The primary objective was to review pediatric ethics consultations at a large academic health center over a nine year period, assessing demographics, ethical issues, and consultant intervention. The secondary objective was to describe the evolution of PECs at our institution. This was a retrospective review of Consultation Summary Sheets compiled for PECs at our Academic Health Center between January 2008 and April 2017. There were 165 PECs reviewed during the study period. Most consult requests came from the inpatient setting, with (...) the Pediatric and Neonatal Intensive Care Units being the highest utilizers. Consultation utilization increased over the study period. The most common patient age was less than one year. Physicians were most likely to request consultation. Patient Best Interest, Withholding/Withdrawing of Life Sustaining Therapy, and Provider Moral Distress were ethical issues most commonly identified by the consultants. Making recommendations was the most common consultant intervention. The ethics consultation process evolved over time from informal provider discussions, to a hospital infant care review committee, to a pediatric only consultation service, to a combined adult/pediatric consultation service, with variable levels of salary support for consultants. Ethics consultation requests are growing at our institution. Similarities in identified ethical issues exist between our findings and existing literature, however meaningful comparisons remains elusive secondary to variability in approaches to investigation and reporting. A combined paid/volunteer/trainee ethics consultation service model appears sustainable and real time ethics consultation is feasible using this approach. (shrink)

Since its publication in 1965 _Political Argument_ has come to be recognized as occupying a key position in the revival of Anglo-American political philosophy. A number of the ideas introduced by Barry have become part of the standard vocabulary, such as the distinction between ideal-regarding and want-regarding principles and the division of principles into aggregative and distributive. _Political Argument_ provided the first precise analysis, still frequently cited, of the conception that political values have trade-off relations; the analysis of the notion (...) of the public interest has also enjoyed wide influence. For this long-awaited reprint, the author has prepared a substantial, new introductory essay in which he recounts the process of writing the book and sets it in the intellectual milieu of its time. He then offers extensive comments on the subsequent fate of some of the leading ideas and assesses the book in light of criticisms and later developments. Finally, Barry evaluates current approaches to political philosophy as they look today. This new edition of _Political Argument_ will interest political theorists, philosophers, economists, and a range of other scholars. Brilliant and incisive, it will engender discussion and debate from many quarters. (shrink)

I argue that the strongest form of consequentialism is one which rejects the claim that we are morally obliged to bring about the best available consequences, but which continues to assert that what there is most reason to do is bring about the best available consequences. Such an approach promises to avoid common objections to consequentialism, such as demandingness objections. Nevertheless, the onus is on the defender of this approach either to offer her own account of what moral obligations we (...) do face, or to explain why offering such a theory is ill-advised. I consider, and reject, one attempt at the second sort of strategy, put forward by Alastair Norcross, who defends a 'scalar' consequentialism which eschews the moral concepts of right, wrong and obligation, and limits itself to claims about what is better and worse. I go on to raise some considerations which suggest that no systematic consequentialist theory of our moral obligations will be plausible, and propose instead that consequentialism should have a more informal and indirect role in shaping what we take our moral obligations to be. (shrink)

: In his work Truth and Truthfulness, Bernard Williams offers a very different interpretation of philosophical genealogy than that expounded in the secondary literature. The “Received View” of genealogy holds that it is “documentary grey”: it attempts to provide historically well-supported, coherent, but defeasible explanations for the actual transformation of practices, values, and emotions in history. However, paradoxically, the standard interpretation also holds another principle. Genealogies are nevertheless polemical because they admit that any evidence that would serve to justify a (...) genealogical account is indexical to a perspective. In short, genealogies are not true per se. This view of genealogy leaves it vulnerable to three criticisms. I call these three: (1) the reflexive, (2) the substantive, and (3) the semantic. In contrast, Williams argues that all genealogies provide a functional account for the manifestation of something and further, that a State of Nature story subtends these accounts. The upshot of Williams’ approach is that it makes for strange philosophical bedfellows. For example, Nietzsche’s account for the rise of Christian morality shares methodological features with Hobbes’ functional explanation for the emergence of civilization and yet Nietzsche seems to take issue with genealogists who are hypothesis mongers gazing haphazardly into the blue. In the following article, I flesh out, more fully, how to make sense of Williams’ novel reclassification of genealogy. I show that Nietzsche’s genealogies are State of Nature stories and, just like Hobbes’ State of Nature story in chapter thirteen of Leviathan, are subtended by our collective corporeality. I then demonstrate how Nietzsche’s three stories in the Genealogy, when brought together, serve to undermine what Williams refers to as “ . . . a new system (of reasons)—which very powerfully resists being understood in such terms . . . ” Finally, I explain how my reconstruction of Williams’ interpretation of the genealogy immunizes it against the three criticisms noted above. (shrink)

