The standard foil for recent theories of hope is the belief-desire analysis advocated by Hobbes, Day, Downie, and others. According to this analysis, to hope for S is no more and no less than to desire S while believing S is possible but not certain. Opponents of the belief-desire analysis argue that it fails to capture one or another distinctive feature or function of hope: that hope helps one resist the temptation to despair;2 that hope engages the sophisticated capacities of (...) human agency, such as planning;3 or that hope involves the imagination in ways desire need not.4 Here, I focus on the role of imagination in hope, and discuss its implications for hope’s relation to practical commitment or end-setting. (shrink)

This article defends a theory of diffuse attention and distinguishes it from focal attention. My view is motivated by evidence from psychology and neuroscience, which suggests that we can deploy visual selective attention in at least two ways: by focusing on a small number of items, or by diffusing attention over a group of items taken as a whole. I argue that diffuse attention is selective and can be object‐based. It enables a subject to select an object to guide behavior, (...) albeit in a different way than focusing does. (shrink)

In cases of identity crowding, a subject consciously sees items in a figure, even though they are presented too closely together for her to shift attention to each item. Block uses such cases to challenge the view that attention is necessary for consciousness. I argue that in identity crowding cases, subjects really do attend to the items. Specifically, they attend to the figure as a global object that contains the individual items as parts. To support this view, I provide evidence (...) that attention can be directed to a global object or a local object. My response helps to defend the view that attention is necessary for conscious perception. (shrink)

I argue for adopting a conception of obligation that is broader than the conception commonly adopted by moral philosophers. According to this broader conception, the crucial marks of an obligatory action are, first, that the reasons for the obliged party to perform the action include an exclusionary reason and, second, that the obliged party is the appropriate target of blaming reactive attitudes, if they inexcusably fail to perform the obligatory action. An obligation is directed if the exclusionary reason depends on (...) the relationship between the obliged person and the person to whom they owe the obligatory action, and the latter person is positioned to personally blame the obligated person for inexcusably failing to perform the obligatory action. Some direc- ted obligations are not owed as a matter of right, and the person to whom the obligatory action is owed is the only person positioned to blame nonperformance. Other directed obligations are owed as a matter of right, and people who are not part of the relationship grounding the obligation nevertheless are also positioned to (impersonally) blame non-performance. Only the rights-based form of directed obligation has received signifi- cant attention from moral philosophers, yet the former—which is at the heart of what I call “personal bonds”—is a pervasive and significant theme of our ordinary interpersonal lives. (shrink)

Apologies are strange. They are, in a certain sense, very small. An apology is just a gesture—a set of words, a physical posture, perhaps a gift. But an apology can also be very powerful—this power is implicit in the facts that it can be difficult to offer an apology and that, when we are wronged, we may want an apology very much. More, even we have been severely wronged, we are sometimes willing to forgive or pardon the wrongdoer, if we (...) receive a sincere apology. In this paper, I want to begin to figure out how a mere gesture can be so powerful. The philosophers who discuss apology generally do not go into much detail, and they discuss it almost exclusively in connection with forgiveness. 2 I, too, will discuss apology’s power to provide reason to forgive, but in order to provide the resources to examine another power. Some apologies, I will argue, fail to provide reason to forgive, but nevertheless do provide the recipient a reason to maintain a relationship with the wrongdoer, or to allow the wrongdoer to remain in her community. To be clear: the “powers” I am interested in are reason-giving powers, or powers to make certain beliefs, attitudes, or actions rational. Apologies also, no doubt, have a sort of bare causal power. The sight of a vicious, racist, cruel war criminal on his knees and in tears, sincerely begging forgiveness, may inspire in us pity or even compassion, in spite of what we believe we have reason to feel. “I can’t help but feel sorry for the bastard,” we may say, even while believing that.. (shrink)

What exactly is hope and how does it influence our decisions? In How We Hope, Adrienne Martin presents a novel account of hope, the motivational resources it presupposes, and its function in our practical lives. She contends that hoping for an outcome means treating certain feelings, plans, and imaginings as justified, and that hope thereby involves sophisticated reflective and conceptual capacities. Martin develops this original perspective on hope--what she calls the "incorporation analysis"--in contrast to the two dominant philosophical conceptions (...) of hope: the orthodox definition, where hoping for an outcome is simply desiring it while thinking it possible, and agent-centered views, where hoping for an outcome is setting oneself to pursue it. In exploring how hope influences our decisions, she establishes that it is not always a positive motivational force and can render us complacent. She also examines the relationship between hope and faith, both religious and secular, and identifies a previously unnoted form of hope: normative or interpersonal hope. When we place normative hope in people, we relate to them as responsible agents and aspire for them to overcome challenges arising from situation or character. Demonstrating that hope merits rigorous philosophical investigation, both in its own right and in virtue of what it reveals about the nature of human emotion and motivation, How We Hope offers an original, sustained look at a largely neglected topic in philosophy. (shrink)

