While a significant literature has appeared discussing theoretical ethical concerns regarding COVID-19, particularly regarding resource prioritization, as well as a number of personal reflections on providing patient care during the early stages of the pandemic, systematic analysis of the actual ethical issues involving patient care during this time is limited. This single-center retrospective cohort mixed methods study of ethics consultations during the first surge of the COVID 19 pandemic in Massachusetts between March 15, 2020 through June 15, 2020 aim to (...) fill this gap. Results indicate that there was no significant difference in the median number of monthly consultation cases during the first COVID-19 surge compared to the same period the year prior and that the characteristics of the ethics consults during the COVID-19 surge and same period the year prior were also similar. Through inductive analysis, we identified four themes related to ethics consults during the first COVID-19 surge including (1) prognostic difficulty for COVID-19 positive patients, (2) challenges related to visitor restrictions, (3) end of life scenarios, and (4) family members who were also positive for COVID-19. Cases were complex and often aligned with multiple themes. These patient case-related sources of ethical issues were managed against the backdrop of intense systemic ethical issues and a near lockdown of daily life. Healthcare ethics consultants can learn from this experience to enhance training to be ready for future disasters. (shrink)

Originally published in 1963, this classic book is a rethinking of the history of Western political philosophy. Charles N. R. McCoy contrasts classical-medieval principles against the "hypotheses" at the root of modern liberalism and modern conservativism. In Part I, "The Classical Christian Tradition from Plato to Aquinas," the author lays the foundation for a philosophical "structure" capable of producing "constitutional liberty." Part II, "The Modern Theory of Politics from Machiavelli to Marx," attempts to show, beginning with Machiavelli, the reversal (...) and destruction of the pre-modern "structure" postulated in Part I. McCoy stresses the great contributions of Aristotle to political thought found in his more familiar Ethics and Politics, but also includes key insights drawn from Metaphysics and Physics. These contributions are developed and perfected, McCoy argues, by Augustine and Aquinas. Two other important features include McCoy's epistemological insights into Plato's work that will be new to many readers and the author's juxtaposition of traditional natural law with "the modernized theory of natural law." The modern account of autonomous natural law, in McCoy's view, helps explain the totalitarian direction of key aspects of modern political thought. This classic volume on the origins of modern philosophical thought remains a standard in the field. (shrink)

Systematic study of the intersection of ethics consultation services and solid organ transplants and recipients can identify and illustrate ethical issues that arise in the clinical care of these patients, including challenges beyond resource allocation. This was a single-centre, retrospective cohort study of all adult ethics consultations between January 1, 2007, and December 31, 2017, at a large academic medical centre in the north-eastern United States. Of the 880 ethics consultations, sixty (6.8 per cent ) involved solid organ transplant, thirty-nine (...) (65.0 per cent) for candidates and twenty-one (35.0 per cent ) for recipients. Ethics consultations were requested for 4.3 per cent of heart, 4.9 per cent of lung, 0.3 per cent of liver, and 0.3 per cent of kidney transplant recipients over the study period. Nurses were more likely to request ethics consultations for recipients than physicians (80.0 per cent vs 20.0 per cent, p = 0.006). The most common reason for consultation among transplant candidates was discussion about intensity of treatment or goals of care after the patient was not or was no longer a transplant candidate. The most common reason for ethics consultation among transplant recipients was disagreement between transplant providers and patients/families/non-transplant healthcare professionals over the appropriate intensity of treatment for recipients. Very few consultations involved questions about appropriate resource allocation. Ethics consultants involved in these cases most often navigated communication challenges between transplant and non-transplant healthcare professionals and patients and families. (shrink)

Critical care society guidelines recommend that ethics committees mediate intractable conflict over potentially inappropriate treatment, including Do Not Resuscitate status. There are, however, limited data on cases and circumstances in which ethics consultants recommend not offering cardiopulmonary resuscitation despite patient or surrogate requests and whether physicians follow these recommendations. This was a retrospective cohort of all adult patients at a large academic medical center for whom an ethics consult was requested for disagreement over DNR status. Patient demographic predictors of ethics (...) consult outcomes were analyzed. In 42 of the 116 cases, the patient or surrogate agreed to the clinician recommended DNR order following ethics consultation. In 72 of 74 of the remaining cases, ethics consultants recommended not offering CPR. Physicians went on to write a DNR order without patient/surrogate consent in 57 of those cases. There were no significant differences in age, race/ethnicity, country of origin, or functional status between patients where a DNR order was and was not placed without consent. Physicians were more likely to place a DNR order for patients believed to be imminently dying. The median time from DNR order to death was 4 days with a 90-day mortality of 88.2%. In this single-center cohort study, there was no evidence that patient demographic factors affected ethics consultants’ recommendation to withhold CPR despite patient/surrogate requests. Physicians were most likely to place a DNR order without consent for imminently dying patients. (shrink)

