Recent contributions to the literature on the topic of futility have focused primarily on two areas: 1) definitions of the term and 2) the suggestion that cardiopulmonary resuscitation may be futile in certain patients. This suggestion is based on “scientific” measures and analyses of outcomes, describing the low probability of success of CPR in patients over age 70, those with cancer, those with multiorgan failure, etc. The research reported suggests that with such patients the physician need not get the patient's (...) consent to withhold resuscitation; the physician need only inform either the patient or the surrogate that CPR will not be Instituted in the event of an arrest. (shrink)

As noted In Part II of this series, perhaps the most critical elements to define in deciding when treatment Is futile are the goals of therapy from, both the physician's and the patient's point of view. A patient's personal goals are based upon value system., life goals, and personal definition of “quality of life.” These personal goals must then be interpreted and applied in a reasonable and realistic fashion against what the physician has previously described as the legitimate, objective, and (...) attainable therapeutic goals. As far as possible, both, parties must work together to eliminate the uncertainties in their discussion. The ideal situation includes a competent, alert patient and a prudent, caring physician who have had a long-term ongoing relationship. The key to collaboration is communication: a sincere interest in and professional concern for the patient; a willingness to be honest and open; a commitment to talk and to listen; an attempt to make one another feel comfortable in the collaboration; and an effort to recognize and to overcome barriers to communication, whether barriers are personal to either the patient or the physician or are professional, institutional, or societal. (shrink)

The patient was a woman in her 30s who, until the rapid progression of an ultimately fatal neurologic disease, had been a very successful professional, enjoying athletics and an active social life. In the 6 months of swift deterioration, she had gone from being extremely vibrant and energetic to being totally unable to care for her personal needs. There had been no loss of intellectual capacity. Her sister later recounted to Dr. J., the emergency department physician, that she had found (...) the patient unconscious and unresponsive at home and had immediately called the patient's neurologist in a neighboring city. He directed her to call the paramedics. (shrink)

A physician recently asked how to respond in the case of an 87-year-old patient with advanced Alzheimer's disease, who was unable to swallow or tolerate a nasogastric tube, when the family insisted a gastrostomy tube be inserted but the physician believed the intervention futile. That question encompasses some of the crucial issues in the concept of futility of the treatment goals of physician, patient, and family; the rights of patients and families to demand care; physician judgment; family values; and, to (...) the degree that it represents many similar dilemmas, justice. What are professionals saying when they pronounce treatment futile? What are patients' rights if they or their surrogates disagree?The word “futile” implies a precision about outcome probability that we do not have, and it ignores the wide range of treatments for a given diagnosis. Is futile the same as useless or the opposite of hope? Futile for what? Cure? Restora tion of function? Prolongation of life? Relief from pain? Relief from anxiety? Com fort? Reassurance? To satisfy or placate the patient or the family? The word “futile” is so imprecise that, rather than clarifying, it confuses and clutters the discussion. (shrink)

The playback experiment -- the playing back of recorded animal sounds to the animals in order to observe their responses -- has twice become central to celebrated researches on non-human primates. First, in the years around 1890, Richard Garner, an amateur scientist and evolutionary enthusiast, used the new wax cylinder phonograph to record and reproduce monkey utterances with the aim of translating them. Second, in the years around 1980, the ethologists Peter Marler, Robert Seyfarth, and Dorothy Cheney used tape (...) recorders in a broadly similar way to test whether the different predator calls of one monkey species, vervet monkeys, warn about different kinds of predator. This paper explores the circumstances leading to the ca. 1890 invention and the ca. 1980 reinvention of the primate playback experiment. In both instances, I show, the experiment served as a riposte to those arguing, on scientific grounds, that an unbridgeable gap divides human language from animal communication. I also consider how far progress in technology explains the timing of invention and reinvention. I conclude with some reflections on sifting contingent from inevitable aspects of the history of the primate playback experiment, and of scientific achievements more generally. (shrink)

