Background: Family members are often required to act as substitute decision-makers when health care or research participation decisions must be made for an incapacitated relative. Yet most families are unable to accurately predict older adult preferences regarding future health care and willingness to engage in research studies. Discussion and documentation of preferences could improve proxies' abilities to decide for their loved ones. This trial assesses the efficacy of an advance planning intervention in improving the accuracy of substitute decision-making and increasing (...) the frequency of documented preferences for health care and research. It also investigates the financial impact on the healthcare system of improving substitute decision-making. Methods/DesignDyads (n = 240) comprising an older adult and his/her self-selected proxy are randomly allocated to the experimental or control group, after stratification for type of designated proxy and self-report of prior documentation of healthcare preferences. At baseline, clinical and research vignettes are used to elicit older adult preferences and assess the ability of their proxy to predict those preferences. Responses are elicited under four health states, ranging from the subject's current health state to severe dementia. For each state, we estimated the public costs of the healthcare services that would typically be provided to a patient under these scenarios. Experimental dyads are visited at home, twice, by a specially trained facilitator who communicates the dyad-specific results of the concordance assessment, helps older adults convey their wishes to their proxies, and offers assistance in completing a guide entitled My Preferences that we designed specifically for that purpose. In between these meetings, experimental dyads attend a group information session about My Preferences. Control dyads attend three monthly workshops aimed at promoting healthy behaviors. Concordance assessments are repeated at the end of the intervention and 6 months later to assess improvement in predictive accuracy and cost savings, if any. Copies of completed guides are made at the time of these assessments. DiscussionThis study will determine whether the tested intervention guides proxies in making decisions that concur with those of older adults, motivates the latter to record their wishes in writing, and yields savings for the healthcare system. Trial RegistrationISRCTN89993391. (shrink)

Negative Concord (NC) constructions such as the news anchor didn’t warn nobody about the floods (meaning “the news anchor warned nobody”), in which two syntactic negations contribute a single semantic one, are stigmatized in English, while their Negative Polarity Item (NPI) variants, such as the news anchor didn’t warn anybody about the floods, are prescriptively correct. Because acceptability is often equated with grammaticality, this pattern has led linguists to treat NC as ungrammatical in “Standard” or standardized English (SE). However, it (...) is possible that SE grammars do generate NC sentences, and their low incidence and acceptability is instead due to social factors. To explore this question, and the relationship between NC and NPI constructions, we compared the acceptability of overtly negative noun phrases (e.g., nobody ), NPIs (e.g., anybody), and bare plurals (e.g., people ), in negative contexts and in conditionals. Negative items were followed by a consequence which supported their single negative meaning, while conditional items were followed by a consequence compatible with the NPI and the bare plural but not the negative noun phrase. Acceptability ratings of the critical NC sentences were reliably lower than constructions with NPIs and bare plurals, but the consequences for all three of these sentence types were rated highly. This reflects an asymmetry in participants’ acceptance of NC and their readiness to interpret it in context. A follow-up study with only conditionals revealed that speakers can also find NPIs infelicitous in conditional contexts with consequences that are compatible with a negative interpretation of the NPI, and that negative arguments are felicitous in these same contexts. Taken together, the results support the hypothesis that speakers who do not accept NC have grammars that generate both NC and NPI constructions, and further, that these speakers have two underlying structures for any -NPIs in English. (shrink)

As interest in aesthetic experience evolved in the eighteenth century, discussions of the sublime located two opposed accounts of its place and use. Ferguson traces these two positions - the Burkean empiricist account and the Kantian formalist one - to argue that they had significance of aesthetics, including recent deconstructive and New Historicist criticism.

Decreasing philanthropic funding from governments and foundations and increasing social needs are putting pressure on nonprofits to generate financial resources in more entrepreneurial ways. This type of social innovation within the nonprofit sector can be facilitated through collaborative alliances with universities, corporations and other public/private partnerships. This paper presents a case study of a university partnership between Institute of Social Innovation at Carnegie Mellon University and the Pittsburgh Social Innovation Accelerator.

This book points the reader toward a renewed sense of wonder and oneness with nature. With balance and beauty Wosmek delivers profound insights combining science, nature, art, philosophy, conscience, and a loving concern for all that lives.

