There is an inconsistency in the ways that doctors make clinical decisions regarding the treatment of babies born extremely prematurely. Many experts now recommend that clinical decisions about the treatment of such babies be individualized and consider many different factors. Nevertheless, many policies and practices throughout Europe and North America still appear to base decisions on gestational age alone or on gestational age as the primary factor that determines whether doctors recommend or even offer life-sustaining neonatal intensive care treatment. These (...) policies are well intentioned. They aim to guide doctors and parents to make decisions that are best for the baby. That is an ethically appropriate goal. But in relying so heavily on gestational age, such policies may actually do the babies a disservice by denying some babies treatment that might be beneficial and lead to intact survival. In this paper, we argue that such policies are unjust to premature babies and ought to be abolished. In their place, we propose individualized treatment decisions for premature babies. This would treat premature babies as we treat all other patients, with clinical decisions based on an individualized estimation of likelihood that treatment would be beneficial. (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)

A recent American Academy of Pediatrics (AAP) clinical report states that it is an acceptable option for pediatric care clinicians to dismiss families who refuse vaccines. This is a clear shift in guidance from the AAP, which previously advised clinicians to “endeavor not to discharge” patients solely because of parental vaccine refusal. While this new policy might be interpreted as encouraging or recommending dismissal of vaccine-refusing families, it instead expresses tolerance for diverse professional approaches. This is unlike the earlier guidance, (...) which promoted a unified response to vaccine refusal. In fact, the resolution (which was presented at the AAP’s Annual Leadership Forum) that led to this clinical report also calls on the AAP “to continue to support pediatricians who continue to provide health care to children of parents who refuse to immunize their children.” However, the shift toward embracing dismissal as an acceptable response to vaccine refusal may erode professional solidarity. Pediatricians are clearly divided on this question; most do not dismiss vaccine-refusing families. By declaring that dismissal is an acceptable option, the AAP has sanctioned a practice that may be unfair to the many clinicians who do not dismiss these families. Clinicians who adopt a policy of dismissal toward families who refuse vaccines might impose burdens on colleagues who remain willing to offer care to those families, and their actions might show insufficient commitment to the efforts of their profession to promote health for all children. (shrink)

Marshall and O’Leary’s thoughtful response to our article suggests that dismissal policies are ethically justifiable because they might induce parents to immunize their children. This outcome is conceivable, but we have only anecdotes about how often it occurs. Such evidence became the thin reed on which the American Academy of Pediatrics rested its new policy of tolerating the practice of dismissing vaccine-hesitant parents. It seems likely that relatively few parents would agree to vaccinate because they were threatened with dismissal. Other (...) heavy-handed interventions have failed to move most such parents. When Washington state made nonmedical exemptions more difficult to obtain, nearly two-thirds of vaccine refusers were unmoved and their children remained unvaccinated. Even if dismissal threats led some parents to accept vaccines, this alone would not justify a dismissal policy. The benefits would still have to be weighed against the risks of dismissing those families who do not change their minds. (shrink)

Parents respond to the death of a child in very different ways. Some parents may be violent or angry, some sad and tearful, some quiet and withdrawn, and some frankly delusional. We present a case in which a father’s reaction to his daughter’s death is a desire to protect his wife from the stressful information. The wife is in the second trimester of a high-risk pregnancy and so is particularly fragile. We asked pediatricians and bioethicists to discuss the ways in (...) which they might respond to the father’s understandable but troubling request. -/- The death of a young child is one of the most stressful events that can happen to parents. The stress of such a loss is compounded if the parents are in a foreign country, far from home, and without a network of family and friends to provide social support. The stress may be more difficult to deal with if the parents have acute health problems of their own. In this month’s “Ethics Rounds,” we present a case in which a father whose daughter died requested that the doctors delay telling his wife. His reason: She is pregnant, in the second trimester, and on bed rest because of preterm labor. He does not want to add to her stress. We asked both pediatricians and bioethicists to respond to this request. (shrink)

A commentary on “Were There ‘Additional Foreseeable Risks’ in the SUPPORT Study?,” by Henry J. Silverman and Didier Dreyfuss; “SUPPORT: Risks, Harms, and Equipoise,” by Robert M. Nelson; “The Controversy over SUPPORT Continues and the Hyperbole Increases,” by Alan R. Fleischman; and “SUPPORT and Comparative Effectiveness Trials: What's at Stake?,” by Lois Shepherd, all in the January‐February 2015 issue.

