Some health care organizations allow physicians to withhold cardiopulmonary resuscitation from a patient, despite patient or surrogate requests that it be provided, when they believe it will be more harmful than beneficial. Such cases usually involve patients with terminal diagnoses whose medical teams argue that aggressive treatments are medically inappropriate or likely to be harmful. Although there is state-to-state variability and a considerable judicial gray area about the conditions and mechanisms for refusals to perform CPR, medical teams typically follow a (...) set of clearly defined procedures for these decisions. The procedures are based on the principle of nonmaleficence and typically include consultation with hospital ethics committees, reflecting the guidelines of relevant professional associations. Ethical debates about when CPR can and should be limited tend to rely more on discussions of theory, principles, and case studies than systematic empirical study of the situations in which such limitations are applied. Sociologists of bioethics call for empirical study, arguing that what ethicists and health professionals believe they are doing when they draft policies or invoke principles does not always mirror what is happening on the ground. In this article, we begin the task of modeling the empirical analyses sociologists call for, focusing on a cohort at Massachusetts General Hospital. We inductively analyzed ethics committee notes and medical records of nineteen patients whose surrogates did not accept the decision to withhold CPR. (shrink)

We conducted a meta-analysis of 17 studies that tested for an association between grandparental survival and grandchild survival in patrilineal populations. Using two different methodologies, we found that the survival of the maternal grandmother and grandfather, but not the paternal grandmother and grandfather, was associated with decreased grandoffspring mortality. These results are consistent with the findings of psychological studies in developed countries (Coall and Hertwig Behavioral and Brain Sciences 33:1-59, 2010). When tested against the predictions of five hypotheses (confidence of (...) paternity; grandmothering, kin proximity, grandparental senescence, and local resource competition), our meta-analysis results are most in line with the local resource competition hypothesis. In patrilineal and predominantly patrilocal societies, the grandparents who are most likely to live with the grandchildren have a less beneficial association than those who do not. We consider the extent to which these results may be influenced by the methodological limitations of the source studies, including the use of retrospective designs and inadequate controls for confounding variables such as wealth. (shrink)

Various analytical tools originally developed for theories of mechanistic explanation have recently been imported into the ongoing debate on the hypothesis of extended cognition. One such tool that appears particularly relevant to that debate is Craver’s mutual manipulability account of constitution, most of all because it promises to settle the debate on experimental grounds. This paper investigates whether it is possible to deliver on that promise. We first find that, far from grounding an experimental evaluation of HEC, MM is conceptually (...) incompatible with both internalist and externalist accounts of cognition. Next, we propose a suitable modification of MM, MM*, but it turns out that MM* presupposes rather than produces clarity on the extension of cognition. Moreover, subject to MM* the inference to constitution is radically empirically underdetermined. Finally, we argue that our results can be generalized and conclude that, for principled reasons, it is impossible to experimentally determine whether cognitive processes have extracerebral constituents. Determining the extension of cognition is an inherently pragmatic matter. (shrink)

The Covid‐19 pandemic has revealed myriad social, economic, and health inequities that disproportionately burden populations that have been made medically or socially vulnerable. Inspired by state and local governments that declared racism a public health crisis or emergency, the Anti‐Racism in Public Health Act of 2020 reflects a shifting paradigm in which racism is considered a social determinant of health. Indeed, health inequities fundamentally rooted in structural racism have been exacerbated by the Covid‐19 pandemic, which calls for the integration of (...) antiracist praxis to promote ethical public health research processes. This commentary describes ways in which antiracist praxis—which emphasizes empowerment of traditionally marginalized populations—offers strategies to explicitly address power imbalance, stigmatization, and other consequences of structural racism in public health research. (shrink)

