The interpretation of the dead donor rule (DDR) has been central to recent debates regarding normothermic regional perfusion with controlled donation after circulatory death (NRP-cDCD). Proponents...

We prove the following surprising property of Heyting's intuitionistic propositional calculus, IpC. Consider the collection of formulas, φ, built up from propositional variables (p,q,r,...) and falsity $(\perp)$ using conjunction $(\wedge)$ , disjunction (∨) and implication (→). Write $\vdash\phi$ to indicate that such a formula is intuitionistically valid. We show that for each variable p and formula φ there exists a formula Apφ (effectively computable from φ), containing only variables not equal to p which occur in φ, and such that for (...) all formulas ψ not involving $p, \vdash \psi \rightarrow A_p\phi$ if and only if $\vdash \psi \rightarrow \phi$ . Consequently quantification over propositional variables can be modelled in IpC, and there is an interpretation of the second order propositional calculus, IpC2, in IpC which restricts to the identity on first order propositions. An immediate corollary is the strengthening of the usual interpolation theorem for IpC to the statement that there are least and greatest interpolant formulas for any given pair of formulas. The result also has a number of interesting consequences for the algebraic counterpart of IpC, the theory of Heyting algebras. In particular we show that a model of IpC2 can be constructed whose algebra of truth-values is equal to any given Heyting algebra. (shrink)

For good or for ill, we have animal bodies. Through them, we move around, eat and drink, and do many other things besides. We owe much – perhaps our very lives – to these ever-present animals. But how exactly do we relate to our animals? Are we parts of them, or they of us? Do we and these living animals co-inhere or constitute or coincide? Or what? Animalism answers that we are identical to them. There are many objections to animalism, (...) and a dizzying array of rival views. In this article, we do not propose to evaluate those objections and rivals. We will instead present a new argument for that view. The argument begins with the fact that we have emotions. (shrink)

This paper focuses on the most common state policy responses to the opioid crisis, dividing them into six broad categories. Within each category we highlight the rationale behind the group of policies within it, discuss the details and support for individual policies, and explore the research base behind them. The objective is to better understand the most prevalent state responses to the opioid crisis.

Materialists about human persons say that we are, and must be, wholly material beings. Substance dualists say that we are, and must be, wholly immaterial. In this paper, I take issue with the “and must be” bits. Both materialists and substance dualists would do well to reject modal extensions of their views and instead opt for contingent doctrines, or doctrines that are silent about those modal extensions. Or so I argue.

Ancient Roman “technical memory” is not (as much of the modern specialist literature would have it) a generative technology of association. Rather it is (as a literal reading of the texts would suggest) a specialized tool for precise serial recall. Modern experimental evidence both confirms the fitness for the purpose of the technique and shows why that purpose is not trivial, as some have suggested. While the mechanism(s) by which the technique operates are not fully understood, a review of the (...) current literature suggests that it would have had the advantage over other mnemonic techniques by virtue of recruiting a variety of cognitive capacities. These likely include spatial/navigational mechanisms and possibly visual/imagery-based ones as well. Finally, small differences between the method as recorded in the ancient texts and similar methods that have been the subject of laboratory experiments are used to suggest possible directions for further experimentation. (shrink)

In thinking about ontology as the study of being or what fundamentally exists, we can adopt an ontology that either takes substances or processes as primary. There are, however, both commonsense and naturalistic reasons for not fully adopting a substance ontology, which indicate that we ought to suspend judgment with respect to the acceptance of a substance ontology. Doing so allows room to further explore other ontologies. In this book, Andrew M. Winters argues that there are both commonsense and (...) naturalistic reasons for further pursuing a process ontology. Adopting a process ontology allows us to overcome many of the difficulties facing a substance ontology while also accommodating many of the phenomenon that substance ontologies were appealed to for explanation. Given these reasons, we have both commonsense and naturalistic reasons for pursuing and developing a metaphysics without substance. (shrink)

