Background: Families and clinicians must often weigh competing priorities when making medical decisions for a pediatric patient at the end of life. Few empirical data exist regarding the importance that clinicians place on varying priorities and whether clinical practice conforms to decision-making standards discussed in the literature. Methods: We administered a discrete choice experiment to understand the relative importance of nine pediatric end-of-life decision-making priorities using responses from 364 nurses and physicians from three intensive care units (ICUs) (pediatric ICU, pediatric (...) cardiothoracic ICU, neonatal ICU) in a large children's hospital, with a 54% response rate. We used latent class analysis to characterize subgroups of health professionals based on their patterns of importance for the nine attributes and examined differences in class membership using multinomial logistic regression. Results: Eighty-two percent of respondents were nurses, consistent with the proportion of nurse and physician staff in the units. Latent class analysis separated our sample of health professionals into five distinct classes. All five groups rated the child's comfort and the best interests as most important but differed regarding how they valued other considerations: Group 1 rated highly consideration of the entire family and medical judgment; Group 2, the entire family's interests, parents’ preferences, and religious beliefs; Group 3, maintaining harmony between parents and medical team; Group 4, responsible use of medical resources; and Group 5, medical evidence and prolonging the child's life. Those with more years of experience were less likely to fall in Group 5 (medical evidence/life-prolonging). Profession was not associated with group membership. Conclusions: Nurses and physicians who care for dying children prioritize foremost the child's best interests and comfort but then possess varying secondary priorities about what is most important when making medical decisions. Pediatric palliative care and ethics consultative services should be aware of and prepared to address these differing concerns. (shrink)

This book is the first comprehensive exposition of the work of one of the most important intellectual historians and political theorists writing today.

It is often maintained that Samuel Pufendorf founded natural equality on human dignity. This article partly questions this interpretation, maintaining that the dignity Pufendorf attributed to human nature did not indicate the Kantian idea of absolute and incomparable worth but only superiority in relation to other animals. This comparative dignity of humanity implied that all humans are equally obliged to obey natural law, but it did not offer a foundation for the similarity of their innate duties. The latter followed from (...) the fundamental principle of natural law, the duty to maintain sociality, and from observations concerning human self-esteem. (shrink)

We confront the following popular views: that mind or life are algorithms; that thinking, or more generally any process other than computation, is computation; that anything other than a working brain can have thoughts; that anything other than a biological organism can be alive; that form and function are independent of matter; that sufficiently accurate simulations are just as genuine as the real things they imitate; and that the Turing test is either a necessary or sufficient or scientific procedure for (...) evaluating whether or not an entity is intelligent. Drawing on the distinction between activities and tasks, and the fundamental scientific principles of ontological lawfulness, epistemological realism, and methodological skepticism, we argue for traditional scientific materialism of the emergentist kind in opposition to the functionalism, behaviourism, tacit idealism, and merely decorative materialism of the artificial intelligence and artificial life communities. (shrink)

An introduction to the seven principles for practicing critical hope.

This article examines narratives, images, and stories that give insight to everyday experimentation and ethical self‐formation. I use the case of World Vision and its early leaders to unpack genealogies of American evangelical humanitarianism. Rather than seeking to identify American evangelicalism’s normative ethical stance, I aim to expand the discussion in anthropology of ethics on ethical self‐formation through examining the tensions, reflections, and processes of becoming among evangelical humanitarians. In doing so, I examine two focal areas of ethical self‐formation among (...) early World Vision leaders. The first is oscillation between and mixing of passion and compassion frameworks in the American evangelical imagination. Second, I identify a range of temporal frames that evangelicals draw on to make sense of and formulate ethical responses to human needs encountered abroad. (shrink)

Next SectionThe principle of respect for autonomy has shaped much of the bioethics' discourse over the last 50 years, and is now most commonly used in the meaning of respecting autonomous choice. This is probably related to the influential concept of informed consent, which originated in research ethics and was soon also applied to the field of clinical medicine. But while available choices in medical research are well defined, this is rarely the case in healthcare. Consideration of ordinary medical practice (...) reveals that the focus on patient choice does not properly grasp the moral aspects involved in healthcare. Medical decisions are often portrayed as if doctors and patients in confidence confront specific decisions about examinations or treatment, yet the reality often involves many different participants, with decisions being made over time and space. Indeed, most of the decisions are never even presented to patients, as it would be unethical to suggest something that is not medically justifiable. The options patients do confront are somewhat arbitrarily constructed within the narrow framework of both what is deemed to be medically appropriate and how the healthcare system is organised practically. While the autonomy discourse has proven valuable, a failure to distinguish between the fields of medical research and clinical medicine has generated a focus on patient choice that does not reflect what is really at stake in healthcare settings. This is alarming, because the current discourse misrepresents medical practice in a way that actually contributes to bioethical self-delusion. (shrink)