ABSTRACT This article proposes that Dorothy Dinnerstein’s philosophy can help us understand the problem of miseducation that places male-dominated and ‘masculine’ rapacity at the center of so many human endeavors, including capitalist economic exploitation and environmental exploitation. Dinnerstein argues that early childhood experiences of female domination lead to reactive and immature adult preferences for excessive, triumphing, rapacious, male rule. In Dinnerstein’s theory, the solution to this psychologically deep-rooted problem is for men to do half of the childcare work. This (...) article acknowledges and refutes arguments against Dinnerstein’s theory, and expounds its soundness and benefits. Dinnerstein’s thought can help us put a brake on the capitalist rapacity that threatens our very survival while increasing possibilities for human self-actualization. (shrink)

Two humanist, critical approaches—those of Dorothy Dinnerstein and Immanuel Kant—are summarized, compared, and employed to critique gender bias in science education. The value of Dinnerstein’s approach lies in her way of seeing conventional “masculinity” and conventional “femininity” as developing in relation to each other from early childhood. Because of women’s dominance of early childcare and adults’ enduring, sexist resentment of that dominance, women become inhumanely associated with the non-adult qualities of immaturity, dependence, and childish vulnerability and punish-ability; and male (...) human beings—to whom woman-resenting convention assigns the impossible task of absolutely triumphing over “the feminine,” childhood experience, and all human vulnerability—become inhumanely held to unachievable standards of super-hero invulnerability and god-like mental and practical infallibility. The value of Kant’s approach lies in his insistence that our sense of what is right and necessary for social progress must arise in a practically engaged and experientially full manner, rather than (1) from concepts (such as rigid ideological prescriptions) conceived as being detached from sense experience and as arising from an otherworldly, divine or quasi-divine realm of moral infallibility (such concepts being conventionally associated with “masculine” authority and leadership), or (2) from a sense of being trapped in what—in a given historical, cultural, or experiential moment—may appear as an absolute and unchangeable reality of embodied human experience (an anti-critical, anti-intellectual, and anti-progressive sense of things often associated with disempowered “feminine” experience). I demonstrate that critique integrating these approaches is useful in a science education setting. (shrink)

"This reviewer had to be restrained from stopping people in the street to urge them to read it: They would learn something of the way science is done,...

A Place for Beauty in the Therapeutic Encounter is written for all psychotherapists, counsellors, and psychologists who practise under the broad banner of psychoanalytic thinking. It is also for anyone who loves beauty and wants to think more about its place in the mind.

Landini discusses the second edition of Principia Mathematica, to show Russella (TM)s intellectual relationship with Wittgenstein and Ramsey.

"This book is very valuable. Today, there are too many books on the Work that are either deliberately impersonal and as a result are just a re-explaining of basic ideas which are already there in Ouspensky.

This book traces the career development and influence on American intellectual life of the first twenty women to earn a PhD in philosophy in the United States. Rogers explores the factors that led these women to pursue careers in academic philosophy, examines the ideas they developed, and evaluates the impact they had on the academic and social worlds they inhabited. This volume investigates not only the success stories of such women as Eliza Ritchie, Julia Gulliver, and Christine Ladd-Franklin, to name (...) a few, but also the policies and practices that made it difficult or impossible for others to succeed. (shrink)

In this paper, I explain the curious role played by the Argument from Absolute Terms in Peter Unger's book Ignorance, I provide a critical presentation of the argument, and I consider some outstanding issues and the argument’s contemporary significance.

There are differences in caregivers’ literacy and health literacy levels that may affect their ability to consent to children participating in clinical research trials. This study aimed to explore the effectiveness, and caregivers’ understandings, of the process of informed consent that accompanied their child’s participation in a dental randomized control trial (RCT). Telephone interviews were conducted with a convenience sample of ten caregivers who each had a child participating in the RCT. Pre-tested closed and open-ended questions were used, and the (...) findings were produced from an inductive analysis of the latter and a descriptive analysis of the former. Participants had limited understanding of the purpose of the RCT and rated the readability of the consent form more highly than they rated their understanding of the research. All felt that informed consent was vital, but some caregivers had not read the consent documents. Some caregivers enrolled their child in the RCT because they trusted the researchers, and the majority wanted to improve dental care for children. The informed consent process was not always effective despite high readability of the informed consent documents. Researchers must consider the health literacy of the study group, and actively engaging with caregivers to achieve meaningful informed consent may be challenging. Future research could explore participants’ perspectives of informed consent in populations with low health literacy and assess whether an underlying expectation not to comprehend health-related information may be a barrier to informed consent. (shrink)

