The number of children with chronic critical illness (CCI) is a growing population in the United States. A defining characteristic of this population is a prolonged hospital stay. Our study assessed the proportion of pediatric patients with chronic critical illness in U.S. hospitals at a specific point in time, and identified a subset of children whose hospital stay lasted for months to years. The potential harms of a prolonged hospitalization for children with CCI, which include over treatment, infection, disruption of (...) family life, and the intensive utilization of resources—combined with the moral distress experienced by the clinicians who care for the children, suggest the need for ethical analysis of this growing issue to identify actions that could be taken at the clinical and health systems levels to reduce the harms associated with prolonged hospital stay.In this article we present three real cases from our study that involved a very long hospital stay. We applied a framework developed by Mackenzie, Rogers, and Dodds to analyze inherent, situational, and pathogenic vulnerabilities to examine the ways that interventions intended to remedy one source of harm for the children in our cohort inadvertently created other harms. We examined the complex ways that children with protracted hospitalization are vulnerable to the choices made by their family and clinicians, as well as by healthcare systems and communities. Finally, we used this analysis to summarize actions and ethical responses to this growing patient population. Such an understanding is essential to making clinical and ethical decisions that arise for children who are at risk for a very long stay in the hospital. (shrink)

We present a computational analysis of de re, de dicto, and de se belief and knowledge reports. Our analysis solves a problem first observed by Hector-Neri Castañeda, namely, that the simple rule -/- `(A knows that P) implies P' -/- apparently does not hold if P contains a quasi-indexical. We present a single rule, in the context of a knowledge-representation and reasoning system, that holds for all P, including those containing quasi-indexicals. In so doing, we explore the difference between reasoning (...) in a public communication language and in a knowledge-representation language, we demonstrate the importance of representing proper names explicitly, and we provide support for the necessity of considering sentences in the context of extended discourse (for example, written narrative) in order to fully capture certain features of their semantics. (shrink)

This project continues our interdisciplinary research into computational and cognitive aspects of narrative comprehension. Our ultimate goal is the development of a computational theory of how humans understand narrative texts. The theory will be informed by joint research from the viewpoints of linguistics, cognitive psychology, the study of language acquisition, literary theory, geography, philosophy, and artificial intelligence. The linguists, literary theorists, and geographers in our group are developing theories of narrative language and spatial understanding that are being tested by the (...) cognitive psychologists and language researchers in our group, and a computational model of a reader of narrative text is being developed by the AI researchers, based in part on these theories and results and in part on research on knowledge representation and reasoning. This proposal describes the knowledge-representation and natural-language-processing issues involved in the computational implementation of the theory; discusses a contrast between communicative and narrative uses of language and of the relation of the narrative text to the story world it describes; investigates linguistic, literary, and hermeneutic dimensions of our research; presents a computational investigation of subjective sentences and reference in narrative; studies children’s acquisition of the ability to take third-person perspective in their own storytelling; describes the psychological validation of various linguistic devices; and examines how readers develop an understanding of the geographical space of a story. This report is a longer version of a project description submitted to NSF. This document, produced in May 2007, is a L ATEX version of Technical Report 89-07 (Buffalo: SUNY Buffalo Department of Computer Science, August 1989), with slightly.. (shrink)

