Extracorporeal membrane oxygenation (ECMO) is a form of life support for cardiac and/or pulmonary failure with unique ethical challenges compared to other forms of life support. Ethical challenges with ECMO exist when conventional standards of care apply, and are exacerbated during periods of absolute ECMO scarcity when “crisis standards of care” are instituted. When conventional standards of care apply, we propose that it is ethically permissible to withhold placing patients on ECMO for reasons of technical futility or when patients have (...) terminal, short-term prognoses that are untreatable by ECMO. Under crisis standards of care, it is ethically permissible to broaden exclusionary criteria to also withhold ECMO from patients who have a low likelihood of recovery, to maximize the overall number of lives saved. Unilateral withdrawal of ECMO against a patient’s preferences is unethical under conventional standards of care, but is ethical under crisis standards of care to increase access to ECMO to others in society. ECMO should only be rationed when true scarcity exists, and allocation protocols should be transparent to the public. When rationing must occur under crisis standards of care, it is imperative that oversight bodies assess for inequities in the allocation of ECMO and make frequent changes to improve any inequities. (shrink)

For much of 2021, allocating the scarce supply of Covid‐19 vaccines was the world's most pressing bioethical challenge, and similar challenges may recur for novel therapies and future vaccines. In the United States, the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP) identified three fundamental ethical principles to guide the process: maximize benefits, promote justice, and mitigate health inequities. We argue that critical components of the recommended protocol were internally inconsistent with these principles. Specifically, the ACIP (...) violated its principles by recommending overly broad health care worker priority in phase 1a, using being at least seventy‐five years of age as the only criterion to identify individuals at high risk of death from Covid‐19 during phase 1b, failing to recommend place‐based vaccine distribution, and implicitly endorsing first‐come, first‐served allocation. More rigorous empirical work and the development of a complete ethical framework that recognizes trade‐offs between principles may have prevented these mistakes and saved lives. (shrink)

We propose 4 equity-advancing operational improvements to eligibility and sign-up processes at mass vaccination sites: (1) preregistration using existing information, (2) eligibility rules that recognize the greater burden of COVID-19 in underserved neighborhoods, (3) appointment assignment that prioritizes those with disadvantage, and (4) socioculturally informed outreach to lottery selectees.

Scarce resource allocation policies vary across the United States. Little is known about regional variation in resource allocation protocols and variation in their application. We sought to evaluat...

Objective: A deep understanding of the relationship between a scarce drug's dose and clinical response is necessary to appropriately distribute a supply-constrained drug along these lines. Summary of key data: The vast majority of drug development and repurposing during the COVID-19 pandemic – an event that has made clear the ever-present scarcity in healthcare systems –has been ignorant of scarcity and dose optimisation's ability to help address it. Conclusions: Future pandemic clinical trials systems should obtain dose optimisation data, as these (...) appear necessary to enable appropriate scarce resource allocation according to societal values. (shrink)

Josiah Royce (1855-1916) was the leading American proponent of absolute idealism, the metaphysical view (also maintained by G. W. F. Hegel and F. H. Bradley) that all aspects of reality, including those we experience as disconnected or contradictory, are ultimately unified in the thought of a single all-encompassing consciousness. Royce also made original contributions in ethics, philosophy of community, philosophy of religion and logic. His major works include The Religious Aspect of Philosophy (1885), The World and the Individual (1899-1901), The (...) Philosophy of Loyalty (1908), and The Problem of Christianity (1913). Royce's friendly but longstanding dispute with William James, known as "The Battle of the Absolute," deeply influenced both philosophers' thought. In his later works, Royce reconceived his metaphysics as an "absolute pragmatism" grounded in semiotics. This view dispenses with the Absolute Mind of previous idealism and instead characterizes reality as a universe of ideas or signs which occur in a process of being interpreted by an infinite community of minds. These minds, and the community they constitute, may themselves be understood as signs. Royce's ethics, philosophy of community, philosophy of religion, and logic reflect this metaphysical position. (shrink)

Of the philosophers in recent times who have striven to heal this rupture between head and heart perhaps none has caught the fancy or stirred the hopes of the American philosophical community as Alfred North Whitehead has. But since the master started this task too late in life, it was left to his disciples to complete his work. And of those disciples who have continued the master's healing in theology, perhaps none has been so energetic or resourceful as Professor Charles (...) Hartshorne. While Professor Hartshorne has usually practised this therapy alone and unaided, he has on one notable occasion enlisted the aid both of another contemporary theological therapist, Professor William L. Reese, and also of most of the great philosophers in history. The fruit of this collaboration, Philosophers Speak of God, while not adding anything essentially novel to Professor Hartshorne's earlier work, presents the physician not only as an isolated laboratory researcher but also, with Professor Reese's help, in the process of actually confronting and healing his patients. Hence this book is an especially interesting and valuable case study of one type of contemporary attempt to cure theological schizophrenia. Theological therapists are to be found among scientists as well as among philosophers, moreover, for even in science the intellect does not- succeed in quieting the restless heart until it finds the God for which that restless heart seeks. Going "through the world with a reverent attitude yet an almost total absence of doctrine or belief--with a religious heart and a skeptical head... is," as we are told in a recent book representing this theological therapy from the point of view of a scientist--a biologist and natural historian--Alexander F. Skutch's The Quest of the Divine, "a most unsatisfactory way to live.". (shrink)

