The Hospital Standardised Mortality Ratio (HSMR) is a commonly used measure of hospital mortality that is standardised for age, comorbidities and other factors. By tradition, this statistic has always excluded patients classified as ‘palliative’. The HSMR has never been validated as a reliable measure of quality of care, and it can be very hard to interpret, partly due to difficulties with defining and applying the term ‘palliative’. In this paper, we review the Canadian experience with the palliative status flag, and (...) explain why it is so difficult to define and apply consistently. We also highlight some potential concerns about clinicians labelling inpatients as ‘palliative’ during their admission. Finally, we propose an organisational ethics framework, and six specific suggestions for hospitals to use when publishing statistics such as the HSMR. (shrink)

Background: Demand for organisational ethics capacity is growing in health organisations, particularly among managers. The role of clinical ethicists in, and perspective on, organisational ethics has not been well described or documented in the literature. Objective: To describe clinical ethicists’ perspectives on organisational ethics issues in their hospitals, their institutional role in relation to organisational ethics, and their perceived effectiveness in helping to address organisational ethics issues. Design and Setting: Qualitative case study involving semi-structured interviews with 18 clinical ethicists across (...) 13 health organisations in Toronto, Canada. Results: From the clinical ethicists’ perspective, the most pressing organisational ethics issues in their organisations are: resource allocation, staff moral distress linked to the organisation’s moral climate, conflicts of interest, and clinical issues with a significant organisational dimension. Clinical ethicists were consulted in particular on issues related to staff moral distress and clinical issues with an organisational dimension. Some ethicists described being increasingly consulted on resource allocation, conflicts of interest, and other corporate decisions. Many clinical ethicists felt they lacked sufficient knowledge and understanding of organisational decision-making processes, training in organisational ethics, and access to organisational ethics tools to deal effectively with the increasing demand for organisational ethics support. Conclusion: Growing demand for organisational ethics expertise in healthcare institutions is reshaping the role of clinical ethicists. Effectiveness in organisational ethics entails a re-evaluation of clinical ethics training to include capacity building in organisational ethics and organisational decision-making processes as a complement to traditional clinical ethics education. (shrink)

R.I.G. Hughes presents a series of eight philosophical essays on the theoretical practices of physics. The first two essays examine these practices as they appear in physicists' treatises (e.g. Newton's Principia and Opticks ) and journal articles (by Einstein, Bohm and Pines, Aharonov and Bohm). By treating these publications as texts, Hughes casts the philosopher of science in the role of critic. This premise guides the following 6 essays which deal with various concerns of philosophy of physics such as laws, (...) disunities, models and representation, computer simulation, explanation, and the discourse of physics. (shrink)

Contemporary emphasis on creating culturally relevant and context specific knowledge increasingly drives researchers to conduct their work in settings outside their home country. This often requires researchers to build relationships with various stakeholders who may have a vested interest in the research. This case study examines the tension between relationship development with stakeholders and maintaining study integrity, in the context of potential harms, data credibility and cultural sensitivity. We describe an ethical breach in the conduct of global health research by (...) a arising from the ad-hoc participation of a community stakeholder external to the visiting research group. A framework for reflection is developed from a careful examination of underlying factors and presented with a discussion of consequences and mitigation measures. This framework aims to present lessons learned for researchers working abroad who might face similar situations in their work. (shrink)

This book provides a collection of sources, many of them fragmentary and previously scattered and hard to access, for the development of Peripatetic philosophy in the later Hellenistic period and the early Roman Empire. It also supplies the background against which the first commentator on Aristotle from whom extensive material survives, Alexander of Aphrodisias (fl. c. AD 200), developed his interpretations which continue to be influential even today. Many of the passages are here translated into English for the first time, (...) including the whole of the summary of Peripatetic ethics attributed to 'Arius Didymus'. (shrink)

Reason and Value collects 15 new papers by leading contemporary philosophers on themes from the work of Joseph Raz. Raz has made major contributions in a wide range of areas, including jurisprudence, political philosophy, and the theory of practical reason; but all of his work displays a deep engagement with central themes in moral philosophy. The subtlety and power of Raz's reflections on ethical topics make his writings a fertile source for anyone working in this area. Especially significant are his (...) explorations of the connections between practical reason and the theory of value, which constitute a sustained and penetrating treatment of a set of issues at the very center of moral philosophy as it is practiced today. The contributors to the volume acknowledge the importance of Raz's contributions by engaging critically with his positions and offering independent perspectives on the topics that he has addressed. The volume aims both to honour Raz's accomplishments in the area of ethical theorizing, and to contribute to an enhanced appreciation of the significance of his work for the subject. (shrink)

BackgroundEthics consultations are established in contemporary health care. Informal ethics consultations often occur and are possibly beneficial, yet they have not been empirically studied. We sought to describe features of informal ethics consultations and to identify facilitators and disruptors of patient participation in such ethics consultations.MethodsWe used a mixed methods (quantitative and qualitative) evaluation design and conveniently sampled 64 sequential informal ethics consultations over a period of 3 years in two academic health care centers in one city in Canada. Data (...) were collected by the two participating ethicists. We used statistical description for the quantitative data and thematic analysis for the qualitative data.ResultsPatients participated in only two (3%) of the informal ethics consultations. Factors that disrupted patient participation in ethics consultations were related to patients’ issues (mental impairments), family issues (family withholding information from the patient), and team members’ issues (efficiency considerations).ConclusionInformal ethics consultations may be used for ethics capacity building of health care providers rather than for engagement with addressed patients. Further research on informal ethics consultations is required, including in different sites. (shrink)

The Nature of God explores a perennial problem in the philosophy of religion.