In this article, we first review the development of clinical ethics in pediatrics in the United States. We report that, over the last 40 years, most children’s hospitals have ethics committees but that those committees are rarely consulted. We speculate that the reasons for the paucity of ethics consults might be because ethical dilemmas are aired in other venues. The role of the ethics consultant, then, might be to shape the institutional climate and create safe spaces for the discussion of (...) difficult and sometimes contentious issues. Finally, we report how pediatric clinical ethics has evolved differently in a number of other countries around the world. (shrink)

Liver transplantation is the treatment of choice for many forms of liver disease. Unfortunately, the scarcity of cadaveric donor livers limits the availability of this technique. To improve the availability of liver transplantation, surgeons have developed the capability of removing a portion of liver from a live donor and transplanting it into a recipient. A few liver transplants using living donors have been performed worldwide.Our purpose was to analyze the ethics of liver transplants using living donors and to propose guidelines (...) for the procedure before it was introduced in the United States. We used a process of research ethics consultation that involves a collaboration between clinical investigators and clinical ethicists. We concluded that it was ethically appropriate to perform liver transplantation using living donors in a small series of patients on a trial basis, and we published our ethical guidelines in a medical journal before the procedure was introduced. We recommend this prospective, public approach for the introduction of other innovative therapies in medicine and surgery. (shrink)

This volume is devoted entirely to exploring the role of animals in the thought of Immanuel Kant. Leading scholars address questions regarding the possibility of objective representation and intentionality in animals, the role of animals in Kant's scientific picture of nature, the status of our moral responsibilities to animals' welfare, and more.

In the last two decades, interest in narrative conceptions of identity has grown exponentially, though there is little agreement about what a "life-narrative" might be. In connecting Kierkegaard with virtue ethics, several scholars have recently argued that narrative models of selves and MacIntyre's concept of the unity of a life help make sense of Kierkegaard's existential stages and, in particular, explain the transition from "aesthetic" to "ethical" modes of life. But others have recently raised difficult questions both for these readings (...) of Kierkegaard and for narrative accounts of identity that draw on the work of MacIntyre in general. While some of these objections concern a strong kind of unity or "wholeheartedness" among an agent's long-term goals or cares, the fundamental objection raised by critics is that personal identity cannot _be_ a narrative, since stories are artifacts made by persons. In this book, Davenport defends the narrative approach to practical identity and autonomy in general, and to Kierkegaard's stages in particular. (shrink)

This book examines Aristotle's critical reaction to the mathematical cosmology of Plato's Academy, and traces the aporetic method by which he developed his own ...

The 1990s saw a revival of interest in Kierkegaard's thought, affecting the fields of theology, social theory, and literary and cultural criticism. The resulting discussions have done much to discredit the earlier misreadings of Kierkegaard's works.

Towards the conclusion of the First Section of the Groundwork of the Metaphysics of Morals, Kant describes a process whereby a subject can undergo a kind of moral corruption. This process, which he calls a “natural dialectic”, can cause one to undermine one’s own or¬dinary grasp of the demands of morality. Kant also claims that this natural dialectic is the basis of the need for moral philosophy itself, since first-order moral reasoning is insufficient to protect against it. I show that (...) this passage is closely related to another in the First Section, one where Kant warns against the threat of “misology”, or the hatred of reason. I argue that both these passages must be read as engaging with specific claims from Rousseau’s writings. Uncovering the historical context and rhetorical function of Kant’s account of moral self-deception can re-orient the reader to his ambitions for the Groundwork itself. (shrink)

Pragmatism, Postmodernism and the Future of Philosophy is a vigorous and dynamic confrontation with the task and temperament of philosophy today. In this energetic and far-reaching new book, Stuhr draws persuasively on the resources of the pragmatist tradition of James and Dewey, and critically engages the work of Continental philosophers like Adorno, Foucault, and Deleuze, to explore fundamental questions of how we might think and live differently in the future. Along the way, the book addresses important issues in public policy, (...) university administration, spirituality, and the notion of community and its meaning in a global world of difference. This book is essential reading for anyone concerned with the future of philosophy, and the ways in which philosophical thinking can help us live better, more fulfilling lives. (shrink)

This is done through a chronology, an introductory essay, an extensive bibliography, and hundreds of cross-referenced dictionary entries on key terms and ...

