Unrepresented patients lack the capacity to make medical decisions for themselves, have no clear documentation of preferences for medical treatment, and have no surrogate decision maker or obvious candidate for that role. There is no consensus about who should serve as the decision maker for these patients, particularly regarding whether to continue or to limit life-sustaining treatment. Several authors have argued that ethics committees should play this role rather than the patient's treating physician, a common current default. We argue that (...) concerns about the adequacy of physicians as surrogates are either empirically unfounded or apply equally to ethics committees. We suggest that physicians should be the primary decision maker for the unrepresented because of their fiduciary duties toward their patients. As part of the process of fulfilling these duties, they should seek the advice of third parties such as ethic committees; but final end-of-life decision-making for the unrepresented should rest with the treating physician. (shrink)

In June 2015, the major North American and European critical care societies released new joint guidelines that delineate a process-based approach to resolving intractable conflicts over the appropriateness of providing or continuing LST.2 This article frames the new guidelines within the history, ethical arguments, legal landscape, and empirical evidence regarding limitation of LST without surrogate consent in cases of intractable conflict.

Systematic study of the intersection of ethics consultation services and solid organ transplants and recipients can identify and illustrate ethical issues that arise in the clinical care of these patients, including challenges beyond resource allocation. This was a single-centre, retrospective cohort study of all adult ethics consultations between January 1, 2007, and December 31, 2017, at a large academic medical centre in the north-eastern United States. Of the 880 ethics consultations, sixty (6.8 per cent ) involved solid organ transplant, thirty-nine (...) (65.0 per cent) for candidates and twenty-one (35.0 per cent ) for recipients. Ethics consultations were requested for 4.3 per cent of heart, 4.9 per cent of lung, 0.3 per cent of liver, and 0.3 per cent of kidney transplant recipients over the study period. Nurses were more likely to request ethics consultations for recipients than physicians (80.0 per cent vs 20.0 per cent, p = 0.006). The most common reason for consultation among transplant candidates was discussion about intensity of treatment or goals of care after the patient was not or was no longer a transplant candidate. The most common reason for ethics consultation among transplant recipients was disagreement between transplant providers and patients/families/non-transplant healthcare professionals over the appropriate intensity of treatment for recipients. Very few consultations involved questions about appropriate resource allocation. Ethics consultants involved in these cases most often navigated communication challenges between transplant and non-transplant healthcare professionals and patients and families. (shrink)

The lung allocation score system in the United States and several European countries gives more weight to risk of death without transplantation than to survival following transplantation. As a result, centers transplant sicker patients, leading to increased length of initial hospitalization. The care of patients who have accumulated functional deficits or additional organ dysfunction during their prolonged stay can be ethically complex. Disagreement occurs between the transplant team, patients and families, and non-transplant health care professionals over the burdens of ongoing (...) intensive intervention. These cases highlight important ethical issues in organ transplantation, including the nature and requirements of transplant informed consent, the limits of physician prognostication, patient autonomy and decision-making capacity following transplant, obligations to organ donors and to other potential recipients, and the impact of program metrics on individualized recipient care. We outline general ethical principles for the care of lung transplant recipients with prolonged hospitalization and give regulatory, research, and patient-centered recommendations for these cases. (shrink)

In 2015, the major critical care societies issued guidelines outlining a procedural approach to resolving intractable conflict between healthcare professionals and surrogates over life-sustaining treatments (LST). We report our experience with a resolving conflict procedure. This was a retrospective, single-centre cohort study of ethics consultations involving intractable conflict over LST. The resolving conflict process was initiated eleven times for ten patients over 2,015 ethics consultations from 2000 to 2020. In all cases, the ethics committee recommended withdrawal of the contested LST. (...) In seven cases, the patient died or was transferred or a legal injunction was obtained before completion of the process. In the four cases in which LST was withdrawn, the time from ethics consultation to withdrawal of LST was 24.8 ± 12.2 days. Healthcare provider and surrogate were often distressed during the process, sometimes resulting in escalation of conflict and legal action. In some cases, however, surrogates appeared relieved that they did not have to make the final decision regarding LST. Challenges regarding implementation included the time needed for process completion and limited usefulness in emergent situations. Although it is feasible to implement a due process approach to conflict over LST, there are factors that limit the procedure’s usefulness. (shrink)