The increasing use of opioid treatment agreements has prompted debate within the medical community about ethical challenges with respect to their implementation. The focus of debate is usually on the efficacy of OTAs at reducing opioid misuse, how OTAs may undermine trust between physicians and patients and the potential coercive nature of requiring patients to sign such agreements as a condition for receiving pain care. An important consideration missing from these conversations is the potential for racial bias in the current (...) way that OTAs are incorporated into clinical practice and in the amount of physician discretion that current opioid guidelines support. While the use of OTAs has become mandatory in some states for certain classes of patients, physicians are still afforded great leeway in how these OTAs are implemented in clinical practice and how their terms should be enforced. This paper uses the guidelines provided for OTA implementation by the states of Indiana and Pennsylvania as case studies in order to argue that giving physicians certain kinds of discretion may exacerbate racial health disparities. This problem cannot simply be addressed by minimising physician discretion in general, but rather by providing mechanisms to hold physicians accountable for how they treat patients on long-term opioid therapy to ensure that such treatment is equitable. There are no data in this work. (shrink)

ABSTRACTThe standard view in philosophy of mind is that the way to understand the difference between perception and misperception is in terms of accuracy. On this view, perception is accurate while...

What should we make of someone whose beliefs prevent her from accurately understanding her medical needs and care? Should that person still make her own health care decisions? In fact, she probably lacks decision‐making capacity. But that does not mean she is not competent.

It is a commonplace in both the popular imagination and the philosophical literature that hope has a special kind of motivational force. This commonplace underwrites the conviction that hope alone is capable of bolstering us in despairinducing circumstances, as well as the strategy of appealing to hope in the political realm. In section 1, I argue that, to the contrary, hope’s motivational essence is not special or unique—it is simply that of an endorsed desire. The commonplace is not entirely mistaken, (...) however, because standard ways of expressing hope do have motivational influence that is different in kind from that of desire. In sections 2 through 4, I examine one of these ways of expressing hope, fantasizing, and argue that fantasies can present us with reasons to modify our goals and projects in multiple ways. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:I Saw My ReflectionAdrienne Feller NovickI saw my reflection as I looked through the window of the isolation room. The image caused me to pause and look again. The reflection of sunlight had merged my image and the patient's together. For a moment, we seemed to be one person.She was pale with translucent skin, her bald head obscured under a colorful scarf. Her three children sat as still as (...) statues, staring at their mother wordlessly. Then, I realized her children appeared to be the same ages as my children. I felt a surge of emotions jumbled together, a mother should not die like this, leaving her young children motherless. She and I shared the exact same birthday; it could have been me in that hospital bed. However, I did not have a terminal diagnosis and my children were safe at home, complaining about doing homework. In the blink of an eye, without even recognizing what had just happened, I was face to face with my mortality.I tampered my emotions and held them back. I collected myself, and remembered the reason I was there. My professionalism took charge. I am a member of the Medical Ethics consultation service at a large healthcare system. A request was made to help with the ethical dilemma of a patient with a grave prognosis unwilling to discuss a hospice referral. The dilemma here represented two issues in conflict: patient autonomy and provider beneficence versus non-maleficence. Respect for autonomy allows each person the right to make informed decisions about their care that respect their values and personal beliefs. Provider beneficence is balanced by non-maleficence: beneficence is the expectation that physicians make treatment decisions in the best interest of the patient and non-maleficence guides physicians to minimize harm. This case called for analyzing the balance of autonomy with proportionality, weighing the risks versus the benefits of treatment decisions.I knocked on the door and they all turned and looked in my direction. The patient signaled me to enter. Although she was smiling, the sadness in the room was palpable. I introduced myself to the patient and her children and diplomatically explained the reason for my visit. I turned to the children and asked if there was anything I could get for them. I got three weak "no thanks." I asked the patient if I could stop by later. Then, I went to see my next patient. When I returned, I listened with rapt attention as she described the mosaic of her life story. When she finished, we sat together for a long time, neither of us speaking. Out of the blue, she told me she was not afraid of dying. She said she would welcome death to end her pain. She continued, explaining that her fear was that her children were not ready to accept her death. She was worried about how her death would hurt them, and all she wanted to do was to protect them. She reiterated her wish to be kept alive with all aggressive medical treatment possible. She communicated [End Page E6] that she understood and appreciated the severity of her condition. Her reason for continuing treatment was to give her children precious time. She said, "I would lie in front of a car to protect my children." As I was heading towards the door, her eyes welled up with tears. She thanked me for listening and for my kindness. We said our goodbyes. She remained full code and died four days later during cardiopulmonary resuscitation. I walked past her empty room later that day and kept walking.I was not prepared for how her death changed me. Throughout my career as a healthcare professional, I have primarily worked with patients at the end of their lives. I have seen many empty rooms following the death of a patient and helped countless people journey through their stages of grief towards acceptance. After I complete a consultation, I move on to the next patient. I do this every day. This time, something was different. After she died, I was not sleeping well, I had a hard time concentrating, I was not eating well, and I was... (shrink)

