BackgroundPalliative sedation and analgesia are employed in patients with refractory and intractable symptoms at the end of life to reduce their suffering by lowering their level of consciousness. The doctrine of double effect, a philosophical principle that justifies doing a “good action” with a potentially “bad effect,” is frequently employed to provide an ethical justification for this practice. Main textWe argue that palliative sedation and analgesia do not fulfill the conditions required to apply the doctrine of double effect, and therefore (...) its use in this domain is inappropriate. Furthermore, we argue that the frequent application of the doctrine of double effect to palliative sedation and analgesia reflects physicians’ discomfort with the complex moral, intentional, and causal aspects of end-of-life care. ConclusionsWe are concerned that this misapplication of the doctrine of double effect can consequently impair physicians’ ethical reasoning and relationships with patients at the end of life. (shrink)

Background In end-of-life situations, the phrase “do everything” is sometimes invoked by physicians, patients, or substitute decision-makers, though its meaning is ambiguous. We examined instances of the phrase “do everything” in the archive of the Ontario Consent and Capacity Board in Canada, a tribunal with judicial authority to adjudicate physician–patient conflicts in order to explore its potential meanings. Methods We systematically searched the CCB’s online public archive from its inception to 2018 for any references to “do everything” in the context (...) of critical care medicine and end-of-life care. Two independent assessors reviewed decisions, collected characteristics, and identified key themes. Results Of 598 cases in the archive, 41 referred to “do everything” in end-of-life situations. The phrase was overwhelmingly invoked by SDMs, typically to advocate for life-prolonging measures that contradicted physician advice. Physicians generally related “doing everything” to describe the interventions they had already performed, using it to recommend focusing on patients’ quality of life. SDMs were generally reluctant to accept death, whereas physicians found prolonging life at all costs to be morally distressing. The CCB did not interpret appeals to “do everything” legally but followed existing laws by deferring to patients’ prior wishes whenever known, or to concepts of “best interests” when not. The CCB generally recommended against life-prolonging measures in these cases, focusing on patients’ “well-being” and “best interests.” Conclusions In this unique sample of cases involving conflict surrounding resuscitation and end-of-life care, references to “do everything” highlighted conflicts over quantity versus quality of life. These appeals were associated with signs of cognitive distress on the behalf of SDMs who were facing the prospect of a patient’s death, whereas physicians identified moral distress related to the prolongation of patients’ suffering through their use of life-sustaining interventions. This divergence in perspectives on death versus suffering was consistently the locus of conflict. These findings support the importance of tools such as the Serious Illness Conversation Guide that can be used by physicians to direct conversations on the patients’ goals, wishes, trade-offs, and to recommend a treatment plan that may include palliative care. Trial Registration Not applicable. (shrink)

Scientific Essentialism defends the view that the fundamental laws of nature depend on the essential properties of the things on which they are said to operate, and are therefore not independent of them. These laws are not imposed upon the world by God, the forces of nature or anything else, but rather are immanent in the world. Ellis argues that ours is a dynamic world consisting of more or less transient objects which are constantly interacting with each other, and whose (...) identities depend on their roles in these processes. Natural objects must behave as they do, because to do otherwise would be contrary to their natures. The laws of nature are, therefore, metaphysically necessary, and consequently, there are necessary connections between events. Brian Ellis calls for the rejection of the theory of Humean Supervenience and an implementation of a new kind of realism in philosophical analysis. (shrink)

In this pithy and highly readable book, Brian Skyrms, a recognised authority on game and decision theory, investigates traditional problems of the social contract in terms of evolutionary dynamics. Game theory is skilfully employed to offer new interpretations of a wide variety of social phenomena, including justice, mutual aid, commitment, convention and meaning. The author eschews any grand, unified theory. Rather, he presents the reader with tools drawn from evolutionary game theory for the purpose of analysing and coming to (...) understand the social contract. The book is not technical and requires no special background knowledge. As such, it could be enjoyed by students and professionals in a wide range of disciplines: political science, philosophy, decision theory, economics and biology. (shrink)

