RationaleSurrogates of critically ill patients often have inaccurate expectations about prognosis. Yet there is little research on how intensive care unit clinicians should discuss prognosis, and existing expert opinion-based recommendations give only general guidance that has not been validated with surrogate decision makers.ObjectiveTo determine the perspectives of key stakeholders regarding how prognostic information should be conveyed in critical illness.MethodsThis was a multicenter study at three academic medical centers in California, Pennsylvania, and Washington. One hundred eighteen key stakeholders completed in-depth semistructured (...) interviews. Participants included 47 surrogates of adult patients with acute respiratory distress syndrome; 45 clinicians working in study ICUs, including physicians, nurses, social workers, and spiritual care providers; and 26 experts in health communication, decision science, ethics, family-centered care, geriatrics, healthcare disparities, palliative care, psychology, psychiatry, and critical care.Measurements and main resultsThere was broad support among surrogates for existing expert recommendations, including truthful prognostic disclosure, emotional support, tailoring the disclosure strategy to each family's needs, and checking for understanding. In addition, stakeholders offered suggestions that add specificity to existing recommendations, including: In addition to conveying prognostic estimates, clinicians should help families "see the prognosis for themselves" by showing families radiographic images and explaining the clinical significance of physical manifestations of severe disease at the bedside. Many physicians did not support using numeric estimates to convey prognosis to families, whereas many surrogates, clinicians from other disciplines, and experts believed numbers could be helpful. Clinicians should conceptualize prognostic communication as an iterative process that begins with a preliminary mention of the possibility of death early in the ICU stay and becomes more detailed as the clinical situation develops. Although prognostic information should be initially disclosed by physicians, other members of the multidisciplinary team-nurses, social workers, and spiritual care providers-should be given explicit role responsibilities to reinforce physicians' prognostications and help families process a poor prognosis emotionally.ConclusionsFamily members, clinicians, and experts identified specific communication behaviors that clinicians should use to discuss prognosis in the critical care setting. These findings extend existing opinion-based recommendations and should guide interventions to improve communication about prognosis in ICUs. (shrink)

In this paper I explore a “variation” on the “theme” of intuition in the evolution of modern metaphysics. My aim is not to criticize A. W. Moore’s account of intuition as one of two ways by which Bergson makes sense of things (the other way is analysis). Instead I will suggest the significance in extending Bergson’s metaphysics to mystical life as “the ‘very life of things’ into which intuition installs itself.” When the metaphysical drama, in The Evolution of Modern Metaphysics, (...) reaches chapter 16, “Bergson: Metaphysics as Pure Creativity,” Moore expresses astonishment that Bergson could have thought philosophers have ever agreed on aligning “analysis” in science with the impossibility of non-perspectival sense-making and “intuition” in metaphysics with the possibility of absolute (non-perspectival) knowledge. Using a method of intuition, not of analysis, as non-perspectival sense-making is the opposite of what Moore himself finds in other philosophical contributions to modern metaphysics as “a most general attempt to make sense of things.” He takes an influential example: Bernard Williams associates analysis, not intuition, with the possibility of non-perspectival sense-making and absolute knowledge. My response defends Bergsonian intuition in giving it a positive—and, why not, non-perspectival?—role in metaphysics as mystical; that is, as unique and inexpressible life. Moore describes intuition in Bergson as both the faculty and the method for the evolution of new concepts and new ways of making sense of things. I will stress that Bergsonian intuition is “an effort to place oneself into a movement, such as that of philosophy itself,” expressing “what is ‘living in philosophers’ rather than what is ‘fixed and dead in theses.’ ” This mystical life pushes out the limits set up by Kant for metaphysics (and science) by allowing intuition (with analysis) to reach for absolute, non-perspectival knowledge. (shrink)

This paper is a discussion of Michael Thau's interesting critique in Chapter 2 of Consciousness and Cognition, Oxford: Oxford University Press, 2002, of the common view that beliefs are internal states.

W. E. B. Du Bois was one of the most profound and influential African-American intellectuals of the twentieth century. This volume addresses the complexities of Du Bois' legacy, showing how his work gets to the heart of today's theorizing about the color line.

Block's cases of superblindsight, the pneumatic drill, and the Sperling experiments do not show that P-consciousness and Aconsciousness can come apart. On certain tendentious but not implausible construals of the concepts of P- and A-consciousness, they refer to the same psychological phenomenon.

Les croyances sont aujourd'hui mieux respectées, mais la crédulité est ignorée tandis qu'on s'évertue à croire. Banalisation derrière laquelle se cache une fonction psychique inquiétante. Il a donc semblé urgent de situer, préciser et expliquer celle-ci. Ceci alors que la penséee active, constructive, se voit fragiliséee, menacée, ou même étoufféee par l'explosion médiatique et informatique. Polémiquer en faveur de la vérité est une nécessité.

The field of metacognition, richly sampled in the book under review, is recognized as an important and growing branch of psychology. However, the field stands in need of a general theory that (1) provides a unified framework for understanding the variety of metacognitive processes, (2) articulates the relation between metacognition and consciousness, and (3) tells us something about the form of meta-level representations and their relations to object-level representations. It is argued that the higher-order thought theory of consciousness supplies us (...) with the rudiments of a theory that meets these desiderata and integrates the principal findings reported in this collection. (shrink)

According to a model of inter-theoretic relations advocated by Patricia S. Churchland, psychology will need to revise its theories so as to fit them for "smooth reduction" to the neurosciences, and this will lead to the elimination of reference to intentional contents from psychology. It is argued that this model is ambiguous; on one reading it is empirically implausible, on the other its methodology is confused. The connectionist program NETtalk, far from exemplifying the model as Churchland claims, suggests a theoretical (...) rationale for employing relations to intentional contents in psychology. (shrink)

To make behavioral choices that are in line with our goals and our moral beliefs, we need to gather and consider information about our current situation. Most information present in our environment is not relevant to the choices we need or would want to make and thus could interfere with our ability to behave in ways that reflect our underlying values. Certain sources of information could even lead us to make choices we later regret, and thus it would be beneficial (...) to be able to ignore that information. Our ability to exert successful self-governance depends on our ability to attend to sources of information that we deem important to our decision-making processes. We generally assume that, at any moment, we have the ability to choose what we pay attention to. However, recent research indicates that what we pay attention to is influenced by our prior experiences, including reward history and past successes and failures, even when we are not aware of this history. Even momentary distractions can cause us to miss or discount information that should have a greater influence on our decisions given our values. Such biases in attention thus raise questions about the degree to which the choices that we make may be poorly informed and not truly reflect our ability to otherwise exert self-governance. (shrink)