Howard Brody expresses concern that citing the “two cases that put futility on the map,” namely Helga Wanglie and Baby K, may be providing ammunition to the opponents of the concept of medical futility. He in fact joins well-known opponents of the concept of medical futility in arguing that it is one thing for the physician to say whether a particular intervention will promote an identified goal, quite another to say whether a goal is worth pursuing. In the latter instance, (...) physicians are laying themselves open “to the criticism of taking on basic value judgments that are more appropriately left to patients and their surrogates.” Brody states that in both the Wanglie and Baby K cases, the “basic value judgments” had to do with the worthiness of maintaining unconscious life via medical technology. He classifies this as “a question of professional integrity—but not a question of futility,” adding that “more than semantics hinges on this distinction.” The “more than semantics” factor is a pragmatic, even political one. Failure to make this distinction renders physicians “that much more suspect and less trustworthy in the public debate.”. (shrink)
Jill North offers answers to questions at the heart of the project of interpreting physics. How do we figure out the nature of the world from a mathematically formulated theory? What do we infer about the world when a physical theory can be mathematically formulated in different ways? The notion of structure is crucial to North's answers.
Ethical loneliness is the experience of being abandoned by humanity, compounded by the cruelty of wrongs not being heard. It is the result of multiple lapses on the part of human beings and political institutions that, in failing to listen well to survivors, deny them redress by negating their testimony and thwarting their claims for justice. Jill Stauffer examines the root causes of ethical loneliness and how those in power revise history to serve their own ends rather than the (...) needs of the abandoned. Out of this discussion, difficult truths about the desire and potential for political forgiveness, transitional justice, and political reconciliation emerge. Moving beyond a singular focus on truth commissions and legal trials, she considers more closely what is lost in the wake of oppression and violence, how selves and worlds are built and demolished, and who is responsible for re-creating lives after they are destroyed. Stauffer boldly argues that rebuilding worlds and just institutions after violence is a broad obligation and that those who care about justice must first confront their own assumptions about autonomy, liberty, and responsibility before an effective response to violence can take place. In building her claims, Stauffer draws on the work of Emmanuel Levinas, Jean Améry, Eve Sedgwick, and Friedrich Nietzsche, as well as concrete cases of justice and injustice across the world. (shrink)
In this paper, I consider the thesis advanced by Lawrence J. Schneiderman and Nancy S. Jecker that physicians should be forbidden from offering futile treatments to patients. I distinguish between a version of this thesis that is trivially true and Schneiderman and Jecker's more substantive version of the thesis. I find that their positive arguments for their thesis are unsuccessful, and sometimes quite misleading. I advance an argument against their thesis, and find that, on balance, their thesis should (...) be rejected. I briefly argue that a resolution of the debate about medical futility will require addressing deeper issues about value. (shrink)
We are used to talking about the “structure” posited by a given theory of physics, such as the spacetime structure of relativity. What is “structure”? What does the mathematical structure used to formulate a theory tell us about the physical world according to the theory? What if there are different mathematical formulations of a given theory? Do different formulations posit different structures, or are they merely notational variants? I consider the case of Lagrangian and Hamiltonian classical mechanics. I argue that, (...) contrary to standard wisdom, these are not genuinely equivalent theories: they differ in statespace structure. I suggest that we should be realists about statespace structure. (shrink)
In a recent paper, Malament (2004) employs a time reversal transformation that differs from the standard one, without explicitly arguing for it. This is a new and important understanding of time reversal that deserves arguing for in its own right. I argue that it improves upon the standard one. Recent discussion has focused on whether velocities should undergo a time reversal operation. I address a prior question: What is the proper notion of time reversal? This is important, for it will (...) affect our conclusion as to whether our best theories are time-reversal symmetric, and hence whether our spacetime is temporally oriented. *Received February 2007; revised March 2008. †To contact the author, please write to: Department of Philosophy, Yale University, P.O. Box 208306, New Haven, CT 06520-8306; e-mail: jill[email protected] (shrink)