Frances Kamm sets out to draw and make plausible distinctions that would show how and why it is, in some circumstances, permissible to kill some to save many more, but is not so in others. To do so she draws on a famous, and famously artificial, example of Judith Thomson, which illustrates the fact that people intutitively reject some instances of such killings but not others. The irrationality, implausibility and in many cases the self-defeating nature of such distinctions I (...) had attempted to expose in my 'The Survival Lottery' over 25 years ago. I still think these distinctions irrational and implausible and I will try, in this response, to show why this remains the case and why doctrines of additional effects, to however many powers they are taken, remain unhelpful in ethics. (shrink)

When we witness a great actor, musician, or sportsperson performing, we share something of their experience. Only recently has it become clear just how this sharing of experience is realised within the human brain. 'Mirrors in the brain' provides an accessible overview of mirror neurons, written by the man who first discovered them.

This article argues, first, that there is plenty of agreement among philosophers on philosophically substantive claims, which fall into three categories: reasons for or against certain views, elementary truths regarding fundamental notions, and highly conditionalized claims. This agreement suggests that there is important philosophical progress. It then argues that although it's easy to list several potential kinds of philosophical progress, it is much harder to determine whether the potential is actual. Then the article attempts to articulate the truth that the (...) deniers of philosophical progress are latching on to. Finally, it comments on the significance of the agreement and progress. (shrink)

The Trolley Problem Mysteries considers whether who turns the trolley and/or how it is turned affect the moral permissibility of acting and suggests general proposals for when we may and may not harm some people to help others.

Philosophers often find themselves in disagreement with contemporary philosophers they know full well to be their epistemic superiors on the topics relevant to the disagreement. This looks epistemically irresponsible. I offer a detailed investigation of this problem of the reflective epistemic renegade. I argue that although in some cases the renegade is not epistemically blameworthy, and the renegade situation is significantly less common than most would think, in a troublesome number of cases in which the situation arises the renegade is (...) blameworthy in her disagreement with recognized epistemic superiors. I also offer some thoughts on what it would mean for philosophical practice for us to refrain from being renegades. Finally, I show how a new kind of radical skepticism emerges from modest theses regarding the renegade. (shrink)

The purpose of this article is to investigate how cultural meanings associated with the left ventricular assist device inform acceptance and experience of this innovative technology when it is used as a destination therapy. We conducted open-ended, semistructured interviews with family caregivers and patients who had undergone LVAD-DT procedures at six U.S. hospitals. A grounded theory approach was used for the analysis. Thirty-nine patients and 42 caregivers participated. Participants described a sense of obligation to undergo the procedure because of its (...) promise for salvation. However, once the device was implanted, patients described being placed into a liminal state of being neither sick nor healthy, with no culturally scripted role. Consideration of end-of-life decisions was complicated by the uncertainties about how patients with LVADs die. Pre-implantation communications among patient, family, and clinicians should take into account the impact of the technology on meaning, identity, and patient experience. (shrink)

Externalism about the mind holds that the explanation of our representational capacities requires appeal to mental states that are individuated by reference to features of the environment. Externalists claim that ‘narrow’ taxonomies cannot account for important features of psychological explanation. I argue that this claim is false, and offer a general argument for preferring narrow taxonomies in psychology.

It has recently been argued that the success of the connectionist program in cognitive science would threaten folk psychology. I articulate and defend a "minimalist" construal of folk psychology that comports well with empirical evidence on the folk understanding of belief and is compatible with even the most radical developments in cognitive science.

Representationalism, in its most widely accepted form, is the view that the human mind is an information-using system, and that human cognitive capacities are to be understood as representational capacities. This chapter distinguishes several distinct theses that go by the name "representationalism," focusing on the view that is most prevalent in cogntive science. It also discusses some objections to the view and attempts to clarify the role that representational content plays in cognitive models that make use of the notion of (...) representation. (shrink)

This chapter contains section titled: Methodological Naturalism Internalism The Limits of Naturalistic Inquiry Computation and Content Intentionality and Naturalistic Inquiry.

