The Patient Self Determination Act of 1991 brought much needed attention to the importance of advance care planning and surrogate decision-making. The purpose of this law is to ensure that a patient’s preferences for medical care are recognized and promoted, even if the patient loses decision-making capacity. In general, patients are presumed to have DMC. A patient’s DMC may come under question when distortions in thinking and understanding due to illness, delirium, depression or other psychiatric symptoms are identified or suspected. (...) Physicians and other healthcare professionals working in hospital settings where medical illness is frequently comorbid with depression, adjustment disorders, demoralization and suicidal ideation, can expect to encounter ethical tension when medically sick patients who are also depressed or suicidal request do not resuscitate orders. (shrink)

Much of today's writing on medical ethics is strong on philosophical theory or on legal speculation, but weak on practice. In this book, practitioners in a wide range of specialties describe the process of making ethical decisions in their everyday work. A moral philosopher analyzes their conclusions, and the theological implications are developed by a Christian theologian and Rabbinic scholar. Thorough and eclectic, this book should be read by all who seek the good of the profession of medicine.

Contents: Ethical principals for environmental protection / Robert Goodin -- Political representation for future generations / Gregory S. Kavka and Virginia L. Warren -- On the survival of humanity / Jan Narveson -- On deep versus shallow theories of environmental pollution / C.A. Hooker -- Preservation of wilderness and the good life / Janna L. Thompson -- The rights of the nonhuman world / Mary Anne Warren -- Are values in nature subjective or objective? / Holmes Rolston III - (...) Duties concerning islands / Mary Midgley -- Gaia and the forms of life / Stephen R.L. Clark -- Western traditions and environmental ethics / Robin Attfield -- Traditional American Indian and traditional western European attitudes toward nature / J. Baird Callicott -- Roles and limits of paradigms in environmental thought and action / Richard Routley. [Book Synopsis]. (shrink)