Critical care society guidelines recommend that ethics committees mediate intractable conflict over potentially inappropriate treatment, including Do Not Resuscitate status. There are, however, limited data on cases and circumstances in which ethics consultants recommend not offering cardiopulmonary resuscitation despite patient or surrogate requests and whether physicians follow these recommendations. This was a retrospective cohort of all adult patients at a large academic medical center for whom an ethics consult was requested for disagreement over DNR status. Patient demographic predictors of ethics (...) consult outcomes were analyzed. In 42 of the 116 cases, the patient or surrogate agreed to the clinician recommended DNR order following ethics consultation. In 72 of 74 of the remaining cases, ethics consultants recommended not offering CPR. Physicians went on to write a DNR order without patient/surrogate consent in 57 of those cases. There were no significant differences in age, race/ethnicity, country of origin, or functional status between patients where a DNR order was and was not placed without consent. Physicians were more likely to place a DNR order for patients believed to be imminently dying. The median time from DNR order to death was 4 days with a 90-day mortality of 88.2%. In this single-center cohort study, there was no evidence that patient demographic factors affected ethics consultants’ recommendation to withhold CPR despite patient/surrogate requests. Physicians were most likely to place a DNR order without consent for imminently dying patients. (shrink)

Adorno: A Critical Reader presents a collection of new essays by many of the world's top critics that examine Adorno's lasting impact on the arts, politics, history, philosophy, psychoanalysis, and sociology.

In Democracy and the Claims of Nature, the leading thinkers in the fields of environmental, political, and social theory come together to discuss the tensions and sympathies of democratic ideals and environmental values. The prominent contributors reflect upon where we stand in our understanding of the relationship between democracy and the claims of nature. Democracy and the Claims of Nature bridges the gap between the often competing ideals of the two fields, leading to a greater understanding of each for the (...) other. (shrink)

If good argument is virtuous, then fallacies are vicious. Yet fallacies cannot just be identified with vices, since vices are dispositional properties of agents whereas fallacies are types of argument. Rather, if the normativity of good argumentation is explicable in terms of virtues, we should expect the wrongness of fallacies to be explicable in terms of vices. This approach is defended through case studies of several fallacies, with particular emphasis on the ad hominem.

This article discusses the emergence of a patenting culture in university science. Patenting culture is examined empirically in the context of the increasing commerciali zation of science, and theoretically within debates over scientific "credibility." The article explores the translation of academic credit into patents, and vice versa, and argues that this process raises new questions for our understanding of scientific recognition and of scientists' networks. In particular, the analysis suggests that scientists must move between two distinct social worlds to manage (...) the rewards that academic and patent cultures carry. (shrink)

In the study of the divinization of Roman emperors, a great deal depends upon the sequence of events. According to the model of consecratio proposed by Bickermann, apotheosis was supposed to be accomplished during the deceased emperor's public funeral, after which the Senate acknowledged what had transpired by decreeing appropriate honours for the new diuus. Contradictory evidence has turned up in the Fasti Ostienses, however, which seem to indicate that both Marciana and Faustina were declared diuae before their funerals took (...) place. This suggests a shift away from the Augustan precedent, whereby the testimony of a witness had been required to establish divinity, to a procedure in which the senators were able to jump ahead to the politically foreordained conclusion and bestow the honour at once. Careful re-examination of the evidence in Tacitus and Suetonius has made it possible to assign this development to the year 54, with the consecration of Claudius. (shrink)

Socrates teaches in the Meno that in order for a belief to be justified, an appropriate relation must ‘tie down’ the belief to its truth. Alvin Goldman’s position of externalism holds that for a belief to be justified, an appropriately reliable process must have obtained. One need not be aware of this reliable process. Conversely, Laurence BonJour’s brand of internalism holds that this relation between a belief and its truth is just what the cognizer needs to be aware of in (...) order for that belief to be justified. This work examines their debate, with particular interest paid to BonJour’s case of Norman: a clairvoyant who forms a belief via this ability but has no evidence for or against the belief or his own clairvoyance. Using this case, I propose an ‘epistemological spectrum’ wherein the insight of externalism is appreciated – what Robert Brandom deems the Founding Insight of Reliabilism – that a reliably produced belief bears some epistemic legitimacy, while retaining the insight of internalism: that objective reliability cannot offset subjective irrationality. This is done by classifying cases wherein only the obtainment of a reliable process occurs as epistemically rational, though not justified. Ultimately I reconcile the virtues of both positions, and propose that Goldman’s brand of full blooded externalism was generated by following an intuitional illusion by way of affirming the consequent. (shrink)

This paper presents two interpretations of the fiber bundle fonnalism that is applicable to all gauge field theories. The constructionist interpretation yields a substantival spacetime. The analytic interpretation yields a structural spacetime, a third option besides the familiar substantivalism and relationalism. That the same mathematical fonnalism can be derived in two different ways leading to two different ontological interpretations reveals the inadequacy of pure fonnal arguments.

