The objectives of this article are, first, to provide improved estimates of recent fertility levels and trends in Nepal and, second, to analyse the components of fertility change. The analysis is based on data from Nepals education. The own-children estimates for the whole country indicate that the TFR declined from 4·96 to 4·69 births per woman between the 3-year period preceding the 1996 survey and the 3-year period preceding the 2001 survey. About three-quarters of the decline stems from reductions in (...) age-specific marital fertility rates and about one-quarter from changes in age-specific proportions currently married. Further decomposition of the decline in marital fertility, as measured by births per currently married woman during the 5-year period before each survey, indicates that almost half of the decline in marital fertility is accounted for by changes in population composition by ecological region, development region, urban/rural residence, education, age at first cohabitation with husband, time elapsed since first cohabitation, number of living children at the start of the 5-year period and media exposure. With these variables controlled, another one-third of the decline is accounted for by increase in the proportion sterilized at the start of the 5-year period before each survey. (shrink)

_A moving meditation on recent geopolitical crises, viewed through the lens of ancient and modern tragedy__ “Spare, elegant and poignant.... If there is a single contemporary book that should be pressed into the hands of those who decide issues of war and peace, this is it.”—John Gray, _New Statesman_ “It is tragic that Robert D. Kaplan’s luminous _The Tragic Mind_ is so urgently needed.”—George F. Will_ Some books emerge from a lifetime of hard-won knowledge. Robert D. Kaplan has (...) learned, from a career spent reporting on wars, revolutions, and international politics in Europe, the Middle East, and East Asia, that the essence of geopolitics is tragedy. In _The Tragic Mind_, he employs the works of ancient Greek dramatists, Shakespeare, German philosophers, and the modern classics to explore the central subjects of international politics: order, disorder, rebellion, ambition, loyalty to family and state, violence, and the mistakes of power. The great dilemmas of international politics, he argues, are not posed by good versus evil—a clear and easy choice—but by contests of good versus good, where the choices are often searing, incompatible, and fraught with consequences. A deeply learned and deeply felt meditation on the importance of lived experience in conducting international relations, this is a book for everyone who wants a profound understanding of the tragic politics of our time. (shrink)

We seek to change the conversation about brain death by highlighting the distinction between brain death as a biological concept versus brain death as a legal status. The fact that brain death does not cohere with any biologically plausible definition of death has been known for decades. Nevertheless, this fact has not threatened the acceptance of brain death as a legal status that permits individuals to be treated as if they are dead. The similarities between “legally dead” and “legally blind” (...) demonstrate how we may legitimately choose bright-line legal definitions that do not cohere with biological reality. Not only does this distinction bring conceptual coherence to the conversation about brain death, but it has practical implications as well. Once brain death is recognized as a social construction not grounded in biological reality, we create the possibility of changing the social construction in ways that may better serve both organ donors and recipients alike. (shrink)

The concept of brain death was recently described as being “at once well settled and persistently unresolved.” Every day, in the United States and around the world, physicians diagnose patients as brain dead, and then proceed to transplant organs from these patients into others in need. Yet as well settled as this practice has become, brain death continues to be the focus of controversy, with two journals in bioethics dedicating major sections to the topic within the last two years.By way (...) of background, the Uniform Determination of Death Act states that “[a]n individual who has sustained either: irreversible cessation of circulatory and respiratory functions, or irreversible cessation of all functions of the entire brain, including the brain stem, is dead. A determination of death must be made in accordance with accepted medical standards.” In other words, death can be defined by either cardiorespiratory or neurological criteria, with “brain death” representing the loss of all brain function. This standard, or closely related variants, has become the accepted approach throughout the United States and in many parts of the world. (shrink)

Over the past several decades, medical ethics has gained a solid foothold in medical education and is now a required course in most medical schools. Although the field of medical ethics is by nature eclectic, moral philosophy has played a dominant role in defining both the content of what is taught and the methodology for reasoning about ethical dilemmas. Most educators largely rely on the case‐based method for teaching ethics, grounding the ethical reasoning in an amalgam of theories drawn from (...) moral philosophy, including consequentialism, deontology, and principlism.In this article we hope to make a case for augmenting the focus of education in medical ethics. We propose complementing the traditional approach to medical ethics with a more embedded approach, one that has been described by others as “microethics,” the ethics of everyday clinical practice. (shrink)

This paper engages critically with anti-representationalist arguments pressed by prominent enactivists and their allies. The arguments in question are meant to show that the “as-such” and “job-description” problems constitute insurmountable challenges to causal-informational theories of mental content. In response to these challenges, a positive account of what makes a physical or computational structure a mental representation is proposed; the positive account is inspired partly by Dretske’s views about content and partly by the role of mental representations in contemporary cognitive scientific (...) modeling. (shrink)

Despite its familiarity and widespread acceptance, the concept of “brain death” remains incoherent in theory and confused in practice. Moreover, the only purpose served by the concept is to facilitate the procurement of transplantable organs. By abandoning the concept of brain death and adopting different criteria for organ procurement, we may be able to increase both the supply of transplantable organs and clarity in our understanding of death.

