Introduction As deep brain stimulation (DBS) has shifted to being used earlier during Parkinson’s disease (PD), data is lacking regarding patient specific attitudes, preferences, and factors which may influence the timing of and decision to proceed with DBS in the United States. This study aims to identify and compare attitudes and preferences regarding the earlier use of DBS in Parkinson’s patients who have and have not undergone DBS. Methods We developed an online survey concerning attitudes about DBS and its timing (...) in PD. The survey was distributed nationally in the United States via the Michael J. Fox Foundation Trial Finder, the American Parkinson Disease Association flyers, and as a link on the Parkinson Alliance website. Differences in responses between PD DBS and non-DBS patients were assessed. Results A total of 445 patients with PD met eligibility criteria for the survey of which 160 self-identified as having undergone DBS. Fifty-five percent (n = 124) of non-DBS patients believed that DBS for PD should only be considered after all medication options have been tried. Patients favoring early DBS had fewer concerns regarding the surgery than those favoring later DBS. Conclusion Our findings highlight a variety of important considerations and concerns patients have regarding DBS and its timing. These viewpoints are important aspects of shared decision-making, as they help to identify patients’ preferences, values, and goals, which should enable providers to better navigate, with their patients, the decision path for therapeutic options to consider. (shrink)

In this book, Carlos Montemayor and Harry Haladjian consider the relationship between consciousness and attention. The cognitive mechanism of attention has often been compared to consciousness, because attention and consciousness appear to share similar qualities. But, Montemayor and Haladjian point out, attention is defined functionally, whereas consciousness is generally defined in terms of its phenomenal character without a clear functional purpose. They offer new insights and proposals about how best to understand and study the relationship between consciousness and (...) attention by examining their functional aspects. The book's ultimate conclusion is that consciousness and attention are largely dissociated. -/- Undertaking a rigorous analysis of current empirical and theoretical work on attention and consciousness, Montemayor and Haladjian propose a spectrum of dissociation—a framework that identifies the levels of dissociation between consciousness and attention—ranging from identity to full dissociation. They argue that conscious attention, the focusing of attention on the contents of awareness, is constituted by overlapping but distinct processes of consciousness and attention. Conscious attention, they claim, evolved after the basic forms of attention, increasing access to the richest kinds of cognitive contents. -/- Montemayor and Haladjian's goal is to help unify the study of consciousness and attention across the disciplines. A focused examination of conscious attention will, they believe, enable theoretical progress that will further our understanding of the human mind. (shrink)

The main thesis of this paper is that two prevailing theories about cognitive penetration are too extreme, namely, the view that cognitive penetration is pervasive and the view that there is a sharp and fundamental distinction between cognition and perception, which precludes any type of cognitive penetration. These opposite views have clear merits and empirical support. To eliminate this puzzling situation, we present an alternative theoretical approach that incorporates the merits of these views into a broader and more nuanced explanatory (...) framework. A key argument we present in favor of this framework concerns the evolution of intentionality and perceptual capacities. An implication of this argument is that cases of cognitive penetration must have evolved more recently and that this is compatible with the cognitive impenetrability of early perceptual stages of processing information. A theoretical approach that explains why this should be the case is the consciousness and attention dissociation framework. The paper discusses why concepts, particularly issues concerning concept acquisition, play an important role in the interaction between perception and cognition. (shrink)

This article presents what I call the Central Normative Proposal of Luis Villoro. This proposal is based on an interpretation of the principle of non-exclusion in ethics and epistemology. The core argument of the paper is based on a linguistic analogy that demonstrates the importance of reasonable communication for non-exclusion in epistemology, which is assumed in various theses of Villoro. A consequence of this analogy for non-exclusion in ethics is that Villoro defends basing what is reasonable on the concrete possibilities (...) of mutual understanding, starting with asymmetries and injustices that are obfuscated or eliminated in a contractualist analysis, or one that begins with strictly egalitarian principles. This criticism is compatible with egalitarian views, but it assumes a radically different point of departure. Although various theses by Villoro are compatible with egalitarian notions, given this point of departure based on asymmetries of power his proposal should be understood based on our cognitive capacities to understand and appreciate such asymmetries. For this reason, the paper concludes with an analysis of the notion of reasonableness, which under my interpretation Villoro defines in terms of our capacities for attention, that are not reducible to beliefs or systems of beliefs. In this way, the Central Normative Proposal of Villoro depends on the convergence between truth and the dignity of the members of communities in which as matter-of-fact asymmetries exist and must be eliminated through concrete communicative efforts. (shrink)

Minding Time: A Philosophical and Theoretical Approach to the Psychology of Time offers an innovative philosophical account of the most fundamental kinds of time representation.

