We analyze the logical strength of theorems on marriage problems with unique solutions using the techniques of reverse mathematics, restricting our attention to problems in which each boy knows only finitely many girls. In general, these marriage theorems assert that if a marriage problem has a unique solution then there is a way to enumerate the boys so that for every m, the first m boys know exactly m girls. The strength of each theorem depends on whether the underlying marriage (...) problem is finite, infinite, or bounded. (shrink)

This collection of essays, offered in honor of the distinguished career of prominent political philosophy professor Clifford Orwin, brings together internationally renowned scholars to provide a wide context and discuss various aspects of the virtue of “humanity” through the history of political philosophy.

Data from the Global Environmental Monitoring System indicate that pollutants such as sulphur dioxide and total suspended particulate routinely appear in the lower atmosphere of major cities at concentrations well above health guidelines set by the World Health Organization. As well, cities are major contributors to the build-up of greenhouse gases which now threaten climate change. These findings underscore the detrimental relation that has evolved between urban industrial society and the atmosphere. If this peculiar civilization is to be changed, three (...) principles—equity, sustainability and peaceful development—must guide the reevolution of urban life. The paradigm of commodification needs to be replaced with a model of a commons of life. The article provides a theoretical framework and strategy for reforming global climate policy and urban sustainability planning in a manner consistent with life in the commons. (shrink)

Some care home residents with dementia have the capacity, some do not. Staff may need to make decisions about administering care interventions to someone whom they believe lacks the capacity to consent to it, but also resists the intervention. Such intervention can be termed forced care. The literature on forced care (especially reflecting empirical work) is scant. This study aims to investigate how the ethics of forced care is navigated in practice, through ten semi-structured interviews with staff in 1 care (...) home in the North East of England. Participants generally avoided situations where there was overt restraint, taking a flexible approach by either modifying their own behaviour or using covert techniques. The underlying justification given for decisions or actions tended to be that the recipients of care should be valued because of their intrinsic worth as fellow human beings. Participants attempted to put themselves in the position of the resident or think about what a beloved elderly relative would want. The intervention seemed acceptable to staff if the resident was not distressed. When staff were presented with scenario-based questions around capacity they were more successful than when asked direct questions relating to the Mental Capacity Act. Scenario-based training may be helpful to reinforce familiarity and facility with the principles of the Mental Capacity Act. (shrink)

Over 100 million Americans suffer from chronic pain, which causes more disability than any other medical condition in the United States at a cost of $560–$635 billion per year. Opioid analgesics are frequently used to treat CP. However, long term use of opioids can cause brain changes such as opioid-induced hyperalgesia that, over time, increase pain sensation. Also, opioids fail to treat complex psychological factors that worsen pain-related disability, including beliefs about and emotional responses to pain. Cognitive behavioral therapy can (...) be efficacious for CP. However, CBT generally does not focus on important factors needed for long-term functional improvement, including attainment of personal goals and the psychological flexibility to choose responses to pain. Acceptance and Commitment Therapy has been recognized as an effective, non-pharmacologic treatment for a variety of CP conditions. However, little is known about the neurologic mechanisms underlying ACT. We conducted an ACT intervention in women with chronic musculoskeletal pain. Functional magnetic resonance imaging data were collected pre- and post-ACT, and changes in functional connectivity were measured using Network-Based Statistics. Behavioral outcomes were measured using validated assessments such as the Acceptance and Action Questionnaire, the Chronic Pain Acceptance Questionnaire, the Center for Epidemiologic Studies Depression Scale, and the NIH Toolbox Neuro-QoLTM scales. Results suggest that, following the 4-week ACT intervention, participants exhibited reductions in brain activation within and between key networks including self-reflection, emotion, and cognitive control. These changes in connectivity strength were correlated with changes in behavioral outcomes including decreased depression and pain interference, and increased participation in social roles. This study is one of the first to demonstrate that improved function across the DMN, SN, and FPN may drive the positive outcomes associated with ACT. This study contributes to the emerging evidence supporting the use of neurophysiological indices to characterize treatment effects of alternative and complementary mind-body therapies. (shrink)

Being the parents of a premature infant can be extremely stressful. Even when parents know that there is a high chance of premature birth, they are often in shock when their infant arrives too earl...