Aristotle famously held that objects are comprised of matter and form. That is the central doctrine of hylomorphism (sometimes rendered “hylemorphism”—hyle, matter; morphe, form), and the view has become a live topic of inquiry today. Contemporary proponents of the doctrine include Jeffrey Brower, Kit Fine, David Hershenov, Mark Johnston, Kathrin Koslicki, Anna Marmodoro, Michael Rea, and Patrick Toner, among others. In the wake of these contemporary hylomorphic theories the doctrine has seen application to various topics within mainstream analytic metaphysics. Here, (...) appeals to form and matter are used to shed light on problems about ontology, personal identity, philosophy of mind, and philosophy of religion. The current entry documents this resurgence of interest in hylomorphism, the ways it has been applied, and its reception. (shrink)

Systematic study of the intersection of ethics consultation services and solid organ transplants and recipients can identify and illustrate ethical issues that arise in the clinical care of these patients, including challenges beyond resource allocation. This was a single-centre, retrospective cohort study of all adult ethics consultations between January 1, 2007, and December 31, 2017, at a large academic medical centre in the north-eastern United States. Of the 880 ethics consultations, sixty (6.8 per cent ) involved solid organ transplant, thirty-nine (...) (65.0 per cent) for candidates and twenty-one (35.0 per cent ) for recipients. Ethics consultations were requested for 4.3 per cent of heart, 4.9 per cent of lung, 0.3 per cent of liver, and 0.3 per cent of kidney transplant recipients over the study period. Nurses were more likely to request ethics consultations for recipients than physicians (80.0 per cent vs 20.0 per cent, p = 0.006). The most common reason for consultation among transplant candidates was discussion about intensity of treatment or goals of care after the patient was not or was no longer a transplant candidate. The most common reason for ethics consultation among transplant recipients was disagreement between transplant providers and patients/families/non-transplant healthcare professionals over the appropriate intensity of treatment for recipients. Very few consultations involved questions about appropriate resource allocation. Ethics consultants involved in these cases most often navigated communication challenges between transplant and non-transplant healthcare professionals and patients and families. (shrink)

The development of ethical guidelines and regulations regarding human subjects research has focused upon protection of vulnerable populations by relying on a limited typology of vulnerabilities. This results in several challenges: First, Institutional Review Boards struggle to interpret and apply the regulations because they are often vague and inconsistent. Second, applying the regulations to subjects who fit within multiple categories of vulnerability can lead to contradictions and the rejection of research that would be permissible if only one category were applicable. (...) Finally, some potential subjects have social and other context-based vulnerabilities that are not described in the federal regulations... (shrink)

In this paper, I will examine John Smeaton’s contribution to the vis viva controversy in Britain, focusing on how the hybridization of science, technology, and industry helped to establish vis viva, or mechanic power, as a measure of motive force. Smeaton, embodying the ‘hybrid expert’ who combined theoretical knowledge and practical knowhow, demonstrated that the notion of vis viva possessed a greater explanatory power than momentum, because it could be used to explain the difference in efficiency between overshot and undershot (...) waterwheels. Smeaton’s conclusions were correct since waterwheel efficiency was already measured in terms that were proportional to vis viva, not momentum, as a result of the industrial applications of waterwheel technology, which favored measuring efficiency by the product of mass and vertical displacement. Toward the end of the eighteenth century, the loss of motive force in the inelastic collision driving the undershot wheel began to be seen as equivalent to the expenditure of labor in the manufacture of commodities, further underlining how strictly scientific conclusions about motive force could have their origin in industrial practices. (shrink)

The main question of this study is whether God has a personality. We show what the question means, why it matters, and that good sense can be made of an affirmative answer to it. A God with personality — complete with particular, sometimes peculiar, and even seemingly unexplainable druthers — is not at war with maximal perfection, nor is the idea irredeemably anthropomorphic. And the hypothesis of divine personality is fruitful, with substantive consequences that span philosophical theology. But problems arise (...) here too, and new perspectives on inquiry itself. Our cosmos is blessed with weirdness aplenty. To come to know it is nothing less than to encounter a strange and untamed God. (shrink)

