Unrepresented patients lack the capacity to make medical decisions for themselves, have no clear documentation of preferences for medical treatment, and have no surrogate decision maker or obvious candidate for that role. There is no consensus about who should serve as the decision maker for these patients, particularly regarding whether to continue or to limit life-sustaining treatment. Several authors have argued that ethics committees should play this role rather than the patient's treating physician, a common current default. We argue that (...) concerns about the adequacy of physicians as surrogates are either empirically unfounded or apply equally to ethics committees. We suggest that physicians should be the primary decision maker for the unrepresented because of their fiduciary duties toward their patients. As part of the process of fulfilling these duties, they should seek the advice of third parties such as ethic committees; but final end-of-life decision-making for the unrepresented should rest with the treating physician. (shrink)

In June 2015, the major North American and European critical care societies released new joint guidelines that delineate a process-based approach to resolving intractable conflicts over the appropriateness of providing or continuing LST.2 This article frames the new guidelines within the history, ethical arguments, legal landscape, and empirical evidence regarding limitation of LST without surrogate consent in cases of intractable conflict.

Systematic study of the intersection of ethics consultation services and solid organ transplants and recipients can identify and illustrate ethical issues that arise in the clinical care of these patients, including challenges beyond resource allocation. This was a single-centre, retrospective cohort study of all adult ethics consultations between January 1, 2007, and December 31, 2017, at a large academic medical centre in the north-eastern United States. Of the 880 ethics consultations, sixty (6.8 per cent ) involved solid organ transplant, thirty-nine (...) (65.0 per cent) for candidates and twenty-one (35.0 per cent ) for recipients. Ethics consultations were requested for 4.3 per cent of heart, 4.9 per cent of lung, 0.3 per cent of liver, and 0.3 per cent of kidney transplant recipients over the study period. Nurses were more likely to request ethics consultations for recipients than physicians (80.0 per cent vs 20.0 per cent, p = 0.006). The most common reason for consultation among transplant candidates was discussion about intensity of treatment or goals of care after the patient was not or was no longer a transplant candidate. The most common reason for ethics consultation among transplant recipients was disagreement between transplant providers and patients/families/non-transplant healthcare professionals over the appropriate intensity of treatment for recipients. Very few consultations involved questions about appropriate resource allocation. Ethics consultants involved in these cases most often navigated communication challenges between transplant and non-transplant healthcare professionals and patients and families. (shrink)

Critical care society guidelines recommend that ethics committees mediate intractable conflict over potentially inappropriate treatment, including Do Not Resuscitate status. There are, however, limited data on cases and circumstances in which ethics consultants recommend not offering cardiopulmonary resuscitation despite patient or surrogate requests and whether physicians follow these recommendations. This was a retrospective cohort of all adult patients at a large academic medical center for whom an ethics consult was requested for disagreement over DNR status. Patient demographic predictors of ethics (...) consult outcomes were analyzed. In 42 of the 116 cases, the patient or surrogate agreed to the clinician recommended DNR order following ethics consultation. In 72 of 74 of the remaining cases, ethics consultants recommended not offering CPR. Physicians went on to write a DNR order without patient/surrogate consent in 57 of those cases. There were no significant differences in age, race/ethnicity, country of origin, or functional status between patients where a DNR order was and was not placed without consent. Physicians were more likely to place a DNR order for patients believed to be imminently dying. The median time from DNR order to death was 4 days with a 90-day mortality of 88.2%. In this single-center cohort study, there was no evidence that patient demographic factors affected ethics consultants’ recommendation to withhold CPR despite patient/surrogate requests. Physicians were most likely to place a DNR order without consent for imminently dying patients. (shrink)

The lung allocation score system in the United States and several European countries gives more weight to risk of death without transplantation than to survival following transplantation. As a result, centers transplant sicker patients, leading to increased length of initial hospitalization. The care of patients who have accumulated functional deficits or additional organ dysfunction during their prolonged stay can be ethically complex. Disagreement occurs between the transplant team, patients and families, and non-transplant health care professionals over the burdens of ongoing (...) intensive intervention. These cases highlight important ethical issues in organ transplantation, including the nature and requirements of transplant informed consent, the limits of physician prognostication, patient autonomy and decision-making capacity following transplant, obligations to organ donors and to other potential recipients, and the impact of program metrics on individualized recipient care. We outline general ethical principles for the care of lung transplant recipients with prolonged hospitalization and give regulatory, research, and patient-centered recommendations for these cases. (shrink)

