Unrepresented patients—people without capacity to make medical decisions who also lack a surrogate decision‐maker—form a large and vulnerable population within the United States health care system. The burden of unrepresentedness has rightly prompted widespread calls for more and better advance care planning, in which still‐healthy patients are encouraged to designate a surrogate decision‐maker and thus avoid the risk of becoming unrepresented. However, we observe that some patients, even with available social contacts and access to adequate advance care planning services, simply (...) decline to name a surrogate decision‐maker. We propose a novel concept of “informed refusal of representation” (“IRR”) to characterize the position held by some such patients, who are often overlooked in prior work on unrepresentedness. We then discuss physicians’ ethical obligations in the face of such a refusal and avenues by which physicians can support patients without surrogates in receiving goal‐concordant care. (shrink)

The most comprehensive collection of essays on Descartes' scientific writings ever published, this volume offers a detailed reassessment of Descartes' scientific work and its bearing on his philosophy. The 35 essays, written by some of the world's leading scholars, cover topics as diverse as optics, cosmology and medicine, and will be of vital interest to all historians of philosophy or science.

Genetic variation in fitness is the fundamental prerequisite for adaptive evolutionary change. If there is no variation in survival and reproduction or if this variation has no genetic basis, then the composition of a population will not evolve over time. Consequently, the factors influencing genetic variation in fitness have received close attention from evolutionary biologists. One key factor is the mode of reproduction. Indeed, it has long been thought that sex enhances fitness variation and that this explains the ubiquity of (...) sexual reproduction among eukaryotes. Nevertheless, theoretical studies have demonstrated that sex need not always increase genetic variation in fitness. In particular, if fitness interactions among beneficial alleles (epistasis) are positive, sex can reduce genetic variance in fitness. Empirical data have been sorely needed to settle the issue of whether sex does enhance fitness variation. A recent flurry of studies1-4 has demonstrated that sex and recombination do dramatically increase genetic variation in fitness and consequently the rate of adaptive evolution. Interpreted in light of evolutionary theory, these studies rule out positive in these experiments epistasis as a major source of genetic associations. Further studies are needed, however, to tease apart other possible sources. BioEssays 25:533–537, 2003. © 2003 Wiley Periodicals, Inc. (shrink)

Background Some have hypothesized that talk about suffering can be used by clinicians to motivate difficult decisions, especially to argue for reducing treatment at the end of life. We examined how talk about suffering is related to decision-making for critically ill patients, by evaluating transcripts of conversations between clinicians and patients’ families.Methods We conducted a secondary qualitative content analysis of audio-recorded family meetings from a multicenter trial conducted in the adult intensive care units of five hospitals from 2012–2017 to look (...) at how the term “suffering” and its variants were used. A coding guide was developed by consensus-oriented discussion by four members of the research team. Two coders independently evaluated each transcript. We followed an inductive approach to data analysis in reviewing transcripts; findings were iteratively discussed among study authors until consensus on key themes was reached.Results Of 146 available transcripts, 34 (23%) contained the word “suffer” or “suffering” at least once, with 58 distinct uses. Clinicians contributed 62% of first uses. Among uses describing the suffering of persons, 57% (n = 24) were related to a decision, but only 42% (n = 10) of decision-relevant uses accompanied a proposal to limit treatment, and only half of treatment-limiting uses (n = 5) were initiated by clinicians. The target terms had a variety of implicit meanings, including poor prognosis, reduced functioning, pain, discomfort, low quality of life, and emotional distress. Suffering was frequently attributed to persons who were unconscious.Conclusions Our results did not support the claim that the term “suffering” and its variants are used primarily by clinicians to justify limiting treatment, and the terms were not commonly used in our sample when decisions were requested. Still, when these terms were used, they were often used in a decision-relevant fashion. (shrink)

One challenge for those reading methodological debates in low consensus fields is determining the outcome when participants do not share standards. When parties to a debate do not agree on the standards to be used in assessing their arguments (i.e., quality), it may be useful to ask first if parties’ contributions meet their own expectations (i.e., integrity). Most protocols for review of qualitative research specify some form of quality assessment. These protocols normally require some test of internal coherence. Coherence is (...) also relevant when describing the match between a rebuttal and the argument it answers. In 2019,Nursing Inquirypublished a critique and rebuttal of the methods used by the Joanna Briggs Institute. In this essay, we attempted to use the Joanna Briggs Institute's own quality assessment standards to assess their rebuttal of this fundamental critique. We found it possible to use the Joanna Briggs Institute's own quality assessment standards to assess this rebuttal, and we found that JBI's rebuttal did not meet their own standards. (shrink)

Michael Peters, Sonja Arndt & Marek TesarThis is a collective writing experiment of PESA members, including its Executive Committee, asking questions of the Philosophy of Education in a New Key. Co...

