Background and PurposeMany critically ill patients in intensive care units are unable to communicate their wishes about goals of care, particularly about the use of life-sustaining treatments. Surrogates and clinicians struggle with medical decisions because of a lack of clarity regarding patients’ preferences, leading to prolonged hospitalizations and increased costs. This project focused on the development and implementation of a tool to facilitate a better communication process by assuring the early identification of a surrogate if indicated on admission and clarifying (...) the decision-making standards that the surrogate was to use when participating in decision making. Before introducing the tool into the admissions routine, the staff were educated about its use and value to the decision-making process. Project and MethodsThe study was to determine if early use of a simple method of identifying a patient’s surrogate and treatment preferences might impact length of stay and total hospital charges. A pre- and post-intervention study design was used. Nurses completed the surrogacy information tool for all patients upon admission to the neuroscience ICU. Subjects were critically ill patients who had been on a mechanical ventilator for 96 hours or longer, or in the ICU for seven days or longer. The project included staff education on biomedical ethics, critical communication skills, early identification of families and staff in crisis, and use of a simple tool to document patients’ surrogates and previously expressed care wishes. Data on hospital LOS and hospital charges were collected through a retrospective review of medical records for similar four-month time frames pre- and post-implementation of the assessment tool. ResultsSignificant differences were found between pre- and post-groups in terms of hospital LOS and total hospital charges . ConclusionsProject findings indicate that the use of a simple admission assessment tool, supported by staff education about its completion, use, and available resources, can decrease LOS and lower total hospital charges. The reasons for the difference between the pre- and post-intervention groups remain unclear. Further research is needed to evaluate if the quality of communications between patients, their legally authorized representatives, and clinicians—as suggested in the literature—may have played a role in decreasing LOS and total hospital charges. (shrink)
Joann Starr, a Roman Catholic nun, and Bruce Zawacki, a burn surgeon, met 22 years ago in the Los Angeles County, University of Southern California Burn Center in the roles of a patient and her physician struggling over issues of autonomy and informed consent. After recovery, she remained a nun and has become a patient advocate and doctoral candidate in bioethics. He remained a burn surgeon and has become a bioethics teacher and author. Although they live in distant locations, (...) they maintain their friendship and frequently discuss their shared experience. Recently they met to reflect on the events, lessons, and meanings of their original encounter. (shrink)
_An investigation into the foundations of democratic societies and the ongoing struggle over the power of concentrated wealth_ Much of our politics today, Paul Starr writes, is a struggle over entrenchment—efforts to bring about change in ways that opponents will find difficult to undo. That is why the stakes of contemporary politics are so high. In this wide‑ranging book, Starr examines how changes at the foundations of society become hard to reverse—yet sometimes are overturned. Overcoming aristocratic power was (...) the formative problem for eighteenth‑century revolutions. Overcoming slavery was the central problem for early American democracy. Controlling the power of concentrated wealth has been an ongoing struggle in the world’s capitalist democracies. The battles continue today in the troubled democracies of our time, with the rise of both oligarchy and populist nationalism and the danger that illiberal forces will entrench themselves in power. _Entrenchment_ raises fundamental questions about the origins of our institutions and urgent questions about the future. (shrink)
During the three centuries from 800 to 500 B.C., the Greek world evolved from a primitive society- -both culturally and economically- -to one whose artistic products dominated all Mediterranean markets, supported by a wide overseas trade. In the following two centuries came the literary, philosophical, and artistic masterpieces of the classic area. Vital to this advance was the development of the polis, a collective institution in which citizens had rights as well as duties under the rule of law, a system (...) hitherto unknown in human history. In this study, the first systematic exploration of the forces that created the political framework of Greek civilization, Chester Starr shows how the Greeks emerged form a Homeric world of individuals to the polis of 500 B.C. The age-old conflict between the self-serving demands of human beings and the less vocally-expressed needs of the community serves as the backbone of Starr's interdisciplinary analysis of the rise of the polis. (shrink)
