Volume 3, Issue 1, March 2019, Page 95-99.

In New Zealand an advance directive can be either an oral statement or a written document. Such directives give individuals the opportunity to make choices about future medical treatment in the event they are cognitively impaired or otherwise unable to make their preferences known. All consumers of health care have the right to make an advance directive in accordance with the common law. When we consider New Zealand's rapidly ageing population, the fact that more people now live with and die (...) of chronic rather than acute conditions, the importance given to respecting autonomous decision-making, increasing numbers of individuals who require long-term residential care, and financial pressures in the allocation of medical resources, there would seem to be a number of compelling reasons to encourage individuals to write or verbalise an advance directive. Indeed the promotion of advance directives is encouraged. However, caution should be exercised in promoting advance directives to older people, especially in light of several factors: ageist attitudes and stereotypes towards them, challenges in the primary healthcare setting, and the way in which advance directives are currently focused and formulated. This paper considers some of the specific challenges that need to be addressed if the promotion of advance directives are to improve outcomes of patient treatment and care near the end of life. (shrink)

Edward O. Wilson's sociobiology, as advocated in On Human Nature, is often criticized for its sensationalism and its anthropomorphisms. Critics have not recognized, however, that the so?called anthropomorphisms are essential to sociobiology, in so far as it seeks to address the humanities, and that the sensationalism derives from them. They are not just the sloppiness usually found in popularizations. Section I reviews the grounds for these criticisms and then ends by demonstrating that it is no less a confusion to label (...) these misuses of language ?anthropomorphisms?. Section II analyzes the style of reasoning, characteristic of scientism in general and sociobiology in particular, that sanctions misuses of language such as Wilson's. The flaw in this reasoning is that it depends upon the very language it sets out to debunk, in a way that renders its own arguments unintelligible. (shrink)

This study examines the issues associated with the disinvestment of U.S. interests from South Africa that took place in the mid-80s from the perspective of three dominant moral theories: utility, rights, and justice. By examining the issues in light of these three theories, the paper attempts to establish a decision framework from which managers and investors can evaluate similar decisions they are facing around the world today. Similarly, the reading may prove useful to educators who incorporate discussions of ethical decision (...) making into the classroom.Training in business ethics too often takes a strictly utilitarian perspective, or worse, a relativistic one. This study attempts to illustrate how utilitarian theory and related rights and justice issues can he interwoven into the heuristics associated with the contemporary concepts of corporate social responsibility. (shrink)

Many widely divergent accounts of luck have been offered or employed in discussing an equally wide range of philosophical topics. We should, then, expect to find some unified philosophical conception of luck of which moral luck, epistemic luck, and luck egalitarianism are species. One of the attempts to provide such an account is that offered by Duncan Pritchard, which he refers to as the modal account. This view commits us to calling an event lucky when it obtains in this world, (...) but fails to obtain in a wide class of nearby possible worlds. In support of this account, Pritchard argues that a theory of luck ought to capture the fact that luck comes in degrees and that luck is closely associated with risk. I argue against this claim by suggesting that an understanding of luck grounded in considerations of probability is better able to satisfy these demands, and that the probability theory better explains exemplary cases of luck like those brought up by Pritchard. (shrink)

In this paper, I propose a novel theory for why we find certain mundane everyday experiences, objects, and phenomena satisfying aesthetic experiences. I refer to these as 'oddly satisfying' experiences, and argue that they assert themselves as aesthetic by being suggestive of the cinematic. This cinematic quality is the product of everyday experiences gesturing towards a kind of careful artistic intent.