Cleary discusses the origin, development, and use of the many senses of priority as a central thesis in Aristotle’s metaphysics. Cleary contends that one of the most revealing problems for the ambiguity of Aristotle’s relationship to Platonism is that of the ontological status of mathematical objects. In support of his claim, Cleary analyzes a curious passage from Aristotle’s _Topics, _where he appears to accept a schema of priorities that makes mathematical entities more substantial than sensible things. How does Aristotle try (...) to reconcile the ordering of things dictated by sciences like mathematics and dialectic with the ordering of sense experience upon which his own physics and metaphysics are based? To find the answer, Cleary reviews three different outlines of the many senses of priority given by Aristotle himself and found in _Categories _12-13, _Metaphysics _Delta 11, and _Metaphysics _Theta 8. Cleary suggests there is an implicit hierarchy for Aristotle that leads him to posit the Prime Mover at its apex as complete actuality and, therefore, as the focus for the concept of priority. Having reviewed Aristotle’s treatment of the many uses of priority, Cleary demonstrates how the concept is used in some typical arguments by Aristotle for his mature metaphysical positions. (shrink)

This article argues for a social proviso concerning capital endowments that is analogous to Locke's original proviso on access to productive natural capital.

From the "New York Times" bestselling author of "If I Stay" Allyson Healeys life is exactly like her suitcase--packed, planned, ordered. Then on the last day of her three-week post-graduation European tour, she meets Willem. A free-spirited, roving actor, Willem is everything shes not, and when he invites her to abandon her plans and come to Paris with him, Allyson says yes. This uncharacteristic decision leads to a day of risk and romance, liberation and intimacy: 24 hours that will transform (...) Allysons life. A book about love, heartbreak, travel, identity, and the "accidents" of fate, "Just One Day" shows us how sometimes in order to get found, you first have to get lost... and how often the people we are seeking are much closer than we know. The first in a sweepingly romantic duet of novels. Willems story--"Just One Year"--is coming soon. (shrink)

The role of analogy appears in surprisingly different areas of the first Critique. On the one hand, Kant considered the concept to have a specific enough meaning to entitle the principle concerned with causation an analogy; on the other hand we can find Kant referring to analogy in various parts of the Transcendental Dialectic in a seemingly different manner. Whereas in the Transcendental Analytic, Kant takes some time to provide a detailed (if not clear) account of the meaning of the (...) term ‘analogy’ and his reasons for his employment of it, in the Transcendental Dialectic on the other hand, Kant’s employment of the term seems far less technical. It would seem on the face of it, that Kant has two senses of ‘analogy’: one technical sense reserved for those constitutive principles of the understanding as laid out in the Analytic, and another casual and commonplace use of the term. This picture, although it contains elements of truth, is ultimately misleading. I argue for three claims in this paper. Firstly, I suggest that there can be found in the first Critique a unified conception of analogy. Secondly, I argue that Kant self-consciously differentiated his employment of analogy from the employment that can be found in many early modern philosophers, e.g. Locke. Thirdly, I will tentatively suggest that this interpretation of analogy can aid us in addressing certain contentious areas of transcendental idealism, most notably the account of causation. (shrink)

In contemporary philosophy, the will is often regarded as a sheer philosophical fiction. In Will as Commitment and Resolve , Davenport argues not only that the will is the central power of human agency that makes decisions and forms intentions but also that it includes the capacity to generate new motivation different in structure from prepurposive desires. The concept of "projective motivation" is the central innovation in Davenport's existential account of the everyday notion of striving will. Beginning with the contrast (...) between "eastern" and "western" attitudes toward assertive willing, Davenport traces the lineage of the idea of projective motivation from NeoPlatonic and Christian conceptions of divine motivation to Scotus, Kant, Marx, Arendt, and Levinas. Rich with historical detail, this book includes an extended examination of Platonic and Aristotelian eudaimonist theories of human motivation. Drawing on contemporary critiques of egoism, Davenport argues that happiness is primarily a byproduct of activities and pursuits aimed at other agent-transcending goods for their own sake. In particular, the motives involved in virtue and in its practice as understood by Alasdair MacIntyre are projective rather than eudaimonist. This theory is supported by analyses of radical evil, accounts of intrinsic motivation in existential psychology, and contemporary theories of identity-forming commitment in analytic moral psychology. Following Viktor Frankl, Joseph Raz, and others, Davenport argues that Harry Frankfurt's conception of caring requires objective values worth caring about, which serve as rational grounds for projecting new final ends. The argument concludes with a taxonomy of values or goods, devotion to which can make life meaningful for us. (shrink)

