Futile medical interventions have virtually no chance of success. Doctors might perform such procedures because of pressure from families or patients. The doctor might also have an ulterior motive of gain or prefer to do it rather than take time to communicate with the patient about a poor prognosis. Established ways to communicate bad news to patients are not always used by managing physicians with time constraints. The SPIKES protocol method is outlined to assist in sensitive communication where further intervention (...) is futile. This review primarily explores various aspects of medical futility. It also explores strategies for effectively communicating with patients and their families regarding futility interventions. A side-effect of futile interventions is burnout in doctors and other health practitioners (HPs). The complex relationship between futility and burnout is described. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:"The Fittest Man in the Kingdom":Thomas Reid and the Glasgow Chair of Moral PhilosophyPaul Wood (bio)Paul Wood Paul Wood is at the Department of History, University of Victoria, PO Box 3045, MS 7381, Victoria BC V8W 3P4 Canada. email: [email protected] August 1996Revised January 1997Notes. An earlier version of this paper was delivered at a plenary session of the 23rd International Hume Conference held at the University of Nottingham. For (...) comments and/or references, the author wishes to thank Roger Emerson, Carol Gibson-Wood, Knud Haakonssen, Ian Simpson Ross, Stephen Snobelen, M. A. Stewart, and the anonymous Hume Studies referees. For permission to cite and quote from manuscripts, he is grateful to the Keeper of the Manuscripts of Scotland as well as to the Librarians of Aberdeen University Library, Edinburgh University Library, Glasgow University Archives and Business Records Centre, Glasgow University Library (Department of Special Collections), the Mitchell Library Glasgow, and Dr. Williams' Library.1. Although little information survives regarding Law's teaching, we do know that he discussed Pufendorf in his classes; see Christine Mary King [Shepherd], "Philosophy and Science in the Arts Curriculum of the Scottish Universities in the Seventeenth Century," (Unpublished Ph.D. Dissertation, University of Edinburgh, 1974), 177. Carmichael's edition of Pufendorf first appeared in Glasgow in 1718, and a second edition was published in Edinburgh in 1724 while Hume was still a student there.2. The surviving correspondence between the two men from this period is to be found in The Letters of David Hume, ed. J.Y.T. Greig, 2 vols. (Oxford: Clarendon Press, 1932), I 32-35; 36-40; 45-48 (hereafter abbreviated as HL).3. The first detailed discussion of the 1745 election appeared in the introduction to David Hume, A Letter from a Gentleman to His Friend in Edinburgh, edited by Ernest C. Mossner and John V. Price (Edinburgh: Edinburgh University Press, 1967). This account has recently been challenged in Roger L. Emerson, "The 'Affair' at Edinburgh and the 'Project' at Glasgow: The Politics of Hume's Attempts to become a Professor," in Hume and Hume's Connexions, edited by M. A. Stewart and John P. Wright (Edinburgh: Edinburgh University Press, 1994), 1-22; and M. A. Stewart, The Kirk and the Infidel (Lancaster: Lancaster University Publications Office, 1995). For historically sensitive contextual analysis of Hume's philosophical relations with Hutcheson, see inter alia James Moore, "Hume and Hutcheson," in Stewart and Wright, 23-57, and M. A. Stewart, Warmth in the Cause of Virtue (Edinburgh: Edinburgh University Press, forthcoming).4. In January 1752, "Mr. Smith read an Account of some of Mr. David Hume's Essays on Commerce" to the Society, and Hume was elected a member in 1753; see Notices and Documents Illustrative of the Literary History of Glasgow, During the Greater Part of Last Century, edited by W. J. Duncan (Glasgow: T. D. Morison, 1886), 132-133. Hume's failed candidacy is discussed in Emerson, "The 'Affair' at Edinburgh," 14-16, and Ian Simpson Ross, The Life of Adam Smith (Oxford: Clarendon Press, 1995), 112-113. Smith's Glasgow colleague from 1751 to 1755, William Cullen, was also sympathetic to Hume's philosophy, as was John Millar, who was elected Professor of Law in 1761. On Cullen and Hume see J.R.R. Christie, "Ether and the Science of Chemistry: 1740-1790," in Conceptions of Ether: Studies in the History of Ether Theories 1740-1900, edited by G. N. Cantor and M.J.S. Hodge (Cambridge: Cambridge University Press, 1981), 90-96.5. David Hume to William Strahan, 26 October 1775, HL II 301.6. See, for example, The Works of Thomas Reid, D.D., edited by Sir William Hamilton, 4th ed. (Edinburgh: Maclachlan and Stewart, 1854), 30n; James McCosh, The Scottish Philosophy, Biographical, Expository, Critical, from Hutcheson to Hamilton (London: Macmillan, 1875), 36; James Veitch, "Philosophy in the Scottish Universities," Mind 2 (1877): 207-234 (209).7. John Rae, Life of Adam Smith (London and New York: Macmillan, 1895); William Robert Scott, Francis Hutcheson: His Life, Teaching and Position in the History of Philosophy (Cambridge: Cambridge University Press, 1900); idem., Adam Smith as Student and Professor (Glasgow: Jackson... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Jean Wyatt THE CELEBRATION OF EROS: GREEK CONCEPTS OF LOVE AND BEAUTY IN TO THE LIGHTHOUSE A voracious reader all her life, Virginia Woolf stored up patterns and images which she naturally wove into the fabric of her novels.1 Integrating literature of the past into her own works was also an affirmation of her belief that "everything comes over again a little differently," as Eleanor says in The Years. (...) Acutely aware of the prevailing fluidity of human life, Virginia Woolf sought a counterbalance in the principle of eternal recurrence. The whole chain of human history forms a "gigantic pattern, momentarily perceptible." It becomes perceptible when elemental forces in human life coincide with the forms of individuals, "making them symbolical, making them representative."3 In Mrs. Ramsay, Virginia Woolf combines a personal portrait of her mother with an evocation of eternal life forces in the "symbolical outline" (p. Ill) of Aphrodite, goddess of love, beauty and marriage, that Mrs. Ramsay irradiates. Events, too, can be "symbolical, and therefore perhaps permanent," in the words of Bernard in The Waves, when they reflect the continuity of human experience. The dinner party in To the Lighthouse contains ritual elements, reminders that it is one in a series of communal feasts. The search for truth in the midst of human pleasures, by means of human love, recalls one such banquet in particular, the Symposium.'' The central concerns of the Symposium are those of To the Lighthouse: striving for knowledge through love; the desire to create that beauty arouses; the paradox of the eternal in the midst of the transitory. The figures and patterns of Greek literature were part of Virginia Woolf's mental formation. She began learning Greek at King's College in 1897, at the age of fifteen.6 For the next few years, Greek was her chief refuge from a stifling Victorian society. From 10:00 a.m. to 1:00 p.m. every day she read Greek: Homer, Aeschylus, Euripides, all of Sophocles, Plato. Twice a week she met for Greek lessons, first 160 Jean WyATT161 with Clara Pater, then with Janet Case. Her letters speak of Greek as "the greatest of comforts to me" (April, 1900), "my daily bread, and a keen delight to me" (June, 1900); it "has so much attraction for me... that I don't want to do anything else" (February, 1905).8 A diary entry from 1924 shows how Greek "worked its way" into her life. Upon meeting a herd of cattle, "I waved my stick and stood at bay; and thought of Homer.... some mimic battle. Grizzle grew more and more insolent and excited and skirmished about yapping. Ajax? That Greek, for all my ignorance, has worked its way into me." Seeing Grizzle as Ajax is not different in kind from transforming Mrs. Ramsay into Aphrodite, Mr. Carmichael into Poseidon. Greek was in the forefront of Virginia Woolf's mind in 1924 because she had been reading Greek steadily since 1922 in preparation for the article "On Not Knowing Greek." "The amount of reading... that went into the production of that essay... was remarkable," comments Quentin Bell. She published the essay in 1925, the year she began To the Lighthouse. "On Not Knowing Greek" shows that Virginia Woolf knew the Symposium well: she discusses it for four pages, not with the analytical lens of a literary critic, but with loving familiarity. She first read the Symposium when she was about sixteen, but her intimacy with it suggests that she must have read it more than once. At the center of the Symposium is Diotima's doctrine: man has to work through a series of human loves to arrive at the eternal. Lily pursues a similar quest for knowledge through love. She loves Mrs. Ramsay, but, unable to satisfy her love on a personal level, casts about for a way of reaching "the spirit in her, the essential thing" (p. 76). She finally finds a way of loving that takes her to the essence of things when, ten years after Mrs. Ramsay's death, she sees and loves a Mrs. Ramsay who transcends the individual to become the form of love and beauty. To understand the... (shrink)

