Our aim was to study how nurses interpret patient autonomy in end-of-life decision making. This study built on our previous quantitative study, which evaluated the experiences of and views on end-of-life decision making of a representative sample of Finnish nurses taken from the whole country. We performed qualitative interviews with 17 nurses and analysed these using discourse analysis. In their talk, the nurses demonstrated three different discourses, namely, the ‘supporter’, the ‘analyst’ and the ‘practical’ discourses, each of which outlined a (...) certain position for patients and relatives, and a certain identity for the nurses in end-of-life decision making. The nurses’ talk showed notable differences when compared with that of physicians, highlighting the differences that take place in respect of the image of a person’s work, professional culture, professional identification and responsibilities. An important finding was that the nurses often described their participation in end-of-life decision making in terms of indirect influence. (shrink)

Clinical trials give rise to ethical dilemmas, especially in the acutely ill, but we take issue with two points raised in a recent comment on a specific acute myocardial infarction (AMI) trial. The commentators judged that the trial most likely could, and therefore should, have been terminated much earlier. By analysing the problem statistically we arrive at results that go against their intuitive judgment—they also see it as mandatory to update the patient Information sheet as trial results accrue and trends (...) begin to emerge. In our view, interpreting subtle trends and borderline p-values must rest with data monitoring boards, not patients. Moreover, patients with AMI or in other medical emergencies need very simple instructions. Empirical studies of the consent process confirm that the idea of a genuinely informed consent is problematic in such cases. (shrink)

In Frege's Conception of Logic Patricia A. Blanchette explores the relationship between Gottlob Frege's understanding of conceptual analysis and his understanding of logic.

This is a unique book. It is excellently written, crammed with information, wise and a pleasure to read.' ---Daniel C. Dennett, Tufts University.

This study investigated Finnish nurses’ experiences and views on end-of-life decision making and compared them with physicians’ views. For this purpose, a questionnaire was sent to 800 nurses, of which 51% responded. Most of the nurses had a positive attitude towards and respect for living wills, more often than physicians. Most also believed that a will had an effect on decision making. Almost all of the nurses considered it their responsibility to talk to physicians about respecting living wills. Do-not-resuscitate (DNR) (...) orders were often interpreted to imply partial or complete palliative (symptom-orientated) care, which may cause confusion. Half of the nurses reported that a DNR decision was discussed always or often with a patient who was able to communicate; physicians were more positive in this respect. Surprisingly, many nurses (44%) stated that active treatment continued too long. Two-thirds thought that their opinions were taken into account sufficiently, even though only half believed that, in general, they had some impact. (shrink)

Introduction to the Institutional Logics Perspective -- Precursors to the Institutional Logics Perspective -- Defining the Inter-institutional System -- The Emergence, Stability and Change of the Inter-institutional System -- Micro-Foundations of Institutional Logics -- The Dynamics of Organizational Practices and Identities -- The Emergence and Evolution of Field-Level Logics -- Implications for Future Research.

Objectives: This study investigated Finnish physicians’ experiences of decisions concerning living wills and do not resuscitate orders and also their views on the role of patients and family members in these decisions.Design: A questionnaire was sent to 800 physicians representing the following specialties: general practice ; internal medicine ; neurology , and oncology .Results: The response rate was 56%. Most of the respondents had a positive attitude toward , and respect for living wills, and 72% reported situations in which such (...) a will would have been helpful, although experience with their use was limited. The physicians reported both benefits and problems with living wills. Thirteen per cent had completed a living will of their own. Half did not consider living wills to be reliable if they were several years old. Do not resuscitate orders were interpreted in two ways: resuscitation forbidden or only palliative care required . The respondents also documented DNR orders differently. Seventy two per cent discussed DNR decisions always or often with patients able to communicate, and even 76% discussed DNR orders with the family members of patients unable to communicate. Most respondents were able to approach a dying patient without difficulty. They also felt that education in general was needed.Conclusions: In general Finnish physicians accept living wills, but find they are accompanied by several problems. Many problems could be avoided if physicians and patients conducted progressive discussions about living wills. The differing interpretations of DNR orders are a matter of concern in that they may affect patient treatment. The promotion of patient autonomy with respect to treatment seems rather good, but the limitations of the study need to be kept in mind. (shrink)