During an initial palliative care assessment, a dying man discloses that he had killed several people whilst a young man. The junior doctor, to whom he revealed his story, consulted with senior palliative care colleagues. It was agreed that legal advice would be sought on the issue of breaching the man’s confidentiality. Two legal opinions conflicted with each other. A decision was made by the clinical team not to inform the police.In this article the junior doctor, the palliative medicine specialist, (...) a medical ethicist, and a lawyer consider the case from their various perspectives. (shrink)

Objectives To characterize the prevalence and content of pediatric triage policies.Methods We surveyed and solicited policies from U.S. hospitals with pediatric intensive care units. Policies were analyzed using qualitative methods and coded by 2 investigators.Results Thirty-four of 120 institutions (28%) responded. Twenty-five (74%) were freestanding children’s hospitals and 9 (26%) were hospitals within a hospital. Nine (26%) had approved policies, 9 (26%) had draft policies, 5 (14%) were developing policies, and 7 (20%) did not have policies. Nineteen (68%) institutions shared (...) their approved or draft policy. Eight (42%) of those policies included neonates. The polices identified 0 to 5 (median 2) factors to prioritize patients. The most common factors were short- (17, 90%) and long- (14, 74%) term predicted mortality. Pediatric scoring systems included Pediatric Logistic Organ Dysfunction-2 (12, 63%) and Score for Neonatal Acute Physiology and Perinatal Extensions-II (4, 21%). Thirteen (68%) policies described a formal algorithm. The most common tiebreakers were random/lottery (10, 71%) and life cycles (9, 64%). The majority (15, 79%) of policies specified the roles of triage team members and 13 (68%) precluded those participating in patient care from making triage decisions.Conclusions While many institutions still do not have pediatric triage policies, there appears to be a trend among those with policies to utilize a formal algorithm that focuses on short- and long-term predicted mortality and that incorporates age-appropriate scoring systems. Additional work is needed to expand access to pediatric-specific policies, to validate scoring systems, and to address health disparities. (shrink)

This case concerns aspects of the treatment of a post-surgical patient in a major public hospital in New Zealand during the author's experiences as a fourth year medical student. This case is used to consider the interlinked ethical issues of sympathy, moral virtue, dignity and how the medical environment can realign these values.

Increasingly through the 1990s, tobacco control advocates questioned the practice of public institutions investing in tobacco company stocks. The questioning was framed in at least three ways. First, is it ethical to fund public expenditures with profits from a product that causes addiction and disease? Second, is it sound social policy to derive public income from a product that increases healthcare costs and reduces worker productivity? Finally, is it sound fiscal policy to invest in an historically profitable industry facing multiplying (...) legal and regulatory challenges? While the tobacco industry preferred to restrict discussion to the fiscal question, and offered an affirmative answer, its position was weakened by depressed stock prices brought on by actions of the industry as much as by tobacco control activism. As part of a campaign to restore its credibility as an investment vehicle with public fund managers, Philip Morris (PM) commissioned a report from the influential investment managers/advisors Wilshire Associates. However, Wilshire had only recently conducted such a study for the Washington State Investment Board (WSIB), assuring the board that the value tobacco stocks added to an investment portfolio – if any – was too small to be measured. Nonetheless, within a year, Wilshire produced a report for PM which appeared to laud the investment value of tobacco and to dismiss tobacco-excluded investment alternatives. This paper examines how Wilshire produced apparently diametrically opposed reports for clients with different interests. It reveals a pattern of potential conflicts of interest among tobacco companies, financial analysis firms, investment authorities, and institutional fund managers. It demonstrates substantial violations of two generally accepted ethical principles of business consulting: veracity and transparency. (shrink)

The standard reading of Kuhn's philosophy attributes to him the view that the incommensurability of rival theories and theory-ladenness of observation make rational debate about competing paradigms nearly impossible. If this reflects his real view, then he has claimed something prima facie absurd, and easily refuted with historical counter-examples. It is not the incommensurability thesis per se that is easily refutable, but Kuhn's gestelt interpretation of it. The gestalt interpretation, moreover misrepresents his more fundamental ideas on paradigms, and is in (...) itself confused. The incommensurability thesis can be explained and defended without invoking gestalts, and this reconstructed view can be used to show that familiar criticisms, such as those of Davidson and Laudan, and unwelcome endorsements, such as that of Barnes, which are based on the assumption that Kuhn must be an extreme relativist, are all directed at views that he need not, and should not, hold. (shrink)

