BackgroundBioethics and law distinguish between the practices of "physician-assisted death" and "allowing the patient to die."DiscussionAdvances in biotechnology have allowed medical devices to be used as destination therapy that are designed for the permanent support of cardiac function and/or respiration after irreversible loss of these spontaneous vital functions. For permanent support of cardiac function, single ventricle or biventricular mechanical assist devices and total artificial hearts are implanted in the body. Mechanical ventilators extrinsic to the body are used for (...) permanent support of respiration. Clinical studies have shown that destination therapy with ventricular assist devices improves patient survival compared to medical management, but at the cost of a substantial alteration in end-of-life trajectories. The moral and legal assessment of the appropriateness and permissibility of complying with a patient's request to electively discontinue destination therapy in a life-terminating act in non-futile situations has generated controversy. Some argue that complying with this request is ethically justified because patients have the right to request withdrawal of unwanted treatment and be allowed to die of preexisting disease. Other commentators reject the argument that acceding to an elective request for death by discontinuing destination therapy is 'allowing a patient to die' because of serious flaws in interpreting the intention, causation, and moral responsibility of the ensuing death.SummaryDestination therapy with cardiac and/or ventilatory medical devices replaces native physiological functions and successfully treats a preexisting disease. We posit that discontinuing cardiac and/or ventilatory support at the request of a patient or surrogate can be viewed as allowing the patient to die if--and only if--concurrent lethal pathophysiological conditions are present that are unrelated to those functions already supported by medical devices in destination therapy. In all other cases, compliance with a patient's request constitutes physician-assisted death because of the pathophysiology induced by the turning off of these medical devices, as well as the intention, causation, and moral responsibility of the ensuing death. The distinction between allowing the patient to die and physician-assisted death is pivotal to the moral and legal status of elective requests for death by discontinuing destination cardiac and/or ventilatory medical devices in patients who are not imminently dying. This distinction also represents essential information that must be disclosed to patients and surrogates in advance of consent to this type of therapy. (shrink)

Background Bioethics and law distinguish between the practices of "physician-assisted death" and "allowing the patient to die." Discussion Advances in biotechnology have allowed medical devices to be used as destination therapy that are designed for the permanent support of cardiac function and/or respiration after irreversible loss of these spontaneous vital functions. For permanent support of cardiac function, single ventricle or biventricular mechanical assist devices and total artificial hearts are implanted in the body. Mechanical ventilators extrinsic to the body (...) are used for permanent support of respiration. Clinical studies have shown that destination therapy with ventricular assist devices improves patient survival compared to medical management, but at the cost of a substantial alteration in end-of-life trajectories. The moral and legal assessment of the appropriateness and permissibility of complying with a patient's request to electively discontinue destination therapy in a life-terminating act in non-futile situations has generated controversy. Some argue that complying with this request is ethically justified because patients have the right to request withdrawal of unwanted treatment and be allowed to die of preexisting disease. Other commentators reject the argument that acceding to an elective request for death by discontinuing destination therapy is 'allowing a patient to die' because of serious flaws in interpreting the intention, causation, and moral responsibility of the ensuing death. Summary Destination therapy with cardiac and/or ventilatory medical devices replaces native physiological functions and successfully treats a preexisting disease. We posit that discontinuing cardiac and/or ventilatory support at the request of a patient or surrogate can be viewed as allowing the patient to die if--and only if--concurrent lethal pathophysiological conditions are present that are unrelated to those functions already supported by medical devices in destination therapy. In all other cases, compliance with a patient's request constitutes physician-assisted death because of the pathophysiology induced by the turning off of these medical devices, as well as the intention, causation, and moral responsibility of the ensuing death. The distinction between allowing the patient to die and physician-assisted death is pivotal to the moral and legal status of elective requests for death by discontinuing destination cardiac and/or ventilatory medical devices in patients who are not imminently dying. This distinction also represents essential information that must be disclosed to patients and surrogates in advance of consent to this type of therapy. (shrink)

