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)

In the mid 1980s it was apparent that the need for organ donors exceeded those willing to donate. Some University of Pittsburgh Medical Center (UPMC) physicians initiated discussion of possible new organ donor categories including individuals pronounced dead by traditional cardiac criteria. However, they reached no conclusion and dropped the discussion. In the late 1980s and the early 1990s, four cases arose in which dying patients or their families requested organ donation following the elective removal of mechanical ventilation. Controversy surrounding (...) these cases precipitated open discussion of the use of organ donors pronounced dead on the basis of cardiac criteria. Prolonged deliberations by many committees in the absence of precedent ultimately resulted in what is, to our knowledge, the country's first policy for organ donation following elective removal of life support. The policy is intricate and conservative. Care was taken to include as many interested parties as possible in an effort to achieve representative and broad based support. This paper describes the development of the UPMC policy on non-heart-beating organ donation. (shrink)

When successful solid organ transplantation was initiated almost 40 years ago, its current success rate was not anticipated. But continuous efforts were undertaken to overcome the two major obstacles to success: injury caused by interrupting nutrient supply to the organ and rejection of the implanted organ by normal host defense mechanisms. Solutions have resulted from technologic medical advances, but also from using organs from different sources. Each potential solution has raised ethical concerns and has variably resulted in societal acclaim, censure, (...) and apathy. Transplant surgery is now well accepted, and the list of transplant candidates has grown far quicker than the availability of organs. More than 30,000 patients were awaiting organs for transplantation at the end of March 1993. While most organs came from donors declared dead by brain criteria, the increasing shortage of donated organs has prompted a reexamination of prior restrictions of donor groups. Recently, organ procurement from donors with cardiac death has been reintroduced in the United States. This practice had been mostly abandoned by the U.S. and some, though not all, other countries. Transplantation has been more successful using organs procured from heart-beating, "brain dead" cadavers than organs from non-heart-beating cadavers. However, recent advances have led to success rates with organs from non-heart-beating donors that may portend large increases in organ donation and procurement from this source. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 11.2 (2001) 115-116 [Access article in PDF] The Ethics of Medical Mistakes: Historical, Legal, and Institutional Perspectives Introduction In late 1999, the Institute of Medicine (IOM) released its report on medical errors, To Err is Human: Building a Safer Health System. The report estimated almost 50,000 deaths per year nationally due to medical mistakes, making it a leading cause of death. IOM speculated that (...) more than half of the deaths related to medical error are preventable. The IOM report shocked the public and medical professionals alike, sparking a national discussion of how to make the health care system safer. This multifaceted issue has profound implications for all aspects of health care, from the very personal--e.g., the relationship of caregiver and patient--to the societal--e.g., a nation's responsibility to its citizens.On 15 May 2000, the University of Pittsburgh Medical Center hosted an ethics conference devoted to the topic of medical mistakes. The goal was to bring together experts from various disciplines, before an audience of both providers and patients, to discuss medical mistakes and their implications. In this issue of the Kennedy Institute of Ethics Journal, we present selected papers resulting from that conference. These papers reflect not only the original oral presentations, but also much of the discussion those presentations generated. Three key perspectives on the ethics of medical mistakes are offered: historical, legal, and institutional.Rosa Lynn Pinkus offers a revealing historical perspective on the ethics of medical mistakes. In analyzing the history of mistake reporting in neurosurgery, she shows how the notion of a mistake developed only as the notion of a standard of practice emerged. Although much of managed care is directed toward systematically fostering a standard of care, this pursuit is relatively new in health care. One might speculate that as more standards are created, mistakes--defined as deviations from standard practice--must increase. If deviation from standard practice is overly castigated, however, then needed innovation in practice may be stifled. Interestingly, as Pinkus discusses, medical malpractice suits quickly followed the emergence of practice standards, driving the initial open reporting of mistakes underground. [End Page 115]Taking up the issue of medical malpractice, Thomas May and Mark Aulisio consider the ramifications of the current malpractice system for mistake prevention. The current system, they argue, while failing to adequately achieve its purported goals of deterring medical mistakes and compensating victims, itself creates a climate that deters the open reporting of mistakes by engendering fear and shame in clinicians. According to May and Aulisio, this failure to report medical mistakes openly has serious ramifications. Chief among these is the inability to do root cause analysis of mistakes, and then, where possible, to implement safeguards to minimize the occurrence of future mistakes. Ultimately, both the prevention of medical mistakes and the goals of malpractice litigation itself will be better served if substantial malpractice reform is undertaken.Andy Thurman argues that even in the current climate institutions ought to have a policy (and practice) of admitting to and openly reporting medical mistakes. Thurman argues that doing so not only is the right thing to do, but is also in the interest of institutions. Interestingly, he contends that failing to admit and openly report mistakes is both at odds with the mission of health care institutions and puts them at higher risk of litigation, and liability. In light of this, Thurman then suggests an institutional process for handling medical mistakes.Michael DeVita concedes that disclosing mistakes is widely supported by the health professionals' principles of ethics, but argues that there are a number of factors that conspire to make doing so a very difficult task. In analyzing an index case, DeVita contends that platitudes about being honest are not nearly enough to foster honest behavior and that policies that offer specific guidance on handling unfavorable events are needed in health care institutions.Finally, we conclude with the policy on disclosure of unfavorable events (this terminology is chosen because it includes both iatrogenic and natural diseases and conditions) that resulted from... (shrink)