General jurisprudence-that branch of legal philosophy concerned with the nature of law and adjudication-has been relatively unaffected by the "naturalistic" strains so evident, for example, in the epistemology, philosophy of mind and moral philosophy of the past forty years. This paper sketches three ways in which naturalism might affect jurisprudential inquiry. The paper serves as a kind of precis of the main themes in my book NATURALIZING JURISPRUDENCE: ESSAYS ON AMERICAN LEGAL REALISM AND NATURALISM IN LEGAL PHILOSOPHY (Oxford University Press, (...) 2007). (shrink)

In cases in which many causes together bring about an effect, it is common to select some as particularly important. Philosophers since Mill have been pessimistic about analyzing this reasoning because of its variability and the multifarious causal and pragmatic details of how it works. I argue Mill was right to think these details matter but wrong that they preclude philosophical analysis of causal selection. I show that analyzing the pragmatic details of scientific debates about the important causes of the (...) Bhopal Gas Tragedy can illuminate causal reasoning about disasters and shed new light on causality and causal selection. (shrink)

Early Renaissance naturalists worked to identify the plans described in ancient sources. But during the middle decades of the sixteenth century, naturalists instead began to describe and name plans unknown to the ancients. They also divided nature much more finely, distinguishing species that their predecessors had lumped together. As a result, they created an information overload. Dictionaries of synonyms and local flora were invented in the early seventeenth century as partial solutions to this problem of information overload.

According to both traditional positivist approaches and also to the sociology of scientific knowledge, social analysts should not themselves become involved in the controversies they are investigating. But the experiences of the authors in studying contemporary scientific controversies—specifically, over the Australian Animal Health Laboratory, fluoridation, and vitamin C and cancer—show that analysts, whatever their intentions, cannot avoid being drawn into the fray. The field of controversy studies needs to address the implications of this process for both theory and practice.

Consciousness often presents itself as a problem for materialists because no matter which physical explanation we consider, there seems to remain something about conscious experience that hasn't been fully explained. This gives rise to an apparent explanatory gap. The explanatory gulf between the physical and the conscious is reflected in the broader population, in which dualistic intuitions abound. Drawing on recent empirical evidence, this essay presents a dual-process cognitive model of consciousness attribution. This dual-process model, we suggest, provides an important (...) part of the explanation for why dualism is so attractive and the explanatory gap so vexing. (shrink)

Applying good inductive rules inside the scope of suppositions leads to implausible results. I argue it is a mistake to think that inductive rules of inference behave anything like 'inference rules' in natural deduction systems. And this implies that it isn't always true that good arguments can be run 'off-line' to gain a priori knowledge of conditional conclusions.