Here is a question as intriguing as it is brief: what are we? The animalist’s answer is equal in brevity: we are animals. This stark formulation of the animalist slogan distances it from nearby claims—that we are essentially animals, for example, or that we have purely biological criteria of identity over time. Is the animalist slogan—unburdened by modal or criterial commitments—still interesting, though? Or has it lost its bite? In this article we address such questions by presenting a positive case (...) for the importance of animalism and applying that case to recent critiques. (shrink)

Grossmann's argument for the “fearful ape hypothesis” rests on an incomplete review of infant responses to emotional faces. An alternate interpretation of the literature argues the opposite, that an early preference for happy faces predicts cooperative learning. Questions remain as to whether infants can interpret affect from faces, limiting the conclusion that any “fear bias” means the infant is fearful.

‘There is no place in the phenomenology of fully absorbed coping’, writes Hubert Dreyfus, ‘for mindfulness. In flow, as Sartre sees, there are only attractive and repulsive forces drawing appropriate activity out of an active body’1. Among the many ways in which history animates dynamical systems at a range of distinctive timescales, the phenomena of embodied human habit, skilful movement, and absorbed coping are among the most pervasive and mundane, and the most philosophically puzzling. In this essay we examine both (...) habitual and skilled movement, sketching the outlines of a multidimensional framework within which the many differences across distinctive cases and domains might be fruitfully understood. Both the range of movement phenomena which can plausibly be seen as instances of habit or skill, and the space of possible theories of such phenomena are richer and more disparate than philosophy easily encompasses. We seek to bring phenomenology into contact with relevant movements in psychological theories of skilful action, in the belief that phenomenological philosophy and cognitive science can be allies rather than antagonists. (shrink)

In some musical genres, professional performers play live shows many times a week. Arduous touring schedules bring encounters with wildly diverse audiences across many different performance ecologies. We investigate the kinds of creativity involved in such repeated live performance, kinds of creativity that are quite unlike songwriting and recording, and examine the central factors that influence musicians’ wellbeing over the course of a tour. The perspective of the professional musician has been underrepresented in research on relations between music and wellbeing, (...) with little attention given to the experience of touring. In this case study, we investigate influences on positive and negative performance experiences for the four professional musicians of Australian pop/rock band Cloud Control. Geeves conducted intensive cognitive ethnographic fieldwork with Cloud Control members over a two-week national Australian tour for their second album, Dream Cave (2013). Adapting a Grounded Theory approach to data analysis, we found the level of wellbeing musicians reported and displayed on tour to be intimately linked to their creative performance experiences through the two emergent, overarching and interdependent themes of Performance Headspace (PH) and Connection with Audience (CA). We explore these themes in detail and provide examples to demonstrate how PH and CA can feed off each other in virtuous ways that positively shape musicians’ wellbeing, or loop in vicious ways that negatively shape musicians’ wellbeing. We argue that their creative practice, in thus re-enacting musical performance afresh in each venue’s distinctive setting, emerges within unique constraints each night, and is in a sense a co-creation of the crowd and the band. (shrink)

Infantologies is a collective writing project designed to express and summarise important ideas, approaches and forms of advocacy in a short and condensed method, in order to present a network of d...