Little is known about health care professionals’ perceptions regarding what it means to treat patients and families with respect and dignity in the intensive care unit (ICU) setting. To address this gap, we conducted nine focus groups with different types of health care professionals (attending physicians, residents/fellows, nurses, social workers, pastoral care, etc.) working in either a medical or surgical ICU within the same academic health system. We identified three major thematic domains, namely, intrapersonal (attitudes and beliefs), interpersonal (behaviors), and (...) system (contextual) factors that influence treatment with respect and dignity. Participants suggested strategies for improving treatment of patients and families in the ICU with respect and dignity, as well as the related need for enhancing respect among the multidisciplinary team of clinicians. Implementing these strategies will require innovative educational interventions and leadership. Future research should focus on the design and evaluation of such interventions on the quality of care. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy and Rhetoric 39.1 (2006) 45-71 [Access article in PDF] Presencing "Communion" in Chaïm Perelman's New Rhetoric Richard Graff Wendy Winn Department of RhetoricUniversity of MinnesotaOver the second half of his long and distinguished career, Chaïm Perelman reiterated the central themes of his theory of rhetoric many times. As the audience for his work expanded, Perelman was repeatedly invited to summarize the principles presented in La nouvelle rhétorique, (...) his magnum opus authored in collaboration with Lucie Olbrechts-Tyteca, which appeared in 1958. On these occasions, he would often attempt to clarify or refine the major concepts presented in that treatise. Nevertheless, even today many aspects of Perelman's work remain enigmatic. In outline, The New Rhetoric itself conveys a sense of structural and theoretical clarity, but for many readers this first impression evaporates when they confront the complexity and detail of the work's exposition. In the preface to their new study of Perelman, Alan Gross and Ray Dearin observe:The New Rhetoric is difficult to read, a task made even more difficult for American audiences because virtually all its examples and illustrations are from a literature in a foreign language.... Moreover, Perelman's later attempts to achieve clarity, in The Realm of Rhetoric, and numerous shorter articles, are equally puzzling. Consequently, some of Perelman's best ideas are virtually buried in a very long work, and therefore largely lost even to the most careful readers. In addition, on such central issues as the relationship between rhetoric and philosophy Perelman remains maddeningly obscure. (2003, ix) While Perelman's status as a pioneering figure in the rejuvenation of rhetorical study in Continental Europe is secure, as is his placement among the canonical twentieth-century theorists by American scholars, such difficulties constitute an impediment to contemporary understanding and future appreciation of his achievement; and the sprawling character of The New Rhetoric certainly has not helped to counteract the less [End Page 45] sympathetic reception his work has received in some corners of rhetorical and argumentation studies.1Gross and Dearin's volume joins several other recent studies that have contributed to the untangling of Perelman's thought and to the profitable application of his ideas.2 Still, some of Perelman's "best ideas" remain buried and sorely in need of excavation. Chief among these are considerations prompted by Perelman's use of the evocative yet mysterious term "communion." Although communion appears repeatedly among the panoply of concepts and argumentative techniques described in The New Rhetoric, explicit discussion of it there is brief and scattered, and the subject receives only glancing mention in Perelman's subsequent publications. In turn, communion has been all but ignored in the scholarship responding to or extending Perelman's work.3 This is even the case in studies where one would expect to see more serious engagement with Perelman's ideas on the subject—notably, in those that consider the status of values in argumentation and the role of rhetoric in the constitution and maintenance of community.4In this essay, we offer a detailed analysis of Perelman's conception of communion and, in the course of endowing the concept with greater "presence," aim to show its rich implications for these areas of inquiry. We argue that the idea of communion is a vital, if understated, component of Perelman's proposed "new rhetoric." Like other aspects of Perelman's theory, however, it is an expansive and somewhat slippery notion. In The New Rhetoric, communion is used in a very general sense as the term denoting a community's agreement on questions of value, but also, more narrowly, as an objective sought in certain forms of discourse and as an effect of specific linguistic-stylistic devices. The exegesis needed to indicate the subtle links between these senses will enable us to describe the manner in which Perelman endeavored to integrate the technical lore inherited from the classical tradition of rhetoric with a broadly social and determinedly pluralisticconception of argumentation.We begin by examining communion in relation to Perelman and Olbrechts-Tyteca's ideas... (shrink)

