The flu has an interesting history with respect to health care rationing in the United States. Consider that just about two years ago, the American public faced a shortage of influenza vaccine. Dire predictions were made about how many people might perish, and rationing protocols were created. However, many of the rationing protocols were ignored. Luckily, that flu season did not result in the horrible fatalities that were predicted. For these reasons, problems of health care rationing around issues of the (...) flu were postponed, rather than resolved.Over the last year, the public has focused its anxious attention on the possible avian influenza pandemic. Last week I noticed that at least once each day I heard mention in some discussion or another of the threat of this disease becoming easily transmissible from human to human. (shrink)

The birth plan has become an increasingly institutionalized tool of Western birth practices, used both in medicalized and midwifery settings. Limited empirical research has been done on the efficacy of birth plans in achieving a commonly-ascribed goal: empowering women in their birth experiences. Still, less work has been done on the ethical dimensions of birth plans. As such, this tool has become nearly ubiquitous in birthing practices, yet they warrant further reflection. In this paper, I articulate the ethical goals of (...) writing birth plans. I frame the birth plan as a narrative project: one that women are encouraged to write out, after careful consideration, as a kind of story that articulates the values, experiences, and relationships that are most important to shaping their experience of a “good birth.” Given the importance of the birth experience for many women, birth plans are ethical projects that the attempt to reframe and improve the deeper political dimensions of birth and patient choice. Birth plans are meant to structure the experience, guide women’s understanding of the process, and foster important clinical relationships. In this way, they are similar to advance directives, which are written to shape successful end-of-life care. Yet, the success of birth plans as tool for this ethical work is questionable. This tool aiming at women’s empowerment and ethical self-reflection often sets women up for a kind of ethical injury, in the attempt to avoid unwanted physical harms of labor and delivery. Birth plans are not legally binding, despite how they are framed as pseudo-contracts. Instead of resisting the challenges of a medicalized birth and to be empowered agreements, birth plans often set women up to fail, often aiming at unreasonable expectations. In my argument, I ask to identify for whom the birth plan works, and in which ways the birth plan experience can be improved. Finally, I address how the failure to give birth plans uptake during emergencies often undermines the patient-physician relationship, working against the primary goal of empowerment. (shrink)

Volume 20, Issue 9, September 2020, Page 78-80.

While sexual and gender minorities are at increased risk for poor health outcomes, there is limited data regarding patient-provider interactions. In this study, we explored the perspectives of LGBTQ patients and their encounters with physicians in order to improve our understanding of patient-physician experiences. Using purposive selection of self-identified LGBTQ patients, we performed fourteen in-depth semi-structured interviews on topics of sexual orientation and gender identity, as well as their perceived role in the patient-provider relationship. Coding using a modified grounded theory (...) approach was performed to generate themes. We identified three major themes that demonstrate the complexity of LGBTQ patient experiences. The first, Lacking trust, identifies mistrust and loss of the physician-patient relationship resulting from physicians’ poor or judgmental communication, or from physicians making assumptions about gender, using incorrect pronouns, and not recognizing heterogeneity within the transgender community. A second theme, Being vulnerable, describes the challenges and fears related to comfort of patients with disclosing their sexual orientation and/or gender identity. A final theme, Navigating discrimination, outlines racial or ethnic discrimination which creates an additional burden on top of illness and stigmatized identity. Our results reveal the complex needs of individuals with multiple stigmatized identities when developing relationships with providers. By using an intersectional perspective that appreciates the plurality of patients’ identities, providers can help to improve their relationships with LGBTQ patients. Incorporating intersectional training for medical students and residents could greatly benefit both LGBTQ patients and their physicians. (shrink)

Among the most important questions in the metaphysics of science are "What are the natures of fundamental laws and chances?" and "What grounds the direction of time?" My aim in this paper is to examine some connections between these questions, discuss two approaches to answering them and argue in favor of one. Along the way I will raise and comment on a number of issues concerning the relationship between physics and metaphysics and consequences for the subject matter and methodology of (...) metaphysics. (shrink)

It is generally thought that objective chances for particular events different from 1 and 0 and determinism are incompatible. However, there are important scientific theories whose laws are deterministic but which also assign non-trivial probabilities to events. The most important of these is statistical mechanics whose probabilities are essential to the explanations of thermodynamic phenomena. These probabilities are often construed as 'ignorance' probabilities representing our lack of knowledge concerning the microstate. I argue that this construal is incompatible with the role (...) of probability in explanation and laws. This is the 'paradox of deterministic probabilities'. After surveying the usual list of accounts of objective chance and finding them inadequate I argue that an account of chance sketched by David Lewis can be modified to solve the paradox of deterministic probabilities and provide an adequate account of the probabilities in deterministic theories like statistical mechanics. (shrink)

