Book reviewed in this article: For the Patient's Good: The Restoration of Beneficence in Health Care. By Edmund D. Pellegrino and David C. Thomasma.

It is traditionally believed that cerebral activation (the presence of low voltage fast electrical activity in the neocortex and rhythmical slow activity in the hippocampus) is correlated with arousal, while deactivation (the presence of large amplitude irregular slow waves or spindles in both the neocortex and the hippocampus) is correlated with sleep or coma. However, since there are many exceptions, these generalizations have only limited validity. Activated patterns occur in normal sleep (active or paradoxical sleep) and during states of anesthesia (...) and coma. Deactivated patterns occur, at times, during normal waking, or during behavior in awake animals treated with atropinic drugs. Also, the fact that patterns characteristic of sleep, arousal, and waking behavior continue in decorticate animals indicates that reticulo-cortical mechanisms are not essential for these aspects of behavior. (shrink)

BackgroundResuscitation and treatment of critically ill newborn infants is associated with relatively high mortality, morbidity and cost. Guidelines relating to resuscitation have traditionally focused on the best interests of infants. There are, however, limited resources available in the neonatal intensive care unit, meaning that difficult decisions sometimes need to be made. This study explores the intuitions of lay people regarding resource allocation decisions in the NICU.MethodsThe study design was a cross-sectional quantitative survey, consisting of 20 hypothetical rationing scenarios. There were (...) 119 respondents who entered the questionnaire, and 109 who completed it. The respondents were adult US and Indian participants of the online crowdsourcing platform Mechanical Turk. Respondents were asked to decide which of two infants to treat in a situation of scarce resources. Demographic characteristics, personality traits and political views were recorded. Respondents were also asked to respond to a widely cited thought experiment involving rationing.ResultsThe majority of respondents, in all except one scenario, chose the utilitarian option of directing treatment to the infant with the higher chance of survival, higher life expectancy, less severe disability, and less expensive treatment. As discrepancy between outcomes decreased, however, there was a statistically significant increase in egalitarian responses and decrease in utilitarian responses in scenarios involving chance of survival, life expectancy, and cost of treatment. In the classic ‘lifeboat’ scenario, all but two respondents were utilitarian.ConclusionsThis survey suggests that in situations of scarcity and equal clinical need, non-health professionals support rationing of life-saving treatment based on probability of survival, duration of survival, cost of treatment or quality of life. However, where the difference in prognosis or cost is very small, non-health professionals preferred to give infants an equal chance of receiving treatment. (shrink)

In orthodox quantum mechanics, it has virtually become the custom to identify properties of a physical system with operationally testable propositions about the system. The causes and consequences of this practice are explored mathematically in this paper. Among other things, it is found that such an identification imposes severe constraints on the admissible states of the physical system.

Recent scholarship, focusing on the rapid decline of microscopy after the late 1680's, has shown that the limitations of microscopy and the ambivalent meaning of its findings led to a wide-spread sense of frustration with the new instrument. The present article tries to connect this fall from favor with the microscope's equally surprising but hitherto little noticed late rise to prominence. The crucial point is that when the microscope, more than a decade after the telescope, finally managed to arouse the (...) interest of natural philosophers, it did so as a corpuscularian tool, and as such it came to share the difficult fate of seventeenth-century corpuscularianism. The essay ends with the claim that the fall of microscopy was not only due to the failure of microscopy to corroborate corpuscularianism, but also to the changing definition of natural philosophy in the late seventeenth and early eighteenth centuries and to the separation of the domains of living matter from a physica whose recent mathematical framework excluded the organic world. (shrink)

With the increasing prices of newly approved anti-cancer treatments contributing to rising healthcare costs, healthcare systems are facing complex economic and ethical dilemmas. Especially in countries with universal access and mandatory health insurance, including many European countries, the organizing of funding or reimbursement of expensive new treatments can be challenging. When expensive anti-cancer treatments are deemed safe and effective, but are not (yet) reimbursed, ethical dilemmas arise. In countries with universal healthcare systems, such as the Netherlands, this gives rise to (...) a rather new ethical dilemma: should patients be allowed to pay out of pocket, using private funds, for medical treatments? On the one hand, to allow patients to pay for treatments out of pocket would be in line with the medical-ethical principles of beneficence and autonomy. On the other hand, allowing patients to pay out of pocket for anti-cancer treatments may lead to unequal access to medical treatments and could be considered unfair to patients who are less well-off. Thus, it could undermine the values of equality and solidarity, on which the Dutch healthcare system is built. Furthermore, out-of-pocket payments could potentially lead to financial hardship and distress for patients, which would conflict with the principle of non-maleficence. Does this mean that patients can rightfully be denied access to approved but not (yet) reimbursed anti-cancer treatments? In this article, we will use the Dutch healthcare system, which is based on equal access and solidarity, as a case study to draw attention to this—currently relatively unknown and unresolved—dilemma and to clarify the values at stake. This article contributes to current discussions about the societal problem of rising healthcare costs by informing policymakers, healthcare professionals, and ethicists about the ethical dilemma of out-of-pocket payments in universal healthcare systems, and aims to support health authorities, policymakers and health professionals in developing policy for whether to allow out-of-pocket payment-based access to newly approved but (too) expensive anti-cancer treatments. (shrink)

Journal of Political Philosophy, EarlyView.