Various laws and theories in the natural and social sciences are presented with a view to discerning the syntactic and semantic characteristics of many idealizations in science. Three different kinds of idealizations are discussed: ideal conditions, ideal cases, and idealized theories. An ideal condition is a formula in which state variables occur, whose existential closure is false, and for which there is another formula that can be constructed out of the original formula such that the existential closure of the new (...) formula is true. An ideal case is a statement which is logically equivalent to a universal conditional which has an ideal condition as its antecedent. And an idealized theory is a set of false universal conditional statements. Alternative syntactic and semantic analyses are viewed and criticized. (shrink)

We use evidence from cognitive psychology and the history of science to examine the issue of the theory-ladenness of perceptual observation. This evidence shows that perception is theory-laden, but that it is only strongly theory-laden when the perceptual evidence is ambiguous or degraded, or when it requires a difficult perceptual judgment. We argue that debates about the theory-ladenness issue have focused too narrowly on the issue of perceptual experience, and that a full account of the scientific process requires an examination (...) of theory-ladenness in attention, perception, data interpretation, data production, memory, and scientific communication. We conclude that the evidence for theory-ladenness does not lead to a relativist account of scientific knowledge. (shrink)

The goal of this chapter is to describe recollective memory and give an account of some of the characteristics of this form of human memory. I take recollective memory to be the type of memory that occurs when an individual recalls a specific episode from their past experience. I start with this very loose definition because a large part of this chapter consists of an attempt to work out a more detailed and analytic description of this form of memory.

In his Critique of Pure Reason, Kant makes the interesting, but obscure claim that the normative constraints that constitute the objectivity of our representations have their source ultimately in transcendental apperception. Keller focuses on this claim. He interprets Kant’s condition of transcendental apperception as the claim that I must represent myself in an impersonal way, and he argues that impersonal self-consciousness is a necessary condition under which I can distinguish my particular take on things from the way things are independently (...) of my own perspective on them. He elaborates his interpretation and defense of the condition of transcendental self-consciousness by discussing its role in each of the central arguments in the Critique in which the notion importantly figures: the transcendental deduction in both the first edition and in the second, the Analogies of Experience, the Paralogisms, and the second-edition refutation of idealism. (shrink)

Hegel's objection -- Is Kant's idealism subjective? -- An ambiguity in 'subjectivism' -- The epistemological problem -- The transcendental deduction of the categories and subjectivism -- Are Kant's categories subjective? -- Hegel's suspicion : Kantian critique and subjectivism -- What is kantian philosophical criticism? -- Hegel's suspicion : initial formulation -- A shallow suspicion? -- Deepening the suspicion : criticism, autonomy, and subjectivism -- Directions of response -- Critique and suspicion : unmasking the critical philosophy -- Hegel's transformation of critique (...) -- The rejection of Kantian critique : philosophy, skepticism, and the recovery of the ancient idea -- Hegel's epistemology in the shadow of Schelling -- Schulze's skepticism contra the critical philosophy -- Ancient versus modern skepticism : Hegel's difference -- Against the modern conception of rational cognition -- Against modern self-certainty -- The history of skepticism: decline into dogmatism -- Philosophy counter culture and time -- The return to Kantian critique : recognizing the rights of ordinary consciousness -- Two conceptions of philosophical critique -- The return to critique and the relation of philosophy to its history -- The rights of ordinary consciousness and the need for critique -- Critique as the realization of the science of metaphysics -- Hegel's self-transformational criticism -- Presuppositionless philosophy -- The problem of the criterion -- Self-transformational criticism -- The problem of the we' -- Our transformation -- Hegel's alternative model : critical transformation as self-realization. (shrink)

A brief discussion is offered of what it means to say that a set of statements provides D-N explanation with special emphasis given to approximative D-N explanation. An idealized theory is seen to provide approximative D-N explanation. An ideal case provides explanation only if postulates are offered which connect the ideal antecedent condition with actual conditions. Such postulates will help in accounting for deviations between what the consequent of the ideal case entails and what actually occurs. Three ways are presented (...) for deciding on the acceptability of idealizations: (i) as actual conditions more closely approximate the ideal antecedent conditions specified in an ideal case, the more closely actual cases ought to approximate the consequent of the ideal case; (ii) the additional postulates connecting ideal antecedent conditions with actual conditions ought to account for deviations between what is entailed by an idealized theory and what actually occurs; and (iii) an idealized theory is explained by a more general theory when certain state variables in the more general theory are given extreme values. It is argued that (iii) is not a necessary condition for the acceptability of idealizations. (shrink)