Positive claims about narrative approaches to healthcare suggest they could have many benefits, including supporting person-centred healthcare (PCH). Narrative approaches have also been criticised, however, on both theoretical and practical grounds. In this paper we draw on epistemological work on narrative and knowledge to develop a conception of narrative that responds to these concerns. We make a case for understanding narratives as accounts of events in which the way each event is described as influenced by the ways other events in (...) the narrative are described. This view of narratives recognises that they can contribute knowledge of different kinds of connections between events: not just causal, and not just of patient’s perspectives. Additionally, narratives can add further epistemic value by suggesting potentially useful lines of inquiry. We take narrative approaches to healthcare to include clinicians considering both patients’ informational offerings and their own professional understandings as narratives. On this understanding, our account is able to overcome the major theoretical and practical criticisms that have been levelled against the use of narrative approaches in healthcare, and can help to explain why and how narrative approaches are consistent with PCH. (shrink)

Arguments for extended cognition and the extended mind are typically directed at human-centred forms of cognitive extension—forms of cognitive extension in which the cognitive/mental states/processes of a given human individual are subject to a form of extended or wide realization. The same is true of debates and discussions pertaining to the possibility of Web-extended minds and Internet-based forms of cognitive extension. In this case, the focus of attention concerns the extent to which the informational and technological elements of the online (...) environment form part of the machinery of the (individual) human mind. In this paper, we direct attention to a somewhat different form of cognitive extension. In particular, we suggest that the Web allows human individuals to be incorporated into the computational/cognitive routines of online systems. These forms of computational/cognitive extension highlight the potential of the Web and Internet to support bidirectional forms of computational/cognitive incorporation. The analysis of such bidirectional forms of incorporation broadens the scope of philosophical debates in this area, with potentially important implications for our understanding of the foundational notions of extended cognition and the extended mind. (shrink)

In 2016, the Office of the State Coroner of New South Wales released its report into the death of an Australian woman, Sheila Drysdale, who had died from complications of an autologous stem cell procedure at a Sydney clinic. In this report, we argue that Mrs Drysdale's death was avoidable, and it was the result of a pernicious global problem of an industry exploiting regulatory systems to sell unproven and unjustified interventions with stem cells.

The analysis and understanding of multilingualism, and its relationship to identity in the face of globalization, migration and the increasing dominance of English as a lingua franca, makes it a complex and challenging problem that requires insights from a range of disciplines. With reference to a variety of languages and contexts, this book offers fascinating insights into multilingual identity from a team of world-renowned scholars, working from a range of different theoretical and methodological perspectives. Three overarching themes are explored – (...) situatedness, identity practices, and investment – and detailed case studies from different linguistic and cultural contexts are included throughout. The chapter authors' consideration of 'multilingualism-as-resource' challenges the conception of 'multilingualism-as-problem', which has dogged so much political thinking in late modernity. The studies offer a critical lens on the types of linguistic repertoire that are celebrated and valued, and introduce the policy implications of their findings for education and wider social issues. (shrink)

The promotion of tourists’ environmentally responsible behavior plays a central role in destination management for sustainability. Based on the stimulus–organism–response framework, this study proposes an integrated model for behavior management by examining the relationship between stimuli and response factors through the organism. Survey data from 458 tourists visiting Mount Heng in Hunan Province, Southern China, were used to empirically evaluate the proposed framework. The findings demonstrate that the perception of a destination’s natural environment positively impacts tourists’ sense of awe and (...) satisfaction; the perception of availability of infrastructure positively and significantly influences awe, satisfaction, and TERB; and awe positively impacts satisfaction and TERB. Moreover, the emotion of awe plays a significant mediating role in this proposed model. The theoretical significance of this study and the implications for tourism destinations are discussed. (shrink)