Andrew Steane reconfigures the public understanding of science, by drawing on a deep knowledge of physics and by bringing in mainstream philosophy of science. Science is a beautiful, multi-lingual network of ideas; it is not a ladder in which ideas at one level make those at another level redundant. In view of this, we can judge that the natural world is not so much a machine as a meeting-place. In particular, people can only be correctly understood by meeting with (...) them at the level of their entire personhood, in a reciprocal, respectful engagement as one person to another. Steane shows that Darwinian evolution does not overturn this but rather is the process whereby such truths came to be discovered and expressed in the world. From here the argument moves towards other aspects of human life. Our sense of value requires from us a response which is not altogether the same as following logical argument. This points us towards what religion in its good forms can express. A reply to a major argument of David Hume, and a related one of Richard Dawkins, is given. The book finishes with some brief chapters setting religion in the context of all human capacities, and showing, in fresh language, what theistic religious response is, or can be, in the modern world. (shrink)

Modal responses to items from a recent survey of independent practitioners regarding the impact of managed care on their practices and ethics were presented to participants as the responses of a hypothetical independent practitioner. Participants were asked to consider seeing this hypothetical practitioner both before and after being informed of the practitioner's responses to the managed care survey. Results indicate that when participants were informed of the practitioner's views toward managed care, their own attitudes toward therapy changed significantly. Specifically, compared (...) to uninformed participants, informed participants were significantly more likely to believe that managed care would have a negative impact on treatment and significantly less likely to see an independent practitioner, use insurance benefits, expect to benefit from treatment, expect to form a strong working relationship, and trust that the practitioner would work in their best interest. Implications regarding ethics and informed consent are discussed. (shrink)

My purpose in this article is to defend the goodness of Whitehead's God against two recent critics: Pierfrancesco Basile and Peter Sjöstedt-Hughes. I will both rely on Whitehead's own statements regarding God's goodness and offer a metaphysical interpretation of these statements in relation to his “axianoetic” universe.

Critical care society guidelines recommend that ethics committees mediate intractable conflict over potentially inappropriate treatment, including Do Not Resuscitate status. There are, however, limited data on cases and circumstances in which ethics consultants recommend not offering cardiopulmonary resuscitation despite patient or surrogate requests and whether physicians follow these recommendations. This was a retrospective cohort of all adult patients at a large academic medical center for whom an ethics consult was requested for disagreement over DNR status. Patient demographic predictors of ethics (...) consult outcomes were analyzed. In 42 of the 116 cases, the patient or surrogate agreed to the clinician recommended DNR order following ethics consultation. In 72 of 74 of the remaining cases, ethics consultants recommended not offering CPR. Physicians went on to write a DNR order without patient/surrogate consent in 57 of those cases. There were no significant differences in age, race/ethnicity, country of origin, or functional status between patients where a DNR order was and was not placed without consent. Physicians were more likely to place a DNR order for patients believed to be imminently dying. The median time from DNR order to death was 4 days with a 90-day mortality of 88.2%. In this single-center cohort study, there was no evidence that patient demographic factors affected ethics consultants’ recommendation to withhold CPR despite patient/surrogate requests. Physicians were most likely to place a DNR order without consent for imminently dying patients. (shrink)

C. S. Peirce made the following claim: If science reveals truth, then consensus among scientists can be expected in the limit. This article does not dispute this claim; it simply assumes it. On the basis of this assumption, the following question is asked: Is it possible to extend Peirce's claim to philosophy in a natural way? It is argued that two important differences between science and philosophy strongly militate against such an extension. Does this mean that there is no truth (...) to be found in philosophy? Are there, perhaps, different kinds of truth (scientific, philosophical, religious, and so on)? But such questions, though related to the present investigation, are nevertheless well beyond the scope of this article. (shrink)

