OBJECTIVE: To describe the issues faced, and how they were addressed, by the University of Toronto Critical Care Medicine Program/Joint Centre for Bioethics Task Force on Appropriate Use of Life-Sustaining Treatment. The clinical problem addressed by the Task Force was dealing with requests by patients or substitute decision makers for life-sustaining treatment that their healthcare providers believe is inappropriate. DESIGN: Case study. SETTING: The University of Toronto Joint Centre for Bioethics/Critical Care Medicine Program Task Force on Appropriate Use of Life-Sustaining (...) Treatment. PARTICIPANTS: The 24-member Task Force included physician and nursing leaders from five critical care units, bioethicists, a legal scholar, a health administration expert, a social worker, and a hospital public relations professional. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Our specific lessons learned include a) a policy focus on process; b) use of a negotiation and mediation model, rather than a hospital ethics committee model, for this process; and c) the policy development process is itself a negotiation, so we recommend equal involvement of interested groups including patients, families, and the public. CONCLUSIONS: This article describes the key issues faced by the Task Force while developing its policy. It will provide a useful starting point for other groups developing policy on appropriate use of life-sustaining treatment. (shrink)

Modern bioethics, which is based on Western moral philosophy and Western biomedical perspectives, has evolved within a complex, highly individualistic culture that draws a sharp distinction between church and state and tolerates a multitude of values. This discipline defines its principles in secular and objective terms that often are bewildering to people of non-Western origin. Despite much discourse, principlism remains the fundamental framework of bioethics. Principlism is held in such high regard that many bioethicists equate autonomy with personhood, as if (...) autonomy exists independently of specific beliefs and commitments.In addition, we continue to minimize the substantial differences in the way people of different cultures perceive, experience, and explain illness, although our views of the potential cultural limitations of Western medicine have grown and expanded in recent years. At the heart of it we continue to be tied to a biomedical focus that largely neglects the context of the situation. (shrink)

Modern bioethics, which is based on Western moral philosophy and Western biomedical perspectives, has evolved within a complex, highly individualistic culture that draws a sharp distinction between church and state and tolerates a multitude of values. This discipline defines its principles in secular and objective terms that often are bewildering to people of non-Western origin. Despite much discourse, principlism remains the fundamental framework of bioethics. Principlism is held in such high regard that many bioethicists equate autonomy with personhood, as if (...) autonomy exists independently of specific beliefs and commitments.In addition, we continue to minimize the substantial differences in the way people of different cultures perceive, experience, and explain illness, although our views of the potential cultural limitations of Western medicine have grown and expanded in recent years. At the heart of it we continue to be tied to a biomedical focus that largely neglects the context of the situation. (shrink)

Sir Austin Bradford Hill’s ‘aspects of causation’ represent some of the most influential thoughts on the subject of proximate causation in health and disease. Hill compiled a list of features that, when present and known, indicate an increasing likelihood that exposure to a factor causes—or contributes to the causation of—a disease. The items of Hill’s list were not labelled ‘criteria’, as this would have inferred every item being necessary for causation. Hence, criteria that are necessary for causation in health, disease (...) and intervention processes, whether known, knowable, or not, remain undetermined and deserve exploration. To move beyond this position, this paper aims to explore factors that are necessary in the constitution of causative relationships between health, disease processes, and intervention. To this end, disease is viewed as a causative pathway through the often overlapping stages of aetiology, pathology and patho-physiology. Intervention is viewed as a second, independent causative pathway, capable of causing changes in health for benefit or harm. For the natural course of a disease pathway to change, we argue that intervention must not only occupy the same time and space, but must also share a common form; the point at which the two pathways converge and interact. This improved conceptualisation may be used to facilitate the interpretation of clinical observations and inform future research, particularly enabling predictions of the mechanistic relationship between health, disease and intervention. (shrink)

