Abstract Context: Established in 1997, Summa Health System’s Medical Ethics Committee (EC) serves as an educational, supportive, and consultative resource to patients/families and providers, and serves to analyze, clarify, and ameliorate dilemmas in clinical care. In 2009 the EC conducted its 100th consult. In 2002 a Palliative Care Consult Service (PCCS) was established to provide supportive services for patients/families facing advanced illness; enhance clinical decision-making during crisis; and improve pain/symptom management. How these services affect one another has thus far been (...) unclear. Objectives: This study describes EC consults: types, reasons, recommendations and utilization, and investigates the impact the PCCS may have on EC consult requests or recommendations. Methods: Retrospective reviews of 100 EC records explored trends and changes in types of consults, reasons for consults, and EC recommendations and utilization. Results: There were 50 EC consults each in the 6 years pre- and post-PCCS. Differences found include: (1) a decrease in number of reasons for consult requests (133–62); (2) changes in top two reasons for EC consult requests from ‘Family opposed to withdrawing life-sustaining treatment (LST)’ and ‘Patient capacity in question’ to ‘Futility’ and ‘Physician opposed to providing LST’; (3) changes in top two recommendations given by the EC from ‘Emotional Support for Patient/Family’ and ‘Initiate DNR Order’ to ‘Comfort Care’ and ‘Withdraw Treatment.’ Overall, 88% of recommendations were followed. Conclusion: PCCS availability and growth throughout the hospital may have influenced EC consult requests. EC consults regarding family opposition to withdrawing LST and EC recommendations for patient/family support declined. Content Type Journal Article Pages 1-16 DOI 10.1007/s10730-011-9170-9 Authors Jessica Richmond Moeller, Department of Psychiatry and Behavioral Sciences, Akron General Medical Center, 400 Wabash Ave, Akron, OH 44307, USA Teresa H. Albanese, Health Services Research and Education Institute, Summa Health System and Northeast Ohio Medical University, 55 Arch St., Suite 1A, Akron, OH 44304, USA Kimberly Garchar, Kent State University, 6000 Frank Ave., N.W, North Canton, OH 44720, USA Julie M. Aultman, Department of Family and Community Medicine, Northeast Ohio Medical University, P.O. Box 95, Rootstown, OH 44272, USA Steven Radwany, Palliative Care and Hospice Services, Summa Health System and Northeast Ohio Medical University, 55 Arch St., Suite 1A, Akron, OH 44304, USA Dean Frate, Internal Medicine, Palliative Care and Hospice Services, Summa Health System and Northeast Ohio Medical University, 55 Arch St., Suite 1A, Akron, OH 44304, USA Journal HEC Forum Online ISSN 1572-8498 Print ISSN 0956-2737. (shrink)

Many contemporary philosophers accept a strong generalization of Hume's denial of necessary causal connections, in the form of Hume's dictum (HD), according to which there are no metaphysically necessary connections between distinct, intrinsically typed entities. Hume's version of his dictum occurs during his investigation into the source of the idea of causal connection. The most powerful role that HD plays in Lewis's system concerns its providing a basis for, as Lewis puts it, a "principle of plentitude" that will guarantee "that (...) the worlds are abundant, and logical space is somehow complete". Lewis's combinatorialism promises to provide a principled, extensionally adequate, and reductive generator of metaphysical modal space. Beyond combinatorialism, there are many other accounts of metaphysical modality that need to be considered, not just with an eye to extensional adequacy but also to the clear desideratum to provide an account of the space of metaphysical modality that is principled. (shrink)

Aim of the study was to analyze the posttraumatic stress disorder risk nurses, detecting the relationship between distress experience and personality dimensions in Italian COVID-19 outbreak. A cross-sectional study was conducted based on 2 data detection. Mental evaluation was carried out in Laboratory of Clinical Psychology on n.69 nurses in range age 22–64 years old. Measurement was focused on symptoms anxiety, personality traits, peritraumatic dissociation and post-traumatic stress for all participants. No online screening was applied. Comparisons within the various demographic (...) characteristics demonstrated few significant differences between groups on DASS-21, PDEQ, and ISE-R scores. Correlation analysis was performed among PDEQ, DASS-21, BFI-10 and IES-R and confirmed between anxiety and peritraumatic dissociation and post-traumatic stress; then anxiety is positively correlated to agreeableness variable of BFI-10 test. The emotional distress was protracted overtime but in long-term personality traits resulted mediator facing subjective stress. Our finding drew details for protective and predictive risk factors as well as mental health issues of nurses dealing with pandemic: healthcare workers faced the protracted challenge caring COVID-19 patients over and over again: in short time the impact was relevant, and the prolonged exposition to the stressor was tackled by personal resources such as personality traits. (shrink)

