BackgroundThe ageing of the population and the increased number of chronic diseases are associated with an increased frequency of end of life care in hospital settings. Residents rotating in hospital wards play a major part in their care, regardless of their specialty. General practitioner (GP) residents are confronted to such activities in hospital settings during their training. Our aim was to know how they feel about taking care of dying patients, as end-of-life care are very different from the clinical activity (...) they are trained to.MethodsWe surveyed all GP trainees of “Ile de France”. The survey was made of 41 questions regarding advanced directives divided in 7 sections about patients’ care, communication, mentoring and repercussion on personal life. The survey was done one time, during two pre-specified days.Results525 residents (53.8%) accepted to fulfill the survey. 74.1% of the residents thought that palliative care could have been better. Possible ways of improvements were: a reduction of unreasonable obstinacy (or therapeutic overkill, two terms defined in French law as curative treatment without reasonable hope of efficiency) (59.6%), patient’s (210 answers, 40%) and relative’s communication (information of patients and relatives about the severity of the disease and risk of death) (199 answers 37.9%). Residents also reported a lack of knowledge regarding end-of-life care specific treatments (411 answers, 79.3%) and 298 (47.2%) wished for better mentoring. Those difficulties were associated with repercussion on their private life (353 answers, 67.2%), particularly with their close relatives (55.4%). Finally, 56.2% of trainees thought that a systematic psychologic follow up should be instituted for those working in “at risk” hospital settings.ConclusionSelf-perception management of dying patients by GP resident emphasize their lack of training and supervision. The feeling of suboptimal care is associated with consequences on personal life. (shrink)

Background The often poor prognosis associated with cancer necessitates empowering patients to express their care preferences. Yet, the prevalence of Advance Directives (AD) among oncology patients remains low. This study investigated oncologists' perspectives on the interests and challenges associated with implementing AD. Methods A French national online survey targeting hospital-based oncologists explored five areas: AD information, writing support, AD usage, personal perceptions of AD's importance, and respondent's profile. The primary outcome was to assess how frequently oncologists provide patients with information (...) about AD in daily clinical practice. Additionally, we examined factors related to delivering information on AD. Results Of the 410 oncologists (50%) who responded to the survey, 75% (n = 308) deemed AD relevant. While 36% (n = 149) regularly inform patients about AD, 25% (n = 102) remain skeptical about AD. Among the respondents who do not consistently discuss AD, the most common reason given is the belief that AD may induce anxiety (n = 211/353; 60%). Of all respondents, 90% (n = 367) believe patients require specific information to draft relevant AD. Physicians with experience in palliative care were more likely to discuss AD (43% vs 32.3%, p = 0.027). Previous experience in critical care was associated with higher levels of distrust towards AD (31.5% vs 18.8%, p = 0.003), and 68.5% (n = 281) of the respondents expressed that designating a “person of trust” would be more appropriate than utilizing AD. Conclusion Despite the perceived relevance of AD, only a third of oncologists regularly apprise their patients about them. Significant uncertainty persists about the safety and relevance of AD. (shrink)

The doctor-patient relationship has evolved to respect “the autonomy and patients’ rights”. One of the cornerstones in such autonomy is the opportunity for patients to draw living wills, also known as advance directives. However, information about AD available to patients remains scarce largely due to the lack of involvement of General practitioners for several reasons. The aim of our study was to evaluate current general practitioner residents’ behavior concerning their role in informing their patients about AD. We built a French (...) nationwide survey from GPR class of 2012 to 2014. Two thousand three hundred ten residents completed our survey. 89.8% declared their willingness to offer patients the opportunity of writing AD. When asked about the usefulness of AD, 73.6% of residents responded that these are a suitable help for patients, but 19.7% considered that AD are essentially geared towards frail patients. Among residents who want to inform patients about AD, 14.7% wanted to involve all patients. Only 20.5% thought that elderly people should be systematically informed about AD. When the question involves other frail people in various disease areas, information seems relevant for 60.1% of GPR considering patient with cancer or malignant hematologic disease and for 56.2% about patients affected by neurodegenerative disease. When considering the routine use of AD, 20.5% of GPR would take them into account only if they are in agreement with the patient’s decision. The results of the survey indicate that GPR would rather choose to decide who should be informed about AD, and when to take AD into account for ethical concerns. (shrink)

A l'epoque hellenistique, la reflexion morale s'engage sur des voies nouvelles.

