With narrow exception, physicians’ treatment of incapacitated patients requires the consent of health surrogates. Although the decision-making authority of surrogates is appropriately broad, their moral authority is not without limits. Discerning these bounds is particularly germane to ethically complex treatments and has important implications for the welfare of patients, for the professional integrity of clinicians, and, in fact, for the welfare of surrogates. Palliative sedation is one such complex treatment; as such, it provides a valuable model for analyzing the scope (...) of surrogates’ moral authority. Guidelines for palliative sedation that present it as a “last-resort” treatment for severe and intractable suffering yet require surrogate consent in order to offer it are ethically untenable, precisely because the moral limits of surrogate authority have not been considered. (shrink)

This study investigated the attitudinal responses of 403 undergraduate students with respect to nine hypothetical marketing moral dilemmas. Participants varied by gender, major, and age.It was found that undergraduate women responded more ethically on the hypothetical marketing moral dilemmas, as hypothesized. Secondly, chosen major did not make a difference on cognitive, affective, or behavioral responses. Further, the overall means for each scenario were in the morally correct direction in every case. Also, all intercorrelations for each story were significant. Finally, whenever (...) there was a nonchance finding for age, the oldest participants answered more morally than the youngest subjects. (shrink)

Educators and policy makers confront challenging questions of ethics, justice, and equity on a regular basis. Should teachers retain a struggling student if it means she will most certainly drop out? Should an assignment plan favor middle-class families if it means strengthening the school system for all? These everyday dilemmas are both utterly ordinary and immensely challenging, yet there are few opportunities and resources to help educators think through the ethical issues at stake. Drawing on research and methods developed in (...) the Justice in Schools project at the Harvard Graduate School of Education,_ Dilemmas of Educational Ethics_ introduces a new interdisciplinary approach to achieving practical wisdom in education, one that honors the complexities inherent in educational decision making and encourages open discussion of the values and principles we should collectively be trying to realize in educational policy and practice. At the heart of the book are six richly described, realistic accounts of ethical dilemmas that have arisen in education in recent years, paired with responses written by noted philosophers, empirical researchers, policy makers, and practitioners, including Pedro Noguera, Howard Gardner, Mary Pattillo, Andres A. Alonso, Jamie Ahlberg, Toby N. Romer, and Michael J. Petrilli. The editors illustrate how readers can use and adapt these cases and commentaries in schools and other settings in order to reach a difficult decision, deepen their own understanding, or to build teams around shared values. (shrink)

Relationalism holds that perceptual experiences are relations between subjects and perceived objects. But much evidence suggests that perceptual states can be unconscious. We argue here that unconscious perception raises difficulties for relationalism. Relationalists would seem to have three options. First, they may deny that there is unconscious perception or question whether we have sufficient evidence to posit it. Second, they may allow for unconscious perception but deny that the relationalist analysis applies to it. Third, they may offer a relationalist explanation (...) of unconscious perception. We argue that each of these strategies is questionable. (shrink)

We introduce the notion of a convex tree. We show that the binary expansion for real numbers in the unit interval ) is equivalent to weak König lemma ) for trees having at most two nodes at each level, and we prove that the intermediate value theorem is equivalent to \ for convex trees, in the framework of constructive reverse mathematics.

I offer here a new hypothesis about the nature of implicit attitudes. Psy- chologists and philosophers alike often distinguish implicit from explicit attitudes by maintaining that we are aware of the latter, but not aware of the former. Recent experimental evidence, however, seems to challenge this account. It would seem, for example, that participants are frequently quite adept at predicting their own perfor- mances on measures of implicit attitudes. I propose here that most theorists in this area have nonetheless overlooked (...) a commonsense distinction regarding how we can be aware of attitudes, a difference that fundamentally distinguishes implicit and explicit attitudes. Along the way, I discuss the implications that this distinction may hold for future debates about and experimental investigations into the nature of implicit attitudes. (shrink)

Working within Bishop’s constructive framework, we examine the connection between a weak version of the Heine–Borel property, a property antithetical to that in Specker’s theorem in recursive analysis, and the uniform continuity theorem for integer-valued functions. The paper is a contribution to the ongoing programme of constructive reverse mathematics.

