Walter Glannon argues that our proposal for routine recovery of transplantable cadaveric organs is unacceptable After carefully reviewing his counterarguments, we conclude that, although some of them have merit, none are sufficiently strong to warrant abandoning this plan. Below we respond to each of Glannon's concerns.

Corporate social responsibility (CSR) activities have become increasingly prevalent in retail settings. In franchised organizations, franchisors typically design and coordinate these activities, leaving operational execution to franchisees. Meanwhile, franchisors may introduce new corporate-led CSR activities over time. Even though changes to CSR activities may refocus outlets’ attention on a CSR initiative, they may also disrupt an outlet’s ongoing CSR routines. Using a longitudinal, secondary dataset consisting of an eight-year panel for a national, franchised restaurant chain, we examine CSR performance dynamics (...) in the presence of two distinct types of CSR activities: an ongoing CSR routine and a distinct, temporary CSR campaign. We find that, when resuming the CSR routine after a temporary CSR campaign, outlets’ performance in CSR routines drops significantly (i.e., immediate decay), then improves gradually (i.e., protracted recovery). We also consider the moderating role of an outlet’s experience, finding that experience stabilizes these decay and recovery cycles. Our findings represent a first step in developing a longitudinal understanding of how a firm’s short-term CSR campaigns may impact ongoing CSR routines, thus contributing to the knowledge of CSR activity development and routinization. (shrink)

The mental health recovery movement promotes patient self-determination and opposes coercive psychiatric treatment. While it has made great strides towards these ends, its rhetoric impairs its political efficacy. We illustrate how psychiatry can share recovery values and yet appear to violate them. In certain criminal proceedings, for example, forensic psychiatrists routinely argue that persons with mental illness who have committed crimes are not full moral agents. Such arguments align with the recovery movement’s aim of providing appropriate treatment (...) and services for people with severe mental illness, but contradict its fundamental principle of self-determination. We suggest that this contradiction should be addressed with some urgency, and we recommend a multidisciplinary collaborative effort involving ethics, law, psychiatry, and social policy to address this and other ethical questions that arise as the United States strives to implement recovery-oriented programs. (shrink)

Introduction: It is essential to detect sacroiliitis earlier to decrease morbidity and unwanted complications such as ankylosing of sacroiliac joints. In recent studies, magnetic resonance imaging (MRI) serves as a key diagnostic tool for identifying sacroiliitis and is now included in the diagnostic criteria. We aim to detect the utility of diffusion-weighted imaging on the MRI in diagnosing sacroiliitis and measure ADC values for the response to treatment in future studies. Materials -methods: There were 39 patients (16 male, 20 female). (...) A 1.5 Tesla MR device with a pelvic coil was used. The sequences were T1 (before and after intravenous contrast administration of gadolinium), T2-weighted fast field echo, short tau inversion recovery (STIR), diffusion-weighted (DW) images, and apparent diffusion coefficient (ADC) mapping. Sacroiliac joints were divided into four quadrants, and two radiologists interpreted all the sequences by giving scores from 0 to 3 depending on bone marrow edema from none to severe. The concordance of scores assigned to STIR, T1-weighted gadolinium-enhanced images, ADC mapping, and diffusion-weighted MR images was evaluated by calculating intraclass correlation coefficients. Results: A statistically significant positive correlation was observed between the activity scores derived from short tau inversion recovery (STIR) and other magnetic resonance (MR) sequences, namely T1-weighted gadolinium-enhanced images, apparent diffusion coefficient (ADC) mapping, and diffusion-weighted MR images. Conclusion: Active bone marrow abnormalities were identified with comparable efficacy using STIR imaging and other MR sequences (T1W-Gad, ADC mapping, DW-MR). In our study, we tried to emphasize the role of the diffusion-weighted images near the other sequences. Diffusion is a fast, easy-applied sequence. After increased experience in the diffusion-weighted images, routine application of this sequence will increase, and even becoming one of the diagnostic criteria will be inevitable. The difference in DWI from the other sequences is that it is measurable. The response to treatment may be followed up by ADC values. (shrink)

In a recent set of papers, Aaron Spital has proposed conscription or routine recovery of cadaveric organs without consent as a way of ameliorating the severe shortage of organs for transplantation. Under the existing consent requirement, organs can be taken from the bodies of the deceased if they expressed a wish and intention to donate while alive. Organs may also be taken when families or other substitute decisionmakers decide on behalf of the deceased to allow organ procurement for (...) the purpose of transplantation. When patients or families do not consent to organ procurement, many transplantable organs are lost. This is a tragic yet avoidable situation. The dead are beyond any benefit or harm, and their organs could be used to prevent harm by saving and improving the lives of many people suffering and dying from end-stage organ failure. (shrink)

Organ shortage is a major survival issue for millions of people worldwide. Globally 1.2 million people die each year from kidney failure. In this paper, we critically examine and find lacking extant proposals for increasing organ supply, such as opting in and opt out for deceased donor organs, and parochial altruism and paired kidney exchange for live organs. We defend two ethical solutions to the problem of organ shortage. One is to make deceased donor organs automatically available for transplant without (...) requiring consent from the donor or their relatives. The other is for society to buy nonvital organs in a strictly regulated market and provide them to people in need for free. (shrink)

Grafts of embryonic neural tissue into the brains of adult patients are currently being used to treat Parkinson's disease and are under serious consideration as therapy for a variety of other degenerative and traumatic disorders. This target article evaluates the use of transplants to promote recovery from brain injury and highlights the kinds of questions and problems that must be addressed before this form of therapy is routinely applied. It has been argued that neural transplantation can promote functional (...) class='Hi'>recovery through the replacement of damaged nerve cells, the reestablishment of specific nerve pathways lost as a result of injury, the release of specific neurotransmitters, or the production of factors that promote neuronal growth. The latter two mechanisms, which need not rely on anatomical connections to the host brain, are open to examination for nonsurgical, less intrusive therapeutic use. Certain subjective judgments used to select patients who will receive grafts and in assessment of the outcome of graft therapy make it difficult to evaluate the procedure. In addition, little long-term assessment of transplant efficacy and effect has been done in nonhuman primates. Carefully controlled human studies, with multiple testing paradigms, are also needed to establish the efficacy of transplant therapy. (shrink)