Thirty years ago Richard Rorty detected the similarities between Wittgenstein's Philosophical Investigations (1953) and the philosophical framework of Charles S. Peirce (1839-1914), the founder of pragmatism. Rorty tried to show that Peirce envisaged and repudiated in advance logical positivism and developed insights and a philosophical mood very close to the analytical philosophers influenced by the later Wittgenstein (Rorty 1961). In spite of that, the majority of scholars have considered both thinkers as totally alien. Some scholars have attributed the pragmatist flavor (...) of the Philosophical Investigations to the influence of Frank P. Ramsey, who awoke Wittgenstein from the dogmatic slumber of the Tractatus. Nevertheless, the real scope of the influence of American pragmatist philosophy in Wittgenstein's later thought is not clearly known. The purpose of my paper is not to describe the common themes between Wittgenstein and Peirce, but the way in which recent scholarship has established some links between both philosophers. -/- . (shrink)

The connection between quantum physics and the mind has been debated for almost a hundred years. There are several proposals as to how quantum effects might be relevant to understanding consciousness, including von Neumann’s Consciousness Causes Collapse interpretation (CCC), Penrose’s Orchestrated objective reduction (Orch OR), Atmanspacher quantum emergence theory, or Vitiello’s field theory. In this paper, we examine the CCC, in particular Stapp’s theory of interaction of mind and matter, and discuss how this imposes constraints to possible brain structures. We (...) then argue that those constraints may allow us to identify a possible locus of the interaction between mind and matter, if CCC is true. (shrink)

Volume 20, Issue 9, September 2020, Page W1-W4.

The scientific investigation of consciousness generates new findings at a rapid pace. We argue that we need a novel theoretical framework, which we call the ALARM theory of consciousness, in order to account for all central observations. According to this theory, we need to distinguish two levels of consciousness, namely basic arousal and general alertness. Basic arousal functions as a specific alarm system, keeping a biological organism alive under sudden intense threats, and general alertness enables flexible learning and behavioural strategies. (...) This two-level theory of consciousness helps us to account for (i) recent discoveries of subcortical brain activities with a central role of thalamic processes, (ii) observations of differences in the behavioural repertoire of non-human animals indicating two types of conscious experiences. Furthermore, the framework enables us (iii) to unify the neural evidence for the relevance of subcortical processes, on the one hand, and of cortico-cortical loops, on the other, and finally (iv) to clarify the evolutionary and actual functional role of conscious experiences. (shrink)

En su más reciente libro, Cuestiones de Filosofía del Lenguaje: Pragmática, David Pérez Chico (2022) nos presenta una muy interesante selección de artículos sobre diferentes temáticas actualmente trabajadas en filosofía del lenguaje. Personalmente, considero que este libro es una lectura imprescindible para cualquier lector de habla hispana que quiera introducirse en las temáticas más contemporáneamente discutidas en esa disciplina. En este marco, en el presente artículo me propongo realizar un análisis crítico de cuatro de los artículos de la compilación que (...) trabajan la temática de las emisiones evaluativas, i.e., emisiones cuya extensión depende de parámetros contextuales semánticamente no estándares. (shrink)

Esta reseña aborda el libro de la estudiosa norteamericana Sophi Esch a propósito de la literatura y la música centroamericana y mexicana producida en medio de acontecimientos que involucran el uso de la violencia. A partir de registros variados, la autora observa los procesos de agencia, vinculados a nociones como masculinidad o independencia. El libro puede ser considerado una historia cultural de producciones sociales que parten de contingentes variados y que se emplazan desde lugares de enunciación diversos. Reseña de Letra (...) y metralla. Cultura y política durante los periodos de conflictos armados en México y Centroamérica (1910-1920), Ciudad de México, Bonilla Artiga Editores, 2022, cuenta con 350 páginas y el ISBN: 978-607-8838-09-7. (shrink)

In this paper the relations between the almost unknown Spanish mathematician Ventura Reyes Prósper (1863-1922) with Charles S. Peirce and Christine Ladd-Franklin are described. Two brief papers from Reyes Prósper published in El Progreso Matemático 12 (20 December 1891), pp. 297-300, and 18 (15 June 1892) pp. 170-173 on Ladd-Franklin, and on Peirce and Mitchell, respectively, are translated for first time into English and included at the end of the paper.

