Background Following passage of the Patient Self Determination Act in 1990, health care institutions that receive Medicare and Medicaid funding are required to inform patients of their right to make their health care preferences known through execution of a living will and/or to appoint a surrogate-decision maker. We evaluated the impact of external factors and perceived patient preferences on physicians’ decisions to honor or forgo previously established advance directives (ADs). In addition, physician views regarding legal risk, patients’ ability to comprehend (...) complexities involved with their care, and impact of medical costs related to end-of-life care decisions were explored. Methods Attendees of two Mayo Clinic continuing medical education courses were surveyed. Three scenarios based in part on previously court-litigated matters assessed impact of external factors and perceived patient preferences on physician compliance with patient-articulated wishes regarding resuscitation. General questions measured respondents’ perception of legal risk, concerns over patient knowledge of idiosyncrasies involved with their care, and impact medical costs may have on compliance with patient preferences. Responses indicating strength of agreement or disagreement with statements were treated as ordinal data and analyzed using the Cochran Armitage trend test. Results Three hundred eighty-eight of 951 surveys were completed (41% response rate). Eighty percent reported they were likely to honor a patient’s AD despite its 5 year age. Fewer than half (41%) would honor the AD of a patient in ventricular fibrillation who had expressed a desire to “pass away in peace.” Few (17%) would forgo an AD following a family’s request for continued resuscitative treatment. A majority (52%) considered risk of liability to be lower when maintaining someone alive against their wishes than mistakenly failing to provide resuscitative efforts. A large percentage (74%) disagreed that patients could not appreciate complexities surrounding their care while 69% agreed that costs should never impact a physician’s decision as to whether to comply with a patient’s AD. Conclusions Our findings highlight the impact, albeit small, external factors have on physician AD compliance. Most respondents based their decision on the clinical situation at hand and interpretation of the patient’s initial wishes and preferences expressed by the AD. (shrink)

Background This study assesses how pediatric assent is conceptualized and justified within the therapeutic context. Pediatric ethicists generally agree that children should participate in medical care decisions in developmentally appropriate ways. Much attention has been paid to pediatric assent for research participation, but ambiguities persist in how assent is conceptualized and operationalized in the therapeutic context where countervailing considerations such as the child’s best interest and parental permission must also be weighed.Methods Searches were conducted in 11 databases including PubMed, Embase, (...) Cochrane Library, and Web of Science. Articles published between 2010 and 2020 were screened in COVIDENCE for meeting each of four criteria: (1) focusing on pediatric assent, (2) focusing on clinical care, (3) including normative claims, and (4) containing substantive statements about the meaning of pediatric assent. Full texts were abstracted for (1) operational definitions of assent, (2) discussion of the temporal nature of assent, (3) description of the concept of “understanding,” and (4) ethical justifications for soliciting assent. These excerpts were coded and code patterns formed themes presented in the results.Results The final analytic data set contained 29 articles. Analysis yielded three key themes. First, valid assent varies by treatment, population (e.g., younger versus older), and geographic/cultural context. Second, assent represents two distinct longitudinal processes: One involves eliciting preferences over a disease course or care episode; the other focuses on children’s developmental maturation. Third, ethical justifications for assent draw variously on instrumental and intrinsic reasons, but often remain ambiguous.Conclusions There is widespread agreement that assent is morally valuable, but there remain substantial ambiguities or disagreements about its meaning, process, and ethical justification. (shrink)

When recalling events that one personally experienced, sometimes one sees oneself in the remembered scene: from an external, detached 'observer perspective'. In such cases one remembers from-the-outside. Remembering from-the-outside is a common yet curious case of personal memory. This book disentangles the puzzles posed by such memories.