Disability through the Lens of Justice offers a contextual framework for considering the limitations that disability places on individuals. Specifically, those that prevent individuals from having control in certain domains of their life, by restricting the availability of acceptable options or the ability to choose between them. Begon argues that our theory of justice should be concerned with the lives individuals can lead, and not with whether their bodies and minds function typically. The problem that disability raises is not the (...) mere fact of difference, but the ways in which that difference is accommodated (or not) and the limitations it may cause. In Disability Through the Lens of Justice, Begon offers a new framework to the disability and justice model. She argues that achieving justice does not require 'normalisation', or the elimination of difference, but through implementating a model which enables all individuals to control their lives as they choose. (shrink)

The premises that a four foot man is short and that a man one tenth of an inch taller than a short man is also short entail by universal instantiation and "modus ponens" that a seven foot man is short. The negation of the second premise seems to entail there are virtually no borderline cases of short men, While to deny the second premise and its negation conflicts with the principle of bivalence, If not excluded middle. But the paradox can (...) be dissolved without resort to degrees of truth or any non-Classical system of logic. If some true predications can be semantically uncertain in a sense suitable for defining borderline cases, The second premise can be denied without denying the vagueness of "short" or reintroducing a sorites paradox along with higher order borderline cases. (shrink)

This chapter presents an overview of the issues that arise when logic is used in helping to understand problems in intelligent reasoning and to guide the design of mechanized reasoning systems. It provides some historical and technical details concerning nonmonotonic logic and reasoning about action and change, a topic that is not only central in artificial intelligence but that is normally of considerable interest to philosophers. The remaining sections provide brief sketches of selected topics, with references to the primary literature.

This paper attempts to revive a once-lively program in the philosophy of language—that of reducing linguistic phenomena to facts about mental states and actions. I argue that recent skepticism toward this project is generated by features of traditional implementations of the project, rather than the project itself. A picture of language as essentially a mechanism for cooperative information exchange attracted theorists to metasemantic accounts grounding language use in illocutionary action (roughly, using an utterance to elicit a propositional attitude). When this (...) picture is rejected, a metasemantics grounding language in locutionary action (using an utterance to direct attention) emerges as a more viable proposal, dissolving an intractable issue for traditional theories: The metasemantics of subsentential expressions. (shrink)

This paper explores in detail an argument for epistemic expressivism, what we call the Argument from Motivation. While the Argument from Motivation has sometimes been anticipated, it has never been set out in detail. The argument has three premises, roughly, that certain judgments expressed in attributions of knowledge are intrinsically motivating in a distinct way (P1); that motivation for action requires desire-like states or conative attitudes (HTM); and that the semantic content of knowledge attributions cannot be specified without reference to (...) the intrinsically motivating judgments that such attributions express (P2). We argue that these premises entail a version of ecumenical expressivism. Since the argument from motivation has not been explicitly stated before, there is no current discussion of the argument. In this paper we therefore consider and reject various objections that one might propose to the argument, including some that stem from the idea that knowledge is factive, or that knowledge involves evidence that rules out relevant alternatives. Other objections to (P1) specifically might be derived from cases of apparent lack of epistemic motivation considered in in Kvanvig (The value of knowledge and the pursuit of understanding, 2003) and Brown (Nous 42(2):167–189, 2008), as well as from general forms of externalism about epistemic motivation. We consider these and find them wanting. Finally, the paper offers some critical remarks about the prospect of denying (P2). (shrink)

This paper defends the use-based metasemantic project against the problem of meaning without use, which allegedly shows the predictions of use-based metasemantic accounts to be indeterminate with respect to unusably long or complex expressions. This criticism is commonly taken to be decisive, prompting various retreats and contributing to the project’s eventual decline. Using metasemantic conventionalism as a case study, I argue the following: either such expressions do not belong to used languages or their meanings are uniquely determined by use. Thus, (...) the alleged problem of meaning without use offers no challenge to the use-based metasemantic project generally, nor to conventionalism in particular. (shrink)

Henri Bergson's philosophy, which Sartre studied as a student, had a profound but largely neglected influence on his thinking. In this paper I focus on the new light that recognition of this influence throws on Sartre's central argument about the relationship between negation and nothingness in his Being and Nothingness. Sartre's argument is in part a response to Bergson's dismissive, eliminativist account of nothingness in Creative Evolution (1907): the objections to the concept of nothingness with which Sartre engages are precisely (...) those raised by Bergson. Even if Sartre's account of nothingness in its entirety is found to be flawed, I argue that the points he makes specifically against Bergson are powerful. My discussion concludes with a brief examination of the wider philosophical background to Sartre's and Bergson's discussion of nothingness: here I point to some important aspects of Sartre's early philosophy, including some features of his conception of nothingness, that may testify to Bergson's positive influence on his thought. (shrink)