This essay argues for a new conception of bad faith based partly on Harry Frankfurt's famous account of personal autonomy in terms of higher‐order volitions and caring, and based partly on Sartre's insights concerning tacit or pre‐thetic attitudes and “transcendent” freedom. Although Sartre and Frankfurt have rarely been connected, Frankfurt's concepts of volitional “wantonness” and “bullshit” (wantonness about truth) are similar in certain revealing respects to Sartre's account of bad faith. However, Sartre leaves no room for Frankfurt's central point that (...) people can volitionally commit themselves to develop certain motives and reduce others, thereby shaping an authentic identity through volitional “identification” and “alienation” of motives. Frankfurt in turn minimizes the role that a sense of liberty to form and alter higher‐order volitions plays in experiences of autonomy, which Sartre recognizes in the transcendence of the “for‐itself.” When these points are combined, we get a tri‐level theory of intrasubjective volitional stances that explains Sartre's cases better than his own theory can, and also clarifies how sincere or procedurally autonomous self‐relation is possible. (shrink)

I argue that Kant’s transcendental idealism and Strawson’s descriptive metaphysics are both examples of what I call methodological conservativism. Methodological conservativism involves the claim that a subset of common first-order beliefs is immune to revision. I argue that there are striking differences between their respective commitments to this position, however. For Kant, his conservativism is based upon a commitment to the reliability of particular results of the sciences of his day. For Strawson, in contrast, his conservativism is based upon his (...) attempted liberation of arguments for the necessity of a certain conceptual scheme from any particular scientific commitments. In fact, for Strawson, no change in scientific commitments could displace the conceptual scheme employed to navigate the manifest world of ordinary perceptual experience. Each approach brings with it challenges with regard to how to accommodate potential scientific theory change. (shrink)

It is often maintained that one insight of Kant's Critical philosophy is its recognition of the need to distinguish accounts of knowledge acquisition from knowledge justification. In particular, it is claimed that Kant held that the detailing of a concept's acquisition conditions is insufficient to determine its legitimacy. I argue that this is not the case at least with regard to geometrical concepts. Considered in the light of his pre-Critical writings on the mathematical method, construction in the Critique can be (...) seen to be a form of concept acquisition, one that is related to the modal phenomenology of geometrical judgement. (shrink)

This chapter addresses the issues that motivate representationalist accounts, and it describes the different versions of representationalism as responses to these issues. It argues that the representationalist views do not adequately respond to the epistemological problems that motivate them and that they engender some ontological problems. The chapter presents an alternative ‘presentationalist’ account that preserves the straightforward sense of the mind's openness to the world. While representationalism and presentationalism agree that the relation between mental events or states is direct but (...) mediated, they radically differ in their views of the nature of the mediation involved in the mind's intentional directedness to the world. This difference and the preferability of the presentationalist account are explored. (shrink)

It is quite common when explicating the nature of Kant's break with the preceding Early Modern tradition to cite his attitude towards the acquisition and deployment of concepts. It is claimed that Kant sought to distinguish two tasks that had become unfortunately intertwined and conflated — explaining how we come to acquire our concepts on the one hand and showing how we are justified in deploying them in judgement on the other. This conflation can be expressed in terms of a (...) conflation of the natural and the normative, of descriptive and prescriptive questions. The topic of the conditions ofconcept-possession, i.e. how we have come to possess the concepts that we do, is an entirely psychological inquiry, involving ‘natural’ descriptive inquiries. The topic ofconcept-deployment, the story about how we use our concepts in veridical judgements about the world, is an entirely philosophical question, since it involves the question of how weoughtto deploy those concepts in judgement. The fundamental distinction between the natural and the normative is drawn by Kant, it is claimed, in order to distinguish these two practices of acquisition and deployment.The manner in which this claim is expressed is through Kant's distinction between the question of fact (quaestio facti) and the question of right (quaestio juris). I want to claim that a proper understanding of this distinction doesn't support this notion of Kant's ‘normative turn’. In fact, the distinction is best understood within an interpretation whereby Kant is understood as continuing to endorse the Early Modern conviction that the provision of a concept's possession-conditionsissufficient to determine that concept's deployment-conditions, and that the task of the Transcendental Deduction is to determine thepossession-conditions for the Categories. (shrink)

It took nearly two thousand years for society to recognize the Hippocratic insistence that “the doctor knows best”1 was an inadequate approach to medical decisionmaking. Today, patient-centered medicine has come to understand that the individual patient has a significant role in the decisionmaking process.2.

The rift which has long divided the philosophical world into opposed schools-the "Continental" school owing its origins to the phenomenology of Husserl and the "analytic" school derived from Frege-is finally closing.