On September 1, 2023, Texas made important revisions to it its decades‐old statute granting legal safe harbor immunity to physicians who withhold or withdraw life‐sustaining treatment over the objection of critically ill patients’ surrogate decision‐makers. However, lawmakers left untouched glaring flaws in a key safeguard for patients—the transfer option. The transfer option is ethically important because, when no hospital is willing to accept the patient in transfer, that fact is taken as strong evidence that the surrogates’ treatment requests fall outside (...) accepted medical practice. But there are serious shortcomings in how the transfer option is carried out in Texas and many other states, which undermines the ethical usefulness of the process. We identify these shortcomings and recommend revisions to state statutes and professional guidelines to overcome them. (shrink)

Objective: Even when critically ill patients are almost certain to die from their illnesses, there is generally an element of prognostic uncertainty. Little is known about how physicians handle this uncertainty in conversations with surrogate decision makers. We sought to evaluate whether and how physicians discuss prognostic uncertainty with surrogate decision makers of patients who are highly likely, but not certain, to die. Design: We audiotaped and transcribed discussions between clinicians and surrogate decision makers at two major California teaching hospitals (...) from 2006 through 2008. Physicians completed a questionnaire addressing their prognostic estimates for patients' survival to hospital discharge. Participants: We included physicians and surrogates of 12 incapacitated, critically ill patients. Measurements: We analyzed transcripts of discussions in which physicians' estimates of patients' chances of hospital survival were 1% to 5%; we coded whether physicians disclosed the prognostic uncertainty and, if so, how they conveyed that death was highly likely but not certain. Results: Physicians' estimates of short-term survival were 1% to 5% for 12 of the 70 patients enrolled in the original study. In 8 of 12 cases, physicians conveyed prognostic uncertainty by using probabilistic language or by an explicit mention of uncertainty. In four cases, physicians made at least one statement that either implied or was ambiguous about whether death was certain. Conclusion: We observed variability in how physicians handle prognostic uncertainty in their discussions with surrogates of patients who are highly likely, but not certain, to die, including some circumstances in which physicians stated or implied that death was certain. (shrink)

Purpose Although surrogate decision-making is prevalent in intensive care units and concerns with decision quality are well documented, little is known about how clinicians help family members understand the surrogate role. We investigated whether and how clinicians provide normative guidance to families regarding how to function as a surrogate. Subjects and methods We audiorecorded and transcribed 73 ICU family conferences in which clinicians anticipated discussing goals of care for incapacitated patients at high risk of death. We developed and applied a (...) coding framework to identify normative statements by clinicians regarding what considerations should guide surrogates’ decisions, including whether clinicians explained one or more of Buchanan and Brock’s three standard principles of SDM to family members. Results Clinicians made at least one statement about how to perform the surrogate role in 24 conferences ). We observed three general types of normative guidance provided to surrogates, with some conferences containing more than one type of guidance: counselling about one or more standard principles of SDM ; counselling surrogates to make decisions centred on the patient as a person, without specifying how to accomplish that ; and counselling surrogates to make decisions based on the family’s values. Conclusions Clinicians did not provide normative guidance about the surrogate role in two-thirds of family conferences for incapacitated patients at high risk for death. When they did, clinicians’ guidance was often incomplete and sometimes conflicted with standard principles of SDM. Future work is needed to understand whether providing explicit guidance on how to perform the surrogate role improves decision-making or mitigates surrogates’ psychological distress. (shrink)

Still the Heart of Darkness analyzes Richard Preston's best-selling account of an Ebola virus outbreak in Reston, Virginia in 1989. Through a textual examination of The Hot Zone, this essay demonstrates how Preston grounds his narrative about the threat of rare emerging viruses from the third world in terms of the colonialist discourse about Africa as the white man's grave, most notably Joseph Conrad's Heart of Darkness. By foregrounding previous outbreaks in Africa, Preston simultaneously darkens its landscape and inscribes (...) the Ebola filovirus as an external biological threat to Americans in a post-Cold War world with porous borders. (shrink)

The purpose of this paper is to provide a historical overview of the ethical concept of organizational due process in relation to contemporary issues in the utilization of company grievance procedures in the rapidly growing nonunion arena. Another objective of this paper is to appraise the current practices that employers have evolved for resolving issues generated by grievances, particularly those of professional, white collar employees.

