Aim: Patients with advanced cancer need information about end-of-life treatment options in order to make informed decisions. Clinicians vary in the frequency with which they initiate these discussions.Patients and methods: As part of a long-term longitudinal study, patients with an expected 2-year survival of less than 50% who had advanced gastrointestinal or lung cancer or amyotrophic lateral sclerosis were interviewed. Each patient’s medical record was reviewed at enrollment and at 3 months for evidence of the discussion of patient wishes concerning (...) ventilator support, artificial nutrition and hydration , resuscitation and hospice care. A Kaplan–Meier analysis was also performed and 2-year survival calculated.Results: 60 cancer and 32 ALS patients were enrolled. ALS patients were more likely than cancer patients to have evidence of discussion about their wishes for ventilator support , ANH , DNR and hospice care . At 6 months, 91% of ALS patients were alive compared with 62% of cancer patients; at 2 years, 63% of ALS patients were alive compared with 23% of cancer patients .Conclusions: Cancer patients were less likely than ALS patients to have had documented advanced care planning discussions despite worse survival. This may reflect perceptions that ALS has a more predictable course, that advanced cancer has a greater number of treatment options, or differing views about hope. Nevertheless, cancer patients may be less adequately prepared for end-of-life decision-making. (shrink)

Purpose: Physicians are often reluctant to discuss “Do Not Resuscitate” orders with patients. Although perceived self-efficacy is a known prerequisite for behavioural change, little is understood about the confidence of physicians regarding DNR discussions.Subjects and methods: A survey of 217 internal medicine attendings and 132 housestaff at two teaching hospitals about their attitudes and confidence regarding DNR discussions.Results: Participants were significantly less confident about their ability to discuss DNR orders than to discuss consent for medical procedures , and this was (...) true for both attendings and housestaff . In a multivariate logistic model of confidence regarding DNR discussions, women were less confident than men ; house officers were less confident than attendings , those who were less confident of their ability to discuss medical procedures were less confident discussing DNR , and those who found talking to patients about DNR orders very difficult reported less confidence than those who did not .Conclusion: We conclude that physicians’ confidence regarding DNR discussions is low compared with their confidence regarding other medical discussions and that confidence varies by sex and perceived difficulty of the task. Efforts to improve DNR discussions should explore the need to tailor educational interventions to fit these characteristics. (shrink)

The issue is obscured by the fact that the word `space' can be used in four different ways. It can be used, first, as a term of pure mathematics, as when mathematicians talk of an `n-dimensional phase-space', an `n-dimensional vector-space', a `three-dimensional projective space' or a `twodimensional Riemannian space'. In this sense the word `space' means the totality of the abstract entities-the `points'-implicitly defined by the axioms. There is no doubt that there exist, iii this sense, non-Euclidean spaces, because all (...) that is claimed by such an assertion is that sets of non-Euclidean axioms constitute possible implicit definitions of abstract entities, that is to say that some sets of non-Euclidean axioms are consistent. If Kant or any other philosopher had denied this, he would have been wrong; but Kant himself took care not to deny it, 2 and there is little reason to suppose that any philosopher concerned about space has been using the word in this, the pure mathematician's, sense. (shrink)

According to the thought experiment most commonly used to argue against reliabilism, Mr. Truetemp is given an unusual but reliable cognitive faculty. Since he is unaware of the existence of this faculty, its deliverances strike him as rather odd. Many think that Truetemp would not have justified beliefs. Since he satisfies the reliabilist conditions for justified belief, reliabilism appears to be mistaken. I argue that the Truetemp case is underdescribed and that this leads readers to make erroneous assumptions about Truetemp's (...) epistemic situation. After examining empirical studies of actual subjects who, like Truetemp, have received new perceptual faculties, I show that Truetemp must have been endowed with all of the reorganized neural circuitry and cognitive skills that subjects with new perceptual faculties normally acquire during a long and difficult process of adaptation and development. When readers realize how much more the designers of Truetemp's new faculty had to do than simply slip an artificial device under Truetemp's scalp, I find that they no longer think his beliefs would be unjustified. Because the thought experiment fails to support anti-reliabilist intuitions when further details of the case are made explicit, the Truetemp thought experiment does not constitute a clear and decisive counterexample to reliabilism. (shrink)

My sights in this paper are trained on facts. Most people think that they know what facts are; that while their friends often, and themselves occasionally, are ignorant of the facts, at least they know what sort of things facts are---they can recognise a fact when they see it. Facts, in the popular philosophy of today, are good, simple souls; there is no guile in them, nor any room for subjective bias, and once we have made ourselves acquainted with them, (...) we have reached the beginning and summit of all wisdom. (shrink)