In a world of ever growing specialization, the idea of a unity of science is commonly discarded, but cooperative work involving cross-disciplinary points of view is encouraged. The aim of this paper is to show with some textual support that Charles S. Peirce not only identified this paradoxical situation a century ago, but he also mapped out some paths for reaching a successful solution. A particular attention is paid to Peirce's classification of the sciences and to his conception of science (...) as a collective and cooperative activity of all those whose lives are animated by the desire to discover the truth. -/- . (shrink)

George M. Searle (1839-1918) and Charles S. Peirce worked together in the Coast Survey and the Harvard Observatory during the decade of 1860: both scientists were assistants of Joseph Winlock, the director of the Observatory. When in 1868 George, a convert to Catholicism, left to enter the Paulist Fathers, he was replaced by his brother Arthur Searle. George was ordained as a priest in 1871, was a lecturer of Mathematics and Astronomy at the Catholic University of America, and became the (...) fourth superior general of his congregation from 1904 to 1909. Among the books he wrote for non-Catholic audiences was Plain Facts for Fair Minds (1895). On the 8th of August of 1895, Peirce found that book in a bookstore and the following day wrote a letter to George Searle developing his strong reservations about the question of the infallibility of the Pope. This letter (L 397) is almost unknown amongst Peirce's scholars. -/- After describing these historical circumstances as a framework, the aim of my paper is to describe Peirce's arguments against papal infallibility presented by George Searle in his book, and the contrast between the genuine scientific attitude and the putative metaphysical notion of absolute truth that is —according to Peirce— behind Searle's defense of infallibility. In this sense, Peirce's fallibilism will be explained with some detail, giving an account also of his practical infallibilism: "The assertion that every assertion but this is fallible, is the only one that is absolutely infallible. But though nothing else is absolutely infallible, many propositions are practically infallible; such as the dicta of conscience" (Minute Logic, CP 2.75, c. 1902). -/- Finally, having in mind the present interest in Peirce's religious ideas it will be suggested that some of Peirce's ideas on infallibility are nearer to contemporary understanding of that issue than Searle's defense. "I would with all my heart join the ancient church of Rome if I could. But your book," —Peirce writes to Searle— "is an awful warning against doing so." -/- . (shrink)

Building upon the insights of scholars attuned to story, narrative, and myth, this article explores the relationship between myth, science, and religion. After clarifying the interplay of the three terms—story, narrative, and myth—and the preference for the term myth, this article will argue that myth can serve as a medium through which religion, neuroscience, and mental well‐being interact. Such an exploration will cover the role of myths in religion, the neurological basis of myth, and the practices of narrative psychology and (...) bibliotherapy. The article will conclude with suggestions for understanding and utilizing the relationship between myth and the scholarly study of the relationship between science and religion. This article ultimately suggests that myth can operate as a methodological aid to the science‐and‐religion field. (shrink)

