OBJECTIVE: To describe the issues faced, and how they were addressed, by the University of Toronto Critical Care Medicine Program/Joint Centre for Bioethics Task Force on Appropriate Use of Life-Sustaining Treatment. The clinical problem addressed by the Task Force was dealing with requests by patients or substitute decision makers for life-sustaining treatment that their healthcare providers believe is inappropriate. DESIGN: Case study. SETTING: The University of Toronto Joint Centre for Bioethics/Critical Care Medicine Program Task Force on Appropriate Use of Life-Sustaining (...) Treatment. PARTICIPANTS: The 24-member Task Force included physician and nursing leaders from five critical care units, bioethicists, a legal scholar, a health administration expert, a social worker, and a hospital public relations professional. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Our specific lessons learned include a) a policy focus on process; b) use of a negotiation and mediation model, rather than a hospital ethics committee model, for this process; and c) the policy development process is itself a negotiation, so we recommend equal involvement of interested groups including patients, families, and the public. CONCLUSIONS: This article describes the key issues faced by the Task Force while developing its policy. It will provide a useful starting point for other groups developing policy on appropriate use of life-sustaining treatment. (shrink)

Modern bioethics, which is based on Western moral philosophy and Western biomedical perspectives, has evolved within a complex, highly individualistic culture that draws a sharp distinction between church and state and tolerates a multitude of values. This discipline defines its principles in secular and objective terms that often are bewildering to people of non-Western origin. Despite much discourse, principlism remains the fundamental framework of bioethics. Principlism is held in such high regard that many bioethicists equate autonomy with personhood, as if (...) autonomy exists independently of specific beliefs and commitments.In addition, we continue to minimize the substantial differences in the way people of different cultures perceive, experience, and explain illness, although our views of the potential cultural limitations of Western medicine have grown and expanded in recent years. At the heart of it we continue to be tied to a biomedical focus that largely neglects the context of the situation. (shrink)

Modern bioethics, which is based on Western moral philosophy and Western biomedical perspectives, has evolved within a complex, highly individualistic culture that draws a sharp distinction between church and state and tolerates a multitude of values. This discipline defines its principles in secular and objective terms that often are bewildering to people of non-Western origin. Despite much discourse, principlism remains the fundamental framework of bioethics. Principlism is held in such high regard that many bioethicists equate autonomy with personhood, as if (...) autonomy exists independently of specific beliefs and commitments.In addition, we continue to minimize the substantial differences in the way people of different cultures perceive, experience, and explain illness, although our views of the potential cultural limitations of Western medicine have grown and expanded in recent years. At the heart of it we continue to be tied to a biomedical focus that largely neglects the context of the situation. (shrink)

Sir Austin Bradford Hill’s ‘aspects of causation’ represent some of the most influential thoughts on the subject of proximate causation in health and disease. Hill compiled a list of features that, when present and known, indicate an increasing likelihood that exposure to a factor causes—or contributes to the causation of—a disease. The items of Hill’s list were not labelled ‘criteria’, as this would have inferred every item being necessary for causation. Hence, criteria that are necessary for causation in health, disease (...) and intervention processes, whether known, knowable, or not, remain undetermined and deserve exploration. To move beyond this position, this paper aims to explore factors that are necessary in the constitution of causative relationships between health, disease processes, and intervention. To this end, disease is viewed as a causative pathway through the often overlapping stages of aetiology, pathology and patho-physiology. Intervention is viewed as a second, independent causative pathway, capable of causing changes in health for benefit or harm. For the natural course of a disease pathway to change, we argue that intervention must not only occupy the same time and space, but must also share a common form; the point at which the two pathways converge and interact. This improved conceptualisation may be used to facilitate the interpretation of clinical observations and inform future research, particularly enabling predictions of the mechanistic relationship between health, disease and intervention. (shrink)