Progress in the neurosciences is profoundly changing our conception of ourselves. Contrary to time-honored intuition, the mind turns out to be a complex of brain functions. And contrary to the wishful thinking of some philosophers, there is no stemming the revolutionary impact that brain research will have on our understanding of how the mind works. Brain-Wise is the sequel to Patricia Smith Churchland's Neurophilosophy, the book that launched a subfield. In a clear, conversational manner, this book examines old questions (...) about the nature of the mind within the new framework of the brain sciences. What, it asks, is the neurobiological basis of consciousness, the self, and free choice? How does the brain learn about the external world and about its own introspective world? What can neurophilosophy tell us about the basis and significance of religious and moral experiences? Drawing on results from research at the neuronal, neurochemical, system, and whole-brain levels, the book gives an up-to-date perspective on the state of neurophilosophy—what we know, what we do not know, and where things may go from here. (shrink)

Overview -- Locke's internal sense and Kant's changing views -- Personal identity amd its problems -- Rationalist metaphysics of mind -- Consciousness, self-consciousness, and cognition -- Strands of Argument in the Duisburg Nachlass -- A transcendental deduction for a priori concepts -- Synthesis : why and how? -- Arguing for apperception -- The power of apperception -- "I-think" as the destroyer of rational psychology -- Is Kant's theory consistent? -- The normativity objection -- Is Kant's thinker (as such) a free (...) and responsible agent? -- Kant our contemporary. (shrink)

Questionnaire studies on the attitudes of Finnish doctors towards euthanasia were conducted in 1993 and 2003, and the results show that they have not become more positive.

What is morality? Where does it come from? And why do most of us heed its call most of the time? In Braintrust, neurophilosophy pioneer Patricia Churchland argues that morality originates in the biology of the brain. She describes the "neurobiological platform of bonding" that, modified by evolutionary pressures and cultural values, has led to human styles of moral behavior. The result is a provocative genealogy of morals that asks us to reevaluate the priority given to religion, absolute rules, (...) and pure reason in accounting for the basis of morality. Moral values, Churchland argues, are rooted in a behavior common to all mammals--the caring for offspring. The evolved structure, processes, and chemistry of the brain incline humans to strive not only for self-preservation but for the well-being of allied selves--first offspring, then mates, kin, and so on, in wider and wider "caring" circles. Separation and exclusion cause pain, and the company of loved ones causes pleasure; responding to feelings of social pain and pleasure, brains adjust their circuitry to local customs. In this way, caring is apportioned, conscience molded, and moral intuitions instilled. A key part of the story is oxytocin, an ancient body-and-brain molecule that, by decreasing the stress response, allows humans to develop the trust in one another necessary for the development of close-knit ties, social institutions, and morality. A major new account of what really makes us moral, Braintrust challenges us to reconsider the origins of some of our most cherished values. (shrink)

Objectives: This study investigated Finnish physicians’ experiences of decisions concerning living wills and do not resuscitate orders and also their views on the role of patients and family members in these decisions.Design: A questionnaire was sent to 800 physicians representing the following specialties: general practice ; internal medicine ; neurology , and oncology .Results: The response rate was 56%. Most of the respondents had a positive attitude toward , and respect for living wills, and 72% reported situations in which such (...) a will would have been helpful, although experience with their use was limited. The physicians reported both benefits and problems with living wills. Thirteen per cent had completed a living will of their own. Half did not consider living wills to be reliable if they were several years old. Do not resuscitate orders were interpreted in two ways: resuscitation forbidden or only palliative care required . The respondents also documented DNR orders differently. Seventy two per cent discussed DNR decisions always or often with patients able to communicate, and even 76% discussed DNR orders with the family members of patients unable to communicate. Most respondents were able to approach a dying patient without difficulty. They also felt that education in general was needed.Conclusions: In general Finnish physicians accept living wills, but find they are accompanied by several problems. Many problems could be avoided if physicians and patients conducted progressive discussions about living wills. The differing interpretations of DNR orders are a matter of concern in that they may affect patient treatment. The promotion of patient autonomy with respect to treatment seems rather good, but the limitations of the study need to be kept in mind. (shrink)