This essay identifies two different methodological strategies used by the proponents of anarchism. In what is termed the "ontological" approach, the rationale for anarchism depends on a particular representation of human nature. That characterization of "being" determines the relation between the individual and the structures of social life. In the alternative approach, the epistemological status of "representation" is challenged, leaving human subjects without stable identities. Without the possibility of stable human representations, the foundations underlying the exercise of institutional power can (...) be challenged. This epistemological discussion is traced from Max Stirner to the twentieth-century movement known as poststructuralism. (shrink)

Even if game theory is broadened to encompass other-regarding preferences, it cannot adequately model all aspects of interactive decision making. Payoff dominance is an example of a phenomenon that can be adequately modeled only by departing radically from standard assumptions of decision theory and game theory – either the unit of agency or the nature of rationality. (Published Online April 27 2007).

A engaging dialogue with the modern “axionoetic” proposals of A.N. Whitehead, Keith Ward, and John Leslie, arguing for the relational nature of ultimacy wherein Mind and Value, Possibility and Actuality, God and the World are affirmed as ultimate only in virtue of their relationality. This relationship Whitehead calls “mutual immanence.”.

The Industrial Enlightenment is widely thought to have been a period when “science” and “technology” became intimately intertwined. In his 1791 book on the building of the Eddystone lighthouse (completed in 1759), the English engineer John Smeaton praised the Royal Society for being more than a group of abstract theoreticians. This article looks at the fellows of Smeaton's Royal Society network who contributed knowledge, reports, specimens, and inventions solicited by Smeaton when he was working on this lighthouse project. I show, (...) in line with other recent research on this topic, that the “artisans” of the 18th century did not confine themselves to practical know-how, and that “scholars” were not merely interested in abstract philosophising; instead, the figures I look at in this paper were hybrid knowers who possessed useful knowledge and book learning. I argue that the advice solicited by Smeaton during the building of the lighthouse was characterised not by exchanges between theory and practice, but by a combining of different types of knowledge from separate fields. A second feature of this intellectual co-operation is that it was not centred on a group of practical industrialists or engineers, but rather it was the Royal Society that served as the common denominator, bringing all of the characters in our story into contact with each other. This is reflected in the subject matter involved, which was characteristic of the research focus of the virtuoso tradition in the 18th-century Royal Society. Smeaton's contact with this tradition was influenced by his friendships, his social activities, and, indirectly, by the way that the dissensions that occupied the Royal Society during the early 1780s impacted his retrospective account of the project. (shrink)

Understanding how chemical energy is converted into directed movement is a fundamental problem in biology. In higher organisms this is accomplished through the hydrolysis of ATP by three families of motor proteins: myosin, dynein and kinesin. The most abundant of these is myosin, which operates against actin and plays a central role in muscle contraction. As summarized here, great progress has been made towards understanding the molecular basis of movement through the determination of the three‐dimensional structures of myosin and actin (...) and through the establishment of systems for site‐directed mutagenesis of this motor protein. It now appears that the generation of movement is coupled to ATP hydrolysis by a series of domain movements within myosin. (shrink)

Background: The bioethics literature contains speculation but little data about sociodemographic differences between patients for whom ethics committees (EC) are consulted for conflict about life-sustaining treatment (LST) and the broader hospital population that these committees serve. To provide an empirical context for this discussion, we examined differences in five sociodemographic factors between patients for whom an EC was consulted for conflict over LST and the general inpatient population, hypothesizing that nonwhite patients were most likely to be disproportionately represented. Methods: This (...) was a retrospective cohort study comparing self-reported race/ethnicity, household income, insurance status, primary language, and religious affiliation between patients involved in EC consultations for conflict over LST and the general adult inpatient population at a large academic hospital from January 1, 2007, through December 31, 2013. Results: There were 169 EC consultations involving conflict over LST and 243,197 adult inpatient admissions over the study period. On bivariate analysis, patients for whom the EC was consulted for conflict over LST were more likely to be nonwhite, low-income, and to speak a primary language other than English. They were not more likely to be underinsured or to report a religious affiliation. On multivariate analysis, patients for whom the EC was consulted for conflict over LST were more likely to be nonwhite (odds ratio [OR], 2.5; 95% confidence interval [CI], 1.7–3.7; p <.001). They were also more likely to be low income (OR, 1.8; 95% CI, 1.1–3.0; p =.02). They were not more likely to speak a primary language other than English (OR, 1.4; 95% CI, 0.9–2.1; p =.17). None of the assessed variables were associated with conflict over LST requiring additional meetings beyond the first EC consultation. Conclusions: Nonwhite and low-income status patients are disproportionately represented in EC committee consultation for conflict over LST compared to the general inpatient population. (shrink)