The Gouldian argument for evolutionary contingency found in Wonderful Life can be dissected into three premises: palaeontological, macro-evolutionary, and developmental. Discussions of evolutionary contingency have revolved primarily around the developmental. However, a shift in methodological practice and new palaeontological evidence subsequent to the book’s publication appears to threaten the palaeontological premise that asserts high Cambrian disparity, or, roughly, that morphological differences between the Cambrian species were high. This presents a prima facie problem: Did the Cambrian consist of enough anatomical variety (...) to fuel a different outcome upon a replay of the tape of life? I investigate the role that disparity plays in the Gouldian argument for evolutionary contingency and conclude that the reduced disparity view does not undermine the argument, per se. As for the macro-evolutionary premise, Gould never offers any explicit justification for the idea that species sorting was indiscriminate or ‘lottery-like’ (though he certainly gestures at it). Putting aside the exegetical, I consider certain empirical avenues for underwriting the macro-evolutionary premise and argue that the most plausible route is to appeal to the special status of mass extinctions, a move that is not entirely unfamiliar to macro-evolutionists. That is, mass extinctions can be good sources of contingency due to their being ‘chancy’ in at least three respects. In sum, I update the palaeontological and macro-evolutionary premises as to reconstrue the Gouldian argument for evolutionary contingency in its strongest form. (shrink)

