The semantic paradoxes are often associated with self-reference or referential circularity. Yablo (Analysis 53(4):251–252, 1993), however, has shown that there are infinitary versions of the paradoxes that do not involve this form of circularity. It remains an open question what relations of reference between collections of sentences afford the structure necessary for paradoxicality. In this essay, we lay the groundwork for a general investigation into the nature of reference structures that support the semantic paradoxes and the semantic hypodoxes. We develop (...) a functionally complete infinitary propositional language endowed with a denotation assignment and extract the reference structural information in terms of graph-theoretic properties. We introduce the new concepts of dangerous and precarious reference graphs, which allows us to rigorously define the task: classify the dangerous and precarious directed graphs purely in terms of their graph-theoretic properties. Ungroundedness will be shown to fully characterize the precarious reference graphs and fully characterize the dangerous finite graphs. We prove that an undirected graph has a dangerous orientation if and only if it contains a cycle, providing some support for the traditional idea that cyclic structure is required for paradoxicality. This leaves the task of classifying danger for infinite acyclic reference graphs. We provide some compactness results, which give further necessary conditions on danger in infinite graphs, which in conjunction with a notion of self-containment allows us to prove that dangerous acyclic graphs must have infinitely many vertices with infinite out-degree. But a full characterization of danger remains an open question. In the appendices we relate our results to the results given in Cook (J Symb Log 69(3):767–774, 2004) and Yablo (2006) with respect to more restricted sentences systems, which we call $\mathcal{F}$ -systems. (shrink)

The COVID-19 pandemic has raised a host of ethical challenges, but key among these has been the possibility that health care systems might need to ration scarce critical care resources. Rationing p...

Postcolonial science studies entails ostensibly contradictory critical and empirical commitments. Science studies scholars influenced by Bruno Latour and Isabelle Stengers embrace forms of realist, radical empiricism, while postcolonial studies scholars influenced by Jacques Derrida trace the limits of the knowable. This essay takes their common use of the term cosmopolitics as an unexpected point of departure for reconciling Derrida’s program with Stengers’s and Latour’s. I read Derrida’s critique of hospitality and Stengers’s and Latour’s ontological politics as necessary complements for conceiving (...) a care-oriented subalternist cosmopolitics, a process of composing common worlds that remains attentive to the limits of representation. (shrink)

Suppose we consider knowledge to be valuable because of the role known propositions play in practical reasoning. This, I argue, does not provide a reason to think that knowledge is valuable in itself. Rather, it provides a reason to think that true belief is valuable from one standpoint, and that justified belief is valuable from another standpoint, and similarly for other epistemic concepts. The value of the concept of knowledge is that it provides an economical way of talking about many (...) epistemic concepts that are valuable in itself from one standpoint or another. In this way knowledge is like a Swiss Army Knife; a Swiss Army Knife is not useful as such on any occasion, but it provides an efficient way of carrying around different tools that are useful in themselves on different occasions. (shrink)

On the one hand, Hume accepts the view -- which he attributes primarily to Stoicism -- that there exists a determinate best and happiest life for human beings, a way of life led by a figure whom Hume calls "the true philosopher." On the other hand, Hume accepts that view -- which he attributes to Scepticism -- that there exists a vast plurality of good and happy lives, each potentially equally choiceworthy. In this paper, I reconcile Hume's apparently conflicting commitments: (...) I argue that Hume's "Sceptical" pluralism about the character of the happiest life need not conflict with his "Stoic" advocacy of the supreme happiness of the true philosopher, given Hume's flexible understanding of how one might live as a true philosopher. (shrink)

In Nicomachean Ethics X.7–8, Aristotle defends a striking view about the good for human beings. According to Aristotle, the single happiest way of life is organized around philosophical contemplation. According to the narrowness worry, however, Aristotle's contemplative ideal is unduly Procrustean, restrictive, inflexible, and oblivious of human diversity. In this paper, I argue that Aristotle has resources for responding to the narrowness worry, and that his contemplative ideal can take due account of human diversity.

