Evidence-based medicine (EBM) has thus far failed to adequately account for the appropriate incorporation of other potential warrants for medical decision making into clinical practice. In particular, EBM has struggled with the value and integration of other kinds of medical knowledge, such as those derived from clinical experience or based on pathophysiologic rationale. The general priority given to empirical evidence derived from clinical research in all EBM approaches is not epistemically tenable. A casuistic alternative to EBM approaches recognizes that five (...) distinct topics, 1) empirical evidence, 2) experiential evidence, 3) pathophysiologic rationale, 4) patient goals and values, and 5) system features are potentially relevant to any clinical decision. No single topic has a general priority over any other and the relative importance of a topic will depend upon the circumstances of the particular case. The skilled clinician must weigh these potentially conflicting evidentiary and non-evidentiary warrants for action, employing both practical and theoretical reasoning, in order to arrive at the best choice for an individual patient. (shrink)

While the importance of mechanisms in determining causality in medicine is currently the subject of active debate, the role of mechanistic reasoning in clinical practice has received far less attention. In this paper we look at this question in the context of the treatment of a particular individual, and argue that evidence of mechanisms is indeed key to various aspects of clinical practice, including assessing population-level research reports, diagnostic as well as therapeutic decision making, and the assessment of treatment effects. (...) We use the pulmonary condition bronchiectasis as a source of examples of the importance of mechanistic reasoning to clinical practice. (shrink)

Consensus is growing among ethicists and lawyers that medical decision making for incompetent patients who were previously competent should be made in accordance with that person's prior wishes and desires. Moreover, this legal and ethical preference for the substituted judgment standard has found its way into the daily practice of medicine. However, what appears on the surface to be an agreement between jurists, bioethicists, and clinicians obscures the very real differences between disciplines regarding the actual implementation of the sub stituted (...) judgment standard. Ethicists and judges have carefully outlined how substituted judgments ought to be made and evaluated. Although differences arise, especially at the state court level, regarding the scope of the substituted judgment standard and its relation to other standards of surrogate decision making, agreement is fairly widespread on the priority of substituted judgment and on the necessity of sufficient evidence being available in order to support a particular substituted judgment. (shrink)

The reality of resource limitation during the Coronavirus Disease 2019 pandemic has deeply challenged established approaches to healthcare system emergency response. Early preparation du...

Within the evidence-based medicine construct, clinical expertise is acknowledged to be both derived from primary experience and necessary for optimal medical practice. Primary experience in medical practice, however, remains undervalued. Clinicians’ primary experience tends to be dismissed by EBM as unsystematic or anecdotal, a source of bias rather than knowledge, never serving as the “best” evidence to support a clinical decision. The position that clinical expertise is necessary but that primary experience is untrustworthy in clinical decision-making is epistemically incoherent. Here (...) we argue for the value and utility of knowledge gained from primary experience for the practice of medicine. Primary experience provides knowledge necessary to diagnose, treat, and assess response in individual patients. Hierarchies of evidence, when advanced as guides for clinical decisions, mistake the relationship between propositional and experiential knowledge. We argue that primary experience represents a kind of medical knowledge distinct from the propositional knowledge produced by clinical research, both of which are crucial to determining the best diagnosis and course of action for particular patients. (shrink)

