BackgroundDecision-making in end-stage dementia is a complex process involving medical, social, legal and ethical issues. In ESD, the person suffers from severe cognitive problems leading to a loss of capacity to decide matters regarding health and end-of-life issues. The decisional responsibility is usually passed to clinicians and relatives who can face significant difficulty in making moral decisions, particularly in the presence of life-threatening swallowing problems.AimThis study aimed to understand the decision-making processes of clinical teams and relatives in addressing life-threatening swallowing (...) difficulties in ESD in long-term care in Malta.MethodThe study followed a qualitative approach where six case studies, involving six different teams and relatives of six different patients, were interviewed retrospectively to understand their decision-making in connection with the management of swallowing difficulties in ESD. Data were collected through semistructured interviews with each stakeholder. All data were transcribed and subjected to thematic analysis.ResultsFour themes were identified: the vulnerability of patients in dementia decision-making; the difficult role of relatives in decision-making; the decisional conflict between aggressive care through tube feeding versus oral comfort feeding; a consensus-building decision-making process as ideal to facilitate agreement and respect for patient’s dignity.ConclusionDecision-making to manage swallowing difficulties in ESD is a challenging process, which involves an interpretation of personal values, beliefs, patient preferences, care needs and clinical practice. Better communication between clinicians and relatives in dementia helps promote agreement between stakeholders leading to a care plan that respects the dignity of patients at their end of life. (shrink)

Afferent feedback can appreciably alter the pharyngeal phase of swallow. In order to measure the stability of the swallow motor pattern during several types of alterations in afferent feedback, we assessed swallow during a conventional water challenge in four anesthetized cats, and compared that to swallows induced by fixed (20 Hz) and stochastic (1-20Hz) electrical stimulation applied to the superior laryngeal nerve. The swallow motor patterns were evaluated by electromyographic activity (EMG) of eight muscles, based on (...) their functional significance: laryngeal elevators (mylohyoid, geniohyoid, and thyrohyoid); laryngeal adductor (thyroarytenoid); inferior pharyngeal constrictor (thyropharyngeus); upper esophageal sphincter (cricopharyngeus); and inspiratory activity (parasternal and costal diaphragm). Both the fixed and stochastic electrical stimulation paradigms increased activity of the laryngeal elevators, produced short-term facilitation evidenced by increasing swallow durations over the stimulus period, and conversely inhibited swallow-related diaphragm activity. Both the fixed and stochastic stimulus conditions also increased specific EMG amplitudes, which never occurred with the water challenges. Stochastic stimulation increased swallow excitability, as measured by an increase in the number of swallows produced. Consistent with our previous results, changes in the swallow motor pattern for pairs of muscles were only sometimes correlated with each other. We conclude that alterations in afferent feedback produced particular variations of the swallow motor pattern. We hypothesize that specific SLN feedback might modulate the swallow central pattern generator during aberrant feeding conditions (food/liquid entering the airway), which may protect the airway and serve as potentially important clinical diagnostic indicators. (shrink)

This paper argues that food security is a very important topic in cosmopolitanism, one that has simply not received the kind of attention that it should receive. The paper reveals how global food monopolies destroy possibilities for national self-sufficiency, raises questions about neo-nationalism in an age of terror, and exposes the insidious and invidious corporate neo-imperialism that attends seed patenting. “Food, eating, and ethics” as a topic is rarely seen as a proper or important part of discussions about “the new (...) cosmopolitanism,” let alone as part of literary discussions. This paper examines the violence and barbarity of transnational corporations such as Monsanto. I show what happens in the global supermarket and how lives and livelihoods are at stake, how the new corporate imperialism swallows up traditions and histories, and how dangerous food has become. (shrink)

As Gelven points out in his Preface, this is the only section-by-section commentary on the full text of Being and Time. Being and Time is divided not only into two "divisions" of six chapters each but also into eighty-three numbered "sections". As such it provides an efficient and useful handbook for those who try to make their way through the rugged terrain of Heidegger's text, especially for the beginner. Gelven's prose is crisp and clean and uncluttered by Germanicisms. He often (...) uses uncomplicated and helpful illustrations. The interpretation stresses the importance of the analysis of "understanding" taking § 31 as "the key to Being and Time". In fact, Gelven groups §§ 25-38 as a whole under the single heading "Understanding". Such an emphasis seems entirely legitimate. He treats the historical sources of Being and Time but often leaves them undeveloped. He is content, for example, to devote a single paragraph to Dilthey whose influence upon Heidegger is so decisive, with the comment that not much is ever said about Dilthey in English philosophical literature. One also finds it a bit hard to swallow the author's argument that "Dasein" means literally "to be here" and, in sentence form: "Here I am, open to possibilities". In all, however, Gelven's work is a distinctive contribution and not a mere reworking of already familiar themes.--J. D. C. (shrink)