When the COVID-19 surge hit New York City hospitals, the Division of Medical Ethics at Weill Cornell Medical College, and our affiliated ethics consultation services, faced waves of ethical issues sweeping forward with intensity and urgency. In this article, we describe our experience over an eight-week period (16 March through 10 May 2020), and describe three types of services: clinical ethics consultation (CEC); service practice communications/interventions (SPCI); and organizational ethics advisement (OEA). We tell this narrative through the prism of time, (...) describing the evolution of ethical issues and trends as the pandemic unfolded. We delineate three phases: anticipation and preparation, crisis management, and reflection and adjustment. The first phase focused predominantly on ways to address impending resource shortages and to plan for remote ethics consultation, and CECs focused on code status discussions with surrogates. The second phase was characterized by the dramatic convergence of a rapid increase in the number of critically ill patients, a growing scarcity of resources, and the reassignment/ redeployment of staff outside their specialty areas. The third phase was characterized by the recognition that while the worst of the crisis was waning, its medium- and long-term consequences continued to pose immense challenges. We note that there were times during the crisis that serving in the role of clinical ethics consultant created a sense of dis-ease as novel as the coronavirus itself. In retrospect we learned that our activities far exceeded the familiar terrain of clinical ethics consultation and extended into other spheres of organizational life in novel ways that were unanticipated before this pandemic. To that end, we defined and categorized a middle level of ethics consultation, which we have termed service practice communication intervention (SPCI). This is an underappreciated dimension of the work that ethics consult services are capable of in times of crisis. We believe that the pandemic has revealed the many enduring ways that ethics consultation services can more robustly contribute to the ethical life of their institutions moving forward. (shrink)

Addressing the issue of how to read Nietzsche, this book presents an accessible series of essays for students and general readers on Nietzsche's individual works, written by such distinguished Nietzsche scholars as Frithjof Bergmann, Arthur Danto, Bernd Magnus, Christopher Middleton, Eric Blondel, Lars Gustaffson, Alexander Nehamas, Richard Schacht, Gary Shapiro, Hugh Silverman, and Ivan Soll. Among the works discussed are On the Genealogy of Morals, Beyond Good and Evil, Thus Spoke Zarathustra, Twilight of the Idols and The Will to (...) Power. (shrink)