Parmenides of Elea was the most important and influential philosopher before Plato. He rejected as impossible the scientific inquiry practiced by the earlier Presocratic philosophers and held that generation, destruction, and change are unreal and that only one thing exists. In this book, Patricia Curd argues that Parmenides sought to reform rather than to reject scientific inquiry, and she offers a more coherent account of his influence on later philosophers._ _The Legacy of Parmenides_ examines Parmenides' arguments, considering his connection (...) to earlier Greek thought and how his account of what-is could have served as a model for later philosophers. Curd also explores the theories of his successors, including the Pluralists, the Atomists, the later Eleatics, and the later Presocratics. She concludes with a discussion of the importance of Parmenides' work to Plato's _Theory of Forms._ _The Legacy of Parmenides_ challenges traditional views of early Greek philosophy and provides new insights into the work of Parmenides. "_The Legacy of Parmenides_ represents a milestone... of Parmenides' interpretation. It is full of ideas and tells a coherent story about Parmenides and early Greek thought." --_ Alexander Nehamas, Princeton University___ "Professor Curd offers a genuinely original and possibly correct interpretation of the core thesis of the poem of Parmenides in a field so well worked over that saying something both new and true is profoundly difficult, this is a notable achievement." --_ Thomas M. Robinson, University of Toronto___ "This will be a substantial book in the story of early Greek philosophy, and future writers on the tradition from Thales through Plato will not be able to ignore it without missing an important interpretive alternative. It will be of value to students of Presocratic philosophy or the Greek tradition, as well as to students of the scientific revolution, cosmology, the origins of logic, or comparative mysticism." --_ Scott W. Austin, Texas A&M University___ PATRICIA CURD_ is professor at Purdue University where she works primarily in Ancient Philosophy. She is a co-editor of _Readings in Ancient Greek Philosophy_, and is the editor of _A Presocratics Reader._. (shrink)

Vaesen infers unique properties of mind from the appearance of specific cultural innovation – a correlation without causal direction. Shifts in habitat, population density, and group dynamics are the only independently verifiable incentives for changes in cultural practices. The transition from Acheulean to Late Stone Age technologies requires that we consider how population and social dynamics affect cultural innovation and mental function.

The medical concept of prognosis is analysed into its basic constituents: patient data, medical intervention, outcome, utilities and probabilities; and sources of utility and probability values are discussed. Prognosis cannot be divorced from contemplated medical action, nor from action to be taken by the patient in response to prognostication. Regrettably, the usual decision-theoretic approach ignores this latter aspect. Elicitation of utilities, decision contemplation and prognostic counselling interweave, diagnostics playing a subsidiary role in decision-oriented clinical practice. At times the doctor has (...) grounds for withholding information. As this is known to the patient, prognostic counselling becomes a conflict-prone and rationality-thwarting activity. The meaning of standard phrases such as prognosis of a disease, the prognosis of this patient, the prognosis is unknown, is examined. (shrink)

Patient autonomy is a fundamental principle in end of life decision making. However, its realisation may take a variety of forms. Discourse analysis was conducted in a qualitative interview study of 19 physicians. The physicians made use of three different discourses, each of which contained a specific understanding of patient autonomy and a physician’s proper activities in the context of end of life decision making.

The ways in which knowledge relates to power have been much discussed in radical education theory. New emphasis on the role of gender and the growing debate about subjectivity have deepened the discussion, while making it more complex. In Getting Smart , Patti Lather makes use of her unique integration of feminism and postmodernism into critical education theory to address some of the most vital questions facing education researchers and teachers.

