Objectives: The objective of this study is to estimate the proportion of different types of end‐of‐life decisions (ELDs) of physicians in the city of Hasselt (Flanders, Belgium). The question is addressed to what degree these ELD meet legal constraints and the ethical requirements for prudent practice. Methodology: All physicians of the city of Hasselt who signed at least one death certificate in 1996 (N=166) received an anonymous self‐administered mail questionnaire per death case (max. 5/doctor) Results: the response rate was 55% (...) (N=269). In 37.3% of all cases at least one ELD was made (16.5% non‐treatment decisions; 16% potential life‐shortening by intensifying the treatment of pain and symptoms; 4.8% administration, supply or prescription of lethal drugs). In 59.5% of the cases were an ELD was made that decision was legally questionable. Patient characteristics were clearly related to the type of ELD. There was no influence of physician characteristics, except for commitment to life‐stance. In 71.3% of the cases the ELD was in no way discussed with the patient. 8.1% of the ELD‐cases were in response to a direct request from the patient Conclusions: The incidences of ELDs in Hasselt are consistent with earlier findings. The study shows that religious commitment influences the behaviour of physicians at the end of their patients' life. The patient's and her family's entitlements to participation in the decision making process were rather poorly respected. (shrink)

International Rules brings together exemplary works from the most prominent approaches to international rules of International Law and International Relations disciplines. Included are chapters on Natural Law, Legal Positivism, Classical Realism, the New Haven School, Institutionalism, Structural Realism, the New Stream, and Feminist Voices. Each of the eight chapters begins with a brief overview, offers a representative work or works, and concludes with a selected bibliography. From Hugo Grotius to David Kennedy, from George Kennan to Robert Keohane, the featured (...) authors provide valuable insights into their common subject: international rules. Despite divergent methods and objectives, they address fundamentally the same questions: What is the nature of such rules? What is their purpose? How do they originate? What role, if any, do they play in politics? Framing the selections assembled are two original chapter-length essays. The first chapter of this volume assesses the prospects for interdisciplinary collaboration; the final one suggests a direction for future research. (shrink)

Rationale In Belgium, several policies regulating reimbursement of acid suppressant drugs and evidence-based recommendations for clinical practice were issued in a short period of time, creating a unique opportunity to observe their effect on prescribing. Aims and objectives To describe the evolution of prescriptions for acid suppressants and explore the interaction of policies and practice recommendations with prescribing patterns. Method Monthly claims-based data for proton pump inhibitors (PPIs) and H-2-antihistamines by general practitioners, internists and "astroenterologists were obtained from the Belgian (...) national health insurance database (1997-2005). The evolution of reimbursed defined daily doses and expenses after introduction of reimbursement regulations and dissemination of practice recommendations was explored. Results Recommendations had no impact on prescribing. All changes can be related to concomitant policies. Lifting reimbursement restrictions for cheaper products did not control growth or save costs in the Iona term. Only restricting reimbursement of all PPIs managed to curb the growth. We observed an unintended increase of non-omeprazole PPIs by gastroenterologists. Conclusions Reimbursement policies influence prescribing, but their effect can be unintended. A dialogue between policymakers and guideline developers, and evidence-based policies that are linked to clinical guidelines, could be an effective way to pursue both cost-containment and quality of care. (shrink)

Objectives: The objective of this study is to estimate the proportion of different types of end‐of‐life decisions (ELDs) of physicians in the city of Hasselt (Flanders, Belgium). The question is addressed to what degree these ELD meet legal constraints and the ethical requirements for prudent practice.Methodology: All physicians of the city of Hasselt who signed at least one death certificate in 1996 (N=166) received an anonymous self‐administered mail questionnaire per death case (max. 5/doctor)Results: the response rate was 55% (N=269). In (...) 37.3% of all cases at least one ELD was made (16.5% non‐treatment decisions; 16% potential life‐shortening by intensifying the treatment of pain and symptoms; 4.8% administration, supply or prescription of lethal drugs). In 59.5% of the cases were an ELD was made that decision was legally questionable. Patient characteristics were clearly related to the type of ELD. There was no influence of physician characteristics, except for commitment to life‐stance. In 71.3% of the cases the ELD was in no way discussed with the patient. 8.1% of the ELD‐cases were in response to a direct request from the patientConclusions: The incidences of ELDs in Hasselt are consistent with earlier findings. The study shows that religious commitment influences the behaviour of physicians at the end of their patients' life. The patient's and her family's entitlements to participation in the decision making process were rather poorly respected. (shrink)