Total knee arthroplasty (TKA) is a commonly implemented elective surgical treatment for end-stage osteoarthritis of the knee, demonstrating high success rates when assessed by objective medical outcomes. However, a considerable proportion of TKA patients report significant dissatisfaction postoperatively, related to enduring pain, functional limitations, and diminished quality of life. In this conceptual analysis, we highlight the importance of assessing patient-centred outcomes routinely in clinical practice, as these measures provide important information regarding whether surgery and postoperative rehabilitation interventions have effectively remediated (...) patients’ real-world “quality of life” experiences. We propose a novel precision medicine approach to improving patient-centred TKA outcomes through the development of a multivariate machine-learning model. The primary aim of this model is to predict individual postoperative recovery trajectories. Uniquely, this model will be developed using an interdisciplinary methodology involving non-linear analysis of the unique contributions of a range of preoperative risk and resilience factors to patient-centred TKA outcomes. Of particular importance to the model’s predictive power is the inclusion of a comprehensive assessment of modifiable psychological risk and resilience factors that have demonstrated relationships with TKA and other conditions in some studies. Despite the potential for patient psychological factors to limit recovery, they are typically not routinely assessed preoperatively in this patient group, and thus can be overlooked in rehabilitative referral and intervention decision-making. This represents a research-to-practice gap that may contribute to adverse patient-centred outcomes. Incorporating psychological risk and resilience factors into a multivariate prediction model could improve the detection of patients at risk of sub-optimal outcomes following TKA. This could provide surgeons and rehabilitation providers with a simplified tool to inform postoperative referral and intervention decision-making related to a range of interdisciplinary domains outside their usual purview. The proposed approach could facilitate the development and provision of more targeted rehabilitative interventions on the basis of identified individual needs. The roles of several modifiable psychological risk and resilience factors in recovery are summarised, and intervention options are briefly presented. While focusing on rehabilitation following TKA, we advocate for the broader utilisation of multivariate prediction models to inform individually-tailored interventions targeting a range of health conditions. (shrink)

On July 4, 1990, while on a morning walk in southern France, Susan Brison was attacked from behind, severely beaten, sexually assaulted, strangled to unconsciousness, and left for dead. She survived, but her world was destroyed. Her training as a philosopher could not help her make sense of things, and many of her fundamental assumptions about the nature of the self and the world it inhabits were shattered.At once a personal narrative of recovery and a philosophical exploration of trauma, (...) this book examines the undoing and remaking of a self in the aftermath of violence. It explores, from an interdisciplinary perspective, memory and truth, identity and self, autonomy and community. It offers imaginative access to the experience of a rape survivor as well as a reflective critique of a society in which women routinely fear and suffer sexual violence.As Brison observes, trauma disrupts memory, severs past from present, and incapacitates the ability to envision a future. Yet the act of bearing witness, she argues, facilitates recovery by integrating the experience into the survivor's life's story. She also argues for the importance, as well as the hazards, of using first-person narratives in understanding not only trauma, but also larger philosophical questions about what we can know and how we should live.Bravely and beautifully written, Aftermath is that rare book that is an illustration of its own arguments. (shrink)

Prognosis after severe brain injury is highly uncertain, and decisions to withhold or withdraw life‐sustaining treatment are often made prematurely. These decisions are often driven by a desire to avoid a situation where the patient becomes ‘trapped’ in a condition they would find unacceptable. However, this means that a proportion of patients who would have gone on to make a good recovery, are allowed to die. I propose a shift in practice towards the routine provision of aggressive care, (...) even in cases where the probability of survival and acceptable recovery is thought to be low. In conjunction with this shift, I argue in favour of a presumption towards withdrawing life‐sustaining treatment, including artificial nutrition and hydration, when it becomes clear that a patient will not recover to a level that would be acceptable to them. I then respond to three potential objections to this proposal. (shrink)

Given the long-standing controversy about whether the brain-dead should be considered alive in an irreversible coma or dead despite displaying apparent signs of life, the ethical and policy issues posed when family members insist on continued treatment are not as simple as commentators have claimed. In this article, we consider the kind of policy that should be adopted to manage a family's insistence that their brain-dead loved one continues to receive supportive care. We argue that while it would be ethically (...) inappropriate to continue to devote scarce acute care resources to such patients in a hospital setting, it may not be ethically inappropriate for patients to receive these resources in certain other settings. Thus, if a family insists on continuing to care for their brain-dead loved at their home, we should not, from a policy perspective, interfere with the family's wishes. We also argue that healthcare professionals should make some effort to facilitate the transfer of brain-dead patients to these other settings when families insist on continued treatment despite being informed about the lack of any potential for recovery of consciousness. Our arguments are strengthened by the fact that patients in a persistent vegetative state, who, when correctly diagnosed, also have no potential for recovery of consciousness, are routinely transferred from hospitals to nursing homes or long-term care facilities where they continue to be ventilated, tube fed and to receive other supportive care. We also briefly explore the question of who should be responsible for the costs of such treatment at the long-term care facility. (shrink)