The Covid-19 pandemic has led to severe shortages of many essential goods and services, from hand sanitizers and N-95 masks to ICU beds and ventilators. Although rationing is not unprecedented, never before has the American public been faced with the prospect of having to ration medical goods and services on this scale.

This special report is published in commemoration of the fiftieth anniversary of the “Report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death,” a landmark document that proposed a new way to define death, with implications that advanced the field of organ transplantation. This remarkable success notwithstanding, the concept has raised lasting questions about what it means to be dead. Is death defined in terms of the biological failure of the organism to (...) maintain integrated functioning? Can death be declared on the basis of severe neurological injury even when biological functions remain intact? Is death essentially a social construct that can be defined in different ways, based on human judgment? These issues, and more, are discussed and debated in this report by leading experts in the field, many of whom have been engaged with this topic for decades. (shrink)

Jahi McMath's case has raised challenging uncertainties about one of the most profound existential questions that we can ask: how do we know whether someone is alive or dead? The case is striking in at least two ways. First, how can it be that a person diagnosed as dead by qualified physicians continued to live, at least in a biological sense, more than four years after a death certificate was issued? Second, the diagnosis of brain death has been considered irreversible; (...) in fact, there has never been a case of a person correctly diagnosed as brain‐dead who improved to the point that the person no longer fulfilled the diagnostic criteria. If the neurologist Alan Shewmon is correct that, prior to her cardiac arrest in June 2018, McMath no longer met the criteria for brain death and was actually in a minimally conscious state, this case could have momentous implications for how we think about this diagnosis going forward. In this essay, I will offer a hypothesis that could, perhaps, explain both these aspects of the case. The hypothesis is based on differences in how we distinguish between biological and legal categories. The law tends to prefer to draw bright‐line distinctions between categories, whereas biological categories tend to fall along a spectrum, without sharp distinctions. (shrink)

Hastings Center Report, Volume 51, Issue 5, Page 56-57, September‐October 2021.

Historically, the practice of medicine has been a physically intimate endeavor. Physicians have used their hands to palpate and reveal the secrets hidden within the body. Smelling the breath for the ketosis of diabetes or tasting the skin for the saltiness of cystic fibrosis were among the physician's essential practices. Today, perhaps the most defining characteristic of a brilliant clinician is the ability to synthesize many images—from electrocardiograms, ultrasounds, CT scans, and so forth—into a coherent picture that can guide our (...) diagnosis and treatment. Yet this is rapidly becoming a Sisyphean task. Just as we are about to drown in a deluge of data, AI is throwing us a life preserver, to save not only our patients but ourselves. But where will AI take us? (shrink)

Savulescu and colleagues have provided interesting insights into how the UK public view the ‘best interests’ of children like Charlie Gard. But is best interests the right standard for evaluating these types of cases? In the USA, both clinical decisions and legal judgments tend to follow the ‘harm principle’, which holds that parental choices for their children should prevail unless their decisions subject the child to avoidable harm. The case of Charlie Gard, and others like it, show how the USA (...) and the UK have strikingly different approaches for making decisions about the treatment of severely disabled children. (shrink)

Philosophers of mind commonly draw a distinction between the personal level – the distinctive realm of conscious experience and reasoned deliberation – and the subpersonal level, the domain of mindless mechanism and brute cause and effect. Moreover, they tend to view cognitive science through the lens of this distinction. Facts about the personal level are given a priori, by introspection, or by common sense; the job of cognitive science is merely to investigate the mechanistic basis of these facts. I argue (...) that this view misrepresents the structure of cognitive-scientific enquiry. Taken at face value, cognitive science makes no commitment to the existence of a distinctive level at which persons or selves appear. Thus, in the age of cognitive science, we should not expect to find the self in an ontologically distinct realm. Instead, we should expect to locate it in cognitive-scientific models themselves. In closing, I indicate likely results of this approach. (shrink)

A theory of cognitive systems individuation is presented and defended. The approach has some affinity with Leonard Talmy's Overlapping Systems Model of Cognitive Organization, and the paper's first section explores aspects of Talmy's view that are shared by the view developed herein. According to the view on offer -- the conditional probability of co-contribution account (CPC) -- a cognitive system is a collection of mechanisms that contribute, in overlapping subsets, to a wide variety of forms of intelligent behavior. Central to (...) this approach is the idea of an integrated system. A formal characterization of integration is laid out in the form of a conditional-probabilitybased measure of the clustering of causal contributors to the production of intelligent behavior. I relate the view to the debate over extended and embodied cognition and respond to objections that have been raised in print by Andy Clark, Colin Klein, and Felipe de Brigard. (shrink)

Clinical ethics is a relatively new discipline within medicine, generated not so much by the Can we . . . ? questions of fact and prognosis that physicians ...