With Empire, Michael Hardt and Antonio Negri reinvigorated debates in political theory and radical philosophy about the cultivation of revolutionary subjectivity. Their theorization of Empire and multitude has also significantly affected the tenor of critical approaches to educational theory during the past two decades. In this article, we discuss Hardt and Negri’s contribution to what we call the biopolitical turn in educational theory, emphasizing the influence of autonomist Marxism on their work. Even more specifically, we discuss the impact of the (...) autonomist tradition on their formulation of the nature of the relationship between the multitude and Empire: that the multitude is the generative force of the social world, whereas Empire is merely an apparatus of capture. This autonomist approach reveals a set of questions regarding subjectivity, materialism, and social ontology, which we argue are ripe for engagement by educational theorists, and indicate the enduring relevance of Empire as a valuable text for educational theorists interested in matters of biopolitical production, collective opposition, and revolutionary subjectivity. (shrink)

Now in its twentieth year of publication, this rich collection, popular among teachers and students alike, provides an in-depth look at major cases that have shaped the field of medical ethics. The book presents each famous (or infamous) case using extensive historical and contextual background, and then proceeds to illuminate it by careful discussion of pertinent philosophical theories and legal and ethical issues.

Virtually all historical treatments of just war recognize the importance of the account given by Thomas Aquinas in Summa theologiae II-II, q. 40, ?De bello?, where he outlines three conditions ? legitimate authority, just cause, and right intention ? for a justifiable use of armed force. It is, however, less well known that within the same section of the work (q. 50, a. 4) Aquinas extended his reflection on just war into a theory of military prudence. By placing generalship under (...) the category of ?prudence?, rather than ?art? or ?science?, he held that military command involves more than a morally neutral skill with victory as its sole aim. Building on the premise that service to the common good constitutes the overarching purpose of the military profession, Aquinas showed how the virtue of prudence provides an inner compass for decision-making amid the uncertainty and confusion of the battlefield. (shrink)

Because we are frightened of being humiliated, being treated like an object, being rejected, losing control of things, and, most of all, we are frightened of uncertainty. Often we get our lies in before any of these things can happen. We lie to maintain our vanity. We lie when we call our fantasies the truth. Lying is much easier than searching for the truth and accepting it, no matter how inconvenient it is. We lie to others, and, even worse, we (...) lie to ourselves.In both private and public life, we damage ourselves with our lies, and we damage other people. Lies destroy mutual trust, and fragment our sense of who we are.Lies have played a major part in climate change and the global economic crisis. Fearing to change how they live, many people prefer to continue lying rather than acknowledge that we are facing a very uncertain but undoubtedly unpleasant future unless we learn how to prefer the truths of the real world in which we live rather than the comforting lies that ultimately betray us. We are capable of changing, but will we choose to do this? (shrink)

Context Conflicts over treatment decisions have been linked to physicians' emotional states. Objective To measure the prevalence of emotional exhaustion and conflicts over treatment decisions among US obstetrician/gynaecologists (ob/gyns), and to examine the relationship between the two and the physician characteristics that predict each. Methods Mailed survey of a stratified random sample of 1800 US ob/gyn physicians. Criterion variables were levels of emotional exhaustion and frequency of conflict with colleagues and patients. Predictors included physicians' religious characteristics and self-perceived empathy. Results (...) Response rate among eligible physicians was 66% (1154/1760). 36% of ob/gyns reported high levels of emotional exhaustion, and majorities reported conflict with colleagues (59%) and patients (61%). Those reporting conflict were much more likely to report emotional exhaustion (58% vs 29% who never conflict, OR, 95% CI 2.8, 1.6 to 4.8 for conflict with colleagues; 55% versus 26%, OR, 95% CI 2.2, 1.4 to 3.5 for conflict with patients). Physicians with lower self-perceived empathy were more likely to report physician-patient conflicts (65% vs 58% with higher empathy, OR, 95% CI 1.4, 1.0 to 1.9), as were female ob/gyns (66% vs 57% of males, OR, 95% CI 1.5, 1.1 to 2.0). Foreign-born physicians were less likely to report such conflicts (47% vs 64% of US born, OR, 95% CI 0.5, 0.4 to 0.8). Physicians' religious characteristics were not significantly associated with reporting conflict. Conclusions Conflicts over treatment decisions are associated with physicians' empathy, gender, immigration history and level of emotional exhaustion. With respect to the latter, conflict in the clinical encounter may represent an overlooked source or sign of burnout among ob/gyns. (shrink)