Sexual reproduction is the dominant reproductive mode in eukaryotes but, in many taxa, it has never been observed. Molecular methods that detect evidence of sex are largely based on the genetic consequences of sexual reproduction. Here we describe a powerful new approach to directly search genomes for genes that function in meiosis. We describe a “meiosis detection toolkit”, a set of meiotic genes that represent the best markers for the presence of meiosis. These genes are widely present in eukaryotes, function (...) only in meiosis and can be isolated by degenerate PCR. The presence of most, or all, of these genes in a genome would suggest they have been maintained for meiosis and, implicitly, sexual reproduction. In contrast, their absence would be consistent with the loss of meiosis and asexuality. This approach will help to understand both meiotic gene evolution and the capacity for meiosis and sex in putative obligate asexuals. BioEssays 30:579–589, 2008. © 2008 Wiley Periodicals, Inc. (shrink)

Rational choice theory enjoys unprecedented popularity and influence in the behavioral and social sciences, but it generates intractable problems when applied to socially interactive decisions. In individual decisions, instrumental rationality is defined in terms of expected utility maximization. This becomes problematic in interactive decisions, when individuals have only partial control over the outcomes, because expected utility maximization is undefined in the absence of assumptions about how the other participants will behave. Game theory therefore incorporates not only rationality but also common (...) knowledge assumptions, enabling players to anticipate their co-players' strategies. Under these assumptions, disparate anomalies emerge. Instrumental rationality, conventionally interpreted, fails to explain intuitively obvious features of human interaction, yields predictions starkly at variance with experimental findings, and breaks down completely in certain cases. In particular, focal point selection in pure coordination games is inexplicable, though it is easily achieved in practice; the intuitively compelling payoff-dominance principle lacks rational justification; rationality in social dilemmas is self-defeating; a key solution concept for cooperative coalition games is frequently inapplicable; and rational choice in certain sequential games generates contradictions. In experiments, human players behave more cooperatively and receive higher payoffs than strict rationality would permit. Orthodox conceptions of rationality are evidently internally deficient and inadequate for explaining human interaction. Psychological game theory, based on nonstandard assumptions, is required to solve these problems, and some suggestions along these lines have already been put forward. Key Words: backward induction; Centipede game; common knowledge; cooperation; epistemic reasoning; game theory; payoff dominance; pure coordination game; rational choice theory; social dilemma. (shrink)

The lung allocation score system in the United States and several European countries gives more weight to risk of death without transplantation than to survival following transplantation. As a result, centers transplant sicker patients, leading to increased length of initial hospitalization. The care of patients who have accumulated functional deficits or additional organ dysfunction during their prolonged stay can be ethically complex. Disagreement occurs between the transplant team, patients and families, and non-transplant health care professionals over the burdens of ongoing (...) intensive intervention. These cases highlight important ethical issues in organ transplantation, including the nature and requirements of transplant informed consent, the limits of physician prognostication, patient autonomy and decision-making capacity following transplant, obligations to organ donors and to other potential recipients, and the impact of program metrics on individualized recipient care. We outline general ethical principles for the care of lung transplant recipients with prolonged hospitalization and give regulatory, research, and patient-centered recommendations for these cases. (shrink)