Physicians are taught that the foundation of the physician-patient relationship is trust, and trust is based in part on truthfulness. While drawing important Òlines in the sandÓ regarding whether and why to tell the truth, ethics codes promulgating honesty fail to provide clinicians with guidance regarding what is the truth, as well as when and how to disclose it. These issues may be at the core of why an adverse event is left undisclosed. Consistently being truthful in the setting of (...) an error is particularly difficult and requires overcoming a number of institutional and personal barriers. The article concludes that if delivering Òthe truthÓ is important, then articulation of criteria for determining what should be told, by whom, and when is essential. A policy that considers the practical issues and provides guidance may be useful. (shrink)

The first reported successful kidney transplantation occurred in 1954, between twins. Since then, organ donation and transplantation has become less a medical marvel than a common expectation of patients with a variety of diseases resulting in organ failure. Those expectations have caused demand for organs to skyrocket far beyond available supply, fueling an organ shortage and resulting in over 60,000 patients on transplant waiting lists. In this special issue, our contributors attempt to shed new light on some of the many (...) old ethical questions raised by transplant in the contemporary context of extreme scarcity. (shrink)

Organ transplantation is an accepted therapy for major organ failure, but it depends on the availability of viable organs. Most organs transplanted in the U.S. come from either "brain-dead" or living related donors. Recently organ procurement from patients pronounced dead using cardiopulmonary criteria, so-called "non-heart-beating cadaver donors" (NHBCDs), has been reconsidered. In May 1992, the University of Pittsburgh Medical Center (UPMC) enacted a new, complicated policy for procuring organs from NHBCDs after the elective removal of life support. Seventeen months later (...) only one patient has become a NHBCD. This article describes her case and the results of interviews with the health care team and the patient's family. The case and interviews are discussed in relation to several of the ethical concerns previously raised about the policy, including potential conflicts of interest, the definition of cardiopulmonary death, and a possible net decrease in organ donation. The conclusion is reached that organ procurement from non-heart-beating cadavers is feasible and may be desirable both for the patient's family and the health care providers. (shrink)

In 1991, the University of Pittsburgh Medical Center implemented a policy that permitted the recovery of organs from cadavers pronounced dead using standardized cardiac criteria. This policy allowed families that had made a decision to forgo life sustaining treatment to then request organ donation. This entailed taking the patient to the operating room, discontinuing therapy, and after the patient is pronounced dead, procuring organs.

In the preceding commentary, Campbell and Weber raise two valid and important issues concerning non-heart-beating organ donation (NHBOD). First, because the procedure links withdrawal of life support and the potential for subsequent organ donation, the desire for organs may create a situation in which care of the dying individual has relatively less importance and the dying may receive suboptimal care. Second, even if concerns about care of the dying were dealt with adequately, there will not be enough non-heart-beating donors to (...) significantly decrease the organ shortage that exists, making the procedure not worth the risk. We agree that attention to the important details of caring for the dying are, and must be, the primary concern of all health care workers caring for those individuals. Ensuring the patients' comfort, dignity, and autonomy, and providing for family and social support are the mainstays of this care. All policies for NHBOD should clearly support and mandate these concepts. Regarding the second concern, we agree that NHBOD is currently rare; however, evidence is increasing that this type of donation has great potential. Continued growth of the practice in this country will depend largely on public acceptance, which we believe will be directly influenced by whether the public perceives that care of the dying is not compromised by this procedure. (shrink)