A Citizen Public Debt Audit is an emancipatory praxis that can mobilize citizens to make legible public debt that has been accrued in their name. Ideally, it should hold creditors accountable for debt that is determined to be odious. This study examines the public debt crisis in Puerto Rico to illustrate the historically unjust circumstances under which public debt was accumulated on the island in the context of US federal taxation and economic policies. It explains how citizens are mobilizing via (...) a CPDA to make these circumstances legible and argues that citizens should not be obliged to service debt that was accrued contrary to their own welfare, especially if conditions of repayment threaten their current and future well-being. (shrink)

On affirme couramment que les trente-quatre homélies sur les Hébreux correspondent aux dernières années de Jean Chrysostome à Constantinople. Les AA. reprennent dans un premier temps les arguments des spécialistes depuis Henry Savile. En second lieu, ils s'arrêtent sur la thèse d'Opelt qui préfère Antioche plutôt que Constantinople comme lieu de provenance. Ces trente-quatre homélies constituent une partie importante de l'oeuvre de prédication de Jean Chrysostome et ne semblent pas appartenir à la série des dernières prédications assurées par ce dernier.

Reply to a commentary by Felicitas Holzer and Ignacio Mastroleoon “Models of Consent to Return of Incidental Findings in Genomic Research.”.

The experience of uncertainties in exploring the unknown—and dealing with them—is a key characteristic of what it means to be a life science researcher, but we have only started to understand how this characteristic shapes cultures of knowledge production, particularly in times when other—more social—uncertainties enter the field. Although the lab studies tradition has explored the workings of epistemic uncertainties, the range of potent uncertainty experiences in research cultures has been broadened within the neoliberal reorganization of academic institutions. Most importantly, (...) the stronger dependency on competitive project funding has led to increased social uncertainties. Being employed part-time and for shorter periods of time, researchers often find themselves in the precarious situation of high employment uncertainty. This article argues that the currently predominant form of organizing academic research creates a structural link between epistemic and social uncertainties. It then describes empirically different modes of coping with these uncertainties that researchers deploy and that seem to have become a variable in the governance of research cultures. To do so, it takes the academic life sciences in Austria as an example and explores them using approaches from both science and technology studies and labor studies. (shrink)

Lloyd (2009) contends that climate models are confirmed by various instances of fit between their output and observational data. The present paper argues that what these instances of fit might confirm are not climate models themselves, but rather hypotheses about the adequacy of climate models for particular purposes. This required shift in thinking—from confirming climate models to confirming their adequacy-for-purpose—may sound trivial, but it is shown to complicate the evaluation of climate models considerably, both in principle and in practice.

Wendy Rogers ist Professorin für klinische Ethik und Catriona Mackenzie ist Professorin für Philosophie. Beide lehren an der Macquarie University in Sydney, Australien. Susan Dodds ist Professorin für Philosophie an der La Trobe University in Melbourne, Australien. Alle drei befassen sich seit Jahren intensiv mit feministischer Theorie, angewandter und biomedizinischer Ethik sowie mit Moralphilosophie.

Building on group discussions and interviews with life science researchers in Austria, this paper analyses the narratives that researchers use in describing what they feel responsible for, with a particular focus on how they perceive the societal responsibilities of their research. Our analysis shows that the core narratives used by the life scientists participating in this study continue to be informed by the linear model of innovation. This makes it challenging for more complex innovation models [such as responsible research and (...) innovation ] to gain ground in how researchers make sense of and conduct their research. Furthermore, the paper shows that the life scientists were not easily able to imagine specific practices that would address broader societal concerns and thus found it hard to integrate the latter into their core responsibilities. Linked to this, researchers saw institutional reward structures as strongly focused on scientific excellence. Thus, they saw reward structures as competing with—rather than incentivising—broader notions of societal responsibility. This narrative framing of societal responsibilities is indicative of a structural marginalisation of responsibility practices and explains the claim, made by many researchers in our sample, that they cannot afford to spend time on such practices. The paper thus concludes that the core ideas of RRI stand in tension with predominant narrative and institutional infrastructures that researchers draw on to attribute meaning to their research practices. This suggests that scientific institutions still have a core role to play in providing new and context-specific narratives as well as new forms of valuing responsibility practices. (shrink)