Every day around the country, patients are discharged from hospitals without difficulty, as the interests of the hospital and the patient tend to align: both the hospital and the patient want the patient to leave and go to a setting that will promote the patient’s continued recovery. In some cases, however, this usually routine process does not go quite as smoothly. Patients may not want to leave the hospital, or they may insist on an unsafe discharge plan. In (...) other cases, there may simply be no good place for the patient to go. These complex hospital discharge situations often involve ethical, legal, financial, and practical considerations, but the ethical issues inherent in these dilemmas have received only sporadic attention from clinical ethicists at best, leaving patients, providers, administrators, and caregivers unsure about what to do. When the ethical issues are in fact brought to light, analysis usually proceeds based on a consideration of the principles of autonomy, beneficence, nonmaleficence, and justice. However, principled analysis often fails to present patients and providers with a satisfactory solution, as the principles inevitably conflict. In this paper, I argue that difficult discharges are ethical dilemmas worthy of scholarly attention that goes beyond principlism, and I argue that providers and those involved in discharge planning ought to cultivate what philosopher Alasdair MacIntyre calls “virtues of acknowledged dependence” in order to care for these patients and their families. I first trace the current conversation about difficult discharge and show that the principled approach to resolving discharge dilemmas is not sufficient. I then argue that a new approach is needed, and to that end, I offer practical ways in which MacIntyre’s account of the virtues of acknowledged dependence may help patients, providers, and family members to navigate issues of difficult discharge. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Incorporating Religion into Psychiatry:Evidenced–Based Practice, Not a Bioethical DilemmaMary D. MollerFor over sixteen years I was the owner and clinical director of an advanced practice nurse–managed outpatient rural psychiatric clinic staffed by APNs, a social worker, a licensed counselor and several graduate students. Many of our patients were victims of severe and often brutal trauma and abuse suffered at the hands of family, friends, and various professionals including spiritual (...) leaders. We also uncovered sources of abuse suffered from those involved in occult practices ranging from seemingly innocent white witchcraft (Wicca, Paganism, New Age) that includes such activities as astral projection and remote viewing to the darkest possible black witchcraft (perpetrating evil, incanting evil spirits, casting spells and hexes, creating dissociative identities) such as occurs in ritual abuse and satanic rites. Both types of witchcraft also typically involved family, friends, various professionals, and spiritual leaders. Recognizing the controversy surrounding the reality of witchcraft I am sharing a story that I hope will help break down the barriers that prevent many patients from receiving the treatment that would provide the most benefit to recovery.Seeking services for these patients led me on an intense personal and professional journey that included a profound Christian born–again experience at almost 50 years of age. My professional career grew in nearly indescribable terms as a result of the incorporation of prayer and deliverance ministry as part of the services we selectively provided. Today I always include assessment of spiritual experiences a patient has as well as spiritual supports that are available with every new patient intake. For patients who indicate that prayer is one of their supports, I ask if they would like prayer at the conclusion of the session. The gratitude that is expressed by individuals who appreciate being able to pray with a psychiatric provider is often profound.In the field of psychiatry there has been a long–standing and distinct taboo regarding incorporating religious and spiritual aspects of life experience into treatment unless it is to frame most of these discussions within the context of psychosis. This stems from the advent of psychoanalysis in which religion was deemed a neurosis and atheism became the goal. Some still hold to that belief and there certainly remains controversy regarding the incorporation of prayer into routine outpatient or inpatient care. The essential starting point is the determination of accurate differential diagnosis, which can often be a lengthy process. The clinician must be careful about distinguishing between religious experiences and religious delusions, and often this takes time to sort out. The determination of the etiology of hearing the voice of God or the devil or demons must be carefully parsed and framed within the context of the situation and culture the patient describes. If the clinician denies the existence of God or the devil or demons or the practice of witchcraft, the patient’s descriptions of such experiences will be quickly [End Page 206] labeled psychotic. The patient may then experience a lengthy hospitalization and treatment with psychotropic medications that can have an extremely negative effect on the possibility of recovery. Once I witnessed the level of healing that occurs with carefully administered spiritual interventions that are related to specific spiritual experiences that are based on the patient’s belief system, there was no going back to using only allopathic medication and non–spiritual psychosocial interventions, even in spite of the criticisms from others. The key is to understand and respect the patient’s belief system, if this is not congruent with the practitioner’s belief system, then practitioner must refer out.In the United States, an increasing persecution of Christianity and a devaluing of the Judeo–Christian heritage of our Constitution are creating a climate of intolerance to the expression of religious values resulting in an expectation that Christians should compromise their beliefs for the sake of political correctness. As a doctorally prepared psychiatric–mental health advanced practice nurse I experienced a profound born–again Christian experience that ultimately led to study of the Hebrew roots of Christianity and I now worship in a Messianic Jewish synagogue. It is impossible for me to not include the concept of spirituality into... (shrink)

The practice of force-feeding dangerously malnourished patients with anorexia nervosa (AN) raises a puzzle for clinical ethics. Force-feeding AN patients may seem justified to save their lives and to help them recover from a debilitating pathological condition. Yet clinical ethics seems committed to a robust anti-paternalism principle, on which it is normally wrong to force treatment on decisionally capacitated patients for their own good. And some AN patients do retain decisional capacity, at least by standard criteria. Thus, routinely force-feeding AN (...) patients seems to constitute an unjustifiable exception to a well-established principle of clinical decision-making. Call this the moral puzzle of AN. I examine three attempts to solve the puzzle and argue that, individually or taken together, they cannot justify force-feeding those AN patients for whom this intervention would be potentially effective at enabling recovery. I conclude that no such justification is currently available. A solution to the moral puzzle of AN may come from a reevaluation of the anti-paternalism principle, a deeper clinical understanding of the psychology of AN, or even a novel reconceptualization of decisional capacity. (shrink)

It’s hardly news that settler culture normalizes ecocide. Those of us raised as settlers who are nevertheless ecoconscious routinely blame ourselves for our failure to live up to our own best expectations when it comes to challenging the norms and practices of our culture. This leads us to overlook that we’re also—and, I think, much more so—among its victims. I outline five manifestations of victimhood routinely exhibited by the ecoconscious settler activists, scholars, and students with whom I interact. I then (...) consider how we can transition from being victims to survivors of our culture, which is vital for ending ecocide. These two concepts, victimhood and survivorship, are regularly juxtaposed when discussing recovery for those subject to abuse, violence, and other trauma-inducing phenomena. Together they provide the basis for a clearer understanding of how we ecoconscious settlers should engage in the ongoing fight for our lives and our futures. (shrink)

This article focuses on public philosophy, the main approaches to interpreting it, current ways for philosophy to reach the public, and obstacles to this. A major hindrance is that philosophy is an area of professional expertise. This circumstance has both conduced to the development of a large close-knit academic community and enfeebled its already weak communication ties with society and other fields of scientific knowledge. It is argued that, on the one hand, publicness has been immanent in philosophy from the (...) very beginning, and, on the other, philosophy needs a public upgrade and a new experience of a constructive dialogue with society. This new publicness of philosophy may be the way to recovery it. It is also shown that tendency towards greater publicness, which is distinctive of modern academic sciences, is a response to the new economic situation. Sciences are becoming engaged in an info-struggle for the attention of the state and society. This is affecting philosophy as well, although the value and importance of philosophical knowledge have been traditionally recognised and emphasised in culture and by the education system. It is stressed that the idea of recovering philosophy is closely linked to what function the philosopher has in the life of society. The contribution considers various possible types of public philosophers. It is concluded that, contrary to the common belief, society needs not an expert philosopher or a mediator in the field of science but a professional consultant capable of calibrating the thinking routines of people and helping them adopt a rational attitude towards themselves, that is, acquire an ability to think critically, form a conscious judgement of their life, and take responsibility for their decisions. (shrink)

