RationaleSurrogates of critically ill patients often have inaccurate expectations about prognosis. Yet there is little research on how intensive care unit clinicians should discuss prognosis, and existing expert opinion-based recommendations give only general guidance that has not been validated with surrogate decision makers.ObjectiveTo determine the perspectives of key stakeholders regarding how prognostic information should be conveyed in critical illness.MethodsThis was a multicenter study at three academic medical centers in California, Pennsylvania, and Washington. One hundred eighteen key stakeholders completed in-depth semistructured (...) interviews. Participants included 47 surrogates of adult patients with acute respiratory distress syndrome; 45 clinicians working in study ICUs, including physicians, nurses, social workers, and spiritual care providers; and 26 experts in health communication, decision science, ethics, family-centered care, geriatrics, healthcare disparities, palliative care, psychology, psychiatry, and critical care.Measurements and main resultsThere was broad support among surrogates for existing expert recommendations, including truthful prognostic disclosure, emotional support, tailoring the disclosure strategy to each family's needs, and checking for understanding. In addition, stakeholders offered suggestions that add specificity to existing recommendations, including: In addition to conveying prognostic estimates, clinicians should help families "see the prognosis for themselves" by showing families radiographic images and explaining the clinical significance of physical manifestations of severe disease at the bedside. Many physicians did not support using numeric estimates to convey prognosis to families, whereas many surrogates, clinicians from other disciplines, and experts believed numbers could be helpful. Clinicians should conceptualize prognostic communication as an iterative process that begins with a preliminary mention of the possibility of death early in the ICU stay and becomes more detailed as the clinical situation develops. Although prognostic information should be initially disclosed by physicians, other members of the multidisciplinary team-nurses, social workers, and spiritual care providers-should be given explicit role responsibilities to reinforce physicians' prognostications and help families process a poor prognosis emotionally.ConclusionsFamily members, clinicians, and experts identified specific communication behaviors that clinicians should use to discuss prognosis in the critical care setting. These findings extend existing opinion-based recommendations and should guide interventions to improve communication about prognosis in ICUs. (shrink)

The corporatization of U.S. health care has directed cost containment efforts toward scrutinizing the clinical decisions of physicians. This stimulated a variety of new utilization management interventions, particularly in hospital and managed care settings. Recent changes in fee-for-service medicine and physicians' traditional agency relationships with patients, purchasers, and insurers are examined here. New information systems monitoring of physician ordering behavior has already begun to impact on physician autonomy and the relationship of physicians to provider organizations in both for-profit and not-for-profit (...) sectors. As managed care practice settings proliferate, serious ethical questions will be raised about agency relationships with patients.This article examines health system dynamics altering the historical agency relationship between the physician and patient and eroding the traditional autonomy of the medical profession in the United States. The corporatization of medicine and the accompanying information systems monitoring of physician productivity is seen to account of such change, now posing serious ethical dilemmas. (shrink)

In On the Origin of Species, Charles Darwin put forward his theory of natural selection. Conventionally, Darwin's argument for this theory has been understood as based on an analogy with artificial selection. But there has been no consensus on how, exactly, this analogical argument is supposed to work – and some suspicion too that analogical arguments on the whole are embarrassingly weak. Drawing on new insights into the history of analogical argumentation from the ancient Greeks onward, as well as on (...) in-depth studies of Darwin's public and private writings, this book offers an original perspective on Darwin's argument, restoring to view the intellectual traditions which Darwin took for granted in arguing as he did. From this perspective come new appreciations not only of Darwin's argument but of the metaphors based on it, the range of wider traditions the argument touched upon, and its legacies for science after the Origin. (shrink)

The existential analysis -- The death of dasein -- The timeliness of dasein -- The derivation of time -- The time of being.