For years, privacy regulators have said that privacy is good for business. Strong privacy management programs and accountability mechanisms build trust with consumers. In the public sector, privacy regulators have seen massive information sharing projects fail when public input or consultation, or independent oversight is not considered. After a sequence of events in 2018, society as a whole began asking questions about what is being done with personal information and questioned whether it is in our best interests. This presentation made (...) at the University of Alberta’s Kule Institute’s event on “AI, Ethics and Society” in May 2019 provides an overview of the shifts that have taken place and how privacy regulators internationally have incorporated discussions about ethical assessments, in addition to traditional privacy impact assessments, as a way to guide current and future tech developments involving personal information in a way that is legal, fair and just. (shrink)

In this first paperback edition, a new introduction by Tom Burke establishes the ongoing importance of Sleeper's analysis of the integrity of Dewey's work and ...

This book is not a study of Plato's philosophy, but a contribution to the literary interpretation of the dialogues, through analysis of their formal structure, ...

Many philosophers believe that there is a causal condition on perception, and that this condition is a conceptual truth about perception. A highly influential argument for this claim is based on intuitive responses to Gricean style thought experiments. Do the folk share the intuitions of philosophers? Roberts et al. (2016) presented participants with two kinds of cases: Blocker cases (similar to Grice’s case involving a mirror and a pillar) and Non-Blocker cases (similar to Grice’s case involving a clock and brain (...) stimulation). They found that a substantial minority agreed that seeing occurs in the Non-Blocker cases, and that in the Blocker cases significantly less agreed that seeing occurs. They thus hypothesized that folk intuitions better align with a no blocker condition than with a causal condition. This paper continues this line of enquiry with two new experiments. The paper investigates the generality and robustness of Roberts et al.’s findings by expanding the sense modalities tested from only vision to audition and olfaction as well. The paper also uses Gricean style thought experiments as a case study for investigating the “reflection defense” against the negative project in experimental philosophy. Our results replicate and extend Roberts et al.’s study and support their hypothesis that folk intuitions better align with a no blocker condition. They also provide an empirical reason to doubt the reflection defense. (shrink)

The author demonstrates that certain forms of irrationality - incontinent action and self-deception - which many philosophers have rejected as being logically or psychologically impossible, are indeed possible.

This book offers a critical introduction to the work of American philosopher D. G. Leahy (1937-2014). Leahy's fundamental thinking can be characterized as an absolute creativity in which all creating is 'live' -- a happening occurring now that manifests a supersaturated polyontological actuality that is essentially created by the logic that characterizes it. Leahy leaves behind the categorial presuppositions of modern thought, eclipsing both Cartesian and Hegelian subjectivities and introducing instead an essentially new form of thinking founded in a nondual (...) logic of creation. The new thinking delineates the absolute unicity of existence as a creative interactivity beyond all traditional dichotomies (such as one vs. many, unity vs. plurality, identity vs. change): a fully "digitized" actuality that is nothing but newness, which inherently implies nothing but change. Through this new form of thinking, change itself is revealed to be the very essence of reality and mind. Any reader looking for a quantum leap beyond the thrall of modern and postmodern fixations is invited to hear and apprehend this new thinking that refuses to be conditioned by paradigms, categories, species, genera, walls, bridges, boundaries, or abstractions: an essentially free thinking that embodies creative novelty itself. (shrink)

In this, the first of two ground-breaking volumes on the nature of language in the light of the way it evolved, James Hurford looks at how the world first came ...

Determining what has gone wrong in a malfunctioning body and proposing an effective treatment requires expertise. Since antiquity, philosophers and doctors have wondered what sort of knowledge this expertise involves, and whether and how it can warrant its conclusions. Few people were as qualified to deal with these questions as Galen of Pergamum. A practising doctor with a keen interest in logic and natural science, he devoted much of his enormous literary output to the task of putting medicine on firm (...) methodological grounds. At the same time he reflected on philosophical issues entailed by this project, such as the nature of experience, its relation to reason, the criteria of truth, and the methods of justification. This volume explores Galen's contributions to epistemology, as they arise in the specific inquiries and polemics of his works, as well as their legacy in the Islamic world. (shrink)

The Hellenistic philosophers and schools of philosophy are emerging from the shadow of Plato and Aristotle and are increasingly studied for their intrinsic philosophical value. They are not only interesting in their own right, but also form the intellectual background of the late Roman Republic. This study gives a comprehensive and readable account of the principal doctrines of the Stoics, Epicureans and various sceptical traditions from the death of Alexander the Great in 323 B.C. to around 200 A.D. Discussions are (...) arranged topically in order to address underlying issues and to make clear what the different schools have in common and how they differ. At the same time the coherence of each system as a whole is emphasized. (shrink)