Background A team-based approach has been advocated for advance care planning in nursing homes. While nurses are often put forward to take the lead, it is not clear to what extent other professions could be involved as well. Objectives To examine to what extent engagement in advance care planning practices, knowledge and self-efficacy differ between nurses, care assistants and allied care staff in nursing homes. Design Survey study. Participants/setting The study involved a purposive sample of 14 nursing homes in Flanders, (...) Belgium. Nurses, care assistants and allied care staff completed a survey. Ethical considerations The study was approved by the University Hospital of Brussels, as part of a cluster randomized controlled trial. Results One hundred ninety-six nurses, 319 care assistants and 169 allied staff participated. After adjusting for confounders, nurses were significantly more likely than care assistants to have carried out advance care planning conversations and documented advance care planning ; differences not found between allied staff and care assistants. Advance care planning knowledge total scores differed significantly, with nurses ; 95% confidence interval 0.08–0.17; p < 0.001) and allied staff scoring higher than care assistants. We found no significant differences regarding self-efficacy. Discussion While nursing home nurses conducted more advance care planning conversations and documentation than allied care staff and care assistants, these two professional groups may be a valuable support to nurses in conducting advance care planning, if provided with additional training. Conclusions Allied care staff and care assistants, if trained appropriately, can be involved more strongly in advance care planning to enhance relational and individual autonomy of nursing home residents, alongside nurses. Future research to improve and implement advance care planning should consider this finding at the intervention development stage. (shrink)

Nozick analyzes fundamental issues, such as the identity of the self, knowledge and skepticism, free will, the foundations of ethics, and the meaning of life.

Several themes of David Lewis's theory of counterfactuals, especially their sensitivity to context, pave the way for a viable theory of non-trivial counterpossibles. If Lewis was successful in defending his account against the early objections, a semantics of counterpossibles can be defended from similar objections in the same way. The resulting theory will be extended to address 'might' counterfactuals and questions about the relative "nearness" of impossible worlds.

In lieu of an abstract, here is a brief excerpt of the content:Democracy in an Uncertain World:Expertise as a Provisional Response to VulnerabilityRobert Smid (bio)In the final chapter of American Immanence, Michael Hogue writes that "[r]ather than asking the foundationalist question of what epistemology is needed to ground or justify democracy, the pragmatist asks what epistemology democracy entails. What 'way of knowing' follows from, or is appropriate to, democracy as an associational ethos of vulnerable life?"1 While Hogue and I have (...) explored similar themes in our research on the promises and perils of democracy, this statement identifies a key difference in our respective approaches that has significant implications for the role that democracy can and should play in inquiry as well as for its potential to revolutionize civilization as we know it in the Anthropocene.In what follows, I raise three interrelated points that interrogate that difference. The first pertains to the role of foundations, provisional or otherwise, in Hogue's work, and results in a challenge to the special status seemingly given to democracy and a proposed inversion of the relation he poses between epistemology and democracy. The second pertains to the role of education in a democracy. This is a dimension of traditional pragmatist discourse on democracy that is conspicuously absent in Hogue's book, yet one that has significant implications for his argument. In this section, I will draw out the Deweyan strains of that discourse that appear to inform Hogue's work and contrast them with a Peircean take that yields notably different outcomes. The third point addresses the relation between democracy and sovereignty, a relation that Hogue explicitly eschews but that I will argue maintains some validity within democratic discourse, albeit in a more modest and provisional form. Finally, I draw these three points together in a conclusion that affirms much of Hogue's argument—including the profound vulnerability manifested by the Anthropocene and the need for more resilient forms of associated life—but assert that democracy is no less vulnerable than any other aspect of our uncertain world and therefore cannot be expected to possess within itself all that is necessary for its ongoing development. Building on the inversion of democracy and epistemology in the first section, the constitutive role of education in a [End Page 30] democracy as laid out in the second section, and the argument for a mitigated sovereignty in the third section, I argue that professional expertise provides an acceptable and necessary default when democratic structures fail.I. Provisional FoundationsAs a theopolitics rooted in religious naturalism, Hogue's understanding of democracy is one that is "embodied, relational, and vulnerable."2 That is, knowledge, meaning, and value all emerge out of and are conditioned by their social context, and shift according to the interests and needs of those who lay claim to them. Accordingly, Hogue's argument for democracy is that it is the way of life that allows for the broadest possible participation in such constructions, and which responds most effectively to the conditions of uncertainty and vulnerability surrounding them. It comes as no surprise, then, that his account of democracy is antifoundational, recognizing not only that all inquiry begins in medias res, but also that it emerges from a wide variety of media and that, while one goal of democratic discourse may be to chart a coherent path forward, both the media and the proposed paths are subject to change at any moment. Such antifoundationalism is a fairly standard commitment in pragmatist and process discourse, and thus relatively uncontroversial in its own right. It is worth noting, however, that being committed to antifoundationalism and actually being antifoundationalist in practice are often two very different things, our best efforts to the contrary notwithstanding.It is clear from Hogue's book that he resists any foundationalist epistemology, opting instead to derive his epistemology from democratic practice. As noted above, he asks "[w]hat 'way of knowing' follows from, or is appropriate to, democracy as an associational ethos of vulnerable life?"3 While it is possible that there is one epistemology that is best suited to democracy understood in this way, that epistemology would not, by his account, stand on its own foundation but be contingent on one... (shrink)