If you retain your belief upon learning that a large number and percentage of your recognized epistemic superiors disagree with you, then what happens to the epistemic status of your belief? I investigate that theoretical question as well has the applied case of philosophical disagreement—especially disagreement regarding purely philosophical error theories, theories that do not have much empirical support and that reject large swaths of our most commonsensical beliefs. I argue that even if all those error theories are false, either (...) (a) the average philosopher’s true commonsensical beliefs are epistemically impoverished, or (b) a good portion of philosophy is bunk and philosophers should give up most of their error theories despite the fact that their supporting arguments are generally as good as or even better than other philosophical arguments. (shrink)

Philosophical expertise consists in knowledge, but it is controversial what this knowledge consists in. I focus on three issues: the extent and nature of knowledge of philosophical truths, how this philosophical knowledge is related to philosophical progress, and skeptical challenges to philosophical knowledge.

By considering the epistemology and relations among certain philosophical problems, I argue for a disjunctive thesis: either (1) it is highly probable that there are (i) several (ii) mutually independent philosophical reductios of highly commonsensical propositions that are successful—so several aspects of philosophy have succeeded at refuting common sense—or (2) there is enough hidden semantic structure in even simple sentences of natural language to make philosophers highly unreliable at spotting deductive validity in some of the simplest cases—so we are much (...) worse at logic than we think and cannot, in general, know when our own arguments are valid. The untoward consequences of each disjunct are explained. (shrink)

I’m going to argue for a set of restricted skeptical results: roughly put, we don’t know that fire engines are red, we don’t know that we sometimes have pains in our lower backs, we don’t know that John Rawls was kind, and we don’t even know that we believe any of those truths. However, people unfamiliar with philosophy and cognitive science do know all those things. The skeptical argument is traditional in form: here’s a skeptical hypothesis; you can’t epistemically neutralize (...) it, you have to be able to neutralize it to know P; so you don’t know P. But the skeptical hypotheses I plug into it are “real, live” scientific-philosophical hypotheses often thought to be actually true, unlike any of the outrageous traditional skeptical hypotheses (e.g., ‘You’re a brain in a vat’). So I call the resulting skepticism Live Skepticism. Notably, the Live Skeptic’s argument goes through even if we adopt the clever anti-skeptical fixes thought up in recent years such as reliabilism, relevant alternatives theory, contextualism, and the rejection of epistemic closure. Furthermore, the scope of Live Skepticism is bizarre: although we don’t know the simple facts noted above, many of us do know that there are black holes and other amazing facts. (shrink)

An analysis of the Third Man Argument, especially in light of Constance Meinwald's book Plato's Parmenides. I argue that her solution to the TMA fails. Then I present my own theory as to what Plato's solution was.

Those of us who take skepticism seriously typically have two relevant beliefs: (a) it’s plausible (even if false) that in order to know that I have hands I have to be able to epistemically neutralize, to some significant degree, some skeptical hypotheses, such as the brain-in-a-vat (BIV) one; and (b) it’s also plausible (even if false) that I can’t so neutralize those hypotheses. There is no reason for us to also think (c) that the BIV hypothesis, for instance, is plausible (...) or probably true. In order to take skepticism seriously it’s sufficient to hold (a) and (b); one need not hold (c). Indeed, philosophers who accept (a) and (b) never endorse (c). Show me a philosopher who suspects that he is a brain in a vat and I’ll show you someone who is deranged! That’s one thing that bothers undergraduates in philosophy. They object: why on earth do some philosophers take the BIV hypothesis to pose any threat at all to our beliefs given that those very same philosophers think that there’s no real chance that the BIV hypothesis is true? Sure, the BIV hypothesis is formally inconsistent with my belief that I have hands, so if the former is true then my belief is false. But so what? Why should that bare inconsistency matter so much? Is this strange attitude amongst philosophers the result of some logic fetish infecting the philosophical community? It is sometimes said that the skeptical hypotheses are not only inconsistent with our beliefs but are explanatory of our experiences, which is supposed to make them more of a threat. But students aren’t fooled: although the skeptical hypotheses may attempt to explain why our experience is as it is, it’s the kind of attempt appropriate for science fiction movies that are all special effects and virtually no plot. No one with any sense of reality will take the evil demon hypothesis to be even tenuously explanatory. (shrink)