Many theorists, including Nietzsche, Adorno, and Foucault, have regarded genealogy as an important technique for social criticism. But it has been unclear how genealogy can go beyond the accomplishments of other, more mundane, critical methods. I propose a new approach to understanding the critical potential of history. I argue that theorists have been misled by the assumption that if a claim is deserving of criticism, it is because the claim is false. Turning to the criticism of concepts rather than criticism (...) of claims, I expand on the distinction between "descriptive semantics" and "foundational semantics" to show that genealogy can be uniquely qualified to explore the foundations of concepts, and hence to criticize concepts that are problematic in nonobvious ways. (shrink)

If we add as an extra premise that the agent does know H, then it is possible for her to know E — H, we get the conclusion that the agent does not really know H. But even without that closure premise, or something like it, the conclusion seems quite dramatic. One possible response to the argument, floated by both Descartes and Hume, is to accept the conclusion and embrace scepticism. We cannot know anything that goes beyond our evidence, so (...) we do not know very much at all. This is a remarkably sceptical conclusion, so we should resist it if at all possible. A more modern response, associated with externalists like John McDowell and Timothy Williamson, is to accept the conclusion but deny it is as sceptical as it first appears. The Humean argument, even if it works, only shows that our evidence and our knowledge are more closely linked than we might have thought. Perhaps that’s true because we have a lot of evidence, not because we have very little knowledge. There’s something right about this response I think. We have more evidence than Descartes or Hume thought we had. But I think we still need the idea of ampliative knowledge. It stretches the concept of evidence to breaking point to suggest that all of our knowledge, including knowledge about the future, is part of our evidence. So the conclusion really is unacceptable. Or, at least, I think we should try to see what an epistemology that rejects the conclusion looks like. (shrink)

There are many controversial theses about intrinsicness and duplication. The first aim of this paper is to introduce a puzzle that shows that two of the uncontroversial sounding ones can’t both be true. The second aim is to suggest that the best way out of the puzzle requires sharpening some distinctions that are too frequently blurred, and adopting a fairly radical reconception of the ways things are.

Philosophical dialogue has the power to improve interdisciplinary scientific research. The Toolbox Dialogue Initiative (TDI) conducts workshops that foster philosophical dialogue among interdisciplinary researchers. This chapter focuses on 20 of these workshops, all of which used the Toolbox STEM (Science, Technology, Engineering, and Mathematics) instrument and were conducted with interdisciplinary research teams of scientists. We analyze data from some of these workshops and demonstrate that philosophical dialogues conducted using the Toolbox method have two salutary effects. First, they lead to a (...) significant increase in belief formation about philosophical topics relevant to interdisciplinary science. Scientists sometimes do not have preconceived commitments on issues in philosophy of science, and Toolbox workshops tend to prompt them to adopt views on these topics. Second, these philosophical …. (shrink)

Perhaps the most fundamental principle of legal interpretation is the presumption that terms should be given their “ordinary” (i.e., general, non-technical) meanings. This principle is a central tenet of modern textualism. Textualists believe a universal presumption of ordinary meaning follows from their theory’s core commitment: A law should be interpreted consistently with what its text communicates to the ordinary public. This Article begins from this textualist premise, empirically examining what legal texts communicate to the public. Five original empirical studies (N (...) = 4,365) reveal a surprising finding: Ordinary people consider genre carefully and regularly take terms in law to communicate technical legal meanings, not ordinary ones. -/- This discovery carries implications for legal interpretation’s theory and practice. Modern textualists—especially at the Supreme Court—justify their theory through “democratic,” fair notice, and rule-of-law appeals to ordinary people. But the empirical studies reveal that fidelity to ordinary people does not imply an unwavering commitment to ordinary meaning. Instead, it requires interpreters to also look to technical meanings. On a practical level, the results support a new presumption of legal meaning and ground a new challenge to textualism’s claim to promote fair notice. As a case study, we consider Bostock v. Clayton County, Georgia, which held that both sexual orientation and gender identity discrimination are prohibited forms of sex discrimination. The Article’s empirics and theory offer a new justification of the Court’s landmark decision. (shrink)

