Resource finitude, cost containment, and a purchaser monopsony market have created public concern-about the moral and legal responsibility for quality assurance in health plans. Resource allocation and standards of care represent a clash of moral values in intensive care treatment. This essay advances a procedural model, based on legislation passed in Oregon, that could govern the incorporation of private sector health insurance plans in Oregon to assure democratic input from consumers, providers, and employers into a limited vision of individual entitlement (...) to consume futile or inappropriate care in intensive care units. The model, which I call the Oregonian ICU, presumes that rationing of care is implicit and not publicly disclosed under managed care. It focuses on maximizing the quality of limited benefits available in the basic managed care insurance tier. Limitations to futile and inappropriate care are developed on the basis of morally weighted prognostic scoring systems that inform the creation of negotiated private sector contracts. (shrink)

The Supreme Court decision in Cruzan reaffirmed the power of the states to set procedural standards for due process regarding the individual's exercise of his liberty interest. As a result, to effect an autonomous decision to refuse treatment when one becomes incompetent requires an affirmative articulation by means of an advance directive. This article argues against simplified advance directives in that they fail to enhance individual liberty and responsibility and fail to provide physicians with needed information. A model protective advance (...) directive is advocated with direction to terminate personal and health insurance payments for health care that is not desired by the patient. Keywords: advanced directive, affirmative articulation, Cruzan, fiduciary trust CiteULike Connotea Del.icio.us What's this? (shrink)

Resource finitude, cost containment, and a purchaser monopsony market have created public concern-about the moral and legal responsibility for quality assurance in health plans. Resource allocation and standards of care represent a clash of moral values in intensive care treatment. This essay advances a procedural model, based on legislation passed in Oregon, that could govern the incorporation of private sector health insurance plans in Oregon to assure democratic input from consumers, providers, and employers into a limited vision of individual entitlement (...) to consume futile or inappropriate care in intensive care units. The model, which I call the Oregonian ICU, presumes that rationing of care is implicit and not publicly disclosed under managed care. It focuses on maximizing the quality of limited benefits available in the basic managed care insurance tier. Limitations to futile and inappropriate care are developed on the basis of morally weighted prognostic scoring systems that inform the creation of negotiated private sector contracts. (shrink)

Research is crucial to advancing knowledge about dementia, yet the burden of the disease currently outpaces research activity. Research often excludes people with dementia and other cognitive impairments because researchers and ethics committees are concerned about issues related to capacity, consent, and substitute decision-making. In Australia, participation in research by people with cognitive impairment is governed by a national ethics statement and a patchwork of state and territorial laws that have widely varying rules. We contend that this legislative variation precludes (...) a consistent approach to research governance and participation and hinders research that seeks to include people with impaired capacity. In this paper, we present key ethical principles, provide a comprehensive review of applicable legal rules in Australian states and territories, and highlight significant differences and ambiguities. Our analysis includes recommendations for reform to improve clarity and consistency in the law and reduce barriers that may exclude persons with dementia from participating in ethically approved research. Our recommendations seek to advance the national decision-making principles recommended by the Australian Law Reform Commission, which emphasize the rights of all adults to make their own decisions and for those with impaired capacity to have access to appropriate supports to help them make decisions that affect their lives. (shrink)

Research is crucial to advancing knowledge about dementia, yet the burden of the disease currently outpaces research activity. Research often excludes people with dementia and other cognitive impairments because researchers and ethics committees are concerned about issues related to capacity, consent, and substitute decision-making. In Australia, participation in research by people with cognitive impairment is governed by a national ethics statement and a patchwork of state and territorial laws that have widely varying rules. We contend that this legislative variation precludes (...) a consistent approach to research governance and participation and hinders research that seeks to include people with impaired capacity. In this paper, we present key ethical principles, provide a comprehensive review of applicable legal rules in Australian states and territories, and highlight significant differences and ambiguities. Our analysis includes recommendations for reform to improve clarity and consistency in the law and reduce barriers that may exclude persons with dementia from participating in ethically approved research. Our recommendations seek to advance the national decision-making principles recommended by the Australian Law Reform Commission, which emphasize the rights of all adults to make their own decisions and for those with impaired capacity to have access to appropriate supports to help them make decisions that affect their lives. (shrink)

Volume 51, Issue 9, August 2019, Page 886-894.