We propose six guideposts that states and hospitals should follow to respect disability rights when designing policies for the allocation of scarce, lifesaving medical treatments. Four relate to criteria for decisions. First, do not use categorical exclusions, especially ones based on disability or diagnosis. Second, do not use perceived quality of life. Third, use hospital survival and near-term prognosis (e.g., death expected within a few years despite treatment) but not long-term life expectancy. Fourth, when patients who use ventilators in their (...) daily lives (e.g., home ventilation) present to acute care hospitals, their personal ventilators should not be reallocated to other patients. Fifth, designate triage officers to assess patients individually on the basis of objective medical evidence, not stereotypes or assumptions. Sixth, include disability rights advocates in policy development and dissemination. (shrink)

Coronavirus disease 2019 can lead to respiratory failure. Some patients require extracorporeal membrane oxygenation support. During the current pandemic, health care resources in some cities have been overwhelmed, and doctors have faced complex decisions about resource allocation. We present a case in which a pediatric hospital caring for both children and adults seeks to establish guidelines for the use of extracorporeal membrane oxygenation if there are not enough resources to treat every patient. Experts in critical care, end-of-life care, bioethics, and (...) health policy discuss if age should guide rationing decisions. (shrink)

During public health crises including the COVID-19 pandemic, resource scarcity and contagion risks may require health systems to shift—to some degree—from a usual clinical ethic, focused on the well-being of individual patients, to a public health ethic, focused on population health. Many triage policies exist that fall under the legal protections afforded by “crisis standards of care,” but they have key differences. We critically appraise one of the most fundamental differences among policies, namely the use of criteria to categorically exclude (...) certain patients from eligibility for otherwise standard medical services. We examine these categorical exclusion criteria from ethical, legal, disability, and implementation perspectives. Focusing our analysis on the most common type of exclusion criteria, which are disease-specific, we conclude that optimal policies for critical care resource allocation and the use of cardiopulmonary resuscitation (CPR) should not use categorical exclusions. We argue that the avoidance of categorical exclusions is often practically feasible, consistent with public health norms, and mitigates discrimination against persons with disabilities. (shrink)

The coronavirus disease 2019 (COVID-19) pandemic has motivated medical ethicists and several task forces to revisit or issue new guidelines on allocating scarce medical resources. Such guidelines are relevant for the allocation of scarce therapeutics and vaccines and for allocation of ICU beds, ventilators, and other life-sustaining treatments or potentially scarce interventions. Principles underlying these guidelines, like saving the most lives, mitigating disparities, reciprocity to those who assume additional risk (eg, essential workers and clinical trial participants), and equal access may (...) compete with one another. We propose the use of a “categorized priority system” (also known as a “reserve system”) as an improvement over existing allocation methods, particularly because it may be able to achieve disparity mitigation better than other methods. (shrink)

