ObjectiveTo increase knowledge of how doctors perceive futile treatments and scarcity of resources at the end of life. In particular, their perceptions about whether and how resource limitations influence end-of-life decision making. This study builds on previous work that found some doctors include resource limitations in their understanding of the concept of futility.SettingThree tertiary hospitals in metropolitan Brisbane, Australia.DesignQualitative study using in-depth, semistructured, face-to-face interviews. Ninety-six doctors were interviewed in 11 medical specialties. Transcripts of the interviews were analysed using thematic (...) analysis.ResultsDoctors’ perceptions of whether resource limitations were relevant to their practice varied, and doctors were more comfortable with explicit rather than implicit rationing. Several doctors incorporated resource limitations into their definition of futility. For some, availability of resources was one factor of many in assessing futility, secondary to patient considerations, but a few doctors indicated that the concept of futility concealed rationing. Doctors experienced moral distress due to the resource implications of providing futile treatment and the lack of administrative supports for bedside rationing.ConclusionsDoctors’ ability to distinguish between futility and rationing would be enhanced through regulatory support for explicit rationing and strategies to support doctors’ role in rationing at the bedside. Medical policies should address the distinction between resource limitations and futility to promote legitimacy in end-of-life decision making. (shrink)

Much of the commentary in the wake of the Charlie Gard litigation was aimed at apparent shortcomings of the law. These include concerns about the perceived inability of the law to consider resourcing issues, the vagueness of the best interests test and the delays and costs of having disputes about potentially life-sustaining medical treatment resolved by the courts. These concerns are perennial ones that arise in response to difficult cases. Despite their persistence, we argue that many of these criticisms are (...) unfounded. The first part of this paper sets out the basic legal framework that operates when parents seek potentially life-sustaining treatment that doctors believe is against a child’s best interests, and describes the criticisms of that framework. The second part of the paper suggests an alternative approach that would give decision-making power to parents, and remove doctors’ ability to unilaterally withhold or withdraw life-sustaining treatment that they regard is futile. This proposal is grounded in several values that we argue should guide these regulatory choices. We also contend that the best interests test is justifiable and since the courts show no sign of departing from it, the focus should be on how to better elucidate the underlying values driving decisions. We discuss the advantages of our proposed approach and how it would address some of the criticisms aimed at the law. Finally, we defend the current role that the judiciary plays, as an independent state-sanctioned process with a precedent-setting function. (shrink)

