There seems no good reason for doctors to work in secret. Individual users of healthcare and the community in general, which ultimately bears the cost, are perfectly entitled to know how their health services and health providers are performing. The promulgation of surgical report cards has been hailed by some as a liberating step in the right direction. This paper seeks to analyse, from a clinician’s perspective, the evolution and limitations of report cards. Ultimately, the importance of report cards will (...) not be their immediate utility, which is minimal, but as a first step in a much wider and far more important debate about how we meaningfully measure the quality of health services and providers (including managers and bureaucrats), the likely cost of such an enterprise, how much we are willing and able to pay and how we reconcile the competing needs of information versus clinical and preventive care when all are competing for the same and inadequate pool of resources. (shrink)

The dictum ‘“ought” implies “can”’ has a status in moral philosophy in some respects like that of ‘a good player needs good co-ordination’ in talk about ball-games. Clearly, you say something important but not conclusive about proficiency in playing a ball-game when you say that it requires good co-ordination: similarly, you say something important but not conclusive about obligation when you say that it implies a certain possibility or power or ability. Each dictum is a reminder: the one about such (...) courses of physical instruction, the other about such exhortations to duty, as are worth persevering with. It would be hopeless to keep on teaching a boy the moves and tricks of rugby football if he could never co-ordinate well enough to get his eye in, so to speak. Correspondingly, it would be meaningless to recommend that someone ought to do something the specification of which involved a contradiction, and pointless to suggest that he ought to do something which, for quite general reasons, was not, and was certain to remain not, within his power. So each dictum expresses a bluff, no-nonsense wisdom which we should count on before involving ourselves in certain more detailed commitments. But probably this is as far as the comparison between the two sayings can well be taken. (shrink)

In spite of a powerful tradition, more than two thousand years old, that in a valid argument the premises must be relevant to the conclusion, twentieth-century logicians neglected the concept of relevance until the publication of Volume I of this monumental work. Since that time relevance logic has achieved an important place in the field of philosophy: Volume II of Entailment brings to a conclusion a powerful and authoritative presentation of the subject by most of the top people working in (...) the area. Originally the aim of Volume II was simply to cover certain topics not treated in the first volume--quantification, for example--or to extend the coverage of certain topics, such as semantics. However, because of the technical progress that has occurred since the publication of the first volume, Volume II now includes other material. The book contains the work of Alasdair Urquhart, who has shown that the principal sentential systems of relevance logic are undecidable, and of Kit Fine, who has demonstrated that, although the first-order systems are incomplete with respect to the conjectured constant domain semantics, they are still complete with respect to a semantics based on "arbitrary objects." Also presented is important work by the other contributing authors, who are Daniel Cohen, Steven Giambrone, Dorothy L. Grover, Anil Gupta, Glen Helman, Errol P. Martin, Michael A. McRobbie, and Stuart Shapiro. Robert G. Wolf's bibliography of 3000 items is a valuable addition to the volume. (shrink)

This paper examines three medical student poems about death to explore how medical students use poetry to understand their encounters with dying patients and to discuss how these poems function as elegies in the context of medical culture.

'Working Memory, Thought, and Action' is the magnum opus of one of the most influential cognitive psychologists of the past 50 years. This new volume on the model he created discusses the developments that have occurred within the model in the past twenty years, and places it within a broader context.

I propose to consider the question, "Can machines think?" This should begin with definitions of the meaning of the terms "machine" and "think." The definitions might be framed so as to reflect so far as possible the normal use of the words, but this attitude is dangerous, If the meaning of the words "machine" and "think" are to be found by examining how they are commonly used it is difficult to escape the conclusion that the meaning and the answer to (...) the question, "Can machines think?" is to be sought in a statistical survey such as a Gallup poll. But this is absurd. Instead of attempting such a definition I shall replace the question by another, which is closely related to it and is expressed in relatively unambiguous words. The new form of the problem can be described in terms of a game which we call the 'imitation game." It is played with three people, a man (A), a woman (B), and an interrogator (C) who may be of either sex. The interrogator stays in a room apart front the other two. The object of the game for the interrogator is to determine which of the other two is the man and which is the woman. He knows them by labels X and Y, and at the end of the game he says either "X is A and Y is B" or "X is B and Y is A." The interrogator is allowed to put questions to A and B. We now ask the question, "What will happen when a machine takes the part of A in this game?" Will the interrogator decide wrongly as often when the game is played like this as he does when the game is played between a man and a woman? These questions replace our original, "Can machines think?". (shrink)