In this paper, we provide a novel explanation of McGee’s (1985) alleged counterexample to Modus Ponens for indicative conditionals. Our strategy is to show that pragmatic phenomena interfere with intuitions concerning the acceptability of the inference. More specifically, we argue that two confounding factors at play affect our intuitions concerning the acceptability of the inference, neither of which is related to validity. First, the indefinite determiner phrase “a Republican” is ambiguous, to wit, it may receive either a specific or a (...) non-specific reading (and as we shall see, substituting a disjunction or a definite description for the indefinite is of no help). Second, the conclusion triggers an ignorance inference concerning its antecedent. In light of this, we shall argue, McGee’s diagnosis must be rejected. (shrink)

These essays treat a heterogeneous group of texts: alongside On the Sublime and How the young man should listen to poetry are an Attic comedy, a satyr play, a Plutarchan fragment, and the epitome of a lost work by Dionysius of Halicarnassus. It is a mixed bag, which is the point. Hunter offers "moments" in the history of criticism because we lack evidence to write a linear narrative . Given the lacunose record, he suggests the best way forward is to (...) lower the barrier separating "literary" from "critical" texts and to look for general patterns of similarity. Thereby he hopes to explain antiquity's predominantly "utilitarian" approach to literature, its "concern with what literature was for" . Although individual chapters show Hunter's characteristic inventiveness and wide range of reference, this reviewer found many of his claims overbroad. Indeed, the general approach recommended here seems less likely to enrich "our understanding of the ways in which the ancients sought to explain and use creative art" than to impede progress toward that worthy goal. (shrink)

I argue that Plato’s deployment of the resumptive phrase πάλιν ἐξ ἀρχῆς illuminates the philosophical significance of his art of transition in Socratic dialogues. These explicit calls for a new beginning often appear when a conversation fails to account for two particular elements of ordinary experience: assumptions about whole-part relations and about the interlocutor’s self-conception as a being responsive to basic rational and normative distinctions. Returning to the archē is a form of ἀνάμνησις, reminding us that these assumptions constitute true, (...) but inarticulate, opinions of a fundamental kind. They are the preconditions for discourse that philosophical διαλέγεσθαι must preserve and ground. (shrink)

Centuries of scientific progress have been devoted to reducing uncertainty. Newtonian physics, introduced over 300 years ago, allowed for precise prediction of planetary and tidal motion, falling bodies and infinitely more, in addition to allowing the construction of the material world. The 20th century witnessed a revolution in our understanding of organ and cellular function and dysfunction, elucidation of pathways, mediators, receptors, and molecular interactions, and breakthroughs in the characterization of replication, transcription, and translation, all of which has been integral (...) to our understanding of human physiology and pathophysiology. Clinical epidemiology has had a revolutionary impact on our .. (shrink)

The article offers a critical but sympathetic reflection on the development of classical and post-classical French sociology. From Comte onwards, I suggest, the modern French treatment of the social has been preoccupied with socio-theological questions; and even with the radical deconstruction of any society-god, this continues to be the case. There are distinctive historical reasons for this (including the Catholic inheritance and an enduring legitimacy problem for the Republican state); but the significance of the issues raised by this intellectual tradition (...) as a result goes beyond the limits of national context. In an age of post-histoire and the `death' of everything, the `French' travails of social ontology, including the quasi-religious register in which these have occurred, have deep and continuing import for any would-be progressive social theory as such. We need to rethink the `we'. With such considerations in mind, the body of the article considers Comte's concept of Humanity and Baudrillard's `end of the social' as exemplifying key aspects of the beginning (reconstructive) and ending (deconstructive) phases of the French sociological story. What began as a detour in the `death of God', I argue, has terminated in a `second death of God' in which a replacement divinity and the rationalist faith associated with it have disintegrated and become impossible to think. But the logic of this development has not been straightforward. It is marked by a double paradox. An interrogation of Comte's `Humanity' reveals it to be a semi-conscious exercise in simulation, haunted by the implications of its own emptiness. On the one hand, then, the attempted religious founding founded nothing (it made a transcendent of its own intended re-socializing effects). On the other hand, as exemplified by Baudrillard's pronouncements about the end of the social, the moment of disintegration has itself seemed to offer a new socio-theological opening. Rather than mourn the anomic or hyper-real impossibility of a transcending `we', Baudrillard would shift terrain in a quasi-Nietzschean (or Bataillian) transvaluation. This implies (against Baudrillard himself) not the definitive end of the French `sociological' project, but the possibility of its continuation, albeit under erasure and in a new key. (shrink)

