Although hope is a pervasive concept in cancer treatment, we know little about how ambulatory patients with cancer define or experience hope. We explored hope through semistructured interviews with ten patients with advanced (some curable, some incurable) colon cancer at one Midwestern, university–based cancer center. We conducted a thematic analysis to identify key concepts related to patient perceptions of hope. Although we did ask specifically about hope, patients also often revealed their hopes in response to indirect questions or by telling (...) stories about their cancer experience. We identified four major themes related to hope: 1) hope is essential, 2) a change in perspective, 3) the content of hope, and 4) communicating about hope. The third theme, the content of hope, included three subthemes: a) the desire for normalcy, b) future plans, and c) hope for a cure. We conclude that hope is an essential concept for patients undergoing treatment for cancer as it pertains to their psychological well–being and quality of life, and hope for a cure is not and should not be the only consideration. In a clinical context, the exploration of patients’ hopes and aspirations in light of their cancer diagnosis is important because it provides a frame for understanding their goals for treatment. Exploration of the content of patients’ hope can not only help to illuminate misunderstandings but also clarify how potential treatments may or may not contribute to achieving patients’ goals. (shrink)

The primary objective was to review pediatric ethics consultations at a large academic health center over a nine year period, assessing demographics, ethical issues, and consultant intervention. The secondary objective was to describe the evolution of PECs at our institution. This was a retrospective review of Consultation Summary Sheets compiled for PECs at our Academic Health Center between January 2008 and April 2017. There were 165 PECs reviewed during the study period. Most consult requests came from the inpatient setting, with (...) the Pediatric and Neonatal Intensive Care Units being the highest utilizers. Consultation utilization increased over the study period. The most common patient age was less than one year. Physicians were most likely to request consultation. Patient Best Interest, Withholding/Withdrawing of Life Sustaining Therapy, and Provider Moral Distress were ethical issues most commonly identified by the consultants. Making recommendations was the most common consultant intervention. The ethics consultation process evolved over time from informal provider discussions, to a hospital infant care review committee, to a pediatric only consultation service, to a combined adult/pediatric consultation service, with variable levels of salary support for consultants. Ethics consultation requests are growing at our institution. Similarities in identified ethical issues exist between our findings and existing literature, however meaningful comparisons remains elusive secondary to variability in approaches to investigation and reporting. A combined paid/volunteer/trainee ethics consultation service model appears sustainable and real time ethics consultation is feasible using this approach. (shrink)

The concept of brain death — first defined decades ago — still presents medical, ethical, and legal challenges despite its widespread acceptance in clinical practice and in law. This article reviews the medicine, law, and ethics of brain death, including the current inconsistencies in brain death determinations, which a lack of standardized federal policy promotes, and argues that a standard brain death policy to be used by all hospitals in all states should be created.

In the United States at this time, no uniform federal law exists regarding commercial surrogacy, and state statutory schemes vary vastly, ranging from criminalization to legal recognition with contract enforcement. The authors examine how commercial surrogacy agencies utilize the Internet as a means for attracting parents and surrogates by employing emotional cultural rhetoric. By inducing both parents and surrogates to their jurisdiction, agencies circumvent vast discrepancies in state statutory regulative schemes and create a distinct interstate business, absent an efficient regulatory (...) framework or legal recourse in some circumstances. The authors propose a uniform federal regulatory scheme premised upon regulating interstate business transactions to create accountability and legal remedies for both the parents and the surrogate. (shrink)

In July of 2005, Indianapolis witnessed streaming headlines in the local newspaper attempting to distill the confusion surrounding the adoption of two premature infants by an adoptive parent. Thirteen articles and opinion pieces introduced the public to a murky legal and ethical transaction. Stating his overwhelming desire to have children, a New Jersey schoolteacher hired the services of a local attorney. The attorney procured a South Carolina woman for a compensated gestational surrogacy contract. Under the contract, the surrogate and the (...) attorney would meet in Indiana to complete the execution of the contract and transfer parental rights via adoption after the birth of the twins. (shrink)