The paper is one of the first empirical attempts that builds on the moral dilemmas and group rationality literature to explore the way in which group composition with respect to group members’ individual choices in moral dilemmas and social influence processes impact on group moral choices. First individually and then, in small groups, 221 participants were asked to decide on 10 moral dilemmas. Our results show that emergent group level utilitarianism is higher than the average individual utilitarianism, yet, lower than (...) the highest individual utilitarianism within groups. We also show that average individual utilitarianism positively predicts group utilitarianism while group fragmentation in individual utilitarianism has a negative effect on group utilitarianism. Next to group composition, minority influence processes explain additional variance in group utilitarianism, cognitive dissent having a positive influence, while normative deviance a negative influence on group utilitarianism. Majority influence has no significant influence on group utilitarianism. Finally, our results show that the relationship between group fragmentation in individual utilitarianism and emergent group utilitarianism is mediated by the two forms of minority influence. (shrink)

This book provides a conceptual basis for recognizing the classroom as an ecology of linguistic and cultural patterns that should be taken into account as part of the teacher's professional decision making. It argues that the orchestration of classroom behaviour cannot be separated from the mental ecology of metaphor and thought patterns that reflect the student's primary culture. Chapters discuss the metaphorical nature of language and thought, primary socilization, nonverbal communication, framing and social control, the classroom as an ecology of (...) power, culturally responsive supervision, and educating teachers for the 21st century - all from a cultural and linguistic point of view. (shrink)

From the perspectives of both an espoused core underlying value of nursing, and of public policy, the patient's voice should be central to our understanding of patient/client need, appropriate care and intervention. However, accessing and hearing the patient's voice is fraught with difficulty. Edwards reminds us that our raison d’être as nurses is human vulnerability; a vulnerability sometimes brought into sharp focus because of illness or disease. However, when people are at their most vulnerable, they are often least able to (...) identify, or indeed to express, their need – beyond the completely obvious. This paper provides a short descriptive record of one patient's experience of nursing care. This description is placed within the context of moral arguments about the nature of nursing and the impact this may have on decision‐making regarding the appropriate distribution of nursing time. One of our most acute deficits in knowledge, regarding nursing in the UK and Ireland, is a lack of knowledge of the day‐to‐day activities judgements, decisions and interventions of staff nurses at the sharp edge of patient care delivery. We also have little understanding of how, or indeed whether, staff nurses identify or articulate these activities, judgements, decisions and interventions as having a moral dimension that is rooted in respect for the needs and perceptions of the individual patient. Recent empirical work suggests that a substantial proportion of nursing time is spent in prioritizing and delegating care. We have little idea of the impact of prioritization and delegation on the quality of patient care, as perceived by the recipients of that care, our patients. It is urgent that these deficits in our knowledge and understanding are addressed. This is the case both from the perspective of providing high standards of patient care and from the point of view of linking perceptions of the moral dimension of nursing practice, organizational structure, manpower planning, nursing decisions and interventions, to patient outcomes. (shrink)

Environmentally oriented philosophers and educational theorists are now attempting to clarify how the ideas of John Dewey can be used as the basis for changing cultural practices that contribute to the ecological crisis. Although Dewey can be interpreted as a nonanthropocentric thinker and his method of experimental inquiry can be used in eco-management projects, Dewey should not be regarded as an environmental and eco-justice philosopher—and by extension, his followers should not be regarded in this light. (1) Dewey’s emphasis on an (...) experimental mode of inquiry did not take account of the knowledge systems of other cultures—particularly cultures that are more ecologically centered. (2) Dewey’s understanding of language prevented him from recognizing how the root metaphors (meta-cognitive schemata) he took for granted were also the basis, with several exceptions, of the Industrial Revolution. (3) Dewey’s failure to understand the complex nature of tradition, including the different ways in which intergenerational knowledge is shared and renewed, makes it difficult for his followers to address a central eco-justice issue—which is to regenerate within diverse cultural communities the non-commodified forms of knowledge, skills, and relationships that enable individuals and communities to have a smaller ecological footprint. (shrink)

Medical-legal partnerships (MLPs) support patients and clinicians by streamlining legal and medical care and helping identify and address a subset of social drivers of health (SDOH). Less is known on the effect of MLPs on the competency of residents regarding SDOH. The aim of this study was to identify how integration of an MLP into a pediatric residency training program affected residents’ experience understanding and addressing SDOH.