How do we encourage patients to be hopeful without exploiting their hope? A medical researcher or a pharmaceutical company can take unfair advantage of someone's hope by much subtler means than simply giving misinformation. Hope shapes deliberation, and therefore can make deliberation better or worse, by the deliberator's own standards of deliberation.

Over the last two decades, legal scholarship has been catching up with the more than century old calls by black Americans for reparations.1 Tax scholar Boris Bittker (in)famously launched the viability of black reparations into legal scholarship with his now classic monograph, The Case for Black Reparations.2 However, it would take more than twenty years for mainstream legal scholarship to take up the robust and wide-ranging set of questions raised by the possibility of reparations for American slavery.3 In the late (...) 1990s private law scholars leapt into the debate, discussing unjust enrichment and torts-based models of black reparations.4 While these scholars made a variety of distinct arguments, collectively, their model rested on the contention that America had wrongfully expropriated the labor of generations of enslaved African Americans and the result had been systemic unjust enrichment, or a species of mass torts. Grounded in various conceptions of corrective justice, these models conceive black reparations as a set of claims that would be litigated through the courts. Over the ensuing two decades, the private law model has become somewhat of an outlier in reparations discussions, largely set aside in favor of broader, more explicitly political approaches. (shrink)

A theory of word meaning developed jointly by Adrienne and Keith Lehrer is summarized, which accommodates the empirical facts of natural languages, especially the diversity of types of words. Reference characterizes the application of words to things, events, properties, etc. and sense the relationship among words and linguistic expressions. Although reference and sense are closely connected, neither can be reduced to the other. We use the metaphor of vectors to show how different, sometimes competing forces interact to provide an (...) understanding of what a word in context means. Topics discussed include vagueness, indeterminacy, the role of experts, possible worlds, pragmatic influences, semantic change, semantic networks, fields, and entailments. A formal theory for understanding the relationship of idiolects, dialects, and communal languages is proposed to account for the dynamic interaction of individuals and communities which occurs continuously. (shrink)

Appreciation and gratitude get good press: They are central virtues in many religious and secular ethical frameworks, core in positive psychology research, and they come highly recommended by the self‐improvement set. Generally, appreciation and gratitude feature as good things, in popular consciousness. Of course, on an Aristotelian model, the belief that these are virtues implies they are something people can get right or wrong. This paper examines bad appreciation and bad gratitude, characterizing forms of appreciation and gratitude at the center (...) of some major social norms and practices, and demonstrating that they mask familiar oppressive expectations and power relations. (shrink)

Rapid advancements in large language models (LLMs) have renewed interest in the question of whether consciousness can arise in an artificial system, like a digital computer. The general consensus is that LLMs are not conscious. This paper evaluates the main arguments against artificial consciousness in LLMs and argues that none of them show what they intend. However strong our intuitions against artificial consciousness are, they currently lack rational support.