According to a natural view of instrumental normativity, if you ought to do φ, and doing ψ is a necessary means for you to do φ, then you ought to do ψ. In “Instrumental Normativity: In Defense of the Transmission Principle,” Benjamin Kiesewetter defends this principle against certain actualist-inspired counterexamples. In this article I argue that Kiesewetter’s defense of the transmission principle fails. His arguments rely on certain principles—Joint Satisfiability and Reason Transmission—which we should not accept in the unqualified forms (...) needed to establish his conclusion. (shrink)

In his Essay concerning Human Understanding, John Locke explicitly refers to Newton’s Philosophiae naturalis principia mathematica in laudatory but restrained terms: “Mr. Newton, in his never enough to be admired Book, has demonstrated several Propositions, which are so many new Truths, before unknown to the World, and are farther Advances in Mathematical Knowledge” (Essay, 4.7.3). The mathematica of the Principia are thus acknowledged. But what of philosophia naturalis? Locke maintains that natural philosophy, conceived as natural science (as opposed to natural (...) history), would give us demonstrations of the necessary connection between the (ultimately, simple) ideas constitutive of our complex ideas of various natural kinds of substances (e.g., gold). Indeed Locke goes so far as to suggest that a completely adequate natural science would also realize (perhaps, per impossibile) the goal of transforming the corpuscularian hypothesis into knowledge by demonstrating the necessary connection between the ‘microstructure’ (primary qualities of insensible corpuscles) of a particular natural kind of substance (e.g., gold) and the ideas of secondary qualities constitutive of the complex idea of that kind of substance. Locke’s conclusion concerning the possibility of the development of a natural science thus conceived is pessimistic: In vain therefore shall we endeavor to discover by our Ideas, (the only true way of certain and universal knowledge,) what other Ideas are to be found constantly joined with that of our complex Idea of any Substance: since we neither know the real Constitution of the minute Parts, on which their Qualities do depend; not, did we know them could we discover any necessary connexion between them, and any of their Secondary Qualities: which is necessary to be done, before we can certainly know their necessary co-existence (Essay, 4.3.14). It is understandable that, with such a conception of the science of nature, Locke found little of it in Newton’s Principia. In this paper, I further explore what might, perhaps with some hyperbole, be termed Locke’s ‘disappointment’ with the Prinicipia as a contribution to natural science. In particular, I argue that Locke’s adherence to the idealist epistemology of the Way of Ideas entails that mathematics cannot lend its certainty as a scientia to natural philosophy. Consequently, he finds more mathematics than natural philosophy in the Principia. (shrink)

Automated influence is one of the most pervasive applications of artificial intelligence in our day-to-day lives, yet a thoroughgoing account of its associated individual and societal harms is lacking. By far the most widespread, compelling, and intuitive account of the harms associated with automated influence follows what I call the control argument. This argument suggests that users are persuaded, manipulated, and influenced by automated influence in a way that they have little or no control over. Based on evidence about the (...) effectiveness of targeted advertising as well as empirical results about the nature of attentional control, I provide reasons to reject this argument. In turn, I use C. Thi Nguyen’s theory of value collapse to develop a new account of the harmfulness of automated influence. (shrink)

There is what might be called a ‘majority position’ in the history of Western philosophy according to which causes are sufficient for or ‘necessitate’ their effects. However, there is also a singificant ‘minority position’ according to which causes are necessary relative to their effects. The second/third century A.D. Peripatetic Alexander of Aphrodisias is an ancient representative of the minority position. He attributes his own view — with some justification, I shall suggest – to Aristotle. This paper has two, somewhat loosely (...) connected purposes. The first is to explore the origin of the conception of ‘causes’ as necessary conditions in Aristotle, particularly in On Generation and Corruption 2.11 and Posterior Analytics 2.12, and the development and use of the conception in Alexander's De fato. The second purpose of the paper is to explore and criticize a sophisticated contemporary version of the conception of causes as ‘necessary in the circumstances,’ that of J.L. Mackie. (shrink)

The current study examined whether Callous-Unemotional (CU) traits, a core component of psychopathy, modulate neural responses of participants engaged in a social exchange game. In this task, participants were offered an allocation of money and then given the chance to punish the offerer. Twenty youth participated and responses to both offers and the participant’s punishment (or not) of these offers were examined. Increasingly unfair offers were associated with increased dorsal anterior cingulate cortex (dACC) activity but this responsiveness was not modulated (...) by CU traits. Increasing punishment of unfair offers was associated with increased dACC and anterior insula activity and this activity was modulated by CU traits. Higher CU trait participants showed a weaker association between activity and punishment level. These data suggest that CU traits are associated with appropriate expectations of other individual’s normative behavior but weaker representations of such information when guiding behavior of the self. (shrink)