In Plato’s Symposium, the mysterious Apollodorus recounts to an unnamed comrade, and to us, Aristodemus’ story of just what happened at Agathon’s drinking party. Since Apollodorus did not attend the party, however, it is unclear what relevance he could have to our understanding of Socrates’ speech, or to the Alcibiadean “satyr and silenic drama” (222d) that follows. The strangeness of Apollodorus is accentuated by his recession into the background after only two Stephanus pages. What difference—if any—does Apollodorus make to the (...) Symposium? Does his inclusion call the dramatic and philosophical unity of the work into question? I argue that despite initial appearances, Plato has important philosophical reasons for including Apollodorus as a character. Far from being an odd appendage to an otherwise complete narrative, the figure of Apollodorus is useful for our understanding of Socrates’s conception of eros later in the work. (shrink)

The impressive variation amongst biological individuals generates many complexities in addressing the simple-sounding question what is a biological individual? A distinction between evolutionary and physiological individuals is useful in thinking about biological individuals, as is attention to the kinds of groups, such as superorganisms and species, that have sometimes been thought of as biological individuals. More fully understanding the conceptual space that biological individuals occupy also involves considering a range of other concepts, such as life, reproduction, and agency. There has (...) been a focus in some recent discussions by both philosophers and biologists on how evolutionary individuals are created and regulated, as well as continuing work on the evolution of individuality. (shrink)

Conspiracy theories are a popular topic of conversation in everyday life but are often frowned upon in academic discussions. Looking at the recent spate of philosophical interest in conspiracy theories, The Philosophy of Conspiracy Theories looks at whether the assumption that belief in conspiracy theories is typically irrational is well founded.

For all of the emphasis on quality improvement—as well as the acknowledged overlap between assessment of the quality of healthcare services and clinical ethics—the quality of clinical ethics consultation has received scant attention, especially in terms of empirical measurement. Recognizing this need, the second edition of Core Competencies for Health Care Ethics Consultation identified four domains of ethics quality: (1) ethicality, (2) stakeholders’ satisfaction, (3) resolution of the presenting conflict/dilemma, and (4) education that translates into knowledge. This study is the (...) first, to our knowledge, to directly measure all of these domains. Here we describe the quality improvement process undertaken at a tertiary care academic medical center, as well as the tools developed to measure the quality of ethics consultation, which include post-consultation satisfaction surveys and weekly case conferences. The information gained through these tools helps to improve not only the process of ethics consultation, but also the measurement and assurance of quality. (shrink)

This book addresses a range of relevant theoretical issues, including the possibility of an interpersonally comparable measure of well-being, or “utility” metric; the moral value of equality, and how that bears on the form of the social welfare function; social choice under uncertainty; and the possibility of integrating considerations of individual choice and responsibility into the social-welfare-function framework. This book also deals with issues of implementation, and explores how survey data and other sources of evidence might be used to calibrate (...) both a utility metric and a social welfare function, and whether distributive goals are ever best pursued through regulation rather than the tax system. In working through this range of theoretical and practical issues, the book draws from a wide variety of literatures, including philosophical scholarship on equality, responsibility, the nature of well-being, and personal identity over time; the social choice literature within economics; applied economic literatures concerning the measurement of inequality and poverty; legal and policy-analysis scholarship on cost-benefit analysis, environmental justice, and the choice between regulation and taxation; and the burgeoning field of “happiness studies”. (shrink)

Clinical simulation using standardized patients has become standard in medical education—and is now being incorporated into some graduate programs in bioethics—for both formative and summative evaluation. In most hospitals, though, clinical ethics consultation is done by the ethics committee (or a subset of it). This study is the first, to our knowledge, to examine the effectiveness of standardized patient simulation in training hospital ethics committees to deal with ethically complex and emotionally fraught clinical situations. Following a substantial revision of the (...) institution’s nonbeneficial treatment policy, ethics committee members underwent a simulation to determine whether a specific requested treatment should be withheld on the basis of futility. Pre- and postintervention surveys showed improvement in all domains, although the small sample size limited the power of the study, with only one measure showing a statistically significant difference. An interesting incidental finding was that one-quarter of committee members voted against a determination of futility, even though the case clearly met the definition set forth in the policy. This highlights the emotional challenges in implementing an ethically rigorous, unanimously accepted policy that ultimately determines the timing and manner of a patient’s death. (shrink)

_Explores the ancient and perennial notion of the four elements as environmental ideas._.