In 2015, the major critical care societies issued guidelines outlining a procedural approach to resolving intractable conflict between healthcare professionals and surrogates over life-sustaining treatments (LST). We report our experience with a resolving conflict procedure. This was a retrospective, single-centre cohort study of ethics consultations involving intractable conflict over LST. The resolving conflict process was initiated eleven times for ten patients over 2,015 ethics consultations from 2000 to 2020. In all cases, the ethics committee recommended withdrawal of the contested LST. (...) In seven cases, the patient died or was transferred or a legal injunction was obtained before completion of the process. In the four cases in which LST was withdrawn, the time from ethics consultation to withdrawal of LST was 24.8 ± 12.2 days. Healthcare provider and surrogate were often distressed during the process, sometimes resulting in escalation of conflict and legal action. In some cases, however, surrogates appeared relieved that they did not have to make the final decision regarding LST. Challenges regarding implementation included the time needed for process completion and limited usefulness in emergent situations. Although it is feasible to implement a due process approach to conflict over LST, there are factors that limit the procedure’s usefulness. (shrink)

Thomas S. Kuhn's classic book is now available with a new index.

This book contains the text of Thomas Kuhn's unfinished book, The Plurality of Worlds: An Evolutionary Theory of Scientific Development, which Kuhn himself described as "a return to the central claims of The Structure of Scientific Revolutions, and the problems that it raised but did not resolve." The Plurality of Worlds is preceded by two related texts that Kuhn publicly delivered but never published in English: his paper "Scientific Knowledge as a Historical Product" and his Shearman Memorial Lectures, "The (...) Presence of Past Science." The book opens with an introduction by the editor that describes the origins and structure of The Plurality of Worlds, and sheds light on its central philosophical problems. Kuhn's aims in his last writings are bold. He sets out to develop an empirically grounded theory of meaning that would allow him to make sense of both the possibility of historical understanding and the inevitability of incommensurability between past and present science. Moreover, he intends to show that incommensurability is fully compatible with a robust notion of a real world that science investigates, with the rationality of scientific belief change, and with the idea that scientific development is progressive. This is a must-read follow-up to The Structure of Scientific Revolutions, one of the most important books of the twentieth century. (shrink)

The significance of the plurality of the Copernican Revolution is the main thrust of this undergraduate text In this study of the Copernican Revolution, the ...

The author's concept of incommensurability is explicated by elaborating the claim that some terms essential to the formulation of older theories defy translation into the language of more recent ones. Defense of this claim rests on the distinction between interpreting a theory in a later language and translating the theory into it. The former is both possible and essential, the latter neither. The interpretation/translation distinction is then applied to Kitcher's critique of incommensurability and Quine's conception of a translation manual, both (...) of which take reference-preservation as the sole semantic criterion of translational adequacy. The paper concludes by enquiring about the additional criteria a successful translation must satisfy. (shrink)

A highly condensed account of the author's present view of some philosophical problems unresolved in The Structure of Scientific Revolutions. The concept of incommensurability, now considerably developed, remains at center stage, but the evolutionary metaphor, introduced in the final pages of the book, now also plays a principal role.

A highly condensed account of the author's present view of some philosophical problems unresolved in The Structure of Scientific Revolutions. The concept of incommensurability, now considerably developed, remains at center stage, but the evolutionary metaphor, introduced in the final pages of the book, now also plays a principal role.

Divided into three parts, this work is a record of the direction Kuhn was taking during the last two decades of his life. It consists of essays in which he refines the basic concepts set forth in "Structure"--Paradigm shifts, incommensurability, and the nature of scientific progress.