Given the long‐standing controversy about whether the brain‐dead should be considered alive in an irreversible coma or dead despite displaying apparent signs of life, the ethical and policy issues posed when family members insist on continued treatment are not as simple as commentators have claimed. In this article, we consider the kind of policy that should be adopted to manage a family's insistence that their brain‐dead loved one continues to receive supportive care. We argue that while it would be ethically (...) inappropriate to continue to devote scarce acute care resources to such patients in a hospital setting, it may not be ethically inappropriate for patients to receive these resources in certain other settings. Thus, if a family insists on continuing to care for their brain‐dead loved at their home, we should not, from a policy perspective, interfere with the family's wishes. We also argue that healthcare professionals should make some effort to facilitate the transfer of brain‐dead patients to these other settings when families insist on continued treatment despite being informed about the lack of any potential for recovery of consciousness. Our arguments are strengthened by the fact that patients in a persistent vegetative state, who, when correctly diagnosed, also have no potential for recovery of consciousness, are routinely transferred from hospitals to nursing homes or long‐term care facilities where they continue to be ventilated, tube fed and to receive other supportive care. We also briefly explore the question of who should be responsible for the costs of such treatment at the long‐term care facility. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Back to the Future:Obtaining Organs from Non-Heart-Beating CadaversRobert M. Arnold (bio) and Stuart J. Youngner (bio)Organ Transplantation requires viable donor organs. This simple fact has become the Achilles' heel of transplantation programs. Progress in immunology and transplant surgery has outstripped the supply of available organs. Between 1988 and 1991, for example, the number of transplant candidates on waiting lists increased by about 55 percent, while the number of donors (...) increased only about 16 percent.1 By the end of March 1993, more than 30,000 potential recipients awaited transplantation (United Network for Organ Sharing Database (UNOS) 1993). Every day six of these patients die prior to receiving a heart or liver transplant, while patients needing kidney transplants must tolerate a lower quality of life on dialysis (Grenvik 1992; Evans, Orians, and Ascher 1992).This scarcity is likely to get worse. As transplantation becomes more successful, it is being offered to sicker and older patients. Attempts to transplant other solid organs, such as small bowel and pancreas, will only fuel the demand for donors. However, the current source of organs is unlikely to grow. Most organs come from patients who have been declared dead by neurologic criteria (commonly referred to as "brain dead" or heart-beating cadaver donors (HBCDs) because their hearts are beating at the time of procurement). Estimates of the potential pool of HBCDs have been revised downward from 20,000-27,000 to roughly 10,000-12,000 (Nathan et al. 1991). Improvements in automobile safety and handgun legislation will likely lead to further reductions. Moreover, the rate of procurement from HBCDs has remained relatively flat despite extensive public awareness campaigns and legislation requiring hospitals to routinely request donation from families of dead patients (Caplan et al. 1992).If organ transplantation is going to continue to flourish, alternative [End Page 103] sources of organs must be found. Recently the University of Pittsburgh Medical Center (UPMC) proposed procuring organs from patients who have been declared dead by traditional cardiopulmonary rather than brain-oriented criteria after they or their families have decided to forgo life-sustaining treatment—hereafter referred to as the Pittsburgh protocol (UPMC Policy 1993). These patients are typically referred to as non-heart-beating cadaver donors (NHBCDs) because their hearts are no longer beating at the time of organ procurement.Although NHBCDs were a major source of transplantable kidneys prior to the institution of death by neurologic criteria, their usefulness was limited by "warm ischemia time." This term refers to the injury to tissues that occurs when the blood supply is interrupted and before the organs are cooled and reperfused. Under the Pittsburgh protocol, therapy is withdrawn in the operating room where a waiting surgical team removes organs immediately after death is declared. By controlling the place and time of death, it has been possible to minimize warm ischemia time and thus solve the technical problems previously associated with procurement from NHBCDs.The potential contribution of NHBCD organs is significant. Nathan (1992), using data from Delaware Valley Transplant Program, concludes that the use of severely brain injured, but not "brain dead" patients, would increase the donor pool by 20-25 percent. Moreover, unpublished data from the Pittsburgh organ procurement organization, the Center for Organ Recovery and Education (CORE), suggests that these organs, particularly kidneys, function as well as those procured from HBCDs (Broznick 1993).This volume is devoted to the ethical, psychosocial, and public policy implications of procuring organs from non-heart-beating cadaver donors after a discussion to forgo life-sustaining treatment. The genesis of this volume was a project in which we invited leading experts in transplantation, ethics, and public policy to use the Pittsburgh protocol as a starting point for exploring a broad range of issues associated with attempts to procure organs from NHBCDs. The issues raised by NHBCDs turned out to have important implications about the fundamental conceptual and moral assumptions underlying organ procurement.Although each of the papers in this volume can be read separately, we intend the volume to be read as a whole. Many of the latter pieces on the ethical implications of the policy are best understood in light of the earlier background papers... (shrink)

This paper examines the competing construals of the phrase recovering alcoholic, which, as a Membership Categorization Device, serves to fulfill a commitment to an identity category and at the same time evokes other category-bound activities, often with unintended consequences. Former problem drinkers are routinely referred to by themselves and others as recovering alcoholics, yet they are not ‘recovering’ in the canonical sense of the word, and they participate in a behavior – not drinking – which is a negation of the (...) behavior that originally qualified them as alcoholics. This use of the relatively new identity marker recovering alcoholic may discourage a problem drinker from attempting sobriety, as it implies an unbounded, never-ending period of recovery, unlike recovery from other diseases. (shrink)

The COVID‐19 pandemic created healthcare backlogs of routine primary and preventive care, elective procedures, dental care, and mental healthcare appointments across the world. So far, governments are responding by enacting pandemic recovery policies that expand their healthcare sector activity, without much, if any, consideration of its effects on the environmental crisis that is (among other things) worsening human health and health equity. This paper argues that, as a matter of health and social justice, governments have an ethical responsibility (...) to equitably reduce the backlog with minimal environmental damage. To do so, a first key action is to give priority to policy options that minimise negative human impacts on the environment. Yet these policies alone will not be sufficient to address the backlog, particularly in relation to elective procedures. The paper therefore contends that a second key action for governments is to enact the policy options that are best able to equitably reduce the remainder of the backlog, while accelerating the transition to sustainable health care in ways that are best able to reduce the specific environmental costs of those policy options. It concludes by considering whether limits apply to governments' ethical responsibilities that ultimately mean accelerating the transition to sustainable health care is not required when addressing the backlog. (shrink)