BackgroundThis paper investigates the content of Australian policies that address withholding or withdrawing life-sustaining treatment to analyse the guidance they provide to doctors about the allocation of resources.MethodsAll publicly available non-institutional policies on withholding and withdrawing life-sustaining treatment were identified, including codes of conduct and government and professional organization guidelines. The policies that referred to resource allocation were isolated and analysed using qualitative thematic analysis. Eight Australian policies addressed both withholding and withdrawing life-sustaining treatment and resource allocation.ResultsFour resource-related themes were (...) identified: doctors’ ethical duties to consider resource allocation; balancing ethical obligations to patient and society; fair process and transparent resource allocation; and legal guidance on distributive justice as a rationale to limit life-sustaining treatment.ConclusionOf the policies that addressed resource allocation, this review found broad agreement about the existence of doctors’ duties to consider the stewardship of scarce resources in decision-making. However, there was disparity in the guidance about how to reconcile competing duties to patient and society. There is a need to better address the difficult and confronting issue of the role of scarce resources in decisions about life-sustaining treatment. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Anthony Close THE EMPIRICAL AUTHOR: SALMAN RUSHDIE'S THE SATANIC VERSES HOBBES, comparing the author ofan action to the owner ofgoods, asserts, "And as the right of possession, is called dominion; so the right of doing any action, is called authority" (Leviathan, Book I, chap. 16). My purpose in this essay is to apply this Hobbesian maxim to the relation Author/Text, expanding somewhat Hobbes's notion of authority. I presuppose that (...) in our day-to-day dealings with our fellow men, we envisage each others' acts as exhibiting purpose and commitment, which make them ours in more than the platitudinous sense that we performed them. By virtue of that, they confer on us a privileged, though clearly not unchallengeable, authority in saying what they are and what they are for. Such, in effect, is the position reached by Austin in How to Do Things with Words, and it broadly corresponds to that of various philosophical writings on human action—by Anscombe, Davidson, and Melden.1 To be sure, we may legitimately consider human behavior from other viewpoints (e.g., structuralist, anthropological, psychoanalytical, Marxist) trained on its unconscious presuppositions. Yet, insofar as such theorizing fails to acknowledge the priority of the Hobbesian perspective, it will seem perverse for a reason that has been well put by Charles Taylor. Precisely because history is made up of purposeful activity, Taylor argues, we need to explain historical patterns in a way that is "intelligible in relation to conscious action" even though they may not "issue from conscious action."2 By this criterion much of our modern literary theory is defective. A vivid measure of the deficiency is provided by the furor over Salman Rushdie's TL· Satanic Verses, culminatingin thefatwa pronounced against Philosophy and Literature, © 1990, 14: 248-267 Anthony Close249 him by the Ayatollah Khomeini in February 1989. I take it that for anyone vocationally committed to the practice or study ofliterature and to the cause of freedom of expression, the defense of Rushdie cannot be a matter of indifference. Nor can one be indifferent to the chasm of misunderstanding that separates Rushdie and his apologists from the novel's Muslim opponents. I believe that these two causes—defending Rushdie and bridging the chasm—can be reconciled by offering better explanations ofhis novel in place ofcrude denunciations or, from some non-Muslim quarters, smug and knowing dismissals. Yet, as we shall see, the task of explanation could be considered hamstrung by our modern poetics. I was reminded ofHobbes's textby Rushdie's lucid and cogent defense of his novel in TL· Independent (London, February 4, 1990). Against the accusations that he had deliberately reviled the Islamic faith, he argued as follows. Though TL· Satanic Verses, like many novels that Rushdie esteems, is a work of radical dissent, questioning, and reimagining, it is motivated by a spirit of serious inquiry rather than debunking derision. More particularly, it reflects a determination that underlies all Rushdie's work: "to create a literary language and literary forms in which the experience offormerly-colonised, still-disadvantaged peoples might find full expression." He continues: "It is written from the very experience of uprooting, disjuncture and metamorphosis... that is the migrant condition, and from which, I believe, can be derived a metaphor for all humanity.... [It] celebrates hybridity, impurity, intermingling, the transformation that comes of new and unexpected combinations of human beings, cultures, ideas, politics, movies, songs. It rejoices in mongrelisation and fears the absolutism of the Pure." Note the insistence on how these themes flow direcdy from Rushdie's own experience. Two days after the publication of this article, Harold Pinter gave on Rushdie's behalf a lecture on the relationship of literature to religion and society at the Institute of Contemporary Arts in London. In this lecture, Rushdie articulated a Bakhtinian view of the novelist's function: to dramatize ironically and noncommittally the clash of voices, languages, and ideologies in a world without gods and without traditionsanctioned truth. Rushdie referred specifically, I think, to a species of postmodernist novel which we may dub "palimpsest history";3 the species includes Rushdie's works, García Márquez's One Hundred Years of Solitude, Carlos Fuentes's Terra Nostra... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Anthony Close CENTERING THE DE-CENTERERS: FOUCAULT AND LAS MENINAS Over the last two decades, French avant-garde critical theory has shaken the pillars of the traditionalist temple with this thought: the interpreter of a literary text should not primarily be concerned with its author's intentional design, but rather with the surreptitious forces which shape it, warp it, and ultimately turn it into a problematic will-ofthe -wisp. The "decoding" of those (...) forces takes many forms (Freudian, anthropological, and so on), of which deconstruction is the most celebrated ; "de-centering"—the banishment of the intentional subject from the focus of interpretation — is common to all. In the first part of this article I wish to set out my philosophical objections to that exclusion, and in the second part, to examine an interesting failure to make it effective in practice: Foucault's analysis of Velazquez's painting Las Meninas, which constitutes the first chapter of Les mots et ks choses. One of my reasons for choosing Foucault's text as an example is that its premises are in some ways comparable to the philosophy of the archdeconstructor, Derrida. My skepticism about them and the analytic method based on them is not meant to suggest that I regard Foucault's historical studies as valueless. On the contrary, I recognize that he, together with some other decoders (particularly Barthes), has important things to say. My attack is a form of defense. I wish to uphold the value of traditional forms of interpretation by showing that though Foucault, like other decoders, casts radical doubts upon them in theory, he tends to negate those doubts by the implications of his practice. 21 22Philosophy and Literature M. H. Abrams has defined the traditionalist historian of culture as one who assumes that (a) authors of the past exploited the norms and possibilities of their language to say something determinate, (b) the properly equipped historian can approximate to their meaning, (c) his interpretation can aspire to a reasonable degree of objectivity. ' Let that serve as a working definition of my traditionalist standpoint. This has a philosophical rationale, basically Wittgensteinian and Austinian, which needs to be explained and set over against some of decoding's typical presuppositions. I choose Derrida's as an example. From my perspective, two objections can be leveled against his thought: its tendency to hypostatize the intentional subject as a metaphysical essence which must be reached through and beyond language, and to see language itself as an unrealistically slippery medium. Both objections were raised against him by Searle in their famous polemic with each other.2 Derrida's thought is inscribed within, even while it reacts against, a traditional conception of language as a name-like substitute for essence. According to this conception, influentially represented in this century by Husserl's phenomenology, bits of language somewhat resemble sterling currency bills which bear on their face the legend: "I promise to pay the bearer on demand the sum of? pound(s)" That is, they are potentially capable ofbeing cashed for lumps of being, which can thus be possessed by mind. Derrida counters that the currency is fraudulent: it continually defers presence and possession, rendering problematic its relation to being and self, and their very existence. In order to foster the illusion that he is master of his words, hence of what they designate, Western Man has historically given status of originality to voice rather than to writing, to a form of expression which is seemingly intimate to consciousness rather than external. The paradoxical thesis ofDe lagrammatologie is that writing came first. One of the routes by which Derrida arrives at this conclusion is Saussure's conception of the discontinuous, articulated nature of language and the negative and differential character of linguistic signifiers, not stably linked to universal referents.3 On this basis he builds his idea of différance (a pun on difference and deferral ), the elusive negative margin which makes language possible, and at the same time, makes impossible consciousness's full presence to itself and to being.4 Hence Derrida's notion of language's anarchic and willful power to detach itself from die intentions or usage of its users and to float... (shrink)