In the conclusion to this multi-part article I first review the discussions carried out around the six essential questions in psychiatric diagnosis – the position taken by Allen Frances on each question, the commentaries on the respective question along with Frances’ responses to the commentaries, and my own view of the multiple discussions. In this review I emphasize that the core question is the first – what is the nature of psychiatric illness – and that in some manner all further (...) questions follow from the first. Following this review I attempt to move the discussion forward, addressing the first question from the perspectives of natural kind analysis and complexity analysis. This reflection leads toward a view of psychiatric disorders – and future nosologies – as far more complex and uncertain than we have imagined. (shrink)

PurposeTo use the power of knowledge acquisition and machine learning in the development of a collaborative computer classification system based on the features of age-related macular degeneration (AMD).MethodsA vocabulary was acquired from four AMD experts who examined 100 ophthalmoscopic images. The vocabulary was analyzed, hierarchically structured, and incorporated into a collaborative computer classification system called IDOCS. Using this system, three of the experts examined images from a second set of digital images compiled from more than 1000 patients with AMD. Images (...) were annotated, and features were identified and defined. Decision trees, a machine learning method, were trained on the data collected and used to extract patterns. Interrelationships between the data from the different clinicians were investigated.ResultsSix drusen classes in the structured vocabulary were largely sufficient to describe all the identified features. The decision trees classified the data with 76.86% to 88.5% accuracy and distilled patterns in the form of hierarchical trees composed of 5 to 15 nodes. Experts were largely consistent in their characterization of soft, and to a lesser extent, hard drusen, but diverge in definition of other drusen. Size and crystalline morphology were the main determinants of drusen type across all experts.ConclusionsMachine learning is a powerful tool for the characterization of disease phenotypes. The creation of a defined feature set for AMD will facilitate the development of an IDOCS-based classification system. (shrink)

This paper locates its genesis in a small town called Vitebsk in Belorussia which experienced a flowering of creativity and artistic energy that led to significant modernist experimentation in the years 1917–1921. Marc Chagall, returning from the October Revolution took up the position of art commissioner and developed an academy of art that became the laboratory for Russian modernism. Chagall’s Academy, Bakhtin’s Circle, and Malevich’s experiments, artistic group UNOVIS—all in fierce dialogue with one another—made the town of Vitebsk into an (...) artistic crucible in the early twentieth century. We argue that this creative collective transformed creative energies of Russian drama, music, theatre, art, and philosophy in a distinctive contribution to modernism, structuralism and formalism that contributed richly to the social understanding of creativity itself that is so evident across Mikhail Bakhtin’s subsequent body of work, and elsewhere across the world. This paper argues that a consideration of such interplay has much potential for twenty-first century educational philosophy. (shrink)

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role (...) of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM - whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article will take up the first two questions. With the first question, invited commentators express a range of opinion regarding the nature of psychiatric disorders, loosely divided into a realist position that the diagnostic categories represent real diseases that we can accurately name and know with our perceptual abilities, a middle, nominalist position that psychiatric disorders do exist in the real world but that our diagnostic categories are constructs that may or may not accurately represent the disorders out there, and finally a purely constructivist position that the diagnostic categories are simply constructs with no evidence of psychiatric disorders in the real world. The second question again offers a range of opinion as to how we should define a mental or psychiatric disorder, including the possibility that we should not try to formulate a definition. The general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances. (shrink)

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role (...) of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM - whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article took up the first two questions. Part II will take up the second two questions. Question 3 deals with the question as to whether DSM-V should assume a conservative or assertive posture in making changes from DSM-IV. That question in turn breaks down into discussion of diagnoses that depend on, and aim toward, empirical, scientific validation, and diagnoses that are more value-laden and less amenable to scientific validation. Question 4 takes up the role of pragmatic consideration in a psychiatric nosology, whether the purely empirical considerations need to be tempered by considerations of practical consequence. As in Part 1 of this article, the general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances. (shrink)

Using relevant encyclicals issued over the last 100 years, the author extracts those principles that constitute the underpinnings of Catholic Social Teaching about the employment relationship and contemplates implications of their incorporation into human resource policy. Respect for worker dignity, for his or her family's economic security, and for the common good of society clearly emerge as the primary guidelines for responsible human resource management. Dovetailing these three Church mandates with the economic objectives of the firm could, in essence, alter (...) the firm's nature because profit motivations would be constrained by consideration for worker and societal welfare. Integration of Church teaching with current corporate goals should therefore impact greatly on a variety of human resource policies. (shrink)

Michael A PetersBeijing Normal UniversityChatGPT is an AI chatbot released by OpenAI on November 30, 2022 and a ‘stable release’ on February 13, 2023. It belongs to OpenAI’s GPT-3 family (generativ...

Michael Peters, Sonja Arndt & Marek TesarThis is a collective writing experiment of PESA members, including its Executive Committee, asking questions of the Philosophy of Education in a New Key. Co...