This paper attempts to explain what a protest is by using the resources of speech-act theory. First, we distinguish the object, redress, and means of a protest. This provided a way to think of atomic acts of protest as having dual communicative aspects, viz., a negative evaluation of the object and a connected prescription of redress. Second, we use Austin’s notion of a felicity condition to further characterize the dual communicative aspects of protest. This allows us to distinguish protest from (...) some other speech acts which also involve a negative evaluation of some object and a connected prescription of redress. Finally, we turn to Kukla and Lance’s idea of a normative functionalist analysis of speech acts to advance the view that protests are a complex speech act constituted by dual input normative statuses and dual output normative statuses. (shrink)

Traditionally, Aristotle is held to believe that philosophical contemplation is valuable for its own sake, but ultimately useless. In this volume, Matthew D. Walker offers a fresh, systematic account of Aristotle's views on contemplation's place in the human good. The book situates Aristotle's views against the background of his wider philosophy, and examines the complete range of available textual evidence. On this basis, Walker argues that contemplation also benefits humans as perishable living organisms by actively guiding human life activity, (...) including human self-maintenance. Aristotle's views on contemplation's place in the human good thus cohere with his broader thinking about how living organisms live well. A novel exploration of Aristotle's views on theory and practice, this volume will interest scholars and students of both ancient Greek ethics and natural philosophy. It will also appeal to those working in other disciplines including classics, ethics, and political theory. (shrink)

Matthew Arnold was born at Laleham-on-Thames on 24 December 1822 as the eldest son of Dr Thomas Arnold and his wife Mary. He was educated at Winchester College, his father's old school; Rugby, where his father was headmaster; and Oxford. In 1851 he was appointed Inspector of Schools, pursuing this taxing career to support his wife and family until his retirement in 1886. He published his first volume of verse, The Strayed Reveller, and other Poems, in 1849 followed by (...) Empedocles on Etna, and other Poems (1852) and five further collections which appeared, with a diminishing number of new poems in each, between 1853 and 1867, after which his creative gift appeared to dwindle still further and he published little poetry. His career as a writer of prose began to take over after his election to the Professorship of Poetry at Oxford in 1857. Stimulated by preparing his lectures, many of the earliest published in 1865 as Essays in Criticism (First Series), he turned increasingly to the vigorous and widely ranging polemical commentaries on culture, religion, and society which were to make him known at home and abroad as the foremost critic of his day. He died suddenly of heart failure on 15 April 1888 while awaiting at Liverpool the arrival of his married daughter from America. (shrink)

Surprisingly little has been written about hedged assertion. Linguists often focus on semantic or syntactic theorizing about, for example, grammatical evidentials or epistemic modals, but pay far less attention to what hedging does at the level of action. By contrast, philosophers have focused extensively on normative issues regarding what epistemic position is required for proper assertion, yet they have almost exclusively considered unqualified declaratives. This essay considers the linguistic and normative issues side-by-side. We aim to bring some order and clarity (...) to thinking about hedging, so as to illuminate aspects of interest to both linguists and philosophers. In particular, we consider three broad questions. 1) The structural question: when one hedges, what is the speaker’s commitment weakened from? 2) The functional question: what is the best way to understand how a hedge weakens? And 3) the taxonomic question: are hedged assertions genuine assertions, another speech act, or what? (shrink)

This chapter offers a complete account of Aristotle’s underexplored treatment of the virtue of wittiness (eutrapelia) in Nicomachean Ethics IV.8. It addresses the following questions: (1) What, according to Aristotle, is this virtue and what is its structure? (2) How do Aristotle’s moral psychological views inform Aristotle’s account, and how might Aristotle’s discussions of other, more familiar virtues, enable us to understand wittiness better? In particular, what passions does the virtue of wittiness concern, and how might the virtue (and its (...) attendant vices) be related to the virtue of temperance (and its attendant vices)? (3) How does wittiness, as an ethical virtue, benefit its possessor? (4) How can Aristotle resolve some key tensions that his introducing a virtue of wittiness apparently generates for his ethics? In addition to exploring these questions, this chapter challenges some commonly accepted accounts of Aristotle’s views on the nature of the laughable. (shrink)

Many patients believe that cardiopulmonary resuscitation is more likely to be successful than it really is in clinical practice. Even when working with accurate information, some nevertheless remain resolute in demanding maximal treatment. They maintain that even if survival after cardiac arrest with CPR is extremely low, the fact remains that it is still greater than the probability of survival after cardiac arrest without CPR. Without realising it, this line of reasoning is strikingly similar to Pascal’s Wager, a Renaissance-era argument (...) for accepting the proposition for God’s existence. But while the original argument is quite logical—if not universally compelling—the modern variant makes several erroneous assumptions. The authors here present a case of a patient who unwittingly appeals to Pascal’s Wager to explain his request for maximal treatment, in order to highlight the crucial divergences from the original Wager. In understanding the faulty assumptions inherent in the application of Pascal’s Wager to code status decisions—and identifying the underlying motivations which the Wager serves to confirm—providers can better ensure that the true values and preferences of patients are upheld. (shrink)