What remains when you eliminate all matter? Can empty space-a void-exist? _Frank Close takes the reader on a lively and accessible tour through ancient ideas and cultural superstitions (including Aristotle, who insisted that the vacuum was impossible) to the frontiers of current scientific research. These newest discoveries tell us extraordinary things about the cosmos and may provide answers to some of our most fundamental questions: What lies outside the universe? If there was once nothing, then how did the universe begin?

This short, smart book tells you everything you need to know about " nothing." What remains when you take all the matter away? Can empty space--" nothing "--exist?

Background Victoria was the first Australian state to legalize voluntary assisted dying (elsewhere known as physician-assisted suicide and euthanasia). Some institutions indicated they would not participate in voluntary assisted dying. The Victorian government issued policy approaches for institutions to consider Objective To describe and analyse publicly available policy documents articulating an institutional objection to voluntary assisted dying in Victoria. Methods Policies were identified using a range of strategies, and those disclosing and discussing the nature of an institutional objection were thematically (...) analysed using the framework method. Results The study identified fifteen policies from nine policymakers and developed four themes: (1) extent of refusal to participate in VAD, (2) justification for refusal to provide VAD, (3) responding to requests for VAD, and (4) appeals to state-sanctioned regulatory mechanisms. While institutional objections were stated clearly, there was very little practical detail in most documents to enable patients to effectively navigate objections in practice. Conclusion This study demonstrates that despite having clear governance pathways developed by centralized bodies (namely, the Victorian government and Catholic Health Australia), many institutions’ public-facing policies do not reflect this guidance. Since VAD is contentious, laws governing institutional objection could provide greater clarity and regulatory force than policies alone to better balance the interests of patients and non-participating institutions. (shrink)