Introduction. The article deals with the problem of the functional status of regions in the system of economic federalism, which is associated with the high spatial heterogeneity of Russia, and explains the need to move from the model of economic fed- eralism, which combines the presence of universal institutions and institutional exceptions, to a model that takes into account the spatial diversity of ter- ritories. The purpose of the study is to substantiate the decrease in the heterogeneity of (...) the economic federalism space when moving on to a model based on macro territories - groups of regions with the same functional status. Methods. The author uses methods of a mono- graphic review, logical and statistical analysis in the context of applying a spatial approach in studying the relations of economic federalism, as well as the concept of “smart specialization” in relation to the regions of Russia to differentiate the relationship of the federal center with the territories within the same specialization. Scientific novelty of the study. The article is the first to present a methodology for determining the functional status of regions, which is the basis for the subsequent formation of a model of relations between the federal center and macro regions. Results. The author proposes methods for deter- mining the functional status of regions and calcu- lating indicators that characterize the relations of economic federalism. The first methodology, based on economic and territorial criteria, makes it possi- ble to attribute each region of Russia to a group of macro regions according to their functional status. The second method makes it possible to substanti- ate a greater asymmetry of indicators character- izing economic federalism in the country as a whole than in the context of macro territories. Conclusions. Regarding the higher stability of indicators characterizing economic federalism by groups of macro-territories than in the country as a whole, the need for a transition to a flexible model of economic federalism based on differentiated measures and specific tools to support regions in the context of their functional specializations is substantiated. (shrink)

Medical technology, specialization, and the corporatization of health delivery systems in the late twentieth century have all helped give birth to an unwelcome but unavoidable responsibility for individuals with family or friends—serving as a health care proxy. The responsibility comes without monetary compensation, is often involuntary, and lacks any real guidelines beyond the duty to make life-and-death decisions in circumstances over which the proxy has little control.The parameters of the proxy's job have evolved somewhat awkwardly in statutes and case law, (...) as lawmakers and judges have tried to apply conventional concepts to novel circumstances. This article examines the legal and functional status of the proxy, as well as the strengths and weaknesses of current public policy as reflected by state advance directive and surrogate decision-making laws. The first section of the article provides a historical perspective of our current notions of agency law as relevant to health care proxies. (shrink)

Medical technology, specialization, and the corporatization of health delivery systems in the late twentieth century have all helped give birth to an unwelcome but unavoidable responsibility for individuals with family or friends—serving as a health care proxy. The responsibility comes without monetary compensation, is often involuntary, and lacks any real guidelines beyond the duty to make life-and-death decisions in circumstances over which the proxy has little control.The parameters of the proxy's job have evolved somewhat awkwardly in statutes and case law, (...) as lawmakers and judges have tried to apply conventional concepts to novel circumstances. This article examines the legal and functional status of the proxy, as well as the strengths and weaknesses of current public policy as reflected by state advance directive and surrogate decision-making laws. The first section of the article provides a historical perspective of our current notions of agency law as relevant to health care proxies. (shrink)

The most debated status of the wave function of Quantum Mechanics is discussed in the light of the epistemological vs ontological opposition.

Occupational therapy often uses craft activities as therapeutic tools, but their therapeutic effectiveness has not yet been adequately demonstrated. The aim of this study was to examine changes in frontal midline theta rhythm and autonomic nervous responses during craft activities, and to explore the physiological mechanisms underlying the therapeutic effectiveness of occupational therapy. To achieve this, we employed a simple craft activity as a task to induce Fmθ and performed simultaneous EEG and ECG recordings. For participants in which Fmθ activities (...) were provoked, parasympathetic and sympathetic activities were evaluated during the appearance of Fmθ and rest periods using the Lorenz plot analysis. Both parasympathetic and sympathetic indices increased with the appearance of Fmθ compared to during resting periods. This suggests that a relaxed-concentration state is achieved by concentrating on craft activities. Furthermore, the appearance of Fmθ positively correlated with parasympathetic activity, and theta band activity in the frontal area were associated with sympathetic activity. This suggests that there is a close relationship between cardiac autonomic function and Fmθ activity. (shrink)