Il est assez rare qu’un concept philosophique s’échappe de l’arène académique. C’est pourtant le cas du concept de spécisme, qui a fait une entrée remarquée dans la sphère publique au cours de la dernière décennie. Il est désormais au cœur du débat de société sur nos devoirs envers les animaux non humains. Hélas, ce concept et les enjeux qu’il soulève sont souvent mal compris. Nombreux sont les auteurs qui contestent sa légitimité alors qu’ils le maitrisent mal. D’autres l’utilisent plus volontiers (...) sans toutefois mieux le comprendre. Les confusions qui entourent cette notion l’empêche de contribuer à la discussion autant qu’elle le pourrait. Le présent ouvrage entend remédier à cet état de faits en donnant de la notion de spécisme une présentation à la fois assez précise pour rendre justice aux discussions philosophiques dont elle fait l’objet et suffisamment claire pour être accessible à quiconque s’intéresse au statut moral des animaux. Il se divise en deux parties. La première aborde des questions ontologiques : Qu’est-ce exactement que le spécisme ? À quelles conditions existe-t-il ? Ces conditions sont-elles remplies dans les faits ? Quant à la seconde, elle porte sur des questions éthiques : Le spécisme peut-il être justifié ? Faut-il au contraire le condamner au même titre que le racisme et le sexisme ? (shrink)

Animal ethicists often distinguish between direct and indirect defenses of speciesism, where the former appeal to species membership and the latter invoke other features that are simply associated with it. The main extant charge against indirect defenses rests on the empirical claim that any feature other than membership in our species is either absent in some humans or present in some nonhumans. This paper challenges indirect defenses with a new argument, which presupposes no such empirical claim. Instead, the argument from (...) discordance resorts to the following principle: a certain feature can only justify discriminating on the basis of that feature. (shrink)

Renowned philosopher and prominent French critic François Noudelmann engages the musicality of Jean-Paul Sartre, Friedrich Nietzsche, and Roland Barthes, all of whom were amateur piano players and acute lovers of the medium. Though piano playing was a crucial art for these thinkers, their musings on the subject are largely scant, implicit, or discordant with each philosopher's oeuvre. Noudelmann both recovers and integrates these perspectives, showing that the manner in which these philosophers played, the composers they adored, and the music they (...) chose reveals uncommon insight into their thinking styles and patterns. Noudelmann positions the physical and theoretical practice of music as a dimension underpinning and resonating with Sartre's, Nietzsche's, and Barthes's unique philosophical outlook. By reading their thought against their music, he introduces new critical formulations and reorients their trajectories, adding invaluable richness to these philosophers' lived and embodied experiences. The result heightens the multiple registers of being and the relationship between philosophy and the senses that informed so much of their work. A careful reader of music, Noudelmann maintains an elegant command of the texts under his gaze and appreciates the discursive points of musical and philosophical scholarship they involve, especially with regard to recent research and cutting-edge critique. (shrink)

At the end of World War II, F. A. Hayek denounced the then-popular idea of central planning by arguing that, if pursued to its logical conclusion, it would entail totalitarianism. But there were at least two problems. First, judging by his example of Nazi Germany, state control over the economy appears to be a consequence, not a cause, of the monopolization of political power. Second, he conflated socialism and mere interference in the market with central planning. Therefore, history did not (...) so much falsify Hayek's prediction as bypass it: Once the vogue for central planning faded in the West, Hayek's book became irrelevant—except, ironically, in Germany. There, it was read as a manifesto for “good planning” through the rule of law. Alongside other “neoliberal” writers, Hayek had a profound (if little acknowledged) influence on the shape of the emerging Federal Republic and, through it, on the whole European institutional framework. (shrink)

A defence of the 'pragmatic' theory of anaphora (which stresses the analogy between anaphora and deixis) against an argument put forward by Gareth Evans.

Я интерпретирую философские взгляды Вернера Гайзенберга как прагматизм и неметафизический реализм виттгенштайновского типа. «Замкнутая теория» – виттгенштайновское правило/концепт. В отличие от Бокулич, предпочитающей позицию Дирака относительно природы связей между различными физическими теориями, я отдаю предпочтение позиции Гайзенберга. Моя позиция, интерпретирующая Гайзенберга, также прямо противоположна позиции Поппера: критерием устоявшейся научной (замкнутой) теории является её нефальсифицируемость. -/- I interpret philosophical views of Werner Heisenberg as a pragmatism and non-metaphysical realism of a Wittgensteinian kind. The “closed theory” is a Wittgensteinian rule/concept. Unlike Alisa (...) Bokulich, favouring Dirac’s position about inter-theoretical relations, I favour Heisenberg’s one. My position, interpreting Heisenberg’s notion of a closed theory, is also in direct opposition to Popper’s one: the criterion of an established scientific (closed) theory is its non-falsifiability. (shrink)

Response to Alex Byrne's paper 'Knowing what I see'.

