Purpose Although surrogate decision-making is prevalent in intensive care units and concerns with decision quality are well documented, little is known about how clinicians help family members understand the surrogate role. We investigated whether and how clinicians provide normative guidance to families regarding how to function as a surrogate. Subjects and methods We audiorecorded and transcribed 73 ICU family conferences in which clinicians anticipated discussing goals of care for incapacitated patients at high risk of death. We developed and applied a (...) coding framework to identify normative statements by clinicians regarding what considerations should guide surrogates’ decisions, including whether clinicians explained one or more of Buchanan and Brock’s three standard principles of SDM to family members. Results Clinicians made at least one statement about how to perform the surrogate role in 24 conferences ). We observed three general types of normative guidance provided to surrogates, with some conferences containing more than one type of guidance: counselling about one or more standard principles of SDM ; counselling surrogates to make decisions centred on the patient as a person, without specifying how to accomplish that ; and counselling surrogates to make decisions based on the family’s values. Conclusions Clinicians did not provide normative guidance about the surrogate role in two-thirds of family conferences for incapacitated patients at high risk for death. When they did, clinicians’ guidance was often incomplete and sometimes conflicted with standard principles of SDM. Future work is needed to understand whether providing explicit guidance on how to perform the surrogate role improves decision-making or mitigates surrogates’ psychological distress. (shrink)

Objective: Even when critically ill patients are almost certain to die from their illnesses, there is generally an element of prognostic uncertainty. Little is known about how physicians handle this uncertainty in conversations with surrogate decision makers. We sought to evaluate whether and how physicians discuss prognostic uncertainty with surrogate decision makers of patients who are highly likely, but not certain, to die. Design: We audiotaped and transcribed discussions between clinicians and surrogate decision makers at two major California teaching hospitals (...) from 2006 through 2008. Physicians completed a questionnaire addressing their prognostic estimates for patients' survival to hospital discharge. Participants: We included physicians and surrogates of 12 incapacitated, critically ill patients. Measurements: We analyzed transcripts of discussions in which physicians' estimates of patients' chances of hospital survival were 1% to 5%; we coded whether physicians disclosed the prognostic uncertainty and, if so, how they conveyed that death was highly likely but not certain. Results: Physicians' estimates of short-term survival were 1% to 5% for 12 of the 70 patients enrolled in the original study. In 8 of 12 cases, physicians conveyed prognostic uncertainty by using probabilistic language or by an explicit mention of uncertainty. In four cases, physicians made at least one statement that either implied or was ambiguous about whether death was certain. Conclusion: We observed variability in how physicians handle prognostic uncertainty in their discussions with surrogates of patients who are highly likely, but not certain, to die, including some circumstances in which physicians stated or implied that death was certain. (shrink)

The aim of this chapter is to address the role of memory in past-life convictions. Although it is commonly accepted in the modern media - and popular western culture more generally - that people believe they have lived before because the memory contains detailed verifiable facts, little is known about how people actually reason about the veracity of their previous existence. To our knowledge, the current project is the most extensive research that probes the role of memory in past life (...) convictions. More specifically, we explore two questions. First, to what extent does memory lead to past-life belief, and is this conviction based on external validation or via the episodic sense of personal identity contained in the memory? Second, what is the conception of self on which one's current self is taken to be the same as the past-life self? -/- In what follows, we propose that memory plays an important role in convincing people that they have lived before. Fundamentally, this memory is episodic insofar as it represents the event as happened to the encoder. This memory contrasts with semantic memory - memory of facts...Further, we contend that it is the episodic sense of personal identity (rather than external validation) that typically contributes to the belief in a past life. Finally, we argue that the conception of self implicated in past-life belief is the non-trait conception. Of course, this fits naturally with the idea that the belief in a past life issues partly from the episodic sense of identity, since it is the non-trait conception of self that is implicated in the episodic sense of identity... -/- Our proposal in this chapter can be construed as a psychological extension of Reid's point in the context of past-life belief. People assume that they are the same person as someone in earlier times, despite large variations in the traits between those individuals, and they think this partly because of the testimony of their episodic memory. If our account is correct, then it makes the belief in a past life less bizarre, at least psychologically. For we are suggesting that the episodic sense of personal identity that led to your conviction that you existed at the time of your sixteenth birthday celebrations some decades ago, is also involved in other people's convictions that they existed 200 years ago. This proposal is also situated in recent cognitive approaches to the study of religion and religious experiences, which suggests that extraordinary convictions are often underpinned by the ordinary processes of social cognition (e.g. see Barrett 2000; Barrett 2007; Boyer 2001; Lawson and McCauley 1990; for reincarnation, see White Forthcoming-a,-b). (shrink)