Fair grading is modeled on two fundamental principles. The first principle is that grading should be impartial and consistent. The second principle is that a fair grade should be based on the student’s competence in the academic content of the course. I derive corollary principles of fair grading from these two basic principles and use them to evaluate common grading practices. I argue that exempting students from completing certain grade components is unfair, as is grading on attendance, class rank, deportment,tardiness, (...) effort, institutional values, moral virtues such as cheerfulness and helpfulness, and other non-course-content criteria. (shrink)

Background In June 2016, Canada legalized medical assistance in dying (MAiD). From the outset, some healthcare institutions (including faith-based and non-faith-based hospitals, hospices, and residential aged care facilities) have refused to allow aspects of MAiD onsite, resulting in patient transfers for MAiD assessments and provision. There have been media reports highlighting the negative consequences of these “institutional objections”, however, very little research has examined their nature and impact. Methods This study reports on findings from 48 semi-structured qualitative interviews conducted with (...) MAiD assessors and providers, MAiD team members (working to coordinate care and lead MAiD programs in institutions and health authorities), and family caregivers on their experiences with institutional objection. Participants were recruited from the Canadian provinces of British Columbia, Ontario, and Nova Scotia. Data were analyzed using inductive thematic analysis. Results Themes identified were: (1) basis for institutional objection (with objections commonly rooted in religious values and a particular philosophy of palliative care); (2) scope of objection (demonstrating a wide range of practices objected to); (3) lack of transparency regarding institutional position; (4) impacts on patients; (5) impacts on health practitioners; and (6) catalysts for change. Participants reported that many institutions’ objections had softened over time, lessening barriers to MAiD access and adverse impacts on patients and health practitioners. Participants attributed this positive change to a range of catalysts including advocacy by health practitioners and family members, policymaking by local health authorities, education, and relationship building. Nevertheless, some institutions, particularly faith-based ones, retained strong objections to MAiD, resulting in forced transfers and negative emotional and psychological impacts on patients, family members, and health practitioners. Conclusions This paper adds to the limited evidence base about the impacts of institutional objection and can inform practical and regulatory solutions in Canada and abroad. Reform is needed to minimize the negative impacts on patients, their caregivers, and health practitioners involved in MAiD practice. (shrink)

A book combining theories and practice of ethics in the practice of criminal justice.

PARC is an "appended numeral" system of natural deduction that I learned as an undergraduate and have taught for many years. Despite its considerable pedagogical strengths, PARC appears to have never been published. The system features explicit "tracking" of premises and assumptions throughout a derivation, the collapsing of indirect proofs into conditional proofs, and a very simple set of quantificational rules without the long list of exceptions that bedevil students learning existential instantiation and universal generalization. The system can be used (...) with any Copi-style set of inference rules, so it is quite adaptable to many mainstream symbolic logic textbooks. Consequently, PARC may be especially attractive to logic teachers who find Jaskowski/Gentzen-style introduction/elimination rules to be far less "natural" than Copi-style rules. The PARC system is also keyboard-friendly in comparison to the widely adopted Jaskowski-style graphical subproof system of natural deduction, viz., Fitch diagrams and Copi "bent arrow" diagrams. (shrink)

Existing regulation of end-of-life care is flawed. Problems include poorly-designed laws, policies, ethical codes, training, and funding programs, which often are neither effective nor helpful in guiding decision-making. This leads to adverse outcomes for patients, families, health professionals, and the health system as a whole. A key factor contributing to the harms of current regulation is a siloed approach to regulating end-of-life care. Existing approaches to regulation, and research into how that regulation could be improved, have tended to focus on (...) a single regulatory instrument (e.g., just law or just ethical codes). As a result, there has been a failure to capture holistically the various forces that guide end-of-life care. This article proposes a response to address this, identifying “regulatory space” theory as a candidate to provide the much-needed holistic insight into improving regulation of end-of-life care. The article concludes with practical implications of this approach for regulators and researchers. (shrink)