This paper addresses both semantic issues of countability in linguistics, and philosophical issues arising from the problem of the many. I argue (i) that the problem of the many is orthogonal to vagueness and we should look to the semantics of count nouns and numerals for its solution; (ii) that the problem of the many is a challenge for contemporary mereological analyses of count nouns in semantics; but (iii) that the count criterion in these theories can be weakened to avoid (...) the problem. Specifically, _weak quantization_ is proposed as the criterion: a sum, _x_, counts as _n_ _P_s if and only if _x_ has _n_ disjoint parts, each of which is in the extension of _P_, but where the sum of no two of them is also in the extension of _P_. I show how importing this idea into the semantics of numerals provides a semantic means of dissolving the paradox. (shrink)

The philosophers of Late Antiquity have sometimes appeared to be estranged from society. 'We must flee everything physical' is one of the most prominent ideas taken by Augustine from Platonic literature. This collection of new studies by leading writers on Late Antiquity treats both the principles of metaphysics and the practical engagement of philosophers. It points to a more substantive and complex involvement in worldly affairs than conventional handbooks admit.

Expert skill in music performance involves an apparent paradox. On stage, expert musicians are required accurately to retrieve information that has been encoded over hours of practice. Yet they must also remain open to the demands of the ever-changing situational contingencies with which they are faced during performance. To further explore this apparent paradox and the way in which it is negotiated by expert musicians, this article profiles theories presented by Roger Chaffin, Hubert Dreyfus and Tony and Helga Noice. For (...) Chaffin, expert skill in music performance relies solely upon overarching mental representations, while, for Dreyfus, such representations are needed only by novices, while experts rely on a more embodied form of coping. Between Chaffin and Dreyfus sit the Noices, who argue that both overarching cognitive structures and embodied processes underlie expert skill. We then present the Applying Intelligence to the Reflexes (AIR) approach?a differently nuanced model of expert skill aligned with the integrative spirit of the Noices? research. The AIR approach suggests that musicians negotiate the apparent paradox of expert skill via a mindedness that allows flexibility of attention during music performance. We offer data from recent doctoral research conducted by the first author of this article to demonstrate at a practical level the usefulness of the AIR approach when attempting to understand the complexities of expert skill in music performance. (shrink)

How do concert pianists commit to memory the structure of a piece of music like Bach’s Italian Concerto, learning it well enough to remember it in the highly charged setting of a crowded performance venue, yet remaining open to the freshness of expression of the moment? Playing to this audience, in this state, now, requires openness to specificity, to interpretation, a working dynamicism that mere rote learning will not provide. Chaffin, Imreh and Crawford’s innovative and detailed research suggests that the (...) key to this skill is a declarative mental roadmap aiding musical performance. This hypothesis is neatly and unintentionally summarized by professional pianist Imreh, who states when learning a new piece of music “My fingers were playing the notes just fine. The practice I needed was in my head. I had to learn to keep track of where I was. It was a matter of learning exactly what I needed to be thinking of as I played, and at exactly what point. (shrink)

Many of us are inclined to accept something like the following principle: We can only be properly morally assessed for what is in our control. And yet our ordinary practices seem to frequently violate this principle. The resulting tension, and the attempt to resolve it, is the problem of moral luck. For example, we tend to punish and think worse of the negligent driver who kills a child than we do the equally negligent driver who was lucky there was no (...) child in his path. Thus, the lucky outcomes of our actions do seem to affect the extent to which we hold and are held responsible, but these are not things over which we exercise control. And, as Thomas Nagel famously illustrated in his response to Bernard Williams (the two of which papers form the founding documents of the moral luck debate), the influence of luck is not limited to outcomes. For the circumstances in which we find ourselves and, indeed, our very constitution are also shaped by luck. Since the publication of Williams's and Nagel's papers, the existence and breadth of moral luck has been hotly debated. This debate is not a mere intellectual trifle but, as the essays in this volume illustrate, a debate which lies at the heart of free will, responsibility, identity, causation, and self-creation. (shrink)

A research project by the Schools of Theology and Psychology of Australia’s Charles Sturt University surveyed a large sample of Salvation Army officers. This article considers survey responses to two questions relating to end-of-life care: the use of pain medications that may shorten life, and the cessation of fluid and food intake. The results of the analyses are evaluated in terms of Michael Banner’s proposal that moral theology should more assiduously converse with ‘patient ethnographic study’, which the survey instantiates to (...) some extent. Banner’s proposal and the results of the survey are contrasted to Peter Singer’s analytical moral philosophical dictums on end-of-life care. The results are also compared to a metastudy by Andrea Rodríguez-Prat and Evert van Leeuwen of 14 ethnographic studies of those who wish to hasten death at the end of life. We conclude that respondents exemplify a form of moral reasoning that is embedded within Christian spirituality; counters the assumptions of Singer’s approach; contrasts the diminishment of ‘meaning’ at the end of life, as seen in Rodríguez-Prat and van Leeuwen; and deserves further respectful ethnographic study. (shrink)