Early in his career, Karl Marx complained that “Philosophers have hitherto only interpreted the world in various ways; the point is to change it.” Philosophers Robert Frodeman and Adam Briggle have recently issued this same complaint against their contemporaries, arguing that philosophy has become an isolated, “purified” discipline, detached from its historical commitments to virtue and to public engagement. In this paper I argue that they are wrong about contemporary philosophy and about its history. Philosophy hitherto has always been characterized (...) both by a concern with practical engagement and by serious misgivings about such engagement. I show that reluctance to engage with practical affairs was a feature of philosophy long before the advent of the modern university and that a wide range of contemporary philosophers are concerned with virtue and public engagement. Finally, I argue that Frodeman and Briggle’s own account of contemporary philosophy makes it unsuitable both as the subject of their title (“When Philosophy Lost Its Way”) and as the object of their call to action. (shrink)

Causation is important when considering how an organism maintains health, why disease arises in a healthy person, and how one may intervene to change the course of a disease. This paper explores the form of causative relationships in health, disease and intervention, with particular regard to the pathological and biopsychosocial models. Consistent with the philosophical view of dispositionalism, we believe that objects are the fundamental relata of causation. By accepting the broad scope of the biopsychosocial model, we argue that psychological (...) and social constructs be considered objects. We think that this 'biopsychosocial dispositionalism' offers the flexibility required to describe causation throughout health, disease and intervention pathways. When constructing mechanistic chains to describe causative pathways, we argue that an object will causally connect with others through actions; transfers of energy from one object to another, initiated by the manifestation of one or more dispositional property. Finally, our analysis of causative interactions utilises the concept that a common form of interaction exists between disease and intervention pathways. This common form will always be an object, but the mode of interaction will vary with each disease. We describe how intervention may act through objects being shared between converging mechanistic chains, or through the removal and/or insertion of objects in such chains. We believe that this analysis provides novel insight to the forms of causative transactions that can occur. In addition, we hope that the findings of this analysis represent the first step towards developing a framework for appraising the composition of mechanistic theories. (shrink)

Causation is important when considering: how an organism maintains health; why disease arises in a healthy person; and, how one may intervene to change the course of a disease. This paper explores the form of causative relationships in health, disease and intervention, with particular regard to the pathological and biopsychosocial models. Consistent with the philosophical view of dispositionalism, we believe that objects are the fundamental relata of causation. By accepting the broad scope of the biopsychosocial model, we argue that psychological (...) and social constructs be considered objects. We think that this ‘biopsychosocial dispositionalism’ offers the flexibility required to describe causation throughout health, disease and intervention pathways. When constructing mechanistic chains to describe causative pathways, we argue that an object will causally connect with others through actions; transfers of energy from one object to another, initiated by the manifestation of one or more dispositional property. Finally, our analysis of causative interactions utilises the concept that a common form of interaction exists between disease and intervention pathways. This common form will always be an object, but the mode of interaction will vary with each disease. We describe how intervention may act through objects being shared between converging mechanistic chains, or through the removal and/or insertion of objects in such chains. We believe that this analysis provides novel insight to the forms of causative transactions that can occur. In addition, we hope that the findings of this analysis represent the first step towards developing a framework for appraising the composition of mechanistic theories. (shrink)