We present a relational proof system in the style of dual tableaux for a multimodal propositional logic for order of magnitude qualitative reasoning to deal with relations of negligibility, non-closeness, and distance. This logic enables us to introduce the operation of qualitative sum for some classes of numbers. A relational formalization of the modal logic in question is introduced in this paper, i.e., we show how to construct a relational logic associated with the logic for order-of-magnitude reasoning and its (...) dual tableau system which is a validity checker for the modal logic. For that purpose, we define a validity preserving translation of the modal language into relational language. Then we prove that the system is sound and complete with respect to the relational logic defined as well as with respect to the logic for order of magnitude reasoning. Finally, we show that in fact relational dual tableau does more. It can be used for performing the four major reasoning tasks: verification of validity, proving entailment of a formula from a finite set of formulas, model checking, and verification of satisfaction of a formula in a finite model by a given object. (shrink)

Background Voluntary assisted dying became lawful in Victoria, the first Australian state to permit this practice, in 2019 via the Voluntary Assisted Dying Act 2017 (Vic). While conscientious objection by individual health professionals is protected by the Victorian legislation, objections by institutions are governed by policy. No research has been conducted in Victoria, and very little research conducted internationally, on how institutional objection is experienced by patients seeking assisted dying. Methods 28 semi-structured interviews were conducted with 32 family caregivers and (...) one patient about the experience of 28 patients who sought assisted dying. Participants were interviewed during August-November 2021. Data from the 17 interviews (all with family caregivers) which reported institutional objection were analysed thematically. Results Participants reported institutional objection affecting eligibility assessments, medication access, and taking the medication or having it administered. Institutional objection occurred across health settings and was sometimes communicated obliquely. These objections resulted in delays, transfers, and choices between progressing an assisted dying application and receiving palliative or other care. Participants also reported objections causing adverse emotional experiences and distrust of objecting institutions. Six mediating influences on institutional objections were identified: staff views within objecting institutions; support of external medical practitioners and pharmacists providing assisted dying services; nature of a patient’s illness; progression or state of a patient’s illness; patient’s geographical location; and the capability and assertiveness of a patient and/or caregiver. Conclusions Institutional objection to assisted dying is much-debated yet empirically understudied. This research found that in Victoria, objections were regularly reported by participants and adversely affected access to assisted dying and the wider end-of-life experience for patients and caregivers. This barrier arises in an assisted dying system that is already procedurally challenging, particularly given the limited window patients have to apply. Better regulation may be needed as Victoria’s existing policy approach appears to preference institutional positions over patient’s choice given existing power dynamics. (shrink)

Affiliation is both an antecedent and a consequence of emotional mimicry (i.e. imitating a counterpart’s emotional expression). Thus, interacting with a disliked partner can decrease emotional mimicry, which in turn can further decrease liking. This perpetuating circle has not been investigated in the context of mental health stigma yet. The present study tested the influence of the label “schizophrenia” on liking, interpersonal closeness, and emotional mimicry. In an online experiment (n = 201), participants recruited from the general population saw (...) several videos of actors displaying emotional expressions. Actors were described with one of four labels: “schizophrenia”, “healthy”, “diabetes”, and a negative adjective (e.g. “hot-tempered”). Emotional mimicry was measured using OpenFace 2.2. Liking and interpersonal closeness were assessed with questionnaires. Overall, compared to other labels, participants reported less liking and interpersonal closeness to the actor with the schizophrenia label. However, no effect on emotional mimicry was found. The decreased liking of the schizophrenia actors was explained by a lack of knowledge about schizophrenia and the explicit stigma of schizophrenia. Our study contributes to the literature by highlighting the need to reduce the stigma of schizophrenia. (shrink)