"Anselm of Canterbury gave the first modal "ontological" argument for God's existence. Yet, despite its distinct originality, philosophers have mostly avoided the question of what modal concepts the argument uses, and whether Anselm's metaphysics entitles him to use them. Here, Brian Leftow sets out Anselm's modal metaphysics. He argues that Anselm has an "absolute", "broadly logical", or "metaphysical" modal concept, and that his metaphysics provides acceptable truth makers for claims in this modality. He shows that his modal argument is (...) committed to the Brouwer system of modal logic, and defends the claim that Brouwer is part of the logic of "absolute" or "metaphysical" modality. He also defends Anselm's premise that God would exist with absolute necessity against all extant objections, providing new arguments in support of it and ultimately defending all but one premise of Anselm's best argument for God's existence"--. (shrink)

Many philosophers of emotion, whether perceptual or cognitive theorists, have claimed that emotions represent evaluative properties. This is often supported by an appeal to the fittingness of emotion: that emotions can be fitting shows they represent evaluative properties. In this paper, however, I argue that this inference is much too fast. In fact, no aspect of the rational assessment of emotion directly supports the claim that emotions represent evaluative properties. This inference can, however, be matured into an inference to the (...) best explanation. But this requires coming to terms with a significant emerging rival, the attitudinal theory of emotion. In this paper, I show how this can be accomplished and the inference from fittingness to content saved. (shrink)

David Lewis (1941–2001) was one of the most important philosophers of the 20th Century. He made significant contributions to philosophy of language, philosophy of mathematics, philosophy of science, decision theory, epistemology, meta-ethics and aesthetics. In most of these fields he is essential reading; in many of them he is among the most important figures of recent decades. And this list leaves out his two most significant contributions. -/- In philosophy of mind, Lewis developed and defended at length a new version (...) of materialism (see the entry on physicalism). He started by showing how the motivations driving the identity theory of mind and functionalism could be reconciled in his theory of mind. He called this an identity theory, though his theory motivated the position now known as analytic functionalism. And he developed detailed accounts of mental content (building on Davidson’s interpretationism) and phenomenal knowledge (building on Nemirow’s ability hypothesis) that are consistent with his materialism. The synthesis Lewis ended up with is one of the central positions in contemporary debates in philosophy of mind. -/- But his largest contributions were in metaphysics. One branch of his metaphysics was his Hume-inspired reductionism about the nomological. He developed a position he called “Humean supervenience”, the theory that said that there was nothing to reality except the spatio-temporal distribution of local natural properties. And he did this by showing in detail how laws, chances, counterfactual dependence, causation, dispositions and colours could be located within this Humean mosaic. The other branch of his metaphysics was his modal realism. Lewis held that the best theory of modality posited concrete possible worlds. A proposition is possible if and only if it is true at one of these worlds. Lewis defended this view in his most significant book, On the Plurality of Worlds. Alongside this, Lewis developed a new account of how to think about modal properties of individuals, namely counterpart theory, and showed how this theory resolved several long-standing puzzles about modal properties. (shrink)

One of the most influential claims made by John Rawls in A Theory of Justice is that the principles of justice apply only to the institutions of the “basic structure of society,” and do not apply directly to the conduct of individuals. In this paper, I aim to cast doubt on this view, which I call “Institutionalism about Justice,” by considering whether several of the prominent motivations for it offered by Rawls and others succeed in providing the support for the (...) view that they claim. I argue that all of the motivations are problematic as grounds for accepting Institutionalism, at least in part because they, and the Institutionalist view that they are thought to support, seem to misconceive what our concern about justice is fundamentally a concern about. (shrink)