Health‐related Quality of Life measures have recently been attacked from two directions, both of which criticize the preference‐based method of evaluating health states they typically incorporate. One attack, based on work by Daniel Kahneman and others, argues that ‘experience’ is a better basis for evaluation. The other, inspired by Amartya Sen, argues that ‘capability’ should be the guiding concept. In addition, opinion differs as to whether health evaluation measures are best derived from consultations with the general public, with patients, or (...) with health professionals. And there is disagreement about whether these opinions should be solicited individually and aggregated, or derived instead from a process of collective deliberation. These distinctions yield a wide variety of possible approaches, with potentially differing policy implications. We consider some areas of disagreement between some of these approaches. We show that many of the perspectives seem to capture something important, such that it may be a mistake to reject any of them. Instead we suggest that some of the existing ‘instruments’ designed to measure HR QoLs may in fact successfully already combine these attributes, and with further refinement such instruments may be able to provide a reasonable reconciliation between the perspectives. (shrink)

A Better Ape covers the evolution of morality from the birth of our ape family through the evolution of human species and all the way up to the development of modern societies. In this summary, we highlight several main elements of this account: the co-evolution of morality with intelligence and complex sociality; the role of social institutions and religious morality in the cultural evolution of behaviorally modern humans in prehistory; the increasing complexity of the moral mind through biological evolution in (...) apes, gene-culture co-evolution in various human species, cultural evolution in Homo sapiens, and rational-cultural evolution in recent centuries; and, finally, a cultural evolutionary model of progressive and regressive moral change on which a key factor driving moral progress is social and democratic integration. (shrink)

O autor Darlei Dall’Agnol é formado em Filosofia pela Universidade de Caxias do sul e cursou mestrado em Filosofia na Universidade Federal do Rio Grande do Sul, com uma dissertação sobre ética e linguagem em Wittgestein; fez Doutorado em Filosofia na Universidade de Bristol, Inglaterra, defendendo tese sobre valor intrínseco na ética de Moore. Publicou vários livros na área de Ética e possui inúmeros artigos e capítulos de livros publicados no Brasil e no exterior. Algumas das obras desse autor são: (...) Ética e Linguagem: uma Introdução ao Tractatus de Wittgenstein, Valor Intrínseco – Metaética, ética normativa e ética prática em G. E. Moore, ambas com publicação em 2005. (shrink)

This paper explores how Pope Francis’ critique of “the technocratic paradigm” in Laudato Si’ can contribute to an environmental ethics governed by asymmetries of power and agency. The technocratic paradigm is here theorized as linked to forms of anthropocentrism that together engender a dangerous alliance between the powers of technology and technologies of power. The meaning and import of this view become clearer when the background of these ideas gets excavated in the works of Romano Guardini. The contemporary manifestation of (...) Guardini’s warnings appears in the form of myriad environmental injustices wrought by structures of power linked to technology. To counter such injustices, we must discern which types of technologies to develop and how to limit technocratic approaches for the sake of other values. The integral ecological outlook favored by Francis may be interpreted as a kind of eco-politics, or even, controversially, an eco-technology, with the cultivation of technologies of contemplation. Applying Peter Sloterdijk’s conceptions of anthropotechnics and monogeism to the Ignatian Exercises animating the Jesuit Francis’ work, we can see how such technologies hold potential for Catholicism to collaborate better with secular strategies in relating to Earth’s agency in a new eco-politics. Such an eco-politics could furnish an alternative to bio-politics, especially if governed by aspects of the Franciscan form-of-life identified by Giorgio Agamben. Such a project ultimately moves us beyond Laudato Si’ and the work of Romano Guardini, pointing up the limitations of Laudato Si’ in engaging the agency of the Earth. (shrink)

This instalment of suggestions is put forward with all the diffidence one is bound to feel after an examination of the great body of the manuscripts. No great writer's text has hung upon a more slender thread of evidence. Larger matters than verbal emendation are touched upon in the discussion of poem LXVIII. My theory of how our texts became dislocated , and some new light I hope to throw upon the form and meaning of the Peleus and Thetis, must (...) be withheld until a later occasion. (shrink)