Is it possible to distinguish communities of arguers by tracking the argumentation schemes they employ? There are many ways of relating schemes to communities, but not all are productive. Attention must be paid not only to the admissibility of schemes within a community of argumentational practice, but also to their comparative frequency. Two examples are discussed: informal mathematics, a convenient source of well-documented argumentational practice, and anthropological evidence of nonstandard reasoning.

This paper explores some of the benefits informal logic may have for the analysis of mathematical inference. It shows how Stephen Toulmin’s pioneering treatment of defeasible argumentation may be extended to cover the more complex structure of mathematical proof. Several common proof techniques are represented, including induction, proof by cases, and proof by contradiction. Affinities between the resulting system and Imre Lakatos’s discussion of mathematical proof are then explored.

Semi-structured interviews with university students in the UK and Japan, undertaken in 2009 and 2010, are analysed with respect to the revealed attitudes to privacy, self-revelation and revelation by/of others on SNS.

Tobey Scharding claims that Bitcoin’s lack of a central regulator makes it open to price fluctuations. I argue that a currency not having a central regulator does not necessitate it being more volatile than centrally regulated currencies. First, I argue that Scharding’s reason for suggesting that Bitcoin is open to price fluctuations – its potential to face legal restrictions – is also faced by centrally regulated currencies. Second, I use silver in London as an example of a non-centrally regulated currency (...) with relatively low price volatility when compared to other centrally regulated currencies showing that non-centrally regulated currencies are not necessarily more volatile. (shrink)

In the latter period of his work, Samuel Beckett began to devote much of his writing to exploring the nature of the voice and the gaze. Even those works that directly concerned silence and blindness implicitly thematized the voice and the gaze by embodying their absence. With later works, Beckett began to call into question the way in which these phenomena contributed to the constitution of subjects, modes of self-identification, and their relation to chosen objects of desire. In the 1950s (...) and 1960s, Beckett produced dozens of short pieces of prose and theatrical works that wholly dispensed with traditional plot and character in favor of a series of experimental reductions, for example, to breath and light, to a disembodied voice, or to a mouth illuminated by a point of light. Jacque Lacan, who would come to secure the place of the voice and the gaze in the philosophical canon, wrote and lectured on these concepts at the same time. If brought into dialogue, the work of each thinker—each highly nuanced and complex in its own right—can serve as a hermeneutic tool for better elucidating the function of the voice and the gaze and the role that they play in the formation of subjects. A great deal of critics have erroneously overlooked Lacan’s insistence that when he invokes these concepts he is not speaking about the phenomenal voice or the gaze of perception as such; similarly, Beckett’s work, though it directly thematizes their phenomenal aspects, treats these concepts in a thoroughly Lacanian manner. (shrink)

I know that it is difficult for some students to distinguish the truth of premises from the validity of an argument. They think that a valid argument has all true statements, and an invalid one a false premise. Clearly, the teaching of validity requires introducing the idea of an argument form, for it is the form which is the vehicle of validity, not what is put in the form. An argument form does not contain statements (but statement forms), so there (...) is nothing in the form to be true or false. Yet the form has the property of validity, which is the property of truth preservation. This is to say that a valid form will never allow the premise forms to be filled with true statements and the conclusion form to be filled with a false statement. (shrink)

From 330b.c. Alexander transformed his court by adopting a number of court personnel and practices from the Achaemenids. This included the adoption by the king of a mixed Persian and Macedonian royal costume,proskynēsis, Persian spear-bearers and certain Persian officers, such as the chiliarch and the chief usher (εἰσαγγελεύς). But Alexander also used an imposing tent and an audience style modelled on that of the Great King. It is my intention here to investigate the Persian-style tent of Alexander and the two (...) court offices called the chiliarch and chief usher, associated with the king's new audience-style. (shrink)