Two potentially lifesaving protocols, emergency preservation and resuscitation and uncontrolled donation after circulatory determination of death, currently implemented in some U.S. emergency departments, have similar eligibility criteria and initial technical procedures, but critically different goals. Both follow unsuccessful cardiopulmonary resuscitation and induce hypothermia to “buy time”: one in trauma patients suffering cardiac arrest, to enable surgical repair, and the other in patients who unexpectedly die in the ED, to enable organ donation. This article argues that to fulfill patient-focused fiduciary obligations (...) and maintain community trust, institutions implementing both protocols should adopt and publicize policies to guide ED physicians to utilize either protocol for particular patients, in order to address the appearance of conflict of interest arising from the protocols' similarities. It concludes by analyzing ethical implications of incentives that may influence institutions to develop the expertise required for uDCDD but not EPR. (shrink)

We call attention to an underappreciated way in which non-epistemic values influence evidence evaluation in science. Our argument draws upon some well-known features of scientific modeling. We show that, when scientific models stand in for background knowledge in Bayesian and other probabilistic methods for evidence evaluation, conclusions can be influenced by the non-epistemic values that shaped the setting of priorities in model development. Moreover, it is often infeasible to correct for this influence. We further suggest that, while this value influence (...) is not particularly prone to the problem of wishful thinking, it could have problematic non-epistemic consequences in some cases. (shrink)

This article identifies conditions under which robust predictive modeling results have special epistemic significance---related to truth, confidence, and security---and considers whether those conditions hold in the context of present-day climate modeling. The findings are disappointing. When today’s climate models agree that an interesting hypothesis about future climate change is true, it cannot be inferred---via the arguments considered here anyway---that the hypothesis is likely to be true or that scientists’ confidence in the hypothesis should be significantly increased or that a claim (...) to have evidence for the hypothesis is now more secure. (shrink)

Today’s most sophisticated simulation studies of future climate employ not just one climate model but a number of models. I explain why this “ensemble” approach has been adopted—namely, as a means of taking account of uncertainty—and why a comprehensive investigation of uncertainty remains elusive. I then defend a middle ground between two camps in an ongoing debate over the transformation of ensemble results into probabilistic predictions of climate change, highlighting requirements that I refer to as ownership, justification, and robustness.

This paper traces the unspoken, implicit white racial logic of the brain disease model of addiction, which is based on seemingly universal, disembodied brains devoid of social or environmental influences. In the United States, this implicit white logic led to “context-free” neuroscience that made the social hierarchies of addiction and its consequences invisible to, and thus exacerbated by, national policies on opioids. The brain disease model of addiction was selectively deployed among the white middle-class population that had long accessed narcotics (...) and pharmaceutical treatments for narcotics disorders from biomedical clinics, as opposed to from illegal sources subject to law enforcement. In turn, new treatments for opioid addiction were racially marketed to the same white clientele to which newly patented opioid analgesics were marketed, tapping into a circumscribed but highly lucrative consumer base that has long benefited from a legally protected, racially segregated safe space for white narcotics consumption. The connecting thread for the contemporary white opioid “crisis,” therefore, is white race as a ghost variable in addiction neuroscience and in its pharmaceutical and biotechnological translation. (shrink)

This volume aims to contextualize the development and reception of Husserl’s transcendental-phenomenological idealism by placing him in dialogue with his most important interlocutors – his mentors, peers, and students. Husserl’s “turn” to idealism and the ensuing reaction to Ideas I resulted in a schism between the early members of the phenomenological movement. The division between the realist and the transcendental phenomenologists is often portrayed as a sharp one, with the realists naively and dogmatically rejecting all of Husserl’s written work after (...) the Logical Investigations. However, this understanding of the trajectory of the phenomenological movement ignores the extensive and intricate contours of the idealism-realism debate. In addition to helping us better interpret Husserl’s attempts to defend his idealism, reconsidering the idealism-realism debate elucidates the relationship and differences between Husserl's phenomenology and the broader landscape of early 20th century German philosophy, particularly the Munich phenomenologists and the Neo-Kantians. The contributions to this volume reconsider many of the early interpretations and critiques of Husserl, inviting readers to assess the merits of the arguments put forward by his critics while also shedding new light on their so-called “misunderstandings” of his idealism. This text should be of interest to researchers working in the history of phenomenology and Husserlian studies. (shrink)

Head transplantation fits within the broader conceptual space occupied by transhumanists and others who seek to extend the lives of human beings indefinitely. It is reasonable to reflect on whether, under what circumstances, and in what ways human immortality would be good. In this paper, I disambiguate the ways in which immortality might be considered a human good and then argue that immortality is neither necessary nor sufficient condition for objective meaning in life. I also argue that mortality is not (...) a necessary condition for objective meaning in life. (shrink)

Proceedings of the Pittsburgh Workshop in History and Philosophy of Biology, Center for Philosophy of Science, University of Pittsburgh, March 23-24 2001 Session 2: Female Orgasms and Evolutionary Theory.