This book offers an important study of Aristotle's theory of the sense-organs. It aims to answer two questions central to Aristotle's psychology and biology: why does Aristotle think we have sense-organs, and why does he describe the sense-organs in the way he does? The author looks at all the Aristotelian evidence for the five senses and shows how pervasively Aristotle's accounts of the sense-organs are motivated by his interest in form and function. The book also engages with the celebrated problem (...) of whether perception for Aristotle requires material changes in the perceiver. It argues that, surprisingly to the modern philosopher, nothing in Aristotle's description of the sense-organs requires us to believe in such changes. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Virgil and the ModernsMichael L. HallVirgil and the Moderns, by Theodore Ziolkowski; xv & 274 pp. Princeton: Princeton University Press, 1993, $35.00.Theodore Ziolkowski’s Virgil and the Moderns is a wonderful book. Everyone interested in modern literature and the western cultural heritage should read it. Ziolkowski does much more than tell us about Virgil and his influence on modern authors and readers; he traces the Latin poet’s appeal from (...) the nineteenth century forward, focusing on different national trends and responses to the Roman past. His book is a veritable education in modern literature and cultural history.In the introductory chapter Ziolkowski situates Virgil in the twentieth century, with references to the Virgilian epigraph on the title page of Freud’s The Interpretation of Dreams (1900) and the Virgilian motto to the first volume of Toynbee’s A Study of History (1934). Ziolkowski concentrates attention, in fact, on the appeal to Roman history in many early twentieth-century historians, and he explores the various European and American reactions to the bimillennial celebrations in 1930 of Virgil’s birth. Like the Bible, the Roman past seems to speak directly to a great variety of points of view: “Roman history, properly comprehended in its broad outlines, is and remains the best teacher not only for today, but indeed for all times”; thus opined the author of Mein Kampf.Ziolkowski’s second chapter, “The Ideological Lives,” begins by observing that “every biography is ideological” and quoting Duane Reed Stuart’s comment that “Every age has tended to fashion a Virgil after its own image.” Ziolkowski tests this proposition against the many “modern” biographies of Virgil that appeared in the nineteenth and twentieth centuries, especially during the bimillennial celebrations. In Italy he finds Virgil described as “a Latin nationalist with conservative messages for the present on government and agriculture”; in France he discovers “a protofascist emerging from the bohemian life of the rive gauche of ancient Rome”; in Germany he encounters “an agrarian anima naturaliter christiana destined to become Father of the West in opposition to the rise of Nazism”; and in Latin America he sees that Virgil has become “an apostle of peace among the pagans with the providential mission to serve the generations as a pedagogue for Christ.”In the five chapters that follow, Ziolkowski shows that these various versions of Virgil’s life and influence resulted in a similar diversity of literary manifestations. In Europe, each country found a Virgil suited to its own preoccupations and prejudices. A rich and indeed overwhelming curriculum in modern literature could be constructed from the authors and texts Ziolkowski discusses in these brief surveys of works influenced by Virgil’s poetry. But although he is a deft literary critic, Ziolkowski goes further, to trace biographical and cultural influences. We discover, for example, that Gide was obsessed with the Eclogues, that it was the Georgics that Mr. Carmichael “liked to lie awake a little reading” in Woolf’s To the Lighthouse, and that Joe Paterno’s first and most enduring hero [End Page 175] was Virgil’s Aeneas, “to whom he was introduced by his high school Latin teacher at Brooklyn Prep.”I confess that my favorite parts of the book were the chapters on Virgil in Britain and the “New World.” I thought I was a pretty good student of the classics and of British and American literature, but I am ashamed to admit how much I learned from Ziolkowski’s discussions of Virgil’s influence on Virginia Woolf, T. S. Eliot, and Cyril Connolly, on Willa Cather and Robert Frost, on Archibald MacLeish, Allen Tate, and Robert Lowell. Ziolkowski is a treasure, and he has given us a rare treat in this very thoughtful study of the way our cultural inheritance is passed on and reaffirmed. As he himself remarks in the book’s final sentences on the ties that bind us to Virgil and our common past: “This reaffirmation, attained at the cost of great spiritual engagement by our intellectual predecessors, we neglect today at our peril.”Michael L. HallAlexandria, VirginiaCopyright © 1995 The Johns Hopkins University Press... (shrink)