For more than 100 years, metaethicists have overlooked the best version of G. E. Moore’s Open Question argument. This despite the fact that it appears on the same page of Principia Ethica as his other, weaker versions of the argument. This better Open Question Argument does not rely on introspection of the meanings of ethical terms, and so does not fall to the standard criticisms of Moore. In this paper, I present this ‘new’ Open Question Argument and show that Moore (...) has done to naturalistic ethics something like what Plato’s Euthyphro does to supernaturalistic ethics. (shrink)

We suggest that in the particular context of medical education, ethics can be considered in a similar way to other kinds of knowledge that are categorised and shaped by academics in the context of wider society. Moreover, the study of medical ethics education is translational in a manner loosely analogous to the study of medical education as adjunct to translational medicine. Some have suggested there is merit in the idea that much as translational research attempts to connect the laboratory scientist's (...) work to its implications for patient care, translational ethics focuses on bringing ethics scholarship into the sphere of personal and public action. We distinguish the term ‘translational ethics’ (the study of ethics being translated between academy, classroom and clinic) from other prominent definitions in the bioethics literature. To do this, we build off a notion of knowledge translation that focuses on the nonlinear movement of information that comes to professionals through multiple competing sources. We suggest that this knowledge, and particularly knowledge about ethics, becomes embodied by the individual. It is through a reflective practice that internally embedded ethics knowledge might be modified, and this work might be best carried out with a moral community that maintains a sense of practical wisdom. Applying this translational approach to the study of medical ethics education can be both academically relevant and practically useful. This view of translation can help bridge the evident, multidirectional relationships between research, education and performance. It might also create further opportunities to develop medical ethics education theory. (shrink)

Wright holds that the following two theses are jointly incoherent: Rules determine correct language use. These rules are discoverable via internal reflection on language use. I argue that incoherence is derivable from alone and examine two types of probabilistic accounts that model a modification of, one in terms of inexact knowledge, the other in terms of viewing semantic rules as reasons for linguistic actions. Both accommodate tolerance by breaking the link between justified assertion and truth, but incoherence threatens their conception (...) of justified assertion. I argue that the rules-as-reasons approach can relocate sharp boundaries to a place where they are not only more tolerable, but to be expected. (shrink)

The comparative utility argument holds that the descendants of African slaves in America are not owed any compensation because they have not been harmed by slavery. Rather, slavery in America was beneficial to the descendants of slaves because they are now able to live in a country that is considerably richer today than any of the African countries from which slaves were taken. In this paper, I show that the comparative utility argument is a red herring with no bearing whatsoever (...) on the question of slave reparations because it conflates two separate wrongs: slavery and forced immigration. The fact that the descendants of slaves now live in America is a consequence of the latter, but not the former. As such, it has no bearing on the legitimacy reparations for slavery. (shrink)

The Doctor, like many time-travelers, often finds himself in the midst of a causal loop. Events in the future cause events in the past, which in turn cause the future events. There is a worry that a person in this situation could never have true libertarian freedom: facts about the past entail their future actions, so they couldn't do otherwise than they in fact do. -/- In this paper, I argue that there are logically coherent (though perhaps unlikely!) ways of (...) understanding the relationship between human actions and Everett's "many worlds" interpretation of quantum mechanics that could salvage The Doctor's libertarian free will. I show that the existence of a causal loop does not entail that *THE* Doctor will have to do a certain thing, only that *A* Doctor will have to do it. On this interpretation, "free will" might turn out to be the choice, not of what happens in the future, but rather of which future person we are going to be. (shrink)