A good book may have the power to change the way we see the world, but a great book actually becomes part of our daily consciousness, pervading our thinking to the point that we take it for granted, and we forget how provocative and challenging its ideas once were—and still are. _The Structure of Scientific Revolutions _is that kind of book. When it was first published in 1962, it was a landmark event in the history and philosophy of science. Fifty (...) years later, it still has many lessons to teach. With _The Structure of Scientific Revolutions, _Kuhn challenged long-standing linear notions of scientific progress, arguing that transformative ideas don’t arise from the day-to-day, gradual process of experimentation and data accumulation but that the revolutions in science, those breakthrough moments that disrupt accepted thinking and offer unanticipated ideas, occur outside of “normal science,” as he called it. Though Kuhn was writing when physics ruled the sciences, his ideas on how scientific revolutions bring order to the anomalies that amass over time in research experiments are still instructive in our biotech age. This new edition of Kuhn’s essential work in the history of science includes an insightful introduction by Ian Hacking, which clarifies terms popularized by Kuhn, including paradigm and incommensurability, and applies Kuhn’s ideas to the science of today. Usefully keyed to the separate sections of the book, Hacking’s introduction provides important background information as well as a contemporary context. Newly designed, with an expanded index, this edition will be eagerly welcomed by the next generation of readers seeking to understand the history of our perspectives on science. (shrink)

This Alfred Schutz Memorial Lecture discusses the relationship between the phenomenological life-world analysis and the methodology of the social sciences, which was the central motive of Schutz’s work. I have set two major goals in this lecture. The first is to scrutinize the postulate of adequacy, as this postulate is the most crucial of Schutz’s methodological postulates. Max Weber devised the postulate ‘adequacy of meaning’ in analogy to the postulate of ‘causal adequacy’ (a concept used in jurisprudence) and regarded both (...) as complementary and, in the context of sociological analysis, critical. Schutz extracted the two postulates from the Neokantian epistemology, dismissed the concept of causality, and reduced Weber’s two postulates of adequacy into one, namely, the adequacy of meaning. I discuss the benefits and shortcomings of this reduction. A major problem, in my view, is that Schutz’s reformulation lost the empirical concern that was inherent in Weber’s ‘causal adequacy’. As a result, the models of economics (which shaped Schutz’s conception of social science) are considered to be adequate if they are ‘understandable’ to an everyday actor, even when they are based on the most unrealistic assumptions. To recapture Weber’s empirical orientation I recommend a more restrictive interpretation of the postulate of adequacy that links it to qualitative research and unfolds the critical potential of Schutz’s phenomenological life-world analysis. My second goal is to report on some current developments in German sociology in which a number of approaches explicitly refer to Schutz’s analysis of the life-world and attempt to pursue ‘adequate’ empirical research. This lecture focuses on three approaches: ethnophenomenology, life-world analytic ethnography, and social scientific hermeneutics. (shrink)

Philosophers, policymakers, and scientists have long asserted that ecological science – and especially notions of homeostasis, balance, or stability – help to determine environmental values and to supply imperatives for environmental ethics and policy. We argue that this assertion is questionable. There are no well developed general ecological theories having predictive power, and fundamental ecological concepts, such as 'community' and 'stability', are used in inconsistent and ambiguous ways. As a consequence, the contribution of ecology to environmental ethics and values lies (...) more in the realm of natural history and case studies than in the realm of general theory. Moreover, although general ecological theory is unable to contribute to environmental values in the way many philosophers and policymakers have hoped, environmental values can and do contribute to ecological hypotheses and methods. Using examples related to preservation versus development, hunting versus animal rights, and controversies over pest control, we show that, because ecology is conceptually and theoretically underdetermined, environmental values often influence the practice of ecological science. (shrink)

A collection of late 20th-century scholarship devoted to Thomas Jefferson as a politician, writer, philosopher, Christian and economist.

It has become a mantra, that doping is immorally and therefore should be punished with exclusion, fines and stigmatization. In most parts of the world, the doping debate is characterised by an extreme tunnel vision since all athletes, politicians and sports managers who have public airtime express that doping is bad or the invention of the devil. -/- The purpose of 'Doping in Sport: A Defence' is to identify, clarify and challenge some of the central arguments that are used in (...) the often extremely emotional debate that primarily focuses on rejecting the use of doping. I hope that my effort to clarify and challenge the arguments will help cultivate a productive dialogue where all arguments are given a fair trial instead of the prevailing one-sided condemnation of doping. An open dialogue about doping is important since the question of where the line should be drawn when it comes to doping in sports is highly relevant in terms of the scope within which athletes, sports physicians, sports managers, coaches and pharmaceutical companies can operate in the world of sports. (shrink)