In 2015, the major critical care societies issued guidelines outlining a procedural approach to resolving intractable conflict between healthcare professionals and surrogates over life-sustaining treatments (LST). We report our experience with a resolving conflict procedure. This was a retrospective, single-centre cohort study of ethics consultations involving intractable conflict over LST. The resolving conflict process was initiated eleven times for ten patients over 2,015 ethics consultations from 2000 to 2020. In all cases, the ethics committee recommended withdrawal of the contested LST. (...) In seven cases, the patient died or was transferred or a legal injunction was obtained before completion of the process. In the four cases in which LST was withdrawn, the time from ethics consultation to withdrawal of LST was 24.8 ± 12.2 days. Healthcare provider and surrogate were often distressed during the process, sometimes resulting in escalation of conflict and legal action. In some cases, however, surrogates appeared relieved that they did not have to make the final decision regarding LST. Challenges regarding implementation included the time needed for process completion and limited usefulness in emergent situations. Although it is feasible to implement a due process approach to conflict over LST, there are factors that limit the procedure’s usefulness. (shrink)

Adorno: A Critical Reader presents a collection of new essays by many of the world's top critics that examine Adorno's lasting impact on the arts, politics, history, philosophy, psychoanalysis, and sociology.

In Democracy and the Claims of Nature, the leading thinkers in the fields of environmental, political, and social theory come together to discuss the tensions and sympathies of democratic ideals and environmental values. The prominent contributors reflect upon where we stand in our understanding of the relationship between democracy and the claims of nature. Democracy and the Claims of Nature bridges the gap between the often competing ideals of the two fields, leading to a greater understanding of each for the (...) other. (shrink)

Alasdair MacIntyre’s critique of managerial capitalism is well known, with some arguing that MacIntyrean thought is antithetical to contemporary capitalist business. Nevertheless, substantial efforts have been taken to demonstrate how different business activities constitute MacIntyrean practices, which points to an incoherence at the heart of MacIntyrean business ethics scholarship. This article proposes a way of bridging these perspectives, suggesting a reimagined MacIntyrean approach to business that is thoroughly ‘practice-led.’ A detailed comparison of accounting and management shows that while neither are (...) practices in ‘good order,’ they differ in significant ways: where management does not meet the criteria for a MacIntyrean practice, accounting is a ‘distorted’ practice. This leads to a categorisation of practice-led business activity, whereby the traditional tasks of management are subsumed, shared or subordinated to practices and practitioners. Insights on how this can be implemented are drawn from the ‘communities of practice’ literature and a consideration of professions. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Deification through the Cross:Reflections from an Implied Ideal WorshiperAndrew J. SummersonKhaled Anatolios's most recent book, Deification through the Cross,1 develops a definition of salvation out of his experience of the Byzantine liturgy. This experience of worship offers an immersion in what he calls "doxological contrition." By this, Anatolios means that Christ saves us by offering us the ability to participate in the mutual glorification of the persons of the (...) Holy Trinity by vicariously repenting for our sins. For Anatolios, this objective content is subjectively appropriated in Byzantine Christian worship. To explore this theme, Anatolios develops a working account of "doxological contrition" through a synthetic discussion of the Lenten Triodion and Pentecostarion, books of liturgical hymnography that govern the Byzantine worship from Lent to Pentecost. Anatolios derives his approach from the adaption of reader response theory, which aims to expose the effect a text should have on the "implied ideal reader." As such, his account speaks from the perspective of the "implied ideal worshiper"—presumably a theologically educated congregant who can seize these themes that evaporate into the ether as quickly as incense swung throughout the church during the services.Let me say from the outset, I heartily recommend Anatolios's book. It is both an ambitious work and a rewarding read. Ambitious because Anatolios's approach makes otherwise fragmented theological disciplines—liturgical [End Page 1089] studies, Scripture, historical theology, and systematics—fruitful dialogue partners in his exposition of a working account of the Christian experience of salvation. Rewarding because the reader can explore in depth the touchstones of the Christian tradition through Anatolios's deep retrieval of a more coherent soteriology. Deification of the Cross demonstrates the perennial value of historical theology to correctly account for the "half-forgotten, half misunderstood" details of the Christian tradition in the face of caricatures that at best misrepresent and at worst present an idolatrous, counterfeit Christianity.Eastern Christian Liturgy and RevelationPerhaps I am not Anatolios's ideal audience; I may be too close to the source material and lack objectivity. That aside, the bulk of my reflections on this book comes from the perspective of an "implied ideal worshiper." I do share some of Anatolios starting points. Like Anatolios, I am a convert, scholar, and Eastern Catholic priest. Furthermore, I also share the discontent with which Anatolios begins his book, though perhaps for different reasons. He bemoans a loss of the experience of salvation. My own vocation as priest and scholar comes out of a frustrated wonder. As a college student, I set out to learn about this Church and its Tradition. I learned about the Sunday experience I was supposed be having. It was in university when I read for the first time John Paul II's 1995 apostolic letter Orientale Lumen, written to acquaint the wider Catholic Church with the riches of the Christian East. John Paul II dedicated much reflection to the "genius of Eastern liturgy," emphasizing its power to envelop all our human senses into the fullness of the mystery of God. It is worth quoting in full:Within this framework, liturgical prayer in the East shows a great aptitude for involving the human person in his or her totality: the mystery is sung in the loftiness of its content, but also in the warmth of the sentiments it awakens in the heart of redeemed humanity. In the sacred act, even bodiliness is summoned to praise, and beauty, which in the East is one of the best loved names expressing the divine harmony and the model of humanity transfigured, appears everywhere: in the shape of the church, in the sounds, in the colors, in the lights, in the scents. The lengthy duration of the celebrations, the repeated invocations, everything expresses gradual identification with the mystery celebrated with one's whole person. Thus the prayer of the Church already becomes participation in the heavenly liturgy, an anticipation of the final beatitude.(§11) [End Page 1090]The experience of this liturgy has been quite potent throughout history. It led to the baptism of the entire kingdom of Rus' in 988 AD. As the story goes, its ruler, Vladimir the Great, sent emissaries to find a... (shrink)

