the early nuclear arms race Content Type Journal Article Pages 1-23 DOI 10.1007/s11016-010-9495-z Authors S. S. Schweber, Department of the History of Science, Harvard University, Science Center 371, Cambridge, MA 02138, USA Alex Wellerstein, Department of the History of Science, Harvard University, Science Center 371, Cambridge, MA 02138, USA Ethan Pollock, Department of History, Box N, Brown University, Providence, RI 02912, USA Barton J. Bernstein, History Department, Building 200, Stanford University, Stanford, CA 94305-2024, USA Michael D. Gordin, (...) History Department, 305 Dickinson Hall, Princeton University, Princeton, NJ 08544, USA Journal Metascience Online ISSN 1467-9981 Print ISSN 0815-0796. (shrink)

The study of alternatives to conventional industrial agricultural production has intensified in recent years. While many types of alternative production systems, and the motivations of individuals to participate in them, have been studied, there are significant gaps in the literature. One such dearth is research on those participating in self-provisioning activities. This study begins to fill the gap by looking at the self-provisioning activity of home gardening using data from the 2008 Ohio Survey of Food, Agriculture, and Environmental Issues. Discerning (...) who household gardeners are is important given the recent economic, cultural, and political climate of the United States. The results show that home gardening occurs throughout the state of Ohio at surprisingly high levels. Bivariate and multivariate analyses reveal several noteworthy associations between gardening and household characteristics, including spatial location, pro-environmental and economic hardship behaviors, and level of participation in localized food systems. (shrink)

The purpose of this article is to integrate two outstanding problems within the philosophy of science. The first concerns what role aesthetics plays in scientific thinking. The second is the problem of how logically testable ideas are generated (the so-called "psychology of research" versus "logic of (dis)proof" problem). I argue that aesthetic sensibility is the basis for what scientists often call intuition, and that intuition in turn embodies (in a literal physiological sense) ways of thinking that have their own meta-logic. (...) Thus, aesthetics is a form of cognition. Scientists think not in equations or words or other logical abstractions, but emotionally and sensually, using visual and aural images, kinesthetic and other proprioceptive feelings, sensations, patterns, and analogies. These aesthetic forms of thinking have their own logics that I call "synosia", from the root words synaesthesia (a combining of senses) and gnosis, "to know". Synosia denotes understanding that integrates feeling that one knows with feeling what one knows. Eminent scientists universally describe an explicitly secondary process in which such personal knowledge must be "translated" into a formal language, such as words or equations, in order to be communicated to other people. Many of the unsolved problems that philosophers of science (as well as psychologists and artificial intelligence researchers) have had in making sense of scientific thinking have arisen from confusing the form and content of the final translations with the hidden means by which scientific insights are actually achieved. (shrink)

Introduction Financial conflicts of interest (fCOI) present well documented risks to the integrity of biomedical research. However, few studies differentiate among fCOI types in their analyses, and those that do tend to use preexisting taxonomies for fCOI identification. Research on fCOI would benefit from an empirically-derived taxonomy of self-reported fCOI and data on fCOI type and payor prevalence.Methods We conducted a content analysis of 6,165 individual self-reported relationships from COI statements distributed across 378 articles indexed with PubMed. Two coders used (...) an iterative coding process to identify and classify individual fCOI types and payors. Inter-rater reliability was κ = 0.935 for fCOI type and κ = 0.884 for payor identification.Results Our analysis identified 21 fCOI types, 9 of which occurred at prevalences greater than 1%. These included research funding (24.8%), speaking fees (20.8%), consulting fees (18.8%), advisory relationships (11%), industry employment (7.6%), unspecified fees (4.8%), travel fees (3.2%), stock holdings (3.1%), and patent ownership (1%). Reported fCOI were held with 1,077 unique payors, 22 of which were present in more than 1% of financial relationships. The ten most common payors included Pfizer (4%), Novartis (3.9%), MSD (3.8%), Bristol Myers Squibb (3.2%), AstraZeneca (3.1%), GSK (3%), Boehringer Ingelheim (2.9%), Roche (2.8%), Eli LIlly (2.5%), and AbbVie (2.4%).Conclusions These results provide novel multi-domain prevalence data on self-reported fCOI and payors in biomedical research. As such, they have the potential to catalyze future research that can assess the differential effects of various types of fCOI. Specifically, the data suggest that comparative analyses of the effects of different fCOI types are needed and that special attention should be paid to the diversity of payor types for research relationships. (shrink)