In recent decades, scholars have come to see 1 Corinthians as a rhetorically unified response to the problem of divisions among Corinthian believers. This essay explores the ways in which Paul presents the cross as the organizing principle that can bind together three different forms of community division: the cult of the personality ; the freedom to eat idol meat ; and economic disparities when gathered for a meal. In each case, Paul appeals implicitly or explicitly to the cross as (...) a remedy for the all-too-familiar strains on the fractured community. In the end, Paul’s countercultural message about the cross offers a word of exhortation for the American church today, as it navigates a society that shares much in common with first-century Corinth. (shrink)

The author argues that the fourth-century philosophers used protreptic discourses to market philosophical practices and to define and legitimize the school of higher learning.

BackgroundChildhood abuse increases risk for high levels of distress in response to future stressors. Interpersonal social support is protective for health, particularly during stress, and may be particularly beneficial for individuals who experienced childhood abuse.ObjectiveInvestigate whether childhood abuse predicts levels of posttraumatic stress disorder (PTSD) symptoms related to the COVID-19 pandemic, and test whether the perceived availability of social companionship preceding the pandemic moderates this relationship.MethodsDuring Phase 1, adults (N= 120; AgeM[SD] = 19.4 [0.94]) completed a retrospective measure of childhood (...) adversity along with a measure of perceived availability of opportunities for social engagement immediately preceding the pandemic. Two weeks after the COVID-19 pandemic declaration, participants completed the Impact of Event Scale-Revised (IES-R) with respect to the pandemic. Hierarchical linear regression analyses examined the interaction between childhood abuse and the perceived availability of social companionship preceding the pandemic as a predictor of PTSD symptoms.ResultsAdjusting for covariates, the interaction between childhood abuse and perceived availability of others to engage with before the onset of the pandemic was a significant predictor of IES-hyperarousal (β = −0.19,t= −2.06,p= 0.04, ΔR2= 0.032, CI: [−0.31 to −0.01]).ConclusionLevels of perceived opportunities for social companionship before the pandemic associates with levels of hyperarousal related to the pandemic, particularly for individuals who experienced high levels of childhood abuse. More research is needed to understand how to mitigate the higher levels of distress related to the pandemic for these individuals in order to reduce risk for future psychiatric disorders. (shrink)

This essay deals with plague and plagues in renaissance and early modern Europe over the longue durée, principally from a methodological perspective. I shall combine an historiographical approach with an historical account of developing reactions to plague and in passing compare measures to cope in the early sixteenth century with reactions to the impact of the Great Pox or the Mal de Naples. I shall concentrate on southern Europe and in particular on Italy and my aim is to re-assess the (...) historiography of plague through the lens of some of the more recent Anglo-Saxon literature in this field. In the process I shall outline some of the debates within the field and end with some general methodological observations drawn from early modern Italy. (shrink)

“I am not mad, most noble Festus, but speak the words of truth and soberness.” In this cry of Paul's we hear the idealist in all ages making his agonized claim to realism in face of the Powers that Be. Festus and Agrippa represent the ex-officio history-makers in this scene. Paul is proclaiming fundamental facts and possibilities that those who have power fail to see. And so, in claiming to be sane, he becomes the spokesman for all who see the (...) Not-Yet as stronger than the Now, and behold What is Meant to Be as more powerful than What Is. (shrink)

He upon whom has descended the “amor intellectualis Dei” must make up his mind to walk much alone. In the world of “intellectuals” he is at present “out of the swim,” and his work must be done against the prevailing current. And among the generality of religious people, he is regarded as rather a disturbing presence in matters of faith, apt to fall short, apparently, of their own standards in the service of God. “The love of the mind for God” (...) has little popular esteem in English-speaking Christianity. The nineteenth century valued feeling as the chief element in religion, and the emphasis of to-day is on the practical service of the will. But in our tradition, from Colet and the Cambridge Platonists to Westcott and von Hiigel, the “amor intellectualis Dei” has produced a line of great men of God, and surely will never be without its witnesses. Their message is a two-fold one. First that every experience of life can be “produced” into an experience of God by an effort of personality in which creative thought and constructive imagination has its part, second that this “love of the mind” is natural in some degree to all men, and an end in itself, giving to each lover an original vision. “It is Origen,” writes Dean Inge, “who in words thrilling alike by their humility and confidence, proclaims that ‘as the eye seeks the light, as our body craves for food, so our mind is impressed with the natural desire of knowing the truth of God and the causes of what we observe.’”. (shrink)