Clear and careful thinking is an indispensable aid in the pursuit of answers to the difficult ethical question faced by clinicians, patients, and families. In this issue of The Journal of Medicine and Philosophy devoted to issues in clinical ethics, the authors engage in this enterprise by reflecting on morally good medical decision making, conscientious objection, presumed consent in organ donation, the permissibility of surrogate decision making, and the failure of legislative limits on the scope of euthanasia in Belgium.

In this paper I examine Albert’s (2000) claim that the low entropy state of the early universe is sufficient to explain irreversible thermodynamic phenomena. In particular, I argue that conditionalising on the initial state of the universe does not have the explanatory power it is presumed to have. I present several arguments to the effect that Albert’s ‘past hypothesis’ alone cannot justify the belief in past non-equilibrium conditions or ground the veracity of records of the past.

This Article examines normative arguments for legal pluralism in regulation. First I briefly set out what we know in fact about how plural regulatory orderings interact and compete with state agency regulatory action. Second, I sketch, and reject, a simple legal pluralist response to regulatory pluralism. In the third part of the Article I show that "responsive" and "reflexive" approaches to intentional pluralization in the design of law should be seen as providing different but complementary pictures of pluralized law. Finally (...) I argue that this pluralized view of law might provide us with the conceptual tools to identify a type of emergent, pluralistic law, without or beyond the state, which would be relevant to thinking about both transnational regulation and multiculturalism. (shrink)

In their paper ’Too much medicine: not enough trust?' Zoë Fritz and Richard Holton explore the connection between trust and overtreatment and overinvestigation. Whilst their paper is insightful, here I argue that much more could be made of a doctor’s trust and how this exacerbates overtreatment and overinvestigation. By taking Fritz and Holton’s view of trust as having ‘our best interests at heart’ as my starting point, I argue that doctor’s do not always trust that patients or the system has (...) their interests at heart and so use overtreatment and overinvestigation to protect themselves. I also point to the tensions created by a lack of trust on the doctor’s part as a focal point for much needed sustained ethical analysis. (shrink)

Do the rich descriptions and narrative shapings of literature provide a valuable resource for readers, writers, philosophers, and everyday people to imagine and confront the ultimate questions of life? Do the human activities of storytelling and complex moral decision-making have a deep connection? What are the moral responsibilities of the artist, critic, and reader? What can religious perspectives—from Catholic to Protestant to Mormon—contribute to literary criticism? Thirty well known contributors reflect on these questions, including iterary theorists Marshall Gregory, James Phelan, (...) and Wayne Booth; philosophers Martha Nussbaum, Richard Hart, and Nina Rosenstand; and authors John Updike, Charles Johnson, Flannery O'Connor, and Bernard Malamud. Divided into four sections, with introductory matter and questions for discussion, this accessible anthology represents the most crucial work today exploring the interdisciplinary connections between literature, religion and philosophy. (shrink)

The authors focus on four major thematic areas – the reform of church, the reform of theology, the reform of perspective, and the reform of method – which together encompasses the breadth and depth of Cusanus’ own reform initiatives.

Recent magnetic resonance imaging and pathological studies have indicated that axonal loss is a major contributor to disease progression in multiple sclerosis. 1 H magnetic resonance spectroscopy, through measurement of N -acetyl aspartate, a neuronal marker, provides a unique tool to investigate this. Patients with primary progressive multiple sclerosis have few lesions on conventional MRI, suggesting that changes in normal appearing white matter, such as axonal loss, may be particularly relevant to disease progression in this group. To test this hypothesis (...) NAWM was studied with MRS, measuring the concentration of N -acetyl derived groups. Single-voxel MRS using a water-suppressed PRESS sequence was carried out in 24 patients with primary progressive multiple sclerosis and in 16 age-matched controls. Ratios of metabolite to creatine concentration were calculated in all subjects, and absolute concentrations were measured in 18 patients and all controls. NA/Cr was significantly lower in NAWM in patients than in controls, as was the absolute concentration of NA. There was no significant difference in the absolute concentration of creatine between the groups. This study supports the hypothesis that axonal loss occurs in NAWM in primary progressive multiple sclerosis and may well be a mechanism for disease progression in this group. (shrink)

Identifiable excess surgical tissue is an important resource for medical research but we have become overly restrictive about consent requirements. I suggest we devolve consent to ethics committees for ordinary research projects involving human tissue, retaining the requirement for explicit consent only for those sensitive research situations where there is significant risk of harm to individual interests in privacy.