Perceptual experiences justify beliefs. A perceptual experience of a dog justifies the belief that there is a dog present. But there is much evidence that perceptual states can occur without being conscious, as in experiments involving masked priming. Do unconscious perceptual states provide justification as well? The answer depends on one’s theory of justification. While most varieties of externalism seem compatible with unconscious perceptual justification, several theories have recently afforded to consciousness a special role in perceptual justification. We argue that (...) such views face a dilemma: either consciousness should be understood in functionalist terms, in which case our best current theories of consciousness do not seem to imbue consciousness with any special epistemic features, or it should not, in which case it is mysterious why only conscious states are justificatory. We conclude that unconscious perceptual justification is quite plausible. (shrink)

It has been suggested that iconic graphical signs evolve into symbolic graphical signs through repeated usage. This article reports a series of interactive graphical communication experiments using a ‘pictionary’ task to establish the conditions under which the evolution might occur. Experiment 1 rules out a simple repetition based account in favor of an account that requires feedback and interaction between communicators. Experiment 2 shows how the degree of interaction affects the evolution of signs according to a process of grounding. Experiment (...) 3 confirms the prediction that those not involved directly in the interaction have trouble interpreting the graphical signs produced in Experiment 1. On the basis of these results, this article argues that icons evolve into symbols as a consequence of the systematic shift in the locus of information from the sign to the users' memory of the sign's usage supported by an interactive grounding process. (shrink)

Just as noncapacitated decision making will forever be a feature of clinical medicine, so will the quest for effective advance care planning and serviceable documentation of these preferences. “Re-...

This paper contrasts two influential theoretical accounts of language change and evolution – Iterated Learning and Social Coordination. The contrast is based on an experiment that compares drawings produced with Garrod et al’s ‘pictionary’ task with those produced in an Iterated Learning version of the same task. The main finding is that Iterated Learning does not lead to the systematic simplification and increased symbolicity of graphical signs produced in the standard interactive version of the task. A second finding is that (...) Iterated Learning leads to less conceptual and structural alignment between participants than observed for those in the interactive condition. The paper concludes with a comparison of the two accounts in relation to how each promotes signs that are effi cient, systematic and learnable. (shrink)

The concept of paternalism is intricately tied to the concept of autonomy. It is commonly assumed that when paternalistic interventions are wrong, they are wrong because they impede individuals’ autonomy. Our aim in this paper is to show that the recent shift towards conceiving of autonomy relationally highlights a separate conceptual space for a nonpaternalistic kind of interpersonal intervention termed maternalism. We argue that maternalism makes a twofold contribution to the debate over the ethics of interpersonal action and decision-making. Descriptively, (...) it captures common experiences that, while not unusual in everyday life, are largely absent from the present discussion. Normatively, it describes a type of intervention with justification conditions distinct from the standard framework of paternalism. We explicate these contributions by describing six key differences between maternalism and paternalism, and conclude by anticipating and responding to potential objections. (shrink)

The ‘best interests’ decision making standard is used in clinical care to make necessary health decisions for non-capacitated individuals for whom neither explicit nor inferred wishes are known. It has been also widely acknowledged as a basis for enrolling some non-capacitated adults into clinical research such as emergency, critical care, and dementia research. However, the best interests standard requires that choices provide the highest net benefit of available options, and clinical research rarely meets this criterion. In the context of modern (...) norms of bioethics, the best interests standard rarely supports surrogate consent for research and should not be accepted as a routine provision. (shrink)

This volume traces the history of animals in philosophy, from antiquity down to contemporary times. Negative attitudes towards animals, as found in Aristotle and Descartes, turn out to be more nuanced than usually supposed, while remarkable discussions of animal welfare appear in late antiquity, India, the Islamic world, and Kant.

ABSTRACTIn our everyday life, we frequently switch between different tasks, a faculty that changes with age. However, it is still not understood how emotion impacts on age-related changes in task s...