Robert Rupert argues against the view that human cognitive processes comprise elements beyond the boundary of the organism, developing a systems-based conception in place of this extended view. He also argues for a conciliatory understanding of the relation between the computational approach to cognition and the embedded and embodied views.

This paper -distinguishes between the Hypothesis of Extended Cognition and the Hypothesis of Embedded Cognition, characterizing them as competitors (both motivated by situated, interactive cognitive processing, with the latter being the more conservative of the two interpretations of the data) -clarifies the relation between content externalism and extended cognition -introduces the problem of cognitive bloat, as part of a critical discussion of Clark and Chalmers's "past-endorsement criterion" (if the criterion is embraced, we privilege the internal, endorsing process -- which looks (...) more like an embedded view -- and if the criterion is rejected, bloat follows) and as a problem for extended views more generally -develops a dilemma critical of Clark and Chalmers's "explanatory kinds" argument for extended mind and cognition (arguing that their reasoning faces serious problems regardless of whether one individuates the kinds in question in a fine-grained or a coarse-grained way) -argues that an appeal to functionalism doesn't resolve the issue -argues for the priority, in debates about extended cognition, of the identification of cognitive systems (e.g., because a functionalist approach can't be applied unless we already know what count as inputs and outputs, which requires having already identified the boundaries of the cognitive system). (shrink)

Robert Cummins argues that any causal theory of mental content (CT) founders on an established fact of human psychology: that theory mediates sensory detection. He concludes,.

This paper asks about the ways in which embodimentoriented cognitive science contributes to our understanding of phenomenal consciousness. It is first argued that central work in the field of embodied cognitive science does not solve the hard problem of consciousness head on. It is then argued that an embodied turn toward neurophenomenology makes no distinctive headway on the puzzle of consciousness; for neurophenomenology either concedes dualism in the face of the hard problem or represents only a slight methodological variation on (...) extant cognitive-scientific approaches to the easy problems of consciousness. The paper closes with the positive suggestion that embodied cognitive science supports a different approach to phenomenal consciousness, according to which the mind is massively representational, cognitive science has no use for the personal-level posits that tend to drive philosophical theorizing about consciousness and mind, and the hard problem is illusory. (shrink)

In this article I chronicle the emergence of two interrelated themes that crystallized in my investigations of emotional trauma during the more than 16 years that followed my own experience of traumatic loss. One pertains to the context-embeddedness of emotional trauma and the other to the claim that the possibility of emotional trauma is built into our existential constitution. I find a reconciliation and synthesis of these two themes—trauma’s contextuality and its existentiality—in the recognition of the bonds of deep emotional (...) attunement we can form with one another in virtue of our common finitude. (shrink)

The claim is frequently made that structured collections of individuals who are themselves subjects of mental and cognitive states – such collections as courts, countries, and corporations – can be, and often are, subjects of mental or cognitive states. And, to be clear, advocates for this so-called group-minds hypothesis intend their view to be interpreted literally, not metaphorically. The existing critical literature casts substantial doubt on this view, at least on the assumption that groups are claimed to instantiate the same (...) species of mental and cognitive properties as individual humans. In this essay, I evaluate a defensive move made by some proponents of the group-oriented view: to concede that group states and individual states aren’t of the same specific natural kinds, while holding that groups instantiate different species of mental or cognitive states – perhaps a different species of cognition itself – from those instantiated by humans. In order to evaluate this defense of group cognition, I develop a view of natural kinds – or at least of the sort of evidence that supports inferences to the sameness of natural kind – a view I have previous dubbed the ‘tweak-and-extend’ theory. Guided by the tweak-and-extend approach, I arrive at a tentative conclusion: that what is common to models of individual cognitive processing and models of group processing does not suffice to establish sameness of cognitive (or mental) kinds, properties, or state-types, not even at a generic or overarching level. (shrink)

This book traces the early history of the Civil Rights Movement in the United States, showing how brutal police treatment of civil rights demonstrators in Birmingham, Alabama, forced President Kennedy to send a strong civil rights bill to Congress in June of 1963. The various legislative strategies used to get the Civil Rights Act of 1964 through Congress are detailed.

Volume 18 of Martin Heidegger's collected works presents his important 1924 Marburg lectures which anticipate much of the revolutionary thinking that he subsequently articulated in Being and Time. Here are the seeds of the ideas that would become Heidegger's unique phenomenology. Heidegger interprets Aristotle's Rhetoric and looks closely at the Greek notion of pathos. These lectures offer special insight into the development of his concepts of care and concern, being-at-hand, being-in-the-world, and attunement, which were later elaborated in Being and Time. (...) Available in English for the first time, they make a significant contribution to ancient philosophy, Aristotle studies, Continental philosophy, and phenomenology. (shrink)