Seeking to expand on previous theories, this paper explores the AIR (Applying Intelligence to the Reflexes) approach to expert performance previously outlined by Geeves, Christensen, Sutton and McIlwain (2008). Data gathered from a semi-structured interview investigating the performance experience of Jeremy Kelshaw (JK), a professional musician, is explored. Although JK’s experience of music performance contains inherently uncertain elements, his phenomenological description of an ideal performance is tied to notions of vibe, connection and environment. The dynamic nature of music performance (...) advocated by the AIR approach is illustrated by the strategies that JK implements during performance. Through executing these strategies, JK attempts to increase the likelihood of vibe and connection by selectively exercising agency over performance variables within his control. In order to achieve this, JK must engage in ongoing monitoring of his performance, whereby the spotlight of his attention pans across a vast array of disparate performance processes (and levels within these processes) in order to ascertain how he can most effectively meet the specific demands of a given performance situation. It is hoped that future research compiling data from numerous interviews and sources as well as using different research methodologies will further unlock the potential that the AIR approach holds for understanding expert performance. (shrink)

An evaluation of the current electoral system in response to calls for its reform.

The animalist says we are animals. This thesis is commonly understood as the universal generalization that all human persons are human animals. This article proposes an alternative: the thesis is a generic that admits of exceptions. We defend the resulting view, which we call ‘generic animalism’, and show its aptitude for diagnosing the limits of eight case-based objections to animalism.

This collection of texts on the Sublime provides the historical context for the foundation and discussion of one of the most important aesthetic debates of the Enlightenment. The significance of the Sublime in the eighteenth century ranged across a number of fields - literary criticism, empirical psychology, political economy, connoisseurship, landscape design and aesthetics, painting and the fine arts, and moral philosophy - and has continued to animate aesthetic and theoretical debates to this day. However, the unavailability of many of (...) the crucial texts of the founding tradition has resulted in a conception of the Sublime often limited to the definitions of its most famous theorist Edmund Burke. Andrew Ashfield and Peter de Bolla's anthology, which includes an introduction and notes to each entry, offers students and scholars ready access to a much deeper and more complex tradition of writings on the Sublime, many of them never before printed in modern editions. (shrink)

Free rides and observational advantages occur in visualizations when they reveal facts that must be inferred from an alternative representation. Understanding whether these concepts correspond to cognitive advantages is important: do they facilitate information extraction, saving the ‘deductive cost’ of making inferences? This paper presents the first evaluations of free rides and observational advantages in visualizations of sets compared to text. We found that, for Euler and linear diagrams, free rides and observational advantages yielded significant improvements in task performance. For (...) Venn diagrams, whilst their observational advantages yielded significant performance benefits over text, this was not universally true for free rides. The consequences are two-fold: more research is needed to establish when free rides are beneficial, and the results suggest that observational advantages better explain the cognitive advantages of diagrams over text. A take-away message is that visualizations with observational advantages are likely to be cognitively advantageous over competing representations. (shrink)

Gaunilo assumes that there is no greatest conceivable island, and most philosophers have followed him in this assumption. But the option was open for Anselm (and remains open for us) to bite the bullet and ‘give him his island.’ I argue that such a response is perfectly reasonable for a Platonist like Anselm, and that even a theist who isn’t a Platonist can tolerate the island as a fairly minor addition his or her ontology.

In this paper, we examine the lawfulness of a proposal to provide elective ventilation to incompetent patients who are potential organ donors. Under the current legal framework, this depends on whether the best interests test could be satisfied. It might be argued that, because the Mental Capacity Act 2005 (UK) (and the common law) makes it clear that the best interests test is not confined to the patient's clinical interests, but extends to include the individual's own values, wishes and beliefs, (...) the proposal will be in the patient's best interests. We reject this claim. We argue that, as things currently stand, the proposal could not lawfully be justified as a blanket proposition by reference to the best interests test. Accordingly, a modification of the law would be necessary to render the proposal lawful. We conclude with a suggestion about how that could be achieved. (shrink)

This article is concerned with developing a philosophical approach to a number of significant changes to academic publishing, and specifically the global journal knowledge system wrought by a range of new digital technologies that herald the third age of the journal as an electronic, interactive and mixed-media form of scientific communication. The paper emerges from an Editors' Collective, a small New Zealand-based organisation comprised of editors and reviewers of academic journals mostly in the fields of education and philosophy. The paper (...) is the result of a collective writing process. (shrink)