Events are always passing; to experience an event is to experience the passing. But how do we perceive an experience that encompasses the just-was and the is-about-to-be as much as what is actually present? In _Semblance and Event_, Brian Massumi, drawing on the work of William James, Alfred North Whitehead, Gilles Deleuze, and others, develops the concept of "semblance" as a way to approach this question. It is, he argues, a question of abstraction, not as the opposite of the (...) concrete but as a dimension of it: "lived abstraction." A semblance is a lived abstraction. Massumi uses the category of the semblance to investigate practices of art that are relational and event-oriented -- variously known as interactive art, ephemeral art, performance art, art intervention -- which he refers to collectively as the "occurrent arts." Each art practice invents its own kinds of relational events of lived abstraction, to produce a signature species of semblance. The artwork's relational engagement, Massumi continues, gives it a political valence just as necessary and immediate as the aesthetic dimension. (shrink)

Orthodox Bayesian decision theory requires an agent’s beliefs representable by a real-valued function, ideally a probability function. Many theorists have argued this is too restrictive; it can be perfectly reasonable to have indeterminate degrees of belief. So doxastic states are ideally representable by a set of probability functions. One consequence of this is that the expected value of a gamble will be imprecise. This paper looks at the attempts to extend Bayesian decision theory to deal with such cases, and concludes (...) that all proposals advanced thus far have been incoherent. A more modest, but coherent, alternative is proposed. Keywords: Imprecise probabilities, Arrow’s theorem. (shrink)

The central thesis of this paper is that fake news and related phenomena serve as defeaters for knowledge transmission via journalistic channels. This explains how they pose a threat to democracy; and it points the way to determining how to address this threat. Democracy is both intrinsically and instrumentally good provided the electorate has knowledge (however partial and distributed) of the common good and the means of achieving it. Since journalism provides such knowledge, those who value democracy have a reason (...) to protect it. Hostile agents, however, can undermine both the effectiveness of democratic decision-making and faith in democracy itself, by deliberately promulgating fake news and hyper-partisan views; moreover, these effects can come about unintentionally on social media. I conclude that we may need to change, not just the way we process information online, but also the informational environment in which we operate. (shrink)

Carey has argued that there is a system of core numerical cognition – the analog magnitude system – in which cardinal numbers are explicitly represented in iconic format. While the existence of this system is beyond doubt, this paper aims to show that its representations cannot have the combination of features attributed to them by Carey. According to the argument from abstractness, the representation of the cardinal number of a collection of individuals as such requires the representation of individuals as (...) such, and this in turn requires non-iconic format, from which it is concluded that the explicit representation of the cardinal number of some individuals requires non-iconic representational format. In support of the first premise, an account is given of what approximate cardinal numbers might be, and in support of the second, a direct argument is articulated and defended. Finally, in response to an objection, a second argument for the central thesis is provided. While the discussion is couched in the terms of Carey’s work, the considerations it adduces are perfectly general, and the conclusion should therefore be taken into consideration by all those aiming to characterize the AM system. (shrink)

Virtues are acquirable, so if intellectual humility is a virtue, it’s acquirable. But there is something deeply problematic—perhaps even paradoxical—about aiming to be intellectually humble. Drawing on Edward Slingerland’s analysis of the paradoxical virtue of wu-wei in Trying Not To Try (New York: Crown, 2014), we argue for an anti-individualistic conception of the trait, concluding that one’s intellectual humility depends upon the intellectual humility of others. Slingerland defines wu-wei as the “dynamic, effortless, and unselfconscious state of mind of a person (...) who is optimally active and effective” (Trying Not to Try, 7). Someone who embodies wu-wei inspires implicit trust, so it is beneficial to appear wu-wei. This has led to an arms race between faking wu-wei on the one hand and detecting fakery on the other. Likewise, there are many benefits to being (or seeming to be) intellectually humble. But someone who makes conscious, strategic efforts to appear intellectually humble is ipso facto not intellectually humble. Following Slingerland’s lead, we argue that there are several strategies one might pursue to acquire genuine intellectual humility, and all of these involve commitment to shared social or epistemic values, combined with receptivity to feedback from others, who must in turn have and manifest relevant intellectual virtues. In other words, other people and shared values are partial bearers of a given individual’s intellectual humility. If this is on the right track, then acquiring intellectual humility demands epistemic anti-individualism. (shrink)