Janet Radcliffe Richards is as always to the point and radical. We agree with her that “if it is presumptively bad to prevent sales altogether because lives will be lost . . . it is for the same reason presumptively bad to restrict the selling of organs”. Her complaint against our paper is that we are unnecessarily restrictive. John Harris indeed has argued that there are no sound ethical or philosophical reasons for objecting on principle to the sale of live (...) tissue and organs.1 If a scheme can be devised …. (shrink)

The ‘beautiful axiom’ to which Dickens refers is a central feature of Thomas Hobbes' thinking but its precise role in his moral philosophy remains unclear. I shall here attempt both to dispel the unclarity and to evaluate the adequacy of the position that emerges. Given the high level of contemporary interest in Hobbes' thought, both within and beyond philosophical circles, this is an enterprise of considerable importance. None the less, my interest is not merely interpretative, since the assessment of Hobbes' (...) attitude to ‘the beautiful axiom’ raises important and difficult questions about what might be termed the preconditions of morality. (shrink)

Thomas Hobbes was the first great philosopher to write in English. His account of the human condition, first developed in The Elements of Law, which comprises Human Nature and De Corpore Politico, is a direct product of the intellectual and political strife of the seventeenth century. It is also a remarkably penetrating look at human nature, and a permanently relevant analysis of the fears and self-seeking that result in the war of `each against every man'. In The Elements of Law (...) Hobbes memorably sets out both the main lines of his general philosophy, later augmented in De Corpore, and the moral and political philosophy later made famous in Leviathan. Copies of Human Nature and De Corpore Politico, until 1889 printed as separate works, are rare antiques or scarcely less rare scholarly texts; this is the first complete popular edition. It is here supplemented by chapters from De Corpore and Three Lives, two from Hobbes's original Latin. These have never before been published together in English. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Dimensions of Agency in Lincoln’s Second InauguralAndrew C. HansenSix days before he delivered his Second Inaugural Address, Abraham Lincoln strode into his White House office. Greeting him were G. B. Lincoln, John A. Bingham, and Francis Carpenter, the last of whom had been living with Lincoln in the White House for six months, painting a portrait of the president reading the Emancipation Proclamation to the cabinet. It is Carpenter's (...) delineation of the president's entrance that contains the "only known description of the preliminaries of the Second Inaugural" (Barondess 1954, 62). "Mr. Lincoln came in through the side passage which had lately been constructed," Carpenter writes, "holding in his hand a roll of manuscripts." Lincoln turned to his guests and quipped, "Lots of wisdom in that document, I suspect; it is what will be called my 'second inaugural' " (quoted in Barondess, 62).The content and modesty of Carpenter's description of the "preliminaries of the Second Inaugural" give the rhetorical critic a telling preview of what might be discovered in a reading of Lincoln's composition of that manuscript. The understatement in the length and simplicity of the address subtly and poignantly charms the reader. And there is "lots of wisdom" in the Second Inaugural: along with the Gettysburg Address, it contains the words of Lincoln that most abide. In a letter to an admiring Thurow Weed, who had penned Lincoln that his inaugural was "the neatest but the most pregnant and effective use to which the English Language was ever put," Lincoln wrote that he "expected" the Second Inaugural to "wear as well as—perhaps better than—anything I have ever produced" (quoted in Barondess 1954, 78).Underscoring Lincoln's perspicacity when he wrote to Weed that he "expected" the speech to "wear well," Carl Schulz's designation of the address as a "sacred poem" and the frequency with which that epithet is quoted by other critics confirm Lincoln's assessment of the oratorical endurance [End Page 223] of the piece. The estimation of the rhetorical durability of the address is perhaps best proven by its ability to withstand the polemics of its detractors, both immediately after its delivery and in successive generations, and the encomia of its admirers, both the obscure journalists and the renowned poets.1 Lately, only praise surrounds the Second Inaugural. Ronald C. White's thorough overview of the Second Inaugural's basic stylistic characteristics and how the oration resonates within Lincoln's social, political, and intellectual context is modestly entitled Lincoln's Greatest Speech (2002). In the last line of Lincoln at Gettysburg, Wills concludes that the Second Inaugural "is the only speech worthy to stand with" the Gettysburg Address (1992, 189) and later argues in the Atlantic Monthly that Lincoln "was at the peak of his creativity when he wrote the Second Inaugural Address" (1999, 70). The Second Inaugural seemingly speaks beyond its content and situation.Contained within the aura of adoration that surrounds the Second Inaugural is a significant charge to the rhetorical critic: what is it particularly about the address that sustains its agency and permits it to escape the evanescence accorded to most rhetorical efforts? When the agency of discourse helps to eliminate or extenuate the immediate exigency that calls forth that speech, it usually becomes remanded to the annals of history and is examined by the public or by scholars only when that historical nidus forces itself back upon the public's or the scholar's attention. The speech is exhausted by its situation and swallowed by its surrounding and future events. There are, however, those speeches like the Gettysburg Address and the Second Inaugural that practice their persuasion on audiences beyond the immediate exigency. They persist, they talk to us still, and their agency endures. Why is this true of Lincoln's Second Inaugural? This is the question that motivates my close reading of Lincoln's speech; and, as I hope to demonstrate, it is only through a close reading that such a question even makes sense. After explicating the scholarship that the Second Inaugural has generated and the critical assumptions that drive my close textual analysis, the essay will proceed with the work... (shrink)