We introduce an Automatic Theorem Prover (ATP) of a dual tableau system for a relational logic for order of magnitude qualitative reasoning, which allows us to deal with relations such as negligibility, non-closeness and distance. Dual tableau systems are validity checkers that can serve as a tool for verification of a variety of tasks in order of magnitude reasoning, such as the use of qualitative sum of some classes of numbers. In the design of our ATP, we have introduced (...) some heuristics, such as the so called phantom variables, which improve the efficiency of the selection of variables used un the proof. (shrink)

In four experiments, we explored the inferences people make when they learn that counterfactual thinking has occurred. Experiment 1 showed that knowing that a protagonist had engaged in counterfactual thinking resulted in participants inferring that the past event was closer in time to the protagonist, but there was no difference in inferring how close the past event was between knowing that a protagonist made many or a single counterfactual statement. Experiment 2 confirmed that participants were not affected by the number (...) of counterfactual statements they read when inferring temporal closeness. Experiment 3 demonstrated that participants who learned that a protagonist had engaged in counterfactual thinking were more likely to infer that the protagonist experienced the controllable event. Experiment 4 indicated that participants who learned that a protagonist had engaged in counterfactual thinking were more likely to infer that the protagonist experienced the exceptional event. We concluded that the existence of counterfactual thoughts can lead people to infer that events were close, exceptional, and controllable, which suggests that the relations between closeness/controllability/exceptionality and counterfactual thinking are bidirectional. These results showed that as well as making inferences based on facts about the real world, people also make inferences about the real world based on hypothetical worlds. (shrink)

In addressing the Lucretian symmetry problem, the temporal bias approach claims that death is bad because it deprives us of something about which it is rational to care (e.g., future pleasures), whereas prenatal nonexistence is not bad because it only deprives us of something about which it is rational to remain indifferent (e.g., past pleasures). In a recent contribution to the debate on this approach, Miguel and Santos argue that a late beginning can deprive us of a future pleasure. Their (...) argument is based on the claim that for birth or death to deprive a person of any value in life, the historically closest counterfactual situation that contains the value is such that the person begins to exist earlier or dies later. This is what they call the Historical Condition. However, the Historical Condition is untenable for several reasons. First, this condition substantially weakens the explanatory capacity of the deprivation account because it implies that most ordinary sorts of pleasures are not deprived by death. In addition, the Historical Condition is vulnerable to counterexamples. In particular, what they offer as a standard case of the deprivation of future pleasure due to a late beginning (what they call Seeing The Beatles), or some of its variants, can be used to falsify this condition. Finally, the Historical Condition is theoretically indefensible because it is based on a faulty analysis of deprivation. (shrink)

Objective Futile treatment, which by definition cannot benefit a patient, is undesirable. This research investigated why doctors believe that treatment that they consider to be futile is sometimes provided at the end of a patient9s life. Design Semistructured in-depth interviews. Setting Three large tertiary public hospitals in Brisbane, Australia. Participants 96 doctors from emergency, intensive care, palliative care, oncology, renal medicine, internal medicine, respiratory medicine, surgery, cardiology, geriatric medicine and medical administration departments. Participants were recruited using purposive maximum variation sampling. (...) Results Doctors attributed the provision of futile treatment to a wide range of inter-related factors. One was the characteristics of treating doctors, including their orientation towards curative treatment, discomfort or inexperience with death and dying, concerns about legal risk and poor communication skills. Second, the attributes of the patient and family, including their requests or demands for further treatment, prognostic uncertainty and lack of information about patient wishes. Third, there were hospital factors including a high degree of specialisation, the availability of routine tests and interventions, and organisational barriers to diverting a patient from a curative to a palliative pathway. Doctors nominated family or patient request and doctors being locked into a curative role as the _main_ reasons for futile care. Conclusions Doctors believe that a range of factors contribute to the provision of futile treatment. A combination of strategies is necessary to reduce futile treatment, including better training for doctors who treat patients at the end of life, educating the community about the limits of medicine and the need to plan for death and dying, and structural reform at the hospital level. (shrink)