This work contributes to recent transdisciplinary efforts to view the Haitian slave revolt (1791–1804) as the historical inspiration for Hegel’s master-slave dialectic. Reconstructions offered by contemporary postcolonial scholars argue that the Haitian revolt was chronicled in Minerva as Hegel raced to finish his Phenomenology. Benhabib recently recognized the Hegel-Haiti thesis as entailing the sort of inclusive dialogical learning process necessary to validate subaltern experiences. The thesis has also drawn its share of sceptical scrutiny as Badiou claims that it risks forcing (...) an unnecessary moral dissymmetry, neglects objectionable features of enslavement and imposes a mismatch between apolitical subject and revolutionary. In reply, we appeal to the pioneering work of Tavares to show that the asymmetrical construction of classification schemes for persons of mixed-racial statuses accords with decades of documented literary exchanges between Hegel and Gregoire. We then turn to the work of James on the role of mixed-race merchants in the testimonial accounts of late 18th century French historians to show that European literate publics were well aware of the extremely coercive forms of commodified labour found in Saint-Domingue. We then invoke the archival work of Du Bois on French, British and American parliamentary proceedings that show the provisional colonial identities ascribed to Caribbean subjects did not hinder their self-conscious exercise of political agency. Viewing Hegel in terms of the historiographic records of the racial ontologies of early modern transatlantic literary exchanges helps explain how he adapted these tropes concerning mixed-race subjects in a manner that better explains many of the anomalous features of the dialectic. However, conferring the Haitian revolution its proper world-historical warrant as inspiration for his infamous master-slave dialectic need not lead us to overlook Hegel’s complicity with many of the epistemic and ontological flaws of colonial tropes held in early modern transatlantic print. (shrink)

Blair's account, like the intelligence field in general, treats many distinct constructs as if they were practically interchangeable – this is not self-evident. Paradigm integration and rationalization of redundant nomenclature are important for the continued development of understanding. The prior task is to demonstrate where synonymity of constructs across paradigms occurs, and where it fails. We present arguments why this is the case. (Published Online April 5 2006).

A table of contents, in lieu of abstract -/- Foreword by Aaron Ehasz -/- Introduction: “We are all one people, but we live as if divided” Helen De Cruz and Johan De Smedt -/- Part I The Universe of Avatar: The Last Airbender -/- 1 Native Philosophies and Relationality in ATLA: It’s (Lion) Turtles All the Way Down Miranda Belarde-Lewis and Clementine Bordeaux 2 Getting Elemental: How Many Elements Are There in Avatar: The Last Airbender? Sofia Ortiz-Hinojosa 3 The Personalities (...) of Martial Arts in Avatar: The Last Airbender Zachary Isrow 4 The End of the World: Nationhood and Abolition in Avatar: The Last Airbender Nicholas Whittaker 5 The Bending World, a Bent World: Supernatural Power and Its Political Implications Yao Lin -/- Part II Water 6 Avatar: The Last Airbender and Anishinaabe Philosophy Brad Cloud 7 “Lemur!” – “Dinner!”: Human–Animal Relations in Avatar: The Last Airbender Daniel Wawrzyniak 8 On the Moral Neutrality of Bloodbending Johnathan Flowers 9 On the Ethics of Bloodbending: Why Is It So Wrong and Can It Ever Be Good? Mike Gregory 10 Mystical Rationality Isaac Wilhelm 11 “I will never, ever turn my back on people who need me”: Repairing the World Through Care Nicole Fice 12 Spirits, Visions, and Dreams: Native American Epistemology and the Aang Gang Justin Skirry and Samuel Skirry -/- Part III Earth 13 Time Is an Illusion: Time and Space in the Swamp Natalia Strok 14 There Is No Truth in Ba Sing Se: Bald-faced Lies and the Nature of Lying Nathan Kellen 15 The Rocky Terrain of Disability Gain in ATLA: Is Toph a Supercrip Stereotype or a Disability Pride Icon? Joseph A. Stramondo 16 The Earth King, Ignorance, and Responsibility Saba Fatima 17 The Middle Way and the Many Faces of Earth Thomas Arnold -/- Part IV Fire 18 The Battle Within: Confucianism and Legalism in the Nation, the Family, and the Soul Kody W. Cooper 19 Not Giving Up on Zuko: Relational Identity and the Stories We Tell Barrett Emerick and Audrey Yap 20 Uncle Iroh, from Fool to Sage – or Sage All Along? Eric Schwitzgebel and David Schwitzgebel 21 Being Bad at Being Good: Zuko’s Transformation and Residual Practical Identities Justin F. White 22 Compassion and Moral Responsibility in Avatar: The Last Airbender: “I was never angry; I was afraid that you had lost your way” Robert H. Wallace -/- Part V Air 23 The Fire Nation and the United States: Genocide as the Foundation for Empire Building Kerri J. Malloy 24 Anarchist Airbenders: On Anarchist Philosophy in ATLA Savriël Dillingh 25 A Buddhist Perspective on Energy Bending, Strength, and the Power of Aang's Spirit Nicholaos Jones and Holly Jones 26 Ahimsa and Aang’s Dilemma: “Everyone … [has] to be treated like they're worth giving a chance” James William Lincoln 27 The Avatar Meets the Karmapa: Interconnections, Friendship, and Moral Training Brett Patterson . (shrink)