: Research involving the dead, especially heart-beating cadavers, may facilitate the testing of potentially revolutionary and life-saving medical treatments. However, to ensure that such research is conducted ethically, it is essential to: (1) identify appropriate standards for this research and (2) assign institutional responsibility and a mechanism for oversight. Protocols for research involving the dead should be reviewed by a special committee and assessed according to nine standards intended to ensure scientific merit, to protect deceased patients and their families, and (...) to promote institutional integrity and responsibility. Federal regulation of research involving the dead will foster appropriate standards and, equally importantly, help establish the acceptability of such research. (shrink)

Management and business literature affirm the role played by stakeholders in corporate social responsibility practices as crucial, but what constitutes a true business–society partnership remains relatively unexplored. This paper aims to improve scholarly and management understanding beyond the usual managers’ perceptions on salience attributes, to include how stakeholders can acquire missing attributes to inform a meaningful partnership. In doing this, a model is proposed which conceptualises CSR practices and outcomes within the frameworks of stakeholder salience via empowerment, sustainable corporate social (...) performances and partnership quality. A holistic discussion leads to generation of propositions on stakeholder salience management, corporate social performance, corporate–community partnership systems and CSR practices, which have both academic and management implications. (shrink)

One way of increasing the supply of vital organs without violating the dead donor rule is to declare death on cardiopulmonary criteria after withdrawing life support. The question then is how quickly death may be declared.

One way of increasing the supply of vital organs without violating the dead donor rule is to declare death on cardiopulmonary criteria after withdrawing life support. The question then is how quickly death may be declared.

BackgroundNormally, physicians understand they have a duty to treat patients, and they perform accordingly consistent with codes of medical practice, standards of care, and inner moral motivation. In the case of COVID-19 pandemic in a developing country such as Bangladesh, however, the fact is that some physicians decline either to report for duty or to treat patients presenting with COVID-19 symptoms. At issue ethically is whether such medical practitioners are to be automatically disciplined for dereliction of duty and gross negligence; (...) or, on the contrary, such physicians may legitimately claim a professional right of autonomous judgment, on the basis of which professional right they may justifiably decline to treat patients.MethodsThis ethical issue is examined with a view to providing some guidance and recommendations, insofar as the conditions of medical practice in an under-resourced country such as Bangladesh are vastly different from medical practice in an industrialized nation such as the USA. The concept of moral dilemma as discussed by philosopher Michael Shaw Perry and philosopher Immanuel Kant’s views on moral appeal to “emergency” are considered pertinent to sorting through the moral conundrum of medical care during pandemic.ResultsOur analysis allows for conditional physician discretion in the decision to treat COVID-19 patients, i.e., in the absence of personal protective equipment (PPE) combined with claim of duty to family. Physicians are nonetheless expected to provide a minimum of initial clinical assessment and stabilization of a patient before initiating transfer of a patient to a “designated” COVID-19 hospital. The latter is to be done in coordination with the national center control room that can assure admission of a patient to a referral hospital prior to ambulance transport.ConclusionsThe presence of a moral dilemma (i.e., conflict of obligations) in the pandemic situation of clinical care requires institutional authorities to exercise tolerance of individual physician moral decision about the duty to care. Hospital or government authority should respond to such decisions without introducing immediate sanction, such as suspension from all clinical duties or termination of licensure, and instead arrange for alternative clinical duties consistent with routine medical care. (shrink)

