One of the greatest revolutions in mathematics occurred when Georg Cantor (1845-1918) promulgated his theory of transfinite sets.

According to the indispensability argument, the fact that we quantify over numbers, sets and functions in our best scientific theories gives us reason for believing that such objects exist. I examine a strategy to dispense with such quantification by simply replacing any given platonistic theory by the set of sentences in the nominalist vocabulary it logically entails. I argue that, as a strategy, this response fails: for there is no guarantee that the nominalist world that go beyond the set of (...) sentences in the nominalist language such theories entail. However, I argue that what such theories show is that mathematics can enable us to express possibilities about the concrete world that may not be expressible in nominalistically acceptable language. While I grant that this may make quantification over abstracta indispensable, I deny that such indispensability is a reason for accepting them into our ontology. I urge that the nominalist should be allowed to quantify over abstracta whilst denying their existence and I explain how this apparently contradictory practice (a practice I call 'weaseling') is in fact coherent, unproblematic and rational. Finally, I examine the view that platonistic theories are simpler or more attractive than their nominalistic reformulations, and thus that abstract ought to be accepted into our ontology for the same sorts of reasons as other theoretical objects. I argue that, at least in the case of numbers, functions and sets, such arguments misunderstand the kind of simplicity and attractiveness we seek. (shrink)

While engaging in rich discussion, Conspiracy Theories analyzes current arguments and evidence while providing real-world examples so students can contextualize and visualize the debates. Each chapter addresses important current questions, provides conceptual tools, defines important terms, and introduces the appropriate methods of analysis.

The deeply entrenched, sometimes heated conflict between the disability movement and the profession of bioethics is well known and well documented. Critiques of prenatal diagnosis and selective abortion are probably the most salient and most sophisticated of disability studies scholars’ engagements with bioethics, but there are many other topics over which disability activists and scholars have encountered the field of bioethics in an adversarial way, including health care rationing, growth-attenuation interventions, assisted reproduction technology, and physician-assisted suicide. The tension between the (...) analyses of the disabilities studies scholars and mainstream bioethics is not merely a conflict between two insular political groups, however; it is, rather, also an encounter between those who have experienced disability and those who have not. This paper explores that idea. I maintain that it is a mistake to think of this conflict as arising just from a difference in ideology or political commitments because it represents a much deeper difference—one rooted in variations in how human beings perceive and reason about moral problems. These are what I will refer to as variations of moral psychology. The lived experiences of disability produce variations in moral psychology that are at the heart of the moral conflict between the disability movement and mainstream bioethics. I will illustrate this point by exploring how the disability movement and mainstream bioethics come into conflict when perceiving and analyzing the moral problem of physician-assisted suicide via the lens of the principle of respect for autonomy. To reconcile its contemporary and historical conflict with the disability movement, the field of bioethics must engage with and fully consider the two groups’ differences in moral perception and reasoning, not just the explicit moral and political arguments of the disability movement. (shrink)

: This paper presents a method of moral problem solving in clinical practice that is inspired by the philosophy of John Dewey. This method, called "clinical pragmatism," integrates clinical and ethical decision making. Clinical pragmatism focuses on the interpersonal processes of assessment and consensus formation as well as the ethical analysis of relevant moral considerations. The steps in this method are delineated and then illustrated through a detailed case study. The implications of clinical pragmatism for the use of principles in (...) moral problem solving are discussed. (shrink)

The crash of two 737 MAX passenger aircraft in late 2018 and early 2019, and subsequent grounding of the entire fleet of 737 MAX jets, turned a global spotlight on Boeing’s practices and culture. Explanations for the crashes include: design flaws within the MAX’s new flight control software system designed to prevent stalls; internal pressure to keep pace with Boeing’s chief competitor, Airbus; Boeing’s lack of transparency about the new software; and the lack of adequate monitoring of Boeing by the (...) FAA, especially during the certification of the MAX and following the first crash. While these and other factors have been the subject of numerous government reports and investigative journalism articles, little to date has been written on the ethical significance of the accidents, in particular the ethical responsibilities of the engineers at Boeing and the FAA involved in designing and certifying the MAX. Lessons learned from this case include the need to strengthen the voice of engineers within large organizations. There is also the need for greater involvement of professional engineering societies in ethics-related activities and for broader focus on moral courage in engineering ethics education. (shrink)

