Advance care planning allows patients to articulate preferences for their medical treatment, lifestyle, and surrogate decision-makers in order to anticipate and mitigate their potential loss of decision-making capacity. Written advance directives are often emphasized in this regard. While these directives contain important information, there are several barriers to consider: veracity and accuracy of surrogate decision-makers in making choices consistent with the substituted judgement standard, state-to-state variability in regulations, literacy issues, lack of access to legal resources, lack of understanding of medical (...) options, and cultural disparities. Given these issues, it is vital to increase the use of patient and healthcare provider conversations as an advance care planning tool and to increase integration of such discourse into advance care planning policy as adjuncts and complements to written advance directives. This paper reviews current legislation about written advance directives and dissects how documentation of spoken interactions might be integrated and considered. We discuss specific institutional policy changes required to facilitate implementation. Finally, we explore the ethical issues surrounding the increased usage and recognition of clinician–patient conversations in advance care planning. (shrink)

If the world itself is metaphysically indeterminate in a specified respect, what follows? In this paper, we develop a theory of metaphysical indeterminacy answering this question.

This paper argues for a comprehensive conception of empathy as comprising epistemic, affective, and motivational elements and introduces the ancient Stoic theory of attachment as a model for describing the embodied, emotional response to others that we take to be distinctive of empathy. Our argument entails that in order to provide a suitable conceptual framework for the interdisciplinary study of empathy one must extend the scope of recent “simulationalist” and “enactivist” accounts of empathy in two important respects. First, against the (...) enactivist assumption that human mindreading capacities primarily rely on an immediate, quasi-perceptual understanding of other’s intentional states, we draw on Alfred Schutz’ analysis of social understanding to argue that reflective types of understanding play a distinct, but equally fundamental role in empathic engagements. Second, we insist that empathy also involves an affective response toward the other and their situation. We suggest analyzing this response in terms of the Stoic concepts of attachment, concern, and a fundamental type of prosocial motivation, that can best be described as an “extended partiality.” By way of conclusion, we integrate the above concepts into a comprehensive conceptual framework for the study of empathy and briefly relate them to current debates about empathic perception and prosocial motivation. The result, we argue, is an account that stays neutral with regard to the exact nature of the processes involved in producing empathy and can therefore accommodate discussion across theoretical divides—e.g., those between enactivist, simulationalist, and so-called theory-theorist approaches. (shrink)

Athens or Jerusalem? By Tertullian.--Philosophy the handmaid of theology, by Clement of Alexandria.--Faith in search of understanding, by St. Augustine.--Revelation and analogy, by St. Thomas Aquinas.--The mystic way, by M. Eckhart.--The darkened intellect, by J. Calvin.--The reasons of the heart, by B. Pascal.--Faith, reason, and enthusiasm, by J. Locke.--Miracles and the skeptic, by D. Hume.--The limits of reason, by I. Kant.--Truth and subjectivity, by S. Kierkegaard.--In justification of faith, by W. James.--Religion as poetry, by G. Santayana.--Faith and symbols, by P. (...) Tillich.--Three parables on falsification, by A. Flew, R. M. Hare, and B. Mitchell.--For further reading (p. 233-235). (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Notes and Discussions PARMENIDES THE PROPHET~ The latest word on Parmenides comes from a recent and exhaustive study by Leonardo Tar~n. 1 Among other illuminating and novel interpretations, Tarhn argues that Parmenides was not, after all, guilty of the confusion between the existential and copulative senses of "to be," that he did not identify thinking with Being, and that he had no conception of atemporal reality.~ In these and (...) other respects Tar~n's volume makes a valuable contribution to our understanding of Parmenides. One might judge, however, that Tars work is unusually insensitive to the religious element in Parmenides' poem, and in this respect his analysis seems to echo Reinhardt's unfortunate judgment which calls Parmenides "einen Denker, der keinen Wunsch kennt als Erkenntnis, keine Fessel ffihlt als Logik, den Gott und Geffihl gleichgiiltig lassen." s This inadequacy of TarAn's approach to Parmenides is evident in his treatment of the poem in general, and especially the prologue. The prologue to Parmenides' poem has always been a source of debate. After exploring and rejecting the allegorical interpretation of Sextus (the main source for the proem), Tar~n then systematically examines and rejects the modern interpretations which (among others) make it out to be a shamanistic rapture (Diels, Cornford), Orphic apocalypse (Burnet), religious revelation (Jaeger, Bowra), and mystical experience (Verdenius).4 TarAn judges that Parmenides did not intend his journey to be taken as a reality in any sense, largely on the grounds (1) that Parmenides speaks of his journey as a repeated experience. To take seriously the iterative expressions of the prologue (e.g. fr. 1, lines 1, 3, 8) is incompatible with interpretations which construe it to refer to a specific occasion.6 He supports the conclusion that the proem is nothing more than a literary device with the observations (2) that symbolic interpretations are incongruous with the fact that the goddess expounds her doctrine without symbols, and (3) that the appeal is to Logos, the rational, critical faculty; (4) that the goddess remains anonymous shows that she stands for no religious figure at all ("the 'revelation' is the truth discovered by Parmenides himself"); and (5) that Parmenides could hardly expect us to take seriously the reality of the goddess and other elements in the proem, the reality of which would be entirely incompatible with the thesis of the poem, viz. that reality is One and that all multiplicity and distinction is unreal. ~ z Parmenides: A Text with Translation, Commentary, and Critical Essays (Princeton, 1965). See my review of this work in The Classical Journal, LXII (1967),232ff. aParmenides und die Geschiehtc der griechischen Philosophic (Bonn, 1916),p. 256. 4TarGn,p. 17ft.Guthrie believes that Parmenides recognized an affinity between his search for truth, and his religious activity and mystical experience, and that he reflected this in his mystical-allegorical prologue (History of Greek Philosophy [Cambridge, 1965],II, 13). Guthrie was not, apparently, aware of Ta~n's work when he wrote his second volume; and on the matter of the prologue he favors the work of Mansfeld (Offenbarung des Parmenides und die menschlichc Welt [Assen, 1964],chap. IV), and Bowra ("The Proem of Parmenides," Classical Philology, XXXII [1987],97ff). Tar~n, p. 30. * P. 30f. [67] 68 HISTORY OF PHILOSOPHY It is probably true that interpretations which find all sorts of religious elements in the proem (and the poem as a whole) go too far. On the other hand, Tar~n gives the impression that Parmenides was nothing more than a pedantic academician, and in this respect he tends to sin in the opposite direction. First, the possible religious significance of the prologue does not depend on its being taken to refer to a literal experience; but even if it did, it need not refer to a specific event; and even if that were so, it is a little forced to exclude a specific event in view of the iterative expressions which may be no more than a function of poetic style. As for his second charge, Tar~n seems unaware that the main part of the poem hardly lends itself to symbolic expression, and afortiori the prologue, with its symbolism, sets the religious mood for... (shrink)