_Ghosts in the Consulting Room: Echoes of Trauma in Psychoanalysis_ is the first of two volumes that delves into the overwhelming, often unmetabolizable feelings related to mourning. The book uses clinical examples of people living in a state of liminality or ongoing melancholia. The authors reflect on the challenges of learning to move forward and embrace life over time, while acknowledging, witnessing and working through the emotional scars of the past. Bringing together a collection of clinical and theoretical papers, _Ghosts (...) in the Consulting Room _features accounts of the unpredictable effects of trauma that emerge within clinical work, often unexpectedly, in ways that surprise both patient and therapist. In the book, distinguished psychoanalysts examine how to work with a variety of ‘ghosts’, as they manifest in transference and countertransference, in work with children and adults, in institutional settings and even in the very founders and foundations of the field of psychoanalysis itself. They explore the dilemma of how to process loss when it is unspeakable and unknowable, often manifesting in silence or gaps in knowledge, and living in strange relations to time and space. This book will be of interest to psychotherapists and psychoanalysts, as well as social workers, family therapists, psychologists, and psychiatrists. It will appeal to those specializing in bereavement and trauma and, on a broader level, to sociologists and historians interested in understanding means of coping with loss and grief on both an individual and larger scale basis. (shrink)

In their classic, Principles of Biomedical Ethics (now in its fifth edition), Beauchamp and Childress, describe a puzzling case: A man who generally exhibits normal behavior patterns is involuntarily committed to a mental institution as the result of bizarre self-destructive behavior (pulling out an eye and cutting off a hand). This behavior results from his unusual religious beliefs. … [H]is peculiar actions follow “reasonably” from his religious beliefs. …While analysis in terms of limited competence might at first appear plausible, such (...) an analysis entails that persons with unorthodox or bizarre religious beliefs are less than competent, even if they reason clearly in light of their beliefs. (shrink)

Many people believe hope’s most important function is to bolster us in despairinducing circumstances. A related but less dramatic view is that instilling or reinforcing hope for a state of affairs is a good way to get people to act to promote that state of affairs. I propose that we conceive of hope as, most paradigmatically, the expression of desire in imagination. I then trace through the implications of this conception for, first, how hope influences motivation and, second, what forms (...) of hope are rational. (shrink)

People with disabilities use more medical care and see health professionals more often than do those of the same age, ethnic group, or economic class who do not have impairments. An indisputable medical goal is.

Recently, there has been a surge of interest in the lexicon. The demand for a fuller and more adequate understanding of lexical meaning required by developments in computational linguistics, artificial intelligence, and cognitive science has stimulated a refocused interest in linguistics, psychology, and philosophy. Different disciplines have studied lexical structure from their own vantage points, and because scholars have only intermittently communicated across disciplines, there has been little recognition that there is a common subject matter. The conference on which this (...) volume is based brought together interested thinkers across the disciplines of linguistics, philosophy, psychology, and computer science to exchange ideas, discuss a range of questions and approaches to the topic, consider alternative research strategies and methodologies, and formulate interdisciplinary hypotheses concerning lexical organization. The essay subjects discussed include: * alternative and complementary conceptions of the structure of the lexicon, * the nature of semantic relations and of polysemy, * the relation between meanings, concepts, and lexical organization, * critiques of truth-semantics and referential theories of meaning, * computational accounts of lexical information and structure, and * the advantages of thinking of the lexicon as ordered. (shrink)

Put relationship-centered communication at the forefront of care Today, physicians face a hypercompetitive marketplace in which they must meet unique and complex patient needs as efficiently as possible. But in a culture prioritizing clinical outcomes above all, there can be a tendency to lose sight of one of the most critical aspects of providing effective care: the communication skills that build and foster physician-patient relationships. Studies have shown that good communication between doctors and patients and among all caregivers who interface (...) with patients directly results in better clinical outcomes, reduced costs, greater patient satisfaction, and lower rates of physician burnout. In Communication the Cleveland Clinic Way, Dr. Adrienne Boissy and her team tell the story of how Cleveland Clinic created and applied the R.E.D.E. to Communicate: Foundations of Healthcare program, making the world-renowned hospital system a leader in relationship-centered care. They provide a step-by-step guide for healthcare leaders and decision-makers to design, develop, and implement communication skills training in their own institutions. Learn how to: • Craft an effective, colleague-supported communication skills program to include veteran physicians, residents, and medical students • Leverage creative program design and data transparency to engage and facilitate staff physicians and advanced care providers • Identify common misperceptions and myths in healthcare communication and respond to them successfully • Cultivate a true sense of empathy—with patients and fellow caregivers alike—while maintaining professionalism In a field where difficult conversations and stressful relationships are commonplace, clinicians need a structured approach to enable them to deliver the best care possible. Communication the Cleveland Clinic Way is the blueprint for establishing a relationship-centered program that will improve patient experience, reinvigorate doctors’ passion for their work, and elevate any organization. (shrink)