Propositional contingentism is the view that what propositions there are is a contingent matter—certain propositions ontologically depend on objects which themselves only contingently exist. Possible worlds are, loosely, complete ways the world could have been. That is to say, the ways in which everything in its totality could have been. Propositional contingentists make use of possible worlds frequently. However, a neglected, but important, question concerns whether there are any notions of worlds which are both theoretically adequate and consistent with propositional (...) contingentism. Some notion of a possible world is adequate if the systematic connection between, at least, possibility and truth at some possible world holds. Here, I argue that no adequate notion of a possible world is available to at least those who subscribe to one natural formulation of propositional contingentism. I also show that this result contrasts with a simple and adequate definition of a possible world available to the necessitist—those who hold that necessarily everything necessarily exists. (shrink)

This article offers several contributions to the interdisciplinary project of responsible research and innovation in data science and AI. First, it provides a critical analysis of current efforts to establish practical mechanisms for algorithmic auditing and assessment to identify limitations and gaps with these approaches. Second, it provides a brief introduction to the methodology of argument-based assurance and explores how it is currently being applied in the development of safety cases for autonomous and intelligent systems. Third, it generalises this method (...) to incorporate wider ethical, social, and legal considerations, in turn establishing a novel version of argument-based assurance that we call ‘ethical assurance.’ Ethical assurance is presented as a structured method for unifying the myriad practical mechanisms that have been proposed. It is built on a process-based form of project governance that enlists reflective innovation practices to operationalise normative principles, such as sustainability, accountability, transparency, fairness, and explainability. As a set of interlocutory governance mechanisms that span across the data science and AI lifecycle, ethical assurance supports inclusive and participatory ethical deliberation while also remaining grounded in social and technical realities. Finally, this article sets an agenda for ethical assurance, by detailing current challenges, open questions, and next steps, which serve as a springboard to build an active (and interdisciplinary) research programme as well as contribute to ongoing discussions in policy and governance. (shrink)

I argue that we have good reason to reject Bernard Suits’ assertion that game-playing is the ideal of human existence, in the absence of a suitably robust account of utopian games. The chief motivating force behind this rejection rests in the fact that Suits begs the question that there exists some possible set of games-by-design in his utopia, such that the playing of its members would sustain an existentially meaningful existence for his utopians, in the event of a hypo-instrumental culture (...) of material superabundance obtaining. But the set of utopian games is unknown and unknowable. Thus any implications of Suits’ vision for the utilization of our leisure time in the present are vitiated by the collapse of his normative ideal: his ‘metaphysics of leisure’ misses its mark. (shrink)

This fully revised and updated edition of God, Humanity and the Cosmos is an essential companion to the field, with exercises for the student, a comprehensive bibliography, and suggestions for further reading.

ABSTRACTI argue that the apparently exclusive choice between Suits’ utopia of gameplay and death by suicide is a false dilemma, one which obscures a ‘third way’ of positive boredom. Further, I offe...

In this paper I give an interpretation of the Wim Wenders film, Paris, Texas, that brings to bear Talbot Brewer’s notion of “dialectical activity.” According to Brewer, dialectical activity is an a...

Contemporary architecture is increasingly grounded in science and mathematics. Architectural discourse has shifted radically from the sometimes disorienting Derridean deconstruction, to engaging scientific terms such as fractals, chaos, complexity, nonlinearity, and evolving systems. That's where the architectural action is -- at least for cutting-edge architects and thinkers -- and every practicing architect and student needs to become conversant with these terms and know what they mean. Unfortunately, the vast majority of architecture faculty are unprepared to explain them to students, not (...) having had a scientific education themselves. Here is an architecture book by an architect/scientist, just in time to help architects in the new millennium. Alexander discusses many of the scientific terms arising in cutting-edge architecture, and explains them to those who don't have scientific training or advanced mathematical knowledge. We find discussions of the evolution of forms; the importance of process in design; iteration; genetic algorithms; sequences of transformations; different levels of scale (i.e. fractals); etc. They are explained here by an architect who is also a scientist, because he wants to change the way architects think and build. Alexander is not merely popularizing other scientists' results and making them accessible to architects: he is in fact presenting new and original scientific work that ties many of these concepts together in a way that will be useful to architects. (shrink)

The philosopher Kant is a key thinker in shaping our contemporary concept of morality, freedom, and happiness. This book argues that Kant believes in God, but that he is not a Christian, and that this opens up an important and neglected dimension of Western Philosophy.

Engineering the Climate: The Ethics of Solar Radiation Management is a wide-ranging and expert analysis of the ethics of the intentional management of solar radiation. This book will be a useful tool for policy-makers, a provocation for ethicists, and an eye-opening analysis for both the scientist and the general reader with interest in climate change.