Purpose Although surrogate decision-making is prevalent in intensive care units and concerns with decision quality are well documented, little is known about how clinicians help family members understand the surrogate role. We investigated whether and how clinicians provide normative guidance to families regarding how to function as a surrogate. Subjects and methods We audiorecorded and transcribed 73 ICU family conferences in which clinicians anticipated discussing goals of care for incapacitated patients at high risk of death. We developed and applied a (...) coding framework to identify normative statements by clinicians regarding what considerations should guide surrogates’ decisions, including whether clinicians explained one or more of Buchanan and Brock’s three standard principles of SDM to family members. Results Clinicians made at least one statement about how to perform the surrogate role in 24 conferences ). We observed three general types of normative guidance provided to surrogates, with some conferences containing more than one type of guidance: counselling about one or more standard principles of SDM ; counselling surrogates to make decisions centred on the patient as a person, without specifying how to accomplish that ; and counselling surrogates to make decisions based on the family’s values. Conclusions Clinicians did not provide normative guidance about the surrogate role in two-thirds of family conferences for incapacitated patients at high risk for death. When they did, clinicians’ guidance was often incomplete and sometimes conflicted with standard principles of SDM. Future work is needed to understand whether providing explicit guidance on how to perform the surrogate role improves decision-making or mitigates surrogates’ psychological distress. (shrink)

This article draws on in-depth interviews with nine white, middle-class, male-to-female transsexuals to examine how they produce and experience bodily transformation. Interviewees’ bodywork entailed retraining, redecorating, and reshaping the physical body, which shaped their feelings, role-taking, and self-monitoring. These analyses make three contributions: They offer support for a perspective that embodies gender, further transsexual scholarship, and contribute to feminist debate over the sex/gender distinction. The authors conclude by exploring how viewing gender as embodied could influence medical discourse on transsexualism (...) and have personal and political consequences for transsexuals. (shrink)

The ethical principle of ‘respect for persons’ in clinical research has traditionally focused on protecting individuals’ autonomy rights, but respect for participants also includes broader, although less well understood, ethical obligations to regard individuals’ rights, needs, interests and feelings. However, there is little empirical evidence about how to effectively convey respect to potential and current participants. To fill this gap, we conducted exploratory, qualitative interviews with participants in a clinical genomics implementation study. We interviewed 40 participants in English or Spanish (...) about their experiences with respect in the study and perceptions of how researchers in a hypothetical observational study could convey respect or a lack thereof. Most interviewees were female, identified as Hispanic/Latino or non-Hispanic white, reported annual household income under US$60 000 and did not have a Bachelor’s degree ; 30% had limited health literacy. We identified four key domains for demonstrating respect: personal study team interactions, with an emphasis on empathy, appreciation and non-judgment; study communication processes, including following up and sharing results with participants; inclusion, particularly ensuring materials are understandable and procedures are accessible; and consent and authorisation, including providing a neutral informed consent and keeping promises regarding privacy protections. While the experience of respect is inherently subjective, these findings highlight four key domains that may meaningfully demonstrate respect to potential and current research participants. Further empirical and normative work is needed to substantiate these domains and evaluate how best to incorporate them into the practice of research. (shrink)

Western science teaches that our beings are governed by the laws of physics and our minds play no part. There are, however, flaws in this thinking, most prominently unexplained paranormal phenomena that defy explanation by modern theories of physics. Collected by a handful of renegade scientists who call themselves parapsychologists, these data include extrasensory perception (ESP), poltergeist occurrences, and psychokinesis. Much of the current data in parapsychology and their implications for understanding the true nature of the self are examined here. (...) Beginning with a consideration of several instances of spontaneous psi, the book examines the theoretical explanations of paranormal phenomena. It also covers the hypothesis and evidence that minds contain the so-called hidden variables that determine the outcomes of the quantum process, thus interweaving parapsychology with modern physics. The minds fate upon the death of the physical body is discussed; the reader is forced to consider in detail the relationship between the conscious mind and the physical brain and the evidence that minds survive the death of bodies. (shrink)

Hobbes and Wallis's "battle of the books" illuminates the intimate relationship between science and crucial seventeenth-century debates over the limits of sovereign power and the existence of God.

In this first modern, critical assessment of the place of mathematics in Berkeley's philosophy and Berkeley's place in the history of mathematics, Douglas M. Jesseph provides a bold reinterpretation of Berkeley's work.