Hume's Reception in Early America: Expanded Edition brings together the original American responses to one of Britain's greatest men of letters, David Hume. Now available as a single volume paperback, this new edition includes updated further readings suggestions and dozens of additional primary sources gathered together in a completely new concluding section. From complete pamphlets and booklets, to poems, reviews, and letters, to extracts from newspapers, religious magazines and literary and political journals, this book's contents come from a wide variety (...) of sources published in colonial America and the early United States between 1758 and 1850. As well as classics by Thomas Jefferson, John Adams and Alexander Hamilton, it contains scores of unknown and hard-to-locate items, many of which have not been reprinted since their original publication. These responses are divided into four parts covering Hume's Essays; his Philosophical Writings; his History of England; and his Character and Death. Each of those parts has a separate introductory essay, and every selection is introduced by a short headnote that sets the piece in its historical context and provides bibliographical references. Packed with new insights into Hume and American thought and culture, Hume's Reception in Early America reveals the relevance and impact of Hume on American political, philosophical, historical, religious, and aesthetic debates. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:BOOK REVIEWS 69~ created mind will reflect the divine essence in its own unique way (e.g., 77, 83) helps to solve some of the problems which Parkinson finds in the pbenomenalism that he attributes to Leibniz (see xxxi and xxxiv) and also partly motivates the original formulation of Leibniz's principle of the identity of indiscernibles (50 and his doctrine of marks and traces (51). But the point of The (...) Yale Leibniz surely has less to do with interpretation and more to do with text. Parkinson's translations are generally good. There are only a few cases where the English obscures both Leibniz's Latin and his argument (e.g., a paragraph on p. i 14 contains instances of the Latinfigura which are translated differently). That The Yale Leibniz has the excellent policy of including the original language on facing pages renders irrelevant the fact that one is bound to disagree with this qualified translator on some minor points. Parkinson's edition might have been a bit more scholar-friendly than it is: while his text contains both the page and essay numbers of the Academy edition, his table of contents contains neither; this means that one can neither make a quick comparison between the contents of the two volumes nor easily move back and forth between them. Nor is one privy, in Parkinson's text, to the many and important corrections which Leibniz made to his essays and which are carefully noted in the Academy volume. This is a serious flaw: these papers afford an extraordinary ringside seat on the development of beibniz's philosophy; it is a pity that many of the details of this metaphysical sparring remain out of sight. Despite these minor disappointments, Parkinson's edition of De Summa Rerum remains a genuinely helpful research tool. By taking on these enormously difficult and profoundly important texts and by placing them so securely in the context of Leibniz's later thought, he has done us a very great favor. He has also whetted our appetite for more of The Yale Leibniz. CHRISTIA MERCER Columbia University Claudio Cesa and Norbert Hinske, eds. Kant und seinJahrhundert: Gedenkschriftfiir Giorgio ToneUi. Frankfurt am Main: Peter Lang, 1993. Pp. xiv + ~lZ. NP. Far-reaching both in historical and philosophical scope as well as in the diversity of scholars represented, this volume is a tribute to an important contemporary historian of philosophy, Giorgio Tonelli (1928-1978). A glance through the seventeen-page chronological bibliography confirms the breadth of Tonelli's historical interests, ranging over work on Albrecht von Hailer, Heine, and Maupertuis as well as his wellknown works on Kant and earlier figures of the Enlightenment. The editors point out in their brief introduction that Tonelli's work was important as an antidote to an earlier tendency in Kant scholarship to read Kant through the lenses of German idealism, rather than focusing on the Kantian corpus in the context of earlier traditions and philosophical achievements. "Sein Jahrhundert" includes essays that encompass the whole of the eighteenth century, as well as important seventeenth-century influences. The volume is quite 692 JOURNAL OF THE HISTORY OF PHILOSOPHY 33:4 OCTOBER ~995 appropriately international and multilinguai, reflecting Tonelli's own background and widespread influence. The essays are for the most part clearly written, well-informed and carefully argued interpretations of important Enlightenment figures that aim to refocus our attention on neglected or misinterpreted aspects of these philosophers' views. What follows will give interested readers a brief overview of the contents. In "Corsi, Ricorsi and the Way Out of Modern Barbarism in Vico's New Science," Craig Walton offers an interesting 'third way' of reading Vico's notions of"course" and "recourse" that parallels Tonelli's approach to Kant. Walton argues against anachronistic idealist interpretations of corsi/ricorsi as cyclic or recurrence concepts, and also against ahistorical readings of these notions as aesthetic or ironic. Rather, for Vico, the "storia ideale eterna'" is to be understood as purposeful but open-ended, and this can only be fully appreciated if the notion of ricorso is interpreted as the possibility of human response to the course of human history. Ezequiel de Olaso's "Spinoza et l'Espagne ~clair6e... (shrink)

Prologue, invitation to thinking about God In the Hebrew Bible? -- Part I, questions about God? -- Why does God in the Bible have a body? -- What do God's body parts in the Bible mean? -- Why is God angry in the Bible? -- Does God in the Bible have gender or sexuality? -- Part II, questions about God in the world? -- What can creation tell us about God? -- Who-or what-is the Satan? -- Why do people suffer (...) according to the Hebrew Bible? -- Epilogue, God in the Bible and beyond. (shrink)

This paper offers a new way to make sense of disagreement expansion from a polylogical perspective by incorporating various places in addition to players and positions into the analysis. The concepts build on prior implicit ideas about disagreement space by suggesting how to more fully account for argumentative context, and its construction, in large-scale complex controversies. As a basis for our polylogical analysis, we use a New York Times news story reporting on an oil train explosion—a significant point in the (...) broader controversy over producing oil and gas via hydraulic fracturing. (shrink)