This article advances the theoretical and practical value of workplace spirituality by drawing on person–organization (PO) fit theory and transpersonal psychology to investigate three questions: (a) What antecedents lead individuals and organizations to seek and foster workplace spirituality? (b) What are the perceived spiritual needs of individuals, and how are those needs fulfilled in the workplace? and (c) What are the consequences of meeting spiritual needs as individuals perceive them? Using constructivist grounded theory, analysis of interview data from thirty-four participants (...) located in organizations across the Netherlands, Ireland, the United Kingdom, and Portugal led to development of a workplace spirituality, PO fit model in which we propose reconciling self as a core factor of workplace spirituality. We note how through the process of reconciling self, workplace spirituality is related to meaning making and how an individual perceives their work environment as conducive to self-expression and inner purpose. Practical and theoretical implications are discussed, as are limitations of the study and ideas for future research. (shrink)

The healthcare ethics consultant holds a widely described role in the modern American hospital. S/he may practice within a clinical discipline and be trained in bioethics, or be a trained phi...

widely held commitments: to phenomenal realism and to naturalism. Phenomenal realism is the view that we are phenomenally consciousness, and that there is no a priori or armchair sufficient condition for phenomenal consciousness that can be stated in nonphenomenal terms . 1,2 Block points out that while phenomenal realists reject.

Tarski’s conceptual analysis of the notion of logical consequence is one of the pinnacles of the process of defining the metamathematical foundations of mathematics in the tradition of his predecessors Euclid, Frege, Russell and Hilbert, and his contemporaries Carnap, Gödel, Gentzen and Turing. However, he also notes that in defining the concept of consequence “efforts were made to adhere to the common usage of the language of every day life.” This paper addresses the issue of what relationship Tarski’s analysis, and (...) Béziau’s further generalization of it in universal logic, have to reasoning in the everyday lives of ordinary people from the cognitive processes of children through to those of specialists in the empirical and deductive sciences. It surveys a selection of relevant research in a range of disciplines providing theoretical and empirical studies of human reasoning, discusses the value of adopting a universal logic perspective, answers the questions posed in the call for this special issue, and suggests some specific research challenges. (shrink)

The American College of Nurse-Midwives, American Society for Pain Management Nursing, American Academy of Pediatrics, and other largely US-based medical organizations have argued that at least some forms of non-therapeutic child genital cutting, including routine penile circumcision, are ethically permissible even when performed on non-consenting minors. In support of this view, these organizations have at times appealed to potential health benefits that may follow from removing sexually sensitive, non-diseased tissue from the genitals of such minors. We argue that these appeals (...) to “health benefits” as a way of justifying medically unnecessary child genital cutting practices may have unintended consequences. For example, it may create a “loophole” through which certain forms of female genital cutting—or female genital “mutilation” as it is defined by the World Health Organization—could potentially be legitimized. Moreover, by comparing current dominant Western attitudes toward female genital “mutilation” and so-called intersex genital “normalization” surgeries (i.e. surgeries on children with certain differences of sex development), we show that the concept of health invoked in each case is inconsistent and culturally biased. It is time for Western healthcare organizations—including the American College of Nurse-Midwives, American Society for Pain Management Nursing, American Academy of Pediatrics, and World Health Organization—to adopt a more consistent concept of health and a unified ethical stance when it comes to child genital cutting practices. (shrink)

In this first installment of a three-part series, I focus on the critique of civility. In so doing, I do not defend incivility. In fact, part of my critique of civility extends equally to incivility. My position is that we must move our normative discourse beyond both the thesis of civility and the antithesis of incivility to a synthesis that reframes the discussion in terms of nonviolence.

