Americans' appetite for life-prolonging therapies has led to unsustainable growth in health care costs. It is tempting to target older people for health care rationing based on their disproportionate use of health care resources and lifespan already lived, but aged-based rationing is unacceptable to many. Systems reforms can improve the efficiency of health care and may lessen pressure to ration services, but difficult choices still must be made to limit expensive, marginally beneficial interventions. In the absence of agreement on principles (...) to govern health care resource allocation, a fair, open priority-setting process should be created to allow for reasonable disagreement on principles while being seen as legitimate by all stakeholders. At the patient-care level, careful discussions about the benefits and burdens of medical intervention and support for slow medicine — a gentle, family-centered care approach for frail elders — can do much to avoid harming these patients with aggressive yet unwanted medical care while reducing wasteful spending. (shrink)

Mr. M. was a 77-year-old decisionally incapacitated long-term nursing home resident with chronic schizophrenia who was admitted to the hospital with a bacterial pneumonia. His past medical history was notable for deteriorating functional status over the past 2-3 years, urinary retention requiring chronic indwelling bladder catheterization, and two recent hospitalizations for urinary tract infections leading to sepsis. He developed respiratory failure soon after admission and was intubated and placed on mechanical ventilation. Follow-up studies suggested worsening pneumonia and acute respiratory distress (...) syndrome, as well as worsening kidney function. (shrink)

English description: We live in a time where the old mechanisms of order have lost their grip on society, leading to numerous infractions and confrontations. In this religious-philosophical study, Kurt Wuchterl develops an epistemic perception of contingency that re-interprets the tense relationship between natural sciences and religion. Contingency always includes the "option of being different," which exacerbates pivotal problems such as chance, chaos, and unavailability. If we as individuals are not able to cope with these contingencies, we encounter the (...) edge of reason; acknowledging this edge, however, poses the question of the otherness of reason. German text. German description: Wir leben in einer Zeit, in der die alten Ordnungsgaranten ihre Orientierungskraft verloren und die Ordnungsbrueche zu vielfaltigen Konfrontationen gefuehrt haben. Kurt Wuchterl entwickelt in seiner religionsphilosophischen Studie einen epistemischen Kontingenzbegriff, mit dem das gespannte Verhaltnis der Naturwissenschaft zur Religion eine neue Deutung erfahrt.Kontingenz beinhaltet immer die Moglichkeit des Anders-sein-konnens. Und damit stellen sich zentrale Probleme wie Zufall, Chaos und Unverfuegbarkeit in verscharfter Form. Wenn es uns als Individuen nicht gelingt, diese Kontingenzen zu bewaltigen, wird die Grenze der Vernunft erreicht. Mit deren Anerkennung aber stellt sich die Frage nach dem Anderen der Vernunft. Wird dies als Chiffre des Religiosen interpretiert, zeigt sich dahinter nicht das Nichts, sondern eben gerade: ein ganz Anderes. In der Kontingenzbegegnung, wie diese Moglichkeit bezeichnet wird, scheiden sich die Geister; ihre Unbestimmtheit ist der Tribut an unsere Endlichkeit. (shrink)

Genetischer Naturalismus und Idealismus : Überlegungen zum genetischen Naturalismus von Günter Dux -- Natur und Freiheit, mit Blick auf Cassirer und Heidegger -- Die Wesentlichkeit einer subjektiven Deduktion -- Hat Platons Höhle einen Ausgang? -- Unerledigte Probleme der Vernunftkritik -- Syllogismus est principium Idealismi -- Die Antinomien in der "Kritik der Urteilskraft" -- Die Logik der Gottesbeweise und die Logik der (Post-)Moderne -- Der logische Ort der Freiheit -- Platons Antizipation und Überwindung des Universalienstreites -- Elementarlehre oder Transzendentale Phänomenologie -- (...) Letztbegründung als transzendentale Theorie konstitutiver Relationalität -- Monade und System oder Perspektivismus versus System? -- Bestimmung und Begründung : zu Kants Deduktion der Ideen der reinen Vernunft. (shrink)

This article makes the case that place-based and environmental education theory and practice must be responsive to, while attempting to transform, the institutional dynamics of schooling. In the present climate of education in the USA two dynamics of schooling deserve particular attention with respect to the possibilities for place-based and environmental education: the discourse of accountability and the discourse of collaboration. Drawing especially on Foucault's analyses of disciplinary power and governmentality, I show how practices associated with accountability and collaboration limit (...) or preclude the deepening and spreading of place-based and environmental education. However, I also argue that even given the serious limitations imposed by current trends of collaboration and accountability, these trends offer place-based and environmental educators powerful entry points through which to initiate change within the formal school setting. The conclusion of the paper outlines three models of collaboration for place-conscious education through which accountability is redefined in the interest of places. (shrink)

