RationaleSurrogates of critically ill patients often have inaccurate expectations about prognosis. Yet there is little research on how intensive care unit clinicians should discuss prognosis, and existing expert opinion-based recommendations give only general guidance that has not been validated with surrogate decision makers.ObjectiveTo determine the perspectives of key stakeholders regarding how prognostic information should be conveyed in critical illness.MethodsThis was a multicenter study at three academic medical centers in California, Pennsylvania, and Washington. One hundred eighteen key stakeholders completed in-depth semistructured (...) interviews. Participants included 47 surrogates of adult patients with acute respiratory distress syndrome; 45 clinicians working in study ICUs, including physicians, nurses, social workers, and spiritual care providers; and 26 experts in health communication, decision science, ethics, family-centered care, geriatrics, healthcare disparities, palliative care, psychology, psychiatry, and critical care.Measurements and main resultsThere was broad support among surrogates for existing expert recommendations, including truthful prognostic disclosure, emotional support, tailoring the disclosure strategy to each family's needs, and checking for understanding. In addition, stakeholders offered suggestions that add specificity to existing recommendations, including: In addition to conveying prognostic estimates, clinicians should help families "see the prognosis for themselves" by showing families radiographic images and explaining the clinical significance of physical manifestations of severe disease at the bedside. Many physicians did not support using numeric estimates to convey prognosis to families, whereas many surrogates, clinicians from other disciplines, and experts believed numbers could be helpful. Clinicians should conceptualize prognostic communication as an iterative process that begins with a preliminary mention of the possibility of death early in the ICU stay and becomes more detailed as the clinical situation develops. Although prognostic information should be initially disclosed by physicians, other members of the multidisciplinary team-nurses, social workers, and spiritual care providers-should be given explicit role responsibilities to reinforce physicians' prognostications and help families process a poor prognosis emotionally.ConclusionsFamily members, clinicians, and experts identified specific communication behaviors that clinicians should use to discuss prognosis in the critical care setting. These findings extend existing opinion-based recommendations and should guide interventions to improve communication about prognosis in ICUs. (shrink)

The Practice of Value is an exploration of a pervasive but puzzling aspect of our world: value. The starting-point is the Berkeley Tanner Lectures delivered in 2001 by the leading moral theorist Joseph Raz. His aim is to make sense of the dependence of value on social practice, without falling back on cultural relativism. The lectures are followed by discussions from three eminent philosophers, Christine Korsgaard, Robert Pippin, and Bernard Williams, and a response from Raz. The result is a fascinating (...) debate, accessible to readers throughout and beyond philosophy, about the relations between human values and human life. (shrink)

The Hedgehog, the Fox, and the Magister's Pox is a controversial discourse, rich with facts and observations gathered by one of the most erudite minds of our ...

In this paper I do three things. Firstly, I defend the view that in his most familiar arguments about morality and the theological postulates, the arguments which appeal to the epistemological doctrines of the first Critique, Kant is as much of a fictionalist as anybody not working explicitly with that conceptual apparatus could be: his notion of faith as subjectively and not objectively grounded is precisely what fictionalists are concerned with in their talk of nondoxastic attitudes. Secondly, I reconstruct a (...) logically distinct argument to a fictionalist conclusion which I argue Kant also gives us, this time an argument to the conclusion that it is a good thing if our commitment to the existence of God is nondoxastic. And finally, I argue that this argument is of continuing interest, to Kantians and non-Kantians alike, not only because it raises interesting questions about the relation of morality to belief in God (which go in the opposite direction to most discussions, which focus on whether and to what extent belief in God can be an aid to morality), but also because this ‘Moral Hazard Argument’ seems to be available to religious realists and non-realists alike, thus suggesting that religious fictionalism is not by any means just an interesting version of religious non-realism. (shrink)

Based on the author's nearly 30 years' of teaching introductory philosophy — and his observations of where beginning readers run into difficulty — this compact “primer” gives readers the basic tools they need to explore philosophical reading and writing for the first time. Provides insights and strategies for helping readers get started with reading, thinking about, and discussing philosophical concepts and writing short philosophical essays about what they've been reading and thinking; includes a new chapter that illustrates techniques for probing (...) beneath the expository surface of a given question to uncover the inevitable structure of presuppositions and problems underlying it. (shrink)