BackgroundPrognostic uncertainty is a challenge for physicians in the neuro intensive care field. Questions about whether continued life-sustaining treatment is in a patient’s best interests arise in different phases after a severe traumatic brain injury. In-depth information about how physicians deal with ethical issues in different contexts is lacking. The purpose of this study was to seek insight into clinicians’ strategies concerning unresolved prognostic uncertainty and their ethical reasoning on the issue of limitation of life-sustaining treatment in patients with minimal (...) or no signs of neurological improvement after severe traumatic brain injury in the later trauma hospital phase.MethodsInterviews with 18 physicians working in a neurointensive care unit in a large Norwegian trauma hospital, followed by a qualitative thematic analysis focused on physicians’ strategies related to treatment-limiting decision-making.ResultsA divide between proactive and wait-and-see strategies emerged. Notwithstanding the hospital’s strong team culture, inter-physician variability with regard to ethical reasoning and preferred strategies was exposed. All the physicians emphasized the importance of team—family interactions. Nevertheless, their strategies differed: (1) The proactive physicians were open to consider limitations of life-sustaining treatment when the prognosis was grim. They initiated ethical discussions, took leadership in clarification and deliberation processes regarding goals and options, saw themselves as guides for the families and believed in the necessity to prepare families for both best-case and worst-case scenarios. (2) The “wait-and-see” physicians preferred open-ended treatment (no limitations). Neurologically injured patients need time to uncover their true recovery potential, they argued. They often avoided talking to the family about dying or other worst-case scenarios during this phase.ConclusionsDepending on the individual physician in charge, ethical issues may rest unresolved or not addressed in the later trauma hospital phase. Nevertheless, team collaboration serves to mitigate inter-physician variability. There are problems and pitfalls to be aware of related to both proactive and wait-and-see approaches. The timing of best-interest discussions and treatment-limiting decisions remain challenging after severe traumatic brain injury. Routines for timely and open discussions with families about the range of ethically reasonable options need to be strengthened. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Transformation:Power in Persistence and PerspectiveTyler BendrickWe've got another meth napper," my resident stated. With an introduction like that, it is hard not to be immediately labeled as a "difficult patient." Being the only Spanish-speaking person on the team, I, a third-year medical student, became the primary point of contact for this severely injured patient. He was an only-Spanish-speaking, 36-year-old male admitted [End Page 7] to our trauma service (...) after he was hit by a truck while riding his bicycle. Unbeknownst to me at the time, the 14 days I spent caring for this man would become one of the most pivotal learning experiences of my medical school career. It changed not only how I understand and approach "difficult patients" but expanded my knowledge of the complexities and challenges of the current healthcare system and how we, as physicians and healthcare providers, can deliver the best care to patients with low health literacy and limited resources.So, what is a "meth napper?" I questioned. "Well, meth is a super stimulant," my resident explained. "When people are frequent meth users, they get used to functioning normally with high levels of stimulants in their body, reducing the normal regulation of wakefulness. When the amphetamine is removed (such as upon admission to the hospital), the body is left to fend for itself, and thus patients oftentimes sleep for 23 hours a day for about 3 to 5 days while their body works to detox and normalize hormones."As predicted, my new friend, "Joe," was napping when I first went to see him. Thinking back, the word "napping" does not accurately describe his level of somnolence. He was virtually unarousable, and I took to a sternal rub to wake him up at 5 a.m. after his traumatic exploratory laparotomy the night before. Once aroused, he was furious. "Estoy bien. Tengo dolor y tengo hambre," he grunted at me. (I am fine, and I am in pain and hungry!). "Ok, Joe," I replied in Spanish, "I am just going to do a quick exam and you can go back to sleep. We will give you medications for your pain. You had a big surgery on your intestines, so you cannot eat or drink right now. If everything goes well in the next couple of days and you start walking around, we can advance your diet." He begrudgingly let me examine him, never opening his eyes, and I left and went about my day.We continued this routine for five days. I would periodically check on him and usually found him sleeping. When awake, he refused to work with physical therapists, get up and walk or go to the bathroom, shower, use his spirometer, or converse with the nursing staff. He seemed completely disinterested in recovery. About day three, we slowly advanced his diet to clear liquids so he could quench his thirst. Sometimes his wife was there, and she would ask for updates, to which I could only reply, "We have to wait until he is more awake or willing to work with us." I was getting frustrated, as it seemed that his noncompliance was becoming his barrier to discharge.But on day six, everything changed. I went to check on Joe, and he was wide awake, vomiting, and irate. He shouted that he was in incredible pain, and his incision was wet. He was also complaining that he had not eaten in five days, and was insisting that we were starving him. Again, I calmly explained (as I had multiple times a day for the past five days) that his major abdominal surgery prevented us from feeding him until his intestines healed. We were giving him fluids and nutrition through his IV lines, so he was not starving to death. I rushed to get my resident to examine his oozing wound, and after a CT scan and an x-ray, we discovered what we feared: His wound had opened down to the fascia, "dehiscence," as it is called. On top of this, he now had a bowel obstruction, causing his vomiting. His lack of mobility for the past five days had slowed his... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Feminist Studies 41, no. 3. © 2015 by Feminist Studies, Inc. 571 Moving through Cancer: An Interview with Carol Collins Artist Carol Collins spoke with Feminist Studies editorial collective member Stephanie Gilmore about her experience of cancer, treatment, and recovery and how it gave rise to an art series that examines what nature means in the midst of unnatural treatments. SG: Carol, thank you for the opportunity to (...) speak with you about your artwork. Having just lost my sister to cancer, your work reminds me of much pain and loss, but also of love and the desire to survive. Before we discuss the work itself, I would like to hear about your journey through cancer, treatment, and recovery. CC: The breast cancer patient’s journey is complex and perilous. When I was healthy, I was ignorant about the magnitude of suffering many cancer patients undergo. And, although I am a private person, I’m now publicly sharing my cancer experience in order to be a voice for those who have suffered through similar treatments—and worse—and those who sadly are no longer with us to tell their story. Being bald and nauseated are not the most awful possible side effects of the treatments, although they are the most well known. Some women survive the cancer but can die from the treatments, or others suffer through the treatments and die anyway. Often, it seems many believe patients can overcome their 572 Carol Collins adversity solely with positive thinking and persistence. However, not discussing the array of physical and psychological damage that even those with good prognoses incur propagates ignorance about this malady. I hope that my artwork and story will promote a deeper understanding of a breast cancer patient’s plight and will encourage more support for research for individualized therapies and prevention. My cancer journey began when I received a breast cancer diagnosis in January 2014. Life just before that point was good; the future was bright. Tendon pain, caused by my flat feet and a lot of exercising, was my only known ailment. But one day a routine mammogram revealed three tumors in my right breast. The radiology oncologist said the masses were highly likely to be cancerous, so he immediately did painful core biopsies at the sites of my three tumors. The next day, it became clear that we needed to act quickly. The biopsy results revealed I had a very aggressive invasive breast cancer with estrogen, progesterone, and HER2 receptors. Breast cancer in premenopausal women grows quickly due to the high level of hormones present. The oncologists and surgeons said I would, at a minimum, need a mastectomy and possibly lymph node resection, and they warned that I would likely need chemotherapy, which would destroy my eggs and ovaries. After learning of my limited options, I approved the removal of one breast and my sterilization. I knew I needed to think rationally and face the giant raven before me head on. However, I did not realize the magnitude and multitude of physical and psychological pains, illnesses, and losses that were soon to come. The first year of cancer treatments inflicted much physical pain. I received three extremely painful injections into my right breast with a radiolabeled colloid just prior to the mastectomy. The pain came from the injected dye, not from the needle. The modified radical mastectomy was more excruciatingly painful than I anticipated, even with painkillers and overnight hospitalization. Breast reconstruction was an option that added more pain and discomfort from weekly fillings of the installed “expander” and additional surgeries. Extreme pain after the mastectomy prevented me from lying down for months. Foolishly, I did not get an injection port installed in my chest. Instead, I endured numerous deep (and often unsuccessful) needle pricks into the seemingly few veins of my left arm (which still had its lymph nodes) that were appropriate for infusions over the period of a year. Shooting pains across my chest and arm were the norm. Carol Collins 573 In addition to the surgically induced physical pain, the chemotherapy quickly caused a myriad of undesirable physical side effects. It is scary to realize that the medical community does not often fully understand... (shrink)