Key commentators on person‐centred care have described it as a “new ethic of care” which they link inextricably to notions of individual autonomy, action, change and improvement. Two key points are addressed in this article. The first is that few discussions about ethics and person‐centred are underscored by any particular ethical theory. The second point is that despite the espoused benefits of person‐centred care, delivery within the acute care setting remains largely aspirational. Choices nurses make about their practice tend to (...) comply more often with prevailing norms than those championed by person‐centred care. We draw on elements of work by moral philosopher Løgstrup and Foucault to provide insight into nurses’ ethical conduct and ask why nurses would want to act otherwise, when what they think and do is viewed as normal, or think and act otherwise if doing so is seen within the organization as transgressive? To address these more specific questions, we discuss them in relation to the following constructs: the ethical demand, sovereign expressions of life and parrhêsia. We conclude by arguing that a ethical theoretical framework enables nurses to increase their perceptibility and appreciation of the ethical demand particularly those emanating from incommensurability between organizational norms and the norms invoked by person‐centred care. We argue that nurses’ responses to the ethical demand by way of parrhêsia can be an important feature of intra‐organizational reflexivity and its transformation towards the delivery care that is more person‐centred, particularly for older people with cognitive impairment. We conclude the article by highlighting the implications of this for nursing education and research. (shrink)

Early in the 20th century Bateson, Doncaster and Punnett formed a cooperative collective to share research findings on the chromosome theory of heredity (CTH). They cross-bred plants and animals to correlate behaviour of chromosomes and heredity of individual traits. Doncaster was the most enthusiastic proponent of the new theory and worked for years to convince Bateson and Punnett on its relevance to their own research. The two younger biologists collaborated with Bateson, the preeminent geneticist in England. As their own reputations (...) developed, their research findings allied with the consensus on the importance of the CTH by the broader scientific community. After Doncaster’s tragic death in 1920, major objections to the theory had been resolved; Bateson and Punnett then utilized the CTH to construct chromosome maps detailing locations of specific genes on particular chromosomes in several different species. The marriage of heredity and cytology enhanced confidence that the theory was an accurate mechanism to explain inheritance in both plants and animals. (shrink)

The ways in which societies and institutions institutionalize and practice invention management reflects not only how new ideas are valued, but also imaginaries about the role of science and technology for societal development. Often taking the US Bayh-Dole-Act as a model, many European states have recently implemented changes in how inventions at academic institutions are to be handled to optimize their societal impact. We analyze how these changes have been taken up—and made sense of—in regions with different pre-existing infrastructures, practices (...) and semantics of invention management. For doing so, we build on a comparative analysis of continuities and changes in infrastructures, practices and semantics of invention management in North-Rhine Westphalia and Saxony to reflect on how academic institutions have been handling inventions along transforming socio-political contexts. Building on document analysis and qualitative interviews with research managers, we discuss ongoing differences in practices of invention management and the semantic framing of the societal value of inventions in NRW and Saxony, and discuss how this can be understood before the background of their ideological, political and economic separation until reunification in 1990. Joining the conceptual perspectives of path dependencies and sociotechnical imaginaries, we argue that two critical incidents in the history of these states allowed for wide-ranging institutional alignments, but also allowed path dependencies in practices and semantics of invention management to prevail. (shrink)

Adapting Wittgenstein's concept of the human species as 'a ceremonial animal', Wendy James discusses in a readable and lively style the conceptual ordering of space, time, and rhythm; the mutualities of language, consciousness, ritual and religious practice; the dialectics of gender and generation; power, war, and peace; and large-scale modern social formations such as the city and the nation. The Foreword is by Michael J. Lambek, Professor of Anthropology, University of Toronto.