The concept of brain death evolved because advancements in medical science permitted unprecedented artificial maintenance of vital body functions by external means. Although the concept of brain death is accepted clinically, ethically, and legally in the United States, there is no national standard for the determination of brain death. There is evidence that variability and inconsistency in the process of determining brain death exist both in clinical settings and in State statutes. Several studies demonstrate that medical personnel determine brain death (...) in variable ways, and have variable understandings of the definition of brain death. The declaration of death has significant legal consequences such as probate proceedings and liability issues for wrongful death. Inconsistencies in the determination of death may therefore be medically, ethically, and legally problematic. (shrink)

"Evidence of a flight from reason is as old as human record-keeping: the fact of it certainly goes back an even longer way. Flight from science specifically, among the forms of rational inquiry, goes back as far as science itself... But rejection of reason is now a pattern to be found in most branches of scholarship and in all the learned professions."--from the introduction In the widely acclaimed Higher Superstition: The Academic Left and Its Quarrels with Science, Paul R. (...) Gross and Norman Levitt offered a spirited response to the "science bashers," raising serious questions about the growing criticism of scientific practice from humanists and social scientists on the academic left. Now, in The Flight from Science and Reason, Gross and Levitt are joined by Martin W. Lewis to bring together a diverse and distinguished group of scholars, scientists, and experts to engage these questions from a wide variety of perspectives. The authors take on critics of science whose views range from moderate to extreme, from social constructivists to deconstructionists, from creationists and feminists to Afro-centrists. They discuss the rise of "alternative medicine" and radical environmentalism (here skewered as "ecosentimentalism"). They explain why the "uncertainty principle" does not work as a metaphor for ambiguity, and why "chaos theory" cannot be invoked without an understanding of mathematics. Throughout, they grapple with the paradox inherent in arguing with opponents who contend that reason itself, and thus logic, is suspect. Distributed for the New York Academy of Sciences. (shrink)

Using astrology as a case study, this paper attempts to establish a criterion for demarcating science from pseudoscience. Numerous reasons for considering astrology to be a pseudoscience are evaluated and rejected; verifiability and falsifiability are briefly discussed. A theory is said to be pseudoscientific if and only if (1) it has been less progressive than alternative theories over a long period of time, and faces many unsolved problems, but (2) the community of practitioners makes little attempt to develop the theory (...) towards solutions of the problems, shows no concern for attempts to evaluate the theory in relation to others, and is selective in considering confirmations and disconfirmations. This criterion has the interesting consequence that a theory can be scientific at one time but pseudoscientific at another. (shrink)

Mandevillian intelligence is a specific form of collective intelligence in which individual cognitive vices are seen to play a positive functional role in yielding collective forms of cognitive success. The present paper introduces the concept of mandevillian intelligence and reviews a number of strands of empirical research that help to shed light on the phenomenon. The paper also attempts to highlight the value of the concept of mandevillian intelligence from a philosophical, scientific and engineering perspective. Inasmuch as we accept the (...) notion of mandevillian intelligence, then it seems that the cognitive and epistemic value of a specific social or technological intervention will vary according to whether our attention is focused at the individual or collective level of analysis. This has a number of important implications for how we think about the design and evaluation of collective cognitive systems. For example, the notion of mandevillian intelligence forces us to take seriously the idea that the exploitation of individual cognitive shortcomings could, in some situations, provide a productive route to collective forms of cognitive and epistemic success. (shrink)

This article explores the notion of the Web-extended mind, which is the idea that the technological and informational elements of the Web can sometimes serve as part of the mechanistic substrate that realizes human mental states and processes. It is argued that while current forms of the Web may not be particularly suited to the realization of Web-extended minds, new forms of user interaction technology as well as new approaches to information representation do provide promising new opportunities for Web-based forms (...) of cognitive extension. In addition, it is suggested that extended cognitive systems often rely on the emergence of social practices and conventions that shape how a technology is used. Web-extended minds may thus depend on forms of socio-technical co-evolution in which social forces and factors play just as important a role as do the processes of technology design and development. (shrink)

There have been a number of attempts to apply mechanism-related concepts to the notion of extended cognition. Such accounts appeal to the idea that extended cognitive routines are realized by mechanisms that transcend some salient border or boundary. The present paper describes some of the challenges confronting the effort to develop a mechanistic account of extended cognition. In particular, it describes five problems that must be resolved if we are to make sense of the idea that extended cognition can be (...) understood via an appeal to extended mechanisms. These problems are intended to guide the philosophical effort to develop a mechanistic account of extended cognition. (shrink)