Interest in John Maynard Keynes has increased significantly over the past decade with the publication of his collected writings, increased access to his unpublished papers, and the resulting explosion of secondary literature. Responding to this renewed attention, this collection brings together economists and historians of economics with scholars from philosophy and other related fields to reconsider Keynes’s work and its legacy. Several of these essays look at Keynes not simply as an economist, but more broadly as a philosopher. Special attention (...) is directed to his views on aesthetics and moral philosophy, as well as his contributions as a probability theorist. The development of the Keynesian heritage is also considered: How did Keynesian ideas become assimilated and domesticated into the mainstream of economic thought—to the point of becoming dominant as the orthodoxy of the economics profession? What was the relationship between postwar British conservatives, Keynes’s work, and Britain’s relative economic decline? The archivist in charge of Keynes’s papers provides an additional vantage point on Keynes’s working methods and the broad range of scholars interested in his writings. Finally, all of the essays are followed by a responder’s comments, thus providing an exchange of viewpoints. _Contributors. _A. W. Coats, Allin F. Cottrell, Jacqueline Cox, William Darity, John Davis, Robert Dimand, Peter Groenewegen, Kevin Hoover, Henry E. Kyburg Jr., David Laidler, Michael S. Lawlor, Greg Lilly, D. E. Moggridge, R. M. O’Donnell, Kerry Pearce, Jochen Runde, Teddy Seidenfeld, J. D. Tomlinson. (shrink)

In this essay, I respond to A. W. Moore’s instructive chapter on Frege. I respond by asking various questions, and I question particularly Moore’s claim that Frege, in reacting to Benno Kerry, falls into Hegelian excess. I toy with responding to my question by regarding Frege as anticipating a Wittgensteinian-Heideggerian exaction. It remains unclear whether this constitutes (much) progress.