First, a number of previous theories of intrinsic motivation are reviewed. Then, several studies of highly motivating computer games are described. These studies focus on what makes the games fun, not on what makes them educational. Finally, with this background, a rudimentary theory of intrinsically motivating instruction is developed, based on three categories: challenge, fantasy, and curiosity.Challenge is hypothesized to depend on goals with uncertain outcomes. Several ways of making outcomes uncertain are discussed, including variable difficulty level, multiple level goals, (...) hidden information, and randomness. Fantasy is claimed to have both cognitive and emotional advantages in designing instructional environments. A distinction is made between extrinsic fantasies that depend only weakly on the skill used in a game, and intrinsic fantasies that are intimately related to the use of the skill. Curiosity is separated into sensory and cognitive components, and it is suggested that cognitive curiosity can be aroused by making learners believe their knowledge structures are incomplete, inconsistent, or unparsimonious. (shrink)

Deep Empiricism: Kant, Whitehead and the Necessity of Philosophical Theism offers a critical and comparative engagement of two great philosophers who are rarely treated together: Immanuel Kant and Alfred North Whitehead. Derek Malone-France provides insightful readings of Kant and Whitehead as he bridges the gap between those who study Kant's transcendental idealism and scholars of Whitehead's organic realism.

In the small but growing literature on the philosophy of country music, the question of how we ought to understand the genre’s notion of authenticity has emerged as one of the central questions. Many country music scholars argue that authenticity claims track attributions of cultural standing or artistic self-expression. However, careful attention to the history of the genre reveals that these claims are simply factually wrong. On the basis of this, we have grounds for dismissing these attributions. Here, I argue (...) for an alternative model of authenticity in which we take claims about the relative authenticity of country music to be evidence of ‘country’ being a dual character concept in the same way that it has been suggested of punk rock and hip-hop. Authentic country music is country music that embodies the core value commitments of the genre. These values form the basis of country artists’ and audiences’ practical identities. Part of country music’s aesthetic practice is that audiences reconnect with, reify, and revise this common practical identity through identification with artists and works that manifest these values. We should then think of authenticity discourse within country music as a kind of game within the genre’s practice of shaping and maintaining this practical identity. (shrink)

Wijdicks and colleagues1 recently presented the Full Outline of UnResponsiveness (FOUR) scale as an alternative to the Glasgow Coma Scale (GCS)2 in the evaluation of consciousness in severely brain-damaged patients. They studied 120 patients in an intensive care setting (mainly neuro-intensive care) and claimed that “the FOUR score detects a locked-in syndrome, as well as the presence of a vegetative state.”1 We fully agree that the FOUR is advantageous in identifying locked-in patients given that it specifically tests for eye movements (...) or blinking on command. This is welcomed given that misdiagnosis of the locked-in syndrome has been shown to occur in more than half of the cases (see Laureys and colleagues3 for review). As for the diagnosis of the vegetative state, the scale explicitly tests for visual pursuit, and hence can disentangle the vegetative state from the minimally conscious state (MCS). The diagnostic criteria for MCS have been proposed4 only recently, but Wijdicks and colleagues1 do not mention the existence of this clinical entity in their article. As for the vegetative state, MCS can be encountered in the acute or subacute setting as a transitional state on the way to further recovery, or it can be a more chronic or even permanent condition. The MCS refers to patients showing inconsistent, albeit clearly discernible, minimal behavioral evidence of consciousness (eg, localization of noxious stimuli, eye fixation or tracking, reproducible movement to command, or nonfunctional verbalization).4 The FOUR scale does not test for all of the behavioral criteria required to diagnose MCS.4 It is known from the literature (see Majerus and colleagues5 for review) that about a third of patients diagnosed with vegetative state are actually in MCS, and this misdiagnosis can lead to major clinical, therapeutic, and ethical consequences. We tested the ability of the newly proposed FOUR scale to correctly diagnose the vegetative state in an acute (intensive care and neurology ward) and chronic (neurorehabilitation) setting.. (shrink)