Contemporary cognitive science clearly tells us that attention is modulated for speech and action. While these forms of goal-directed attention are very well researched in psychology, they have not been sufficiently studied by epistemologists. In this book, Abrol Fairweather and Carlos Montemayor develop and defend a theory of epistemic achievements that requires the manifestation of cognitive agency. They examine empirical work on the psychology of attention and assertion, and use it to ground a normative theory of epistemic achievements and (...) virtues. The resulting study is the first sustained naturalized virtue epistemology, and will be of interest to readers in epistemology, cognitive science, and beyond. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:To Nurse BetterJaime HenselWhen things were quiet again I asked him what training he’d had to become the director of hospital security. “I worked for 20 years in corrections,” he answered proudly, and I was saddened but not surprised.In September 2010 I started an accelerated graduate entry nurse practitioner program to become a family nurse practitioner. Accelerated programs leave little time for preamble, since the idea is to take (...) a total novice and turn her first into a nurse and then into a nurse practitioner in just three years. While the classroom information was vital, it was our clinical experiences that really initiated us into the profession. In just the second week of school, we were divided into small groups and assigned to clinical preceptors—hands–on teachers who introduced us to our first patients, curbed our mistakes, quelled our fears, and pushed and pulled and cajoled us into being nascent healthcare providers. In showing us how to give bed baths, suction secretions, insert Foley catheters, and hang IV bags, our preceptors really began showing us how to use our hands as healers.In that first semester my patients also proved to be invaluable instructors. Talking to them, administering their medication, washing their bodies made me keenly aware of the delicate balance of vulnerability and power and trust and respect and intimacy that underlies all healthcare relationships. I hope, wherever those patients are now, they know how deeply I appreciate their patience and good humor and their collusion in my education.In December, the first semester and the first clinical rotations ended. Four months into nursing school I had a basic understanding of what it means to be a nurse. Frankly, most days I still felt like an impostor in blue pajamas sporting a stethoscope I didn’t really know how to use and new Dansko clogs that squeaked with every step. But in an accelerated program, fast and furious is the name of the game. We went away for winter break—a much needed breather—and came back to something completely different: psychiatric nursing.In preparation for these new clinicals, we were taught in class that we should not wear dangly jewelry or stethoscopes. That we should never let the patient get between us and the door. That psychiatric (psych) patients could escalate quickly; psych patients could have surprising triggers; psych patients could be very unpredictable. And psych patients could be violent. We were taught about physical and chemical restraints, and about show of force. We were cautioned, as students, to stay out of the way if things got tense on the floor. In stark contrast to medical patients, psych patients were made to sound less like people who had diseases and more like adversaries. I drove to my first day on the floor with trepidation.My new preceptor had spent her entire career in psych. She loved her job, loved the care of psychiatric patients. She set up a rotation because she wanted our entire clinical group to get full exposure to the breadth of psychiatric services offered by this medium–sized community hospital. We would each get to spend shifts on the locked psych floor, observing outpatient group therapy sessions, and in the psych emergency department (ED).I rotated to the psych ED for the first time on a Friday night. The first couple hours of the shift were very slow. I started talking to the mustachioed guard on duty, who looked as bored as I felt. He told me about his kids, I told him about nursing school. He seemed nice.When our conversation flagged, I explored the psych ED. It didn’t take long—just a short hallway with a bathroom, the social workers’ office, and two patient rooms without doors. The majority of the designated psych beds were actually around the corner in the main room of the medical ED—stretchers lined against the wall, without curtains or any [End Page 98] other attempt at privacy. I noticed that from where the guard stood at the corner of the psych hall he had a pretty good view of all the beds. Then again, so did most of the other patients... (shrink)

This article is a response to Josh Reeves's recent book Against Methodology in Science and Religion: Recent Debates on Rationality and Theology that welcomes Reeves's proposal for an anti‐essentialist future for the field of science‐and‐religion, particularly because it has the potential to move the field beyond current, well‐worn methods: the dominance of Christian theology and doctrine, the importance of credibility strategies, and the dependence upon philosophical discourses. Reeves’ proposal has the potential to open the science‐and‐religion field to other topics, problems, (...) and methods, such as studying lived science‐and‐religion. One way of doing this is to study popular culture and its artifacts such as literature, which portrays a co‐mingling of religion and science at the level of day‐to‐day experiences and practices of characters. For at the level of lived experience, religion and science are not well‐defined disciplines neatly compartmentalized into separate academic departments. (shrink)

Climate change exacts a devastating toll on health that is rarely incorporated into the economic calculus of climate action. By aligning health and environmental policy and collaborating across borders, governments and industries can develop powerful initiatives to promote both environmental and human health.

This edited volume examines aspects of the mind/consciousness that are relevant to the interpretations of quantum mechanics. In it, an international group of contributors focus on the possible connections between quantum mechanics and consciousness. They look at how consciousness can help us with quantum mechanics as well as how quantum mechanics can contribute to our understanding of consciousness. For example, what do different interpretations aimed at solving the measurement problem in quantum mechanics tell us about the nature of consciousness, such (...) as von Neumann's interpretation? Each interpretation has, associated to it, a corresponding metaphysical framework that helps us think about possible “models” of consciousness. Alternatively, what does the nature of consciousness tell us about the role of the observer and time reversibility in the measurement process? The book features 20 papers on contemporary approaches to quanta and mind. It brings together the work of scholars from different disciplines with diverse views on the connections between quanta and mind, ranging from those who are supportive of a link between consciousness and quantum physics to those who are very skeptical of such link. Coverage includes such topics as free will in a quantum world, contextuality and causality, mind and matter interaction, quantum panpsychism, the quantum and quantum-like brain, and the role of time in brain-mind dynamics. (shrink)