Using the example of recent attempts to engineer the concept of conspiracy theory, I argue that philosophers should be far more circumspect in their approach to conceptual engineering than we have been – in particular, that we should pay much closer attention to the history behind and context that surrounds our target concept in order to determine whether it is a site of what I have elsewhere called ‘conceptual domination’. If it is, we may well have good reason to avoid (...) engineering. In their recent ‘What is a Conspiracy Theory?’, M. Giulia Napolitano and Kevin Reuter argue that the disagreement between generalists and particularists in the literature on conspiracy theories is best characterized as a set of dueling conceptual engineering projects. While I agree with their turn to this metaphilosophical literature, I give a very different account of its applicability. Particularists, on my account, are better read as aiming to diagnose the ways in which many discussions of the concept of conspiracy theories are a form of conceptual domination, where this broader context should then prompt us to abandon or block any concept of conspiracy theory that treats its referents as inherently defective. Broader metaphilosophical lessons are drawn. (shrink)

Philosophers, Henri Bergson once observed, "seem to philosophize as if they were sealed in the privacy of their study and did not live on a planet surrounded by the vast organic world of animals, plants, insects, and protozoa." Providing a solid overview of ecological philosophy and original insights into this developing field, Minding Nature focuses on some of the most influential thinkers who, in fact, have emphasized our natural relations to the earth, our social creations, and each other. Combining philosophy, (...) ecology, and political theory, chapters thoroughly examine, critique, and build upon the ideas of such luminaries as Thomas Hobbes, Martin Heidegger, Ernst Bloch, Hannah Arendt, Herbert Marcuse, Barry Commoner, Rachel Carson, and Jurgen Habermas, among others. Each thinker considered has contributed significantly to both contemporary discussion and historical understanding of political, epistemological, or social aspects related to nature and, with several exceptions, stimulated constructive dialogue within progressive, democratic, and radical left circles. By challenging the notion that conservation is inherently politically conservative or that our oikos (home) must be rendered uniformly economic where ecology is concerned, they enable us to rethink the possibility of creating a more democratic and ecological society. (shrink)

Research in the neurosciences continues to provide evidence that sleep plays a role in the processes of learning and memory. There is less of a consensus, however, regarding the precise stages of memory development during which sleep is considered a requirement, simply favorable, or not important. This article begins with an overview of recent studies regarding sleep and learning, predominantly in the procedural memory domain, and is measured against our current understanding of the mechanisms that govern memory formation. Based on (...) these considerations, I offer a new neurocognitive framework of procedural learning, consisting first of acquisition, followed by two specific stages of consolidation, one involving a process of stabilization, the other involving enhancement, whereby delayed learning occurs. Psychophysiological evidence indicates that initial acquisition does not rely fundamentally on sleep. This also appears to be true for the stabilization phase of consolidation, with durable representations, resistant to interference, clearly developing in a successful manner during time awake (or just time, per se). In contrast, the consolidation stage, resulting in additional/enhanced learning in the absence of further rehearsal, does appear to rely on the process of sleep, with evidence for specific sleep-stage dependencies across the procedural domain. Evaluations at a molecular, cellular, and systems level currently offer several sleep specific candidates that could play a role in sleep-dependent learning. These include the upregulation of select plasticity-associated genes, increased protein synthesis, changes in neurotransmitter concentration, and specific electrical events in neuronal networks that modulate synaptic potentiation. Key Words: consolidation; enhancement; learning; memory; plasticity; sleep; stabilization. (shrink)

By scholarly consensus, extant fragments from, and testimony about, Aristotle’s lost dialogue Eudemus provide strong evidence for thinking that Aristotle at some point defended the human soul’s unqualified immortality (either in whole or in part). I reject this consensus and develop an alternative, deflationary, speculative, but textually supported proposal to explain why Aristotle might have written a dialogue featuring arguments for the soul’s unqualified immortality. Instead of defending unqualified immortality as a doctrine, I argue, the Eudemus was most likely offering (...) a dramatically engaging propaedeutic to the sort of philosophical inquiry about the soul and its prospects that Aristotle pursues more scientifically in the De anima and Parva naturalia. (shrink)