A specific issue for argumentation theory is whether information and communication technologies play any role in governing argument — that is, as parties engage in practical activities across space and time via ICTs, does technology matter for the interplay of argumentative content and process in managing disagreement? The case made here is that technologies do matter because they are not merely conduits of communication but have a role in the pragmatics of communication and argumentation. In particular, ICTs should be recognized (...) as communication-information services that are delegated degrees of responsibility for managing disagreements arising from practical activities. These services are organized around practical theories for designing disagreement space. However, recognizing this relationship between argument and technology requires accounting for procedures, techniques, or rules and speech acts that are not argumentative propositions in any strict sense but that are consequential for what becomes argumentation in any setting. An account about designing disagreement space, grounded in Jackson and Jacobs’s theory of Disagreement Management, is put forward to address these issues while more generally contributing to understanding argument in context. (shrink)

It is time to bring the rich resources of these traditions into the contemporary debate about the nature of self. This volume is the first of its kind.

It is argued here that large-scale organization and networked computing enable new divisions of communicative work aimed at shaping the content, direction, and outcomes of societal conversations. The challenge for argumentation theory and practice lies in attending to these new divisions of communicative work in constituting contemporary argumentative realities. Goffman’s conceptualization of participation frameworks and production formats are applied to articulate the communicative work of organizations afforded by networked computing that invents and innovates argument in all of its senses—as product, (...) process, and procedure. Communicative work, however, may be scaffolding argumentative contexts and practices that are quite different than what has constituted past argumentative realities. The computerization of argument happens as organizations invent and innovate argument practice relative to the demands and opportunities of interorganizational communication. The cases and examples examined here suggest that argument practice is evolving around the logic of conversation and the principle of personalization. The analysis challenges argumentation theory to seriously engage with the construction of communicative contexts and the realization of ideas about disagreement management in organizational practice and information infrastructures. Directions for integrating insights from a design perspective on argument with insights from organizational and information systems theory are proposed for coming to terms with an era of large-scale organization and computerization, in particular the evolution of argument practice, the inscription of argument in the built environment, and the absorption of socio-cultural argument practices by organizations and computation. (shrink)

Since the 1960s, many artists have incorporated ecological concerns into their work, an endeavor that has required new strategies in art-making. To explore recent American manifestations of these interests, the David and Alfred Smart Museum commissioned new projects from artists Mark Dion, Peter Fend, and Dan Peterman, each focusing on interrelationships between particular organisms—human beings-and a specific group of sites—a museum building, a river landscape, and a university campus. The results, exhibited at the Smart Museum during the summer of (...) 2000, evoke the varied scales, from the microscopic to the global, at which human actions affect the environment. This catalog documents each of the artists' projects through an array of images and words: Smart Museum Associate Curator Stephanie Smith provides an introduction and brief overviews of the three projects, each of the artists contribute statements, and photographers Susan Anderson and Tom van Eynde document—in over 100 images—the processes and projects that comprise the exhibition. (shrink)

A revelatory new theory of consciousness that returns emotions to the center of mental life. For Mark Solms, one of the boldest thinkers in contemporary neuroscience, discovering how consciousness comes about has been a lifetime's quest. Scientists consider it the "hard problem" because it seems an impossible task to understand why we feel a subjective sense of self and how it arises in the brain. Venturing into the elementary physics of life, Solms has now arrived at an astonishing answer. (...) In The Hidden Spring, he brings forward his discovery in accessible language and graspable analogies. Solms is a frank and fearless guide on an extraordinary voyage from the dawn of neuropsychology and psychoanalysis to the cutting edge of contemporary neuroscience, adhering to the medically provable. But he goes beyond other neuroscientists by paying close attention to the subjective experiences of hundreds of neurological patients, many of whom he treated, whose uncanny conversations expose much about the brain's obscure reaches. Most importantly, you will be able to recognize the workings of your own mind for what they really are, including every stray thought, pulse of emotion, and shift of attention. The Hidden Spring will profoundly alter your understanding of your own subjective experience. (shrink)

Bringing together the latest scientific advances and some of the most enduring subtle philosophical puzzles and problems, this book collects original historical and contemporary sources to explore the wide range of issues surrounding the nature of life. Selections ranging from Aristotle and Descartes to Sagan and Dawkins are organised around four broad themes covering classical discussions of life, the origins and extent of natural life, contemporary artificial life creations and the definition and meaning of 'life' in its most general form. (...) Each section is preceded by an extensive introduction connecting the various ideas discussed in individual chapters and providing helpful background material for understanding them. With its interdisciplinary perspective, this fascinating collection is essential reading for scientists and philosophers interested in astrobiology, synthetic biology and the philosophy of life. (shrink)

A Clearly argued and easy to read defense of Karl Popper's philosophy.