Every set can been thought of as a directed graph whose edge relation is ∈. We show that many natural examples of directed graphs of this kind are indivisible: for every infinite κ, for every indecomposable λ, and every countable model of set theory. All of the countable digraphs we consider are orientations of the countable random graph. In this way we find indivisible well‐founded orientations of the random graph that are distinct up to isomorphism, and ℵ1 that are distinct (...) up to siblinghood. (shrink)

Frank Hindriks has attempted to derive a variant of Timothy Williamson’s knowledge rule for assertion on the basis of a more fundamental belief expression analysis of that speech act. I show that his attempted derivation involves a crucial equivocation between two senses of ‘must,’ and therefore fails. I suggest two possible repairs; but I argue that even if they are successful, we should prefer Williamson’s fully general knowledge rule to Hindriks’s restricted moral norm.

Permissivism in epistemology is a family of theses, each of which says that rationality is compatible with a number of distinct attitudes. This paper argues that thinking about symmetric games gives us new reason to believe in permissivism. In some finite games, if permissivism is false then we have to think that a player is more likely to take one option rather than another, even though each option has the same expected return given that player’s credences. And in some infinite (...) games, if permissivism is false there is no rational way to play the game, although intuitively the games could be rationally played. The latter set of arguments rely on the recent discovery that there are symmetric games with only asymmetric equilibria. It was long known that there are symmetric games with no pure strategy symmetric equilibria; the surprising new discovery is that there are symmetric games with asymmetric equilibria, but no symmetric equilibria involving either mixed or pure strategies. (shrink)

Adolescents present a puzzle. There are foundational unclarities about how they should be regarded as decision-makers. Although superficially adolescents may appear to have mature decisional capacity, their decision-making is in many ways unlike that of adults. Despite this seemingly obvious fact, a concern for the claims of autonomy has led to the development of the legal doctrine of the mature minor. This legal construct considers adolescents, as far as possible, as equivalent to adults for the purpose of medical decision-making. The (...) movement to support independent decision-making by adolescents through providing information to them and securing their consent apart from their parents is encouraged by those legal understandings that hold that unemancipated minors should generally be considered as possessing effective decisional capacity. Such legal structures, however, do not adequately take account of the wide variations in adolescent capacities, the immaturity of most adolescent decision-makers, or the important contributions made by parents to the development of their adolescents through parental partnering in the adolescent’s decision-making. The data available indicate that in general adolescents should be regarded as apprentice decision-makers who should make decisions in collaboration with their parents until at least the age of 18. Steps should not be taken pre-emptively to isolate adolescents from the guidance of their parents. As a general rule, what Piker has referred to as “collaborative paternalism” appears most likely both to protect adolescents from their own untoward choices, while also very importantly helping them with parental guidance to develop into mature decision-makers with the capacity to make medical choices on their own. (shrink)

Harvey Siegel's (1985) attempts to revive the traditional epistemological formulation of the rationality of science. Contending that "a general commitment to evidence" is constitutive of method and rationality in science, Siegel advances its compatibility with specific, historically attuned formulations of principles of evidential support as a virtue of his aprioristic candidate for science's rationality. In point of fact, this account is compatible with virtually any formulation of evidential support, which runs afoul of Siegel's claim that scientific beliefs must be evaluated (...) with respect to their rationality. The unwelcome consequence of Siegel's view is that most any belief, scientific or pseudoscientific, can be defended as rational. Indeed, if we want to furnish a warrant for rational choice, we must turn to the very historically informed principles of evidential support that are dismissed by Siegel as providing a misleading portrait of science's rationality. (shrink)