In this paper, I argue that there is an inconsistency between two presentist doctrines: that of ontological symmetry and asymmetry of fixity. The former refers to the presentist belief that the past and future are equally unreal. The latter refers to the A-Theoretic intuition that the past is closed or actual, and the future is open or potential. My position in this paper is that the presentist is unable to account for the temporal asymmetry that is so fundamentally a part (...) of her theory. In Section I, I briefly outline a recent defence of presentism due to Craig, and argue that a flaw in this defence highlights the tension between the presentist's doctrines of ontological symmetry and asymmetry of fixity. In Section II, I undertake an investigation, on the presentist's behalf, in order to determine whether she is capable of reconciling these two doctrines. In the course of the investigation, I consider different asymmetries, other than that of ontology, which might be said fundamentally to constitute temporal asymmetry, and the asymmetry of fixity in particular. In Section III, I also consider whether the presentist is able to avail herself of some of the standard B-Theoretic accounts of the asymmetry of fixity, and argue that she cannot. Finally, I conclude that temporal asymmetry cannot be accounted for (or explained) other than through the postulation of an ontological asymmetry. (shrink)

This essay is an investigation into the existence of a very unusual and some would say unacceptably exotic type of property: namely, the property of being a certain individual; or, if you prefer, the property of being identical to a certain individual. In other words, this essay will investigate whether in spite of their exotic nature there are thisnesses, and, in particular, whether thisnesses are instantiated by events. Of course, I have not really said enough yet about thisnesses to motivate (...) the criticism that such properties are exotic; for it might be the case that an individual x s thisness is merely a conjunction of all of x s qualitative properties. And, if we allow for the existence of all of the properties of an individual, it is not overly profligate to allow for the existence of this one additional conjunctive property. This, apparently, was Leibniz s view. Though seemingly ontologically mundane, however, such a qualitative1 thisness is not ontologically innocent. Given the definition of a thisness above, an individual s thisness is essential to it, and there are few philosophers who would wish to hold that all of an individual s properties are essential to it.2 Rather, it.. (shrink)

This paper seeks to give an account of what it is for an individual to instantiate thisness (i.e. primitive individual essence). Thisnesses are peculiar entities, and even those who endorse their existence and instantiation by objects/entities, have said very little about how an individual and its thisness are related. My approach will be to seek out a model for the instantiation of thisness by canvassing broadly Aristotelian accounts of the substance/attribute relation, and then by making appropriate modifications to the most (...) likely candidates in order to accommodate an individual's instantiation of thisness. What will emerge is that the model with the most utility makes thisness redundant in the case of material substances. Nonetheless, I will suggest that a version of the model can be appropriately applied in the case of other individuals which might instantiate thisness: for example, events (where these are conceived as a fundamental category of ontology distinct from material substances). (shrink)

Fact checking has become a prominent facet of political news coverage, but it employs a variety of objectionable methodological practices, such as treating a statement containing multiple facts as if it were a single fact and categorizing as accurate or inaccurate predictions of events yet to occur. These practices share the tacit presupposition that there cannot be genuine political debate about facts, because facts are unambiguous and not subject to interpretation. Therefore, when the black-and-white facts—as they appear to the fact (...) checkers—conflict with the claims produced by politicians, the fact checkers are able to see only (to one degree or another) “lies.” The examples of dubious fact-checking practices that we discuss show the untenability of the naïve political epistemology at work in the fact-checking branch of journalism. They may also call into question the same epistemology in journalism at large, and in politics. (shrink)

ABSTRACT:Almost thirty years after its initial use in the Brundtland Report, the concept of “sustainability” has become ubiquitous within business, with virtually every company division across a broad range of industries developing “sustainable” models and practices. While the original Brundtland idea of sustainable development has the potential to do much good in guiding business practice, this potential is being undermined by the systematic misuse, misunderstanding, and flawed application of the concept in many business settings. Under the guise of sustainability, business (...) is being asked to do both less than and more than what should be required by a commitment to sustainable development. As a result, serious ethical and practical questions go unanswered, questions that must be addressed before sustainability can become a meaningful business strategy. This address situates sustainable business within its original context of sustainable development and argues against attempts to convert sustainability either into a narrow concept of risk management or into a broad concept of social responsibility. It then lays out a sustainability research agenda that helps us understand how to create businesses that can meet present and future needs without jeopardizing future generations via the destruction of the biosphere. (shrink)

: This response to Lynn Jansen's critique of clinical pragmatism concentrates on two themes: (1) contrasting approaches to moral epistemology and (2) the connection between theory and practice in clinical ethics. Particular attention is paid to the status of principles and the role of consensus, with some closing speculations on how Dewey might view the current state of bioethics.