The sudden emergence of the COVID-19 pandemic brought global disruption to every aspect of society including healthcare, supply chain, the economy, and social interaction. Among the many emergent considerations were the safety and public health of the public, patients, essential workers, and healthcare professionals. In certain locations, clinical research was halted—or terminated—in deference to the immediate needs of patient care, and clinical trials focusing on the treatment and prevention of coronavirus infection were prioritized over studies focusing on other diseases. Difficult (...) decisions were made rapidly; flexibility and reconsideration were necessary not only because the intensity and severity of infection varied over time and by locale but also because knowledge of the disease and understanding of its treatment grew. Here we discuss the ethical challenges in decision-making and competing ethical tensions during the pandemic in an effort to advance future preparedness. (shrink)

Supererogation has gained attention as a means of explaining the voluntary behaviours of individuals and organizations that are done for the benefit of others and which go above what is required of legislation and what may be expected by society. Whilst the emerging literature has made some significant headway in exploring supererogation as an ethical lens for the study of business there remain several important issues that require attention. These comprise, the lack of primary evidence upon which such examinations have (...) been made, attention has been given to only singular pro-social acts of organizations, and the focus has been upon the actions of large organizations. Furthermore, Heyd’s (Supererogation, Cambridge University Press, 1982) original taxonomy of six supererogatory acts, comprising Moral Heroism, Beneficence, Volunteering, Favour, Forgiveness and Forbearance, has been considered to be complete and other forms of supererogatory acts have not yet been explored. In order to address these gaps this study poses the research questions: First, it studies how a single, contemporary SME performs multiple supererogatory acts in its attempts to address its social and environmental goals that go beyond CSR. Second, it seeks to gain a deeper theoretical understanding of Heyd’s (Supererogation, Cambridge University Press, 1982) taxonomy of six forms of supererogation through the capture of primary data. This research makes a three-year case study examination of a single SME that has been formally recognized for its work in addressing social and environmental issues at local, national and global levels. Primary data are acquired of the supererogatory acts that it performs through a three-year participant observation case study, utilizing 61 interviews and 3 focus groups with internal and external stakeholders. In doing so, it addresses the empirical limitations of the extant research, substantiates each of the forms that supererogatory acts may take, and makes a contribution to the theory of supererogation by identifying a further class of act that is ‘Sharing’. (shrink)

Are predictions about how one will freely and intentionally behave in the future ever relevant to how one ought to behave? There is good reason to think they are. As imperfect agents, we have responsibilities of self-management, which seem to require that we take account of the predictable ways we're liable to go wrong. I defend this conclusion against certain objections to the effect that incorporating predictions concerning one's voluntary conduct into one's practical reasoning amounts to evading responsibility for that (...) conduct. There is, however, some truth to this sort of objection. To understand the legitimate role of self-prediction in practical reasoning, we need to distinguish instances of coping responsibly with an anticipated failure to behave as one ought, on the one hand, from mere acquiescence in one's flaws, on the other. I argue that, to draw this distinction, we must recognize certain limits on the use of self-prediction as a ground of choice. (shrink)

A Master-like argument, in the usage of the present paper, is an argument that employs a reductio ad impossibile principle to transmit the necessity of what are or become past truths to the remainder of time by means of necessary conditionals of some sort. The conclusion of such an argument is some no-unactualized-possibilities principle. This paper argues that the formulation of a Master-like argument by A. N. Prior in a mixed modal temporal propositional logic introduces certain artifacts into the logical (...) analysis of the argument. One of these, a principle of temporal discreteness, is not essential to a Master-like argument. Another, a principle of forwards temporal linearity, is technically essential; but it is usually tacitly presupposed by the necessary temporal conditionals employed to 'tie together' past and future time in less formal accounts of Master-like arguments. (shrink)