Biodiversity studies comprise the systematic examination of the full array of different kinds of organisms together with the technology by which the diversity can be maintained and used for the benefit of humanity. Current basic research at the species level focuses on the process of species formation, the standing levels of species numbers in various higher taxonomic categories, and the phenomena of hyperdiversity and extinction proneness. The major practical concern is the massive extinction rate now caused by human activity, which (...) threatens losses in the esthetic quality of the world, in economic opportunity, and in vital ecosystem services. (shrink)

This chapter reviews the aspects of Mencius that did and did not interest Han-dynasty writers. With the help of digital concordances, it is easy to discover that many of the passages considered crucial today were rarely, if ever, cited in the Han. These include the parable of the infant about to fall into a well (2A.6), the debate with a Mohist named Yi Zhi 夷之 (3A.5), and the concept of liangzhi 良知 (7A.15), which, since Wang Yangming 王陽明 (1472–1528), has been (...) considered a cornerstone of Mencian ethics. The chapter discusses other key passages that are never mentioned in Han sources. Absence of evidence is not evidence of absence, and thus one cannot simply infer that these passages were unknown in the Han dynasty, but it remains significant that they were not regarded as essential to understanding Mencius’s philosophy. The conclusion will explore the differences between Mencius’s reception in the Han dynasty and his Neo-Confucianized reception today. (shrink)

To all appearances, the basic building blocks of reality tend to keep existing unless something intervenes to destroy them. In other words, basic things seem to have existential inertia. But why might this be? This paper considers a number of arguments for and against existential inertia. It discusses arguments inspired by Aquinas, Descartes, and Spinoza, as well as considerations deriving from Occam’s Razor, entropy, and certain views about the nature of time and change.

Since Plato, most philosophers have drawn a sharp line between reason and emotion, assuming that emotions interfere with rationality and have nothing to contribute to good reasoning. In his dialogue the Phaedrus, Plato compared the rational part of the soul to a charioteer who must control his steeds, which correspond to the emotional parts of the soul (Plato 1961, p. 499). Today, scientists are often taken as the paragons of rationality, and scientific thought is generally assumed to be independent of (...) emotional thinking. (shrink)

Substantially revised to include a wealth of new material, the second edition of this highly acclaimed work provides a concise, coherent introduction that brings structure to an increasingly fragmented and amorphous discipline. Paul R. McHugh and Phillip R. Slavney offer an approach that emphasizes psychiatry's unifying concepts while accommodating its diversity. Recognizing that there may never be a single, all-encompassing theory, the book distills psychiatric practice into four explanatory methods: diseases, dimensions of personality, goal-directed behaviors, and life stories. These (...) perspectives, argue the authors, underlie the principles and practice of all psychiatry. With an understanding of these fundamental methods, readers will be equipped to organize and evaluate psychiatric information and to develop a confident approach to practice and research. Praise for the original edition: "This brilliant book illuminates psychiatry more clearly than any other work I know.... This is the best (and the shortest) single volume on psychiatry that anyone could read."-- New England Journal of Medicine "Every psychiatry department, regardless of ideology, should build a course around this... work. Open-mindedness might become fashionable."-- Journal of Clinical Psychiatry "An elegantly reasoned and eloquently written book that enriches our understanding of clinical events.... [It provides] an opportunity to open our eyes to new possibilities."-- Hospital and Community Psychiatry. (shrink)

Chapter 49 of the Han Feizi, entitled 'Wudu', includes one of the earliest discussions in Chinese history of the concepts of gong and si: Han Fei takes si to mean 'acting in one's own interest'. Gong is simply what opposes si. 'Acting in one's own interest' is not inherently reprehensible in Han Fei's view; but a ruler must remember why ministers propose their policies: they are concerned only with enriching themselves, and look upon the ruler as nothing more than a (...) resource to be exploited in their quest for material aggrandizement. The interests of the ministers and the ruler are diametrically opposed. Ministers hope for a comfortable career; a ruler must weed out the posers in his search for those rare and invaluable adjuvants who are genuinely capable of administering the state. In short, if si is the self-interest of the minister, gong is the self-interest of the ruler. (shrink)