Doctors’ survival predictions for terminally ill patients have been shown to be inaccurate and there has been an argument for less guesswork and more use of carefully constructed statistical indices. As statisticians, the authors are less confident in the predictive value of statistical models and indices for individual survival times. This paper discusses and illustrates a variety of measures which can be used to summarise predictive information available from a statistical model. The authors argue that models and statistical indices can (...) be useful at the group or population level, but that human survival is so uncertain that even the best statistical analysis cannot provide single-number predictions of real use for individual patients. (shrink)

The rapid adoption and implementation of artificial intelligence in medicine creates an ontologically distinct situation from prior care models. There are both potential advantages and disadvantages with such technology in advancing the interests of patients, with resultant ontological and epistemic concerns for physicians and patients relating to the instatiation of AI as a dependent, semi- or fully-autonomous agent in the encounter. The concept of libertarian paternalism potentially exercised by AI (and those who control it) has created challenges to conventional assessments (...) of patient and physician autonomy. The unclear legal relationship between AI and its users cannot be settled presently, an progress in AI and its implementation in patient care will necessitate an iterative discourse to preserve humanitarian concerns in future models of care. This paper proposes that physicians should neither uncritically accept nor unreasonably resist developments in AI but must actively engage and contribute to the discourse, since AI will affect their roles and the nature of their work. One’s moral imaginative capacity must be engaged in the questions of beneficence, autonomy, and justice of AI and whether its integration in healthcare has the potential to augment or interfere with the ends of medical practice. (shrink)

Potts (2005) and many subsequent works have argued that the semantic content of appositive (non-restrictive) relative clauses, e.g., the underlined material in John, who nearly killed a woman with his car, visited her in the hospital, must be in some way separate from the content of the rest of the sentence, i.e., from at-issue content. At the same time, there is mounting evidence from various anaphoric processes that the two kinds of content must be integrated into a single, incrementally evolving (...) semantic representation. The challenge is how to reconcile this informational separation with these pervasive anaphoric connections. We propose a dynamic semantic account that accomplishes this by taking appositive and at-issue content to involve two different kinds of updates to the Context Set (CS). Treating the context set as a distinguished propositional variable, pcs, we argue that appositives directly impose their content on the CS by eliminating possible values assigned to pcs. In contrast, we treat at-issue assertions as introducing a new propositional dref and proposing that pcs be updated with its content, subject to addressee's response. In addition to capturing the behavior of appositives in discourse, we show that the account can be extended to capture the projection of appositive content past various sentential operators. (shrink)

Co-published with the University of Queensland Press. HPC holds rights in North America and U. S. Dependencies. Since its first publication in 1976, Alan Chalmers's highly regarded and widely read work--translated into eighteen languages--has become a classic introduction to the scientific method, known for its accessibility to beginners and its value as a resource for advanced students and scholars. In addition to overall improvements and updates inspired by Chalmers's experience as a teacher, comments from his readers, and recent developments (...) in the field, this fourth edition features an extensive chapter-long postscript that draws on his research into the history of atomism to illustrate important themes in the philosophy of science. Identifying the qualitative difference between knowledge of atoms as it figures in contemporary science and metaphysical speculations about atoms common in philosophy since the time of Democritus offers a revealing and instructive way to address the question at the heart of this groundbreaking work: What is this thing called science? (shrink)

ABSTRACT:What more can be said about COVID-19 and the social determinants of health? This article describes neglected perspectives that derive from the history of social epidemiology, a field that identifies the social etiology of disease and variations in disease incidence among people differentially located in the social structure. The "discovery" of social determinants of diseases like COVID-19 is nothing new for epidemiology: debate over how to analyze structural determinants versus individual-level risk factors persisted throughout the 19th and 20th centuries. By (...) the late 20th century, research had highlighted fundamental causes of health disparities, such as social conditions and structural racism; these are structural factors, embedded in the social fabric of life. Measurement of structured inequalities within systems faces complex and challenging problems, as research aims to better account for these lived realities at different levels of analysis and as multiple factors merge to influence outcomes (revealed in intersectionality theory). At each of these intersections, there are opportunities for bioethicists to consider their ethical implications. It is imperative to understand the social and ethical roots of our present conversations about health inequalities, in order to partner intelligently with researchers on the forefront of advocating for change. (shrink)