This paper uses neo-Fregean-style abstraction principles to develop the integers from the natural numbers (assuming Hume’s principle), the rational numbers from the integers, and the real numbers from the rationals. The first two are first-order abstractions that treat pairs of numbers: (DIF) INT(a,b)=INT(c,d) ≡ (a+d)=(b+c). (QUOT) Q(m,n)=Q(p,q) ≡ (n=0 & q=0) ∨ (n≠0 & q≠0 & m⋅q=n⋅p). The development of the real numbers is an adaption of the Dedekind program involving “cuts” of rational numbers. Let P be a property (of (...) rational numbers) and r a rational number. Say that r is an upper bound of P, written P≤r, if for any rational number s, if Ps then either s<r or s=r. In other words, P≤r if r is greater than or equal to any rational number that P applies to. Consider the Cut Abstraction Principle: (CP) ∀P∀Q(C(P)=C(Q) ≡ ∀r(P≤r ≡ Q≤r)). In other words, the cut of P is identical to the cut of Q if and only if P and Q share all of their upper bounds. The axioms of second-order real analysis can be derived from (CP), just as the axioms of second-order Peano arithmetic can be derived from Hume’s principle. The paper raises some of the philosophical issues connected with the neo-Fregean program, using the above abstraction principles as case studies. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:BOOK REVIEWS 249 larger sections of the work will be translated-preferably not from the Latin, but from the Arabic original. JOSEPHL. B~u Columbia University Commentary on the Metaphysics of Aristotle. By St. Thomas Aquinas. Trans. by John P. Rowan. (Chicago, Illinois: Henry Regnery Company, 1961. Pp. xxiii + 955.2 vols., boxed, $25.00.) Generally speaking, the two Summae of St. Thomas, long available in English translation, contain all that is (...) most personal and most profound in his philosophical thought. Nonetheless, it is quite impossible to get a fully adequate conception of St. Thomas' place in the history of western thought from a consideration of his theological writings alone. Hence, by translating St. Thomas' Commentary on the Metaphysics of Aristotle into English, Professor J. P. Rowan has provided the non-Latin reading student of the history of philosophy an invaluable service. For it is in his r61e as Aristotelian commentator that we see St. Thomas creating for the Schoolmen a version of Aristotle which served to render the Stagirite's thought into terms which became fundamental to the philosophical defense of Christianity. Further, by keeping in mind the fully-developed notions of St. Thomas on the existence of God and the nature of being as these are given us to understand in the Summae, the reader becomes better enabled, by a critical reading of Thomas' Commentary, to grasp the sense in which the Saint's theological writings are said by his enthusiasts to represent a "completing" and "perfecting" of Aristotle's thought. Professor Rowan's translation is based upon the Turin, 1950, edition of R. M. Spiazzi. This edition is itself fundamentally the older edition of M. R. Cathala, containing but few emendations. Although the translator was obliged to check Spiazzi occasionally against the Parma and Viv6s editions of Thomas' Opera Omnia, the usefulness of such consultation was, as Professor Rowan himself states, "limited inasmuch as both the editions of Viv~s and that of Cathala use Parma as their basic text" (p. vii). Further, since the edition from which he worked was not critical, Professor Rowan found it necessary in some instances to himself emend the reading of the Spiazzi text. However, where such alterations were made, and where indeed they were not obviously required, Professor Rowan indicated his iustification for the change in a footnote. It is unfortunate that no critical edition of Thomas' work was available to his translator; still, although a final evaluation of his emendations must, of course, attend the future appearance of a critical edition of Thomas' work, so far as we were able to judge, Professor Rowan's 250 HISTORY OF PHILOSOPHY changes were in all instances quite reasonable and well ]ustified. Professor Rowan has wisely included a translation of that version of the Aristotelian text upon which St. Thomas (in all probability) based his commentary. As this Latin version frequently departs from such currently available English translations as those of W. D. Ross, H. Tredennik, and others which are based upon Greek sources, a good deal of confusion as to Thomas' actual point of departure would have been introduced had this inclusion not been made. The general value and utility of Professor Rowan's work is further increased by his footnoted indications of the more important variations obtaining between the Greek text (as given in Bekker), and the Latin version employed by St. Thomas. For the reader who wishes to compare the Latin version, the Greek text, and the English translations, Professor Rowan has provided the standard Bekker reference numbers at the beginning of each of Thomas' Lectiones. To further simplify the whole matter of reference and cross-reference, Professor Rowan has used the letter C, followed by a numeral, to designate sections of Thomas' Commentary. These sections are the same as those established originally by Cathala. Numbers not preceded by C designate the appropriate sections of the Latin version of Aristotle's text, and correspond with those given by Spiazzi in his revision of the Cathala edition. Thus, as example, in such a reference as (241:C345), the first number designates the section of the version of Aristotle employed by St. Thomas, and the second, the section of St. Thomas... (shrink)

This paper challenges T. S. Gendler's notion of aliefs, a novel kind of mental state which she introduces to explain a wide variety of belief-discordant behaviors. In particular, I argue that many of the cases which she uses to motivate such a mental state can be fully explained by accounts that make use only of commonplace attitudes such as beliefs and desires.

It has recently been argued that hope is polysemous in that it sometimes refers to hoping and other times to being hopeful. That it has these two distinct senses is reflected in the observation that a person can hope for an outcome without being hopeful that it will occur. Below, I offer a new argument for this distinction. My strategy is to show that accepting this distinction yields a rich account of two distinct ways in which hope can be lost, (...) ways that map onto the two senses of hope: A person can lose hope either by ceasing to hope for an outcome (hopelessness) or by ceasing to be hopeful that it will obtain (despair). Thinking about these negative attitudes in these two ways, I contend, is explanatorily rich and fruitfully reveals how they differ in phenomenology, behavioral differences, and the ways in which a person can escape them. (shrink)