In spite of contemporary theoretical disagreement on the nature of language, there is a widespread informal agreement about what linguistic facts are. This article argues that a functional approach to language can provide the foundation for an explicit account of what the informal consensus implies. The account bridges the ‘internalist’ and the ‘externalist’ views of language by understanding mental constructs such as those involved in human languages as aspects of a dynamic social equilibrium. As in evolutionary biology, processes of (...) selection can work to stabilize certain features while others vary; and this process (in which ‘function’ plays a key role) is a necessary supplement to a purely mentalist account. This position is seen as a development of the position of Searle on social facts and Keller on language change. (shrink)

We argue that there is a variety of convention, effective coordinating agreement, that has not been adequately identified in the literature. Its distinctive feature is that it is a structure of conditional we-intentions of parties, unlike more familiar varieties of convention, which are structures of expectations and preferences or obligations. We argue that status functions constitutively involve this variety of convention, and that what is special about it explains, and gives precise content to the central feature of status (...) functions, namely, that objects with status functions can perform their functions only insofar as they have been collectively accepted as having them. (shrink)

This contradiction ”1. The universal right to free speech did not exist before the European Enlightenment, at which time it came into existence. 2. The universal right to free speech has always existed, but this right was recognized only at the time of the European Enlightenment.” draws on two common and conflicting intuitions: The human right to free speech exists because institutions, or the law, says so. In contrast, the human right to free speech can exist independently of institutions—these institutions (...) simply recognize a right we already have. John Searle argues that his status function account of human rights can preserve both intuitions by showing that the inconsistency between and is merely apparent. I argue that this solution works for tokens of human rights but not for types, while the contradiction concerns types. Hence, the status function account of human rights fails to preserve both intuitions. (shrink)

In this article, I articulate and defend an account of corporations motivated by John Searle’s discussion of them in his Making the Social World. According to this account, corporations are abstract entities that are the products of status function Declarations. They are also connected with, though not reducible to, various people and certain of the power relations among them. Moreover, these connections are responsible for corporations having features that stereotypical abstract entities lack (e.g., the abilities to take actions and (...) make profits). (shrink)

Cardiopulmonary resuscitation of a patient with an uncertain resuscitation status, and a discharging implantable cardiac defibrillator, presents a significant ethical challenge to healthcare professionals in the emergency department. Presently, no literature discusses these challenges or their implications for ethical healthcare delivery. This report will discuss the issues that arose during the management of such a case and attempt to raise awareness among healthcare professionals to ensure better preparation for similar situations.

We are able to participate in countless different sorts of social practice. This indefinite set of capacities must be explainable in terms of a finite stock of capacities. This paper compares and contrasts two different explanations. A standard decomposition of the capacity to participate in social practices goes something like this: the interpreter arrives on the scene with a stock of generic practice-types. He looks at the current scene to fill-in the current tokens of these types. He looks at the (...) current state of these practice tokens to see what actions are available to him. He uses his current desires to choose between these various possible actions. I argue that this standard explanation is defective, drawing on arguments by Searle and Wittgenstein and Garfinkel. I propose an alternative explanation, in which the participants must continually show each other the state of the scene in order to maintain the scene’s intelligibility. I provide a simple formal language in which to describe this alternative approach, in which we can state quite precisely what someone is doing when they participate in a practice. This language is related to both deontic and epistemic logics, but it is much simpler – it does not include the classic propositional connectives, and it is driven by a very different set of assumptions. The inspirations for this formal language are Searle’s analysis of directions of fit, Wittgenstein’s remarks on rule-following and Garfinkel’s ethnomethodology. (shrink)

This article discusses John Searle’s status function account of human rights and Åsa Burman’s “A Critique of the Status Function Account of Human Rights.” While recognizing the validity of part of the critique, based on the distinction between types and tokens, the author argues that, nonetheless, one is not compelled to accept Burman’s conclusion, that “one must give up the status function account of human rights to explain how a human right can exist without collective recognition”. Specifically, (...) the author accepts Burman’s critique of Searle’s attempt to preserve the intuition that human rights have existed without collective recognition, but concludes offering three ways to understand human rights even in the absence of collective recognition, all of which preserve the status function account. (shrink)

Recent years have witnessed a growing interest in the measurement of health status. One of the most well-known health status instruments is the Sickness Impact Profile (SIP). This paper examines the nature, development and testing of the SIP (and its UK equivalent the FLP). The practical merits of these instruments are explained, and some cautionary remarks are offered about their limitations.