Sir George Etherege, William Wycherley and William Congreve introduce into their play-worlds major female characters who demand independence and equality from their male counterparts. This book focuses on each major female character who demands independence and equality of her gallant-libertine before she will commit to marriage or courtship with him. This demand for equality is a contrast to the social and marital relationships found in the real world of 17th century English Restoration society where marriage was a bargaining process for (...) property and where the woman was treated as the man's property. Each of the three playwrights develops his virtuous women in a different way. Wycherley's approach to his characters, for instance, is quite different from that of Etherege and Congreve. But in each case, the playwrights present major female characters who prove themselves superior in wit and wisdom and thoroughly modern in their outlook. (shrink)

In this first modern, critical assessment of the place of mathematics in Berkeley's philosophy and Berkeley's place in the history of mathematics, Douglas M. Jesseph provides a bold reinterpretation of Berkeley's work. Jesseph challenges the prevailing view that Berkeley's mathematical writings are peripheral to his philosophy and argues that mathematics is in fact central to his thought, developing out of his critique of abstraction. Jesseph's argument situates Berkeley's ideas within the larger historical and intellectual context of the Scientific Revolution. (...) Jesseph begins with Berkeley's radical opposition to the received view of mathematics in the philosophy of the late seventeenth and early eighteenth centuries, when mathematics was considered a "science of abstractions." Since this view seriously conflicted with Berkeley's critique of abstract ideas, Jesseph contends that he was forced to come up with a nonabstract philosophy of mathematics. Jesseph examines Berkeley's unique treatments of geometry and arithmetic and his famous critique of the calculus in The Analyst. By putting Berkeley's mathematical writings in the perspective of his larger philosophical project and examining their impact on eighteenth-century British mathematics, Jesseph makes a major contribution to philosophy and to the history and philosophy of science. (shrink)

The dissertation is a detailed analysis of Berkeley's writings on mathematics, concentrating on the link between his attack on the theory of abstract ideas and his philosophy of mathematics. Although the focus is on Berkeley's works, I also trace the important connections between Berkeley's views and those of Isaac Barrow, John Wallis, John Keill, and Isaac Newton . The basic thesis I defend is that Berkeley's philosophy of mathematics is a natural extension of his views on abstraction. The first chapter (...) is devoted to a consideration of Berkeley's treatment of abstraction, including his arguments against the doctrine of abstract ideas and his own account of how the explanatory ideas traditionally assigned to abstract ideas can be filled by a non-abstractionist account of human knowledge. In chapter two I investigate the details of Berkeley's proposed new foundations for geometry, showing how his rejection of abstract ideas led him to a critique of the traditional conception of geometry . Of particular importance in this context is Berkeley's denial of infinite divisibility and his attempts to show that a satisfactory account of geometry does not require that geometric magnitudes be infinitely divisible. Chapter three is concerned with Berkeley's treatment of arithmetic and algebra. Here I argue that Berkeley's denial of the claim that arithmetic is the science of abstract ideas of number ultimately results in his advocacy of a strongly nominalistic conception of arithmetic which has strong similarities to modern fomalism. In chapter four I discuss Berkeley's famous critique of the calculus in The Analyst and other works, concluding that his criticism of the calculus is essentially correct, although his attempted explanation of the success of infinitesimal methods is unconvincing. (shrink)

PrefaceList of AbbreviationsChapter One: The Mathematical Career of the Monster of MalmesburyChapter Two: The Reform of Mathematics and of the UniversitiesIdeological Origins of the DisputeChapter Three: De Corpore and the Mathematics of MaterialismChapter Four: Disputed FoundationsHobbes vs. Wallis on the Philosophy of MathematicsChapter Five: The "Modern Analytics" and the Nature of DemonstrationChapter Six: The Demise of Hobbesian GeometryChapter Seven: The Religion, Rhetoric, and Politics of Mr. Hobbes and Dr. WallisChapter Eight: Persistence in ErrorWhy Was Hobbes So Resolutely Wrong?Appendix: Selections from (...) Hobbes's Mathematical WritingsReferencesIndex Copyright © Libri GmbH. All rights reserved. (shrink)