The problem of diachronic personal identity is this: what explains why a person P1 at time T1 is numerically identical with a person P2 at a later time T2, even if they are not at those times qualitatively identical? One traditional explanation is the soul theory, according to which persons persist in virtue of their nonphysical souls. I argue here that this view faces a new and arguably insuperable dilemma: either souls, like physical bodies, change over time, in which case (...) the soul theory faces an analogue problem of diachronic soul identity, or souls, unlike physical bodies, do not change over time, in which case the soul theory cannot explain why souls relate to particular bodies over time and so at best only partially explains personal identity. I conclude that the soul theory fares no better than physicalist-friendly accounts of personal identity such as bodily- or psychological-continuity-based views. (shrink)

It is shown, with intuitionistic logic, that if every locally constant function from to has a property akin to constancy, then the fan theorem for -bars holds, and conversely.

Fortunato and colleagues' target article extends both the ethical analysis and the clinical practice of nondisclosure by focusing on nocebo effects (Fortunato, Wasserman, and Menkes 2017). Instance...

The American Journal of Bioethics, Volume 11, Issue 7, Page 51-53, July 2011.

BACKGROUND: Little is known about how hospitalized patients share decisions with physicians. METHODS: We conducted an observational study of patient-doctor communication on an inpatient medicine service among 18 hospitalized patients and 9 physicians. A research assistant (RA) approached newly hospitalized patients and their physicians before morning rounds and obtained consent. The RA audio recorded morning rounds, and then separately interviewed both patient and physician. Coding was done using integrated analysis. RESULTS: Most patients were white (61%) and half were female. Most (...) physicians were male (66%) and of Southeast Asian descent (66%). All physicians explained the plan of care to the patients; most believed that their patient understood. However, many patients did not. Physicians rarely asked the patient for their opinion. In all those cases, the decision had been made previously by the doctors. No decisions were made with the patient. Patients sometimes disagreed. CONCLUSIONS: Shared decision-making may not be the norm in hospital care. Although physicians do explain treatment plans, many hospitalized patients do not understand enough to share in decisions. When patients do assert their opinion, it can result in conflict. PRACTICE IMPLICATIONS: Some hospitalized patients are interested in discussing treatment. Improving hospital communication can foster patient autonomy. (shrink)

The purpose of this paper is to explore the concepts of issue legitimacy and organizational legitimacy, providing a new measure of each construct. The scales were developed and tested using data collected through a statewide survey of Alabama residents. Assessments of issue legitimacy were based on perceptions of direct-to-consumer advertising, whereas assessments of organizational legitimacy were based on perceptions of the pharmaceutical industry as a whole. The findings provide evidence that organizational legitimacy can be reliably measured using a five-item scale (...) and issue legitimacy can be reliably measured using a six-item scale. The implications of the results and potential uses of the scales are discussed. (shrink)

Providers and patients bring different understandings of health and disease to their encounters in the hospital setting. The literature to date only infrequently addresses patient and provider concordance on the reported reason for hospitalization, that is, whether they express this reason in similar ways. An agreement or common ground between such understandings can serve as a basis for future communication regarding an illness and its treatment. We interviewed a convenience sample of patients on the medical wards of an urban academic (...) medical center. We asked subjects to state the reason why their doctors admitted them to the hospital, and then compared their statement with the reason in the medical record. We defined concordance on reported reason for hospitalization as agreement between the patient’s report and the reason abstracted from the chart. We interviewed and abstracted chart data from a total of 46 subjects. Concordance on reported reason for hospitalization was present in 24 (52%) and discordance in 17 (37%); 5 patients (11%) could not give any reason for their hospitalization. Among the 17 patients whose report was discordant with their chart, 12 (71%) reported a different organ system than was recorded in the chart. A significant proportion of medical inpatients could not state their physicians’ reason for admission. In addition, patients who identify a different reason for hospitalization than the chart often give a different organ system altogether. Providers should explore patient understanding of the reason for their hospitalization to facilitate communication and shared decision making. (shrink)