Physicians have an ethical responsibility to their patients to offer the best available medical care. This responsibility conflicts with their role as gatekeepers of the limited health care resources available for all patients collectively. It is ethically untenable to expect doctors to face this trade-off during each patient encounter; the physician cannot be expected to compromise the wellbeing of the patient in the office in favour of anonymous patients elsewhere. Hence, as in other domains of public policy where individual and (...) collective interests conflict, some form of collective solution is required. Collective solutions may take the form of placing explicit resource constraints on resources available to physicians, or clinical practice guidelines that recognise cost-effective care as acceptable. Such solutions will be politically and ethically sustainable only if patients as citizens of the larger population accept the need for rationing of limited resources in health care. (shrink)

The answer to philosophical questions will often depend on the position one takes regarding the fact-value problem. It is, therefore, not surprising that, in the tradition of western philosophy, the past 200 years or so record an animated discussion of it. In the present collection the debate is continued by representatives of various "schools" in contemporary western thought. A number of philosophers from non-western cultures, too, enter into it. The contributions do not all reflect on the same theme, nor do (...) they use the same approach. Essays written by philosophers sympathetic to the analytical tradition are followed by reflections on the part of those inspired by phe nomenology. A third group of contributions is by non-western thinkers, who are more likely to approach the problem in terms of culture. Their engage ment with the issue clearly shows, among other things, that it is almost exclusively in the western tradition that the fact-value distinction is often understood as an outright dichotomy. The occasion for the publication of this collection is Dr. Cornelis Anthonie van Peursen's retirement as Professor of Philosophy. This year he leaves the Free University, Amsterdam; until 1982 he was professor at the University of Leyden as well. In the Netherlands and beyond he has become known for his concern with constructive comparison of diverging philosophical trends and the cross-cultural fertilization of thought. Characteristic of his career are his efforts to render the results of academic philosophizing understand able to a broader audience. (shrink)

Today's modern car is an assemblage of mechanical and digital components, of metal panels that comprise its structure and silicon chips that run its functions. Communication and information studies scholars have interrogated the problematic aspects of the programs that run those functions, revealing serious issues surrounding privacy and security, worker surveillance, and racial, gendered, and class-based bias. This article contributes to that work by taking a step back and asking about the issues inherent not in the software running on these (...) chips, but on the microchips themselves. Using the lens of “chipification”—the process by which a device is rendered capable of reading and processing data through the embedding of microchips—this article explores how the integration of microchips also involves processes that are often borne from, replicate, or create troubling power dynamics of their own. It takes light-duty passenger vehicles as a case study into how chipification is radically reshaping such processes as resource allocation, labor flows, and cultural practices around car manufacture, use, repair, and modification. By naming the process of chipification, this article allows researchers to identify and analyze the ways that integrating data processing capabilities into everyday devices is not a frictionless practice, but rather one that implicates a variety of power dynamics within these massive industries. (shrink)

The requirement of gauge invariance for the Schwinger-DeWitt equations, interpreted as a manifestly covariant quantum theory for the evolution of a system in spacetime, implies the existence of a five-dimensional pre-Maxwell field on the manifold of spacetime and “proper time” τ. The Maxwell theory is contained in this theory; integration of the field equations over τ restores the Maxwell equations with the usual interpretation of the sources. Following Schwinger's techniques, we study the Green's functions for the five-dimensional hyperbolic field equations (...) for both signatures ± [corresponding to O(4, 1) or O(3, 2) symmetry of the field equations] of the proper time derivative. The classification of the Green's functions follows that of the four-dimensional theory for “massive” fields, for which the “mass” squared may be positive or negative, respectively. The Green's functions for the five-dimensional field are then given by the Fourier transform over the “mass” parameter. We derive the Green's functions corresponding to the principal part ΔP and the homogeneous function Δ 1 ; all of the Green's functions can be expressed in terms of these, as for the usual field equations with definite mass. In the O(3, 2) case, the principal part function has support for x2⩾τ2, corresponding to spacelike propagation, as well as along the light cone x2=0 (for τ=0). There can be no transmission ofinformation in spacelike directions, with this propagator, since the Maxwell field, obtained by integration over τ, does not contain this component of the support. Measurements are characterized by such an integration. The spacelike field therefore can dynamically establish spacelike correlations. (shrink)