At a certain stage of advance in any science it may be well to re-examine and perhaps to rearrange its fundamentals. One seeks an ideal, logical order of development, which may or may not be the best pedagogical order. Many a high school beginner in physics has become acquainted with “force” as something that gets in between two bodies of matter and pulls them together or pushes them apart, like himself between two carts or like “magnetism” between two magnets. Whether (...) or not this might ever be a proper view, the mature student of today will consider that for him, a knowledge of accelerations and strains, inter alia, is prerequisite to a knowledge of force. (shrink)

I argue that a counterexample proposed by donald nute shows only that past tenses involve indexical restriction to a limited domain of times. The purpose of this note is to defend the thesis that there is a single conditional connective figuring in both indicative and 'had'--'would' connectives, And that the differences in logical form between the two sorts of english conditional expressions have to do with tense.

From its beginnings in Aristotle, logic was intended to account not only for reasoning that is theoretical (or conclusion-oriented), but for reasoning that is practical (or actionoriented). However, despite an interest in the topic that continues to the present, the practical side of reasoning has remained broadly speculative. At least in some domains (mathematics, in particular), there are well developed proof-theoretic and semantic theories that yield quite detailed models of correct reasoning, and these models are useful for both theoretical and (...) practical purposes. In contrast, the logical work on practical reasoning has remained broadly speculative and disengaged from applications. Logical formalisms have not been forthcoming that would be useful either in designing an agent that needs to act intelligently, or in helping an intelligent agent to evaluate its reasoning about action. (shrink)

Around 1998, internet postings began appearing under the alias ‘ Timetravel_0 ’. This alias was later replaced by ‘John Titor’, and it's as such I'll designate the posts' author. Remarkably, Titor claimed to have time-travelled from 2036 on a mission to retrieve an IBM 5100 in 1975. Titor refrained from public appearances and any evidence for his story remains web-bound but before closing shop c. March 24 th 2001, he described various future events, e.g.: Y2K is a disaster. Many people (...) die on the highways when they freeze to death trying to get to warmer weather. Cancellation of the Olympics after 2004 due to world conflict. America will soon be engaged in civil war with itself; a civil war that we'll see the beginnings of during 2004 and 2005, escalating until it is indisputable by 2008. This equivocal civil war fizzles until global nuclear war kills three billion people in 2015. (shrink)

This Common Knowledge guest column is a partly comical, partly biographical speculation on how Anthony Woodville, brother-in-law of King Edward IV, passed the time while being held under guard at the “Newe Inn” Norwich, from August 20 to 25, 1469.

Women, particularly those in public positions (e.g. journalists, politicians, celebrities, activists) are subject to disproportionate amounts of abuse on social media platforms like Twitter. This abuse occurs in a landscape that those platforms designed, and maintain. Focusing in particular on Twitter, as typical of the kind of platform we’re interested in, we argue that it is the platform not (usually) the individuals who use it, that bears collective responsibility as a corporate agent for misogyny. Social media platforms, however, should not (...) overstep the prevention of misogyny into interference in open political debates. (shrink)

Presents profiles of such well-known authors and celebrities as Susan Sontag, Beverly Sills, Bernard Malamud, Isaac Bashevis Singer, and Joseph Brodsky.

Combining time travel with certain kinds of supertask, this paper proposes a novel model for Hell. Temporally-closed spacetimes allow otherwise impossible opportunities for material kinds of damnation and reveal surprising limitations on metaphysical objections to Hell. Prima facie, eternal damnation requires either infinite amounts of time or time for the damned to speed-up arbitrarily. However, spatiotemporally finite ‘time travel’ universes can host unending personal torment for infinitely many physical beings, while keeping fixed finite limits on rates of temporal passage. Such (...) ‘Hilbert's Inferno’ spacetimes suggest neither materialism nor the finitude of time and space need forbid Hell. A material Hell can be spatiotemporally finite yet eternal for its inhabitants. Hilbert's Inferno also sheds light on Hell's location and accessibility, and shows that some spacetimes are intrinsically better suited to punishment than reward. (shrink)

Blok makes a compelling case for renewed consideration of philosophical method in the pressing context of environmental threats, plunging readers into the depths of Heidegger’s philosophical method...

Significant changes in the natural environment over the past 40 years pose key challenges to health and health care in the 21st century. Health care has not yet given serious attention to what the current environmental situation means for human health, or for maintaining an effective health care system. Bioethics is in a good position to help health professionals engage environmental questions. But bioethics, as a field, will first need to explore and integrate ecological thinking —thinking based in the concept (...) of connectedness and committed to viewing humans are part of nature rather than exempt from it. (shrink)