Introduction: our environment is out of control -- The foundation: your environment shapes you -- Every hero is the product of a situation : understanding the proximity effect -- How your environment shapes you : the myth of willpower -- Use positive-stress environments to promote change -- Create enriched environments : the key of "forcing functions" to promote change -- More than good intentions : how to adapt to new and difficult environments -- Grow into your goals : outsource your (...) motivation to high pressure environments -- Optimal environments for rapid learning : shortcuts to success -- Rotate your environments : change it up based on the work you're doing -- Find unique collaborations : design your world through transformational relationships -- Never forget where you came from : remember the environment where you began -- Pse rejuvinating environments to promote recovery and growth -- Establish your value system : the clearer you get, the more successful you'll be -- Remove everything that conflicts with your values : how to make tough choices -- Change your defaults : outsource your behavior to your environment -- Create triggers to prevent self-sabotage : putting failure-planning to work -- Shock your routine : the power of regular sabbaticals -- Reset your body and brain every week: the power of a fast -- Designate a sacred space : create an environment to stay on course -- Conclusion: no matter where you are, you can change -- Acknowledgments -- Index -- About the author. (shrink)

ObjectiveTo investigate the short-term effect of music therapy combined with binaural frequency difference therapy on patients with consciousness disorder.Materials and methodsNinety patients with definite diagnosis of disorders of consciousness were selected. These patients were randomly divided into control group, experiment 1 group and experiment 2 group, with 30 patients in each group. The control group was treated with routine clinical treatment and rehabilitation. In experiment 1 group, music therapy was added to the control group. In experimental group 2, music (...) therapy combined with binaural α frequency difference therapy was added to the control group. All patients were assessed before and after 30 treatments. The assessment items included Glasgow Coma Scale, Coma Recovery Scale revised, electroencephalogram, upper somatosensory evoked potential, and brainstem auditory evoked potential.ResultsBefore treatment, there were no significant differences in GCS score, CRS-R score, USEP, BAEP, and EEG scores among the three groups. After 30 times of treatment, GCS score, CRS-R score, USEP, BAEP, and EEG scores in 3 groups were significantly higher than those before treatment. And the consciousness rate of experimental group 2 was better than experimental group 1, experimental group 1 was better than the control group and the difference was statistically significant.ConclusionMusic therapy combined with binaural α frequency difference therapy is more effective in stimulating DOC patients. (shrink)

Two recent defences of the recovery postulate for contraction of belief sets are analyzed. It is concluded that recovery is defensible as a by-product of a formalization that is idealized in the sense of being simplified for the sake of clarity. However, recovery does not seem to be a required feature of the doxastic behaviour of ideal (perfectly rational) agents. It is reasonable to expect that there should be epistemic residues (remnants of rejected beliefs), but not that (...) these should always suffice to recover all the original beliefs if the discarded belief is reinstated. (shrink)

Recovery is a model of care in (forensic) mental health settings across Western nations that aims to move past the paternalistic and punitive models of institutional care of the 20th century and toward more patient‐centered approaches. But as we argue in this paper, the recovery‐oriented services that evolved out of the early stages of this liberating movement signaled a shift in nursing practices that cannot be viewed only as improvements. In effect, as “recovery” nursing practices became more (...) established, more codified, and more institutional(ized), a stasis developed. Recovery had been reterritorialized. The purpose of this paper is to examine some of the threads of recovery, from its early days of antipsychiatry activism to its codification into mental health—including forensic mental health—institutions through the lens of poststructuralist philosophers Gilles Deleuze and Felix Guattari. We believe that Deleuze and Guattari's scholarship provides the necessary, albeit uncomfortable, framework for this critical examination. From a conceptualization of recovery as an assemblage, we critically examine how we can go about creating something new, caught in a tension between stasis and change. (shrink)

This paper examines recovery from a narrative perspective. Narrativity theory is the view that life takes the form of a story. Human experience happens within an ongoing storyline. My aim here is not to indulge in disclosure or claim that I developed otherwise unattainable insight through the course of my illness. We will instead be looking at how the process of recovery brings on opportunities for moral understanding in the form of insights into the nature of suffering, increased (...) sensitivity to what is going around you, and appreciation of how certain things can affect the whole of life. (shrink)