Mechanistic explanation is at present the received view of scientific explanation. One of its central features is the idea that mechanistic explanations are both “downward looking” and “upward looking”: they explain by offering information about the internal constitution of the mechanism as well as the larger environment in which the mechanism is situated. That is, they offer both constitutive and contextual explanatory information. Adequate mechanistic explanations, on this view, accommodate the full range of explanatory factors both “above” and “below” the (...) target phenomenon. The aim of this paper is to demonstrate that mechanistic explanation cannot furnish both constitutive and contextual information simultaneously, because these are different types of explanation with distinctly different aims. Claims that they can, I argue, depend on several intertwined confusions concerning the nature of explanation. Particularly, such claims tend to conflate mechanistic and functional explanation, which I argue ought to be understood as distinct. Conflating them threatens to oversell the explanatory power of mechanisms and obscures the means by which they explain. I offer two broad reasons in favor of distinguishing mechanistic and functional explanation: the first concerns the direction of explanation of each, and the second concerns the type of questions to which these explanations offer answers. I suggest an alternative picture on which mechanistic explanation is understood as fundamentally constitutive, and according to which an adequate understanding of a phenomenon typically requires supplementing the mechanistic explanation with a functional explanation. (shrink)

In the majority of research, resettled immigrant and refugee parents are often considered to be less involved with their children’s schooling than majority parents. This study challenges such research positions, based on narrative interviews about parenting in exile conducted with refugee parents resettled in Norway. Cultural psychology and positioning theory have inspired the analyses. The choice of methodology and conceptualisations have brought forth a rich vein of material, which illuminated agency and active positions in the parents’ narratives about involvement with (...) their children’s education. Involvement narratives of success achieved by parents taking action are presented as well as narratives of thwarted agency. Parents’ narrated action includes also involvement outside officialdom, such as informal contact with teachers. It is assumed that the latter involvement forms have become invisible in the majority of earlier research on refugee parents’ school involvement due to methodological choices, and may have contributed to deficit positioning of refugee parents as passive in school involvement. This article’s agency narratives form a sharp contrast to such deficit positioning. (shrink)

In recent years, many philosophers of science have attempted to articulate a theory of non-epistemic emergence that is compatible with mechanistic explanation and incompatible with reductionism. The 2005 account of Fred C. Boogerd et al. has been particularly influential. They argued that a systemic property was emergent if it could not be predicted from the behaviour of less complex systems. Here, I argue that Boogerd et al.'s attempt to ground emergence in complexity guarantees that we will see emergence, but at (...) the cost of rendering it either trivial or epistemic. There are three basic problems. First, neither the measures of complexity explicitly mentioned by Boogerd et al. nor the most popular measures in the literature can do the practical and theoretical work that they assign to complexity. Second, I argue that while the success of their view depends on restricting the base of information available to the reductionist, this cannot be done in a way that is metaphysically neutral with respect to emer.. (shrink)

Recently, some mechanists have embraced reductionism and some reductionists have endorsed mechanism. However, the two camps disagree sharply about the extent to which mechanistic explanation is a reductionistic enterprise. Reductionists maintain that cellular and molecular mechanisms can explain mental phenomena without necessary appeal to higher-level mechanisms. Mechanists deny this claim. I argue that this dispute turns on whether reduction is a transitive relation. I show that it is. Therefore, mechanistic explanations at the cellular and molecular level explain mental phenomena. I (...) make my case in part by noting that mechanisms at higher levels are composed of mechanisms at lower levels. Compositional relations are transitive. In addition, they are explanatory. I conclude that there are explanatory linkages from cellular and molecular mechanisms to mental phenomena within a hierarchy of nested mechanisms. (shrink)

We introduce a new model of reduction inspired by Kemeny and Oppenheim’s model [Kemeny & Oppenheim 1956] and argue that this model is operative in a “ruthlessly reductive” part of current neuroscience. Kemeny and Oppenheim’s model was quickly rejected in mid-20th-century philosophy of science and replaced by models developed by Ernest Nagel and Kenneth Schaffner [Nagel 1961], [Schaffner 1967]. We think that Kemeny and Oppenheim’s model was correctly rejected, given what a “theory of reduction” was supposed to account for at (...) that time. But their guiding insights about what constitutes scientific reduction—increases in explanatory scope and systematization—reflect actual practices of current reductionistic neuroscience. The key rehabilitative step to make their insights fit current scientific details is to restate them using resources from recent work on causal-mechanistic explanation. We begin with a scientific case study, drawn from the relatively new field of “molecular and cellular cognition”. It provides an explanation of the well-known Ebbinghaus spacing effect on learning and memory in terms of interactions between a transcriptional enhancer protein and its inhibiting phosphatase in neurons recruited into the memory trace. Next we briefly describe some popular models of reduction from mid-20th-century philosophy of science. We point out how these models fail to illuminate key features of our scientific case study. Finally we present our causal-mechanistically updated Kemeny and Oppenheim-inspired model and argue that it nicely accounts for the details of our scientific case study. We close with a remark that will hopefully undercut the surprise many may feel to learn that a long-rejected philosophical account of reduction actually is at work in one of the most prominent reductionistic endeavors in current science. (shrink)