The World Professional Association for Transgender Health’s Standards of Care, now in its seventh edition, is a frequently cited, internationally recognized, evidence-based document that details a comprehensive framework for gender-related care of trans people. However, the WPATH SOC still relies heavily in some cases on gatekeeping practices, dubbed “triadic therapy,” or a process where a trans patient is encouraged to seek out psychotherapy, and hormone therapy, and only then be able to engage in surgical options for transitioning. I use G. (...) Alan Marlatt’s harm reduction framework to argue that the triadic process creates its own set of harms that trans people have to contend with, especially insofar as it focuses on resolving gender dysphoria in a demanding, moralizing, and top-down way as opposed to enriching trans lives by reducing harms that prevent us from flourishing. Using Marlatt’s criterion that harm reduction ought to be bottom-up, low threshold, and not moralizing, I develop a list of suggestions for what ought to be centrally considered in treating trans patients. (shrink)

Despite the recent backlash against epistemic consequentialism, an explicit systematic alternative has yet to emerge. This paper articulates and defends a novel alternative, Epistemic Kantianism, which rests on a requirement of respect for the truth. §1 tackles some preliminaries concerning the proper formulation of the epistemic consequentialism / non-consequentialism divide, explains where Epistemic Kantianism falls in the dialectical landscape, and shows how it can capture what seems attractive about epistemic consequentialism while yielding predictions that are harder for the latter to (...) secure in a principled way. §2 presents Epistemic Kantianism. §3 argues that it is uniquely poised to satisfy the desiderata set out in §1 on an ideal theory of epistemic justification. §4 gives three further arguments, suggesting that it (i) best explains the objective normative significance of the subject's perspective in epistemology, (ii) follows from the kind of axiology needed to solve the swamping problem together with modest assumptions about the relation between the evaluative and the deontic, and (iii) illuminates certain asymmetries in epistemic value and obligation. §5 takes stock and reassesses the score in the debate. (shrink)

In this article we frame a set of important issues in the emerging field of Mind, Brain, and Education in terms of three broad headings: methods, models, and morality. Under the heading of methods we suggest that the need for synthesis across scientific and practical disciplines entails the pursuit of usable knowledge via a catalytic symbiosis between theory, research, and practice. Under the heading of models the goal of producing usable knowledge should shape the construction of theories that provide comprehensive (...) accounts of human learning and development spanning multiple levels of analysis. Under the heading of morality usable knowledge must be put to good use: Its application and dissemination ought to be infused with moral considerations gleaned from dialogue among all those potentially affected. Generally, the field should be shaped not only by its constituent scientific disciplines but also by its applications to education and learning. Thus we argue for the adoption of a kind of pragmatism that would be best actualized by building research‐school collaborations between researchers and practitioners. (shrink)

Many meta-ethicists have thought that rationality requires us to heed apparent normative reasons, not objective normative reasons. But what are apparent reasons? There are two kinds of standard answers. On de dicto views, R is an apparent reason for S to \ when it appears to S that R is an objective reason to \ . On de re views, R is an apparent reason for S to \ when R’s truth would constitute an objective reason for S to \ (...) , and it appears to S that R. De re views are currently more popular because they avoid overintellectualizing rationality. But they face problems owing to the way in which they do so. Some assume that we can escape these problems by requiring more information to be apparent or by appealing to defeat. But these strategies fail. So, I defend a new view: apparent reasons are apparent facts that agents are competently attracted to treat like objective reasons, where competence is indirectly defined in terms of objective reasons and a competence/performance distinction is honored. Since one can treat X like an F without having the concept of an F, the view does not overintellectualize rationality. But it is also strong enough to dodge the pitfalls of de re views. (shrink)