Cognitive neuroscience is an interdisciplinary enterprise aimed at explaining cognition and behavior. It appears to be succeeding. What accounts for this apparent explanatory success? According to one prominent philosophical thesis, cognitive neuroscience explains by discovering and describing mechanisms. This "mechanist thesis" is open to at least two interpretations: a strong metaphysical thesis that Carl Craver and David Kaplan defend, and a weaker methodological thesis that William Bechtel defends. I argue that the metaphysical thesis is false and that the methodological thesis (...) is too weak to account for the explanatory promise of cognitive neuroscience. My argument draws support from a representative example of research in this field, namely, the neuroscience of decision-making. The example shows that cognitive neuroscience explains in a variety of ways and that the discovery of mechanisms functions primarily as a way of marshaling evidence in support of the models of cognition that are its principle unit of explanatory significance. -/- The inadequacy of the mechanist program is symptomatic of an implausible but prominent view of scientific understanding. On this view, scientific understanding consists in an accurate and complete description of certain "objective" explanatory relations, that is, relations that hold independently of facts about human psychology. I trace this view to Carl Hempel's logical empiricist reconceptualization of scientific understanding, which then gets extended in Wesley Salmon's causal-mechanistic approach. I argue that the twin objectivist ideals of accuracy and completeness are neither ends we actually value nor ends we ought to value where scientific understanding is concerned. -/- The case against objectivism motivates psychologism about understanding, the view that understanding depends on human psychology. I propose and defend a normative psychologistic framework for investigating the nature of understanding in the mind sciences along three empirically-informed dimensions: 1) What are the ends of understanding? 2) What is the nature of the cognitive strategy that we deploy to achieve those ends; and 3) Under what conditions is our deployment of this strategy effective toward achieving those ends? To articulate and defend this view, I build on the work of Elliot Sober to develop a taxonomy of psychologisms about understanding. Epistemological psychologism, a species of naturalism, is the view that justifying claims about understanding requires appealing to what scientists actually do when they seek understanding. Metaphysical psychologism is the view that the truth-makers for claims about understanding include facts about human psychology. I defend both views against objections. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Living Organ Donors’ Stories: (Unmet) Expectations about Informed Consent, Outcomes, and CareElisa J. Gordon, Symposium EditorKeywordsEthics, informed consent, kidney, liver, living donor, narrative, transplantationLiving donor organ transplantation has become standard treatment for patients with end-stage kidney or end-stage liver disease. Live donors comprised approximately 5,769 (34%) and 247 (4%) of all kidney and liver transplants in 2011, respectively (OPTN/UNOS). The reasons why people donate, the perception that donating (...) does not entail a decision per se, and the attendant fears and anxieties living donors feel about donating, have all been previously well investigated (Lennerling, Forsberg, Meyer, & Nyberg, 2004; Papachristou, Walter, Frommer, & Klapp, 2010). But much less is known about how donors experienced the overall donation process including the donor evaluation, preparation, appreciation of risks, decision-making, informed consent, post-operative, recovery processes, and the impact of donating on all aspects of their life, from their point of view. Thus, a narrative approach is essential for gaining insights into these less well known phenomena.There is good reason to remain concerned about the safety and ethical basis of living donation considering that living donors undergo serious health risks for no direct medical benefit to themselves (Ethics Committee of the Transplantation Society, 2004; Laird, 2012; Neergaard, 2011; Ratner & Sandoval, 2010; Shelton, 2011). The situation raises serious ethical questions specifically about nonmaleficence and informed consent, and more broadly about using people as a means to an end. The absence of long-term information may not undermine a willing donor’s commitment to save a loved one’s life, but is certainly cause for concern among transplant clinicians who want to be sure to disclose information that may be material for donors in order to provide adequate informed consent. In other words, the disjuncture between what transplant clinicians find important to disclose to donors and what prospective donors need to know—which follows along the lines of what Elliot Mishler referred to as the ‘voice of medicine’ versus the ‘voice of the lifeworld’(1984)—seems to complicate donors’ preparation for donation. Donors’ stories are important for addressing these concerns by identifying risks that typically do not get reported in the scientific literature—perhaps owing to a different [End Page 1] conceptualization of what should be construed as noteworthy risks—as well as by demonstrating how personal situations can enhance or detract from the experience overall.This issue of Narrative Inquiry in Bioethics (NIB) affords a unique entrée into both the often heard and unheard stories of living organ donors. A set of topical areas were presented for the authors’ consideration that relate to the donation process in general and the informed consent process more specifically: whether donors were prepared to donate; comprehended what they were told; could have understood the process better, as well as, the impact of donation on health, employment, finances, and personal relationships (Table 1). When soliciting donors’ stories, every effort was made to include a full range of experiences—both good and bad—from a variety of donors: kidney donation, liver donation, adult-to-adult and adult-to-child donation, related, unrelated, directed and anonymous (also known as ‘altruistic’ or ‘good Samaritan’ donors), paired chain exchange, and list exchange (Table 2)—in order to present a balanced perspective on live donation. Additionally, this issue includes a full breadth of stories about the donor experience, ranging from positive to mixed to negative (Table 3). While donors were given tremendous leeway in what stories they told, they were asked to focus their narratives on the lesser known dimensions of donation—the experience of it. While additional stories from liver donors would have helped to underscore common concerns among liver donors, we only received a few. Some of the donors are themselves health care professionals, active in the United Network for Organ Sharing (UNOS) or their local OPO, or have leveraged their experiences to help others by becoming a donor buddy or donor advocate. Given that we received more stories than Click for larger view View full resolutionTable 1.Topical areas to address[End Page 2] Click for larger view View full resolutionTable 2.Forms of Living Donation Click for larger view View... (shrink)

Volume 19, Issue 9, September 2019, Page 54-56.

Most research on aboriginal mind and mental health has sought to apply or confirm preexisting European-derived theories among aboriginal people. Culture has been underappreciate. An understanding of uniquely aboriginal models for mind and mental health might lead to more effective and robust interventions. To address this issue, a core group of elders from five separate regions of North America was developed to help determine how aboriginal people conceived of mind, self, and identity before European contact. The process utilized for this (...) study is iterative and involves discussions of teachings, traditional stories, and elder's comments on conclusions drawn. The elders endorsed a relational theory of mind in which mind exists between people as a product of the stories told and created within and by that relationship. Mind is distinguished from consciousness which is without language and exists within the individual as awareness. Language immediately results in an "out there" orientation in which two or more individuals generate stories about their experiences. The community is the basic unit of study for mind and mental health, and mental "illness" is not distinguished from physical "illness," but rather all are seen as a continuum of suffering and pain. What emerged from this research is that North American theories of mind are more closely related to Daoist and Shinto theories than to the logical positivism which drives most of North America's conventional psychology and psychiatry. Within European traditions, however, the philosophy of Mikhail Bakhtin with his emphasis on a dialogical self coupled with system theory comes closest to resembling North American aboriginal theories. This model explains why ceremony and ritual, community interventions, talking circles, and family therapy are more compatible with aboriginal thought than conventional North American biomedicine and psychology. (shrink)