This article considers how the metaphor of the vaccine line and the subjectivity of the line jumper came to frame COVID vaccination experiences. Drawing on analysis of interviews (n = 24) with self-identified vaccine line jumpers, this article reports on three narratives that arose across interviews: (1) vaccine line jumping is a necessary strategy of health-advocacy, (2) vaccines are personal healthcare tools earned through individual merit, and (3) vaccine refusal is a problem of belief rather than access. Findings advance research (...) about the personalization of vaccination and public health while contributing insights about the constrained subjectivities that people adopt in individualistic health landscapes. (shrink)

This essay teases out the intimate connections between the scientific and fiscal realms in the context of American germ theory and obstetrics. By uncovering the economic and medical contexts of Henry James’s Washington Square—set during the infancy of germ theory and the heyday of American obstetrics—this essay exposes a previously unexplored subtextual history of contagion in the text. Although this scientific history seems relegated to the novel’s margins, understanding the changing scientific cosmologies and professional organizations in the context of the (...) novel’s setting and composition reveals that these tiny infectious particles and their vectors fundamentally shape the plot of the novel. (shrink)

Many have argued that sexualized banter is indicative of “masculine” culture, serving as a mechanism by which men construct masculine identity and dominance and create a climate of sexual harassment. While this claim has much empirical support, sexualized banter among women remains undertheorized. Furthermore, many contemporary scholars agree that the meaning of a sexual exchange may vary widely between cultural and material contexts, but this insight has only recently been applied to studies of workplace sexuality. This article considers the issues (...) of gender, sexuality, power, and context in light of ethnographic data collected in two service work establishments. Within these organizations, many workplace sexualized interactions emerge as facilitating camaraderie and empowerment between workers. The article concludes that the sexual particularities of a workplace should be interpreted as one of its many cultural features, reflective more of its organizational conditions than of a static sexual symbolism. (shrink)

The dominant view of women has changed radically during the last century. These changes have had an important impact on the way of life of women in general and, undoubtedly, on women as patients. So far, gender differences have received little attention when developing healthcare services. Stroke hits a great number of elderly women. Wyller et al. found that women seemed to be harder hit by stroke than men; they achieved lower scores in tests of motor, cognitive and ADL functions, (...) both in the acute phase and 1 year after stroke. It is reasonable to expect that differences in outcome among male and female sufferers may in part be explained by the fact that rehabilitation services are designed primarily to meet the needs of men. de Beauvoir's feminist theory maintains that one's body is fundamental in creating the person, which is a lifelong process. Traditionally, the female body has been exposed to alienation and oppression through life. This has led women to develop a life in immanence. This we feel can be of significance in connection with rehabilitation after a stroke, particularly for elderly women. In this article we will discuss how de Beauvoir's theory can throw new light on the experiences and rehabilitation of elderly women and point to ways of improving the process of rehabilitation. (shrink)

Although Daniel Engster's “caring” human rights are, on the surface, a compelling way to bring the concept of care into the international political realm, I argue they actually serve to perpetuate some of the same problems of mainstream human-rights discourses. The problem is twofold. First, Engster's particular care theory relies on an uncritical acceptance of our dependence relations. It can, therefore, not only overlook how local and global institutions, norms, and the marketplace shape our relations of dependence, but also serve (...) to further naturalize our current dependence relations. Second, Engster's caring human rights are only minimally feminist, which means that they do not pay attention to the way in which women's full and equal political participation is a necessary component to challenging and overcoming the oppression, marginalization, and exploitation of women and their caring labor worldwide. Although I am sympathetic to Engster's goals and some of his proposed policy solutions, I argue that we should not abandon the critical, feminist lens of care ethics in favor of “caring” human rights that cannot overcome the care critique of mainstream human-rights discourses. (shrink)