Ontological arguments like those of Gödel (1995) and Pruss (2009; 2012) rely on premises that initially seem plausible, but on closer scrutiny are not. The premises have modal import that is required for the arguments but is not immediately grasped on inspection, and which ultimately undermines the simpler logical intuitions that make the premises seem plausible. Furthermore, the notion of necessity that they involve goes unspecified, and yet must go beyond standard varieties of logical necessity. This leaves us little reason (...) to believe the premises, while their implausible existential import gives us good reason not to. (shrink)

There is a need for all industries, including healthcare, to reduce their greenhouse gas emissions. In anaesthetic practice, this not only requires a reduction in resource use and waste, but also a shift away from inhaled anaesthetic gases and towards alternatives with a lower carbon footprint. As inhalational anaesthesia produces greenhouse gas emissions at the point of use, achieving sustainable anaesthetic practice involves individual practitioner behaviour change. However, changing the practice of healthcare professionals raises potential ethical issues. The purpose of (...) this paper is twofold. First, we discuss what moral duties anaesthetic practitioners have when it comes to practices that impact the environment. We argue that behaviour change among practitioners to align with certain moral responsibilities must be supplemented with an account of institutional duties to support this. In other words, we argue that institutions and those in power have second-order responsibilities to ensure that practitioners can fulfil their first-order responsibilities to practice more sustainably. The second goal of the paper is to consider not just the nature of second-order responsibilities but the content. We assess four different ways that second-order responsibilities might be fulfilled within healthcare systems: removing certain anaesthetic agents, seeking consensus, education and methods from behavioural economics. We argue that, while each of these are a necessary part of the picture, some interventions like nudges have considerable advantages. (shrink)

Offering philosophical insights into the popular morning brew, _Coffee -- Philosophy for Everyone_ kick starts the day with an entertaining but critical discussion of the ethics, aesthetics, metaphysics, and culture of coffee. Matt Lounsbury of pioneering business Stumptown Coffee discusses just how good coffee can be Caffeine-related chapters cover the ethics of the coffee trade, the metaphysics of coffee and the centrality of the coffee house to the public sphere Includes a foreword by Donald Schoenholt, President at Gillies Coffee Company.

This work has been selected by scholars as being culturally important, and is part of the knowledge base of civilization as we know it. This work was reproduced from the original artifact, and remains as true to the original work as possible. Therefore, you will see the original copyright references, library stamps (as most of these works have been housed in our most important libraries around the world), and other notations in the work. This work is in the public domain (...) in the United States of America, and possibly other nations. Within the United States, you may freely copy and distribute this work, as no entity (individual or corporate) has a copyright on the body of the work. As a reproduction of a historical artifact, this work may contain missing or blurred pages, poor pictures, errant marks, etc. Scholars believe, and we concur, that this work is important enough to be preserved, reproduced, and made generally available to the public. We appreciate your support of the preservation process, and thank you for being an important part of keeping this knowledge alive and relevant. (shrink)

I am grateful for these four wide-ranging and incisive commentaries on my paper discussing the ethical issues that arise when we consider the carbon footprint of inhalers.1 As I am unable to address every point raised, instead I focus on what I take to be the common thread running through these papers. Each response has something to say regarding the scope of healthcare’s responsibility to mitigate climate change. This can be explored at the intuitional or structural level, or at the (...) individual patient and practitioner level leading to a further issue of the relationship between these perspectives. Coverdale argues for broadening the scope of individual responsibilities regarding the climate.2 Discussing inhalers does not go far enough and doctors, argues Coverdale, are well placed to draw attention to the various behaviour changes patients can undertake both through role modelling and in the clinic. While Coverdale makes some excellent points, I have three worries about his proposal. One is relevance. Climate concerns may not always be pertinent in the clinical encounter; think of counselling a bereaved patient or somebody needing a fit note. Related to this is opportunity. General practitioners capacity to cover an inordinate amount in a 10 min consultation …. (shrink)

A probability distribution is regular if it does not assign probability zero to any possible event. Williamson argued that we should not require probabilities to be regular, for if we do, certain “isomorphic” physical events must have different probabilities, which is implausible. His remarks suggest an assumption that chances are determined by intrinsic, qualitative circumstances. Weintraub responds that Williamson’s coin flip events differ in their inclusion relations to each other, or the inclusion relations between their times, and this can account (...) for their differences in probability. Haverkamp and Schulz rebut Weintraub, but their rebuttal fails because the events in their example are even less symmetric than Williamson’s. However, Weintraub’s argument also fails, for it ignores the distinction between intrinsic, qualitative differences and relations of time and bare identity. Weintraub could rescue her argument by claiming that the events differ in duration, under a non-standard and problematic conception of duration. However, we can modify Williamson’s example with Special Relativity so that there is no absolute inclusion relation between the times, and neither event has longer duration except relative to certain reference frames. Hence, Weintraub’s responses do not apply unless chance is observer-relative, which is also problematic. Finally, another symmetry argument defeats even the appeal to frame-dependent durations, for there the events have the same finite duration and are entirely disjoint, as are their respective times and places. (shrink)

In this essay, I argue that the way American bioethics has traditionally conceived of the distinction between public and private has given rise to some ethically problematic blind spots in its analyses to date. Furthermore, I argue that bioethics's view of the public and private spheres has reinforced a shortsighted view of bioethics's analytical sphere of influence. In particular, it has led bioethics to conceptualize issues largely from the perspective of health professionals, eschewing analyses of the problems of health and (...) health information that patients and their intimates face outside of professional relationships and traditional health-care settings. It has also led some bioethical analyses to reflect, and to some degree reinforce, relationships of power that they might instead challenge. (shrink)

However distorted and dysfunctional, gangs satisfy the hunger for honor among adolescents. Churches that take ministry with youth seriously will seek to enable them to express their need for honor, group belonging, and hope in life-affirming ways.