In this paper we provide a psychological account of the nature and development of explanation. We propose that an explanation is an account that provides a conceptual framework for a phenomenon that leads to a feeling of understanding in the reader/hearer. The explanatory conceptual framework goes beyond the original phenomenon, integrates diverse aspects of the world, and shows how the original phenomenon follows from the framework. We propose that explanations in everyday life are judged on the criteria of empirical accuracy, (...) scope, consistency, simplicity, and plausibility. We conclude that explanations in science are evaluated by the same criteria, plus those of precision, formalisms, and fruitfulness. We discuss several types of explanation that are used in everyday life – causal/mechanical, functional, and intentional. We present evidence to show that young children produce explanations that have the same essential form as those used by adults. We also provide evidence that children use the same evaluation criteria as adults, but may not apply those additional criteria for the evaluation of explanations that are used by scientists. (shrink)

Phenomenal reports were obtained immediately after participants retrieved information from long-term memory. Data were gathered for six basic forms of memory and for three forms of memory that asked for declarative information about procedural tasks . The data show consistent reports of mental imagery during retrieval of information from the generic perceptual, recollective, motor—declarative, rote—declarative, and cognitive—declarative categories; much less imagery was reported for the semantic, motor, rote, and cognitive categories. Overall, the data provide support for the theoretical framework outlined (...) in Brewer and Pani. (shrink)

The metamemory approach to memory confidence was extended and elaborated to deal with semantic memory tasks. The metamemory approach assumes that memory confidence is based on the products and processes of a completed memory task, as well as metamemory beliefs that individuals have about how their memory products and processes relate to memory accuracy. In two experiments participants were asked deceptive and nondeceptive questions involving geographical information. In both experiments, as predicted by the metamemory approach to memory confidence, there was (...) a positive confidence/ accuracy relationship for nondeceptive items and a negative relationship for deceptive items. Experiment 2 used items that constrained the memory strategies (e.g., hierarchical reasoning about spatial location) used by the participants. The results supported the hypothesis that the participants were aware of the levels of memory accuracy associated with the different strategies and used that information to generate their memory confidence judgments. (shrink)

The doctrine of divine simplicity, according to which God is devoid of physical or metaphysical complexity, is widely believed to be incoherent. I argue that although two prominent recent attempts to defend it fail, it can be defended against the charge of obvious incoherence. The defense rests on the isolation and rejection of a crucial assumption, namely, that no property is an individual. I argue that there is nothing in our ordinary concepts of property and individual to warrant the assumption, (...) and that once the assumption is rejected, the way is clear to viewing the divine attributes as self-exemplifying properties whose self-exemplification entails their identity with an individual. (shrink)

This article articulates and defends F. H. Bradley's regress argument against external relations using contemporary analytic techniques and conceptuality. Bradley's argument is usually quickly dismissed as if it were beneath serious consideration. But I shall maintain that Bradley's argument, suitably reconstructed, is a powerful argument, plausibly premised, and free of such obvious fallacies as petitio principii. Thus it does not rest on the question‐begging assumption that all relations are internal, as Russell, and more recently van Inwagen, maintain. Bradley does not (...) attack external relations in order to affirm a doctrine of internal relations, and his monism is not derived from the internality of all relations, but from the self‐contradictory nature of all relations. For Bradley, it is the “relational situation”as such that is ontologically defective. (shrink)

This highly readable book offers a contemporary interpretation of the political thought of Edmund Burke, drawing on his experiences to illuminate and address fundamental questions of politics and society that are of particular interest today. For Burke, one’s imaginative context provides meaning and is central to judgment and behavior. Many of Burke’s ideas can be brought together around his concept of the “moral imagination,” which has received little systematic treatment in the context of Burke’s own experience. In _Edmund Burke for (...) Our Time_, Byrne asserts that Burke’s politics is reflective of unique and sophisticated ideas about how people think and learn and about determinants of political behavior. Burke’s thought is shown to offer much of contemporary value regarding the sources of order and meaning and the potential for a modern crisis if those sources are weakened or obscured. In addition to providing a re-interpretation of Burke’s response to a number of historical situations—including problems of colonial or imperial policy with regard to India, Ireland, and America—Byrne looks at the relationship between emotion and reason, and the role of culture in shaping political, social, and personal behaviors. To assist even readers with limited knowledge of Burke, the book includes biographical and historical information to provide needed context. Byrne’s important study will appeal to political philosophers, literature scholars, and those interested in addressing problems of politics and society in this late-modern age. (shrink)

In Divine Providence, Swedish visionary Emanuel Swedenborg describes how God works in our lives to turn us away from evil and toward him while still allow us to make our own choices. Swedenborg addresses a number of questions that challenge people of faith, such as why accidents and disasters happen, and why evil people seem to prosper while others suffer. This edition is a reprint of a 1963 translation by William F. Wunsch.

A discussion of Christian ethics focuses on the physician's image as a parent, warrior against death, expert, and teacher, and the oath that guides his or her practice.

Charity is not only about giving to those in need, but in a broader sense about loving your neighbor and doing good things for other people without thought of reward. So wrote Swedish visionary Emanuel Swedenborg, who believed that charity, along with faiths, was part of the foundation of spiritual practice. This work combines two of Swedenborg's unpublished manuscripts to form a practical, inspirational handbook for appying the principle of doing good to daily life.