Because anticipated and retrospective regret play important roles in practical deliberation and motivation, better understanding them can illuminate the contours of human agency. However, the possibility of self-ignorance and the fact that we change over time can make regret—especially anticipatory regret—not only a poor predictor of where the agent will be in the future but also an unreliable indicator of where the agent stands. Granting these, this paper examines the way in which prospective and, particularly, retrospective regret can nevertheless yield (...) important insight into the sorts of creatures we are, both generally and individually. The experience of retrospective regret can show a person she values something in a way she did not know or that she is (or was) a different person than she had thought, insights which can factor into forward-looking, or prospective, deliberation. Such instances of revelatory regret reveal something to the agent about herself as agent. I examine two cases of agential self-ignorance. In the first, the experience of regret reveals what the agent values, not only to others but even to the agent himself. In the second, the agent anticipates experiencing regret for an action but does not experience the regret, suggesting that the agent did not value the rejected alternative in the way she thought. Anticipatory regret is forward-looking and can play an important role in practical deliberation. But insofar as anticipatory regret flows from one’s imperfect judgment and prospection about oneself, retrospective regret can be an important corrective in helping the agent understand her own standpoint. (shrink)

Supernatural agent concepts are regarded as a defining trait of religion. The interaction of the minimally counterintuitive mnemonic effect and the hypersensitive agency detection device may be employed to explain the universal presence of concepts of gods and deities. Using the measure of free-recall, a broad model of cultural transmission investigated this pan-cultural transmission bias with a large age-representative sample in UK and China. Results were analyzed by four-way mixed ANOVA considering counterintuitiveness, familiarity, ontological category, and delay, and with age (...) as a covariate. A significant interaction of counterintuitiveness × HADD was found for both UK and China samples. These findings support assertions that supernatural agent concepts are more easily transmitted than other concepts because the present study finds that concepts similar to supernatural agents were more readily recalled. (shrink)

Bioethics, Volume 36, Issue 4, Page 472-473, May 2022.

Malcolm S Justins; Fairness, Equality and Needs as Claims to Education, Journal of Philosophy of Education, Volume 4, Issue 1, 30 May 2006, Pages 121–137, https.

If “Big Gods” evolved in part because of their ability to morally regulate groups of people who cannot count on kin or reciprocal altruism to get along, then powerful gods would tend to be good gods. If the mechanism for this cooperation is some kind of fear of supernatural punishment, then we may expect that mighty gods tend to be punishing gods. The present study is a statistical analysis of superhuman being concepts from 20 countries on five continents to explore (...) whether the goodness of a god is related to its mightiness. Gods that looked more like the God of classical theism and gods that were low in anthropomorphism were more likely to be regarded as morally good and to be the target of religious practices. Mighty gods were not, however, especially likely to punish or to be a “high god.”. (shrink)

The concept of dominance is used in the behavioral and biological sciences to describe outcomes in a variety of competitive interactions. In some taxa, a history of agonistic encounters among individuals modifies the course of future agonistic encounters such that the existence of a certain type of relationship can be inferred. If one is to characterize such relationships as dominance, however, then they must be distinguished from other kinds of interaction patterns for which the term tends to be used, as (...) well as from factors such as territoriality and "trained" winners and losers, which may also influence the expression of agonistic behavior. Operational definitions based on causal, functional, evolutionary, and ontogenetic considerations have been proposed. Reliability and validity problems have been discussed, but the dominance concept has proved useful despite methodological difficulties. The confusion of dominance relationships (which involve two or more individuals) with dominance ranks (which are assigned to a single individual) has obscured the possible evolutionary basis of dominance relationships. If benefits accrue to dominant members of pairs, then those attributes which allow an animal to establish dominance can be selected. Dominance per se and dominance ranks, on the other hand, cannot be genetically transmitted since they constitute relationships with other individuals rather than absolute attributes. Dominance rankings in particular may be useful for describing behavioral patterns within a group, but they may reflect our own ability to count rather than any important variable in social organization. (shrink)

The recent Minnesota case of In re Emergency Guardianship of Albert Barnes illustrates an emerging class of cases where a dispute between a family proxy and a hospital over “medical futility” requires legal resolution. The case was further complicated by the patient’s spouse who fraudulently claimed to be the patient’s designated health care proxy and who misrepresented the patient’s previously expressed treatment preferences. Barnes demonstrates the degree of significant administrative and institutional support to the health care team, ethics consultants, and (...) futility committees that is required when a futility dispute escalates to the need for judicial resolution. An institutional futility policy, especially one that is endorsed by other regional medical centers and organizations, is an important foundation for a hospital that seeks judicial support in a dispute over medical futility in end of life care. (shrink)