The National Institute of Mental Health (Bethesda, MD) reports that approximately 5.2 million Americans experience post-traumatic stress disorder (PTSD) each year. PTSD can be severely debilitating and diminish quality of life for patients and those who care for them. Studies have indicated that propranolol, a beta-blocker, reduces consolidation of emotional memory. When administered immediately after a psychic trauma, it is efficacious as a prophylactic for PTSD. Use of such memory-altering drugs raises important ethical concerns, including some futuristic dystopias put forth (...) by the President's Council on Bioethics. We think that adequate informed consent should facilitate ethical research using propranolol and, if it proves efficacious, routine treatment. Clinical evidence from studies should certainly continue to evaluate realistic concerns about possible ill effects of diminishing memory. If memory-attenuating drugs prove effective, we believe that the most immediate social concern is the over-medicalization of bad memories, and its subsequent exploitation by the pharmaceutical industry. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Hume Studies Volume 30, Number 2, November 2004, pp. 265-296 A Symposium on Louis E. Loeb, Stability and Justification in Hume's Treatise The Unity of Hume's Philosophical Project MICHAEL WILLIAMS 1. Introduction In both his Treatise of Human Nature and Enquiry concerning Human Understanding, Hume presents a protean figure.1 By turns, he appears as a naturalistic theorist of the mind, a proto-Positivist critic of speculative metaphysics, and an (...) utter skeptic. Can these various characters be seen to work together? On the whole, Hume's interpreters seem to think not. The typical approach is to pick a dominant personality, leaving Hume's other philosophicalpersonae to be squeezed in as an afterthought, deprecated, or simply ignored. Louis Loeb is a shining exception.2 His new book, subtle and densely argued, offers an account of Hume's epistemology that makes a sustained effort to come to terms with its multi-faceted character. However, while Loeb's interpretation marks a real advance in our understanding of Hume, it is not one that I find ultimately persuasive. As I shall try to show, for all his insights, Loeb too fails to provide a satisfyingly unified account of Hume's philosophical pro j ect. In the course of explaining why I think this, I shall indicate how I think a better account ought to go. 2. Varieties of Skepticism The key to understanding Hume is to come to terms with the ways in which Hume is and is not a skeptic. So before going farther it will be useful to distinguish the Michael Williams is Krieger-Eisenhower Professor of Philosophy at The Johns Hopkins University, 347 Gilman Hall, Baltimore, MD 21218, USA. e-mail: [email protected] 266 Michael Williams various forms that skepticism takes, or might be thought to take, in Hume's epistemological writings. The distinctions I shall introduce will also make it easier to characterize different ways of reading Hume, Loeb's included. First, we must distinguish between epistemological skepticism, which has to do with knowledge and belief, and conceptual skepticism which has to do with meaning. So for example, where an epistemological skeptic may wonder whether beliefs of a certain broad kind can be justified, a conceptual skeptic will wonder whether the words we use to express such purported beliefs are so much as meaningful. It seems clear that both kinds of skepticism figure in Hume's theory of the understanding. However, commentators differ sharply over their relative importance. Second, we must distinguish two forms of epistemological skepticism: theoretical (or Academic) skepticism and suspensive skepticism (or Pyrrhonism). As its name suggests, theoretical skepticism is a thesis (or family of theses) about the epistemic status of human beliefs: for example, the thesis that such and such beliefs do not amount to knowledge or are not justifiable. It is important to note that one can entertain such a thesis in a purely speculative or theoretical way, without becoming inclined to relinquish any fundamental beliefs. By contrast, Pyrrhonism involves an actual breakdown in belief. Again, though we seem to be able to find both Academic and Pyrrhonian elements in Hume's epistemological outlook, commentators are seriously at odds over how to put them together. Third, both theoretical and suspensive skepticism can be either qualified (Hume says "mitigated") or unqualified (we can say "radical"). The most important form of qualified theoretical skepticism is anti-Rationalism. Anti-Rationalism embraces such theses as that our beliefs never amount to knowledge, or are not supportable by (what we can show to be) truth-conducive reasons. By contrast, theoretical skepticism in its most radical form is the claim that no beliefs are in any sense more reasonable than others: i.e., that normative-epistemological distinctions between beliefs are completely indefensible. We can make an analogous distinction with respect to suspensive skepticism. A qualifiedly skeptical outlook might take the form of anti-Dogmatism: we hold beliefs, but in an open-minded, fallibilist spirit, taking nothing to be altogether certain, suspending final judgment. Alternatively, we might suffer a complete breakdown of belief. Once more, we find serious differences of opinion among commentators. In what way is Hume's skepticism mitigated, or qualified, if indeed it is qualified... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Hermeneutics, Neuroscience and PsychiatryMichael T. H. Wong, MBBS, MD, MA, MDiv, PhD, FRCPsych, FRANZCP, FHKAM (bio)Hermeneutic practice in mental health has been a theme in Philosophy, Psychiatry, & Psychology (PPP) since its very beginnings. In this essay I argue that hermeneutics, the theory and practice of interpretation, promotes therapeutic interaction between mental health professionals, patients and their family.Why does this patient present in such a way at this particular (...) point in time? The distressing symptoms are there. The changes in behavior are obvious. Impairments of functions are hurting. A mental illness clearly runs in the family. There were early losses of loved ones, physical abuse at home, bullying by peers and self-medication with drugs and alcohol. Three in four adults with a mental illness first experienced that before they turned 24. The brain goes through major reorganization during adolescence and early adulthood. If synaptic pruning went wrong, psychoses emerged. When stresses activated the hypothalamic–pituitary–adrenal axis the elevated cortisol level impacted the size and function of the hippocampus and amygdala in the genetically vulnerable; anxiety, depression, bipolar, and personality disorders developed. The patient needs a voice/language to describe all these experiences and events and the psychiatrist needs a discourse to make sense of them.Eisenberg laments the swings between "brainlessness" and "mindlessness" in psychiatry. Engel argues for a "biopsychosocial" discourse. The major challenge for psychiatry is how to organize clinical information of different nature (categories, dimensions, narratives; i.e., objective vs. subjective, personal vs. interpersonal) into a coherent and comprehensible account for us all. Mental illnesses are not only neuropsychiatric spectrum disorders but also dysfunctions of social relationship and environmental/ecological adaptation. Psychiatry as a clinical neuroscience per se lacks the semantics to address the rich interactions between the physical, psychological, social, cultural, and spiritual in the illness experience of our patients. Explanation in the diagnostic formulation (objective scientific discourse on cause and effect) and understanding in the patient narrative (subjective ordinary everyday discourse on significance and meaning) are irreducible to each other (Wong, 2018). They instead interact with one another to achieve an integrative formulation, not through merging different discourses into a single assertion/monologue but via the dialectic/dialogue of "explaining more in order to understand better," as Ricoeur puts it, and between "the whole and the parts," as Schleiermacher highlights.This "therapeutic hermeneutic circle" of "explanation vs understanding" and "the whole vs the parts" includes symptoms behavior function and life events. It correlates between bio-psychosociocultural-spiritual dimensions/perspectives and does not reduce them to any particular/single [End Page 13] stance. The whole integrates the parts and the parts enrich the whole. It explains but does not explain away. It understands through an articulation of meaning and significance. This discourse is a multilayered (bio-psycho-social-cultural-spiritual) personal narrative that formulates diagnosis and care in a correlative (linking different voices/discourses) and non-reductive (no particular voice/discourse is prejudiced against) manner that is comprehensible to us all (Wong, 2021).PPP will be an excellent forum for discussing clinical hermeneutics in the future. In this digital era of social media and virtual reality, hermeneutics has the never-ending task to tackle the unprecedented challenges to meaning illness and health posed by polarizing discourses.Michael T. H. Wong Michael T.H. Wong, MBBS, MD, MA, MDiv, PhD, FRCPsych, FRANZCP, FHKAM, is Hon Clinical Professor, Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, HKSAR, China. Michael is Chair, Section of Philosophy & Humanities in Psychiatry, World Psychiatric Association. He is an Organizational Partner & International Lead with The Collaborating Centre for Values-Based Practice in Health and Social Care, St Catherine's College Oxford. He is Advisor to the Chinese Health Foundation of Australia.ReferencesWong M. T. H. (2018). Ricoeur and the third discourse of the person: From philosophy and neuroscience to psychiatry and theology. London: Lexington Books. Google ScholarWong, M. T. H. (2021). Values, meanings, hermeneutics and mental health. In Stoyanov, D., Fulford, K. M. W. F., Stanghellini, G., Van Staden, W., & Wong, M. TH. (Eds.), International perspectives in values-based mental health practice: Case studies and commentaries (pp. 341–349... (shrink)