Efficient markets are alienating if they inhibit us from recognizably caring about one another in our productive activities. I argue that efficient market behaviour is both exclusionary and fetishistic. As exclusionary, the efficient marketeer cannot manifest care alongside their market behaviour. As fetishistic, the efficient marketeer cannot manifest care in their market behaviour. The conjunction entails that efficient market behavior inhibits care. It doesn’t follow that efficient market behavior is vicious: individuals might justifiably commit to efficiency because doing so serves (...) the common good. But efficient market systems nevertheless have significant opportunity costs. The discussion yields a range of desiderata for non-alienated economic organization. (shrink)

The most important theories in fundamental physics, quantum mechanics and statistical mechanics, posit objective probabilities or chances. As important as chance is there is little agreement about what it is. The usual “interpretations of probability” give very different accounts of chance and there is disagreement concerning which, if any, is capable of accounting for its role in physics. David Lewis has contributed enormously to improving this situation. In his classic paper “A Subjectivist's Guide to Objective Chance” he described a framework (...) for representing single case objective chances, showed how they are connected to subjective credences, and sketched a novel account what they are within his Humean account of scientific laws. Here I will describe these contributions and add a little to them. (shrink)

This paper develops an account of the metaphysics of fundamental laws I call “the Package Deal Account ” that is a descendent of Lewis’ BSA but differs from it in a number of significant ways. It also rejects some elements of the metaphysics in which Lewis develops his BSA. First, Lewis proposed a metaphysical thesis about fundamental properties he calls “Humean Supervenience” according to which all fundamental properties are instantiated by points or point sized individuals and the only fundamental relations (...) are geometrical spatial and temporal relations between these. While the BSA does not require HS Lewis seems to hope that it is true. In contrast, the PDA is not committed to HS or even to the fundamental arena in which fundamental properties are instantiated possessing geometrical structure and thus is able to accommodate relations and structures found in contemporary physics that apparently conflict with HS. Second, although Lewis’ BSA doesn’t require HS his Humeanism does require that fundamental properties are categorical. In contrast, the PDA allows for the possibility that fundamental properties are individuated in terms of laws and so are not categorical. Third, the PDA expands and develops the criteria for what counts in favor of a candidate system with more attention to the criteria employed by physicists in evaluating proposed theories. Fourth and most importantly, unlike Lewis’ BSA, the PDA does not presuppose metaphysically primitive elite properties/quantities that Lewis calls “perfectly natural” properties/quantities or presuppose a metaphysically preferred language whose terms denote such properties/quantities. It replaces Lewis’ account with an account on which natural properties are not metaphysically prior to the laws but are elements of a package that includes a fundamental arena that plays the role of space-time as well as fundamental laws and properties. By doing so it responds to some epistemological and metaphysical issues that have been raised regarding natural properties and their role in the BSA. In sum, the PDA goes further in explicating the notion of laws in terms of the aims and practices of science especially fundamental physics rather than in terms of prior metaphysics. I begin by reviewing Lewis’ account of perfectly natural properties and his Humean BSA of laws. (shrink)

In ordinary conscious experience, consciousness of time seems to be ubiquitous. For example, we seem to be directly aware of change, movement, and succession across brief temporal intervals. How is this possible? Many different models of temporal consciousness have been proposed. Some philosophers have argued that consciousness is confined to a momentary interval and that we are not in fact directly aware of change. Others have argued that although consciousness itself is momentary, we are nevertheless conscious of change. Still others (...) have argued that consciousness is itself extended in time. In this entry, the motivations and merits of these and other positions will be expounded and assessed. (shrink)

Canada has recently published a new Clinical Practice Guideline on the diagnosis and management of brain death. It states that consent is not necessary to carry out the interventions required to make the diagnosis. A supporting article not only sets out the arguments for this but also contends that ‘UK laws similarly carve out an exception, excusing clinicians from a prima facie duty to get consent’. This is supplemented by the claim that recent court decisions in the UK similarly confirm (...) that consent is not required, referencing two judgements inBattersbee. We disagree with the authors’ interpretation of the law on consent in the UK and argue that there is nothing inBattersbeeto support the conclusion that consent to testing is not necessary. Where there is a disagreement about testing for brain death in the UK, court authorisation is required. (shrink)