Death is the destiny we all share, and this will not change. Yet the way we die, which had remained the same for many generations, has changed drastically in a relatively short time for those in developed countries with access to healthcare. For generations, if people were lucky enough to reach old age, not having died in infancy or childhood, in childbirth, in war, or by accident, they would take to bed, surrounded by loved ones who cared for them, and (...) fade into death. Most likely, they would have seen their parents and grandparents die the same way, and so this manner of dying would be familiar: it was part of the natural cycle of life. Now less than 25 per cent of Americans die at home, having reached much older ages than people would have dreamed of in past generations, often after surviving many illnesses and even diseases that would have been terminal for their grandparents. We are fortunate to live (and die) today, supported by myriad scientific, medical, and technological advancements, however we also face new problems as a result of the new way in which we die. We can no longer anticipate a peaceful waning at home with family. We know our lives will likely end in hospitals likely after we have endured grueling treatments to prolong life. We have to decide what decisions we want our loved ones, or care-givers, to make when we cannot choose for ourselves. We have to think about whether in any circumstances we would seek physician-assisted death. We know we face other questions as well, but we may not even know where to start. In the face of these decisions, we can feel daunted and afraid. The best remedy is information and planning. In this book, Gregory Eastwood - a physician who has cared for dying patients, served as an ethics consultant, and taught end of life issues to medical and other health profession students - draws from his substantial experience with patients and families to provide the information that will help us think clearly about the choices and issues we will face at the end of our own lives, and when faced with the deaths of our loved ones. With sensitivity and profound insight, Eastwood guides us through all the important questions about death and dying in straightforward, clear language, enhanced by real-life stories. Throughout, he shows us how we can take ownership of the way we want to die, when we must die, and feel more in control as death approaches. (shrink)

Henry Kyburg’s lottery paradox (1961, p. 197) arises from considering a fair 1000 ticket lottery that has exactly one winning ticket. If this much is known about the execution of the lottery it is therefore rational to accept that one ticket will win. Suppose that an event is very likely if the probability of its occurring is greater than 0.99. On these grounds it is presumed rational to accept the proposition that ticket 1 of the lottery will not win. Since (...) the lottery is fair, it is rational to accept that ticket 2 won’t win either—indeed, it is rational to accept for any individual ticket i of the lottery that ticket i will not win. However, accepting that ticket 1 won’t win, accepting that ticket 2 won’t win, . . . , and accepting that ticket 1000 won’t win entails that it is rational to accept that no ticket will win, which entails that it is rational to accept the contradictory proposition that one ticket wins and no ticket wins. (shrink)

In this essay I respond to three of the most forceful objections to the open view of the future. It is argued that a) open view advocates must deny bivalence; b) the open view offers no theodicy advantages over classical theism; and c) the open view can’t assure believers that God can work all things to the better. I argue that the first objection is premised on an inadequate assessment of future tensed propositions, the second is rooted in an inadequate (...) assessment of free will, and the third is grounded in an inadequate assessment of God’s intelligence. (shrink)