Robert Misrahi élabore une philosophie exigeante qui s'est toujours tenue à distance des modes traversant le champ intellectuel. Son propos est de définir les conditions d'accès de chacun et de tous à une existence heureuse. Mais le bonheur n'y est pas envisagé comme le résultat de simples techniques de développement personnel. Il est l'acte d'un sujet pleinement responsable de son existence, la prenant en charge, lui conférant du sens et se donnant les moyens de tracer son propre itinéraire. Connaître, (...) fonder, aimer, agir, créer sont les principales étapes qui jalonnent cet itinéraire. Ce livre s'ouvre par une série d'entretiens réalisés de janvier à juin 2011 : l'éthique, la liberté, le judaïsme, la jouissance d'être y sont, tour à tour, discutés. Il se poursuit par une présentation de concepts essentiels : la crise, le désir, l'existence, la réflexion. Ces concepts redéfinis par l'auteur constituent les pivots d'une philosophie originale et créatrice apte à relever les défis posés par notre modernité. (shrink)

Perfect for students with no background in logic or philosophy, Simple Formal Logic provides a full system of logic adequate to handle everyday and philosophical reasoning. By keeping out artificial techniques that aren’t natural to our everyday thinking process, Simple Formal Logic trains students to think through formal logical arguments for themselves, ingraining in them the habits of sound reasoning. Simple Formal Logic features: a companion website with abundant exercise worksheets, study supplements (including flashcards for symbolizations and for deduction rules), (...) and instructor’s manual two levels of exercises for beginning and more advanced students a glossary of terms, abbreviations and symbols. This book arose out of a popular course that the author has taught to all types of undergraduate students at Loyola University Chicago. He teaches formal logic without the artificial methods–methods that often seek to solve farfetched logical problems without any connection to everyday and philosophical argumentation. The result is a book that teaches easy and more intuitive ways of grappling with formal logic–and is intended as a rigorous yet easy-to-follow first course in logical thinking for philosophy majors and non-philosophy majors alike. (shrink)

Are mystical experiences primarily formed by the mystic's cultural background and concepts, as modern day "constructivists" maintain, or do mystics in some way transcend language, belief, and culturally conditioned expectations? Do mystical experiences differ in the different religious traditions, as "pluralists" contend, or are they identical across cultures? Twelve contributors here attempt to answer these questions through close examination of a particular form of mystical experience, "Pure Consciousness"--the experience of being awake but devoid of intentional content for consciousness. The contributors (...) analyze pure consciousness and other mystical experiences from historical Hindu, Buddhist, Christian, and Jewish sources, as well as from modern mystics. They demonstrate that pure consciousness poses serious conceptual problems for a contructivist understanding of mysticism. Revealing the inconsistencies and inadequacies of current models, they make significant strides towards developing new models for the phenomenon of mysticism, breaking new ground for our understanding of mysticism and of human experience in general. (shrink)