In this book, Michael Arbib, a researcher in artificial intelligence and brain theory, joins forces with Mary Hesse, a philosopher of science, to present an integrated account of how humans 'construct' reality through interaction with the social and physical world around them. The book is a major expansion of the Gifford Lectures delivered by the authors at the University of Edinburgh in the autumn of 1983. The authors reconcile a theory of the individual's construction of reality as a network (...) of schemas 'in the head' with an account of the social construction of language, science, ideology and religion to provide an integrated schema-theoretic view of human knowledge. The authors still find scope for lively debate, particularly in their discussion of free will and of the reality of God. The book integrates an accessible exposition of background information with a cumulative marshalling of evidence to address fundamental questions concerning human action in the world and the nature of ultimate reality. (shrink)

This volume compares the writings of Aristotle, St. Thomas Aquinas, Jacques Maritain, and Charlis De Koninck on the dignity of the individual and the common good, topics fundamental to Catholic social teaching.

Michael A. PetersBeijing Normal University, Beijing, PR China;There is an ecology of bad ideas, just as there is an ecology of weeds– Gregory Bateson (1972, p. 492)While there are classical anteced...

Michael A. PetersBeijing Normal UniversityThe ancient concept of ‘self-cultivation’ with its roots in Confucianism and Hellenistic philosophy can also be utilised as tool for understanding the prac...

The human mind has proven uniquely capable of unraveling untold mysteries, and yet, the mind is fundamentally challenged when it turns back on itself to ask what it itself is. How do we conceive of mind in this postmodern world; how can we use philosophical anthropology to understand mind and its functions? While philosophers and social scientists have made important contributions to our understanding of mind, existing theories are insufficient for penetrating the complexities of mind in the twenty-first century. Mind (...) Unmasked: A Political Phenomenology of Consciousness draws on twentieth-century philosophies of consciousness to explain the phenomenon of mind in the broadest sense of the word. Michael A. Weinstein and Timothy M. Yetman develop a thought provoking discourse that moves beyond the nature of the human experience of mind at both the individual and interpersonal levels and present a meditation on life in the contemporary world of global mass-mediated human culture. (shrink)

Open Peer Review: Educational Philosophy and Theory (EPAT)Michael A. Peters, Beijing Normal University, PR ChinaIn 2016 EPAT started experimenting with open peer review for articles that were part...

Choice Outstanding Academic Title, 1996. In hundreds of articles by experts from around the world, and in overviews and "road maps" prepared by the editor, The Handbook of Brain Theory and Neural Networkscharts the immense progress made in recent years in many specific areas related to two great questions: How does the brain work? and How can we build intelligent machines? While many books have appeared on limited aspects of one subfield or another of brain theory and neural networks, the (...) Handbookcovers the entire sweep of topics—from detailed models of single neurons, analyses of a wide variety of biological neural networks, and connectionist studies of psychology and language, to mathematical analyses of a variety of abstract neural networks, and technological applications of adaptive, artificial neural networks. The excitement, and the frustration, of these topics is that they span such a broad range of disciplines including mathematics, statistical physics and chemistry, neurology and neurobiology, and computer science and electrical engineering as well as cognitive psychology, artificial intelligence, and philosophy. Thus, much effort has gone into making the Handbookaccessible to readers with varied backgrounds while still providing a clear view of much of the recent, specialized research in specific topics. The heart of the book, part III, comprises of 267 original articles by leaders in the various fields, arranged alphabetically by title. Parts I and II, written by the editor, are designed to help readers orient themselves to this vast range of material. Part I, Background, introduces several basic neural models, explains how the present study of brain theory and neural networks integrates brain theory, artificial intelligence, and cognitive psychology, and provides a tutorial on the concepts essential for understanding neural networks as dynamic, adaptive systems. Part II, Road Maps, provides entry into the many articles of part III through an introductory "Meta-Map" and twenty-three road maps, each of which tours all the Part III articles on the chosen theme. (shrink)

Western Marxism, since its Western deviation and theoretical development in the 1920s, developed in diverse ways that has reflected the broader philosophical environment. First, a theory of conscio...

This article is concerned with developing a philosophical approach to a number of significant changes to academic publishing, and specifically the global journal knowledge system wrought by a range of new digital technologies that herald the third age of the journal as an electronic, interactive and mixed-media form of scientific communication. The paper emerges from an Editors' Collective, a small New Zealand-based organisation comprised of editors and reviewers of academic journals mostly in the fields of education and philosophy. The paper (...) is the result of a collective writing process. (shrink)

Michael A. Petersa and Fazal Rizvib aBeijing Normal University, Beijing, PR China; bMelbourne University, Melbourne, Australia Our minds are still racing back and forth, longing for a return to ‘no...