The Institute of Medicine and the American Heart Association have issued a “call to action” to expand the performance of cardiopulmonary resuscitation in response to out-of-hospital cardiac arrest. Widespread advertising campaigns have been created to encourage more members of the lay public to undergo training in the technique of closed-chest compression-only CPR, based upon extolling the virtues of rapid initiation of resuscitation, untempered by information about the often distressing outcomes, and hailing the “improved” results when nonprofessional bystanders are involved. We (...) describe this misrepresentation of CPR as a highly effective treatment as the fetishization of this valuable, but often inappropriately used, therapy. We propose that the medical profession has an ethical duty to inform the public through education campaigns about the procedure's limitations in the out-of-hospital setting and the narrow clinical indications for which it has been demonstrated to have a reasonable probability of producing favorable outcomes. (shrink)
In Wrong Medicine, Lawrence J. Schneiderman, M.D., and Nancy S. Jecker, Ph.D., address issues that have occupied the media and the courts since the time of Karen Ann Quinlan. The authors examine the ethics of cases in which medical treatment is offered--or mandated--even if a patient lacks the capacity to appreciate its benefit or if the treatment will still leave a patient totally dependent on intensive medical care. In exploring these timely issues Schneiderman and Jecker reexamine the doctor-patient (...) relationship and call for a restoration of common sense and reality to what we expect from medicine. They discuss economic, historical, and demographic factors that affect medical care and offer clear definitions of what constitutes futile medical treatment. And they address such topics as the limits on unwanted treatment, the shift from the "Age of Physician Paternalism" to the "Age of Patient Autonomy," health care rationing, and the adoption of new ethical standards. (shrink)
I argue that the fundamental space of a quantum mechanical world is the wavefunction's space. I argue for this using some very general principles that guide our inferences to the fundamental nature of a world, for any fundamental physical theory. I suggest that ordinary three-dimensional space exists in such a world, but is non-fundamental; it emerges from the fundamental space of the wavefunction.
Regina R. is a 12-year-old girl with recently diagnosed insulin-dependent diabetes. Before discharging her from the hospital, her family physician and consulting diabetes specialist try to instruct the girl and her parents in the appropriate program of treatment, including diet, insulin, and regular self-monitoring. However, the parents become upset when they learn what is involved in insulin treatment and inform the family physician they plan to employ the services of an alternative healing clinic that promises to cure their daughter with (...) a combination of herbal potions, macrobiotics, aroma therapy, therapeutic touch, Ayurveda, homeopathy, and guided imagery. (shrink)
We should see the debate over the existence of spacetime as a debate about the fundamentality of spatiotemporal structure to the physical world. This is a non-traditional conception of the debate, which captures the spirit of the traditional one. At the same time, it clarifies the point of contention between opposing views and offsets worries that the dispute is stagnant or non-substantive. It also unearths a novel argument for substantivalism, given current physics. Even so, that conclusion can be overridden by (...) future physics. I conclude that this debate is a substantive one, which the substantivalist is currently winning. (shrink)
In this introductory textbook to Kant's Critique of Pure Reason, Jill Vance Buroker explains the role of this first Critique in Kant's Critical project and offers a line-by-line reading of the major arguments in the text. She situates Kant's views in relation both to his predecessors and to contemporary debates, explaining his Critical philosophy as a response to the failure of rationalism and the challenge of skepticism. Paying special attention to Kant's notoriously difficult vocabulary, she explains the strengths and (...) weaknesses of his arguments, while leaving the final assessment up to the reader. Intended to be read alongside the Critique, this guide is accessible to readers with little background in the history of philosophy, but should also be a valuable resource for more advanced students. (shrink)
A few years ago a battered infant was admitted to a California hospital. After a period of observation and testing, the physicians concluded that the infant had been beaten so badly that his brain was almost completely destroyed, leaving him permanently unconscious. The hospital had just adopted a policy specifying that life-sustaining treatment for permanent unconsciousness was futile and, therefore, not indicated. According to this policy, after suitable subspecialty consultations and deliberations, including efforts to gain parental agreement and documentation of (...) unanimous ethics committee support, the patient's physician had the authority to discontinue life-sustaining treatment. The infant's physician wished to do this. The mother, however, who was the prime battery suspect, insisted that the baby be kept alive. (shrink)
One of the most entrenched commandments in medicine is: “Never take away a patient's hope!” Often it is issued during the treatment of a terminally ill patient to spur and justify the continuation of aggressive life-prolonging efforts. Hope has been called one of a patient‘s “most powerful internal resources,” and “a powerful ally, our last defense against despair.” One editorialist confidently stated: “[C]ommunicating hope can improve patients’ prognosis.”.