While it might seem prima facie plausible that divine foreknowledge is all that is needed for prophecy, this seems incorrect. To issue a prophecy, God hasto know not just how someone will act, but how someone would act were the prophecy issued. This makes some think that Middle Knowledge is required.I argue that Thomas Flint’s two Middle Knowledge based accounts of prophecy are unsatisfactory, but one of them can be repaired. However the resources needed for repair also yield a sketch (...) of a foreknowledge-only account of prophecy. (shrink)

The renowned philosopher John Searle reveals the fundamental nature of social reality. What kinds of things are money, property, governments, nations, marriages, cocktail parties, and football games? Searle explains the key role played by language in the creation, constitution, and maintenance of social reality. We make statements about social facts that are completely objective, for example: Barack Obama is President of the United States, the piece of paper in my hand is a twenty-dollar bill, I got married in London, etc. (...) And yet these facts only exist because we think they exist. How is it possible that we can have factual objective knowledge of a reality that is created by subjective opinions? This is part of a much larger question: How can we give an account of ourselves, with our peculiar human traits DS mind, reason, freedom, society - in a world that we know independently consists of mindless, meaningless particles? How can we account for our social and mental existence in a realm of brute physical facts? In answering this question, Searle avoids postulating different realms of being, a mental and a physical, or worse yet, a mental, a physical, and a social. There is just one reality: Searle shows how the human reality fits into that one reality. Mind, language, and civilization are natural products of the basic facts of the physical world described by physics, chemistry and biology. Searle explains how language creates and maintains the elaborate structures of human social institutions. These institutions serve to create and distribute power relations that are pervasive and often invisible. These power relations motivate human actions in a way that provides the glue that holds human civilization together. Searle shows how this account illuminates human rationality, free will, political power, and human rights. Our social world is a world created and maintained by language. (shrink)

"The philosophy of mind is unique among contemporary philosophical subjects," writes John Searle, "in that all of the most famous and influential theories are false." In Mind, Searle dismantles these famous and influential theories as he presents a vividly written, comprehensive introduction to the mind. Here readers will find one of the world's most eminent thinkers shedding light on the central concern of modern philosophy. Searle begins with a look at the twelve problems of philosophy of mind--which he calls "Descartes (...) and Other Disasters"--problems which he returns to throughout the volume, as he illuminates such topics as the freedom of the will, the actual operation of mental causation, the nature and functioning of the unconscious, the analysis of perception, and the concept of the self. One of the key chapters is on the mind-body problem, which Searle analyzes brilliantly. He argues that all forms of consciousness--from feeling thirsty to wondering how to translate Mallarme--are caused by the behavior of neurons and are realized in the brain system, which is itself composed of neurons. But this does not mean that consciousness is nothing but neuronal behavior. The main point of having the concept of consciousness, Searle points out, is to capture the first person subjective features of the phenomenon and this point is lost if we redefine consciousness in third person objective terms. Described as a "dragonslayer by temperament," John Searle offers here a refreshingly direct and open discussion of philosophy, one that skewers accepted wisdom even as it offers striking new insights into the nature of consciousness and the mind. (shrink)

R. G. Swinburne; XIII*—Personal Identity, Proceedings of the Aristotelian Society, Volume 74, Issue 1, 1 June 1974, Pages 231–247, https://doi.org/10.1093/arist.

Opstellen eerder verschenen in het Nederlands Tijdschrift voor rechtsfilosofie en rechtstheorie en in andere periodieken.

Shoemaker (1996) presenteda prioriarguments against the possibility of ‘self‐blindness’, or the inability of someone, otherwise intelligent and possessed of mental concepts, to introspect any of her concurrent attitude states. Ironically enough, this seems to be a position that Gopnik (1993) and Carruthers (2006, 2008, 2009a,b) have proposed as not only possible, but as the actual human condition generally! According to this ‘Objectivist’ view, supposed introspection of one's attitudes is not ‘direct’, but an ‘inference’ of precisely the sort we make about (...) the attitudes of others, an inference that has the advantage in our own case ofonlyour own sensory data and memories, our behavior, and of the context we are in; i.e. we are all substantially self‐ blind. After sorting out a number of methodological and verbal issues, I argue, first, that thea prioriarguments against Objectivism don't succeed, and that Gopnik and Carruthers are right to regard the issue as an empirical one. On the other hand, I think they seriously underestimate the difficulty of establishing Objectivism. It is unlikely there is an inferential procedure from the data of pure sensation, behavior and context to the relevant self‐attributions that would be as spectacularly reliable as people manifestly seem to be. Moreover, there is a simpler model: the mind very likely consists of a panoply of sub‐routines some of whose outputs are ‘tagged’ for their having been so processed, rather in the way that software ‘documents’ are on standard computers. Introspection plausibly consists in a person's simply attending to distinctive constellations of these tags, even though they may lack phenomenal feels. This draws attention to an important independent fact: that much of phenomenology (or ‘what it's like’ to be in a certain state) may be constituted by facts that are not phenomenal. (shrink)