Digitalisation of health and the use of health data in artificial intelligence, and machine learning (ML), including for applications that will then in turn be used in healthcare are major themes permeating current UK and other countries’ healthcare systems and policies. Obtaining rich and representative data is key for robust ML development, and UK health data sets are particularly attractive sources for this. However, ensuring that such research and development is in the public interest, produces public benefit and preserves privacy (...) are key challenges. Trusted research environments (TREs) are positioned as a way of balancing the diverging interests in healthcare data research with privacy and public benefit. Using TRE data to train ML models presents various challenges to the balance previously struck between these societal interests, which have hitherto not been discussed in the literature. These challenges include the possibility of personal data being disclosed in ML models, the dynamic nature of ML models and how public benefit may be (re)conceived in this context. For ML research to be facilitated using UK health data, TREs and others involved in the UK health data policy ecosystem need to be aware of these issues and work to address them in order to continue to ensure a ‘safe’ health and care data environment that truly serves the public. (shrink)

One of the key learning objectives in any health professional course is to develop ethical and judicious practice. Therefore, it is important to address how medical and pharmacy students respond to, and deal with, ethical dilemmas in their clinical environments. In this paper, we examined how students communicated their resolution of ethical dilemmas and the alignment between these communications and the four principles developed by Beauchamp and Childress. Three hundred and fifty-seven pharmacy and medical students (overall response rate=63%) completed a (...) questionnaire containing four clinical case scenarios with an ethical dilemma. Data were analysed using multiple methods. The findings revealed that 73% of the qualitative responses could be exclusively coded to one of the ‘four principles’ determined by the Beauchamp and Childress' framework. Additionally, 14% of responses overlapped between the four principles (multiple codes) and 13% of responses could not be coded using the framework. The subsequent subgroup analysis revealed different response patterns depending on the case being reviewed. The findings showed that when students are faced with challenging ethical dilemmas their responses can be aligned with the Beauchamp and Childress framework, although more contentious dilemmas involving issues of law are less easily categorised. The differences between year and discipline groups show students are developing ethical frames of reference that may be linked with their teaching environments and their levels of understanding. Analysis of these response patterns provides insight into the way students will likely respond in ‘real’ settings and this information may help educators prepare students for these clinical ethical dilemmas. (shrink)

Logicians disagree on (1) criteria for the presence of an argument, (2) criteria for adding implicit premises and (3) criteria for linking premises. I attempt to resolve all three problems, and in the process to remove the main obstacles to teaching diagramming. The first problem is resolved by working with real discourse that students find on their own, rather than the artificial examples and problems found in logic texts; it is further reduced by examining the different uses of argument and (...) understanding the extent to which the basic rules of diagramming are the same for the various uses. The other disagreements persist because logicians neglect to clarify the principal type of eakness we remedy by adding implicit premises and linking premises: in real discourse we do so to block substantive counterexamples, an idea correlated with that of substantive deduction, discussed by Govier, Wright and others. (shrink)

Many legal arguments pertaining to equal rights for gay and lesbian families have relied upon empirical research on the `healthy' childraising environment of these families. While neither disputing recent legal gains nor diminishing their importance, this article looks at some of the conceptual categories that drive this research. The limitations of such research, as salutary as it is, are typically understood in terms of their obvious political context. Such research avoids highlighting any differences between gay/lesbian families and traditional families because (...) an emphasis on such differences feeds cultural stereotypes that are damaging to non-traditional families. This article takes a different tack, looking at how the concepts that frame research are based in binaries and fantasies about families and sex that we argue are too limiting. It assumes that the elision of sexuality within such studies is symptomatic of a broader repression of a variety of meanings of family. In response, the article brings in queer theory and psychoanalysis to broaden our approach to understanding new forms of family and kinship initiated by gay and lesbian families. The article addresses single household lesbian families that are most frequently the object of empirical research. (shrink)

Medical trainees should learn from the actions of Nazi physicians to inform a more just contemporary practice by examining the subtle assumptions, or moral orientations, that led to such heinous actions. One important moral orientation that still informs contemporary medical practice is the moral orientation of elimination in response to suffering patients. We propose that the moral orientation of presence, described by theologian Stanley Hauerwas, provides a more fitting response to suffering patients, in spite of the significant barriers to enacting (...) such a moral orientation for contemporary trainees. (shrink)