Causation is important when considering how an organism maintains health, why disease arises in a healthy person, and how one may intervene to change the course of a disease. This paper explores the form of causative relationships in health, disease and intervention, with particular regard to the pathological and biopsychosocial models. Consistent with the philosophical view of dispositionalism, we believe that objects are the fundamental relata of causation. By accepting the broad scope of the biopsychosocial model, we argue that psychological (...) and social constructs be considered objects. We think that this 'biopsychosocial dispositionalism' offers the flexibility required to describe causation throughout health, disease and intervention pathways. When constructing mechanistic chains to describe causative pathways, we argue that an object will causally connect with others through actions; transfers of energy from one object to another, initiated by the manifestation of one or more dispositional property. Finally, our analysis of causative interactions utilises the concept that a common form of interaction exists between disease and intervention pathways. This common form will always be an object, but the mode of interaction will vary with each disease. We describe how intervention may act through objects being shared between converging mechanistic chains, or through the removal and/or insertion of objects in such chains. We believe that this analysis provides novel insight to the forms of causative transactions that can occur. In addition, we hope that the findings of this analysis represent the first step towards developing a framework for appraising the composition of mechanistic theories. (shrink)

Causation is important when considering: how an organism maintains health; why disease arises in a healthy person; and, how one may intervene to change the course of a disease. This paper explores the form of causative relationships in health, disease and intervention, with particular regard to the pathological and biopsychosocial models. Consistent with the philosophical view of dispositionalism, we believe that objects are the fundamental relata of causation. By accepting the broad scope of the biopsychosocial model, we argue that psychological (...) and social constructs be considered objects. We think that this ‘biopsychosocial dispositionalism’ offers the flexibility required to describe causation throughout health, disease and intervention pathways. When constructing mechanistic chains to describe causative pathways, we argue that an object will causally connect with others through actions; transfers of energy from one object to another, initiated by the manifestation of one or more dispositional property. Finally, our analysis of causative interactions utilises the concept that a common form of interaction exists between disease and intervention pathways. This common form will always be an object, but the mode of interaction will vary with each disease. We describe how intervention may act through objects being shared between converging mechanistic chains, or through the removal and/or insertion of objects in such chains. We believe that this analysis provides novel insight to the forms of causative transactions that can occur. In addition, we hope that the findings of this analysis represent the first step towards developing a framework for appraising the composition of mechanistic theories. (shrink)

Early in his career, Karl Marx complained that “Philosophers have hitherto only interpreted the world in various ways; the point is to change it.” Philosophers Robert Frodeman and Adam Briggle have recently issued this same complaint against their contemporaries, arguing that philosophy has become an isolated, “purified” discipline, detached from its historical commitments to virtue and to public engagement. In this paper I argue that they are wrong about contemporary philosophy and about its history. Philosophy hitherto has always been characterized (...) both by a concern with practical engagement and by serious misgivings about such engagement. I show that reluctance to engage with practical affairs was a feature of philosophy long before the advent of the modern university and that a wide range of contemporary philosophers are concerned with virtue and public engagement. Finally, I argue that Frodeman and Briggle’s own account of contemporary philosophy makes it unsuitable both as the subject of their title (“When Philosophy Lost Its Way”) and as the object of their call to action. (shrink)