In recent years, there has much attention given by philosophers to the ubiquitous role of models and modeling in the biological sciences. Philosophical debates has focused on several areas of discussion. First, what are models in the biological sciences? The term ‘model’ is applied to mathematical structures, graphical displays, computer simulations, and even concrete organisms. Is there an account which unifies these disparate structures? Second, scientists routinely distinguish between theories and models; however, this distinction is more difficult to draw in (...) the biological sciences since biologists often only have a variety of models and rarely have something like a fundamental theory. What then is a theory in biology? Third, how are models related to empirical or “target” systems? (shrink)

Recently, there has been a rise in pessimism concerning what theoretical ecology can offer conservation biologists in the formation of reasonable environmental policies. In this paper, I look at one of the pessimistic arguments offered by Kristin Shrader-Frechette and E. D. McCoy (1993, 1994)--the argument from conceptual imprecision. I suggest that their argument rests on an inadequate account of the concepts of ecological stability and that there has been conceptual progress with respect to complexity-stability hypotheses. Such progress, I maintain, can (...) supply important resources for conservation biologists in determining environmental policies. (shrink)

We often think of trust as an interpersonal relation, and of the distinction between trust and reliance as a distinction between kinds of interpersonal relations. Indeed this is often the case. I may trust one colleague but not find her reliable; rely on another but find him untrustworthy; both trust and rely on my best friend; neither trust nor rely on my dean. One of us has discussed the nature of such relations and distinctions at length. But trust is not (...) only an interpersonal matter. Human society comprises not only individuals but also institutions, and indeed individuals who occupy crucial institutional roles. We often individually or collectively trust, distrust, rely on, or fail or refuse to rely on such institutions or institutional players qua players. In this essay we explore the structure, scope and value of such institutional trust and distrust, which we call “public trust.” Public trust, we will argue, plays a central role in constituting the public sphere and in structuring societies in which it is worth living. (shrink)

Hume raises the issue of how common life and philosophy are related. He presents the possibility that they are irreconcilably opposed, that philosophy rigorously and honestly pursued must lead to skepticism. I discuss some prominent interpretive issues about Hume in light of this opposition between common life and philosophy. I also argue that this opposition is a deep and general philosophical problem, and sketch an approach to this problem. ;These are my interpretive claims: I argue that Hume has constructive aims (...) in his epistemology, and that he is surprised when his naturalism subverts these constructive aims and leads to skepticism. I argue that Hume does not entertain a moral skepticism similar to his skepticism about the external world and causal relations, but that he should have entertained such a skepticism. I argue that, in the Dialogues, Philo does not concede that religious belief is natural and therefore secure despite its unreasonableness. Rather, Philo contends that religious belief is not natural, and contends that this lack of naturalness gives us principled grounds for preferring causal and moral beliefs to natural ones. However, I argue, the problem of general philosophical skepticism keeps this religious skepticism from being satisfactory. ;I use the interpretation of Hume to clarify and deepen Hume's Problem, and to begin working toward a solution of that problem. I argue that there is a perspective we can take up that makes skepticism about the status of our physical and moral beliefs and practices seem inevitable. To resolve Hume's Problem, we must show that this perspective is the wrong perspective on human life, or at least that there is some alternative perspective that does not lead to skepticism but is no less rational than the perspective that does lead to skepticism. (shrink)

The doctrine of informed consent, borrowed from the law of torts, cannot be readily transplanted into therapeutic settings. The broader, as yet unrealized, idea of informed consent, which suggests that parties must make decisions jointly, should guide interactions between physicians and patients or investigators and subjects.

Among Carl Schmitt's most notable and controversial contributions to political theory was his claim that “all the significant concepts of the modern doctrine of the state are secularized theological concepts.” First formulated in 1922 in his Political Theology, this contention remained constant throughout his long career, as evidenced by its return in his Political Theology II, published in 1970. Here Schmitt's Cadtholic background was clearly apparent, for in so arguing, he was recapitulating the familiar topos of biblical prefiguration in which (...) the New Testament was understood as realizing the latent meaning of the Old. Viewing modern politics as merely the secularized version of a prior theology allowed Schmitt to develop his strong notion of the sovereign as a profane divinity with virtually all of the omnipotent attributes of its alleged sacred predecessor. (shrink)