Or better: time asymmetry in thermodynamics. Better still: time asymmetry in thermodynamic phenomena. “Time in thermodynamics” misleadingly suggests that thermodynamics will tell us about the fundamental nature of time. But we don’t think that thermodynamics is a fundamental theory. It is a theory of macroscopic behavior, often called a “phenomenological science.” And to the extent that physics can tell us about the fundamental features of the world, including such things as the nature of time, we generally think that only fundamental (...) physics can. On its own, a science like thermodynamics won’t be able to tell us about time per se. But the theory will have much to say about everyday processes that occur in time; and in particular, the apparent asymmetry of those processes. The pressing question of time in the context of thermodynamics is about the asymmetry of things in time, not the asymmetry of time, to paraphrase Price ( , ). I use the title anyway, to underscore what is, to my mind, the centrality of thermodynamics to any discussion of the nature of time and our experience in it. The two issues—the temporal features of processes in time, and the intrinsic structure of time itself—are related. Indeed, it is in part this relation that makes the question of time asymmetry in thermodynamics so interesting. This, plus the fact that thermodynamics describes a surprisingly wide range of our ordinary experience. We’ll return to this. First, we need to get the question of time asymmetry in thermodynamics out on the table. (shrink)
The concept of meaningful work has recently received increased attention in philosophy and other disciplines. However, the impact of the increasing robotization of the workplace on meaningful work has received very little attention so far. Doing work that is meaningful leads to higher job satisfaction and increased worker well-being, and some argue for a right to access to meaningful work. In this paper, we therefore address the impact of robotization on meaningful work. We do so by identifying five key aspects (...) of meaningful work: pursuing a purpose, social relationships, exercising skills and self-development, self-esteem and recognition, and autonomy. For each aspect, we analyze how the introduction of robots into the workplace may diminish or enhance the meaningfulness of work. We also identify a few ethical issues that emerge from our analysis. We conclude that robotization of the workplace can have both significant negative and positive effects on meaningful work. Our findings about ways in which robotization of the workplace can be a threat or opportunity for meaningful work can serve as the basis for ethical arguments for how to—and how not to—implement robots into workplaces. (shrink)
There has been a massive advocacy movement over the last 15 years that has sought to advance the case of religion into view of decision-makers in the international development sector. This advocacy effort has been dispersed and not centrally organised, and is made up of the efforts of multiple development actors, religious institutions, researchers and others. This article shows how this advocacy approach has been highly successful in increasing acceptance of the fact that religion is relevant to development, and religious (...) communities and institutions make contributions to the development effort - and this acceptance can now be seen at the highest levels. However, the article highlights several challenges that have come with this advocacy approach. It therefore supports urgent reflection on the direction of this advocacy going forward and suggests that major and uncomfortable adaptations might now be required. (shrink)
Partly because physicians can “never say never,” partly because of the seduction of modern technology, and partly out of misplaced fear of litigation, physicians have increasingly shown a tendency to undertake treatments that have no realistic expectation of success. For this reason, we have articulated common sense criteria for medical futility. If a treatment can be shown not to have worked in the last 100 cases, we propose that it be regarded as medically futile. Also, if the treatment fails to (...) restore consciousness or alleviate total dependence on intensive care, we propose such treatment be judged futile. This definition provides clear end points and encourages the profession to review data from the past and perform, prospective clinical studies that not only report treatments that work but also treatments that do not work. We have also argued that, in a variety of settings, physicians have no ordinary ethical obligation to offer futile interventions. Although physicians should inform, and discuss all decisions to withhold or withdraw medical treatments with patients, they need not obtain the patient's permission to desist from futile interventions. (shrink)