This work contributes to recent transdisciplinary efforts to view the Haitian slave revolt (1791–1804) as the historical inspiration for Hegel’s master-slave dialectic. Reconstructions offered by contemporary postcolonial scholars argue that the Haitian revolt was chronicled in Minerva as Hegel raced to finish his Phenomenology. Benhabib recently recognized the Hegel-Haiti thesis as entailing the sort of inclusive dialogical learning process necessary to validate subaltern experiences. The thesis has also drawn its share of sceptical scrutiny as Badiou claims that it risks forcing (...) an unnecessary moral dissymmetry, neglects objectionable features of enslavement and imposes a mismatch between apolitical subject and revolutionary. In reply, we appeal to the pioneering work of Tavares to show that the asymmetrical construction of classification schemes for persons of mixed-racial statuses accords with decades of documented literary exchanges between Hegel and Gregoire. We then turn to the work of James on the role of mixed-race merchants in the testimonial accounts of late 18th century French historians to show that European literate publics were well aware of the extremely coercive forms of commodified labour found in Saint-Domingue. We then invoke the archival work of Du Bois on French, British and American parliamentary proceedings that show the provisional colonial identities ascribed to Caribbean subjects did not hinder their self-conscious exercise of political agency. Viewing Hegel in terms of the historiographic records of the racial ontologies of early modern transatlantic literary exchanges helps explain how he adapted these tropes concerning mixed-race subjects in a manner that better explains many of the anomalous features of the dialectic. However, conferring the Haitian revolution its proper world-historical warrant as inspiration for his infamous master-slave dialectic need not lead us to overlook Hegel’s complicity with many of the epistemic and ontological flaws of colonial tropes held in early modern transatlantic print. (shrink)

Things and Their Place in Theories Our talk of external things, our very notion of things, is just a conceptual apparatus that helps us to foresee and ...

This book is hoped to be only the beginning of explorations of the ancient Egyptian notion of upholding Order (Ma'at) through violence. Because of the scope of the topic, this study is limited to the most extreme measure of violence perpetrated in the service of Order: sanctioned killing. This study explores texts that affirm the proper occasions for such killings, and the religious framework behind these actions."--Publisher's website.

This research compares and analyzes the verbal commentary of televised coverage of two women's and men's athletic events: the “final four” of the women's and men's 1989 National Collegiate Athletic Association basketball tournaments and the women's and men's singles, women's and men's doubles, and the mixed-doubles matches of the 1989 U.S. Open tennis tournament. Although we found less overtly sexist commentary than has been observed in past research, we did find two categories of difference: gender marking and a “hierarchy of (...) naming” by gender and, to a certain extent, by race. These differences are described and analyzed in light of feminist analyses of gendered language. It is concluded that televised sports commentary contributes to the construction of gender and racial hierarchies by marking women's sports and women athletes as “other,” by infantilizing women athletes, and by framing the accomplishments of women athletes ambivalently. (shrink)

While provisions of youth sports concussion laws are very similar, little is known as to how they are being implemented, factors that promote or impede implementation, or the level of compliance in each jurisdiction. We aimed to describe state experiences with implementation in order to inform ongoing efforts to reduce the harm of sports-related traumatic brain injury and to guide future evaluations of the laws’ impacts and the development of future public health laws. We conducted key-informant interviews in 35 states (...) with recently enacted concussion legislation. States varied considerably in their readiness and capacity for implementation. Factors facilitating implementation included existing partnerships, procedures, and resources; centralized implementation authority; prior related efforts; and involvement in the policymaking process by those now charged with implementation. Inhibitors included ambiguous statutory language, unclear delegation of authority, and compliance difficulties. Ongoing challenges persist, including primary prevention; determining which providers are qualified to make return-to-play assessments and contents of those assessments; compliance difficulties in rural and under-served areas; and unclear responsibility for enforcement. Despite the similarity of youth sports concussion laws, early evidence suggests there is considerable variation in their implementation. These findings are critical for ongoing empirical investigations to accurately evaluate the laws’ provisions and to identify successful legal approaches to protecting young athletes. (shrink)

Over the past decade, a flurry of media stories devoted to sports-related concussions have drawn attention to the previously “silent epidemic” of traumatic brain injury in athletes. From 2001 to 2009, the annual number of sports-related TBI emergency department visits in individuals age 19 and under climbed from 153,375 to 248,414, an increase of increase of 62 percent. Multiple head injuries place youth athletes at risk for serious health conditions, including cerebral swelling, brain herniation, and even death — postconcussive conditions (...) that have collectively been referred to as “second impact syndrome.” Studies have shown that children and teens — and girls, in particular — are more likely to sustain a concussion and have a longer recovery time than adults. Recent research also suggests that even subconcussive hits in children and adolescents may result in longer-term health effects such as decreased cognitive functioning, increased rates of depression, memory problems, and mild cognitive impairment. (shrink)