ABSTRACT Samuel Pufendorf’s major work on natural law, De jure nature et gentium, included a long chapter on the power of the civil sovereign to determine the value of citizens. There, Pufendorf identified several forms of esteem (existimatio), according to which human beings are ranked in social life. The article argues that behind Pufendorf’s discussion of this topic was the idea that the way people esteem others and want others to esteem them has profound consequences for maintaining peaceful social life (...) and is therefore morally regulated by the fundamental natural-law duty to maintain sociality. The article explores the key elements of Pufendorf’s multifaceted analyses of esteem, making apparent how they were connected to sociality. The article also analyses Pufendorf’s argument for the duty to esteem other humans as one’s equals by nature, questioning the view that this relied on the idea of human dignity understood as an intrinsic value of human beings. Pufendorf’s argument for this duty was a part of same project as his analyses of existimatio, namely, to define how natural law regulates the way human beings esteem each other, and it relied on his observations concerning the character of human self-esteem. (shrink)

The current antireductionist consensus rests in part on the indefensibility of the deductive-nomological model of explanation, on which classical reductionism depends. I argue that the DN model is inessential to the reductionist program and that mechanism provides a better framework for thinking about reductionism. This runs counter to the contemporary mechanists’ claim that mechanism is an alternative to reductionism. I demonstrate that mechanists are committed to reductionism, as evidenced by the historical roots of the contemporary mechanist program. This view shares (...) certain core commitments with reductionism. It is these shared commitments that constitute the essential elements of the reductionist program. (shrink)

Background:Dignity is an important ideal in the nursing of older women who need municipal care. Dignity can be challenged when health is impaired by feeling grief and suffering associated with bodily changes and impaired functions. Aim and research questions:The study aimed to deepen the understanding of the meaning of dignity in the life of fragile older women who daily needed help from municipal care service. The research questions are: What is older women’s experience of dignity, and what is it not (...) to be met with dignity when needing service from municipality care? Research design: The study has a qualitative design, and the methodology is based on Gadamer’s ontological hermeneutics. Ten women receiving municipal care, aged from 66 to 91 were interviewed in their home environments. Kvale and Brinkmanns’ three levels of interpretation were applied in the analysis of the interviews: self-understanding, a critical understanding based on common sense, and theoretical understanding. Ethical considerations: The study follows the guidelines for good scientific practice according to the Declaration of Helsinki and was approved by the Norwegian Centre for Research Data. Results: The interviews revealed fragments of the women’s unique life history. Two themes emerged from the interpretation: Confirming encounters provide human dignity; and Not being confirmed as a human being violates human dignity. Conclusions:For the women, dignity is about feeling seen and understood by the individual nurse and this takes place both in conversation and in bodily care. Not being seen or confirmed gives rise to suffering. The reason for this seems to be lack of competence on the part of the staff or little continuity. (shrink)

The interventional case-study presented in this report was intended to explore how the use of a conceptual meta-model representing coherent and conceptual relations commonly appearing in expository texts helped a blind reader to use structuring strategies in reading them. The instructional approach designed and tested in the study was based on the key elements of the theory of planned stage-by-stage formation of mental acts and concepts (PSFMAC), introduced by Galperin, and also drew on contemporary approaches in reading comprehension interventions. The (...) participant of the study was a 17-year-old, blind man with semantic and syntactic disorders in his early language development. The results of the study indicate that the use of the developed conceptual meta-model appeared to considerably affect his strategies in structuring the expository text content. During the intervention, the participant started more accurately to take account of some frequent coherent and conceptual, particularly causal, relations that he was previously prone to ignore. He also started more actively to use external speech while reading. The results provide evidence that the developed conceptual meta-model can serve as an external organizer helping a blind reader to actively structure text content. (shrink)

In this essay, I argue that the deflationary view of truth is inconsistent with Davidson's theory of meaning. I take deflationism to consist of two basic theses: the linguistic thesis that truth talk is always expressive and never explanatory, and the metaphysical thesis that truth is not a property. Since Davidson construes meaning in terms of truth-conditions, it appears that Davidson regards truth talk as explanatory, and truth as a property. Michael Williams argues otherwise, suggesting that Davidson's theory of meaning (...) can be understood in terms of his theory of radical interpretation, and that radical interpretation does not require a notion of truth richer than the deflationist allows. I argue that at the level of the T-sentences Davidson's theory of meaning entails (T-sentences yielded through the practice of radical interpretation), a non-deflationary notion of truth is indeed required. This is because, first, for Davidson, to grasp the meaning of a sentence is to grasp the T-sentence associated with it, and the T-sentence predicates the property truth of that sentencesecond, because it does so, in T-sentences "true" is explanatory, not merely expressive. I then consider the objection that T-sentences can be understood in terms of a norm of assertion, rather in terms of "true" as predicating a property of sentences, and I respond that the objection confuses pragmatic issues with semantic issues. (shrink)

The notion of an instrument in the quantum theory of measurement is studied in the context of transformation valued linear maps on von Neumann algebras and their *-subalgebras. An extension theorem is proved which yields among other things characterizations of the Fourier transforms of instruments and their noncommutative analogues. As an application, an ergodic type theorem for a general class of transformation valued functions on a locally compact group is obtained.