Background:Clinical investigation is a growing field employing increasing numbers of nurses. This has created a new specialty practice defined by aspects unique to nursing in a clinical research context: the objectives, setting, and nature of the nurse–participant relationship. The clinical research nurse role may give rise to feelings of ethical conflict between aspects of protocol implementation and the duty of patient advocacy, a primary nursing responsibility. Little is known about whether research nurses experience unique ethical challenges distinct from those experienced (...) by nurses in traditional patient-care settings.Research objectives:The purpose of the study was to describe the nature of ethical challenges experienced by clinical research nurses within the context of their practice.Research design:The study utilized a qualitative descriptive design with individual interviews.Participants and research context:Participating nurses self-identified as having experienced ethical challenges during screening. The majority were Caucasian, female, and worked in outpatient settings. Approximately 50% had > 10 years of research experience.Ethical considerations:The human subjects review board approved the study. Written informed consent was obtained.Findings:Predominant themes were revealed: the inability to provide a probable good, or/do no harm, and dual obligations. The following patterns and subthemes emerged: conflicted allegiances between protocol implementation, needs of the participant, desire to advance science, and tension between the nurse–patient therapeutic relationship versus the research relationship.Discussion:Participants described ethical challenges specific to the research role. The issues are central to the nurse–participant relationship, patient advocacy, the nurse’s role in implementing protocols, and/or advancing science.Conclusion:Ethical challenges related to the specialized role of clinical research nurses were identified. More research is warranted to fully understand their nature and frequency and to identify support systems for resolution. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Hope Draped in Black: Decolonizing Utopian StudiesCaroline Edwards (bio)What does utopian studies have to learn from critical race theory, Black studies, and ideas of Black futurity? While utopian scholars have begun unpicking the colonial entanglements of utopianism’s origins (particularly as a literary genre grounded in pelagic crossings to the New World that have advocated slavery, extractivism, and eugenics to name a few notable examples across the utopian canon), few, (...) if any, have incorporated the perspectives, aesthetics, and theoretical work of Black scholars themselves.1 The following are a few brief remarks organized around keywords (in a nod to Raymond Williams, a fierce advocate of utopian thinking) that attempt to sketch an answer to these questions, with a focus on my own area of utopian study: utopian literary and cultural production in the contemporary period.ProgressWe might start by considering the literary utopia’s most prolific period, from roughly 1880 to 1915. In a deluge of utopian narratives, many of them penned by amateur writers, we find the emergence of a genre that is thoroughly [End Page 498] rooted in industrialized progress. Whatever their perspective on capitalism and waged labor, these works privilege advanced industrialization as the primary means to eliminate poverty and disease, thereby liberating workers into automated futures of post-scarcity abundance. Examples include Edward Bellamy’s highly rationalized system of pneumatic delivery (Looking Backward: 2000–1887 [1888]), Mary E. Bradley Lane’s chemical production of food from waste products (Mizora: A World of Women [1890] 1999), H. G. Wells’s titanic hydro-powered engineering (Men Like Gods [1923]), Edward Bulwer Lytton’s lithic limitless energy, Vril (The Coming Race [1871]), or the ubiquitous electricity that powers Elizabeth Burgoyne Corbett’s clean city (New Amazonia: A Foretaste of the Future [1899] 2011), Alice Ilgenfritz Jones and Ella Marchant’s advanced Martian society (Unveiling a Parallel: A Romance [1893]), and Alexander Bogdanov’s advanced scientific culture on the red planet (Красная звезда [Red Star (1908) 1984]). Indeed, many notable dystopian novels begin with the same premise of highly automated societies that focus, rather, on the awfulness of life without purpose (Anna Bowman Dodd’s The Republic of the Future; Or, Socialism a Reality [1887], E. M. Forster’s “The Machine Stops” [1909], Kurt Vonnegut’s Player Piano [1952]). While they are far from uncritical of the telos of historical progress (most of the works highlight the class and gender inequalities of their own time), utopian novels in this period tend to view the utopian process as one of harnessing historical progress in a more equitable direction; they rarely question the Hegelian premise that history moves through contradictory forces in a dialectical series of stages.In his 2016 book Hope Draped in Black, Joseph R. Winters explores the lasting damage that ideas of historical progress have wrought on Black writers, artists, and thinkers. While notions of racial uplift are loaded with a linear narrative of Black progress such conceptions, he writes, “are mediated by melancholy, loss, and a recalcitrant sense of tragedy” (6–7). Building on Adorno and Horkheimer’s landmark critique in Dialectic of Enlightenment (1944) as well as the works of W. E. B. Du Bois, Winters notes thatmodern notions of progress and freedom are inherently flawed and problematic because they rely on and are intertwined with practices and conditions—capitalism, colonial expansion, racial hierarchies, endeavors, and incentives to usurp and possess that earth—that are harmful to non-Europeans, working-class bodies, women, and other groups.(2016, 8) [End Page 499]Examining the relationship between melancholy and hope in Black literary and aesthetic traditions, Winters explores how writers such as Toni Morrison and Ralph Ellison incorporate jazz into their works, using its discordant, improvisational structures to imagine time out of joint (the Derridean deferral of justice announced by the arrival of the specter of old King Hamlet, who returns) (Derrida 1994). Here, Winters writes, “the past can always haunt and disturb the present [so that] the present is always a site of potential breaks and ruptures that can signify both dislocation and pain as well as novelty and possibility” (2016, 25). If we are to contemplate the almost overwhelming task of decolonizing utopian studies, then... (shrink)