Certainly I am in no way opposed to philosophy, or metaphysics in the sense that Wm. James defined it as a particularly intense effort to think clearly. Indeed, Klein would like to say that what I am talking about is nothing but metaphysics. But the kind of philosophy/metaphysics that is needed here is of a particular kind: a kind that does not separate philosophy/metaphysics and physics into two disjoint realms. It is of the kind that seeks to construct useful testable (...) physical theories that are adequately connected to what we can know. (shrink)

There couldn't be a more appropriate method for illustrating the dynamics of psychoanalysis than the vehicle of story. In this book, Kerry L. Malawista, Anne J. Adelman, and Catherine L. Anderson share amusing, poignant, and sometimes difficult stories from their personal and professional lives, inviting readers to explore the complex underpinnings of the psychoanalytic profession and its esoteric theories. Through their narratives, these practicing analysts show how to incorporate psychodynamic concepts and identify common truths at the root of shared (...) experience. Their approach demystifies dense material and the emotional consequences of deep clinical work. The book covers psychodynamic theory, the development of ideas, various techniques, the challenges of treatment, and the experiences of trauma and loss. Each section begins with a brief memoir by one of the authors and leads into a discussion of related concepts. Overall the text follows a developmental trajectory, opening with stories from early childhood and concluding with present encounters. The result is a unique approach enabling the absorption of psychodynamic concepts as they unfold across the life span. (shrink)

In June 2021, Missouri passed the “Second Amendment Preservation Act” (SAPA). Though SAPA passed easily and had gubernatorial support, many Missouri law enforcement agencies, including the Missouri Sheriff’s Association, oppose it. Missing from this policy conversation, and deserving of analysis, is the voice of Missouri citizens. Using qualitative interview data and survey data, we explored what if anything Missouri gun owners knew about SAPA and what they perceived its effects would be on gun-related murders, suicides, gun thefts, and mass shootings. (...) Most Missouri gun owners had not heard about SAPA and were ambivalent about its potential effect on gun safety outcomes. Our findings also indicate that respondents’ attitudes toward SAPA and the impact of such policy on safety is driven by gun ownership (i.e., primary versus living in a household with firearms), partisan identification, and attitudes toward government firearm regulation. (shrink)

The pull to coordinate with other individuals is fundamental, serving as the basis for our social connectedness to others. Discussed is a dynamical and ecological perspective to joint action, an approach that embeds the individual’s mind in a body and the body in a niche, a physical and social environment. Research on uninstructed coordination of simple incidental rhythmic movement, along with research on goal‐directed, embodied cooperation, is reviewed. Finally, recent research is discussed that extends the coordination and cooperation studies, examining (...) how synchronizing with another, and how emergent social units of perceiving and acting are reflected in people’s feelings of connection to others. (shrink)

In this article, I address concerns that the ontological priority claims definitive of ontic structural realism are as they stand unclear, and I do so by placing these claims on a more rigorous formal footing than they typically have been hitherto. I first of all argue that Kit Fine’s analysis of ontological dependence furnishes us with an ontological priority relation that is particularly apt for structuralism. With that in place, and with reference to two case studies prominent within the structuralist (...) literature, I consider whether any of structuralism’s distinctive priority claims may be regarded as warranted. The discussion as a whole has largely negative implications for the radical structuralism of French and Ladyman (including their ‘eliminativist’ interpretation of it), largely positive implications for the moderate structuralism primarily advocated by Esfeld and Lam, and some broad lessons for contemporary fundamentalist metaphysics as a whole. 1 Introduction2 The Right Priority Relation for Structuralism: Supervenience or Dependence?3 Introducing Ontological Dependence4 Fine’s System5 The Priority of Structure 1: Entangled Quantum Particles6 The Priority of Structure 2: The Group-Theoretic Conception of Elementary Particles7 Concluding Remarks. (shrink)