The coronavirus disease 2019 (COVID-19) pandemic has motivated medical ethicists and several task forces to revisit or issue new guidelines on allocating scarce medical resources. Such guidelines are relevant for the allocation of scarce therapeutics and vaccines and for allocation of ICU beds, ventilators, and other life-sustaining treatments or potentially scarce interventions. Principles underlying these guidelines, like saving the most lives, mitigating disparities, reciprocity to those who assume additional risk (eg, essential workers and clinical trial participants), and equal access may (...) compete with one another. We propose the use of a “categorized priority system” (also known as a “reserve system”) as an improvement over existing allocation methods, particularly because it may be able to achieve disparity mitigation better than other methods. (shrink)

Purpose Although surrogate decision-making is prevalent in intensive care units and concerns with decision quality are well documented, little is known about how clinicians help family members understand the surrogate role. We investigated whether and how clinicians provide normative guidance to families regarding how to function as a surrogate. Subjects and methods We audiorecorded and transcribed 73 ICU family conferences in which clinicians anticipated discussing goals of care for incapacitated patients at high risk of death. We developed and applied a (...) coding framework to identify normative statements by clinicians regarding what considerations should guide surrogates’ decisions, including whether clinicians explained one or more of Buchanan and Brock’s three standard principles of SDM to family members. Results Clinicians made at least one statement about how to perform the surrogate role in 24 conferences ). We observed three general types of normative guidance provided to surrogates, with some conferences containing more than one type of guidance: counselling about one or more standard principles of SDM ; counselling surrogates to make decisions centred on the patient as a person, without specifying how to accomplish that ; and counselling surrogates to make decisions based on the family’s values. Conclusions Clinicians did not provide normative guidance about the surrogate role in two-thirds of family conferences for incapacitated patients at high risk for death. When they did, clinicians’ guidance was often incomplete and sometimes conflicted with standard principles of SDM. Future work is needed to understand whether providing explicit guidance on how to perform the surrogate role improves decision-making or mitigates surrogates’ psychological distress. (shrink)

We examine the ethical, social, and regulatory barriers that may hinder research on therapeutic potential of certain controversial controlled substances like marijuana, heroin, or ketamine. Hazards for individuals and society and potential adverse effects on communities may be good reasons for limiting access and justify careful monitoring of these substances. Overly strict regulations, fear of legal consequences, stigma associated with abuse and populations using illicit drugs, and lack of funding may, however, limit research on their considerable therapeutic potential. We review (...) the surprisingly sparse literature and address the particular ethical concerns pertinent to research with illicit and addictive substances, such as undue inducement, informed consent, therapeutic misconception, and risk to participants, researchers, and institutions. We consider the perspectives of key research stakeholders and explore whether they may be infected with bias. We conclude by proposing an empirical research agenda to provide an evidentiary basis for ethical reasoning. (shrink)

In the United States, people may donate organs and tissues to a family member, friend, or anyone whose specific need becomes known to them. For example, in late 2003 dozens of people came forward to donate a kidney to a professional basketball player known to them only through his sports performances. People may also donate a kidney to no one in particular through a process known as nondirected donation. In nondirected donation, people donate a kidney to the organ allocation system (...) rather than to anyone known to them personally. There are limits, though, to generosity. People are usually not allowed to donate to groups of people, no matter the contours of the group, whether white, black, Catholic or Presbyterian, third-time liver recipient, and so on. As the agency that oversees national transplantation policy, the United Network for Organs Sharing does not allow this sort of restricted donation, though it appears that some regional Organ Procurement Organizations occasionally bend the rules when donors insist that their organs go to children or to first-time recipients. Those ad hoc arrangements are, however, the exception to the rule. (shrink)