Anydomainofscientificresearchhasitssustainingorthodoxy. Thatis, research on a problem, whether in astronomy, physics, or biology, is con- ducted against a backdrop of broadly shared assumptions. It is these as- sumptionsthatguideinquiryandprovidethecanonofwhatisreasonable-- of what "makes sense." And it is these shared assumptions that constitute a framework for the interpretation of research results. Research on the problem of how we see is likewise sustained by broadly shared assump- tions, where the current orthodoxy embraces the very general idea that the business of the visual system is to (...) create a detailed replica of the visual world, and that it accomplishes its business via hierarchical organization and by operatingessentiallyindependently of other sensorymodalitiesas well as independently of previous learning, goals, motor planning, and motor execution. (shrink)

We propose that people typically reason about realistic situations using neither content-free syntactic inference rules nor representations of specific experiences. Rather, people reason using knowledge structures that we term pragmatic reasoning schemas, which are generalized sets of rules defined in relation to classes of goals. Three experiments examined the impact of a “permission schema” on deductive reasoning. Experiment 1 demonstrated that by evoking the permission schema it is possible to facilitate performance in Wason's selection paradigm for subjects who have had (...) no experience with the specific content of the problems. Experiment 2 showed that a selection problem worded in terms of an abstract permission elicited better performance than one worded in terms of a concrete but arbitrary situation, providing evidence for an abstract permission schema that is free of domain-specific content. Experiment 3 provided evidence that evocation of a permission schema affects not only tasks requiring procedural knowledge, but also a linguistic rephrasing task requiring declarative knowledge. In particular, statements in the form if p then q were rephrased into the form p only if q with greater frequency for permission than for arbitrary statements, and rephrasings of permission statements produced a pattern of introduction of modals totally unlike that observed for arbitrary conditional statements. Other pragmatic schemas, such as “causal” and “evidence” schemas can account for both linguistic and reasoning phenomena that alternative hypotheses fail to explain. (shrink)

In this innovative study Patricia Kitcher argues that we can only understand the deduction of the categories in Kant's Critique of Pure Reason in terms of his attempt to fathom the psychological prerequisites of thought. Thus a consideration of his conception of psychology is essential to an understanding of his philosophy. Kitcher specifically considers Kant's claims about the unity of the thinking self; the spatial forms of human perceptions; the relations among mental states necessary for them to have content; (...) the relations between perceptions and judgment; and the limits of philosophical insight into psychological processes. (shrink)

In the early years of the twentieth century, Gottlob Frege and David Hilbert, two titans of mathematical logic, engaged in a controversy regarding the correct understanding of the role of axioms in mathematical theories, and the correct way to demonstrate consistency and independence results for such axioms. The controversy touches on a number of difficult questions in logic and the philosophy of logic, and marks an important turning-point in the development of modern logic. This entry gives an overview of that (...) controversy and of its philosophical underpinnings. (shrink)

A dialogue between virtue and care ethics is formed as a step towards meeting Pellegrino's challenge to create a more comprehensive moral philosophy. It is also a dialogue between nursing and medicine since each practice draws on the Greek Virtue Tradition and the Judeo-Christian Tradition of care differently. In the Greek Virtue Tradition, the point of scrutiny lies in the inner character of the actor, whereas in the Judeo-Christian Tradition the focus is relational, i.e. how virtues are lived out in (...) specific relationships, particularly unequal relationships where vulnerability of one of the members is an issue. In a care ethic relational qualities such as attunement rather than inner qualities are the point of scrutiny. A dialogue between these two traditions makes it possible to consider the relational virtues and skills of openness and responsiveness that are required for a respectful meeting of the other. (shrink)

Asperger's syndrome is a pervasive developmental condition characterized by features of autism. As observed in clinical practice, individuals with Asperger's syndrome present an impairment related to inflexibility in their everyday routine, an immediate manner of experiencing and relating, and difficulties in estimating periods of time. Following a phenomenological perspective, this study is an attempt to examine these aforementioned aspects in terms of temporality. Thirteen participants with Asperger's syndrome, from 13 to 20 years old, were interviewed about their experience of periods (...) of time, personal history, their past, present and future; and their concept of time and finitude. After the interviews, it was possible to identify three general themes which emerged in the invariant aspects of their experience of time: factual experience of present and future dimensions, chronological time and the past experience. Moreover, participants' descriptions evidenced aspects of experience based on the specificity of lived facts and a sense of time specifically related to what was lived in the past. (shrink)