A common kind of explanation in cognitive neuroscience might be called functiontheoretic: with some target cognitive capacity in view, the theorist hypothesizes that the system computes a well-defined function (in the mathematical sense) and explains how computing this function constitutes (in the system’s normal environment) the exercise of the cognitive capacity. Recently, proponents of the so-called ‘new mechanist’ approach in philosophy of science have argued that a model of a cognitive capacity is explanatory only to the extent that it reveals (...) the causal structure of the mechanism underlying the capacity. If they are right, then a cognitive model that resists a transparent mapping to known neural mechanisms fails to be explanatory. I argue that a functiontheoretic characterization of a cognitive capacity can be genuinely explanatory even absent an account of how the capacity is realized in neural hardware. (shrink)

Abstract Finding the western just war criterion of reasonable chance of success to be a contribution to ethical decision making about armed conflict requires dealing with a number of critiques. Specifying ?probability? rather than the alternatives ?hope? or ?chance?, and raising standards of evidence involved, makes the term less vague. Expanding the concept of ?success? to include morally defensible aims that can be achieved without military victory enriches the understanding of the moral relationship between ends and means in armed conflict. (...) Asking decision makers to accept moral responsibility for the costs of possible failure is a unique contribution to the just war criteria. The enriched concept of reasonable probability of success thus offers morally significant insights to prewar jus ad bellum decisions, and can benefit ethical decision-making about whether to continue once fighting has begun. (shrink)

Phenomenology is a well‐founded qualitative methodology that is frequently used by nurse researchers and considered of value when addressing research questions in nursing practice and nurse education. However, at present, nurse researchers using phenomenology tend to divide phenomenological methodology into the descriptive and interpretive formats. The nursing literature suggests that there is a deep divide between researchers following the methodological underpinnings and basic precepts pertaining to these two camps. If we are to reach a clearer understanding of the theory underlying (...) phenomenological methods it would be more helpful if we started to recognise that there are also important associations between transcendental and interpretive phenomenology. One such association is that a paradigm of movement exists that is not unique to transcendental and interpretive phenomenology but is common to them, as well as being inherent within a variety of fields of study. If we consider the universality of such imagery, looking to examples through parallel texts, we can obtain insights into phenomenology and its transposition into a workable scientific method that can be of use to the nurse researcher. (shrink)

For years philosophers argued for the existence of distinct yet materially coincident things by appealing to modal and temporal properties. For instance, the statue was made on Monday and could not survive being flattened; the lump of clay was made months before and can survive flattening. Such arguments have been thoroughly examined. Kit Fine has proposed a new set of arguments using the same template. I offer a critical evaluation of what I take to be his central lines of reasoning.

Ever since Berkeley discussed the problem at length in his Essay Toward a New Theory of Vision, theorists of vision have attempted to explain why the moon appears larger on the horizon than it does at the zenith. Prevailing opinion has it that the contemporary perceptual psychologists Kaufman and Rock have finally explained the illusion. This paper argues that Kaufman and Rock have not refuted a Berkeleyan account of the illusion, and have over-interpreted their own experimental results. The moon illusion (...) remains unexplained, and a Berkeleyan account is still a contender. (shrink)

As an example of Aristophanic literary criticism the portrayal of Agathon in the prologue of theThesmophoriazusaehas been rather overshadowed by the poetry contest of theFrogs. This is largely because more can be said about parody when something substantial of the author parodied has survived.1Before many of the specific difficulties of the Agathon scenes we have no alternative but to confess our ⋯πορ⋯α.On the other hand, we need not despair of understanding the general point of these scenes, and in this the (...) most helpful method is that of identifying those Aristophanic techniques which shaped them. This method has already taken us a good way forward, so that there is no need now to argue for the structural integrity of these scenes2or their thematic relevance to the play.3Accordingly, in this paper I will discuss the portrayal of Agathon in relation to typical Aristophanic techniques. My main concern, however, will be with the significance of the different conceptions of literature raised in the course of the parody, Agathon being satirized in turn as an inspired poet, a craftsman poet and an effeminate poet. I hope to show that, for Aristophanes, Agathon's effeminacy is as much a reflection of his art as of his personality. (shrink)