Ogni tentativo di ripensare le nostre categorie politiche deve muovere dalla consapevolezza che della distinzione classica fra zoé e bios, tra vita naturale ed esistenza politica (o tra l'uomo come semplice vivente e l'uomo come soggetto politico), non ne sappiamo piú nulla. Nel diritto romano arcaico homo sacer era un uomo che chiunque poteva uccidere senza commettere omicidio e che non doveva però essere messo a morte nelle forme prescritte dal rito. È la vita uccidibile e insacrificabile dell' 'uomo sacro' (...) a fornire qui la chiave per una rilettura critica della nostra tradizione politica. Quando la vita diventa la posta in gioco della politica e questa si trasforma in biopolitica, tutte le categorie fondamentali della nostra riflessione, dai diritti dell'uomo alla democrazia alla cittadinanza, entrano in un processo di svuotamento e di dislocazione il cui risultato sta oggi davanti ai nostri occhi. Seguendo il filo del rapporto costitutivo fra nuda vita e potere sovrano, da Aristotele ad Auschwitz, dall'Habeas corpus alle Dichiarazioni dei diritti, il libro di Agamben cerca di decifrare gli enigmi - prima di tutti il fascismo e il nazismo - che il nostro secolo ha proposto alla ragione storica. Fino a vedere, nel campo di concentramento, il paradigma biopolitico nascosto della modernità in cui città e casa sono diventate indiscernibili e la possibilità di distinguere tra il nostro corpo biologico e il nostro corpo politico ci è stata tolta una volta per tutte. (shrink)

According to Veritism, true belief is the sole fundamental epistemic value. Epistemologists often take Veritism to entail that all other epistemic items can only have value by standing in certain instrumental relations—namely, by tending to produce a high ratio of true to false beliefs or by being products of sources with this tendency. Yet many value theorists outside epistemology deny that all derivative value is grounded in instrumental relations to fundamental value. Veritists, I believe, can and should follow suit. After (...) setting the stage in §1, I explain in §2 why Veritism should not take an Instrumentalist form. Instrumentalist Veritism faces a generalized version of the swamping problem. But this problem undermines Instrumentalism, not Veritism: granting Instrumentalism, similar problems arise for any economical epistemic axiology. I show in §3 how Veritism can take a less narrow form and solve the swamping problem. After answering some objections in §4, I consider in §5 what some would regard as a less radical alternative solution and argue that it either fails or collapses into mine. I close in §6 by taking stock and re-evaluating the overall prospects for Veritism, suggesting that it is a highly promising epistemic axiology when divorced from Instrumentalism. (shrink)

This paper considers the place of reasons in the metaphysics of epistemic normativity and defends a middle ground between two popular extremes in the literature. Against members of the ‘reasons first’ movement, we argue that reasons are not the sole fundamental constituents of epistemic normativity. We suggest instead that the virtue-theoretic property of competence is the key building block. To support this approach, we note that reasons must be possessed to play a role in the analysis of central epistemically normative (...) properties, and argue that the relation of possession must be analyzed in terms of competence. But while we diverge with reasons-firsters on this score, we also distance ourselves from those who deny reasons any important role in epistemology. For we maintain that possessed reasons do help to ground deontic facts in the epistemic domain (e.g., facts about what one epistemically ought to believe, may believe, or is justified in believing). Indeed, we present an argument that the possession of sufficient epistemic reasons is necessary and sufficient for propositional justification, and that proper basing on such reasons yields doxastic justification. But since possession and proper basing are themselves grounded in competence, reasons are not the end of the explanatory road: competence enables them to do their work, putting them—and us—in the middle. (shrink)

It is often assumed that believing that p for a normative reason consists in nothing more than (i) believing that p for a reason and (ii) that reason’s corresponding to a normative reason to believe that p, where (i) and (ii) are independent factors. This is the Composite View. In this paper, we argue against the Composite View on extensional and theoretical grounds. We advocate an alternative that we call the Prime View. On this view, believing for a normative reason (...) is a distinctive achievement that isn’t exhausted by the mere conjunction of (i) and (ii). Its being an achievement entails that (i) and (ii) are not independent when one believes for a normative reason: minimally, (i) must hold because (ii) holds. Apart from its intrinsic interest, our discussion has important upshots for central issues in epistemology, including the analysis of doxastic justification, the epistemology of perception, and the place of competence in epistemology. (shrink)