This article identifies conditions under which robust predictive modeling results have special epistemic significance---related to truth, confidence, and security---and considers whether those conditions hold in the context of present-day climate modeling. The findings are disappointing. When today’s climate models agree that an interesting hypothesis about future climate change is true, it cannot be inferred---via the arguments considered here anyway---that the hypothesis is likely to be true or that scientists’ confidence in the hypothesis should be significantly increased or that a claim (...) to have evidence for the hypothesis is now more secure. (shrink)

Despite over three decades of research into the sources and costs of what has become an “epidemic” of moral distress among healthcare professionals, spanning many clinical disciplines and roles, there has been little significant progress in effectively addressing moral distress. We believe the persistent sense of frustration, helplessness, and despair still dominating the clinical moral distress narrative signals a need for re-orientation in the way moral distress is understood and worked with. Most fundamentally, moral distress reveals moral investment and energy. (...) It is the troubled call of conscience, an expression of fidelity to moral commitments seen as imperiled or compromised.It is crucial that we find ways to empower clinicians in heeding this call—to support clinicians’ moral agency and voice, foster their moral resilience, and facilitate their ability to contribute to needed reform within the organizations and systems in which they work. These objectives must inform creative expansion in the design of strategies for addressing moral distress in the day-to-day of clinical practice. We include suggestions about promising directions such strategies might take in the hope of spurring further innovation within clinical environments. (shrink)

As artist-in-residence at the Zen Hospice Project Guest House, Wendy MacNaughton experienced firsthand how difficult it is to know what to do when we're sharing final moments with a loved one. In this tenderly illustrated guide to saying goodbye, with a foreword by renowned physician and author BJ Miller, MacNaughton shows how to make sure those moments are meaningful. Using a framework of "the five things" taught to her by a professional caregiver, How to Say Goodbye provides a model (...) for having conversations of love, respect, and closure: with the words "I forgive you," "Please forgive me," "Thank you," "I love you," and "Goodbye," each oriented toward finding mutual peace and understanding when it matters most. How to Say Goodbye features MacNaughton's drawn-from-life artwork from both the Zen Hospice Project Guest House and her own aunt's bedside as she died, each paired with hospice caregivers' gentle advice on creating a positive sensory experience, acknowledging what you can't control, and sharing memories and gratitude. A poignant guide to embracing the present and deepening relationships during great vulnerability, How to Say Goodbye shows that just as there is no one right way to live a good life, there is no one right way to say goodbye. Whether confused, scared, or uncertain, this book is a starting point. (shrink)

Whether in characterizing Catharine MacKinnon's theory of gender as itself pornographic or in identifying liberalism as unable to make good on its promises, Wendy Brown pursues a central question: how does a sense of woundedness become the basis for a sense of identity? Brown argues that efforts to outlaw hate speech and pornography powerfully legitimize the state: such apparently well-intentioned attempts harm victims further by portraying them as so helpless as to be in continuing need of governmental protection. "Whether (...) one is dealing with the state, the Mafia, parents, pimps, police, or husbands," writes Brown, "the heavy price of institutionalized protection is always a measure of dependence and agreement to abide by the protector's rules." True democracy, she insists, requires sharing power, not regulation by it; freedom, not protection.Refusing any facile identification with one political position or another, Brown applies her argument to a panoply of topics, from the basis of litigiousness in political life to the appearance on the academic Left of themes of revenge and a thwarted will to power. These and other provocations in contemporary political thought and political life provide an occasion for rethinking the value of several of the last two centuries' most compelling theoretical critiques of modern political life, including the positions of Nietzsche, Marx, Weber, and Foucault. (shrink)