The word “beautiful” plays a surprisingly unimportant part in the language of sophisticated artistic appreciation; I mean in the informed criticism and comparison of specific works of art. Though in ordinary conversation it can be used naturally and easily, it does not serve readily as a technical term in expert writing or discussion. To become a technical term of this kind it would have to be definable, and definable in terms which commanded sufficient agreement: but attempts to define “beauty” and (...) “beautiful” may well have become restrained by the popularity of philosophical discussion about the significance of these words. No philosophical question is discussed more commonly or from more firmly held opposite positions than the question whether beauty is “objective” or not. Discussion of this and related topics, however, not being the monopoly of professed philosophers but being familiar amongst artists and art critics themselves, tends to remove all shadow of technicality from the crucial terms discussed. Other terms come to serve for the “objective” features of works of art, and others again for the impressions which works of art may make upon us: “beauty” and “beautiful” tend to fall away between these two classes. (shrink)

I want to explore the possibility of an a posteriori approach to the elucidation of certain moral notions. These are: (a) the notion of a duty, some specific thing which it is incumbent on me to do, and (b) the notion of something that is a good thing for me to do. I want to consider these notions, so far as I can, independently of rules. There is a certain sense in which having a duty to do this or that (...) is a function of circumstances, and in which this or that's being a good thing to do is likewise a function of circumstances. I shall suggest specific examples in which this is a conspicuous feature of ‘my duty’ or of what I can, beneficially, do. In these examples what I ought to do, and what it is good to do, can be represented as special ways in which what I am to do presents itself. (shrink)

In the course of his life a man surrounds himself with questions, much as he surrounds himself with furniture, books or pictures. Personality is expressed not only by the selection of a Chippendale chair, the amassing of early colour-plate books, or the purchase of a Renoir, but also by the kind of questions which a man “collects”-raises, without necessarily solving. Some questions, like some books, are to be brooded over and studied; some are introduced only to be contemplated from time (...) to time, like fine bindings; and some occur so casually as hardly to rouse any attention at all. There is an obvious difference between a man who bids carefully at a book auction or forces himself on to his knees to identify a dust-covered quarto in a slum bookshop, and a man whose library is inherited from parents or grandparents; acceptances and not choices will distinguish the casual possessor from the bookman. Similarly, there are many questions which sit lightly on a man's mind, which are as little the object of sustained wondering or bafflement as his ancestors” well bound volumes of theology or game-shooting are the reflection of his own tastes or interests. These may be questions of any sort: they may be factual questions, important or trivial, or they may be theoretical questions, philosophical perhaps, or religious or scientific. A student of literature, for instance, has been known to congratulate himself on his ignorance of modern science, ignorance so deliberate that any scientific question raised in his presence fails even to make him wonder. For any person, however, there are ranges of questions which barely touch his mind: he may be aware that he does not know how to derive answers to them for himself, but his inability will not cause him concern. The memory, the practical or the reasoning skill of the kind that would be required are perhaps so much out of proportion to what he possesses that to bemoan the lack of them is unrealistic -as it is often idle and merely conventional for one who is tone-deaf to say how much he wishes he could sing an aria . Other questions altogether, important or trivial, he takes seriously and troubles to answer, because they touch his own special interests directly: he may pride himself on never neglecting a newspaper problem in bridge or chess, or he may never fail to answer correctly a question about the construction of some instrument or machine. The same person, however, will also get the length of raising many questions which remain mere questions. He may be troubled and puzzled about certain political or social question which circumstances do not compel him to answer: but he will not be hypocritical in professing an interest in them. Some of these questions, of course, may become solved after a fashion, if he listens to the voice of politician, statistician, priest or psychologist and is lucky enough to get an answer which satisfies him. But many will survive with just enough recurrences of wondering about them to make them, as you might say, chronic. This is the intermediate class of questions. (shrink)