Ideal theory has been extensively contested on the grounds that it is ideology: namely, that it performs the distorting social role of reifying and enforcing unjust features of the status quo. Indeed, a growing number of philosophers adopt a nonideal methodology—which dispenses with ideal theory—because of this ideology critique. I argue, however, that such philosophers are confused about the ultimate dialectical upshot of this critique even if it succeeds. I do so by constructing a parallel—equally plausible—ideology critique of nonideal methodology; (...) specifically, I argue that capitalist and managerial social attitudes have commodified people’s conception of justice and induced suspicion of ideal theory, which is not construed as having direct practical value. Consequently, nonideal methodology performs the distorting role of reifying and enforcing the hegemonies of capitalism and managerialism. Ideal theory and nonideal methodology are, therefore, in symmetrically bad positions. (shrink)

Encyclopedia entry covering the growing literature on the Knowledge Norm of Assertion (and its rivals), the Knowledge Norm of Action (and pragmatic encroachment), the Knowledge Norm of Belief, and the Knowledge Norm of Disagreement.

Should we remain neutral between our interests and those of future generations? Or are we ethically permitted or even required to depart from neutrality and engage in some measure of intergenerational discounting? This Article addresses the problem of intergenerational discounting by drawing on two different intellectual traditions: the social welfare function (“SWF”) tradition in welfare economics, and scholarship on “prioritarianism” in moral philosophy. Unlike utilitarians, prioritarians are sensitive to the distribution of well-being. They give greater weight to well-being changes affecting (...) worse-off individuals. Prioritarianism can be captured, formally, through an SWF which sums a concave transformation of individual utility, rather than simply summing unweighted utilities in utilitarian fashion. The Article considers the appropriate structure of a prioritarian SWF in intergenerational cases. The simplest case involves a fixed and finite intertemporal population. In that case, I argue, policymakers can and should maintain full neutrality between present and future generations. No discount factor should be attached to the utility of future individuals. Neutrality becomes trickier when we depart from this simple case, meaning: (1) “non-identity” problems, where current choices change the identity of future individuals; (2) population-size variation, where current choices affect not merely the identity of future individuals, but the size of the world’s future population (this case raises the specter of what Derek Parfit terms “the repugnant conclusion,” i.e., that dramatic reductions in the average level of individual well-being might be compensated for by increases in population size); or (3) an infinite population. The Article grapples with the difficult question of outfitting a prioritarian SWF to handle non-identity problems, population-size variation, and infinite populations. It tentatively suggests that a measure of neutrality can be maintained even in these cases. (shrink)

This paper examines some of the key ways in which water is mediated by technology and human artifacts. I show how the modes in which we conceive and experience this vital fluid are affected deeply by the techniques and instruments we use to interact with it. I argue that a notion of the domestication of water enables us to better grasp our relations with the environment given that vast volumes of water are now neither completely natural nor artificial in the (...) conventional senses of the terms. Instead, water is often filtered through an expansive technological network that not merely changes its flows and phenomenal forms but greatly alters or multiplies its meanings. As examples of this process, I investigate the practical engagement with water by the first Western philosopher; the construction of several large hydrological projects; efforts at river management in the aesthetic landscape; and the emergence of bottled water. (shrink)

Prioritarianism is an ethical theory that gives extra weight to the well-being of the worse off. In contrast, dominant policy-evaluation methodologies, such as benefit-cost analysis, cost-effectiveness analysis, and utilitarianism, ignore or downplay issues of fair distribution. Based on a research group founded by the editors, this important book is the first to show how prioritarianism can be used to assess governmental policies and evaluate societal conditions. This book uses prioritarianism as a methodology to evaluate governmental policy across a variety of (...) policy domains: taxation, health policy, risk regulation, education, climate policy, and the COVID-19 pandemic. It is also the first to demonstrate how prioritarianism improves on GDP as an indicator of a society's progress over time. Edited by two senior figures in the field with contributions from some of the world's leading economists, this volume bridges the gap from the theory of prioritarianism to its practical application. (shrink)