This paper argues that questions concerning the nature of concepts that are central in cognitive psychology are also important to epistemology and that there is more to conceptual change than mere belief revision. Understanding of epistemic change requires appreciation of the complex ways in which concepts are structured and organized and of how this organization can affect belief revision. Following a brief summary of the psychological functions of concepts and a discussion of some recent accounts of what concepts are, I (...) propose a view of concepts as complex computational structures. This account suggests that conceptual change can come in varying degrees, with the most extreme consisting of fundamental conceptual reorganizations. These degrees of conceptual change are illustrated by the development of the concept of an acid. (shrink)

__Augustine and the Cure of Souls __situates Augustine within the ancient philosophical tradition of using words to order emotions. Paul Kolbet uncovers a profound continuity in Augustine's thought, from his earliest pre-baptismal writings to his final acts as bishop, revealing a man deeply indebted to the Roman past and yet distinctly Christian. Rather than supplanting his classical learning, Augustine's Christianity reinvigorated precisely those elements of Roman wisdom that he believed were slipping into decadence. In particular, Kolbet addresses the manner (...) in which Augustine not only used classical rhetorical theory to express his theological vision, but also infused it with theological content. This book offers a fresh reading of Augustine's writings--particularly his numerous, though often neglected, sermons--and provides an accessible point of entry into the great North African bishop's life and thought. "For someone who does not know Augustine well this book will be an excellent introduction to his thought from an absolutely crucial viewpoint. Augustine's preaching, teaching, and attempts to reach the minds and hearts of his congregation have been largely overlooked. This book has the great virtue of demonstrating why these were important." --_Carol Harrison, Durham Universi_ty "In this insightful and lucid study Kolbet leads his readers across the boundaries of ancient philosophy, psychology, rhetoric, and theology. He examines the ancient practice of the 'cure of the soul' and charts its Christian appropriation by Augustine. The volume offers its own medicinal promise--the reordering of our contemporary understanding of early Christianity and its complex association with classical culture." --_John Peter Kenney, St. Michael's College_. (shrink)

L. J. Savage and I. J. Good have each demonstrated that the expected utility of free information is never negative for a decision maker who updates her degrees of belief by conditionalization on propositions learned for certain. In this paper Good's argument is generalized to show the same result for a decision maker who updates her degrees of belief on the basis of uncertain information by Richard Jeffrey's probability kinematics. The Savage/Good result is shown to be a special case of (...) the more general result. (shrink)

This chapter explores the notion of the Web‐extended mind, which is the idea that the technological and informational elements of the Web can sometimes serve as part of the mechanistic substrate that realizes human mental states and processes. It is argued that while current forms of the Web may not be particularly suited to the realization of Web‐extended minds, new forms of user interaction technology as well as new approaches to information representation do provide promising new opportunities for Web‐based forms (...) of cognitive extension. In addition, it is suggested that extended cognitive systems often rely on the emergence of social practices and conventions that shape how a technology is used. Web‐extended minds may thus depend on forms of socio‐technical co‐evolution in which social forces and factors play just as important a role as do the processes of technology design and development. (shrink)

Nietzsche’s conception of eros and its role in the development of philosophers is similar to the conception of those same topics espoused by Diotima in Plato’s Symposium. Nietzsche and Diotima agree that eros is an insatiable desire to possess the beautiful, that eros aims at immortality through reproduction, and that philosophy requires an ascent beyond sexual desire to “higher” forms of eros, which nevertheless are still modeled on heterosexual reproduction. Understanding these facets of Nietzsche’s view leads to an apparent contradiction (...) in that Nietzsche thinks of philosophy on the model of reproduction and ascribes to the philosopher both the female and the male roles in heterosexual reproduction. I argue that this ambivalence reflects Nietzsche’s view that practicing philosophy requires balancing two conflicting philosophical tendencies: on the one hand, pursuit of truth, which involves dissatisfaction with oneself; on the other hand, creation, which involves acknowledgment of one’s own capacity and value. (shrink)

This paper details many ways in which this input has been inadequate, especially during the Bush administration. It also recounts examples of successful use of scientific inputs, and discussed the reasons for both successes and failures. Then it proposes ways to accomplish the critical task of seeing to it that science is properly considered in the policy process.