According to a view I’ll call Epistemic Normativism, knowledge is normative in the same sense in which paradigmatically normative properties like justification are normative. This paper argues against EN in two stages and defends a positive non-normativist alternative. After clarifying the target in §1, I consider in §2 some arguments for EN from the premise that knowledge entails justification. I first raise some worries about inferring constitution from entailment. I then rehearse the reasons why some epistemologists reject the Entailment Thesis (...) and argue that a non-normativist picture provides the best explanation of all the intuitions surrounding this thesis, favorable and unfavorable. On this picture, human knowledge is a structured non-normative complex that has as one of its parts a justification-making property, analogous in role to good-making properties like pleasurableness. After giving three arguments against EN in §3 and answering an objection in §4, I turn in §5 to further develop the positive view sketched in §2. In §6, I take stock and conclude. (shrink)

Rationality requires us to respond to apparent normative reasons. Given the independence of appearance and reality, why think that apparent normative reasons necessarily provide real normative reasons? And if they do not, why think that mistakes of rationality are necessarily real mistakes? This paper gives a novel answer to these questions. I argue first that in the moral domain, there are objective duties of respect that we violate whenever we do what appears to violate our first-order duties. The existence of (...) these duties of respect, I argue, ensures that apparent moral reasons are exceptions to the independence of appearance and reality. I then extend these arguments to the domain of overall reason. Just as there are objective duties of respect for moral reasons that explain moral blameworthiness, so there are objective duties of respect for reasons that explain blameworthiness in the court of overall reason. The existence of these duties ensures that apparent reasons are exceptions to the independence of appearance and reality. (shrink)

This paper is an opinionated guide to the literature on normative epistemic reasons. After making some distinctions in §1, I begin in §2 by discussing the ontology of normative epistemic reasons, assessing arguments for and against the view that they are mental states, and concluding that they are not mental states. In §3, I examine the distinction between normative epistemic reasons there are and normative epistemic reasons we possess. I offer a novel account of this distinction and argue that we (...) in fact ought to acknowledge a threefold distinction between objective, possessed, and apparent normative epistemic reasons. In §4, I discuss the question of which normative reasons for doxastic attitudes are the epistemic ones, evaluating reasons against a simple evidentialist answer. Finally, in §5, I look at the role of reasons in epistemology, considering challenges to viewing reasons as the building blocks of epistemic normativity and maintaining that the challenges recommend a novel bi-level epistemology rather than a marginalization of reasons in epistemology. (shrink)

Mind perception entails ascribing mental capacities to other entities, whereas moral judgment entails labeling entities as good or bad or actions as right or wrong. We suggest that mind perception is the essence of moral judgment. In particular, we suggest that moral judgment is rooted in a cognitive template of two perceived minds—a moral dyad of an intentional agent and a suffering moral patient. Diverse lines of research support dyadic morality. First, perceptions of mind are linked to moral judgments: dimensions (...) of mind perception (agency and experience) map onto moral types (agents and patients), and deficits of mind perception correspond to difficulties with moral judgment. Second, not only are moral judgments sensitive to perceived agency and experience, but all moral transgressions are fundamentally understood as agency plus experienced suffering—that is, interpersonal harm—even ostensibly harmless acts such as purity violations. Third, dyadic morality uniquely accounts for the phenomena of dyadic completion (seeing agents in response to patients, and vice versa), and moral typecasting (characterizing others as either moral agents or moral patients). Discussion also explores how mind perception can unify morality across explanatory levels, how a dyadic template of morality may be developmentally acquired, and future directions. (shrink)

Reasons fundamentalists maintain that we can analyze all derivative normative properties in terms of normative reasons. These theorists famously encounter the Wrong Kind of Reasons problem, since not all reasons for reactions seem relevant for reasons-based analyses. Some have argued that this problem is a general one for many theorists, and claim that this lightens the burden for reasons fundamentalists. We argue in this paper that the reverse is true: the generality of the problem makes life harder for reasons fundamentalists. (...) We do this in two stages. First, we show that reflection on the generality of the distinction between wrong-kind reasons and right-kind reasons shows that not all right-kind reasons are normative reasons. So, not only do reasons-based analyses require a distinction between right-kind reasons and wrong-kind reasons, they also need a distinction between normative right-kind reasons from nonnormative right-kind reasons. We call this the Right Kind of Reasons Problem. In the second stage of the paper, we argue that reasons fundamentalism places tight constraints on its proper solution: in particular, it forbids one from appealing to anything normative to distinguish normative RKRs from nonnormative RKRs. It hence seems that reasons fundamentalists can only appeal to natural facts to solve the problem, but it is unclear which ones can do the job. So, reflection on the generality of the distinction only multiplies the fundamentalist’s problems. We end by exploring several solutions to these problems, and recommend a form of constitutivism as the best. (shrink)