Patients with Wilson’s disease suffer from prospective memory impairment, and some of patients develop cognitive impairment. However, very little is known about how brain structure and function changes effect PM in WD. Here, we employed multimodal neuroimaging data acquired from 22 WD patients and 26 healthy controls who underwent three-dimensional T1-weighted, diffusion tensor imaging, and resting state functional magnetic resonance imaging. We investigated gray matter volumes with voxel-based morphometry, DTI metrics using the fiber tractography method, and RS-fMRI using the (...) seed-based functional connectivity method. Compared with HC, WD patients showed GM volume reductions in the basal ganglia and occipital fusiform gyrus, as well as volume increase in the visual association cortex. Moreover, whiter matter tracks of WD were widely impaired in association and limbic fibers. WM tracks in association fibers are significant related to PM in WD patients. Relative to HC, WD patients showed that the visual association cortex functionally connects to the thalamus and hippocampus, which is associated with global cognitive function in patients with WD. Together, these findings suggested that PM impairment in WD may be modulated by aberrant WM in association fibers, and that GM volume changes in the association cortex has no direct effect on cognitive status, but indirectly affect global cognitive function by its aberrant functional connectivity in patients with WD. Our findings may provide a new window to further study how WD develops into cognitive impairment, and deepen our understanding of the cognitive status and neuropathology of WD. (shrink)

This article develops an institutional understanding of borders. Drawing on constitutive constructivism and theories of practical communication we argue that bordering as a process is a form of sorting through the imposition of status-functions on people and things, which alters the perception of that thing by setting it within a web of normative claims, teleologies and assumptions. Studying any border, therefore, extends to include the rule structure that constitutes it as well as the sources of that structure’s legitimacy. Furthermore, (...) rule structures are both restrictive and facilitative and importantly they overlap while retaining different sources of legitimacy: actors bring different constitutive perspectives on the border depending on the particular rule structure they are drawing on in order to make legitimate claims about what that border produces. This recognition sensitizes analysis to the interplay between different sense-making regimes and their authoritative underpinnings. Methodologically it points researchers towards the practical and discursive methods actors use when making arguments about what a particular border can and does do. (shrink)

What is the nature of law and what is the best way to discover it? This book argues that law is best understood in terms of the social functions it performs wherever it is found in human society. In order to support this claim, law is explained as a kind of institution and as a kind of artefact. To say that it is an institution is to say that it is designed for creating and conferring special statuses to people so (...) as to alter their rights and responsibilities toward each other. To say that it is an artefact is to say that it is a tool of human creation that is designed to signal its usability to people who interact with it. This picture of law's nature is marshalled to critique theories of law that see it mainly as a product of reason or morality, understanding those theories via their conceptions of law's function. It is also used to argue against those legal positivists who see law's functions as relatively minor aspects of its nature. -/- This method of conceptualizing law's nature helps us to explain how the law, understood as social facts, can make normative demands upon us. It also recommends a methodology for understanding law that combines elements of conceptual analysis with empirical research for uncovering the purposes to which diverse peoples put their legal activities. (shrink)

Comatose survivors of cardiac arrest may die following withdrawal of life-sustaining therapy (WLST) due to poor neurologic prognosis. Family members, acting as surrogate decision makers, are frequently asked to decide whether the patient should continue to receive ongoing life-sustaining therapy such as mechanical ventilation in this context of risk of death following removal. Sometimes, physicians and family members disagree about what is in the patient's best interest, and this conflict causes distress for both families and medical personnel. This article (...) examines themes recorded in the medical records of 24 cardiac arrest patients at Columbia University Medical Center (CUMC) whose families chose to pursue continued life support despite physician recommendations for withdrawal. In documented conversations between patients' families and their providers, the most prominent themes included faith in miracles, the inappropriateness of "playing God," the value of more time with the patient, and differences in how providers and family members perceived the patient's status. (shrink)