This paper explores aspects of GPT-3 that have been discussed as harbingers of artificial general intelligence and, in particular, linguistic intelligence. After introducing key features of GPT-3 and assessing its performance in the light of the conversational standards set by Alan Turing in his seminal paper from 1950, the paper elucidates the difference between clever automation and genuine linguistic intelligence. A central theme of this discussion on genuine conversational intelligence is that members of a linguistic community never merely respond “algorithmically” (...) to queries through a selective kind of pattern recognition, because they must also jointly attend and act with other speakers in order to count as genuinely intelligent and trustworthy. This presents a challenge for systems like GPT-3, because representing the world in a way that makes conversational common ground salient is an essentially collective task that we can only achieve jointly with other speakers. Thus, the main difficulty for any artificially intelligent model of conversation is to account for the communicational intentions and motivations of a speaker through joint attention. These joint motivations and intentions seem to be completely absent from the standard way in which systems like GPT-3 and other artificial intelligent systems work. This is not merely a theoretical issue. Since GPT-3 and future iterations of similar systems will likely be available for commercial use through application programming interfaces, caution is needed regarding the risks created by these systems, which pass for “intelligent” but have no genuine communicational intentions, and can thereby produce fake and unreliable linguistic exchanges. (shrink)

Artificial Intelligence is at a turning point, with a substantial increase in projects aiming to implement sophisticated forms of human intelligence in machines. This research attempts to model specific forms of intelligence through brute-force search heuristics and also reproduce features of human perception and cognition, including emotions. Such goals have implications for artificial consciousness, with some arguing that it will be achievable once we overcome short-term engineering challenges. We believe, however, that phenomenal consciousness cannot be implemented in machines. This becomes (...) clear when considering emotions and examining the dissociation between consciousness and attention in humans. While we may be able to program ethical behavior based on rules and machine learning, we will never be able to reproduce emotions or empathy by programming such control systems—these will be merely simulations. Arguments in favor of this claim include considerations about evolution, the neuropsychological aspects of emotions, and the dissociation between attention and consciousness found in humans. Ultimately, we are far from achieving artificial consciousness. (shrink)

This paper aims to clarify the relationship between consciousness and attention through theoretical considerations about evolution. Specifically, we will argue that the empirical findings on attention and the basic considerations concerning the evolution of the different forms of attention demonstrate that consciousness and attention must be dissociated regardless of which definition of these terms one uses. To the best of our knowledge, no extant view on the relationship between consciousness and attention has this advantage. Because of this characteristic, this paper (...) presents a principled and neutral way to settle debates concerning the relationship between consciousness and attention, without falling into disputes about the meaning of these terms. A decisive conclusion of this approach is that extreme views on the relationship between consciousness and attention must be rejected, including identity and full dissociation views. There is an overlap between the two within conscious attention, but developing a full understanding of this mechanism requires further empirical investigations. (shrink)

Current methods of obtaining an informed consent leave much to be desired. Patients rarely read consent forms or understand all of the risks, benefits, or alternatives associated with their treatment. Evaluating the advantages and disadvantages of treatment options often presents a more significant challenge for patients with lower levels of health literacy. This article reviews the evidence of shortcomings in our informed consent system and then explores the potential for a new approach to engage patients at all levels of health (...) literacy in their treatment decisions. Specifically, the article will examine the potential of shared decision-making to bridge gaps in knowledge, increase patient adherence to treatment, and improve health outcomes in low health literacy patient populations. Leveling barriers to treatment information for disadvantaged populations should be a public health imperative, especially if it can be shown to improve health outcomes and reduce health disparities. (shrink)

Current methods of obtaining an informed consent leave much to be desired. Patients rarely read consent forms or understand all of the risks, benefits, or alternatives associated with their treatment. Evaluating the advantages and disadvantages of treatment options often presents a more significant challenge for patients with lower levels of health literacy. This article reviews the evidence of shortcomings in our informed consent system and then explores the potential for a new approach to engage patients at all levels of health (...) literacy in their treatment decisions. Specifically, the article will examine the potential of shared decision-making to bridge gaps in knowledge, increase patient adherence to treatment, and improve health outcomes in low health literacy patient populations. Leveling barriers to treatment information for disadvantaged populations should be a public health imperative, especially if it can be shown to improve health outcomes and reduce health disparities. (shrink)