Ontic structural realism is a thesis of fundamentality metaphysics: the thesis that structure, not objects, has fundamental status. Claimed as the metaphysic most befitting of modern physics, OSR first emerged as an entreaty to eliminate objects from the metaphysics of fundamental physics. Such elimination was urged by Steven French and James Ladyman on the grounds that only it could resolve the ‘underdetermination of metaphysics by physics’ that they claimed reduced any putative objectual commitment to a merely ‘ersatz’ form of realism. (...) Few, however, have joined French and Ladyman either in acknowledging that such underdetermination exists or in attributing to it such drastic consequences. However, an alternative view that physics does sanction objects, albeit merely as ontologically secondary entities, represents a different and seemingly less extreme route to the same conclusion regarding the fundamentality of structure. But since what it means to be ‘ontologically prior’ is itself a vexed philosophical question, a stance must be taken as to how we are to understand priority before its prospects may be evaluated. In an earlier paper, I outlined how Fine’s notion of ontological dependence might be utilized to defend the priority-based approach to structuralism. Since then, however, I have become convinced that that ontological dependence is not a relation of priority after all. As a result, the arguments outlined in that paper stand in need of reassessment. In this work, I consider the prospects for priority-based structuralism when expressed in the idiom of determination. My conclusion will be that it has yet to be vindicated by our best physical theories, owing to the failure of symmetry structures to determine the world’s inventory of fundamental kinds. Nevertheless, the same symmetry considerations point towards there being renewed prospects for eliminativism—an eliminativism, moreover, of more naturalistic appeal than that hitherto associated with OSR. 1Introduction 2Structuralist Strategies 3Defining Ontological Priority: Dependence or Determination? 4Structuralism in the Idiom of Determination 4.1Determining plurality 4.2Determining kind properties 5A Reinvigorated Eliminativism. (shrink)

This paper proposes a reformulation of the treatment of boundaries, at parts and aggregates of entities in Basic Formal Ontology. These are currently treated as mutually exclusive, which is inadequate for biological representation since some entities may simultaneously be at parts, boundaries and/or aggregates. We introduce functions which map entities to their boundaries, at parts or aggregations. We make use of time, space and spacetime projection functions which, along the way, allow us to develop a simple temporal theory.

A priori metaphysics has come under repeated attack by naturalistic metaphysicians, who take their closer connection to the sciences to confer greater epistemic credentials on their theories. But it is hard to see how this can be so unless the problem of theory change that has for so long vexed philosophers of science can be addressed in the context of scientific metaphysics. This paper argues that canonical metaphysical claims, unlike their scientific counterparts, cannot meaningfully be regarded as ‘approximately true,’ and (...) that this means that the epistemic progress that science arguably enjoys through episodes of theory change cannot be expected to transfer to its metaphysics. What the value of engaging in metaphysics of science before the emergence of a final theory becomes correspondingly unclear. (shrink)

This essay explores the viability of theologies of nonviolent peacebuilding through reflection on constructive agents under duress. John Howard Yoder’s messianic theology was once a default model of peacebuilding in Christian ethics, but he mixes eschatologies, with problematic results. This essay extends insights from participant observation in Colombia to suggest that if we relate distinct accounts of messianic and gradual eschatologies without mixing them, we articulate a relationship between church and state that is fruitful for theological peacebuilding. This relationship is (...) best described as an interplay that allows for transformative displacement. (shrink)

The hypothesis that play behavior is more prevalent in larger-brained animals has recently been challenged. It may be, for example, that only certain brain structures are related to play. Here, we analyze social play behavior with regards to the cerebellum: a structure strongly implicated in motor-development, and possibly also in cognitive skills. We present an evolutionary analysis of social play and the cerebellum, using a phylogenetic comparative method. Social play frequency and relative cerebellum size are positively correlated. Hence, there appears (...) to be a link between the evolutionary elaboration of social play and the cerebellum. (shrink)

Anthropology of Consciousness, EarlyView.