Detailed studies of people who have experienced the Capgras delusion (the delusion that certain other people, usually close relatives, have been replaced by impostors) have led to advances in constructing an account which can deal with the basic symptomatology, testing alternative possibilities, generating and testing non‐trivial predictions, and broadening the scope of the basic account to encompass other delusions. This paper outlines these developments. It uses them to explore implications for understanding the formation and maintenance of beliefs, and to discuss (...) basic principles of what has come to be known as cognitive neuropsychiatry. (shrink)

Central to Spinoza’s ethical theory is a model of human nature: the model of the free man. In this paper I argue that the idea of the free man is an inadequate idea when this is understood as the idea of a perfectly free finite thing. But when properly understood--that is, when the idea of the free man is understood as the idea of the perfection of our nature and power--the idea of the free man is a way of conceiving (...) God and is, as such, an adequate idea. (shrink)

According to a widely accepted reading of the "Ethics," Spinoza subscribes to a desire-satisfaction theory of value. A desire-satisfaction theory says that what has value is the satisfaction of one’s desires and whatever leads to the satisfaction of one’s desires. In this paper I argue that this standard reading is incorrect, and I show that in Spinoza’s view the foundation of what is truly valuable is the perfection of a person’s essence, not the satisfaction of a person’s desires.

An array of new cases of lies is presented in support of the idea that lying does not require an intention to be deceptive. The crucial feature of these cases is that the agents who lie have some sort of motivation to lie alternative to an intention to be deceptive. Such alternative motivation comes in multiple varieties, such that we should think that the possibility of lying without an intention to be deceptive is common.

Distributivism holds that private property should be widely distributed among as many as possible and that such a distribution best serves the common good. This paper applies a distributist approach rooted in subsidiarity to the contemporary issue of the unaffordability of single-family homes and the impact of investors buying up more single-family homes, increasing their own wealth at the expense of typical home buyers. Here, we will first consider multiple factors in the housing “crisis,” then highlight the impact of investors (...) on the market. Second, we will consider a critique and analysis of the situation from a distributist perspective, rooted in principles of private property, solidarity, dignity, and subsidiarity (particularly turning to G.K. Chesterton's view on the importance of home). Due consideration is given to some objections to such a distributist critique, with response. Finally, several examples of proposals and implemented practices are provided to discourage this growing trend concerning the concentration of ownership of housing by investors and to better enable homeownership by families. (shrink)

Andrew Sayer undertakes a fundamental critique of social science's difficulties in acknowledging that people's relation to the world is one of concern. As sentient beings, capable of flourishing and suffering, and particularly vulnerable to how others treat us, our view of the world is substantially evaluative. Yet modernist ways of thinking encourage the common but extraordinary belief that values are beyond reason, and merely subjective or matters of convention, with little or nothing to do with the kind of beings (...) people are, the quality of their social relations, their material circumstances or well-being. The author shows how social theory and philosophy need to change to reflect the complexity of everyday ethical concerns and the importance people attach to dignity. He argues for a robustly critical social science that explains and evaluates social life from the standpoint of human flourishing. (shrink)