This chapter examines the views of seventeenth-century British philosophers on the notion of logic and demonstrative knowledge, particularly Francis Bacon, Thomas Hobbes, and John Locke, offering an overview of traditional Aristotelianism in relation to logic and describing Bacon's approach to demonstration and logic. It also analyzes the contribution of the Cambridge Platonists and evaluates the influence of Cartesianism. The chapter concludes that theorizing about logic and demonstrative knowledge followed an arc familiar from other branches of philosophy such as metaphysics or (...) the philosophy of science. (shrink)

The emergence of the global administrative sector and its new forms of knowledge production, expert rationality, and standardization, remains an understudied topic in science studies. Using a coproductionist theoretical framework, we argue tha the mutual construction of epistemic and legal authority across international organizations has been critical for constituting and stabilizing a global regime for the regulation of food safety. The authors demonstrate how this process has also given rise to an authoritative framework for risk analysis touted as ‘‘scientifically rigorous’’ (...) but embodying particular value choices regarding health, environment, and the dispensation of regulatory power. Finally, the authors trace how enrollment of the Codex Alimentarius in World Trade Law has heightened institutional dilemmas around legitimacy and credibility in science advice at the global level. Taken together, the case illustrates the importance of attending to the iterative construction of law and science in the constitution of new global administrative regimes. (shrink)

Do continuing education (CE) mandates increase participation in ethics programs and enhance their perceived outcomes? In a study of 5,198 North American psychologists, significant differences were found between mandated and nonmandated psychologists in relation to their participation in ethics programs but not in the perceived outcomes associated with those trainings. Although 64.3% of those psychologists operating under ethics mandates reported completing at least one ethics training within the previous year, only 40.7% of those without such mandates reported doing likewise. Overall, (...) both groups tended to view their ethics training quite favorably in relation to its perceived outcomes, though they differed in relation to their endorsement of CE mandates. Results are discussed in relation to the ongoing development of evidence-based CE and its role in developing critical professional competencies. (shrink)

This article examines Hobbes’s conception of mathematical method, situating his methodological writings in the context of disputed mathematical issues of the seventeenth century. After a brief exposition of the Hobbesian philosophy of mathematics, it investigates Hobbes’s attempts to resolve three important mathematical controversies of the seventeenth century: the debates over the status of analytic geometry, disputes over the nature of ratios, and the problem of the “angle of contact” between a curve and tangent. In the course of these investigations, Hobbes’s (...) account of mathematics and its method is contrasted with the those of Descartes, Isaac Barrow, John Wallis, and Christopher Clavius. (shrink)

This paper analyzes Berkeley's arguments for the existence of God in the Principles of Human Knowledge, Three Dialogues, and Alciphron. Where most scholarship has interpreted Berkeley as offering three quite distinct attempted proofs of God's existence, I argue that these are all variations on the strategy of inference to the best explanation. I also consider how this reading of Berkeley connects his conception of God to his views about causation and explanation.

The purpose of this paper is to analyze what some private universities are doing in the area of mediation and other alternative ways of solving faculty complaints – what some term "alternative dispute resolution." Special attention will be given to one of the most important ethical issues in this area at the operating level of individual universities – the due process procedures with respect to the processing of the grievances of individual faculty members in nonunionized colleges. The paper concludes with (...) recommendations for university administrators and faculty senates, as well as recommendations for future research. (shrink)

This study employs the uses and gratification approach to investigate how different forms of Facebook use are linked to bridging social capital and bonding social capital. A survey of 152 college students was conducted to address research questions and to test hypotheses. Factor analysis identified six unique uses and gratifications: (a) information seeking, (b) entertainment, (c) communication, (d) social relations, (e) escape, and (f) Facebook applications. Findings reveal that intensity of Facebook use and the use of Facebook for social relations (...) are positive predictors of bridging social capital, whereas the use of Facebook for escape is negatively linked to bonding social capital. (shrink)