In The Recovery of the Soul, Kenneth Rankin suggests that the current impasse over solutions to many philosophical problems is the result, in part, of a failure to consider how each of these problems bears on the rest. Rankin shows that a libertarian theory of free will, an A-theory of time, a corporealist theory of personal identity, and a non-relativist interpretation of the foundation of ethics all contribute to or are derived from a psychocentric form of physicalism. The proposed (...) Modal Identity thesis identifies the mind, or that which ensouls the body, with a strictly physical power, the power to act intentionally from occasion to occasion in any one of several mutually exclusive ways. Rankin argues further that the non-arbitrary individuation of particular physical things derives from the causal powers they possess. The distinctive power that ensouls our bodies is identified as the primary causal power: all other powers derive their status as powers from it in so far as they are constitutive, or instruments, of it. Rankin demonstrates that many of our ontological preconceptions are Aristotelian in origin. The psychocentric physicalism of the central thesis is a response to Aristotle's question "What is being?" and in the earlier chapters of the book Aristotle's contributions to a theory of being are used as a preliminary study to suggest which parts of these preconceptions should be kept and which revised. Later chapters suggest that failure to resolve many philosophical problems results in part from the failure of Aristotle's philosophy to fulfil its promise. (shrink)

Discourses of recovery and resilience have risen to positions of dominance in the mental health field. Models of recovery and resilience enjoy purchase, in both policy and practice, across a range of settings from self-described psychiatric survivors through to mental health charities through to statutory mental health service providers. Despite this ubiquity, there is confusion about what recovery means. In this article we problematize notions of recovery and resilience, and consider what, if anything, should be recovered (...) from these concepts. We focus on three key issues, i) individualization, ii) the persistence of a deficit model, and iii) collective approaches to recovery. Through documentary analysis we consider these issues across third sector organizations, and public and mental health policy. Firstly, definitional debates about recovery reflect wider ideological debates about the nature of mental health. The vagueness of these concepts and implicit assumptions inherent in dominant recovery and resilience discourses render them problematic because they individualize what are social problems. Secondly, these discourses, despite being seen as inherently liberatory are conceptually dependent on a notion of deficit in that talk of “positives” and “strengths” requires the existence of “negatives” and “weaknesses” for these concepts to make sense. We argue that this does little to substantially transform dominant understandings of psychological distress. Thirdly, these issues combine to impact upon the progressive potential of recovery. It comes to be seen as an individualistic experiential narrative accompaniment to medical understandings where the structural causes of distress are obscured. This in turn impacts upon the potential for recovery to be used to explore more collective, political aspects of emotional distress. Drawing on the work of Fraser, we use this critique to characterize “recovery” as a “struggle for recognition,” founded on a model of identity politics which displaces and marginalizes the need for social, political and economic redistribution to address many of the underlying causes of emotional distress. We conclude by stating that it is only when the collective, structural experiences of inequality and injustice are explicitly linked to processes of emotional distress that recovery will be possible. (shrink)

In some recent articles, Cobreros, Egré, Ripley, & van Rooij have defended the idea that abandoning transitivity may lead to a solution to the trouble caused by semantic paradoxes. For that purpose, they develop the Strict-Tolerant approach, which leads them to entertain a nontransitive theory of truth, where the structural rule of Cut is not generally valid. However, that Cut fails in general in the target theory of truth does not mean that there are not certain safe instances of Cut (...) involving semantic notions. In this article we intend to meet the challenge of answering how to regain all the safe instances of Cut, in the language of the theory, making essential use of a unary recovery operator. To fulfill this goal, we will work within the so-called Goodship Project, which suggests that in order to have nontrivial naïve theories it is sufficient to formulate the corresponding self-referential sentences with suitable biconditionals. Nevertheless, a secondary aim of this article is to propose a novel way to carry this project out, showing that the biconditionals in question can be totally classical. In the context of this article, these biconditionals will be essentially used in expressing the self-referential sentences and, thus, as a collateral result of our work we will prove that none of the recoveries expected of the target theory can be nontrivially achieved if self-reference is expressed through identities. (shrink)

There are two foundational, but not fully developed, ideas in paraconsistency, namely, the duality between paraconsistent and intuitionistic paradigms, and the introduction of logical operators that express metalogical notions in the object language. The aim of this paper is to show how these two ideas can be adequately accomplished by the logics of formal inconsistency and by the logics of formal undeterminedness. LFIs recover the validity of the principle of explosion in a paraconsistent scenario, while LFUs recover the validity of (...) the principle of excluded middle in a paracomplete scenario. We introduce definitions of duality between inference rules and connectives that allow comparing rules and connectives that belong to different logics. Two formal systems are studied, the logics mbC and mbD, that display the duality between paraconsistency and paracompleteness as a duality between inference rules added to a common core—in the case studied here, this common core is classical positive propositional logic. The logics mbC and mbD are equipped with recovery operators that restore classical logic for, respectively, consistent and determined propositions. These two logics are then combined obtaining a pair of LFI and undeterminedness, namely, mbCD and mbCDE. The logic mbCDE exhibits some nice duality properties. Besides, it is simultaneously paraconsistent and paracomplete, and able to recover the principles of excluded middle and explosion one at a time. The last sections offer an algebraic account for such logics by adapting the swap structures semantics framework of the LFIs the LFUs. This semantics highlights some subtle aspects of these logics, and allows us to prove decidability by means of finite nondeterministic matrices. (shrink)

Dominant discourses of recovery permeate substance use research, policy, and practice recommendations around the world, exercising the power to shape the identities of people with substance use issues. Drawing on Foucauldian and intersectionality theories, this study explores power operations embedded in recovery discourses constructing a certain type of recovery for a certain type of subject. A critical discourse analysis using van Leeuwen’s social semiotic approach examines two Canadian federal recovery documents to consider the discursive representation of (...) people with substance use issues, legitimization of recovery, and interpretation of space. Findings suggest that substance use recovery discourses are entwined in a complex web of neoliberal, biomedical, and moral discourses by which stigmatized identities are (co)constructed at micro, mezzo, and macro levels. This study offers a unique and relevant opportunity to complicate the dominant recovery literature by challenging oppression, deconstructing normative identities, and facilitating the empowerment of marginalized populations. (shrink)

An ascent routine (AR) allows a speaker to self-ascribe a given propositional attitude (PA) by redeploying the process that generates a corresponding lower level utterance. Thus, we may report on our beliefs about the weather by reporting (under certain constraints) on the weather. The chief criticism of my AR account of self-ascription, by Alvin Goldman and others, is that it covers few if any PA’s other than belief and offers no account of how we can attain reliability in identifying (...) our attitude as belief, desire, hope, etc., without presupposing some sort of recognition process. The criticism can be answered, but only by giving up a tacit—and wholly unnecessary—assumption that has influenced discussions of ascent routines. Abandoning the assumption allows a different account of ARs that avoids the criticism and even provides an algorithm for finding a corresponding lower level utterance for any PA. The account I give is supported by research on children’s first uses of a propositional attitude vocabulary. (shrink)