Children deserve optimal medical care. Although prescription drugs play a prominent and essential role in pediatric health care delivery, health care providers often must make prescribing decisions for their young patients based on imperfect or absent safety and efficacy data for pediatric populations. Until relatively recently, the Food and Drug Administration made surprisingly little effort to improve the quality or quantity of clinical research data for this patient group. Despite recent agency efforts to improve the situation, only one-third of drugs (...) prescribed to children currently have been studied for safety and efficacy in pediatric populations. Moreover, recent agency initiatives to encourage pediatric drug research have generated mixed results and unintended consequences. The complex of issues surrounding the testing and prescribing of prescription drugs used for children will require that pharmaceutical companies, the FDA, and health care providers examine current practices, acknowledge their shortcomings, and consider cooperative, creative solutions. (shrink)

Children deserve optimal medical care. Although prescription drugs play a prominent and essential role in pediatric health care delivery, health care providers often must make prescribing decisions for their young patients based on imperfect or absent safety and efficacy data for pediatric populations. The safe and effective use of prescription drugs in children depends on a thorough understanding of the physiologic differences between children and adults. Currently, only one-third of drugs prescribed to children have been studied for safety and efficacy (...) in pediatric populations. Until relatively recently, the Food and Drug Administration made surprisingly little effort to improve the quality or quantity of clinical research data for this patient group. Recent agency efforts to encourage pediatric drug research have generated mixed results and created unintended consequences. The development, prescribing, and safety evaluation of prescription drugs for children will require that the FDA and health care providers examine current practices, acknowledge their shortcomings, and consider creative solutions to the challenges associated with gathering additional data through pediatric drug research. (shrink)

Aim: Patients with advanced cancer need information about end-of-life treatment options in order to make informed decisions. Clinicians vary in the frequency with which they initiate these discussions.Patients and methods: As part of a long-term longitudinal study, patients with an expected 2-year survival of less than 50% who had advanced gastrointestinal or lung cancer or amyotrophic lateral sclerosis were interviewed. Each patient’s medical record was reviewed at enrollment and at 3 months for evidence of the discussion of patient wishes concerning (...) ventilator support, artificial nutrition and hydration , resuscitation and hospice care. A Kaplan–Meier analysis was also performed and 2-year survival calculated.Results: 60 cancer and 32 ALS patients were enrolled. ALS patients were more likely than cancer patients to have evidence of discussion about their wishes for ventilator support , ANH , DNR and hospice care . At 6 months, 91% of ALS patients were alive compared with 62% of cancer patients; at 2 years, 63% of ALS patients were alive compared with 23% of cancer patients .Conclusions: Cancer patients were less likely than ALS patients to have had documented advanced care planning discussions despite worse survival. This may reflect perceptions that ALS has a more predictable course, that advanced cancer has a greater number of treatment options, or differing views about hope. Nevertheless, cancer patients may be less adequately prepared for end-of-life decision-making. (shrink)

The Editors’ Preface to the fourth edition of Wittgenstein's Philosophical Investigations is disparaging of the earlier editorial efforts of G. E. M. Anscombe and Rush Rhees and in particular of their inclusion and titling of the material in “Part II”. I argue, on both historical and philosophical grounds, that the Editors have failed to refute the editorial decisions of Rhees and Anscombe – a failure born both of a neglect of the historical circumstances and Wittgenstein's own expressed hopes and intentions (...) for his writings, and of a myopic understanding of his philosophy. Wittgenstein's legacy has not been well served by their interventions, which should be undone in future editions. (shrink)

Ever since its inception, the theory of evolution has been reified into an “-ism”: Darwinism. While biologists today tend to shy away from the term in their research, the term is still actively used in the broader academic and societal contexts. What exactly is Darwinism, and how precisely are its various uses and abuses related to the scientific theory of evolution? Some call for limiting the meaning of the term “Darwinism” to its scientific context; others call for its abolition; yet (...) others claim the term refers to a myth-like story. In this paper we propose a conceptually grounded overview of the term. We show how the scientific dimension of Darwinism feeds into, and is influenced by, guises of Darwinism as a methodology and as an ethically and politically charged “worldview”. The full meaning of Darwinism, as well as how this meaning has changed over time, can only be understood through the complex interaction between these three dimensions. (shrink)

The problem of knowledge is generally regarded as an essential part of philosophy, and since the time of Descartes at least, every philosopher has found it necessary to show that his own view can afford a solution to the problem. In this paper, however, the method of approach is psychological rather than philosophical, and an attempt is made to deal with the question from a point of view differing in several respects from those more commonly accepted.