In _Pharmaceutical Freedom_ Professor Flanigan argues we ought to grant people self-medication rights for the same reasons we respect people’s right to give (or refuse to give) informed consent to treatment. Despite being the most comprehensive argument in favour of self-medication written to date, Flanigan’s _Pharmaceutical Freedom_ leaves a number of questions unanswered, making it unclear how the safe-guards Flanigan incorporates to protect people from harming themselves would work in practice. In this paper, I extend Professor Flanigan’s account by discussing (...) a hypothetical case to illustrate how these safe-guards could work together to protect people from harms caused by their own ignorance or incompetence. (shrink)

A variety of approaches have appeared in academic literature and in design practice representing “ethics-first” methods. These approaches typically focus on clarifying the normative dimensions of design, or outlining strategies for explicitly incorporating values into design. While this body of literature has developed considerably over the last 20 years, two themes central to the endeavour of ethics and values in design (E + VID) have yet to be systematically discussed in relation to each other: (a) designer agency, and (b) the (...) strength of normative claims informing the design process. To address this gap, we undertook a structured review of leading E + VID approaches and critiques, and classified them according to their positions on normative strength, and views regarding designer agency. We identified 18 distinct approaches and 13 critiques that met the inclusion criteria for our review. Included papers were distributed across the spectrum of views regarding normative strength, and we found that no approaches and only one critique represented a view characteristic of “low” designer agency. We suggest that the absence of “low” designer agency approaches results in the neglect of crucial influences on design as targets of intervention by designers. We conclude with suggestions for future research that might illuminate strategies to achieve ethical design in information mature societies, and argue that without attending to the tensions raised by balancing normatively “strong” visions of the future with limitations imposed on designer agency in corporate-driven design settings, “meaningful” ethical design will continue to encounter challenges in practice. (shrink)

Approaches to clinical ethics dilemmas that rely on basic principles or rules are difficult to apply because of vagueness and conflict among basic values. In response, casuistry rejects the use of basic values, and specification produces a large set of specified rules that are presumably easily applicable. Balancing is a method employed to weigh the relative importance of different and conflicting values in application. We argue against casuistry and specification, claiming that balancing is superior partly because it most clearly exhibits (...) the reasoning behind moral decision-making. Hence, balancing may be most effective in teaching bioethics to medical professionals. (shrink)

My goal in this paper is to address what I call the ‘Incoherence’ objection to the growing universe theory of time. At the root of the objection is the thought that one cannot wed objective temporal becoming with the existence of a tenseless past—which is apparently what the growing universe theorist tries to do. To do so, however, is to attribute both dynamic and static aspects to time, and, given the mutual exclusivity of these two aspects—so the thought goes—incoherence results. (...) My solution to the problem is to offer an alternative account of past existence that is compatible with a dynamic conception of time. I take as my starting point Adams’ suggestion that the past exists in virtue of the existence of thisnesses of past individuals. I first seek to defend this suggestion, before amending it in order to provide a satisfactory response to the Incoherence objection. The result is a new growing universe theory which avoids the Incoherence objection but which has some surprising features of its own. Chief among these is the rejection of present events. I argue, however, that such a rejection is a necessary consequence of endorsing the growing universe theory, and that it is not as counter-intuitive as it initially sounds. (shrink)