Few figures of the Middle Ages command the attention of so many modern disciplines as Robert Grosseteste (c. 1170-1253). Theology, Philosophy, History, and Science are all areas which his life and thought continue to have significance and to inspire re-interpretation. Accompanied by a series of original commentaries, this new edition of Grosseteste's work, with English translation, draws together the perspectives of modern scientists and medieval specialists. Volume I of a six volume series, Knowing and Speaking presents two of the (...) earliest of Grosseteste's works, the treatises On the Liberal Arts and On the Generation of Sounds. These are accompanied by a significant Middle English treatise on the Seven Liberal Arts whose anonymous fifteenth-century author translated and excerpted passages from Grosseteste's treatises in a re-imagining of their structure and function.0Each work is treated separately within the volume, which is constructed in three parts. On the Liberal Arts sets Grosseteste's thoughts on the arts subjects and emphasises moral concerns about the purpose of learning. On the Generation of Sounds builds on the theories and statements of On the Liberal Arts in connection to the production of sound, elaborating the earlier position, relating the generation of sounds to human vocal and speech production. (shrink)

A longitudinal study of 308 white -collar U.S. employees revealed that feelings of hope and gratitude increase concern for corporate social responsibility. In particular, employees with stronger hope and gratitude were found to have a greater sense of responsibility toward employee and societal issues; interestingly, employee hope and gratitude did not affect sense of responsibility toward economic and safety/quality issues. These findings offer an extension of research by Giacalone, Paul, and Jurkiewicz.

The sounds of the college campus raise important questions of participation, identity, privilege, disability, and marginalization. During the 2019–2020 academic year, three university instructors from distinct disciplines (music, history, and political science) and a student research assistant (history) used sound as a method for inquiring into contested and erased sites on the campus of Western Carolina University, a regional comprehensive university located in the southeastern United States. The project came to be called Sonic Histories. Paid student volunteers were led on (...) a soundwalk and completed three online questionnaires that engaged questions of race and belonging on campus. This study presents findings on how students experience and interpret contested and erased sites through sounds heard and imagined. Sonic Histories explores two central questions. Historically, whose voices have been included and whose have been excluded on college campuses? How can sound promote awareness of racialized spaces and, in turn, achieve social engagement? The authors challenge the triumphant narrative of campus histories, which highlights racial reconciliation and progress while eliding the ways predominantly white campuses still exclude minorities. By re-centering minority voices in campus spaces, the authors explore the systemic exclusion of minorities that has occurred on college campuses across the country. At a time when places of higher education are refining and developing their commitment to diversity and inclusivity—while assessing their past in honest ways—the Sonic Histories project builds upon ongoing initiatives to position the college campus as a scholarly community that lives up to its democratic ideals of inclusion. (shrink)

"Simone Weil's bibliography": p. [181]-194. Includes index. Introduction / George Abbott White -- The jagged edge / Michele Murray -- Simone Weil's mind / Robert Coles -- The life and death of Simone Weil / J.M. Cameron -- Simone Weil, last things / Michele Murray -- Simone Weil's Iliad / Michael K. Ferber -- Notes on Simone Weil's Iliad / Joseph H. Summers -- Patriotism and The need for roots / Conor Cruise O'Brien -- Marxism-Leninism and the language of (...) Politics magazine / Staughton Lynd -- Simone Weil's work experiences / George Abbott White. (shrink)

Since its inception in 2010, the Network for Public Health Law has aligned with federal, state, tribal, and local public health practitioners to assess how law can promote and protect the public’s health. In 2013, Network authors illustrated major trends in public health laws and policies emanating from an internal assessment of thousands of requests for technical assistance nationally. More recently, the Robert Wood Johnson Foundation has invited the Network and other partners to consider new ideas and strategies toward (...) building a “culture of health.” Per Figure 1, RWJF’s conception of a culture of health emphasizes key action areas essential to the promotion of health across all sectors and diverse populations. (shrink)