In Philosophy for April 1961 Mr J. R. Lucas argues that Gödel's theorem proves that Mechanism is false. I wish to dispute this view, not because I maintain that Mechanism is true, but because I do not believe that this issue is to be settled by what looks rather like a kind of logical conjuring-trick. In my discussion I take for granted Lucas's account of Gödel's procedure, which I am not competent to criticise.

We prove that the observational equivalence of third-order finitary Idealized Algol is decidable using Game Semantics. By modelling the state explicitly in our games, we show that the denotation of a term M of this fragment of IA is a compactly innocent strategy-with-state, i.e. the strategy is generated by a finite view function fM. Given any such fM, we construct a real-time deterministic pushdown automaton that recognizes the complete plays of the knowing-strategy denotation of M. Since such plays characterize observational (...) equivalence, and there is an algorithm for deciding whether any two DPDAs recognize the same language, we obtain a procedure for deciding the observational equivalence of third-order finitary IA. Restricted to second-order terms, the DPDA representation cuts down to a deterministic finite automaton; thus our approach gives a new proof of Ghica and McCusker’s regular-expression characterization for this fragment. Our algorithmic representation of program meanings, which is compositional, provides a foundation for model-checking a wide range of behavioural properties of IA and other cognate programming languages. Another result concerns second-order IA with full recursion: we show that observational equivalence for this fragment is undecidable. (shrink)

The relation between Emanuel Swedenborg and Immanuel Kant has been the subject of many discussions. The chief aim of this paper is not to elucidate this question from an historical point of view, but to compare the teachings of the two thinkers, as those teachings have come to us. Kant's "Träme eines Geistersehers" embodies a very unfavourable opinion about Swedenborg. It is a curious circumstance, that this judgement is not based on decisive arguments. On the contrary, Swedenborg's fundamental doctrines about (...) the existence of a spiritual world and the communication between the living and the dead, are accepted by Kant as plausible. Du Prel and others have concluded, that Kant was a Swedenborgian in his heart, and that his negative attitude was due to the fear of losing his scientific reputation. A careful consideration of the two philosophical systems does not tend to bear out this opinion; nevertheless, such a comparative study is very instructive. In the mental development of the two thinkers there are remarkable analogies. Both were occupied with the great problems of God and the human soul; and both were disappointed by the leading philosophical and theological doctrines of their days. To Swedenborg those doctrines seemed to lead straightforwardly to naturalism and atheism. Kant was struck by the diversity of the opinions expressed and by the succession of heterogeneous doctrines without lasting results. But the reactions of the two men in these circumstances were different. In his cosmological and anatomical works Swedenborg aims at acquiring a comprehensive view of the Universe, in which view God and the soul should obtain their proper places. When he had reached the age of about 55 years, a crisis set in, which he described as "the opening of his spiritual senses". From that time he could see the spiritual world and speak with its inhabitants; he could study the workings of God and of the soul with the help of living experience. Kant raised the question, whether there are departments of knowledge in which certainty is attainable, and what is the ground of this certainty. His answer is, that the fundamental propositions of mathematical physics are absolutely certain. The ground lies in the fact, that these propositions are not derived from experience, but that they are "synthetic judgments a priori". They express the workings of the "categories" and "forms of intuition". by means of which the mind constructs, out of a chaos of sense-impressions, the ordered universe of science. Of objects to which these propositions do not apply, e.g. God and the soul, no certain knowledge is possible. This precludes the knowledge of "another world", fundamentally different from our ordinary world. So there seems to be an irreconcilable opposition between the teachings of Kant and of Swedenborg, But further considerations tend to lessen this contrast. Notwithstanding his own teaching, Kant accepted a life after death and he even speculated on it. If we follow this example, we come to remarkable conclusions. It is reasonable to suppose, that the spirits, who have been men, use the same categories as we do. Then out of the impressions which reach them, they will construct a world built on the same pattern as our earthly world. So life before and after death will not be very different. And this is precisely Swedenborg's teaching. This may be confirmed by the experiences of our dream-life. In dreams, our mind out of different impressions builds a world closely resembling our ordinary world. The spiritual world, as described by Swedenborg, presents many analogies with the world of our dreams. Now it is a very remarkable circumstance, that modern physics has been under the necessity of modifying the system of categories as described by Kant. In quantum mechanics the connection between cause and effect is less stringent than in classical mechanics. This adds fresh interest to the study of a system like that of Swedenborg, where quantitative laws are largely replaced by qualitative laws. (shrink)