This book analyzes contemporary visual art produced in the context of conflict and trauma from a range of countries, including Colombia, Northern Ireland, South Africa, and Australia. It focuses on what makes visual language unique, arguing that the "affective" quality of art contributes to a new understanding of the experience of trauma and loss. By extending the concept of empathy, it also demonstrates how we might, through art, make connections with people in different parts of the world whose experiences differ (...) from our own. The book makes a distinct contribution to trauma studies, which has tended to concentrate on literary forms of expression. It also offers a sophisticated theoretical analysis of the operations of art, drawing on philosophers such as Gilles Deleuze, but setting this within a postcolonial framework. _Empathic Vision_ will appeal to anyone interested in the role of culture in post-September 11 global politics. (shrink)
We often use symmetries to infer outcomes’ probabilities, as when we infer that each side of a fair coin is equally likely to come up on a given toss. Why are these inferences successful? I argue against answering this with an a priori indifference principle. Reasons to reject that principle are familiar, yet instructive. They point to a new, empirical explanation for the success of our probabilistic predictions. This has implications for indifference reasoning in general. I argue that a priori (...) symmetries need never constrain our probability attributions, even when it comes to our initial credences. (shrink)
The paper explores the ethical and psychological issues that arise when family members request that “everything possible” be done for a particular patient. The paper first illustrates this phenomenon by reviewing the well known case of Helga Wanglie. We proceed to argue that in Wanglie and similar cases family members may request futile treatments as a means of conveying that (1) the loss of the patient is tantamount to losing a part of themselves; (2) the patient should not be abandoned (...) or disvalued in any way; or (3) the patient is owed special obligations by virtue of the special relationship in which the family and the patient stand. We maintain that families can best express these important messages by caring for patients, rather than by making requests for futile interventions. Likewise, when life-sustaining measures are futile, health providers can best fulfill their professional obligations by assuring patients' dignity and comfort, rather than by applying futile interventions. (shrink)
Previous studies have documented the fallibility of attempts by surrogates and physicians to act in a substituted judgment capacity and predict end-of-life treatment decisions on behalf of patients. We previously reported that physicians misperceive their patients' preferences and substitute their own preferences for those of their patients with respect to four treatments: cardiopulmonary resuscitation in the event of cardiac arrest, ventilator for an indefinite period of time, medical nutrition and hydration for an indefinite period of time, and hospitalization in the (...) event of pneumonia. (shrink)
In the twenty interviews collected in this volume, seventeen of which appear in English for the first time, Levinas sets forth the central features of his ethical philosophy and discusses biographical matters not available elsewhere.
Can the documentary be useful? Can a film change how its viewers think about the world and their potential role in it? In Kill the Documentary, the award-winning director Jill Godmilow issues an urgent call for a new kind of nonfiction filmmaking. She critiques documentary films from Nanook of the North to the recent Ken Burns/Lynn Novick series The Vietnam War. Tethered to what Godmilow calls the "pedigree of the real" and the "pornography of the real," they fail to (...) activate their viewers' engagement with historical or present-day problems. Whether depicting the hardships of poverty or the horrors of war, conventional documentaries produce an "us-watching-them" mode that ultimately reinforces self-satisfaction and self-absorption. In place of the conventional documentary, Godmilow advocates for a "postrealist" cinema. Instead of offering the faux empathy and sentimental spectacle of mainstream documentaries, postrealist nonfiction films are acts of resistance. They are experimental, interventionist, performative, and transformative. Godmilow demonstrates how a film can produce meaningful, useful experience by forcefully challenging ways of knowing and how viewers come to understand the world. She considers her own career as a filmmaker as well as the formal and political strategies of artists such as Luis Buñuel, Georges Franju, Harun Farocki, Trinh T. Minh-ha, Rithy Panh, and other directors. Both manifesto and guidebook, Kill the Documentary proposes provocative new ways of making and watching films. (shrink)