Background and objectives Conscientious refusal of abortion has been discussed widely by medical ethicists but little information on practitioners' opinions exists. The American College of Obstetricians and Gynecologists (ACOG) issued recommendations about conscientious refusal. We used a vignette experiment to examine obstetrician-gynecologists' (OB/GYN) support for the recommendations. Design A national survey of OB/GYN physicians contained a vignette experiment in which an OB/GYN doctor refused a requested elective abortion. The vignette varied two issues recently addressed by the ACOG ethics committee—whether the (...) doctor referred and whether the doctor disclosed their objection to the abortion. Participants and setting 1800 OB/GYN randomly selected physicians were asked to complete a mail survey containing the vignette. The response rate was 66% (n=1154) after excluding 40 ineligible cases. Measurement Physicians indicated their approval for the vignette doctor's decision. Main results Overall, 43% of OB/GYN physicians responded that the conscientious refusal exercised by the vignette physician was appropriate. 70% rated the vignette doctor as acting appropriately when a referral was made. This dropped to 51% when the doctor disclosed objections to the patient, and to 12% when the doctor disclosed objections and refused to make a referral. Consistent with previous research, males were more likely to support disclosure and refusal to refer. Highly religious physicians supported non-referral but not disclosure. Conclusion OB/GYN physicians are less likely to support conscientious refusal of abortion if physicians disclose their objections to patients. This is at odds with ACOG recommendations and with some models of the doctor–patient relationship. (shrink)

The purpose of this article is to explore the close link between technology and death in the philosophical writings of Lewis Mumford. Mumford famously argued that throughout the history of western civilization we find intertwined two competing forms of technics; the democratic biotechnic form and the authoritarian monotechnic form. The former technics were said to be strongly compatible with an organic form of life while the latter were said to be allied to a mechanical power complex. What is perhaps less (...) well known is the extent to which Mumford characterizes the authoritarian technical form as being a technics of death. This article will argue that the connection between death and technics is a key theme in Mumford’s philosophy of technology. In addition to elaborating this theme and detailing how it informs Mumford’s other positions on the nature of technology, this article will also argue that Mumford’s theory of a technics of death bears witness, both implicitly and explicitly, to the influence of Sigmund Freud’s theory of the death instinct. Freud’s account of the death instinct will be outlined briefly and its influence on Mumford’s writings will be explained. Death, in Mumford’s technological writings, has a generally negative function and serves to warn humanity of the perilous course that its technological civilization is set upon. However it also has a positive function in that it encourages man to transcend its biological existence in acts of creativity and purpose. Death, in this positive sense, serves the purpose of life whereas, in the negative sense, it hinders it. The role of death, in both aspects, will be explored and related to Mumford’s overall perspective on technics and life. It is argued that Mumford’s philosophy of technology cannot be fully understood without an awareness of his views on death and its role in the life of technological society. (shrink)

Preliminary Abstract: -/- The late Mary Midgley (1919-2018) was one of the most relevant and wide-ranging moral philosophers of the last century. For over forty years, she drew attention to the necessity of philosophy in everyday life while making significant contributions on such topics as human nature, ethics, animals and the environment, science, religion, and other real-world issues. Midgley’s remarkable career saw the publication of over 250 books, journal articles, pamphlets, and other materials, concluding with the publication of What Is (...) Philosophy For? at age 99, just one month before her death. This work was the last in a series of publications late in Midgley’s career that underscored her reputation as a singular thinker and a shining example of the significant presence of women in philosophy. -/- Mary Midgley on What Matters offers a window into this noteworthy period late in Midgley’s career. This volume invites the reader into a series of visits and conversations between Gregory McElwain and Mary Midgley at her home in Newcastle from 2011-2018. Framed and thematically curated by McElwain, these conversations present Midgley’s thoughts, reminiscences, and concerns on life and the topics for which she is best known, with special emphasis on her influential perspective on animals and the environment. Midgley’s witty and lively voice is emphasized throughout this accessbile book, engaging the reader with one of the more vibrant philosophers in living memory. (shrink)

The Nicomachean Ethics is generally thought to be a “dialectical” work, aimed at resolving aporia in a set of endoxa, which it takes as its starting-point. I argue that Aristotle’s aim in the treatise is, rather, to produce definitions of key ethical terms, and that his starting-points are limited to evaluative and discriminative judgments of a certain sort, which are demanded by the nature of the discipline and are not endoxa. I discuss also how the definitions are reached (focusing on (...) the cases of the virtues of character) and the roles that aporiai do play in the process. (shrink)