Discussions of monotheism often consider its bigotry toward other gods as a source of conflict, or emphasize its universality as a source of peaceful tolerance. Both approaches, however, ignore the combined danger and liberation in monotheism's 'intolerance.' In this volume, Christopher Haw reframes this important argument. He demonstrates the value of rejecting paradigms of inclusivity in favor of an agonistic pluralism and intolerance of absolutism. Haw proposes a model that retains liberal, pluralistic principles while acknowledging their limitations, and he (...) relates them to theologies latent in political ideas. His volume offers a nuanced, evolutionary, and historical understanding of the biblical tradition's emergence and its political consequences with respect to violence. It suggests how we can mediate impasses between liberal and conservative views in culture wars; between liberal inclusivity and conservative decisionism; and, on the religious front, between apologetics for exclusive monotheism and critiques of its intolerance. (shrink)

This book offers a broad-based critical survey of recent anti-realist arguments in the philosophy of science, cultural theory, hermeneutics, the sociology of knowledge and the interpretation of quantum-mechanics.

Aristotle admits the possibility of many vices opposed to one virtue, but insists that there are always at least two, related as deficiency and excess. The doctrine that "virtue is in a mean" is thus both true and useful.

The first comprehensive collection of the work of Richard Rorty, The Rorty Reader brings together the influential American philosopher’s essential essays from over four decades of writings. Offers a comprehensive introduction to Richard Rorty's life and body of work Brings key essays published across many volumes and journals into one collection, including selections from his final volume of philosophical papers, Philosophy as Cultural Politics ) Contains the previously unpublished essay, “Redemption from Egotism” Includes in-depth interviews, and several revealing autobiographical pieces (...) Represents the fullest portrait available today on Rorty’s relationship with American pragmatism and the trajectory of his thought. (shrink)

This chapter explores the idea of one variable making a causal contribution to another variable, and how this idea applies to economics. It also explores the related concept of what-if questions in economics. In particular, it contrasts the modular theory of causal contributions and what-if questions (advocated by interventionists) with the ceteris paribus theory (advocated by Jim Heckman and others). It notes a problem with the modular theory raised by Nancy Cartwright. And it notes how, according to the ceteris paribus (...) theory, causal contributions and what-if questions are often indeterminate in economics. (shrink)

In the United States, food banks served an estimated 46 million people in 2015. A combination of government policy reforms and political economic trends contributed to the rising numbers of individuals relying on private food assistance in the US, the United Kingdom and other high-income countries. Although researchers frequently map urban food environments, this project is one of the first to map private food assistance and potential need at the census-tract scale. We utilize Geographic Information Systems, demographic data, and food (...) assistance locations to develop a rapid assessment tool that could support food banks, pantries, soup kitchens, and government agencies that seek to answer the question of whether people with the greatest need have food distribution sites in close proximity. We define access based on distance and then calculate potential food insecurity using either poverty rates or a food insecurity index. We apply these methods in a case study analysis of Santa Clara County, California. Our findings suggest that food assistance distribution locations match the areas of potential need in more than 80% of urban census tracts. However, there are several potentially underserved locations and populations that could benefit from new food assistance operations. The poverty and index-based approaches show significant spatial overlap in mapped areas of high food insecurity and low access. The poverty only approach produces a higher estimate of food insecurity rates, is easier to calculate, and draws attention to the need to address poverty as a root cause of hunger. (shrink)

The article examines two claims made by Antoine Panaïoti: (1) That both Nietzsche and Buddhists denounce the self as a misleading fiction. (2) That Buddhist compassion is close to a “compassion of strength” that Nietzsche approves. This article agrees with (1) and disagrees with (2). The descriptive metaphysical commitments of Nietzsche and Buddhism are subordinate to their divergent normative projects. Both reject a single, enduring, and independent self; but where Mahāyāna Buddhism advocates care or compassion toward all sentient beings, Nietzsche (...) questions the value of compassion, holding that suffering is not bad in itself. Some recent commentators suggest that a text by the Buddhist philosopher Śāntideva offers an argument from “no‐self” to universal compassion. Nietzsche disputes this connection; and Śāntideva's Madhyamaka position, in which nothing has an intrinsic nature, cannot easily counter Nietzsche's claim that suffering is not intrinsically bad. Nietzsche's privileging of states of “becoming,” “discovering,” or “creating” oneself sets him deeply at odds with Buddhism. For Buddhists the fundamentally problematic attitude is a pre‐theoretical sense of self, “egoism,” or “self‐grasping” which is at the root of human craving. Agreeing with the philosophical claim that there is no self is not sufficient to dispel this pre‐theoretical orientation. (shrink)