The aim of this article is to provide a systematic reconstruction and critique of what is taken to be a central ethical concern against the use of non-medical egg freezing. The concern can be captured in what we can call the individualisation argument. The argument states, very roughly, that women should not use NMEF as it is an individualistic and morally problematic solution to the social problems that women face, for instance, in the labour market. Instead of allowing or expecting (...) women to deal with them on an individual level, we should address them by challenging the patriarchal structures of the labour market—for example, by securing equal pay, or paid maternal leave, or ‘paid paternal [partner] leave and sick leave and affordable child care’. It will be made clear that there are several versions of this argument. The author will try to elaborate this claim, and it will be explained that the differences depend on the way in which bioethicists believe that individuals use of NMEF is morally problematic, compared with the alternative of securing social change for women in, say, the labour market. Finally, a critical discussion of three versions of the individualisation argument will follow, and it will be shown why all versions are on rather thin ice, or in other words, that they are implausible. (shrink)

To what extent is the scientist's endeavor qua scientist influenced by his philosophic image of himself? A preliminary and partial answer to this question is suggested by a study of eight physiological thinkers of the second half of the eighteenth century, a period during which biology was much influenced by the scientific and philosophical ideas of Isaac Newton. At this time, physiologists invoked certain "principles," "properties," and "powers" which were deemed useful as explanatory devices, even though they could not themselves (...) be explained. The use of these devices in physiology was often defended in terms of their supposed similarity to devices used in mathematics and Newtonian physics. The results of this practice are considered critically, partly in the light of current studies of scientific explanation. (shrink)

“This important collection of essays will help all Americans to consider anew the relationship between the ‘spirit of liberty’ and the ‘spirit of religion’ at work in the American Founding. Michael Zuckert’s masterful response establishes him as one of the leading scholars of the period.” —Jean Yarbrough, author of _American Virtues: Thomas Jefferson on the Character of a Free People_ "_Protestantism and the American Founding_ is an extraordinarily rich and thought provoking dialogue on the religious dimension of the nation's (...) foundations." —Thomas L. Pangle, University of Texas at Austin “This collection of essays by some of the most eminent scholars in the field will have a wide-ranging influence on both academic and political debate on the vital interaction of religion and politics in historical and contemporary America.” —Garrett Ward Sheldon, University of Virginia’s College at Wise This welcome new textbook explores the relationship between Protestant theology and American political thought of the founding era. It gathers together both new and well-known essays by scholars and outstanding thinkers in political philosophy and is enriched by classic selections from Alexis de Tocqueville's _Democracy in America_. _Protestantism and the American Founding_ will serve as a valuable classroom guide for discussion and debate about issues in American and modern political philosophy. (shrink)

This study is a kind of applied phenomenology, or more precisely, of applied phenomenological hermeneutics. I argue that phenomenologists hardly analyze concrete phenomena but prefer to engage in theoretical debates, and therefore I call for more applied studies. The case of a patient who suffered a cerebralhemorrhage is used in order to reconstruct how she slowly regained everyday sense-connexions. The case is very interesting as the patient was rather disoriented when waking up from an artificial coma of several weeks, and (...) it took her many years to fully recover. The goal of this paper is to describe some aspects of this process from a subjective perspective as well as from a participant observer’s viewpoint. The data used for this chapter mainly stem from in-depth qualitative interviews. The structures of the life-world of Alfred Schutz are used to analyze the processes of sense constitution. This proves helpful but the data also suggest a revision of Schutz’s analyses in some respects. (shrink)

This study is a kind of applied phenomenology, or more precisely, of applied phenomenological hermeneutics. I argue that phenomenologists hardly analyze concrete phenomena but prefer to engage in theoretical debates, and therefore I call for more applied studies. The case of a patient who suffered a cerebral hemorrhage is used in order to reconstruct how she slowly regained everyday sense-connexions. The case is very interesting as the patient was rather disoriented when waking up from an artificial coma of several weeks, (...) and it took her many years to fully recover. The goal of this paper is to describe some aspects of this process from a subjective perspective as well as from a participant observer’s viewpoint. The data used for this chapter mainly stem from in-depth qualitative interviews. The structures of the life-world of Alfred Schutz are used to analyze the processes of sense constitution. This proves helpful but the data also suggest a revision of Schutz’s analyses in some respects. (shrink)