The intention of this paper is to suggest that the educational philosophy of Allan Bloom merits renewed consideration, and that such consideration reveals major failings in contemporary educational philosophy. A prerequisite of such consideration is an examination of the ways in which his ideas have been misinterpreted. In particular, Bloom is neither a political conservative nor an educational traditionalist, nor an advocate of the Great Books programme. Bloom's recovery of the Socratic or classical political rationalist approach to education both reveals (...) enormous shortcomings in the dominant conceptions of the nature of philosophy of education, and revitalises an alternative conception already widely accepted among classicists and political philosophers. (shrink)

§1. The origins of recursion theory. In dedicating a book to Steve Kleene, I referred to him as the person who made recursion theory into a theory. Recursion theory was begun by Kleene's teacher at Princeton, Alonzo Church, who first defined the class of recursive functions; first maintained that this class was the class of computable functions ; and first used this fact to solve negatively some classical problems on the existence of algorithms. However, it was Kleene who, in his (...) thesis and in his subsequent attempts to convince himself of Church's Thesis, developed a general theory of the behavior of the recursive functions. He continued to develop this theory and extend it to new situations throughout his mathematical career. Indeed, all of the research which he did had a close relationship to recursive functions.Church's Thesis arose in an accidental way. In his investigations of a system of logic which he had invented, Church became interested in a class of functions which he called the λ-definable functions. Initially, Church knew that the successor function and the addition function were λ-definable, but not much else. During 1932, Kleene gradually showed1 that this class of functions was quite extensive; and these results became an important part of his thesis 1935a. (shrink)

A plural referring expression (‘the Fs’ or ‘Tom, Dick and Harriet’) may be used to refer either distributively, saying something which applies to each of the Fs individually, or collectively, to the Fs taken as a single totality. Predicate Logic has to analyse both uses in terms of singular reference, treating them quite differently in so doing; but we think of such an expression as functioning in basically the same way in both kinds of use. This understanding can be vindicated (...) if we recognise that what a plural referring expression picks out is not either an aggregate simpliciter or a set, but a plurality– an aggregate taken relative to a principle for individuating its constituents; this admits of being seen either as many things or as one. In any given case, it is the nature of what is being said about the plurality which tells us whether the reference to it is to be taken as distributive, collective, or a combination of the two. Talk about pluralities is extensional. Augmenting Predicate Logic to accommodate the distinctive inference‐pattern associated with distributive plural reference is simple – and arguably necessary, to cope with cases in which distributive and collective reference are essentially combined (e.g., attributions of concerted action). (shrink)

5-43 This article aims to consider the robust field of environmental history as a whole, as it stands and as it has developed over the past twenty-five years around the world. It necessarily adopts a selective approach but still offers more breadth than depth. It treats the links between environmental history and other fields within history, and with other related disciplines such as geography. It considers the precursors of environmental history, its emergence since the 1970s, its condition in several settings (...) and historiographies. Finally it touches on environmental history’s relationship to social theory and to the natural sciences as they have evolved in recent decades. It concludes that while there remains plenty of interesting work yet to do, environmental history has successfully established itself as a legitimate field within the historical profession, and has a bright future, if perhaps for discouraging reasons. (shrink)

It is human nature to try to recognize patterns and to make sense of that which we observe. Unfortunately, our intuition is often wrong, and so there is a need to impose some objectivity on the methods by which observations are converted into knowledge. One definition of biostatistics could be precisely this, the rigorous and objective conversion of medical and/or biological observations into knowledge. Both consumers of biostatistical principles and biostatisticians themselves vary in the extent to which they recognize the (...) need to continue the improvement. Some may not recognize the need for (some or all of) the methods that have already been developed; others may accept these as they find them completely sufficient; still others recognize both the value and the shortcomings of these methods, and seek to develop even better methods to ensure that future medical conclusions are less subject to biases than current ones are. (shrink)

Hume’s view of reason is notoriously hard to pin down, not least because of the apparently contradictory positions which he appears to adopt in different places. The problem is perhaps most clear in his writings concerning induction - in his famous argument of Treatise I iii 6 and Enquiry IV, on the one hand, he seems to conclude that “probable inference” has no rational basis, while elsewhere, for example in much of his writing on natural theology, he seems happy to (...) acknowledge that such inference is not only reasonable, but is even a paradigm of reasoning against which the theistic arguments must be judged. In the face of this apparent contradiction, many recent commentators have proferred “non-sceptical” interpretations of Hume’s argument concerning induction, but in this paper I sketch an alternative and perhaps less radical method of resolving the problem, by identifying a major threefold ambiguity in Hume’s use of the word “reason”. On this interpretation, Hume indeed sees induction as a paradigm of reasonableness in what is arguably the most important sense, but he nevertheless believes induction to be entirely non-reasonable in another sense, which though less important in common life is nevertheless very significant philosophically. A comparison with Locke can help to illuminate Hume’s position, which though indeed not entirely sceptical about induction, is by no means entirely non-sceptical either. (shrink)