Administraation of antiretroviral therapy to women during pregnancy, labor and delivery, and to infants postnatally can dramatidy reduce mother-to- child HIV transmission. However, pregnant women need to know that they are HIV-infected to take advantage of antiretroviral therapy, and many women do not know their HIV status. One-half of HIV-infected infants in the United States were bornto women who had not been tested for HIV or for whom the time of testing was not known. Although fewer than 400infants are infected (...) perinatally in the United States each year, that number could be reduced even further through policies aimed at HIV testing during pregnancy.The reasons toadopt such a policy are strong: the pathophysiology of perinatal transmission is clear, prophylaxis is effective and safe, and the intended beneficiaries of the intervention - babies - cannot protect themselves. (shrink)

Summary The genealogy of observation as a philosophical term goes back to the ancient Greek astronomical and medical traditions, and the revival of the concept in the Renaissance also happened in the astronomical and medical context. This essay focuses primarily on the medical genealogy of the concept of observation. In ancient Greek culture, an elaboration of the concept of observation (tērēsis) first emerged in the Hellenistic age with the medical sect of the Empirics, to be further developed by the ancient (...) Sceptics. Basically unknown in the Middle Ages, the Empirics’ conceptualisation of tērēsis trickled back into Western medicine in the fourteenth century, but its meaning seems to have been fully recovered by European scholars only in the 1560s, concomitantly with the first Latin translation of the works of Sextus Empiricus. As a category originally associated with medical Scepticism, observatio was a new entry in early modern philosophy. Although the term gained wide currency in general scholarly usage in the seventeenth century, its assimilation into standard philosophical language was very slow. In fact, observatio does not even appear as an entry in the philosophical dictionaries until the eighteenth century—with one significant exception, the medical lexica, which featured the lemma, reporting its ancient Empiric definition, as early as 1564. (shrink)

Objectives: Neuroplastic changes that drive recovery of shoulder/elbow function after stroke have been poorly understood. The purpose of this study was to determine the relationship between neuroplastic brain changes related to shoulder/elbow movement control in response to treatment and recovery of arm motor function in chronic stroke survivors.Methods: Twenty-three chronic stroke survivors were treated with 12 weeks of arm rehabilitation. Outcome measures included functional Magnetic Resonance Imaging (fMRI) for the shoulder/elbow components of reach and a skilled motor function (...) test (Arm Motor Abilities Test, AMAT), collected before and after treatment.Results: We observed two patterns of neuroplastic changes that were associated with gains in motor function: decreased or increased task-related brain activation. Those with significantly better motor function at baseline exhibited a decrease in brain activation in response to treatment, evident in the ipsilesional primary motor and contralesional supplementary motor regions; in contrast, those with greater baseline motor impairment, exhibited increased brain activation in response to treatment. There was a linear relationship between greater functional gain (AMAT) and increased activation in bilateral primary motor, contralesional primary and secondary sensory regions, and contralesional lateral premotor area, after adjusting for baseline AMAT, age, and time since stroke.Conclusions: Recovery of functional reach involves recruitment of several contralesional and bilateral primary motor regions. In response to intensive therapy, the direction of functional brain change (i.e., increase or decrease in task-related brain recruitment) for shoulder/elbow reach components depends on baseline level of motor function and may represent either different phases of recovery or different patterns of neuroplasticity that drive functional recovery. (shrink)

This study sought to examine the effect of the quality of chatbot services on customer satisfaction, repurchase intention, and positive word-of-mouth by comparing two groups, namely chatbots with and without emotion words. An online survey was conducted for 2 weeks in May 2021. A total of 380 responses were collected and analyzed using structural equation modeling to test the hypothesis. The theoretical basis of the study was the SERVQUAL theory, which is widely used in measuring and managing service quality in (...) various industries. The results showed that the assurance and reliability of chatbots positively impact customer satisfaction for both groups. However, empathy and interactivity positively affect customer satisfaction only for chatbots with emotion words. Responsiveness did not have an impact on customer satisfaction for both groups. Customer satisfaction positively impacts repurchase intention and positive word-of-mouth for both groups. The findings of this study can serve as a priori research to empirically prove the effectiveness of chatbots with emotion words. (shrink)

There are two foundational, but not fully developed, ideas in paraconsistency, namely, the duality between paraconsistent and intuitionistic paradigms, and the introduction of logical operators that express meta-logical notions in the object language. The aim of this paper is to show how these two ideas can be adequately accomplished by the Logics of Formal Inconsistency (LFIs) and by the Logics of Formal Undeterminedness (LFUs). LFIs recover the validity of the principle of explosion in a paraconsistent scenario, while LFUs recover the (...) validity of the principle of excluded middle in a paracomplete scenario. We introduce definitions of duality between inference rules and connectives that allow comparing rules and connectives that belong to different logics. Two formal systems are studied, the logics mbC and mbD, that display the duality between paraconsistency and paracompleteness as a duality between inference rules added to a common core– in the case studied here, this common core is classical positive propositional logic (CPL + ). The logics mbC and mbD are equipped with recovery operators that restore classical logic for, respectively, consistent and determined propositions. These two logics are then combined obtaining a pair of logics of formal inconsistency and undeterminedness (LFIUs), namely, mbCD and mbCDE. The logic mbCDE exhibits some nice duality properties. Besides, it is simultaneously paraconsistent and paracomplete, and able to recover the principles of excluded middle and explosion at once. The last sections offer an algebraic account for such logics by adapting the swap-structures semantics framework of the LFIs the LFUs. This semantics highlights some subtle aspects of these logics, and allows us to prove decidability by means of finite non-deterministic matrices. (shrink)

The most controversial condition that the AGM theory of rational belief change places on belief contraction is the recovery condition. The condition is controversial because of a series of putative counterexamples due (separately) to I. Levi and S. O. Hansson. In this paper we show that the conflicts that Levi and Hansson arrange between AGM contraction and our intuitions about how to give up beliefs are merely apparent. We argue that these conflicts disappear once we attend more closely to (...) the identification of the beliefs contracted away in each counterexample case. Since, on our view, speakers' belief contraction intentions are often more complicated than they may first appear, we are led to develop apparatus for thinking about the communication and identification of those intentions. Our argument refocuses attention on the difficult question of how to apply the AGM theory to particular cases. (shrink)