ABSTRACTWhat does it take for lawyers and others to think or talk about the same legal topic—e.g., defamation, culpability? We argue that people are able to think or talk about the same topic not when they possess a matching substantive understanding of the topic, as traditional metasemantics says, but instead when their thoughts or utterances are related to each other in certain ways. And what determines the content of thoughts and utterances is what would best serve the core purposes of (...) the representational practice within which the thought or utterance is located. In thus favoring a “relational model” in metasemantics, we share Ronald Dworkin's goal of explaining fundamental legal disagreements, and also his reliance on constructive interpretation. But what we delineate is a far more general and explanatorily resourceful metasemantics than what Dworkin articulated, which also bypasses some controversial implications for the nature of law that Dworkin alleged. (shrink)

In this book it explores science and technology, makes connections between these epistemic, cultural, and political trends, and develops profound insights into the nature of our postmodernity.

Cumulative technological culture (CTC) refers to the increase in the efficiency and complexity of tools and techniques in human populations over generations. A fascinating question is to understand the cognitive origins of this phenomenon. Because CTC is definitely a social phenomenon, most accounts have suggested a series of cognitive mechanisms oriented toward the social dimension (e.g., teaching, imitation, theory of mind, and metacognition), thereby minimizing the technical dimension and the potential influence of non-social, cognitive skills. What if we have failed (...) to see the elephant in the room? What if social cognitive mechanisms were only catalyzing factors and not thesufficient and necessaryconditions for the emergence of CTC? In this article, we offer an alternative, unified cognitive approach to this phenomenon by assuming that CTC originates in non-social cognitive skills, namely technical-reasoning skills which enable humans to develop the technical potential necessary to constantly acquire and improve technical information. This leads us to discuss how theory of mind and metacognition, in concert with technical reasoning, can help boost CTC. The cognitive approach developed here opens up promising new avenues for reinterpreting classical issues (e.g., innovation, emulation vs. imitation, social vs. asocial learning, cooperation, teaching, and overimitation) in a field that has so far been largely dominated by other disciplines, such as evolutionary biology, mathematics, anthropology, archeology, economics, and philosophy. (shrink)

Long undervalued in France, philosophical anthropology has played an essential role in Germany, helping to address some of the most important issues straddling philosophy and the social sciences: humanity's place in nature and in history; the individual and others; and relations between human groups.

Illusionism about phenomenal consciousness is the thesis that phenomenal consciousness does not exist, even though it seems to exist. This thesis is widely judged to be uniquely counterintuitive: the idea that consciousness is an illusion strikes most people as absurd, and seems almost impossible to contemplate in earnest. Defenders of illusionism should be able to explain the apparent absurdity of their own thesis, within their own framework. However, this is no trivial task: arguably, none of the illusionist theories currently on (...) the market is able to do this. I present a new theory of phenomenal introspection and argue that it might deal with the task at hand. (shrink)

Phenomenal consciousness appears to be particularly normatively significant. For this reason, sentience-based conceptions of ethics are widespread. In the field of animal ethics, knowing which animals are sentient appears to be essential to decide the moral status of these animals. I argue that, given that materialism is true of the mind, phenomenal consciousness is probably not particularly normatively significant. We should face up to this probable insignificance of phenomenal consciousness and move towards an ethic without sentience.

Illusionism about consciousness is the thesis that phenomenal consciousness does not exist, but merely seems to exist. Embracing illusionism presents the theoretical advantage that one does not need to explain how consciousness arises from purely physical brains anymore, but only to explain why consciousness seems to exist while it does not. As Keith Frankish puts it, illusionism replaces the “hard problem of consciousness” with the “illusion problem.” However, a satisfying version of illusionism has to explain not only why the illusion (...) of consciousness arises, but also why it arises with its particular strength: Notably, why we are so deeply reluctant to recognize the illusory nature of consciousness. Explaining our strong intuitive resistance to illusionism means solving what I call the “illusion meta-problem,” which I think is a part of the illusion problem. In this paper, I argue that current versions of illusionism are unable to solve the illusion meta-problem. I focus on two of the most promising recent illusionist theories of consciousness, and I show why they fail to explain the peculiar reluctance we encounter whenever we try to accept that consciousness is an illusion. (shrink)

The prevalent view in animal ethics is that speciesism is wrong: we should weigh the interests of humans and non-humans equally. Shelly Kagan has recently questioned this claim, defending speciesism against Peter Singer’s seminal argument based on the principle of equal consideration of interests. This critique is most charitably construed as a dilemma. The principle of equal consideration can be interpreted in either of two ways. While it faces counterexamples on the first reading, it makes Singer’s argument question-begging on the (...) second. In response, Singer has grasped the first horn of this dilemma and tried to accommodate Kagan’s apparent counterexamples. In my opinion, this attempt is unpersuasive: the principle of equal consideration is inconsistent with common-sense intuitions on Kagan’s cases. Worse, Singer’s argument begs the question anyway. It therefore faces two serious objections. This is not to say that there is nothing wrong with speciesism, however. In the second half of the paper, I propose another, better argument against speciesism, which I argue is immune to both objections. According to this other argument, speciesism is wrong because it involves discriminating on the basis of a merely biological property. (shrink)