Beginning with Thomas Nagel, various philosophers have propsed setting conscious experience apart from all other problems of the mind as ‘the most difficult problem’. When critically examined, the basis for this proposal reveals itself to be unconvincing and counter-productive. Use of our current ignorance as a premise to determine what we can never discover is one common logical flaw. Use of ‘I-cannot-imagine’ arguments is a related flaw. When not much is known about a domain of phenomena, our inability to imagine (...) a mechanism is a rather uninteresting psychological fact about us, not an interesting metaphysical fact about the world. Rather than worrying too much about the meta-problem of whether or not consciousness is uniquely hard, I propose we get on with the task of seeing how far we get when we address neurobiologically the problems of mental phenomena. (shrink)

Husserl’s writings on sociality have received increasing attention in recent years. Despite this growing interest, Husserl’s reflections on the specific role of communication remain underexplored. In this paper, we aim to fill this gap by reconstructing the various ways in which Husserl draws systematic connections between communication and communalization. As will become clear, Husserl’s analysis converges with much more recent ideas defended by Margaret Gilbert and Naomi Eilan.

Neurophenomenological (NP) methods integrate objective and subjective data in ways that retain the statistical power of established disciplines (like cognitive science) while embracing the value of first-person reports of experience. The present paper positions neurophenomenology as an approach that pulls from traditions of cognitive science but includes techniques that are challenging for cognitive science in some ways. A baseline study is reviewed for “lessons learned,” that is, the potential methodological improvements that will support advancements in understanding consciousness and cognition using (...) neurophenomenology. These improvements, we suggest, include (1) addressing issues of interdisciplinarity by purposefully and systematically creating and maintaining shared mental models among research team members; (2) making sure that NP experiments include high standards of experimental design and execution to achieve variable control, reliability, generalizability, and replication of results; and (3) conceiving of phenomenological interview techniques as placing the impetus on the interviewer in interaction with the experimental subject. (shrink)

Introduction : schizoanalysis, digital screens and new brain circuits -- Schizoid minds, delirium cinema and powers of machines of the invisible -- Illusionary perception and powers of the false -- Surveillance screens and powers of affect -- Signs of time : meta/physics of the brain-screen -- Degrees of belief : epistemology of probabilities -- Powers of creation : aesthetics of material-force -- The open archive : cinema as world-memory -- Divine in(ter)vention : micropolitics and resistance -- Logistics of perception 2.0 (...) : multiple screens as affective weapons -- Conclusion : the neuro-image : brain-screens from the future. (shrink)

Gottlob Frege famously rejects the methodology for consistency and independence proofs offered by David Hilbert in the latter's Foundations of Geometry. The present essay defends against recent criticism the view that this rejection turns on Frege's understanding of logical entailment, on which the entailment relation is sensitive to the contents of non-logical terminology. The goals are (a) to clarify further Frege's understanding of logic and of the role of conceptual analysis in logical investigation, and (b) to point out the extent (...) to which his understanding of logic differs importantly from that of the model-theoretic tradition that grows out of Hilbert's work. (shrink)

'During the course of the seventeenth century, within the scholastic tradition itself, commentaries on Aristotle's natural philosophical works increasingly gave way to textbooks and compendia organized along thematic lines' (Dear 1985, 161).

This paper focuses on the cognitive/computational and evolutionary levels. It describes three proposals to make cognition computationally tractable, namely: Resource Rationality, the Adaptive Toolbox and Massive Modularity. While each of these proposals appeals to evolutionary considerations to dissolve the intractability of cognition, Rich, Blokpoel, de Haan, and van Rooij argue that, in each case, the intractability challenge is not resolved, but just relocated to the level of evolution.