The current definition of death used for donation after cardiac death relies on a determination of the irreversible cessation of the cardiac function. Although this criterion can be compatible with transplantation of most organs, it is not compatible with heart transplantation since heart transplants by definition involve the resuscitation of the supposedly "irreversibly" stopped heart. Subsequently, the definition of "irreversible" has been altered so as to permit heart transplantation in some circumstances, but this is unsatisfactory. There are three (...) available strategies for solving this "irreversibility problem": altering the definition of death so as to rely on circulatory irreversibility, rather than cardiac; defining death strictly on the basis of brain death (either whole-brain or more pragmatically some higher brain criteria); or redefining death in traditional terms and simultaneously legalizing some limited instances of medical killing to procure viable hearts. The first two strategies are the most ethically justifiable and practical. (shrink)

According to the most popular theories of intentionality, a family of theories we will refer to as “functional intentionality,” a machine can have genuine intentional states so long as it has functionally characterizable mental states that are causally hooked up to the world in the right way. This paper considers a detailed description of a robot that seems to meet the conditions of functional intentionality, but which falls victim to what I call “the composition problem.” One obvious way (...) to escape the problem (arguably, the only way) is if the robot can be shown to be a moral patient – to deserve a particular moral status. If so, it isn’t clear how functional intentionality could remain plausible (something like “phenomenal intentionality” would be required). Finally, while it would have seemed that a reasonable strategy for establishing the moral status of intelligent machines would be to demonstrate that the machine possessed genuine intentionality, the composition argument suggests that the order of precedence is reversed: The machine must first be shown to possess a particular moral status before it is a candidate for having genuine intentionality. (shrink)

This is a new volume of original essays on the metaphysics of quantum mechanics. The essays address questions such as: What fundamental metaphysics is best motivated by quantum mechanics? What is the ontological status of the wave function? Does quantum mechanics support the existence of any other fundamental entities, e.g. particles? What is the nature of the fundamental space of quantum mechanics? What is the relationship between the fundamental ontology of quantum mechanics and ordinary, macroscopic objects like tables, chairs, (...) and persons? This collection includes a comprehensive introduction with a history of quantum mechanics and the debate over its metaphysical interpretation focusing especially on the main realist alternatives. (shrink)

Obviously, subject is what is said, style is how. A little less obviously, that formula is full of faults. Architecture and nonobjective painting and most of music have no subject. Their style cannot be a matter of how they say something, for they do not literally say anything; they do other things, they mean in other ways. Although most literary works say something, they usually do other things, too; and some of the ways they do some of these things are (...) aspects of style. Moreover, the what of one sort of doing may be part of the how of another. Indeed, even where the only function in question is saying, we shall have to recognize that some notable features of style are features of the matter rather than the manner of the saying. In more ways than one, subject is involved in style. For this and other reasons, I cannot subscribe to the received opinion that style depends upon an artist's conscious choice among alternatives. And I think we shall also have to recognize that not all differences in ways of writing or painting or composing or performing are differences in style. Nelson Goodman, professor of philosophy at Harvard University, has written The Structure of Appearance; Fact, Fiction and Forecast; Languages of Art: An Approach to a Theory of Symbols; Problems and Projects; and numerous articles. Logic and Art: Essays in Honor of Nelson Goodman was published in 1972. His contributions to Critical Inquiry include "Metaphor as Moonlighting" , "Twisted Tales; or, Story, Study, and Symphony" , and "The Telling and the Told". (shrink)

Consciousness has an important role in ethics: when a being consciously experiences the frustration or satisfaction of its interests, those interests deserve higher moral priority than those of a behaviourally similar but non-conscious being. I consider the relationship between this ethical role and an a posteriori (or “type-B”) materialist solution to the mind-body problem. It is hard to avoid the conclusion that, if type-B materialism is correct, then the reference of the concept of phenomenal consciousness is radically indeterminate between a (...) neuronal-level property that is distinctive to mammals and a high-level functional property that is much more widely shared. This would leave many non-mammalian animals (such as birds, fish, insects and octopuses) with indeterminate moral status. There are ways to manage this radical moral indeterminacy, but all of these ways lead to profoundly troubling consequences. (shrink)