The paper proposes a formal account of Aristotle's trichotomy of verbs, in terms of properties of their continuous tensings, into S(state)-verbs, K(kinesis)-verbs, and E-(energeia)-verbs. Within a Fregean tense framework in which predicates are relativized to times, an account of the continuous tenses is presented and a preliminary account of the trichotomy devised, which permits an illuminating analogy to be drawn between the temporal properties of E- and K-verbs and the spatial properties of stuffs and substances. This analogy is drawn upon (...) in constructing a sophisticated version of the preliminary theory accommodating more of the linguistic data. (shrink)

In an article in Cognition, Machery, Mallon, Nichols, and Stich [Machery et al., 2004] present data which purports to show that “East Asian” native Cantonese speakers tend to have descriptivist intuitions about the referents of proper names, while “Western” native English speakers tend to have causal-historical intuitions about proper names. Machery et al take this finding to support the view that some intuitions, the universality of which they claim is central to philosophical theories, vary according to cultural background. Machery et (...) al hypothesize that the differences in intuitions about reference stem from general psychological differences between Eastern and Western subjects. Machery et al conclude from their findings that the philosophical methodology of consulting intuitions about hypothetical cases is flawed vis ` a vis the goal of determining truths about some philosophical domains. To quote Machery et al, “our data indicate that philosophers must radically revise their methodology” because “the intuitions philosophers pronounce from their armchairs are likely to be a product of their own culture and their academic training” ( [Machery et al., 2004] pp.B9). “The evidence suggests that it is wrong for philosophers to assume a priori the universality of their own semantic intuitions” ( [Machery et al., 2004] pp. B8). In the following study, I present data incompatible with Machery et al’s results. Native Cantonese-speaking immigrants from a Cantonese diaspora 1 in Southern California do not have descriptivist intuitions about the referents of proper names when presented with a Cantonese story and Cantonese questions about reference and truth-value. This data raises questions about the quality of Machery et al’s study and the conclusions they draw from it. (shrink)

NRP is a family of views differing by how they understand “reduction” and “physicalism.” Following Kim I understand the non-reduction as holding that some events and properties are distinct from any physical events and properties. A necessary condition for physicalism is that mental properties, events, and laws supervene on physical ones. Kim allows various understandings of “supervenience” but I think that physicalism requires at least the claim that any minimal physical duplicate of the actual world is a duplicate simpliciter. Some (...) complications aside this means that true mental propositions, e.g. Jaegwon is thinking about sailing, are metaphysically entailed by true physical propositions. Kim says that supervenience is too weak to capture the root idea of physicalism that mental property instantiations depend on physical property instantiations so he adds that the mental depends on the physical. One way in which this dependance might be spelled out is that mental properties are higher order functional properties whose instantiations are realized by instantiations of physical properties. An event is an instantiation of a property by an individual and a time. A mental event is the instantiation of a mental property. Not every predicate expresses a genuine property. Kim further suggests that properties are individuated, at least partly, by nomological and causal relations. For physicalism to have content something must be said about the difficult issue of characterizing the physical. Kim’s view seems to be that the micro-physical properties of ideal physics are physical. He also counts as physical properties that are conjunctions and aggregates of micro-physical properties and higher level properties defined over lower-level physical properties.. Since these latter two classes of properties supervene on the micro-properties and laws there is no need to include them in the supervenience base. (shrink)

INTRODUCTION Much attention has been devoted to the different tensions and conflicts between science and religion in the modern age. ...

Acceptance of Humean Supervenience and thereductive Humean analyses that entail it leadsto a litany of inadequately explained conflictswith our intuitions regarding laws andpossibilities. However, the non-reductiveHumeanism developed here, on which law claimsare understood as normative rather than factstating, can accommodate those intuitions. Rational constraints on such norms provide aset of consistency relations that ground asemantics formulated in terms offactual-normative worlds, solving theFrege-Geach problem of construing unassertedcontexts. This set of factual-normative worldsincludes exactly the intuitive sets ofnomologically possible worlds associated witheach possible (...) set of laws. The extension ofthe semantics to counterfactual and subjunctiveconditionals is sketched. Potential objectionsinvolving subjectivity, mind-dependence, andnon-factuality are discussed. (shrink)

There are several powerful motivations for neutral value‐based deontic theories such as Act Consequentialism. Traditionally, such theories have had great difficulty accounting for partiality towards one's personal relationships and projects. This paper presents a neutral value‐based theory that preserves the motivations for Act Consequentialism while vindicating some crucial intuitions about reasons to be partial. There are two central ideas. The first is that when it comes to working out what you ought to do, your friends’ interests, the needs of your (...) family, the significance of your own projects and ideals, etc. have more weight than the interests and needs of strangers. Your friends’ interests are not (thereby) more neutrally valuable than the interests of others. So there is a difference between the value of an outcome and its deontic significance. The second familiar idea is that reasons are modifiable. Reasons of partiality are reasons the weights of which are a function of the value of the relevant outcome modified by facts about the value of caring about the outcome in question. The resulting principle has various further explanatory advantages; in particular, it accounts for project‐ and relationship‐specific permissions and requirements, both at a time and across time. (shrink)

(2000). CASSIRER, SCHLICK AND ‘STRUCTURAL’ REALISM: THE PHILOSOPHY OF THE EXACT SCIENCES IN THE BACKGROUND TO EARLY LOGICAL EMPIRICISM. British Journal for the History of Philosophy: Vol. 8, No. 1, pp. 71-106.