In 1783, as part of an exchange in the Berliner Monatsschrift, Johann Friedrich Zöllner’s “famous request for an answer to the question ‘What is Enlightenment?’ was prompted by his sense that the m...

Are you a Reluctant Metaphysician? A career change, an upsetting external event, a serious illness, a painful breakup, or an unravelling culture can all be invitations to enter a deeper world behind the world. You may not have chosen to go there, but you evolve thereby. This book weaves together stories and reflections to introduce teachings and practices from ancient wisdom traditions that illuminate our unique life path.The Path of a Reluctant Metaphysician speaks to the importance of a holistic spiritual (...) philosophy in our current times of the "great unraveling" of our political, economic, cultural, and ecological world. Here you will find an approach to finding your life stance in such troubled times. The metaphysical path is an "all vector approach" that incorporates both "spiritual" and "soulful" pathways, traditions of postural initiation such as Tai Chi, mythology, depth psychology, bodymind healing methods, a non-deterministic approach to astrology, and a multi-dimensional approach to the political sphereDr. Mayer transmits stories, teachings, and practices from his multifaceted career that are so captivating, they may lead you to reluctantly take time out of your busy everyday life. Be forewarned if you read this book you too may become a Reluctant Metaphysician! Kirkus Reviews says: "A meaningful contribution to the spiritual self-help library...A psychologist blends spiritual paths from the East, West, and beyond for an innovative approach to healing...an expansive tale told with humility and insight." Larry Dossey, MD says, Dr. Mayer's revelations in various metaphysical domains are a guide for anyone who desires a richer and more fulfilling experience of life. If you think life must contain more juice than you have known so far, this book is for you. (shrink)

Developments in the last several years have sparked renewed interest in the ethics of research involving humans. Issues relating to the global extent of research and its guiding principles are of particular importance to researchers, health officials, and individual ethics committees who want a deeper and more encompassing inquiry regarding the foundation and evolution of human research. This department of CQ launches a long overdue effort to explore these wider issues. Readers are invited to submit papers to Charles MacKay, 5011 (...) Worthington Drive, Bethesda, MD, 20816, USA. E-mail: [email protected]. (shrink)

The Ontology Summit 2012 explored the current and potential uses of ontology, its methods and paradigms, in big systems and big data: How ontology can be used to design, develop, and operate such systems. The systems addressed were not just software systems, although software systems are typically core and necessary components, but more complex systems that include multiple kinds and levels of human and community interaction with physical-software systems, systems of systems, and the socio-technical environments for those systems which can (...) include cultural, legal, and economic components. The focus themes used for this exploration were Big Systems Engineering, Big Data Challenge, Large Scale Domain Applications, and cross-cutting aspects Ontology Quality, and Federation and Integration of Systems. The Ontology Summit 2012 consisted of over three months of intensive virtual collaborative elaboration of these issues in presentations, panels, and group email. The culmination of these activities was a face-to-face Symposium at the US National Institute of Standards and Technology (NIST), Gaithersburg, MD, USA, 12–13 April 2012. The primary product of this Ontology Summit is the communiqué reported here. But there are other products, some continuing as collaborative, more specifically focused analysis and modeling efforts aligned with various open standards activities. Behind all of these particular products, of course, is the real overriding purpose of the Ontology Summit 2012, which was: the joint collaboration of three distinct communities, the ontology, systems engineering and big systems stakeholder communities, who came together to address common problems, create common understanding and propose common solutions. (shrink)

'Fundamentals of Bayesian Epistemology' provides an accessible introduction to the key concepts and principles of the Bayesian formalism. This volume introduces degrees of belief as a concept in epistemology and the rules for updating degrees of belief derived from Bayesian principles.--.

Michael Devitt is a distinguished philosopher of language. In this book he takes up one of the most important difficulties that must be faced by philosophical semantics: namely, the threat posed by holism. Three important questions lie at the core of this book: what are the main objectives of semantics; why are they worthwhile; how should we accomplish them? Devitt answers these 'methodological' questions naturalistically and explores what semantic programme arises from the answers. The approach is anti-Cartesian, rejecting the (...) idea that linguistic or conceptual competence yields any privileged access to meanings. This new methodology is used first against holism. Devitt argues for a truth-referential localism, and in the process rejects direct-reference, two-factor, and verificationist theories. The book concludes by arguing against revisionism, eliminativism, and the idea that we should ascribe narrow meanings to explain behaviour. (shrink)