_Repair of the Soul_ examines transformation from the perspective of Jewish mysticism and psychoanalysis, addressing the question of how one achieves self-understanding that leads not only to insight but also to meaningful change. In this beautifully written and thought-provoking book, Karen Starr draws upon a contemporary relational approach to psychoanalysis to explore the spiritual dimension of psychic change within the context of the psychoanalytic relationship. Influenced by the work of Lewis Aron, Steven Mitchell and other relational theorists, and drawing (...) upon contemporary scholarship in the field of Jewish studies, Starr brings the ideas of the Kabbalah, the ancient Jewish mystical tradition, into dialogue with modern psychoanalytic thought. _Repair of the Soul_ provides a scholarly integration of several kabbalistic and psychoanalytic themes relating to transformation, including faith, surrender, authenticity, and mutuality, as well as a unique exploration of the relationship of the individual to the universal. Starr uses the Kabbalah’s metaphors as a vivid framework with which to illuminate the experience of transformation in psychoanalytic process, and to explore the evolving view of the psychoanalytic relationship as one in which both parties - the analyst as well as the patient - are transformed. (shrink)
A uniform theory of conditionals is one which compositionally captures the behavior of both indicative and subjunctive conditionals without positing ambiguities. This paper raises new problems for the closest thing to a uniform analysis in the literature (Stalnaker, Philosophia, 5, 269–286 (1975)) and develops a new theory which solves them. I also show that this new analysis provides an improved treatment of three phenomena (the import-export equivalence, reverse Sobel-sequences and disjunctive antecedents). While these results concern central issues in the study (...) of conditionals, broader themes in the philosophy of language and formal semantics are also engaged here. This new analysis exploits a dynamic conception of meaning where the meaning of a symbol is its potential to change an agent’s mental state (or the state of a conversation) rather than being the symbol’s content (e.g. the proposition it expresses). The analysis of conditionals is also built on the idea that the contrast between subjunctive and indicative conditionals parallels a contrast between revising and consistently extending some body of information. (shrink)
Imperative sentences like Dance! do not seem to represent the world. Recent modal analyses challenge this idea, but its intuitive and historical appeal remain strong. This paper presents three new challenges for a non-representational analysis, showing that the obstacles facing it are even steeper than previously appreciated. I will argue that the only way for the non-representationalist to meet these three challenges is to adopt a dynamic semantics. Such a dynamic semantics is proposed here: imperatives introduce preferences between alternatives. This (...) characterization of meaning focuses on what function a sentence serves in discourse, rather than what that sentence refers to (e.g. a state of the world). By representing the meaning of imperatives, connectives and declaratives in a common dynamic format, the challenges posed for non-representationalism are met. (shrink)
No existing conditional semantics captures the dual role of 'if' in embedded interrogatives — 'X wonders if p' — and conditionals. This paper presses the importance and extent of this challenge, linking it to cross-linguistic patterns and other phenomena involving conditionals. Among these other phenomena are conditionals with multiple 'if'-clauses in the antecedent — 'if p and if q, then r' — and relevance conditionals — 'if you are hungry, there is food in the cupboard'. Both phenomena are shown to (...) be problematic for existing analyses. Surprisingly, the decomposition of conditionals needed to capture the link with interrogatives provides a new analysis that captures all three phenomena. The model-theoretic semantics offered here relies on a dynamic conception of meaning and compositionality, a feature discussed throughout. (shrink)
This paper proposes a semantics for free choice permission that explains both the non-classical behavior of modals and disjunction in sentences used to grant permission, and their classical behavior under negation. It also explains why permissions can expire when new information comes in and why free choice arises even when modals scope under disjunction. On the proposed approach, deontic modals update preference orderings, and connectives operate on these updates rather than propositions. The success of this approach stems from its capacity (...) to capture the difference between expressing the preferences that give rise to permissions and conveying propositions about those preferences. (shrink)