D.T. a 35-year-old woman, was found to have breast cancer. At the time of mastectomy axillary lymph nodes were positive and the cancer was classified as adenocarcinoma, grade 4. The patient underwent conventional chemotherapy. When it became apparent the disease was metastatic, the patient's oncologist contacted a well-known cancer center regarding the possibility of treating the patient with high dose chemotherapy and autologous bone marrow transplantation. The patient's health insurance provider informed the patient, however, that the treatment—estimated to cost in (...) the range of $150,000–200,000—was “considered experimental or research in nature” and therefore was not included in coverage. D.T. did not pursue this further. Approximately 2 years later, cancer was detected in the patient's spine. This time she applied to another well-known cancer center for HDC/ABMT. The cancer center agreed to accept her on the condition of proof of ability to pay for the treatment. Again her insurer refused coverage on the same grounds as before. D.T. found another source for the money, underwent treatment, then sued the insurance carrier. She sought a declaratory judgment that the treatment was covered under the insurance policy. The court ruled in favor of D.T. finding the contract phrase “considered experimental” ambiguous. (shrink)
Dominant food systems, based on industrial methods and corporate control, are in a state of flux. To enable the transition towards more sustainable and just food systems, food movements are claiming new roles in governance. These movements, and the initiatives they spearhead, are associated with a range of labels (e.g., food sovereignty, food justice, and community food security) and use a variety of strategies to enact change. In this paper, we use the concept of relational fields to conduct a post-hoc (...) analysis of nine cases, examining how social movement organizations and other actors actively create new deliberative governance spaces. We argue that successes are related to the “power to convene,” a process-oriented approach that increases movements’ capacity to mobilize; leverage different types of power; and integrate, coordinate, and build a systems-oriented vision. The power to convene and create deliberative spaces is demonstrated in a variety of contexts and often results in outcomes that further movement aims, including policy change and repositioning food movement actors vis-à-vis others in the field. Our findings suggest that success is not only measured as policy outcomes, but as an advantageous repositioning of social movement actors that enables them to be part of governance processes beyond simple policy advocacy. (shrink)
This is a collection of thirteen new philosophical essays exploring the inequities in our contemporary food system. The book addresses topics including food and property, food insecurity, food deserts, food sovereignty, the gendered aspects of food injustice, food and race, and locavorism.
Huw Price argues that there are two conceptions of the puzzle of the time-asymmetry of thermodynamics. He thinks this puzzle has remained unsolved for so long partly due to a misunderstanding about which of these conceptions is the right one and what form a solution ought to take. I argue that it is Price’s understanding of the problem which is mistaken. Further, it is on the basis of this and other misunderstandings that he disparages a type of account which does, (...) in fact, hold promise of a solution. (shrink)
Using a Solomon four-group design, we investigate the effect of a case-based critical thinking intervention on students’ critical thinking skills. We randomly assign 31 sessions of business classes to four groups and collect data from three sources: in-class performance, university records, and Internet surveys. Our 2 × 2 ANOVA results showed no significant between-subjects differences. Contrary to our expectations, students improve their critical thinking skills, with or without the intervention. Female and Caucasian students improve their critical thinking skills, but males (...) and non-Caucasian do not. Positive performance goals and negative mastery goals enhance and decrease improvements of their CTA scores, respectively. ACT and age are related to pre- and post-test. Gender is related to pre-test. GPA is related to post-test. Results shed light on the Pygmalion effect, the Galatea effect, ability, motivation, and opportunity as signals for human capital, and business ethics. (shrink)
Historienne, professeure associée à l’Université North Carolina Charlotte, Jill Massino est spécialiste de l’Europe de l’Est, de la Guerre froide, du genre, de l’histoire culturelle et de la mémoire, du socialisme et du postsocialisme. Sa monographie publiée en 2019 s’inscrit dans la continuité d’un volume collectif qu’elle a codirigé avec Shana Penn en 2009 (Gender Politics and Everyday Life in State Socialist Eastern and Central Europe, Palgrave Macmillan) et explore la problématique de la...
Researchers tracking social trends have discovered a remarkable labor-saving device called the computer. They sit down before the instrument, call up a search engine, enter a key word that they believe represents the trend, and count the number of articles aroused by that key word. They track these numbers over a period of time and even graph them. Those who dislike a certain concept are happy to report the concept's rise and fall. Such has occurred with two articles, one of (...) which appeared in CQ, reporting the rise and fall of medical futility. We are impressed with the power of this research methodology, which seems capable of eliminating concepts, even when our own more labor-intensive yet apparently less perceptive daily experience finds evidence of their existence all around us. (shrink)