Philosophers of the life sciences have devoted considerably more attention to evolutionary theory and genetics than to the various sub-disciplines of ecology, but recent work in the philosophy of ecology suggests reflects a growing interest in this area (Cooper 2003; Ginzburg and Colyvan 2004). However, philosophers of biology and ecology have focused almost entirely on conceptual and methodological issues in population and community ecology; conspicuously absent are foundational investigations in ecosystem ecology. This situation is regrettable. Ecosystem concepts play a central (...) role in many branches of theoretical and applied ecology, and in environmental literature generally. Indeed, for some historians, the division of ecological theory into population-community and ecosystem research traditions, and the methodological and conceptual debates that have arisen between workers in these respective camps, is the distinguishing feature of 20th century ecological science (Hagen 1992). These include debates over, among others: reductionistic vs. holistic research methodologies; the existence and metaphysics of ecological “kinds”; the relationship between evolutionary mechanisms and ecosystem phenomena; and the nature and scope of ecological science and its relationship to other branches of natural and social science. Philosophers of ecology have written on all these topics, but almost exclusively from the theoretical perspective of population, community or evolutionary ecology. Philosophical attention to these issues from the perspective of ecosystem ecology is long overdue. It would be misleading to assert that philosophers in general have ignored ecosystem ecology. Environmental philosophers, including environmental ethicists so-called “radical” environmental philosophers (deep ecologists, social ecologists, ecofeminists, etc.), and policy theorists, have had a long-standing interest in ecosystem ecology (e.g. Callicott 1986; Cahen 1988; Warren and Cheney 1993; Westra 1994; Sagoff 1997; Fitzsimmons 1999).. (shrink)

The question of Hegel's views on Buddhism and its place within his system must be asked again as the history of effects, transmission, and reception continues to unfold. This unfolding highlights not only Hegel's effect on the Western European reception and understanding of Buddhism (and its sharp orientalist critique), but also the canny use of Hegel's philosophy by certain members of the so-called Kyoto School of Japanese neo-Buddhist philosophy, who, though primarily concerning themselves with Heidegger, were notable in their creative (...) use of Hegel's philosophy of spirit (especially Nishida, Nishitani, Tanabe, and Abe). Our present task is likewise to look back to Hegel's own writing on Buddhism through the lens of the history of its effects—that is, to read Hegel again with his legacy in mind—so that we might, as strange as it may perhaps seem, see things more clearly. Our goal is relatively modest, as it aims only to seek out and coordinate Buddhism within Hegel's history of philosophy. Thus, as we have a proximate goal in mind, we also have an order of importance with respect to Hegel's texts, which, of course, brings the Lectures on the History of Philosophy to the fore. (shrink)

Christopher D. Stone has claimed that natural objects can and should have rights. I accept Stone’s premise that the possession of rights is tied to the possession of interests; however, I argue that the concept of a natural object needs a more careful analysis than is given by Stone. Not everything that Stone calls a natural object is an object “naturally.” Some must be taken as artificial rather than as natural. Thistype of object cannot be said to have intrinsic interests (...) and hence cannot be given rights that can protect “its own sake”-which is the sort of right that Stone focuses on. Further, there are other sorts of natural objects which, although they are objects “naturally,” cannot meaningfully be said to have intrinsic interests, and thus cannot have the sorts of rights that Stone is concerned with. Finally, there are other sorts of natural objects which are objects naturally and which have intrinsic interests, but which are not proper candidates for the possession of rights. The prerequisites for being “owed” rights are the possession of intrinsic interests and the capability to suffer when those interests are interfered with or denied or threatened. (shrink)

In this paper we argue that the phenomenon of evidentiality, the grammatical marking in some languages of the source of one's knowledge, gives us a revealing window into the developmental processes in middle childhood that subserve the achievement of narrative competence. First, we argue that the mastery of evidentiality is connected to the development of an understanding of inference, and of the ability to mobilize this understanding in the construction of human narratives. Second, we examine the role that parent-child discourse (...) plays in clarifying the contrastive uses of sources of knowledge. Finally, we discuss the difference between first person and third person narratives, and suggest that evidentials might reveal something of the sources of evidence for persistence of self as the protagonist in one's own life story. (shrink)