Scientists have recently discovered a new law of nature. Its footprints are virtually everywhere - in the spread of forest fires, mass extinctions, traffic jams, earthquakes, stock-market fluctuations, the rise and fall of nations, and even trends in fashion, music and art. Wherever we look, the world is modelled on a simple template: like a steep pile of sand, it is poised on the brink of instability, with avalanches - in events, ideas or whatever - following a universal pattern of (...) change. This remarkable discovery heralds what Mark Buchanan calls the new science of 'ubiquity', a science whose secret lies in the stuff of the everyday world. Combining literary flair with scientific rigour, this enthralling book documents the coming revolution by telling the story of the researchers' exploration of the law, their ingenious work and unexpected insights. Mark Buchanan reveals how the principle of ubiquity will help us to manage, control and predict the future. More controversially, he claims that it may well contain the beginnings of a mathematics of cultural and historical change. Every decade sees a major scientific breakthrough that has implications that go way beyond science. 'Ubiquity' is one of them. This book, the world's first on the topic, will change how we think about the world and our place in it. Chaos Disorder from order. Complexity Complexity from simplicity. UBIQUITY World has a natural 'rhythm': there is a mysterious archetypal organisation that works in the world at all levels and which gives rise to a universal pattern of change - in groups of people, things or ideas. (shrink)

In The Politics of Exodus, Mark Dooley offers a lively interpretation of Kierkegaard as a precursor of the ethical and political insights of Jacques Derrida. While many connections have been forged in recent years between these two quintessentially "Continental" figures, Dooley's book argues that these affiliations run much deeper than any previous commentators have suggested. Indeed, his most controversial claim is that Kierkegaard is anything but a proponent of asocial individualism, but is one whose writings bear witness to the (...) notion of an "open quasi-community" which has driven much of Derrida's work over the past decade. In vigorously challenging conventional wisdom surrounding the place of Kierkegaard in contemporary thought and political theory, Dooley shows how powerfully postmodern and politically charged the latter's specifically 'religious' ideas are. As such, Kierkegaard ought to be read as someone who anticipated Derrida's claim that genuine responsibility in the political sphere depends upon a phophetic call for justice on behalf of the least among us. will appeal to anyone interested in the intersection of religion and postmodernism, as well as to those with interests in ethics and politics from a Continental perspective. It will undoubtedly change the way we read Kierkegaard in the new millennium. (shrink)

This book initiates a conversation between the two traditions showing how concepts and tools drawn from one philosophical tradition can help solve problems ...

In The Psychologizing of Modernity, Mark Jarzombek examines the impact of psychology on twentieth-century aesthetics. Analysing the interface between psychology, art history and avant-gardist practices, he also reflects on the longevity of the myth of aesthetic individuality as it infiltrated not only avant-garde art, but also history writing. The principal focus of this study is pre-World War II Germany, where theories of empathy and Entartung emerged; and post-war America, where artists, critics and historians gradually shifted from their reliance on (...) psychology to philosophy, and, most recently, to theory. Included are discussions of writers such as Heinrich Wölfflin, Ludwig Volkmann, John Dewey, Vincent Scully and Richard Arnheim, among others. The Psychologizing of Modernity is a broad and erudite study of the evolution of modern aesthetic thinking in the fields of art and architectural history. (shrink)

The principle of gratuitous suffering -- The value of humans and the value of animals -- The holocaust of factory farming -- Hunting -- Animal experimentation -- The law and animals -- Women and animals.

In this largely antimetaphysical treatment of free will and determinism, Mark Balaguer argues that the philosophical problem of free will boils down to an open scientific question about the causal histories of certain kinds of neural events. In the course of his argument, Balaguer provides a naturalistic defense of the libertarian view of free will. The metaphysical component of the problem of free will, Balaguer argues, essentially boils down to the question of whether humans possess libertarian free will. Furthermore, (...) he argues that, contrary to the traditional wisdom, the libertarian question reduces to a question about indeterminacy--in particular, to a straightforward empirical question about whether certain neural events in our heads are causally undetermined in a certain specific way; in other words, Balaguer argues that the right kind of indeterminacy would bring with it all of the other requirements for libertarian free will. Finally, he argues that because there is no good evidence as to whether or not the relevant neural events are undetermined in the way that's required, the question of whether human beings possess libertarian free will is a wide-open empirical question. (shrink)