Reviews the book, Enjoy your symptom: Jacques Lacan in Hollywood and out by Slavoi Zizek. The following reviews one of Slavoi Zizek's books, Enjoy your symptom: Jacques Lacan in Hollywood and out. Zizek's book and this review aim to address the relevance of Lacan for many of the ethical questions that arise when psychology begins to envision its own concepts and practices as culturally embedded. The matrix of discourse, power, and subject is most often articulated in psychology through the ideas (...) of Foucault, but Lacan illuminates the same field of effects with closer attention given to the specifics of language, the body, the individual, and intersubjectivity. Lacan most obviously addresses the role of speech in a clinical setting. But the implications reach further and Slavoi Zizek takes the Lacanian intervention into the social order. At present Zizek represents the most explicit and uncompromising Lacanian reader of contemporary culture. 2012 APA, all rights reserved). (shrink)

This collection brings together an internationally known and interdisciplinary group of scholars, including a major new essay by Laruelle himself. Together they use non-philosophy to cross the boundaries between philosophy and performance.

Loneliness in medicine is a serious problem not just for patients, for whom illness is intrinsically isolating, but also for physicians in the contemporary condition of medicine. We explore this problem by investigating the ideal physician-patient relationship, whose analogy with friendship has held enduring normative appeal. Drawing from Talbot Brewer and Nir Ben-Moshe, we argue that this appeal lies in a dynamic form of companionship incompatible with static models of friendship-like physician-patient relationships: a mutual refinement of embodied virtue that draws (...) both persons together. The ideal physician-patient relationship has a dialectical character that fosters each member's improvement of phenomenologically recognizing and embodying moral virtues. A key component of this dynamic is a commitment to the common goal of the patient's health, realized through joint interactivities and conversations over time. The physician's presence to the patient's suffering—understood best as an alienating phenomenological condition for the patient—orients and discloses possibilities for virtuous caregiving by structuring the meanings of the goals, conversations, and joint narrative constitutive of their relationship. Presence to suffering, paradoxically, is perhaps an important prerequisite for this dynamic partnership. These activities dialectically build an interpretive horizon of understanding through which moral goods and character refinement—in and for the other—may become revealed for both persons in their shared being-in-the-world. This analysis of suffering, mood, and revealing of (possible) moral goods has implications for addressing the modern problem of loneliness for patients and physicians, who are increasingly inhibited from building flourishing relationships with each other. (shrink)

Country music critics and scholars have noticed an apparent contradiction between the practical identity of country music with the image of the male country singer as the 'rhinestone cowboy'. In this case, the problem is one of how we can make sense of the rural, working-class, ruggedly masculinity persona common to the genre with its elaborately embroidered, brightly colored, and highly embellished male fashion. The intractability of this problem has led some to argue that the simplest solution is to just (...) deny the legitimacy of country music authenticity discourse altogether. That is, all the genre’s talk of the rural working class is inauthentic and should be discarded. Here, I argue that by accounting for country music authenticity in terms of the genre being a dual character concept, we can fully address the skeptic's worries. Beyond merely being compatible with the Nudie suit however, this notion of authenticity is also our best way of understanding the aesthetic value of the rhinestone cowboy image at all. The resulting picture, in which the suit primarily serves as an epistemic signifier of one’s standing in the country music community, allows for the Nudie suit to function as a class, and sometimes queer, commentary on mainstream culture. (shrink)

Genres inform our appreciative practices. What it takes for a work to be a good work of comedy is different than what it takes for a work to be a good work of horror, and a failure to recognize this will lead to a failure to appreciate comedies or works of horror particularly well. Likewise, it is not uncommon to hear people say that a film or novel is a good work, but not a good work of x (where x (...) is the genre of that work). A work can be good all things considered, but genre membership provides us with an additional set of evaluative criteria over and above those of the medium, which colors how we interpret and appreciate the work. Given this importance, it is not surprising that philosophers of art have been interested in providing an account of what, exactly, a genre is. Despite this interest, there is not widespread agreement about what it takes for something to be a genre, nor what kinds of considerations are relevant in determining whether a work is a member of that genre. Beyond this, we might also want to know to what degree we ought to consider genre in evaluating a work of art and why it should matter at all. Here, I explore the variety of recent theories that philosophers have taken up on the topic of genre and why we should ultimately think of genres as artistic practices rather than the alternatives. (shrink)