_Zoographies_ challenges the anthropocentrism of the Continental philosophical tradition and advances the position that, while some distinctions are valid, humans and animals are best viewed as part of an ontological whole. Matthew Calarco draws on ethological and evolutionary evidence and the work of Heidegger, who called for a radicalized responsibility toward all forms of life. He also turns to Levinas, who raised questions about the nature and scope of ethics; Agamben, who held the "anthropological machine" responsible for the horrors (...) of the twentieth century; and Derrida, who initiated a nonanthropocentric ethics. Calarco concludes with a call for the abolition of classical versions of the human-animal distinction and asks that we devise new ways of thinking about and living with animals. (shrink)

According to Nicomachean Ethics I.7 1098a16–18, eudaimonia consists in activity of soul “according to the best and most final” virtue. Ongoing debate between inclusivist and exclusivist readers of this passage has focused on the referent of “the best and most final” virtue. I argue that even if one accepts the exclusivist's answer to this reference question, one still needs an account of what it means for activity of soul to accord with the best and most final virtue. I examine the (...) nature of this accordance relation and defend a novel inclusivist reading of the whole passage. (shrink)

The problem of evil is the most prominent argument against the existence of God. Skeptical theists contend that it is not a good argument. Their reasons for this contention vary widely, involving such notions as CORNEA, epistemic appearances, 'gratuitous' evils, 'levering' evidence, and the representativeness of goods. We aim to dispel some confusions about these notions, in particular by clarifying their roles within a probabilistic epistemology. In addition, we develop new responses to the problem of evil from both the phenomenal (...) conception of evidence and the knowledge-first view of evidence. (shrink)

As the population in the United States gets older, more people suffer from dementia, which often causes neuropsychiatric symptoms such as agitation and paranoia. This can lead patients to refuse medications, prompting consideration of covert administration (that is, concealing medication in food or drink). While many condemn this practice as paternalistic, deceptive, and potentially harmful, the end result of assuming the “moral high ground” can be increased suffering for patients and families. This article addresses common criticisms of covert medication and (...) presents a detailed algorithm by which to determine whether the practice is ethically permissible in specific cases. It also explores why so little attention has been paid in the U.S. to this presumably common practice, and reviews professional statements from Europe that endorse the practice. Finally, it presents a compelling argument for the role of Ulysses clauses in advance care planning, not only for patients with psychiatric illness but also for those who may suffer from dementia, which is far more common. (shrink)

I examine the kindred phenomena of shadows and night in order to reveal their significance for better understanding our lifeworld and the elemental environment. I first describe how light is primary to ecological perception and how it conditions our conceptions of space, truth, and beauty. Light and darkness are involved in a dialectical relationship rather than conceived as polar opposites. Borne of the interplay of both realms, shadows have been disparaged historically and deserve to be reconsidered for their aesthetic appearance (...) and their relevance to an ecology and anthropology of perception. Night, in turn, is often marked by a negative ontology that points toward the possibility of a kind of elemental a priori, but it is important to characterize darkness in terms of its subtle shades and filtering by way of the creative matrix of the human imagination. Seeing the night in novel and unexpected ways, especially via the insights and descriptions of phenomenologists, poets, and artists, enables us to grasp the depth and atmosphere of the surrounding world and to light up our geographical perspectives, our philosophical visions, and our environmental awareness. (shrink)

Given narrow operating margins, health care organizations are increasingly relying on philanthropy to fund operations. Since individuals provide the majority of philanthropic support, many organizations have expanded their “grateful patient fundraising” programs to include current inpatients, both established donors as well as persons of wealth. While this is legally permissible under HIPAA, it raises substantial ethical concerns for potential coercion of vulnerable patients, as well as unequal care stemming from preferential treatment and provided “amenities.” While some have drawn the analogy (...) to the additional comforts provided to first-class airline passengers, this analogy is flawed because of the potential clinical impact of the opportunities and services provided, especially to merely potential donors. From an ethical perspective, such programs should only provide non-clinical amenities to established donors, and at the same time strive for maximal transparency whereby all patients are assured of equal care and are fully informed of the specific benefits associated with any potential donation. (shrink)

: Health care reform is bottled up. Socially responsible physicians, forced to curtail care to uninsured patients, should respond with organized, open defiance, by billing the costs of the care to the accounts of patients covered under Medicaid or Medicare. Reverse cost-shifting: maybe it could work, certainly it would be justified.

Health care reform is bottled up. Socially responsible physicians, forced to curtail care to uninsured patients, should respond with organized, open defiance, by billing the costs of the care to the accounts of patients covered under Medicaid or Medicare. Reverse cost‐shifting: maybe it could work, certainly it would be justified.