In lieu of an abstract, here is a brief excerpt of the content: There is an abundance of scholarship on John Dewey. Dewey's writings are vast, so scholars try to find the crux that connects their many themes into a distinctive vision for philosophy and life. Many claim that the democratic way of life is the center of Dewey's philosophical vision. Others claim that Dewey's response to Darwin was the impetus for a philosophical experimentalism that could envision a better life (...) by responding to the needs in an age of modern industry. Some claim that the crux is a dynamic and non-mechanistic naturalism that Dewey develops to critically undo the dualisms of tradition, most especially the distinction between nature and culture. There has even been an effort to interpret each of these themes within Dewey's theory about the conditions for aesthetics in life, the life of art within an experience, and an experience of life as art. Arguably, no strategy is more preferable than another because each is plausible. Each plausibly selects a crux that connects the many themes across an array of writings, since Dewey's philosophy is multimodal by design and shuns reductionism for pluralism. Even amidst plurality, through many modes of activity and existence, each of these themes and all of Dewey's writings have a concern for meaning in life and how life is a process of meaning-making. And yet, meaning, for Dewey, is irreducible to verbal or written language and is made by more than propositions, but extends beyond the divide of nature and culture to potentially encompass all of life and life's processes. This expansive conception of meaning has more in common with semiotics, especially those of Charles Sanders Peirce, than any philosophy of language. And yet almost no scholar has sought to semiotically interpret Dewey's philosophy as a whole. Perhaps, though, Dewey's multimodal and pluralistic vision for philosophy and life also has a semiotic crux that intersects with the others in ways that are fundamentally important. There are scholars who have dealt with semiotic themes or insights with implications for semiotics in Dewey's writings. None have sought to semiotically interpret Dewey's philosophy as a whole, or, as a consequence, to chronologically survey Dewey's writings to determine if there is a conceivably Deweyan approach to semiotics that might contrast with or contribute to the more dominant approaches. There is a reason scholars may not have sought a Deweyan approach to semiotics. Dewey did not have an explicit theory of semiotics. There is no attempt to devise a doctrine of signs in Dewey's writings. Never did Dewey try to classify the fundamental types of sign, analyze the relations of signification by which they differ, or methodically explain how the logic of signification works. This contrasts sharply with Charles Sanders Peirce. Peirce has an explicit theory of semiotics that divides the fundamental types of sign into icons, indices, and symbols by their distinct relations of signification that are at work in the logic of inference by the categories. During his second year at Johns Hopkins, Dewey was actually Peirce's student in a class on logic. This already suggests the possibility of influence. Dewey's writings around 1883 even espouse the central thesis of Peirce's semiotics. All signs, however else their significations may differ, are triadic relations for both Peirce and Dewey. Whether and how far Peirce's logic was an influence on Dewey at Johns... (shrink)

Some bioethicists have argued in favor of a sliding scale notion of competence, paternalistically requiring greater competence in relation to more significant risk. I argue against a sliding scale notion, taking issue with the positions of Allen E. Buchanan and Dan W. Brock, Ian Wilkes, and Joel Feinberg. Rejecting arguments that a sliding scale is supported by legal cases, by ordinary usage, and by fallible judgments about competence, I argue in favor of greater evidence of competence when risk is greater. (...) Two clinical cases are examined, both involving amputation, to show that my fixed concept of competence, with a requirement of clearer evidence of competence when risk is high, better accounts for good moral decisions in bioethics. (shrink)

In this article we will draw on experiences from our own research on deep brain stimulation of the central thalamus in the minimally conscious state. We describe ethical challenges faced in clinical research involving medical devices and offer several cautionary notes about its funding and the interplay of market forces and scientific inquiry and suggest some reforms.

I begin by briefly mentioning two different logical fatalistic argument types: one from temporal necessity, and one from antecedent truth value. It is commonly thought that the latter of these involves a simple modal fallacy and is easily refuted, and that the former poses the real threat to an open future. I question the conventional wisdom regarding these argument types, and present an analysis of temporal necessity that suggests the anti-fatalist might be better off shifting her argumentative strategy. Specifically, two (...) points of interest emerge from my analysis: first, temporal necessity turns out to be an inappropriate and ineffective tool for the fatalist to make use of; and, second, the dismissal of the argument from antecedent truth value turns out to be an over-hasty one. (shrink)

This article addresses the problem of divine foreknowledge and human freedom by developing a modified version of Boethius' solution to the problem – one that is meant to cohere with a dynamic theory of time and a conception of God as temporal. I begin the article by discussing the traditional Boethian solution, and a defence of it due to Kretzmann and Stump. After canvassing a few of the objections to this view, I then go on to offer my own modified (...) Boethian solution, according to which temporal reality is fundamentally dynamic, but truth is not. My claim is that there are eternally existing, tenseless propositions, with determinate truth values, but that these are made true by events that come into existence, and are not themselves eternal.Send article to KindleTo send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle. Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply. Find out more about the Kindle Personal Document Service.Eternity, knowledge, and freedomVolume 49, Issue 1JOSEPH DIEKEMPER DOI: https://doi.org/10.1017/S0034412512000170Your Kindle email address Please provide your Kindle email.@free.kindle.com@kindle.com Available formats PDF Please select a format to send. By using this service, you agree that you will only keep articles for personal use, and will not openly distribute them via Dropbox, Google Drive or other file sharing services. Please confirm that you accept the terms of use. Cancel Send ×Send article to Dropbox To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about sending content to Dropbox. Eternity, knowledge, and freedomVolume 49, Issue 1JOSEPH DIEKEMPER DOI: https://doi.org/10.1017/S0034412512000170Available formats PDF Please select a format to send. By using this service, you agree that you will only keep articles for personal use, and will not openly distribute them via Dropbox, Google Drive or other file sharing services. Please confirm that you accept the terms of use. Cancel Send ×Send article to Google Drive To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about sending content to Google Drive. Eternity, knowledge, and freedomVolume 49, Issue 1JOSEPH DIEKEMPER DOI: https://doi.org/10.1017/S0034412512000170Available formats PDF Please select a format to send. By using this service, you agree that you will only keep articles for personal use, and will not openly distribute them via Dropbox, Google Drive or other file sharing services. Please confirm that you accept the terms of use. Cancel Send ×Export citation Request permission. (shrink)