Despite increased calls for hospital ethics committees to serve as default decision-makers about life-sustaining treatment for unrepresented patients who lack decision-making capacity or a surrogate decision-maker and whose wishes regarding medical care are not known, little is known about how committees currently function in these cases. This was a retrospective cohort study of all ethics committee consultations involving decision-making about LST for unrepresented patients at a large academic hospital from 2007 to 2013. There were 310 ethics committee consultations, twenty-five of (...) which involved unrepresented patients. In thirteen cases, the ethics consultants evaluated a possible substitute decision-maker identified by social workers and/or case managers. In the remaining cases, the ethics consultants worked with the medical team to contact previous healthcare professionals to provide substituted judgement, found prior advance care planning documents, or identified the patient’s best interest as the decision-making standard. In the majority of cases, the final decision was to limit or withdraw LST or to change code status to Do Not Resuscitate/Do Not Intubate. Substitute decision-makers who had been evaluated through the ethics consultation process and who made the final decision alone were more likely to continue LST than cases in which physicians made the final decision. In our centre, the primary role of ethics consultants in decision-making for unrepresented patients is to identify appropriate decision-making standards. In the absence of other data suggesting that ethics committees, as currently constituted, are ready to serve as substitute decision-makers for unrepresented patients, caution is necessary before designating these committees as default decision-makers. (shrink)

Philosophical and political discussions of health inequalities have largely focused on questions of justice. The general strategy employed by philosophers like Norman Daniels is to identify a certain state of affairs—in his case, equality of opportunity—and then argue that health disparities limiting an individual's or group's access to that condition are unjust, demanding intervention. Recent work in epidemiology, however, has highlighted the importance of socioeconomic status in creating health inequalities. I explore the ways in which theories of justice have been (...) expanded in light of this data, suggesting that more work is required if such theories are to provide an adequate framework for addressing health disparities. I conclude by sketching an alternative possibility for thinking about health disparities outside of the context of justice. (shrink)

In a recent article in this journal, Duijf claims to have proved that team reasoning can be viewed as a payoff transformation. His formalization mimics team reasoning but ignores its essential agency switch. The possibility of such a payoff transformation was never in doubt, does not imply that team reasoning can be viewed as a payoff transformation, and makes no sense in a game in which payoffs represent players’ utilities. A theorem is proved here that a simpler and more intuitive (...) payoff transformation can mimic any theory that predicts what strategies players will choose in a well-defined game. (shrink)

Short interspersed repetitive elements, or SINEs, are tRNA-derived retroposons that are dispersed throughout eukaryotic genomes and can be present in well over 104 total copies. The enormous volume of SINE amplifications per organism makes them important evolutionary agents for shaping the diversity of genomes, and the irreversible, independent nature of their insertion allows them to be used for diagnosing common ancestry among host taxa with extreme confidence. As such, they represent a powerful new tool for systematic biology that can be (...) strategically integrated with other conventional phylogenetic characters, most notably morphology and DNA sequences. This review covers the basic aspects of SINE evolution that are especially relevant to their use as systematic characters and describes the practical methods of characterizing SINEs for cladogram construction. It also discusses the limits of their systematic utility, clarifies some recently published misunderstandings, and illustrates the effective application of SINEs for vertebrate phylogenetics with results from selected case studies. BioEssays 22:148–160, 2000. ©2000 John Wiley & Sons, Inc. (shrink)

Childress et al. (2023) have provided a cogent overview of the ethical considerations involved in withdrawing extracorporeal membrane oxygenation (ECMO) over a capacitated patient’s objection. Alth...

Recent studies in canine communication are reviewed using Deacon’s framework of iconic, indexical, and symbolic reference. The presented analysis examines these studies using Deacon’s notion of interpretant, taking into account the evolutionary and perceptual capacities of the dog. By taking these dispositions and capacities into account, the conclusions that have been drawn in current studies of canine communication with respect to Deacon’s framework are critically evaluated. The analysis proceeds by investigating clusters of studies that align with symbolic, indexical, or iconic (...) reference. (shrink)