Aim: Patients with advanced cancer need information about end-of-life treatment options in order to make informed decisions. Clinicians vary in the frequency with which they initiate these discussions.Patients and methods: As part of a long-term longitudinal study, patients with an expected 2-year survival of less than 50% who had advanced gastrointestinal or lung cancer or amyotrophic lateral sclerosis were interviewed. Each patient’s medical record was reviewed at enrollment and at 3 months for evidence of the discussion of patient wishes concerning (...) ventilator support, artificial nutrition and hydration , resuscitation and hospice care. A Kaplan–Meier analysis was also performed and 2-year survival calculated.Results: 60 cancer and 32 ALS patients were enrolled. ALS patients were more likely than cancer patients to have evidence of discussion about their wishes for ventilator support , ANH , DNR and hospice care . At 6 months, 91% of ALS patients were alive compared with 62% of cancer patients; at 2 years, 63% of ALS patients were alive compared with 23% of cancer patients .Conclusions: Cancer patients were less likely than ALS patients to have had documented advanced care planning discussions despite worse survival. This may reflect perceptions that ALS has a more predictable course, that advanced cancer has a greater number of treatment options, or differing views about hope. Nevertheless, cancer patients may be less adequately prepared for end-of-life decision-making. (shrink)

In what follows, I reply to critical appraisals of my book entitled Hippocrates’ Oath and Asclepius’ Snake: The Birth of the Medical Profession. Professors Tollefsen, McPherson, and Potts separately offer these thoughtful critiques. Professor Tollefsen approaches the work from the standpoint of the physician-patient relationship. Professors McPherson and Potts both address it in terms of virtues. Potts treats the theme of virtue generally while McPherson focuses on the virtue of piety. Since virtues attend relationships, in what follows, I discuss, first, (...) the physician-patient relationship ; second, virtue generally ; and third, and finally, the virtue of piety specifically. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:372 THE ROLE OF REASON IN HUME'S THEORY OF BELIEF Much has been written on Hume's theory of belief, yet problems of interpretation remain as serious as ever. The most pervasive and persistent problem relates to the role reason plays in Hume's conception of belief. When Hume says that belief is a matter of feeling, does he mean to say that reason has nothing to do with it, or (...) that belief is not a matter of choice? Does he imply that one cannot be blamed for believing as one does? The view that belief is unavoidable and not a matter of choice, and its implication, seem counter-intuitive, if not drastic. Are there grounds for attributing such a view to Hume? There is indeed a tendency to interpret Hume as saying that reason plays no role, not just in the moral sphere, but in the understanding as well. Thus, Barry Stroud claims that "in Hume's hands the denigration of the role of reason and the corresponding elevation of feeling and sentiment is generalized into a total theory of man." Elsewhere I have argued against this view insofar as it relates 2 to Hume's moral theory. But the dismay at Hume's (alleged) denigration of reason is even greater in the case of belief. For instance, Antony Flew considers Hume's view that belief is "a species of natural instincts, which no reason or process of the thought and understanding is able either to produce or to prevent" as a "drastic and disastrous conclusion." According to Flew, one drastic and disastrous consequence of such a view is that "insofar as belief really is necessary and unavoidable we can neither criticize others for the irrationality of their convictions nor retain any 4 confidence about the rationality of our own." 373 In a more sympathetic reading of Hume, J. A. Passmore has cited evidence to show that Hume acknowledges that belief can be a matter of choice, 5 and thus there can be an ethics of belief. However, in doing so Passmore presents an inconsistency in Hume's view of belief, and does nothing to account for this inconsistency. Barbara Winters also sees inconsistencies, or paradoxes, in Hume's treatment, not only within Book I of the Treatise, but also between it and the other two Books (and between the Enquiries). Her resolution of the paradox is the suggestion that there are two conceptions of reason in Hume, the "traditional" and the "naturalistic," the former "plays no role in our acquisition of fundamental beliefs," and the latter is such that we do indeed "arrive at our beliefs through reasoning." In this paper I wish to argue that there are no inconsistencies, or paradoxes, in Hume's treatment of belief, and that his view is neither drastic nor disastrous. I wish to show that there is no 'denigration' of reason, " and that while belief is a matter of feeling, it is also, to an important degree, a matter of choice. In promoting the "undoubted truth, that belief is nothing but a peculiar feeling," Hume does write in such a way as to encourage the interpretation that he subordinates the role of reason to feelings (or sentiments, or passions), or worse, that he denigrates the role of reason. He tells us that belief is not "some new idea, such as that of reality or existence, which we join to the simple conception of an object" (T 623). If it were, "it wou'd be in a man's power to believe what he 374 pleas 'd" (T 624), as the mind can mix or join any two ideas. Hume tells us that we can easily "discover by experiments" that belief "arises immediately, without any new operation of the reason or imagination" (T 102). The widely quoted sentence is the following: "When the mind... passes from the idea or impression of one object to the idea or belief of another, it is not determin'd by reason..." (T 92). These and other statements clearly encourage the interpretation that belief does not arise from reason, or indeed that reason has nothing to do with belief. Depending on how far one sees the... (shrink)

Suppose that there are good or morally defensible reasons for not responding truthfully to a question or request for information. Is a lie or a deception better as a means to avoid telling the truth? There are many situations in public and private life in which the answer to this question would serve as a useful moral guide, for instance, clinical situations involving dying patients, educational situations involving young children and personal situations involving close friends. Intuitively, we feel that there (...) is a moral asymmetry in favor of deceiving over lying. However, doubts have been cast on such intuition. The aim of this paper is to bolster this intuition. It will be argued that the claim of moral asymmetry in favor of deception can be supported on a consideration of the different degrees of expectation involved in communicative ethics. Two other objections to the claim of asymmetry will also be considered. (shrink)

This paper argues that kant's general epistemology incorporates a theory of algebra which entails a less constricted view of kant's philosophy of mathematics than is sometimes given. To extract a plausible theory of algebra from the "critique of pure reason", It is necessary to link kant's doctrine of mathematical construction to the idea of the "schematism". Mathematical construction can be understood to accommodate algebraic symbolism as well as the more familiar spatial configurations of geometry.