ABSTRACTMichelle Amazeen's rebuttal of Uscinski and Butler 2013 is unsuccessful. Amazeen's attempt to infer the accuracy of fact checks from their agreement with each other fails on its own terms and, in any event, could as easily be explained by fact checkers’ political biases as their common access to the objective truth. She also ignores the distinction between verifiable facts and unverifiable claims about the future, as well as contestable claims about the causes of political, social, and economic phenomena. The (...) social benefits that she claims for the fact-checking enterprise must, at the very least, be weighed against the strong possibility that what passes for fact checking is actually just a veiled continuation of politics by means of journalism rather than being an independent, objective counterweight to political untruths. (shrink)

Recently, social epistemologists have sought to establish what the governing epistemic relationship should be between novices and experts. In this paper, I argue for, and expand upon, Helen De Cruz’s expert-as-teacher model. For although this model is vulnerable to significant challenges, I propose that a specifically extended version can sufficiently overcome these challenges (call this the “extended-expert-as-teacher” model, or the “EEAT” model). First, I show the respective weaknesses of three influential models in the literature. Then, I argue the expert-as-teacher model (...) can overcome its weaknesses by adding what I call the "Authority Clause", "Advisor Clause", and "Ex Post Facto Clause" of the EEAT model. After developing a robust account of these clauses, I entertain three major objections. First, I respond to the charge that the EEAT model is little better than the expert-as-authority model. Second, I respond to a double-counting objection. Lastly, I respond to a pragmatic objection from complexity. (shrink)

The Bush administration's military war on terrorism is a blunt, ineffective, and unjust response to the threat posed to innocent civilians by terrorism. Decentralized terrorist networks can only be effectively fought by international cooperation among police and intelligence agencies representing diverse nation‐states, including ones with predominantly Islamic populations. The Bush administration's allegations of a global Islamist terrorist threat to the national interests of the United States misread the decentralized and complex nature of Islamist politics. Undoubtedly there exists a “combat fundamentalist” (...) element within Islamism. But the threat posed to U.S. citizens by Islamist terrorism neither necessitates nor justifies as a response massive military invasions of other nations. Not only does the Bush administration's war on alleged “terrorist states” violate the doctrine of just war, but in addition these wars arise from a new, unilateral, imperial foreign‐policy doctrine of “preventive wars.” Such a doctrine will isolate the United States from international institutions and long‐standing allies. The weakening of these institutions and alliances will only weaken the ability of the international community to deter terrorism. (shrink)

ABSTRACTIn this paper I argue that a remotely piloted aircraft pilot’s act of killing remotely, when it is done in the defense of another person, can be viewed as an act of sacrifice. This argument concludes from two premises. First, the RPA pilot faces psychological risk to self by carrying out such an action; second, the RPA pilot is motivated to some significant degree by something other than self-interest. Moreover, I challenge both the view that RPA represent merely an incremental (...) development in technology yielding an incremental expansion of the distance between the war-fighter and the target and the view that RPA is revolutionary in some fundamental sense. I instead argue that, based upon the natural geometric boundary imposed by the earth’s shape, RPA have maximized the physical distance between the war-fighter and the target and, over time, this fact will change, not only the psychological effects on the RPA pilot, but also the way we view killing and distance in general. When taken togethe... (shrink)

Leading Frankfurt School theorist, Herbert Marcuse, possessed an intricate relationship with higher education. As a professor, Marcuse participated in the 1960s student movements, believing that college students had potential as revolutionary subjects. Additionally, Marcuse advocated for a college education empowered by a form of praxis that extended education outside the university into realms of critical thought and action. However, the more pessimistic facet of his theory, best represented in the canonical One Dimensional Man, now seems to be the dominant ideology (...) in the contemporary college experience. With the rise of the corporate university, knowledge is commodified and praxis is supplanted by rampant consumerism. Once a haven for critical theory, the college experience has been overtaken by capitalism, substantially limiting the revolutionary potential for college students in favour of an institutionalised, one dimensional university. (shrink)