Foreword by Oliver Sacks Kurt Goldstein (1878-1965) was already an established neuropsychologist when he emigrated from Germany to the United States in the 1930s. This book, his magnum opus and widely regarded as a modern classic in psychology and biology, grew out of his dissatisfaction with traditional natural science techniques for analyzing living beings. It offers a broad introduction to the sources and ranges of application of the "holistic" or "organismic" research program that has since become a standard part (...) of biological thought. Goldstein was especially concerned with the breakdown of organization and the failure of central controls that take place in catastrophic responses to situations such as physical or mental illness. But he was equally attuned to the amazing powers of the organism to readjust to such catastrophic losses, if only by withdrawal to a more limited range that it could manage by a redistribution of its reduced energies, thus reclaiming as much wholeness as new circumstances allowed. Goldstein's theses in The Organism have had an important impact on philosophical and psychological thought throughout the twentieth century, as evidenced in the work of Maurice Merleau-Ponty, Georges Canguilhem, Ernst Cassirer, and Ludwig Binswanger. (shrink)

The paper is an opinionated tour of the literature on the reasons for which we hold beliefs and other doxastic attitudes, which I call ‘operative epistemic reasons’. After drawing some distinctions in §1, I begin in §2 by discussing the ontology of operative epistemic reasons, assessing arguments for and against the view that they are mental states. I recommend a pluralist non-mentalist view that takes seriously the variety of operative epistemic reasons ascriptions and allows these reasons to be both propositions (...) and truth-making facts. In §3, I turn to consider what it takes for a consideration to be an operative epistemic reason, examining three conditions – the representational, treating, and explanatory conditions – that have been proposed. I offer a novel view about the explanatory condition. In §4, I discuss the special case of inferential operative reasons and examine attempts to understand them in terms of rule-following, sketching a competence-based spinoff of dispositionalism. Finally, in §5, I consider whether there are non-inferential operative reasons, observing that one needn't countenance them to be a foundationalist but then developing a view about what they are and how they do and don't differ from inferential reasons. (shrink)

Philosophy and Phenomenological Research, EarlyView.

The uncanny valley—the unnerving nature of humanlike robots—is an intriguing idea, but both its existence and its underlying cause are debated. We propose that humanlike robots are not only unnerving, but are so because their appearance prompts attributions of mind. In particular, we suggest that machines become unnerving when people ascribe to them experience, rather than agency. Experiment 1 examined whether a machine’s humanlike appearance prompts both ascriptions of experience and feelings of unease. Experiment 2 tested whether a machine capable (...) of experience remains unnerving, even without a humanlike appearance. Experiment 3 investigated whether the perceived lack of experience can also help explain the creepiness of unfeeling humans and philosophical zombies. These experiments demonstrate that feelings of uncanniness are tied to perceptions of experience, and also suggest that experience—but not agency—is seen as fundamental to humans, and fundamentally lacking in machines. (shrink)

First English translation of revolutionary paper that established that even in elementary parts of arithmetic, there are propositions which cannot be proved or disproved within the system. Introduction by R. B. Braithwaite.

Previously published: Princeton University Press, 1940.

It is widely recognised that mainstream economics has failed to translate micro consistently into macro economics and to provide endogenous explanations for the continual changes in the economic system. Since the early 1980s, a growing number of economists have been trying to provide answers to these two key questions by applying an evolutionary approach. This new departure has yielded a rich literature with enormous variety, but the unifying principles connecting the various ideas and views presented are, as yet, not apparent. (...) This 2005 volume brings together fifteen original articles from scholars - each of whom has made a significant contribution to the field - in their common effort to reconstruct economics as an evolutionary science. Using meso economics as an analytical entity to bridge micro and macro economics as well as static and dynamic realms, a unified economic theory emerges. (shrink)

Having direct doxastic control would not be particularly desirable if exercising it required a failure of epistemic rationality. With that thought in mind, recent writers have invoked the view that epistemic rationality gives us options to defend the possibility of a significant form of direct doxastic control. Specifically, they suggest that when the evidence for p is sufficient but not conclusive, it would be epistemically rational either to believe p or to be agnostic on p, and they argue that we (...) can in these cases effectively decide to form either attitude without irrationality. This paper argues against the version of epistemic permissivism invoked by these writers and shows that other plausible versions of permissivism do not support their cause. It concludes that if we can exercise direct doxastic control without irrationality, it is not because epistemic rationality gives us options. (shrink)