Aworkshop was held August 26–28, 2015, by the Earth- Life Science Institute (ELSI) Origins Network (EON, see Appendix I) at the Tokyo Institute of Technology. This meeting gathered a diverse group of around 40 scholars researching the origins of life (OoL) from various perspectives with the intent to find common ground, identify key questions and investigations for progress, and guide EON by suggesting a roadmap of activities. Specific challenges that the attendees were encouraged to address included the following: What key (...) questions, ideas, and investigations should the OoL research community address in the near and long term? How can this community better organize itself and prioritize its efforts? What roles can particular subfields play, and what can ELSI and EON do to facilitate research progress? (See also Appendix II.) The present document is a product of that workshop; a white paper that serves as a record of the discussion that took place and a guide and stimulus to the solution of the most urgent and important issues in the study of the OoL. This paper is not intended to be comprehensive or a balanced representation of the opinions of the entire OoL research community. It is intended to present a number of important position statements that contain many aspirational goals and suggestions as to how progress can be made in understanding the OoL. The key role played in the field by current societies and recurring meetings over the past many decades is fully acknowledged, including the International Society for the Study of the Origin of Life (ISSOL) and its official journal Origins of Life and Evolution of Biospheres, as well as the International Society for Artificial Life (ISAL). (shrink)

a comprehensive, somewhat Gricean theory of speech acts, including an account of communicative intentions and inferences, a taxonomy of speech acts, and coverage of many topics in pragmatics -/- .

I shared Raanan Gillon’s1 surprise at Robert Veatch’s criticism of the white coat ceremonies,2 and I think that the points raised by Veatch were quite adequately countered by Gillon’s response. The provocative points raised by Veatch do stimulate some valuable critical thinking about the process, although I think Veatch was carried away a bit by hyperbole. To label the drama of the ceremony as “ominous” goes a bit far by any criterion.I should like to describe an oath taking initiation (...) ceremony in use at the Ben Gurion University Faculty of Health Sciences for almost three decades, its history, features, current practice, and conclusions. I believe that Veatch’s specific objections are addressed by our process and merit consideration by other institutions as well.When the medical school was founded in 1974 the then dean , Professor Moshe Prywes, met with the just entering class several weeks before the onset of the academic year during a summer preliminary orientation period . Professor Prywes, an imaginative, charismatic innovator with a flair for public relations and the dramatic, suggested to the entering class that they take the physician’s oath during the first weeks of the academic year, coinciding with their first exposure to patients . He explained that he wanted the students to regard themselves as already bearing responsibilities and duties, and not just rights. He saw them as “change agents” working to upgrade the medical care and the health of the patients and community, right from the first days of their schooling.I had just arrived in Israel as a new immigrant to assume the foundation professorship of medicine, coming from …. (shrink)

Arthur W. H. Adkins's writings have sparked debates among a wide range of scholars over the nature of ancient Greek ethics and its relevance to modern times. Demonstrating the breadth of his influence, the essays in this volume reveal how leading classicists, philosophers, legal theorists, and scholars of religion have incorporated Adkins's thought into their own diverse research. The timely subjects addressed by the contributors include the relation between literature and moral understanding, moral and nonmoral values, and the contemporary meaning (...) of ancient Greek ethics. The volume also includes an essay from the late Adkins himself illustrating his methodology in an analysis of the "Speech of Lysias" in Plato's _Phaedrus_. _The Greeks and Us_ will interest all those concerned with how ancient moral values do or do not differ from our own. Contributors include Arthur W. H. Adkins, Stephanie Nelson, Martha C. Nussbaum, Paul Schollmeier, James Boyd White, Bernard Williams, and Lee Yearley. Commentaries by Wendy Doniger, Charles M. Gray, David Grene, Robert B. Louden, Richard Posner, and Candace Vogler. (shrink)

Abstract:This essay argues for lyric as an anthropomorphic pattern of thought which shapes our readings of poetry and Earth. Theorizing what I call "lyric geology," the essay foregrounds two critical conjunctions: (1) the historical co-emergence of the normative lyric subject and the human species as geologic agent; and (2) the anthropomorphic genealogy of literary criticism called "lyricization" as it dovetails with Sylvia Wynter's account of the "over-representation" of colonial man as "the human itself." Reading across a seemingly eclectic archive—Charles Lyell, (...) Robert Knox, Richard Owen, and a maroon known in the Mauritian imperial archive as Simon—I show how the colonial anthropos as self-consciously theorized in and across the nineteenth century materially effectuates on a planetary scale the very racialized anthropomorphosis fallaciously naturalized as lyric. So understood, man's generic "over-representation" and lyric are co-constitutive projects. Together, they proliferate a human fantasy whose flat speciesism at once reproduces and effaces white supremacist violence and colonial dispossession. (shrink)