Several scholars have claimed that small-scale agriculture in which farmers sell goods to the local market has the potential to strengthen social ties and a sense of community, a phenomenon referred to as “civic agriculture.” Proponents see promise in the increase in the number of community supported agriculture programs, farmers markets, and other locally orientated distribution systems as well as the growing interest among consumers for buying locally produced goods. Yet others have suggested that these novel or reborn distribution mechanisms (...) are still primarily means of instrumental economic exchange and that optimistic characterizations of a renewed sense of community emerging from these practices are unfounded. This study provides an empirical assessment of the extent to which these community-based agriculture markets are associated with connection to community, volunteerism, and civic and political activities. In order to assess the relationship between civic agriculture and community engagement, we surveyed over 1,300 people in the Mid-Hudson region of New York State. The study design includes “civic agriculture participants” as the unit of analysis, defined as CSA farm members, shoppers at independent health food stores, and farmers market patrons. For comparison, a telephone survey of randomly selected residents of the region’s general population was also conducted. Unlike studies that focus solely on the perceptions of certain civic agriculture participants, by comparing the perceptions and behaviors of those engaged in a range of civic agriculture practices, we are able to identify the effects of different forms of participation. The results demonstrate higher levels of voluntarism and engagement in local politics among civic agriculture participants relative to the general population. In addition, we found variation among those engaged in different forms of civic agriculture, with those immersed in more socially embedded forms of exchange demonstrating greater community and political involvement. These findings lend empirical support to the civic agriculture thesis. (shrink)

As the author ofJustice as Impartiality, I am not ashamed to admit that I was delighted by the liveliness of the discussion generated by it at the meeting on which this symposium is based. I am likewise grateful to the six authors for finding the book worthy of the careful attention that they have bestowed on it. Between them, the symposiasts take up many more points than I can cover in this response. I shall therefore focus on some themes that (...) cluster round the contractual device that I associate with the notion of justice as impartiality. Is it necessary? If it is not necessary is it nevertheless useful? Within an overall contractual framework is the form of contract that I propose uniquely justifiable? And does the form of contract that I defend generate the implications that I claim for it? (shrink)

In _Couplets_, Brian Massumi presents twenty-four essays that represent the full spectrum of his work during the past thirty years. Conceived as a companion volume to _Parables for the Virtual_, _Couplets_ addresses the key concepts of _Parables_ from different angles and contextualizes them, allowing their stakes to be more fully felt. Rather than organizing the essays chronologically or by topic, Massumi pairs them into couplets to encourage readers to make connections across conventional subject matter categories, to encounter disjunctions, and (...) to link different phases in the evolution of his work. In his analyses of topics ranging from art, affect, and architecture to media theory, political theory, and the philosophy of experience, Massumi charts a field on which a family of conceptual problems plays out in ways that bear on the potentials for acting and perceiving the world. As an essential guide to Massumi's oeuvre, _Couplets_ is both a primer for his new readers and a supplemental resource for those already engaged with his thought. (shrink)

The values which are definitive of the humanist project, such as freedom and self-determination, are of central concern to environmentalism. This means, according to Lewis P. Hinchman, that environmentalists should seek a rapprochement with humanism, rather than rejecting it for its apparent anthropocentrism. He argues that this requires in turn the acceptance of those approaches to human self-understanding which are central to the hermeneutic traditions and the rejection of naturalist approaches, such as sociobiology, which is accused of producing deterministic, reifying, (...) reductionist, dehumanising forms of understanding of human beings and human life. This paper seeks to show that sociobiology does not pose the kinds of threat to humanism and environmentalism outlined by Hinchman. (shrink)

This paper outlines Hans Ulrich's reworking of the Lutheran doctrine of the estates. He conceives the estates as descriptions of the new patterns of social life that God has promised to found and secure. This emphasis on the divine activity of generating social order is an expression of Ulrich's agreement with common and familiar criticisms of the doctrine, and why he nevertheless believes it indispensable for an evangelical ethic. A construal of the traditional doctrine of the estates that is unique (...) even in his native Lutheran context, it aims not at conservatism, but at a more thoroughly theological and therefore critical relationship to social order than rival theories much more inclined to revisionist rhetorical stances. In a contemporary context in which moral certainties and categories can be disputed at the most fundamental levels, Ulrich's theology seeks a form of theological reasoning that genuinely seeks the illumination of Christian beliefs about reality by taking other moral languages seriously. (shrink)