This work explores the hypothesis that natural language is a tool for changing a language user's state of mind and, more specifically, the hypothesis that a sentence's meaning is constituted by its characteristic role in fulfilling this purpose. This view contrasts with the dominant approach to semantics due to Frege, Tarski and others' work on artificial languages: language is first and foremost a tool for representing the world. Adapted to natural language by Davidson, Lewis, Montague, et. al. this dominant approach (...) has crystalized as truth-conditional semantics: to know the meaning of a sentence is to know the conditions under which that sentence is true. Chapter 1 details the animating ideas of my alternative approach and shows that the representational function of language can be understood in terms of the more general function of changing representational mental states. Chapters 2-4 argue that the additional resources of this more general conception of meaning allow us to explain certain phenomena involving conditionals and grammatical mood that truth-conditional semantics does not. In the analysis of these specific phenomena and the articulation of the general approach on offer, it emerges that this approach combines insights and benefits from both use-theoretic and truth-theoretic work on meaning. (shrink)
Research explored methods for “shortening the food links” or developing the “local foodshed” by connecting farmers with food service buyers (for restaurants and institutions) in Colorado. Telephone interviews were used to investigate marketing and purchasing practices. Findings include that price is not a significant factor in purchasing decisions; that food buyers prioritize quality as their top purchasing criterion but are not aware that local farmers can provide higher quality, that institutions are interested in buying locally; that small farms can offer (...) comparable or higher quality produce andservice; and that farmers need to show buyers what the quality of produce and service they can provide. (shrink)
Although the demographics on male versus female death-row prisoners suggest that males are the criminal justice system’s primary targets, the author argues that the system still discriminates against women. Utilizing postmodern scholarship, he argues that female prisoners are punished primarily for violating dominant norms of gender correctness.
The objective of the study was to investigate the relationship between childhood IQ of parents and characteristics of their adult offspring. It was a prospective family cohort study linked to a mental ability survey of the parents and set in Renfrew and Paisley in Scotland. Participants were 1921-born men and women who took part in the Scottish Mental Survey in 1932 and the Renfrew/Paisley study in the 1970s, and whose offspring took part in the Midspan Family study in 1996. There (...) were 286 offspring from 179 families. Parental IQ was related to some, but not all characteristics of offspring. Greater parental IQ was associated with taller offspring. Parental IQ was inversely related to number of cigarettes smoked by offspring. Higher parental IQ was associated with better education, offspring social class and offspring deprivation category. There were no significant relationships between parental IQ and offspring systolic blood pressure, diastolic blood pressure, cholesterol, glucose, lung function, weight, body mass index, waist hip ratio, housing, alcohol consumption, marital status, car use and exercise. Structural equation modelling showed parental IQ associated with offspring education directly and mediated via parental social class. Offspring education was associated with offspring smoking and social class. The smoking finding may have implications for targeting of health education. (shrink)
A close reading of Mary Robinson’s late-eighteenth-century poem “London’s Summer Morning,” which captures all the noises and smells of a busy London street, is not enough to convince the reader that it isn’t all a dream. But whose dream? René Descartes and Wallace Stevens suggest that it may not matter.
The second International Knowledge and Discourse Conference, held at the University of Hong Kong in June 2002, was the forum for the long-awaited debate between Bruno Latour and Steve Fuller. Bruno Latour counts beyond two. He places the blame for the emphasis in academia on the subject-object distinction on Kant. Latour wants academics to acknowledge that things act, and suggests we look at other traditions, e.g. the Chinese, for alternatives to the subject-object dichotomy. Steve Fuller concentrated on the moral project (...) of science, which is to draw a distinction between the human and the non-human and, to highlight the fact that, as the culmination of the sciences, social science has a particular responsibility to make this distinction. He accused Bruno Latour of evading the moral issue. The debate can be read as a reiteration of the postions of Bruno Latour and Steve Fuller on the question of heterogeneity at the theoretical level, but it did not address the topic at the practical or research level. (shrink)
This paper attempts to provide a conceptual underpinning for codes of ethics in business and the professions. Rule-utilitarianism is a theory of ethics which I believe can successfully do this. Business persons and professionals, hopefully, will be able to develop codes of ethics in a manner consistent with a well-formulated general ethical theory. This will help enable codes of ethics to be a bridge between general ethical theory and specific ethical decisions made in business and the professions.