This paper develops an interpretation of the fourth account of conditionals in Sextus Empiricus's Outlines of Pyrrhonism that conceptually links it with contemporary ?relevance? interpretations of entailment. It is argued that the third account of conditionals, which analyzes the truth of a conditional in terms of the joint impossibility of antecedent and denial of consequent, should not be interpreted in terms of a relative incompatibility of antecedent and denial of consequent because of Stoic acceptance of the truth of some conditionals (...) of the form p ? ?p and its converse. Rather, it is suggested, ancient attempts to avoid the so-called paradoxes of implication involve the fourth account of conditionals. I hypothesize that this account is related to Stoic attempts to define truth conditions for conditionals in terms of a theory of the concludency (validity) of arguments in opposition to the more common procedure (represented by the first three accounts of conditionals) of specifying truth conditions for conditionals ?semantically? and using those truth conditions in the development of a theory of argument validity. (shrink)

Numerical studies of the Hubbard model and its strong-coupling form, the t-J model, show evidence for antiferromagnetic, $d_{x^{\text{2}} - y^2 } $ -pairing and stripe correlations which remind one of phenomena seen in the layered cuprate materials. Here, we ask what these numerical results imply about various scenarios for the pairing mechanism.

By introducing the concept of “mental data,” Palermos (2023) highlights an underappreciated aspect of data ethics that policymakers would do well to heed. Sweeping artificial intelligence (AI) legi...

From Greek antiquity to the latest theories, this historical survey of political philosophy not only covers the major thinkers in the field but also explores the theme of how political philosophy relates to the nature of man. It illustrates how the great political thinkers have always grounded their political thought in what the author terms a "normative anthropology," which typically has not only ethical but metaphysical and/or theological components. Starting with the ancient Greek Sophists, author Michael J. White examines how (...) thinkers over the centuries have approached such political and philosophical concerns as justice, morality, and human flourishing, offering substantial studies of--among others--Plato, Aristotle, Cicero, Locke, Hobbes, Rousseau, Marx, and J. S. Mill. White highlights the impact of Christianity on political philosophy, illustrating the diversity of that impact by studies of Augustine, Aquinas, and Marsilius of Padua. Concluding with an in-depth analysis of John Rawls and contemporary liberal political philosophy, this text blends insight and information in a refreshing and useful manner. A brief Epilogue considers both the value and the limitations of political philosophy and its study. (shrink)

Hare used his thesis of universalizability to generate specific normative results and a defense of utilitarianism. To accomplish the latter task, he enjoined that one consider oneself in various roles in a given situation, and that the concluding judgment must be one that is affirmable in any of the various roles. In effect this means that one must, says Hare, give equal weight to the interests of all involved parties, an axiom of utilitarianism. The paper argues that he did not (...) succeed. (shrink)

A well-known epigram by Callimachus on the philosopher Diodorus Cronus reads as follows:The question of the third line, while perhaps recondite from a contemporary perspective, was clear in antiquity. The crows are asking ‘What follows ?’, in allusion to the Hellenistic disputes concerning the truth conditions of conditional propositions , disputes in which the views of Diodorus figured prominently.I agree with Sedley that the question of the last line is ‘much more problematic’. The common interpretation has been to read the (...) αθι as a form of αθις and to interpret it temporally. The result, in Pfeiffer's estimation, is ‘quomodo posthac erimus?’.This interpretation derives from Sextus Empiricus' discussion at M. 1.309–12 of the last two lines of the epigram. After crediting the grammarian with the ability to understand the allusion in the crows' first question , he proceeds to argue that the philosopher has a better chance than the grammarian of understanding the second question. But, to quote Sedley, Sextus ‘makes a ghastly mess of it’ when he attempts his own elucidation. According to an argument of Diodorus, a living thing does not die in the time in which it lives nor in a time in which it does not live. Hence, Sextus concludes, it must be the case that it never dies and, ‘if this is the case, we are always living and, according to him, we shall come to be hereafter ’. (shrink)

We report on the small-scale (0.5 13 h - 1M, a large-scale bias of ~2.0 and a satellite fraction of 12 ± 2 per cent. Thus, these galaxies occupy haloes with average masses in between those of the higher redshift BOSS CMASS sample and the original SDSS I/II luminous red galaxy sample © 2012 The Authors Published by Oxford University Press on behalf of the Royal Astronomical Society © doi:10.1093/mnras/sts314.