In their account of theory change in logic, Aberdein and Read distinguish 'glorious' from 'inglorious' revolutions--only the former preserves all 'the key components of a theory' [1]. A widespread view, expressed in these terms, is that empirical science characteristically exhibits inglorious revolutions but that revolutions in mathematics are at most glorious [2]. Here are three possible responses: 0. Accept that empirical science and mathematics are methodologically discontinuous; 1. Argue that mathematics can exhibit inglorious revolutions; 2. Deny that inglorious revolutions are (...) characteristic of science. Where Aberdein and Read take option 1, option 2 is preferred by Mizrahi [3]. This paper seeks to resolve this disagreement through consideration of some putative mathematical revolutions. [1] Andrew Aberdein and Stephen Read, The philosophy of alternative logics, The Development of Modern Logic (Leila Haaparanta, ed.), Oxford University Press, Oxford, 2009, pp. 613-723. [2] Donald Gillies (ed.), Revolutions in Mathematics, Oxford University Press, Oxford, 1992. [3] Moti Mizrahi, Kuhn's incommensurability thesis: What's the argument?, Social Epistemology 29 (2015), no. 4, 361-378. (shrink)

Evidence has accumulated that rod activation under mesopic and scotopic light levels alters visual perception and performance. Here we review the most recent developments in the measurement of rod and cone contributions to mesopic color perception and temporal processing, with a focus on data measured using the four-primary photostimulator method that independently controls rod and cone excitations. We discuss the findings in the context of rod inputs to the three primary retinogeniculate pathways to understand rod contributions to mesopic vision. Additionally, (...) we present evidence that hue perception is possible under scotopic, pure rod-mediated conditions that involves cortical mechanisms. (shrink)

In Part 4 of his "Ethics," Spinoza puts forward and defends what might appear to be the controversial Hobbesean thesis that the desire to prolong one’s life is the basis of virtue (i.e., E4p22). Indeed there is a tradition of commentators offering an egoistic, Hobbesean interpretation of Spinoza’s ethical theory. In this paper, however, I argue that we should not understand Spinozistic self-preservation in the commonsense, empiricist sense of prolonging our lives. Instead I argue that, for Spinoza, self-preservation is a (...) matter of perfection-preservation and perfection-enhancement, which does not essentially involve extending the duration of an individual’s existence. (shrink)

The social sciences, and particularly economics, play an important role in business. This article reviews the account of the interdisciplinary conversation between Catholic Social Teaching and the social sciences (especially economics) over the last century, and describes Benedict XVI’s development of this account in Caritas in Veritate . Over time the popes recognized that the technical approach of economics was a barrier to fruitful collaboration between economics and Catholic Social Teaching, both because the economic approach is reductionist, and because modern (...) social science is skeptical of comprehensive accounts of human nature. Through an appeal to charity in truth, one can deduce from Caritas in Veritate that economists, along with business and management theorists, need to take seriously the project of reflecting on and promoting true human goods in society. To love the person one must reflect on what is truly good for the person; to discover the true good of the person, one must love the person. (shrink)

The influence that philosophy of science has had on scientific practice is as controversial as it is undeniable, especially in the case of biology. The dynamic between philosophy and biology as disciplines has developed along two different lines that can be characterized as 'paternal', on the one hand, and more 'fraternal', on the other. The role Popperian principles of demarcation and falsifiability have played in both the systematics community as well as the ongoing evolution-creation debates illustrate these contrasting forms of (...) interdisciplinary engagement, underscoring the influence philosophy of science in shaping our contemporary understanding of biology in the North American context. However, a strict disciplinary distinction between philosophy and science may itself be a false dichotomy that risks hampering future development of the biological sciences. By actively engaging with philosophical considerations as an integral part of their scientific practice, nineteenth-century biologists offer an interesting counterpoint to current trends of overspecialization and provide a model of scientists who avoided extremes of antagonism with, or subservience to, philosophy. (shrink)

Why we get the world wrong -- Intuitive theories of the physical world -- Matter : what is the world made of? How do those components interact? -- Energy : what makes something hot? What makes something loud? -- Gravity : what makes something heavy? What makes something fall? -- Motion : what makes objects move? What paths do moving objects take? -- Cosmos : what is the shape of our world? What is its place in the cosmos? -- Earth (...) : why do continents drift? Why do climates change? -- Intuitive theories of the biological world -- Life : what makes us alive? What causes us to die? -- Growth : why do we grow bigger? Why do we grow older? -- Inheritance : why do we resemble our parents? Where did we get our traits? -- Illness : what makes us ill? How does illness spread? -- Adaptation : why are there so many lifeforms? How do they change over time? -- Ancestry : where do species come from? How are they related? -- How to get the world right. (shrink)

Virtue-based approaches have attracted significant recent interest in argumentation, including a recent anthology of Chinese translations of important articles in the field. In this article, adapted from the introduction to that anthology, we discuss the origins of virtue argumentation and some of the challenges it has faced, as well as attempt to provide an overview of recent work on the virtues and vices relevant to argumentation. In the final section we discuss the articles that were selected and motivate their selection.