It is hard to imagine a threat to international security or a tension within U.S. foreign policy that does not involve the imposition of economic sanctions. The United Nations Security Council has fourteen sanctions regimes currently in place, and all member states of the United Nations are obligated to participate in their enforcement. The United States has some thirty sanctions programs, which target a range of countries, companies, organizations, and individuals, and many of these are autonomous sanctions that are independent (...) of the measures required by the United Nations. Australia, Canada, the European Union, Japan, South Korea, and others also have autonomous sanctions regimes, spanning a broad range of contexts and purpose. Most well-known are those concerning weapons proliferation, terrorism, and human rights violations; but sanctions are also imposed in such contexts as money laundering, corruption, and drug trafficking. States may also impose sanctions as a means to achieve foreign policy goals: to pressure a foreign state to bend to the sanctioner's will, to punish those who represent a threat to the sanctioner's economic or political interests, or to seek the end of a political regime toward which the sanctioner is hostile, to give but a few examples. (shrink)

ABSTRACTMemory bias is a risk factor for depression. In two independent studies, the efficacy of one CBM-Memory session on negative memory bias and depressive symptoms was tested in vulnerable samples. We compared positive to neutral CBM-Memory trainings in highly-ruminating individuals and individuals with elevated depressive symptoms. In both studies, participants studied positive, neutral, and negative Swahili words paired with their translations. In five study–test blocks, they were then prompted to retrieve either only the positive or neutral translations. Immediately following the (...) training and one week later, we tested cued recall of all translations and autobiographical memory bias; and also measured mood, depressive symptoms, and rumination. Retrieval practice resulted in training-congruent recall both immediately after and one week after the training. Overall, there was no differential decrease in symptoms or difference in autobiographical memory bias between the tra... (shrink)

This important handbook provides a comprehensive, authoritative review of achievement motivation and establishes the concept of competence as an organizing ...

This is the second volume of analytical commentary on Wittgenstein's masterpiece, the Philosophical Investigations. Like the first, it consists of philosophical essays and critical exegesis. The six essays deal comprehensively with various themes in Wittgenstein''s philosophy: the relationship between his mathematics and his philosophy of mind; his conception of grammar and rules of grammar; the relation between a rule and what accords with a rule; the characterization of rule-following as mastery of a technique manifest in practice; his notion of a (...) form of life, and of agreement in definitions and judgements; a comprehensive investigation into his account of logical and mathematical necessity and other topics. (shrink)

Background: Genomic analysis may reveal both primary and secondary findings with direct relevance to the health of probands’ biological relatives. Researchers question their obligations to return findings not only to participants but also to family members. Given the social value of privacy protection, should researchers offer a proband’s results to family members, including after the proband’s death? Methods: Preferences were elicited using interviews and a survey. Respondents included probands from two pancreatic cancer research resources, plus biological and nonbiological family members. (...) Hypothetical scenarios based on actual research findings from the two cancer research resources were presented; participants were asked return of results preferences and justifications. Interview transcripts were coded and analyzed; survey data were analyzed descriptively. Results: Fifty-one individuals (17 probands, 21 biological relatives, 13 spouses/partners) were interviewed. Subsequently, a mailed survey was returned by 464 probands, 1,040 biological family members, and 399 spouses/partners. This analysis highlights the interviews, augmented by survey findings. Probands and family members attribute great predictive power and lifesaving potential to genomic information. A majority hold that a proband’s genomic results relevant to family members’ health ought to be offered. While informants endorse each individual’s choice whether to learn results, most express a strong moral responsibility to know and to share, particularly with the younger generation. Most have few concerns about sharing genetic information within the family; rather, their concerns focus on the health consequences of not sharing. Conclusions: Although additional studies in diverse populations are needed, policies governing return of genomic results should consider how families understand genomic data, how they value confidentiality within the family, and whether they endorse an ethics of sharing. A focus on respect for individual privacy—without attention to how the broad social and cultural context shapes preferences within families—cannot be the sole foundation of policy. (shrink)

Summary Benjamin Moore (1867?1922), physiologist and biochemist, was an eminent member of the British scientific and medical community in the early twentieth century. As a founder and president of the State Medical Services Association (SMSA) from its establishment in 1912 until his untimely death in 1922, Moore was a prominent medical services activist and planner in a period of intense debate on health services reform. As a medical scientist, Moore was also a participant in the campaign by laboratory scientists to (...) obtain a larger role in clinical education, research, and medicine in this period. This article examines the medical services activism and ideas of Benjamin Moore. In particular, it seeks to demonstrate how his health services proposals and those he influenced, including SMSA and Labour Party plans, sought to advance the interests of laboratory scientists. (shrink)