The concept of right (jus) as a moral power is traced in Leibniz's earliest to latest philosophical work.

Charles Griswold’s 2007 book Forgiveness argues that genuine forgiveness of an unexcused, unjustified and unignored offence must be normgoverned and conditional. In the same way that gift-giving is governed by norms of appropriateness, so too is forgiveness; and the appropriateness of forgiving is centrally dependent on the offender’s repentance. In response, I claim that genuine forgiveness must always be elective and unconditional, and therefore genuinely unpredictable, no matter how much – or how little – the offender repents. I consider and (...) reject one defence of unconditional forgiveness, that of Garrard and McNaughton. I then develop my own account, which builds on Bernard Williams’ notion of practical necessity. (shrink)

Abstract:Schelling’s early philosophy and his ground breaking dynamism sought to present what was beneath the surface of nature, in order to reveal the ideal interiority of nature’s real power, which for Schelling, was teeming with intensities, and forces displaying the unique inner life of the natural world. This paper’s thesis, is an attempt to revive Schelling’s early philosophy and Naturphilosophie, in the hopes of reconfiguring the modern conceptual gaze that has turned the natural world into a lifeless, empty, system. With (...) our current climate crisis on the horizon, a return to Schelling’s philosophy is an urgent endeavor and a call to philosophical arms in order to re-create a new relationship between modern humanity and nature, which ultimately seeks to grasps the organic world as not only productive, but also creative and alive. (shrink)

Semantic role is the actual role a participant plays in some real or imagined situation, apart from the linguistic encoding of those situations. Semantic roles, also known as thematic roles, are one of the oldest classes of constructs in linguistic theory. Semantic roles are used to indicate the role played by each entity in a sentence and are ranging from very specific to very general. Also, semantic roles are useful in natural language processing. They have proved attractive because they provide (...) a way of representing commonalities across different uses of the same predicate or across uses of distinct but semantically related predicates that may be obscured because arguments with certain semantic roles may have various syntactic realisations. Thus they provide a level of abstraction for the statement of generalisations concerning a variety of linguistic phenomena. In particular, argument realisation generalisations are often stated over a thematic hierarchy, a ranking of semantic roles. However, semantic roles have not lived up to their initial promise. It has proved impossible to find a small set of roles that can be applied across all verbs in a language, let alone across languages. Advances in Research on Semantic Roles provide more sustained discussion of the notion of semantic role. It often traces the development of the notion, as well as its place within current linguistic theory. In addition, it introduces several approaches to semantic role inventories, highlighting the similarities and differences among them, and discusses the limitations both of particular approaches and of semantic role approaches in general. Semantic roles continue to be useful in stating linguistic generalisations, and so descriptive, if not theoretical, uses of semantic role labels persist across subfields, including language acquisition, psycholinguistics, and neurolinguistics. (shrink)

We present a novel algorithm for the fast computation of PageRank, a hyperlink-based estimate of the “importance” of Web pages. The original PageRank algorithm uses the Power Method to compute successive iterates that converge to the principal eigenvector of the Markov matrix representing the Web link graph. The algorithm presented here, called Quadratic Extrapolation, accelerates the convergence of the Power Method by periodically subtracting off estimates of the nonprincipal eigenvectors from the current iterate of the Power Method. In Quadratic Extrapolation, (...) we take advantage of the fact that the first eigenvalue of a Markov matrix is known to be 1 to compute the nonprincipal eigenvectors using successive iterates of the Power Method. Empirically, we show that using Quadratic Extrapolation speeds up PageRank computation by 50- 300% on a Web graph of 80 million nodes, with minimal overhead. (shrink)