This book presents 12 original essays on historical and contemporary philosophical discussions of judgment. The central issues explored in this volume can be separated into two groups namely, those concerning the act and object of judgment. What kind of act is judgment? How is it related to a range of other mental acts, states, and dispositions? Where and how does assertive force enter in? Is there a distinct category of negative judgments, or are these simply judgments whose objects are negative? (...) Concerning the object of judgment: How many objects are there of a given judgment? One, as on the dual relation theory of Frege and Moore? Or many as in Russell's later multiple relation theory? If there is a single object, is it a proposition? And if so, is it a force-neutral, abstract entity that might equally figure as the object of a range of intentional attitudes? Or is it somehow constitutively tied to the act itself? These and related questions are approached from a variety of historical and contemporary perspectives. This book sheds new light on current controversies by drawing on the details of the distinct intellectual contexts in which previous philosophers' positions about the nature of judgment were formulated. In turn, new directions in present-day research promise to raise novel interpretive prospects and challenges in the history of philosophy. istorical and contemporary perspectives. This book sheds new light on current controversies by drawing on the details of the distinct intellectual contexts in which previous philosophers' positions about the nature of judgment were formulated. In turn, new directions in present-day research promise to raise novel interpretive prospects and challenges in the history of philosophy. (shrink)

Br> Philosophy of Religion : A Guide to the Subject by Davies, Brian (Editor) Terms of use This concise, introduction asks the fundamental questions about life from a variety of religious viewpoints: Does God exist? Is there life after death? Can philosophy shed light on the diversity of religious beliefs? What does science tell us about religious matters? The authors then suggest how we can think about these issues today. Descriptive content provided by Syndetics"! a Bowker service.

This book argues that, despite recent calls to arms to seek out and remove "corporate psychopaths" from the business world, efforts to eliminate the corporate psychopath presence would be illegal as well as unethical.

Should we understand our lives as stories? Narrativism answers Yes, a view that has recently been the subject of vigorous debate. But what should Christian philosophers make of narrativism? In this essay, I argue that, in fact, narrativism is a commitment of Christian teaching. I argue that there are practices which Christians have decisive reasons to engage in, which require us to see our lives as narratives, practices such as confession and thanksgiving.

The healthcare ethics consultant holds a widely described role in the modern American hospital. S/he may practice within a clinical discipline and be trained in bioethics, or be a trained phi...

A personal and professional issue that confronts all nurses is that of attempting to understand the experiences of our patients or clients. The position taken here is that understanding another person as a human being is much more than being able to explain their experience according to a particular model of ill‐health. Rather, it is an issue of human dignity and respectfulness. Gadamerian hermeneutics has been used in nursing research to articulate the process of understanding and to develop interpretations of (...) particular experiences. Gadamer's exposition of understanding shows that we need to be aware that our understanding of other people is developed through a fusion of our own history, language and culture with that of the other person. This occurs through a hermeneutic question–answer dialogue in which we put our ideas at risk of being modified or rejected in the process. Understanding then, is a perceptual and conceptual process in which we fully participate. In this way, the experience of understanding those we nurse increases our understanding of ourselves as well as enhancing our ability to further understand others. (shrink)

Anselm of Canterbury (1033-1109), Benedictine monk and the second Norman archbishop of Canterbury, is regarded as one of the most important philosophers and theologians of the Middle Ages. The essays in this volume explore all of his major ideas both philosophical and theological, including his teachings on faith and reason, God's existence and nature, logic, freedom, truth, ethics, and key Christian doctrines. There is also discussion of his life, the sources of his thought, and his influence on other thinkers. New (...) readers will find this the most convenient, accessible guide to Anselm currently available. Advanced students and specialists will find a conspectus of recent developments in the interpretation of Anselm. (shrink)

Federal discrimination laws have defined two distinct types of activity that constitute sexual harassment – "hostile environment" and "quid pro quo." The Civil Rights Act of 1991 and more recent Supreme Court rulings make it easier for workers to win lawsuits claiming they were sexually harassed in the work environment.While the public accounting profession continues to address gender-related problems, it remains vulnerable to claims of sexual harassment. In an attempt to better understand the underlying risk the public accounting profession faces, (...) this study focuses on identifying (1) the extent of sexual harassment in the public accounting profession, (2) the type of harassing behavior that is most common, and (3) where the harassment occurs. (shrink)