Ethicists have tended to treat the psychology of attributing mental states to animals as an entirely separate issue from the moral importance of animals’ mental states. In this paper I bring these two issues together. I argue for two theses, one descriptive and one normative. The descriptive thesis holds that ordinary human agents use what are generally called phenomenal mental states to assign moral considerability to animals. I examine recent empirical research on the attribution of phenomenal states and agential states (...) to argue that phenomenal mental states are the primary factor, psychologically, for judging an animal to be morally considerable. I further argue that, given the role of phenomenal states in assigning moral considerability, certain theories in animal ethics will meet significant psychological resistance. The normative thesis holds that ethicists must take the psychology of attributing mental states into account when constructing moral ideals concerning animals. I draw from the literature in political philosophy on ideal and non-ideal theory to argue that non-ideal theories for animals must account for human psychology because—like current social and political conditions—human psychology limits the achievement of moral ideals. (shrink)

The term “mental illness” implies that persons with such illnesses are more likely to be dangerous to themselves and/or others than are persons without such illnesses. This is the source of the psychiatrist’s traditional social obligation to control “harm to self and/or others,” that is, suicide and crime. The ethical dilemmas of psychiatry cannot be resolved as long as the contradictory functions of healing persons and protecting society are united in a single discipline.Life is full of dangers. Our highly developed (...) consciousness makes us, of all living forms in the universe, the most keenly aware of, and the most adept at protecting ourselves from, dangers. Magic and religion are mankind’s earliest warning systems. Science arrived on the scene only about 400 years ago, and scientific medicine only 200 years ago. Some time ago I suggested that “formerly, when religion was strong and science weak, men mistook magic for medicine; now, when science is strong and religion weak, men mistake medicine for magic”.1We flatter and deceive ourselves if we believe that we have outgrown the apotropaic use of language .Many people derive comfort from magical objects , and virtually everyone finds reassurance in magical words . The classic example of an apotropaic is the word “abracadabra,” which The American Heritage Dictionary of the English Language defines as “a magical charm or incantation having the power to ward off disease or disaster”. In the ancient world, abracadabra was a magic word, the letters of which were arranged in an inverted pyramid and worn as an amulet around the neck to protect the wearer against disease or trouble. One fewer letter appeared in each line of the pyramid, until only the letter “a” remained to form the vertex of the triangle. As …. (shrink)

T. A. Cavanaugh's Hippocrates' Oath and Asclepius' Snake: The Birth of the Medical Profession articulates the Oath as establishing the medical profession's unique internal medical ethic - in its most basic and least controvertible form, this ethic mandates that physicians help and not harm the sick. Relying on Greek myth, drama, and medical experience (e.g., homeopathy), the book shows how this medical ethic arose from reflection on the most vexing medical-ethical problem -- injury caused by a physician -- and argues (...) that deliberate iatrogenic harm, especially the harm of a doctor choosing to kill (physician assisted suicide, euthanasia, abortion, and involvement in capital punishment), amounts to an abandonment of medicine as an exclusively therapeutic profession. The book argues that medicine as a profession necessarily involves stating before others what one stands for: the good one seeks and the bad one seeks to avoid on behalf of the sick, and rejects the view that medicine is purely a technique lacking its own unique internal ethic. It concludes noting that medical promising (as found in the White Coat Ceremony through which U. S. medical students matriculate) implicates medical autonomy which in turn merits respect, including honoring professional conscientious objections. (shrink)

Locke considers miracles to be crucial in establishing the credibility and reasonableness of Christian faith and revelation. The performance of miracles, he argues, is vital in establishing the "credit of the proposer" who makes any claim to providing a divine revelation. He accords reason a pivotal role in distinguishing spurious from genuine claims to divine revelation, including miracles. According to Locke, genuine miracles contain the hallmark of the divine such that pretend revelations become intuitively obvious. This paper argues that serious (...) tensions exist in Locke's position regarding miracles, which impact on the reasonableness of the assent to Christianity which he presumes they provide. (shrink)

This “Legal Briefing” column covers recent legal developments involving patient decision aids. This topic has been the subject of recent articles in JCE. It is included in the 2010 Patient Protection and Affordable Care Act. And it has received significant attention in the biomedical literature, including a new book, a thematic issue of Health Affairs, and a recent article in the New England Journal of Medicine. Moreover, physicians and health systems across the United States are increasingly integrating decision aids into (...) their clinical practice. Both federal and state laws play a significant role in promoting this expanded use. On the other hand, concerns about liability could stymie development and implementation. We categorize legal developments concerning patient decision aids into the following five sections:1. Development of decision aids2. Effectiveness of decision aids3. Federal regulation of decision aids4. State regulation of decision aids5. Legal concerns regarding decision aids. (shrink)

. Ill BERGSONS THEORY OF ART . . .141 THE PHILOSOPHY OF INTENSIVE MANIFOLDS I I CINDERS ..... 215 APPENDICES A. REFLECTIONS ON VIOLENCE . . 249 B. PLAN FOR A ...

T. D. Campbell; IV*—Equality of Opportunity, Proceedings of the Aristotelian Society, Volume 75, Issue 1, 1 June 1975, Pages 51–68, https://doi.org/10.1093/aris.

Recently, in Found. Phys. 53: 64 (2023), it has been argued that there is no reality to the PBR theorem. In Found. Phys. 54: 36 (2024), Hofer-Szabó has commented that the argument is flawed and that PBR theorem remains in tact. Here we reply to Hofer-Szabó by showing that his counterargument does not hold up, concluding that the PBR theorem has been disproved.