From the ferment of recent debates about the intellectual virtues, Roberts and Wood develop an approach they call 'regulative epistemology', exploring the connection between knowledge and intellectual virtue. In the course of their argument they analyse particular virtues of intellectual life - such as courage, generosity, and humility - in detail.

It is a near truism of philosophy of language that sentences are prior to words--that they are the only things that fundamentally have meaning. Robert's Stainton's study interrogates this idea, drawing on a wide body of evidence to argue that speakers can and do use mere words, not sentences, to communicate complex thoughts.

In this book, Robert Sokolowski argues that being a person means to be involved with truth. He shows that human reason is established by syntactic composition in language, pictures, and actions and that we understand things when they are presented to us through syntax. Sokolowski highlights the role of the spoken word in human reason and examines the bodily and neurological basis for human experience. Drawing on Husserl and Aristotle, as well as Aquinas and Henry James, Sokolowski here employs (...) phenomenology in a highly original way in order to clarify what we are as human agents. (shrink)

Winner of the 1975 National Book Award, this brilliant and widely acclaimed book is a powerful philosophical challenge to the most widely held political and social positions of our age--liberal, socialist, and conservative.

Plausibly, no agent ever performs an action without some desire to perform that action. If so, a regress argument shows that, given incompatibilism, we are only rarely free. The argument sidesteps recent objections to this thesis.

The value ofPatriarcha as a historical document consists primarily inits revelation of the strength and persistence in Europeanculture of the patriarchal ...

George Berkeley notoriously claimed that his immaterialist metaphysics was not only consistent with common sense but that it was also integral to its defense. Roberts argues that understanding the basic connection between Berkeley's philosophy and common sense requires that we develop a better understanding of the four principle components of Berkeley's positive metaphysics: The nature of being, the divine language thesis, the active/passive distinction, and the nature of spirits. Roberts begins by focusing on Berkeley's view of the nature of being. (...) He elucidates Berkeley's view on Locke and the Cartesians and by examining Berkeley's views about related concepts such as unity and simplicity. From there he moves on to Berkeley's philosophy of language arguing that scrutiny of the famous "Introduction" to the Principles of Human Knowledge reveals that Berkeley identified the ideational theory of meaning and understanding as the root cause of some of the worst of man's intellectual errors, not "abstract ideas." Abstract ideas are, rather, the most debilitating symptom of this underlying ailment. In place of the ideational theory, Berkeley defends a rudimentary "use theory" of meaning. This understanding of Berkeley's approach to semantics is then applied to the divine language thesis and is shown to have important consequences for Berkeley's pragmatic approach to the ontology of natural objects and for his approach to our knowledge of, and relation to other minds, including God's. Turning next to Berkeley's much aligned account of spirits, the author defends the coherence of Berkeley's view of spirits by way of providing an interpretation of the active/passive distinction as marking a normative distinction and by focusing on the role that divine language plays in letting Berkeley identify the soul with the will. With these four principles of Berkeley's philosophy in hand, he then returns to the topic of common sense and offers a defense of Berkeley's philosophy as built upon and expressive of the deepest metaphysical commitments of mainstream Christianity. Roberts' reappraisal of this important figure should appeal to all historians of philosophy as well as scholars in metaphysics and philosophy of language. (shrink)

Robert Stern investigates how scepticism can be countered by using transcendental arguments concerning the necessary conditions for the possibility of experience, language, or thought. He shows that the most damaging sceptical questions concern neither the certainty of our beliefs nor the reliability of our belief-forming methods, but rather how we can justify our beliefs.

A revised edition of an undergraduate text for students in history of psychology courses. Designed for one semester, covers: the history of psychology in ancient philosophy, structuralism, neurophysiology, functionalism, behaviorism, psychoanalysis, and gestalt theories. The new edition has expanded.