Provability, Computability and Reflection.

1. The “puzzle” Physical objects are coloured: roses are red, violets are blue, and so forth. In particular, physical objects have fine-grained shades of colour: a certain chip, we can suppose, is true blue (unique, or pure blue). The following sort of scenario is commonplace. The chip looks true blue to John; in the same (ordinary) viewing conditions it looks (slightly) greenish-blue to Jane. Both John and Jane are “normal” perceivers. Now, nothing can be both true blue and greenish-blue; since (...) the chip is true blue, it is not greenish-blue. Hence Jane, unlike John, is misperceiving the chip. Generalizing, the conclusion is that there is widespread misperception of fine-grained shades. According to Tye (2006), and Cohen, Hardin, and McLaughlin (2006), the previous paragraph amounts to a paradox: an apparently unacceptable conclusion has been drawn from apparently acceptable premises via apparently acceptable reasoning. (See also Hawthorne and Kovakovich 2006, 180-1.) Tye swallows the conclusion, aided by a dose of evolutionary speculation. Hardin (1988), on the other hand, rejects the first premise, and denies that physical objects are coloured. Cohen (2004) and McLaughlin (2003) claim that both Jane and John have the colour of the chip right. Our opening paragraph concealed a crucial parameter. In fact, the chip looks greenish-blue-relative-to- circumstances-C to Jane, and true-blue-relative-to-circumstances-C* to John, and the chip has both these relativized colours.1 All this ingenious philosophizing would be in vain, of course, if the conclusion of the opening paragraph were not puzzling or problematic. So, why is it supposed to be? According to Tye, the conclusion is puzzling because John and Jane are both “normal perceivers” (xx). He seems to think that it is (prima facie) plausible to assume.. (shrink)

Collections of essays and conference papers are always liable to two defects. One is that the essays are not all of the same quality. The other is that the collection is ad hoc with no structural unity or organized purpose. The present collection—arising from the 1997 Claremont conference on the philosophy of religion—almost unavoidably exemplifies the first defect. I myself would pick out the contributions of Simon Blackburn, D. Z. Phillips R. W. Beardsmore, Jane McIntyre, Antony Flew, and Peter Jones (...) as the most interesting. Many of the others are well worth the attention of Hume scholars, but two or three are turgid, over-annotated examples of argument by authority of the sort “Wittgenstein tells us...” compounded with emotive appeals to what is alleged to be Hume’s insufferable moral narrowness. But as I say, the uneven quality of contributions is a standard hazard of conference collections. The second hazard—lack of structure—is much less in evidence. There is a real coherence of subject and purpose in the eighteen sections that make up this book, and an effort has been made to relate the articles to each other. An odd omission is, however, the absence of any standard system of reference to agreed editions of Hume’s works. It happens, for example, that most contributors refer to the Selby-Bigge edition of the Enquiries, but this is an accident of common usage not a virtue of editorial policy. There is a general index. (shrink)

I argue that beliefs about what appears possible are justified in much the same way as beliefs about what appears actual. I do so by chisholming, and then modalizing, the epistemic principle associated with phenomenal conservatism. The principle is tested against a number of examples, and it gives the intuitively correct results. I conclude by considering how it can be used to defend two controversial modal arguments, a Cartesian argument for dualism and an ontological argument for the existence of God.