Typically, the determination of death by neurological criteria follows a very specific protocol. An apnea test is performed with further confirmation as necessary, and then mechanical ventilation is withdrawn with the consent of the family after they have had an opportunity to “say goodbye,” and at such a time to permit organ retrieval (with authorization of the patient or consent of the next of kin). Such a process maximizes transparency and ensures generalizability. In exceptional circumstances, however, it may be necessary (...) to deviate from this protocol in order to spare family members unnecessary suffering and to reduce moral distress felt by clinical staff. It may also be appropriate, we argue, to refrain from even inquiring about organ donation when the next-of-kin is not only certain to refuse, but lacks the decision-making capacity to potentially consent. The case described in this article calls into question generally reliable assumptions about determination of death by neurological criteria, where the best the clinical team could do for the patient and his family was “the least bad option.”. (shrink)

I examine the ancient and perennial notion of the elements (stoicheia) and its relation to an idea of place proper (topos) and natural place (topos oikeios) in Aristotle's work. Through an exploration of his accounts, I argue that Aristotle develops a robust theory of place that is relevant to current environmental and geographical thought. In the process, he provides a domestic household and home for earth, air, fire and water that offers a supplement or an alternative to more abstract and (...) controversial uses of a conception of 'nature' (physis). I identify and elaborate upon environmental aspects of place-based and elemental philosophy. (shrink)

Background Because opioids can suppress respiratory drive, the principle of double effect (PDE) has been used to justify their use for terminally ill patients. Recent studies, however, suggest that the risk of respiratory depression in typical end-of-life (EOL) situations may be overstated and that heightened concern for this rare occurrence can lead to inadequate treatment of pain. The purpose of this study is to examine the role of the PDE in medical school ethics education, with specific reference to its potential (...) impact on pain management at EOL. Method After obtaining institutional review board approval, an electronic survey was sent to ethics educators at every allopathic medical school in the USA. Results One-third of ethics educators felt that opioids were ‘likely’ to cause significant respiratory depression that could hasten death. Educators' opinions of opioid effects did not influence their view of the relevance of the PDE, with approximately 70% deeming it relevant to EOL care. Only 15% of ethics educators believed that associating the PDE with opioid use might discourage clinicians from optimally treating pain, out of concern for respiratory depression. Conclusion This study demonstrates that a significant minority of ethics educators believe, contrary to current evidence, that opioids are ‘likely’ to cause significant respiratory depression that could hasten death in terminally ill patients. Yet, many of those who do not feel this is likely still rely on the PDE to justify this possibility, potentially (and unknowingly) contributing to clinical misperceptions and underutilisation of opioids at EOL. (shrink)

Aristotle’s views on the choiceworthiness of friends might seem both internally inconsistent and objectionably instrumentalizing. On the one hand, Aristotle maintains that perfect friends or virtue friends are choiceworthy and lovable for their own sake, and not merely for the sake of further ends. On the other hand, in Nicomachean Ethics IX.9, Aristotle appears somehow to account for the choiceworthiness of such friends by reference to their utility as sources of a virtuous agent’s robust self-awareness. I examine Aristotle’s views on (...) the utility and choiceworthiness of friends, and offer a novel reading of Nicomachean Ethics IX.9. On this reading, Aristotle accepts a version of instrumental conditionalism about final value, that is, the thesis that goods (including friends) can be choiceworthy for their own sake (i.e., possess final or end value) at least partly on account of their instrumental properties. In articulating what sort of instrumental conditionalism it is reasonable to attribute to Aristotle, I argue that Aristotle appeals to the utility of perfect friends as part of a broadly material causal account of why such friends are choiceworthy for their own sake. On this reading, perfect friends are not choiceworthy for the sake of their utility in eliciting self-awareness; rather, their choiceworthiness for their own sake is (at least partly) realized in, or constituted by, their conduciveness to the virtuous agent’s self-awareness. This reading, I argue, frees Aristotle from the charge of inconsistency: Aristotle can appeal to the conduciveness of perfect friends to the virtuous agent’s self-awareness as a way of explaining why such friends are choiceworthy for their own sake. (shrink)

A response to Lee Basham's 'The Need for Accountable Witnesses: A Reply to Dentith'.

This collection of essays forms a lively debate over the fundamental characteristics of legal and moral rights. The essays examine whether rights fundamentally protect individuals' interests or whether they instead fundamentally enable individuals to make choices.