The rapid recent expansion of copyright law worldwide has sparked efforts to defend the ‘public domain’ of non-propertized information, often on the ground that an expansive public domain is a condition of a ‘free culture’. Yet questions remain about why the public domain is worth defending, what exactly a free culture is, and what role (if any) authors’ rights might play in relation to it. From the standard liberal perspective shared by many critics of copyright expansionism, the protection of individual (...) expression by means of marketable property rights in authors’ works serves as an engine of progress towards a fully competitive ‘marketplace of ideas’ – though only if balanced by an extensive public domain from which users may draw in the exercise of their own expressivity. This article shows that a significantly different, and arguably richer, conception of what a free culture is and how authors’ rights underpin it emerges from a direct engagement with the philosophy of Immanuel Kant. For Kant, progress towards a fully emancipated (i.e. a ‘mature’ or ‘enlightened’) culture can only be achieved through the critical intellectual activity that public communication demands: individual expressive freedom is only a condition, not constitutive, of this ‘freedom to make public use of one’s reason in all matters’. The main thesis defended in this article is that when Kant’s writings on publicity (critical public debate) are read in relation to his writings on the legal organization of publishing, a necessary connection emerges between authors’ rights – as distinct from copyrights – and what Jürgen Habermas and others have named the public sphere. I conclude that it is the public sphere, and not the public domain as such, that should serve as the key reference point in any evaluation of copyright law’s role in relation to the possibility of a free culture. (shrink)
The dilemma confronted by Buridan’s Ass leads into a problem about nil-preference situations, to which there is a solution in the literature that is inspired by Alan Turing: we have evolved with a computational module in our brains that comes into play in such situations by picking a random action among the alternatives that detennines the subject’s choice. We relate these Buridan’s Ass situations to a larger, theoretically interesting category in which there is no alternative that is decisively superior to (...) others with respect to expected utility, and we try to show how our emotional makeup figures in a rational response, particularly as informed by symbolic utilitythat we draw down from our culture’s shared understandings. The category is theoretically interesting because it contains moral dilemmas, as well as hard cases in which an imponant choice must be made without an option that has clearly superior expected utility. We argue that our Emotional Response Model is preferable to Turing’s Randomizer for this category, as well as more illuminating about nil-preference situations or close approximations thereto. (shrink)
There is a big difference between saying Maya is singing, Is Maya singing? and Sing Maya! This paper examines and criticizes two attempts to rigorously explain this difference: Searle’s speech act theory and the truth-conditional reductionism advocated by Davidson and Lewis. On the speech act analysis, each utterance contains a marker which says what kind of speech act the utterance counts as performing. The truth-conditional reductionists try to reanalyze the non-declaratives as complex declarative forms. The former analysis fails to recognize (...) the indirect relationship between sentence type and utterance force. The latter analysis fails to recognize the distinctive and thoroughly compositional contribution that the imperative, interrogative and declarative mood make to sentences containing them. (shrink)
This article seeks to identify and address the normative void that resides at the heart of postmodernist-feminist theory, and to propose a philosophical framework – beyond postmodernism, but incorporating its central insights – for thinking through the normative questions with which feminists are inevitably confronted in their engagements with positive law. Two varieties of postmodernist-feminism are identified and critically analysed: the ‘corporeal feminism’ of Elizabeth Grosz and Judith Butler, which seeks to ground feminist critical practice in the irruptive capacities of (...) the material body considered as an arte fact of social construction; and the deconstructionist feminism of Drucilla Cornell, for whom ‘the feminine’ is an indeterminate but disruptive force beyond its construction in law and in other social sites. The first component of the argument elaborated here is that each of these approaches ultimately reduces to a form of aestheticism which is incapable of generating a worthwhile and workable feminist approach to the restructuring of politics and law. The second component of the argument involves a return to aesthetics, in particular to the philosophical aesthetics of Kant’s Critique of Judgement. Kant’s aesthetic philosophy, it will be suggested, yields a framework of concepts which, duly re-manipulated, could speak to the very concerns that have inspired postmodernist-feminism: how to attend to (bodily) particularity while avoiding the dangers associated with ‘essentialism’; and how to theorise the propensity of the unrepresentable power of the feminine to exceed both embodied human capacities and the confining rein of socially privileged rationalities. Crucially, however it also responds to a set of preoccupations – those of the feminist lawyer – that cannot be accommodated by postmodernism: how to translate embodied experience into (legal) norms; generalise from the particular; seek consensus; and codify an endless potentiality in the form of law. (shrink)