Abstract:This essay explores with the help of the discipline of philosophy of education the educational implications of the practice of canceling individuals or ideas. In particular, it investigates what gets lost or undermined when we cancel various opinions, words, and practices. To advance my argument, I first introduce some basic definitions while analyzing the problem with the notion of cancel culture. Then, I briefly review various historical examples of canceling going back to Socrates. The next part of this paper presents (...) some of the philosophical arguments against canceling and restricting speech made by John Stuart Mill. After presenting Mill’s contentions in favor of liberty of expression, I revisit John Dewey’s conception of democratic association in order to show that the practice of canceling people and ideas is antithetical to Dewey’s dynamic view of democracy. Based on the insights of Mill and Dewey, in the final part I attempt to make an educational case against the practice of canceling. (shrink)

An examination of tool marks and other evidence of manufacturing techniques on two astrolabes of identical pattern made by Hartman of Nuremberg in 1537 shows that all of the parts have been laid out with scribers and filed to final dimensions. All parts except the rings of the maters, which are castings, are made of sheet brass. The only machine tool employed was a small lathe with longitudinal feed, which was used to turn the diameters of the pins. Corresponding dimensions (...) of the two astrolabes differ by less than 0·2 mm on average, but parts are not interchangeable between the instruments. There is evidence that this pattern of astrolabe was made in batches with division of labour in Harman's shop. This paper is an introductory study intended to show methods of examination that reveal manufacturing techniques. (shrink)

Advancing a creolizing reading of the eighteenth-century philosopher, Jean-Jacques Rousseau, this volume explores Rousseau’s strong resonances in Caribbean thought and politics.

It is well known that we owe the term ‘aesthetics’ in its philosophical sense to the 18th century German philosopher Alexander Baumgarten. The eighteenth century's interest in aesthetics, however, pre-dated the invention of the term. In 1725, Francis Hutcheson published an Inquiry into the Original of Our Idea of Beauty and Virtue. This may be said to be the first sustained and significant work in philosophical aesthetics as we now know it. Hutcheson's volume preceded Baumgarten's by 10 years, and within (...) Scotland it inaugurated a series of philosophical writings on taste and beauty that continued for almost a century. Contributors included major philosophical figures like David Hume, Thomas Reid and Adam Smith, as well as influential figures less well known today such as Alexander Gerard, George Turnbull and Lord Kames. (shrink)

This paper aims to show how philosophical debates about the nature of music as an art can throw light on one of the problems raised by Plato’s Euthryphro—how can human beings serve the gods?—and applies this to the use of music in worship. The paper gives a broad overview of expressivist, representationalist and formalist philosophies of music. Drawing in part on Hanslick, Nietzsche and Schleiermacher, it argues that formalism as a philosophy of sacred music can generate an answer to Plato’s (...) problem. (shrink)

This introduction outlines the core debates in the 8-piece symposium dedicated to critically engaging Amartya Sen’s The Idea of Justice. Among these is whether the establishment communities that are Sen’s primary interlocutors could ever be allies in the projects of freedom and social transformation that he so powerfully elucidated and the relationship of general theories of justice to the choice of some empirical examples over those that emerge from the places in the global South where conditions of self-determination for citizens (...) are most lacking. While asking whether we need a political ideal beyond justice, the richness of the articles and Sen’s very substantive reply are testament to his profound contribution both to scholarship and as a model alternative to the often unjust and ungenerous character of the contemporary academy. (shrink)

Commentators since antiquity have seen connections between Virgil's Dido and the philosophy of the Garden, and several recent studies have drawn attention to the echoes of Lucretius in the first and fourth books of the Aeneid. This essay proposes that there is an even richer and more extensive Epicurean presence intertwined with the Dido episode. Although Virgilian quotations of Lucretius provide the most obvious references to Epicureanism, too narrow a focus on the traces of the De Rerum Natura obscures important (...) resonances with Virgil's more obvious models: the Odyssey and Apollonius' Argonautica. Reversion to Homer and Apollonius, however, does not dim the Epicurean aura around Dido. Rather: echoes of Nausikaa and other Phaeacian traditions reinforce Dido's links with the Garden. At play here is a widespread ancient tradition of disparaging Epicurus by calling him "the Phaeacian philosopher." But by evoking this tradition, Virgil is not necessarily engaging in a standard polemic against the Epicureans. Instead of foreclosing any particular reading, the intertextual modes of the Aeneid turn various possibilities of interpretation over to the reader. (shrink)

Gordon Finlayson's response to Peter Gordon’s Adorno and Existence.