Early in his mathematical career Leibniz discovered some important methods and results but had to recognize that his findings had been anticipated by other mathematicians such as Pierre de Fermat, James Gregory, Isaac Newton, François Regnauld, John Wallis, etc. This paper investigates the cases of Isaac Barrow and Pietro Mengoli who, earlier than Leibniz, had been familiar with the characteristic triangle, transmutations methods, the inverse connection between determining tangents and areas of curves or the sums of the reciprocal figurate numbers, (...) and the harmonic triangle. To what extent was Leibniz aware of the results and publications of his predecessors? How did he assess their methods and results? Why did Leibniz never acknowledge any influence of these two mathematicians on his own studies? After publication of Leibniz’s manuscripts concerning the prehistory and early history of the calculus in the Academy Edition these questions can be investigated on the solid foundation of original texts. (shrink)

In their recent article, Kirsch and Hyland questioned the relation between psychological and associated neurophysiological phenomena in the introduction of complementarity into psychology. Mishkin's work on the neurophysiological basis of memory and perception provides an example of the extension of complementarity that I have proposed and that can serve as the basis for empirical testing of this extension. Mishkin's thesis that memory storage occurs at sensory stations in the cortex allows for the resolution of a fundamental problem in cognitive psychology, (...) namely the reciprocal dependence of perception and memory. Also, Mishkin's thesis allows that psychological phenomena do not depend on an objective world for their existence. (shrink)

Elitzur maintains that in quantum mechanical measurement consciousness does not have a significant impact on the physical world. His thesis is refuted through an elaboration of Schrödinger's gedankenexperiment called the cat paradox. The generally conservative tone of Elitzur's article as regards the involvement of consciousness in the physical world is discussed. Through discussing the conservation of energy and the second law of thermodynamics much differently than did Elitzur, it is shown how the involvement of human cognition in the functioning of (...) the physical world can be found in the structure of physical theory itself. Elitzur's major argument concerning a demonstration of a non-material basis for consciousness is shown to be inadequate. (shrink)

Marriage is a subject of perennial interest, and we should like to be able to assess the exact degree of importance which the Greeks attached to this institution. One of the chief questions is how the formality of marriage, or the lack of it, affected the children of a union; above all, was illegitimate birth a bar to citizenship even in democratic Athens? Unfortunately there is still no general agreement about the answer to this question.

If you look up οκος in Liddell and Scott, you find the instances classified in three main divisions: first those meaning a house, or sometimes other kinds of building; secondly ‘one's household goods, substance’, for which I shall generally say ‘property’, though Liddell and Scott do not actually use that word; and thirdly ‘family’. This threefold distinction is sound, and I shall adhere to it here. Admittedly one sometimes finds an instance where it is not easy to decide which sense (...) the word has. Two of the senses, occasionally even all three, may overlap. But in the great majority of instances it is clear which sense is meant. (shrink)

This is a puzzling book. On the one hand, Stoneham insists that “we cannot appreciate the contributions made by philosophers like Berkeley without coming to terms with the full breadth and detail of his thought”. On the other hand, his interpretive efforts are directed almost exclusively at the Three Dialogues between Hylas and Philonous—a work Berkeley intended as a popular recasting of his doctrines and one that scholars generally regard as conspicuously lacking the “full breadth and detail” of his philosophy. (...) There is an evident tension between the goal of thoroughly examining Berkeley’s thought and the chosen means of focusing on the Three Dialogues. This tension arises, in large part, from the fact that Stoneham’s intended audience is not Berkeley scholars, but rather people seriously interested in philosophy and its history, yet lacking significant familiarity with Berkeley’s thought or its background in early modern philosophy. As a way to introduce advanced undergraduates or graduate students to Berkeley, the book is a reasonably successful effort, although there are some significant shortcomings. (shrink)