Few automated legal reasoning systems have been developed in domains of law in which a judicial decision maker has extensive discretion in the exercise of his or her powers. Discretionary domains challenge existing artificial intelligence paradigms because models of judicial reasoning are difficult, if not impossible to specify. We argue that judicial discretion adds to the characterisation of law as open textured in a way which has not been addressed by artificial intelligence and law researchers in depth. We demonstrate that (...) systems for reasoning with this form of open texture can be built by integrating rule sets with neural networks trained with data collected from standard past cases. The obstacles to this approach include difficulties in generating explanations once conclusions have been inferred, difficulties associated with the collection of sufficient data from past cases and difficulties associated with integrating two vastly different paradigms. A knowledge representation scheme based on the structure of arguments proposed by Toulmin has been used to overcome these obstacles. The system, known as Split Up, predicts judicial decisions in property proceedings within family law in Australia. Predictions from the system have been compared to those from a group of lawyers with favourable results. (shrink)

A queue‐jumping argument concludes that some course of action is impermissible by likening it to the presumptively impermissible act of jumping a queue. Arguments of this sort may be found in a disparate range of contexts and in support of policies favoured by both left and right. Examples include arguments against private education and private health care but also arguments against accommodations for learning disabilities, refugee resettlement, and birthright citizenship. We infer that, although queue‐jumping arguments are strictly analogies, they constitute (...) a sufficiently distinct class of arguments to justify their separate treatment. The paper proposes an argumentation scheme for queue‐jumping arguments and demonstrates its applicability to some existing arguments of this type. (shrink)

The second edition of Andrew Skinner's essays has been updated to take account of his latest thinking on Adam Smith's system of social and moral science and his experience of teaching Smith to a student audience. The material from the first edition has been extensively rewritten in the light of recent scholarship, and four new essays have been included. Each essay can be read as a self-contained unit, supported by a full bibliography and notes; the book as a whole (...) expounds a single coherent argument which demonstrates how Smith's works are inter-related. (shrink)

Ralph Johnson argues that mathematical proofs lack a dialectical tier, and thereby do not qualify as arguments. This paper argues that, despite this disavowal, Johnson’s account provides a compelling model of mathematical proof. The illative core of mathematical arguments is held to strict standards of rigour. However, compliance with these standards is itself a matter of argument, and susceptible to challenge. Hence much actual mathematical practice takes place in the dialectical tier.

Journal of Philosophy of Education, EarlyView.

If good argument is virtuous, then fallacies are vicious. Yet fallacies cannot just be identified with vices, since vices are dispositional properties of agents whereas fallacies are types of argument. Rather, if the normativity of good argumentation is explicable in terms of virtues, we should expect the wrongness of fallacies to be explicable in terms of vices. This approach is defended through case studies of several fallacies, with particular emphasis on the ad hominem.

We analyse the contention that privacy is an alien concept within Japanese society, put forward in various presentations of Japanese cultural norms at least as far back as Benedict in The chrysanthemum and the sword: patterns of Japanese culture. Houghton Mifflin, Boston, 1946. In this paper we distinguish between information privacy and physical privacy. As we show, there is good evidence for social norms of limits on the sharing and use of personal information (i.e. information privacy) from traditional interactions in (...) Japanese society, as well as constitutional evidence from the late 19th century (in the Meiji Constitution of 1889). In this context the growing awareness of the Japanese public about problems with networked information processing by public sector and commercial organisations from the 1980s (when a law governing public sector use of personal information was first passed) to recent years (when that law was updated and a first law governing commercial use of personal information was adopted) are not the imposition or adoption of foreign practices nor solely an attempt to lead Japanese society into coherence with the rest of the OECD. Instead they are drawing on the experience of the rest of the developed world in developing legal responses to the breakdown of social norms governing interchange and use of personal information, stressed by the architectural changes wrought by networked information processing capabilities. This claim is supported by consideration of standard models of Japanese social interactions as well as of Supreme Court judgements declaring reasonable expectations of protection of privacy to hold in Japan. (shrink)