Consciousness exists in time, but time is also to be found within consciousness: we are directly aware of both persistence and change, at least over short intervals. On reflection this can seem baffling. How is it possible for us to be immediately aware of phenomena which are not (strictly speaking) present? What must consciousness be like for this to be possible? In "Stream of Consciousness" I argued that influential accounts of phenomenal temporality along the lines developed by Broad and Husserl (...) were fundamentally flawed, and proposed a quite different account: the overlap model. While recognizing that the latter has merits, Gallagher argues that it too is fundamentally flawed; he also takes issue with some of my claims concerning Broad and Husserl. My reply comes in three main parts. I start by clarifying my use of certain terms, in particular realism and anti-realism as applied to theories of phenomenal temporality in general, and the accounts of Broad and Husserl in particular. I then turn to Gallagher’s main criticisms of the overlap theory. Gallagher argues that the theory is sunk by a problem with ongoing contents, that if our experience possessed the structures I ascribe to it, we would be aware of contents as having longer durations than is actually the case. I suggest otherwise: the version of the overlap theory which is afflicted by this difficulty is not the version I put forward, as becomes clear when two distinct forms of overlap are distinguished. Gallagher is also concerned that the theory lacks phenomenological grounding, and has difficulties with experiential holism. The latter worry, I argue, is completely misplaced. While the former has more warrant, it too is rooted in a misconception: the overlap theory was intended only to provide an account of the most basic sensory components of our short-term experience of temporality, and can easily be expanded to accommodate other aspects. I supply a sketch an augmented theory to back up this claim. I conclude with an assessment of the intentional account of time-consciousness Gallagher ascribes to Husserl. A meaning-based account of this kind is incapable of accounting for experienced sensory continuity, or so I argue. I also suggest that both Broad and Husserl may have had leanings towards the Simple Conception of consciousness. -/- . (shrink)

This paper is particularly concerned with shame, sometimes considered the ‘master emotion’, and its possible role in affecting the consent process, specifically where that shame relates to the issue of diminished health literacy. We suggest that the absence of exploration of affective issues in general during the consent process is problematic, as emotions commonly impact upon our decision-making process. Experiencing shame in the healthcare environment can have a significant influence on choices related to health and healthcare, and may lead to (...) discussions of possibilities and alternatives being closed off. In the case of impaired health literacy we suggest that it obstructs the narrowing of the epistemic gap between clinician and patient normally achieved through communication and information provision. Health literacy shame prevents acknowledgement of this barrier. The consequence is that it may render consent less effective than it otherwise might have been in protecting the person's autonomy. We propose that the absence of consideration of health literacy shame during the consent process diminishes the possibility of the patient exerting full control over their choices, and thus bodily integrity. (shrink)

In this book, Christian Barry and Sanjay G. Reddy propose ways in which the international trading system can support poor countries in promoting the well-being of their peoples.

According to one influential view, consciousness has an awareness– content structure: any experience consists of the awareness of some content. I focus on one version of this dualism, and argue that it should be rejected. My principal argument is directed at the status of the supposed contents of aware- ness; I argue that neither of the principal options is tenable, albeit for different reasons. Although the doctrine in question may seem to be supported by the find- ings of researchers in (...) meditative traditions, I question whether this evidence sup- ports the dualism that is my target here. To conclude, I introduce an innocuous mode of pure awareness. (shrink)

"Pace" michael devitt and other recent writers, this paper argues that realism essentially involves commitment to a substantial theory of truth. it also tries to chart the ways whereby the commitment arises.

" Barry Allen shows what truth has come to mean in the philosophical tradition, what is wrong with many of the ways of conceiving truth, and why philosophers ...

Consensus has been highlighted by African philosophers as an element essential to African societies, past and present, that has not been assigned the importance it deserves. The philosophers involved have done this in part by drawing upon firsthand experience of their own indigenous cultures. Consensual governance presents a rather different view of the constitution of indigenous African societies and what should be their most appropriate form of political order today. A legitimate concern, therefore, is why this element supposedly foundational to (...) sub-Saharan African societies came to be underrated. (shrink)