Aversive experiences have been thought to provoke or exacerbate clinical depression. The present review provides a brief survey of the stress-depression literature and suggests that the effects of stressful experiences on affective state may be related to depletion of several neurotransmitters, including norepinephrine, dopamine, and serotonin. A major element in determining the neurochemical changes is the organism's ability to cope with the aversive stimuli through behavioral means. Aversive experiences give rise to behavioral attempts to cope with the stressor, coupled with (...) increased utilization and synthesis of brain amines to contend with environmental demands. When behavioral coping is possible, neurochemical systems are not overly taxed, and behavioral pathology will not ensue. However, when there can be no behavioral control over the stressful stimuli, or when the aversive experience is perceived as uncontrollable, increased emphasis is placed on coping through endogenous neurochemical mechanisms. Amine utilization increases appreciably and may exceed synthesis, resulting in a net reduction of amine stores, which in turn promotes or exacerbates affective disorder. The processes governing the depletions may be subject to sensitization or conditioning, such that exposure to traumatic experiences may have long-term repercussions when the organism subsequently encounters related stressful stimuli. With continued uncontrollable stimulation, adaptation occurs in the form of increased activity of synthetic enzymes, and levels of amines approach basal values. It is suggested that either the initial amine depletion provoked by aversive experiences or a dysfunction of the adaptive processes, resulting in persistent amine depletion, contributes to behavioral depression. Aside from the contribution of behavioral coping, several organismic, experiential, and environmental variables will influence the effects of aversive experiences on neurochemical activity, and may thus influence vulnerability to depression. (shrink)

Applied ontologies have been used more and more frequently to enhance systems engineering. In this paper, we argue that adopting principles of ontological realism can increase the benefits that ontologies have already been shown to provide to the systems engineering process. Moreover, adopting Basic Formal Ontology (BFO), an ISO standard for top-level ontologies from which more domain specific ontologies are constructed, can lead to benefits in four distinct areas of systems engineering: (1) interoperability, (2) standardization, (3) testing, and (4) data (...) exploitation. Reaping these benefits in a model-based systems engineering (MBSE) context requires utilizing an ontology’s vocabulary when modeling systems and entities within those systems. If the chosen ontology abides by the principles of ontological realism, a semantic standard capable of uniting distinct domains, using BFO as a hub, can be leveraged to promote greater interoperability among systems. As interoperability and standardization increase, so does the ability to collect data during the testing and implementation of systems. These data can then be reasoned over by computational reasoners using the logical axioms within the ontology. This, in turn, generates new data that would have been impossible or too inefficient to generate without the aid of computational reasoners. (shrink)

This particular volume differs from other members of the series, in that it is historically as well as dialectically oriented, and is also less encyclopedic than the others. The first part develops six different theories of happiness and the second presents different controversies about happiness. In the first chapter, the author proposes Aristotle's eudemonism [[sic]] as the most complete and most influential of all theories of happiness, and he uses it as a matrix for most of the discussions in the (...) second part. Chapters following this initial exposition of Aristotle treat Plato's "mixed" eudemonism [[sic]], Stoic suppression of desire, concepts of transcendent happiness in Plotinus, Augustine and Aquinas, Kant's valorization of duty and Hegel's critique thereof, and Bentham's and Mill's utilitarianism. Moral issues discussed in the second part include: self-realization, happiness vs. performance of duty, fulfillment vs. prudence, and eudemonism [[sic]] vs. hedonism. The last thirty pages focus on contemporary pursuits of the good life, centered around the issue of self-actualization. This section is predominantly psychological, and treats very briefly some theories of Kurt Goldstein, G. W. Allport, Robert W. White, A. H. Maslow, Marie Jahoda, Carl Rogers, and Fromm. Although the author take sides, he does stimulate reflection about the good life through expositions which avoid more difficult philosophical problems but which definitely evoke practical individual and social overtones.--C. M. R. (shrink)

Many studies have shown that marijuana can negatively affect the cognitive development of adolescents. For some individuals, marijuana use may also initiate opioid use, dose escalation, and opioid use disorder. States that legalize marijuana should help adolescents through regulation of advertising and availability of marijuana-infused edibles. Such policies may assist in protecting neurodevelopment of the adolescent and young adult brain. The federal government should also remove its prohibition of marijuana sales and use, leaving their regulation to state law-makers.