What are the limits of the use of artificial intelligence (AI) in the relational aspects of medical and nursing care? There has been a lot of recent work and applications showing the promise and efficiency of AI in clinical medicine, both at the research and treatment levels. Many of the obstacles discussed in the literature are technical in character, regarding how to improve and optimize current practices in clinical medicine and also how to develop better data bases for optimal parameter (...) adjustments and predictive algorithms. This paper argues that there are also in principle obstacles to the application of AI in clinical medicine and care where empathy is important, and that these problems cannot be solved with any of the technical and theoretical approaches that shape the current application of AI in specific areas of clinical medicine in which care for patients is fundamental. This is important, because it generates specific risks that may be overlooked otherwise, and it justifies the necessity of human monitoring and emotional intervention in clinical medicine. Consequently, difficult issues concerning moral and legal responsibility may ensue if these in principle problems are ignored. (shrink)

Integrated Information Theory (IIT) is one of the most influential theories of consciousness, mainly due to its claim of mathematically formalizing consciousness in a measurable way. However, the theory, as it is formulated, does not account for contextual observations that are crucial for understanding consciousness. Here we put forth three possible difficulties for its current version, which could be interpreted as a trilemma. Either consciousness is contextual or not. If contextual, either IIT needs revisions to its axioms to include contextuality, (...) or it is inconsistent. If consciousness is not contextual, then IIT faces an empirical challenge. Therefore, we argue that IIT in its current version is inadequate. (shrink)

The Whorfian hypothesis has received support from recent findings in psychology, linguistics, and anthropology. This evidence has been interpreted as supporting the view that language modulates all stages of perception and cognition, in accordance with Whorf’s original proposal. In light of a much broader body of evidence on time perception, I propose to evaluate these findings with respect to their scope. When assessed collectively, the entire body of evidence on time perception shows that the Whorfian hypothesis has a limited scope (...) and that it does not affect early stages of time perception. In particular, all the available evidence shows that the scope of language modulation is limited in the case of time perception, and that the most important mechanisms for time perception are cognitive clocks and simultaneity windows, which we use to perceive the temporal properties of events. Language modulation has distorting effects, but only at later stages of processing or with respect to specific categorization tasks. The paper explains what is the role of these effects in the context of all the available evidence on time cognition and perception. (shrink)

Several aspects of the personality, thought and work of Don Vasco de Quiroga are known today, but a deeper awareness of his legal thinking would enable us to understand better the motives for his actions in New Spain and the Michoacán region. In order to do this we need to place him in the conceptual, institutional and legal context in which he was educated and where he developed throughout his life. Well versed in the different legal systems in use at (...) the time, he absorbed Roman laws, which he respected as the work of esteemed scholars, while at the same time basing his evangelical mission in Mexico on the canons of the Church. And the legal system that was to govern the villages he created according to a new model would be based on custom coming from the grassroots. (shrink)

POLITICS is a system of computer programs which simulates humans in comprehending and responding to world events from a given political or ideological perspective. The primary theoretical motivations were: (1) the implemention of a functional system which applies the knowledge structures of Schank and Abelson (1977) to the domain of simulating political belief systems; (2) the development of a tentative theory of intentional goal conflicts and counterplanning. Secondary goals of the POLITICS project include developing a representation for belief systems, investigating (...) cognitive processes such as goal‐directed inferencing, and the integration of several types of knowledge representations into a functional system. (shrink)

The American Journal of Bioethics, Volume 12, Issue 7, Page 32-33, July 2012.

The history of Latin American societies since their beginnings has been marked by popular revolts. It is a history written the majority of the time with violence which claims the right to life. It is the history of a community that refuses and resists the loss of its spaces. It has always been..

Recognizing that GLBTI individuals are often barred from visiting their partners in hospitals or from acting as health care surrogates for incapacitated partners, President Obama directed the Department of Health and Human Services to address these issues. In response, the department amended its rules to prohibit hospitals from restricting, limiting, or denying visitation privileges on the basis of gender identity or sexual orientation. But the changes do not affect the designation of a health care surrogate, a matter largely governed by (...) state law. Therefore, subject to state law, same-sex partners can still be legally barred from making health care decisions for their incapacitated partners, and it remains essential that they execute advance directives and appoint one another as their health care proxies. (shrink)