I must explain at once that these few pages do not attempt or pretend to be anything like a formal review of the recently published posthumous volume of Professor Bowman with the same title. I am precluded from writing such a review partly by the wide range of problems attacked by the author, partly by my own insufficient familiarity with many of the positions of the most recent physical and natural science which are brought under review. I will therefore (...) confine myself, so far as the strict business of the reviewer is concerned, to the single remark that the editor, Professor J. W. Scott, has discharged his difficult task of preparing the book for publication—no easy matter, as will be seen from his Preface—with equal skill and devotion, and has laid himself open to no worse criticism than that there are less than a dozen obvious slight misprints which have escaped detection, but will readily be detected by a careful reader. What I propose to do in the remarks which follow is simply to indicate the very real importance of the book by saying something as to its main purpose and thesis, and the points where I still feel that there is some difficulty or ambiguity about the writer's position which would, no doubt, have been largely cleared up if he had lived to reconstruct the whole six of his Vanuxem Lectures for publication as he has done the first three. (shrink)

Generative AI programs can produce high-quality written and visual content that may be used for good or ill. We argue that a credit–blame asymmetry arises for assigning responsibility for these outputs and discuss urgent ethical and policy implications focused on large-scale language models.

As late as the mid-1970s the term ‘ false consciousness ’ was still applied by critical social theorists to instances of ideological delusion. Yet, in the wake of the postmodernist revolution and its neo-Nietzschean declaration of all truths to be merely truth-effects, a concept of false consciousness appeared impossible to sustain. Drawing on an incident in the history of South African politics, this article reconsiders the ways in which a concept of false consciousness, built upon a representational model of truth (...) and falsity, might assist us in explaining the dynamics of ideological contestation. (shrink)

BackgroundJunior medical doctors have a key role in discussions and decisions about treatment and end-of-life care for people with dementia in hospital. Little is known about junior doctors’ decision-making processes when treating people with dementia who have advance care directives, or the factors that influence their decisions. To describe among junior doctors in relation to two hypothetical vignettes involving patients with dementia: their legal compliance and decision-making process related to treatment decisions; the factors influencing their clinical decision-making; and the factors (...) associated with accurate responses to one hypothetical vignette. MethodA cross-sectional survey of junior doctors, including trainees, interns, registrars and residents, on clinical rotation in five public hospitals located in one Australian state. The anonymous, investigator-developed survey was conducted between August 2018 and June 2019. Two hypothetical vignettes describing patients with dementia presenting to hospital with an ACD and either: bacterial pneumonia; or suspected stroke were presented in the survey. Participants were asked to indicate whether they would commence treatment, given the ACD instructions described in each vignette.ResultsOverall, 116 junior doctors responded. In Vignette 1, 58% of respondents selected the legally compliant option. Participants who chose the legally compliant option perceived ‘following patient wishes’ and ‘legal requirements to follow ACDs’ as equally important reasons for complying with the ACD. The most common reason for not selecting the legally compliant option in Vignette 1 was the ‘ACD is relevant in my decision-making process, but other factors are more relevant’. In Vignette 2, 72% of respondents indicated they would commence treatment and 18% selected they would not commence treatment.. Similar reasons influenced participant decision-making in Vignette 2, a less legally certain scenario.ConclusionsThere are critical gaps in junior doctors’ compliance with the law as it relates to the implementation of ACDs. Despite there being differences in relation to the legal answer and its certainty, clinical and ethical factors guided decision-making over and above the law in both vignettes. More education and training to guide junior doctors’ clinical decision-making and ensure compliance with the law is required. (shrink)