Against the historically widespread view that divine conservation is a continuation of the act of creation, William Lane Craig argues that conservation is a different kind of act since, unlike creation ex nihilo, it is diachronic and it acts on a patient. Timothy Miller poses a timing objection against Craig's view, arguing that on such a view either the existence of a conserved entity is discontinuous, or the conserving activity overdetermines its effect, or the conserving activity is not continuous. The (...) present paper explores the options that remain for a diachronic, agent-patient account of conservation. It includes several models of conservation on which divine activity is continuous but not overdetermined since its effect at each time is something less specific than the existence of a created being at a time. (shrink)

This is an extensively re-written second edition of a well regarded and much cited text on the issue of animal protection. It remains the only text to combine an examination of the philosophy and politics of the issue. Its central argument is that the philosophical debate is central to an understanding and evaluation of the substantive issues involving animals and the nature of the movement for change. The book has been thoroughly revised to include major theoretical and empirical developments. Specifically, (...) the "second generation" of animal ethics literature is examined in detail, and attention is paid to the campaigns and public controversy over the export of live animals and the use of animals in research, the impact of genetic engineering on the welfare of animals and the latest developments in the controversy over hunting. (shrink)

In this book, Dr. Robert J. Levine reviews federal regulations, ethical analysis, and case studies in an attempt to answer these questions.

Philosophy has as much to do with feelings as it does with thoughts and thinking. Philosophy, accordingly, requires not only emotional sensitivity but an understanding of the emotions, not as curious but marginal psychological phenomena but as the very substance of life. In this, the second book in a series devoted to his work on the emotions, Robert Solomon presents a defense of the emotions and of sentimentality against the background of what he perceives as a long history of (...) abuse in philosophy and social thought and art and literary criticism. The title piece reopens a classic debate about the role of sentimentality in art and literature. In subsequent chapters, Solomon discusses not only such "moral sentiments" as sympathy and compassion but also grief, gratitude, love, horror, and even vengeance. He also defends, with appropriate caution, the "seven deadly sins." The emotions, at least some emotions--are essential to a well-lived life. They are or can be virtues, features of the human condition without which civilized life would be unimaginable. (shrink)

Many theorists claim that if an agent benefits from an action that harms others, that agent has a moral duty to compensate those who are harmed, even if the agent did not cause the harm herself. In the debate on climate justice, this idea is commonly referred to as the beneficiary-pays principle . This paper argues that the BPP is implausible, both in the context of climate change and as a normative principle more generally. It should therefore be rejected.

Many theorists claim that if an agent benefits from an action that harms others, that agent has a moral duty to compensate those who are harmed, even if the agent did not cause the harm herself. In the debate on climate justice, this idea is commonly referred to as the beneficiary-pays principle. This paper argues that the BPP is implausible, both in the context of climate change and as a normative principle more generally. It should therefore be rejected.

A recently advanced argument for purgatory hinges on the need for complete sanctification before one can enter heaven. The argument has a modal gap.The gap can be exploited to fashion a competing account of how sanctification occurs in the afterlife according to which it is in part a heavenly process.The competing account usefully complicates the overall case for purgatory and raises questions about how the notion ought to be understood.

This paper develops a view of the content of perceptual states that reflects the cognitive significance those states have for the subject. Perhaps the most important datum for such a theory is the intuition that experiences are ‘transparent’, an intuition promoted by philosophers as diverse as Sartre and Dretske. This paper distinguishes several different transparency theses, and considers which ones are truly supported by the phenomenological data. It is argued that the only thesis supported by the data is much weaker (...) than those typically considered in the literature, and has no obvious implications for the existence of sensory intermediaries. It does, however, have implications for the content of perceptual experience. It is argued that combining the first personal project with the transparency intuition yields an error theory of perception. The counterintuitive implications of this error theory are mitigated, however, by an account of perceptual beliefs which allows for them to be true even if the perceptual states are non-veridical. (shrink)

An examination and defence of the concept of personality, long central to Western moral culture but now increasingly under attack. Robert Spaemann tackles urgent practical questions, such as our treatment of the severely disabled human and the moral status of intelligent non-human animals.