Working parents in are struggling to balance the demands of their occupation with those of childcare and homeschooling during the COVID-19 pandemic. Moreover, studies show that women are shouldering more of the burden and reporting greater levels of psychological distress, anxiety, and depression relative to men. However, research has yet to show that increases in psychological symptoms are linked to changes in stress during the pandemic. Herein, we conduct a small-N study to explore the associations between stress and psychological symptoms (...) during the pandemic among mothers using structural equation modeling, namely latent change score models. Thirty-three mothers completed questionnaires reporting current anxious and depressive symptoms, as well as stressful life experiences prior to-versus during the pandemic. Women endorsed significantly more stressful events during the pandemic, relative to the pre-pandemic period. Additionally, 58% of mothers scored as moderate-to-high risk for developing a stress-related physical illness in the near future because of their pandemic-level stress. Depressive symptoms were associated with the degree of change in life stress, whereas anxiety symptoms were more related to pre-pandemic levels of stress. The present study preliminarily sheds light on the nuanced antecedents to mothers’ experiences of anxious and depressive symptoms during the COVID-19 pandemic. Although further work is needed in larger, more diverse samples of mothers, this study highlights the potential need for appropriate policies, and prevention and intervention programs to ameliorate the effects of pandemics on mothers’ mental health. (shrink)

In jurisdictions where voluntary assisted dying is legal, eligibility assessments, prescription and administration of a VAD substance are commonly performed by senior doctors. Junior doctors’ involvement is limited to a range of more peripheral aspects of patient care relating to VAD. In the Australian state of Victoria, where VAD has been legal since June 2019, all health professionals have a right under the legislation to conscientiously object to involvement in the VAD process, including provision of information about VAD. While this (...) protection appears categorical and straightforward, conscientious objection to VAD-related care is ethically complex for junior doctors for reasons that are specific to this group of clinicians. For junior doctors wishing to exercise a conscientious objection to VAD, their dependence on their senior colleagues for career progression creates unique risks and burdens. In a context where senior colleagues are supportive of VAD, the junior doctor’s subordinate position in the medical hierarchy exposes them to potential significant harms: compromising their moral integrity by participating, or compromising their career progression by objecting. In jurisdictions intending to provide all health professionals with meaningful conscientious objection protection in relation to VAD, strong specific support for junior doctors is needed through local institutional policies and culture. There are no data in this work. (shrink)

In Meta. Λ 8, Aristotle argues that the heaven –and, thus, the cosmos – is numerically unique on the grounds that its first unmoved mover is numerically unique. The latter is numerically unique because it is ‘essence’ and does not have matter. “But whatever is many in number has matter.” I refer to this inference as Aristotle’s metaphysical argument for the uniqueness of the cosmos. A problem arises: If the subsidiary unmoved movers of the planetary spheres are, like the prime (...) unmoved mover, immaterial substances and belong to the same species of unmoved mover, it seems that they could not be numerically distinct from that first unmoved mover – while Aristotle maintains that they are, in fact, numerically distinct. That is, as immaterial substance, it/they could not be individuated by matter. However, if they do, as souls or soul-like forms, inform matter, it seems that there is no reason why the first unmoved mover, which moves the sphere of fixed stars or outermost, celestial sphere, should not similarly inform the matter of that celestial sphere. In the latter case, Aristotle’s argument for the uniqueness of the heaven and cosmos would be vitiated. The first unmoved mover would be the form of the outermost celestial sphere; and there would evidently be no metaphysical reason why that form could not be materially instantiated by other outermost celestial spheres, each enclosing its own cosmos distinct from our own. I argue that neither of the two salient options for resolving this problem with Aristotle’s metaphysical argument for the uniqueness of the cosmos is satisfactory. The result, so I maintain, is Aristotle’s diremption of divinity into two essentially unrelated aspects: divinity as autonomous, ‘hermetic’ cognition and divinity as ultimate cause of cosmic motion and change. (shrink)