Healthcare ethics has become part of the standard curriculum of students in the health professions. The goals of healthcare ethics education are to give students the skills they need to identify, assess, and address ethical issues in clinical practice and to develop virtuous practitioners. Incorporating the medical humanities into medical school, for example, is intended to foster empathy and professionalism among students and to provide mechanisms for enhanced physician well-being. Yet, despite the long-standing inclusion of the humanities in nursing curricula, (...) increases in the amount and kinds of scientific knowledge essential for clinical practice has resulted in the erosion of the “humanistic arts” from nursing education. One potential solution to this challenge comes with the increase in interprofessional education, where students in a variety of healthcare professions programs come together to learn about issues common to all healthcare fields. (shrink)

Wittgenstein's scant remarks on the roots of language in instinctive behaviour have been both difficult to interpret and controversial, not least because they may seem to incline towards forms of explanation that elsewhere he eschewed. Nevertheless, they are of importance in philosophy, not least because they bear upon age-old questions of foundationalism and concept-formation. In a recent Discussion Note in this journal, H. O. Mounce is not only attracted by but also champions such explanation – though he finds Wittgenstein's own (...) “explanations” inadequate in important respects, as evidenced in his misguided criticisms of Moore in On Certainty and in his behaviouristic remarks on the roots of the “cause and effect” language-game. In this response, I try to identify the philosophical roots of this attraction and the points at which Mounce's account departs from the elucidatory and non-explanatory path established by Wittgenstein. (shrink)

Wittgenstein's scant remarks on the roots of language in instinctive behaviour have been both difficult to interpret and controversial, not least because they may seem to incline towards forms of explanation that elsewhere he eschewed. Nevertheless, they are of importance in philosophy, not least because they bear upon age-old questions of foundationalism and concept-formation. In a recent Discussion Note in this journal, H. O. Mounce is not only attracted by but also champions such explanation – though he finds Wittgenstein's own (...) “explanations” inadequate in important respects, as evidenced in his misguided criticisms of Moore in On Certainty and in his behaviouristic remarks on the roots of the “cause and effect” language-game. In this response, I try to identify the philosophical roots of this attraction and the points at which Mounce's account departs from the elucidatory and non-explanatory path established by Wittgenstein. (shrink)

Philosophical Investigations, EarlyView.

One hundred eighty trauma-focused dissertations published in the United States were examined to determine the variation in risk language used in the informed consents. Level of risk proposed in the informed consents was poorly related to ratings of risk by graduate coders and virtually unrelated to vulnerability factors such as the age of participants and clinical or nonclinical status. Risk language in the informed consents was markedly elevated over that rated by the coders, with more than one third of the (...) dissertations presenting the risk of participation as severe (i.e., associated with substantial risk of reactivity and lasting discomfort). These statements are not in keeping with the literature and raise ethical concerns in relation to (a) nocebo effects, (b) distortion of correlational findings, and (c) discouragement of participants from disclosing trauma in other settings. (shrink)

Rush Rhees identified the question of “what language is” as central to Wittgenstein's philosophy, but believed he failed to follow up adequately the connections between the reality of discourse and our reality as persons. Integral to this is Rhees's elaboration of the distinction between such investigations into language and approaches to philosophy restricted to elucidating “the grammars of particular expressions.” The failure to fully acknowledge Rhees's contribution to the understanding of these issues has vitiated recent New Wittgensteinian discussion of both (...) Wittgenstein and Rhees. (shrink)

The role of corporate counsel in the corporate governance process has been long overlooked. This paper uses recent comments by Breeden as the springboard for a discussion of the issues surrounding significant roles for lawyers in corporations. It considers these both from a practical and a theoretical perspective and identifies why it is problematic merely to assume hiring lawyers will ensure good compliance both in terms of legal and ethical obligations.