This volume sheds light on still unexplored issues and raises new questions in the main areas addressed by the philosophy of science. Bringing together selected papers from three main events, the book presents the most advanced scientific results in the field and suggests innovative lines for further investigation. It explores how discussions on several notions of the philosophy of science can help different scientific disciplines in learning from each other. Finally, it focuses on the relationship between Cambridge and Vienna in (...) twentieth century philosophy of science. The areas examined in the book are: formal methods, the philosophy of the natural and life sciences, the cultural and social sciences, the physical sciences, and the history of the philosophy of science. (shrink)

0$^{\sharp}$ can be invisibly class generic.

A new human life comes into being not when there is mere cellular life in a human embryo, but when the newly developing body organs and systems begin to function as a whole, the author argues. This is symmetrical with the dealth of an existing human life, which occurs when its organs and systems have permanently ceased to function as a whole. Thus a new human life cannot begin until the development of a functioning brain which has begun to co-ordinate (...) and organise the activities of the body as a whole. (shrink)

Despite the many successes of the relativistic quantum theory developed by Horwitz et al., certain difficulties persist in the associated covariant classical mechanics. In this paper, we explore these difficulties through an examination of the classical. Coulomb problem in the framework of off-shell electrodynamics. As the local gauge theory of a covariant quantum mechanics with evolution paratmeter τ, off-shell electrodynamics constitutes a dynamical theory of ppacetime events, interacting through five τ-dependent pre-Maxwell potentials. We present a straightforward solution of the classical (...) equations of motion, for a test event traversing the field induced by a “fixed” event (an event moving uniformly along the time axis at a fixed point in space). This solution is seen to be unsatisfactory, and reveals the essential difficulties in the formalism at the classical levels. We then offer a new model of the particle current—as a certain distribution of the event currents on the worldline—which eliminates these difficulties and permits comparison of classisical off-shell electrodynamics with the standard Maxwell theory. In this model, the “fixed” event induces a Yukawa-type potential, permitting a semiclassical identification of the pre-Maxwell time scale λ with the inverse mass of the intervening photon. Numerical solutions to the equations of motion are compared with the standard Maxwell solutions, and are seen to coincide when λ≳10−6 seconds, providing an initial estimate of this parameter. It is also demonstrated that the proposed model provides a natural interpretation for the photon mass cut-off required for the renormalizability of the off-shell quantum electrodynamics. (shrink)

If T has only countably many complete types, yet has a type of infinite multiplicity then there is a c.c.c. forcing notion Q such that, in any Q-generic extension of the universe, there are non-isomorphic models M 1 and M 2 of T that can be forced isomorphic by a c.c.c. forcing. We give examples showing that the hypothesis on the number of complete types is necessary and what happens if `c.c.c.' is replaced by other cardinal-preserving adjectives. We also give (...) an example showing that membership in a pseudo-elementary class can be altered by very simple cardinal-preserving forcings. (shrink)

The first part of this paper examines the practice of informed treatment decisions in the protective medical system in China today. The second part examines how health care professionals in China perceive and carry out their responsibilities when relaying information to vulnerable patients, based on the findings of an empirical study that I had undertaken to examine the moral experience of nurses in practice situations. In the Chinese medical ethics tradition, refinement [jing] in skills and sincerity [cheng] in relating to (...) patients are two cardinal virtues that health care professionals are required to possess. This notion of absolute sincerity carries a strong sense of parental protectiveness. The empirical findings reveal that most nurses are ambivalent about telling the truth to patients. Truth-telling would become an insincere act if a patient were to lose hope and confidence in life after learning of his or her disease. In this system of protective medical care, it is arguable as to whose interests are being protected: the patient, the family or the hospital. I would suggest that the interests of the hospital and the family members who legitimately represent the patient's interests are being honoured, but at the expense of the patient's right to know. (shrink)