Part I of this trilogy, Historical and Scientific Setting, set out a general context for selecting a certain subclass of inter-theoretic relations as achieving appropriate explanatory and ontological unification – hence for properly being labelled reductive. Something of the complexity of these relations in real science was explored. The present article concentrates on the role which identity plays in structuring the reduction relation and so in achieving ontological and explanatory unification.

In this volume C.A. (Chet) Bowers, whose pioneering work on education and environmental and sustainability issues is widely recognized and respected around the world, brings together a carefully curated selection of his seminal work on the ideological, cultural, and linguistic roots of the ecological crisis; misconceptions underlying modern consciousness; the cultural commons; a critique of technology; and educational reforms to address these pressing concerns. In the World Library of Educationalists, international scholars themselves compile career-long collections of what they judge to (...) be their finest pieces - extracts from books, key articles, salient research findings, major theoretical and/practical contributions - so the world can read them in a single manageable volume. Readers will be able to follow the themes and strands of their work and see their contribution to the development of a field, as well as the development of the field itself. Contributors to the series include : Michael Apple, James A. Banks, Joel Spring, William F. Pinar, Stephen J. Ball, Elliot Eisner, Howard Gardner, John Gilbert, Ivor F. Goodson, Peter Jarvis. (shrink)

This paper develops and defends an anger-based account of bitterness. In particular, it argues that contrary to what some scholars have maintained, an adequate account of bitterness does not require the concept of hope. That is, bitterness is neither disappointed hope (McFall) nor hopeless anger (Stockdale). Instead, it proposes that bitterness is better understood as unresolved anger, an emotion experienced when a lack of resolution to our violated moral expectations forces us to swallow our anger. Construing the emotion this (...) way not only accurately captures instances of bitterness, but is also more explanatorily adequate than competing accounts. (shrink)

This book seeks to examine the mutual interplay between existentialism and Christian belief as seen through the work of three existentialist thinkers who were also committed Christians - a Spaniard, a Russian, and a Frenchman. They are compared with each other and with leading non-religious existentialists. The major themes studied include reason, freedom, the self, belief, hope, love, suffering, and immortality.

This article presents the first results of a study of the decisions made by health professionals in South Australia concerning the management of death, dying, and euthanasia, and focuses on the findings concerning the attitudes and practices of medical practitioners. Mail-back, self-administered questionnaires were posted in August 1991 to a ten per cent sample of 494 medical practitioners in South Australia randomly selected from the list published by the Medical Board of South Australia. A total response rate of 68 per (...) cent was obtained, 60 per cent of which (298) were usable returns. It was found that forty-seven per cent had received requests from patients to hasten their deaths. Nineteen per cent had taken active steps which had brought about the death of a patient. Sixty-eight per cent thought that guidelines for withholding and withdrawal of treatment should be established. Forty-five per cent were in favour of legalisation of active euthanasia under certain circumstances. (shrink)

C. A. J. Coady; VIII*—Descartes' Other Myth, Proceedings of the Aristotelian Society, Volume 83, Issue 1, 1 June 1983, Pages 121–142, https://doi.org/10.1093/ar.

Any theory of reduction that goes only so far as carried in Parts I and II does only half the job. Prima facie at least, there are cases of would-be reduction which seem torn between two conflicting intuitions. On the one side there is a strong intuition that reduction is involved, and a strongly retentive reduction at that. On the other side it seems that the concepts at one level cross-classify those at the other level, so that there is no (...) way to identify properties at one level with those at the other. There is evidence to suggest that there will be no unique mental state/neural state association that can be set up, because, e.g., many different parts of the nervous system are all capable of taking over ‘control’ of the one mental function. And it is alleged that infinitely many, worse: indefinitely many, different bio-chemo-physical states could correspond to the economic property ‘has a monetary system of economic exchange’; and similarly for the property ‘has just won a game of tennis’. Yet one doesn't want an economic system or a game of tennis to be some ghostly addition to the actual bio-chemo-physical processes and events involved. Similarly one hopes that neurophysiology allied with the rest of natural science will render human experience and behaviour explicable. (shrink)