Select groups and organizations embrace practices that perpetuate their inferiority. The result is the phenomenon we call “mediocrity.” This article examines the conditions under which mediocrity is selected and maintained by groups over time. Mediocrity is maintained by a key social process: the marginalization of the adept, which is a response to the group problem of what to do with the highly able. The problem arises when a majority of a group is comprised of average members who must decide what (...) to do with high performers in the group. To solve this problem, reward systems are subverted to benefit the less able and the adept are cast as deviant. Marginalization is a resolution of two tensions: marginalization of the adept for their behavior, and protection from the adept for the mediocre. The American research university is used as an example to describe the phenomenon and to formulate a theoretic argument. The forms and consequences of marginalization are discussed. Marginalizing the adept illustrates an anti-meritocratic behavioral pattern which serves to sustain social systems on which all people, however able, depend. (shrink)

This article examines the interpretive dimensions of human action. Although it takes the reflexive sociology of Pierre Bourdieu as its starting point, the article attempts to develop a more robust hermeneutical account of the reflexivity of social actors and those who study them than Bourdieu himself has considered. It is argued that interpretation is best understood not as the homologous expression of inculcated structures but rather as context-sensitive and reflexively context-transforming action—or what the author wishes to characterize, respectively, as first- (...) and second-order thematizations of embeddedness. The article concludes by contrasting the author's position with the thick description of Clifford Geertz. (shrink)

Susan D. McCammon and Nicole M. Piemonte offer a thoughtful and thorough commentary on our manuscript entitled “Expanding the use of Continuous Sedation Until Death.” In this reply we attempt to clarify and further defend our position. We show how continuous sedation until death is not a “first resort” but rather a legitimate option among many that should available to terminally ill patients whose life expectancy is less than six months. We also attempt to show that we do not equivocate (...) the meaning of palliative care as the commentators suggested. We argue that the traditional notion of palliative care should move beyond relief of “experienced suffering” to relief of potential suffering for those whose life expectancy is less than six months. Lastly, we challenge the commentator’s position that the realm of ordinary medicine” should be the guide to care, by showing how the notion of ordinary medicine has been successfully challenged in both bioethical scholarship and the courts in a way that shows ordinary medicine to be an evolving concept rather than a static, universal guide. (shrink)

As currently practiced, the use of continuous sedation until death (CSD) is controlled by clinicians in a way that may deny patients a key choice in controlling their dying process. Ethical guidelines from the American Medical Association and the American Academy of Pain Medicine describe CSD as a “last resort,” and a position statement from the American Academy of Hospice and Palliative Medicine describe it as “an intervention reserved for extreme situations.” Accordingly, patients must progress to unremitting pain and suffering (...) and reach a last-resort stage before the option to pursue CSD is considered. Alternatively, we present and defend a new guideline in which decisionally capable, terminally ill patients who have a life expectancy of less than six months may request CSD before being subjected to the refractory suffering of a treatment of “last resort.”. (shrink)

In this response to Paul Gaffney’s “The Nature and Meaning of Teamwork,” I draw on recent work in analytic social philosophy to provide a more robust vocabulary for understanding teamwork as a distinctly social fact. I argue that teamwork entails complex reflexive social cooperation aimed at achieving shared excellence within constraints of various kinds.

Organ donation after cardiac or circulatory death (DCD) has been introduced to increase the supply of transplantable organs. In this paper, we argue that the recovery of viable organs useful for transplantation in DCD is not compatible with the dead donor rule and we explain the consequential ethical and legal ramifications. We also outline serious deficiencies in the current consent process for DCD with respect to disclosure of necessary elements for voluntary informed decision making and respect for the donor's autonomy. (...) We compare two alternative proposals for increasing organ donation consent in society: presumed consent and mandated choice. We conclude that proceeding with the recovery of transplantable organs from decedents requires a paradigm change in the ethics of organ donation. The paradigm change to ensure the legitimacy of DCD practice must include: (1) societal agreement on abandonment of the dead donor rule, (2) legislative revisions reflecting abandonment of the dead donor rule, and (3) requirement of mandated choice to facilitate individual participation in organ donation and to ensure that decisions to participate are made in compliance with the societal values of respect for autonomy and self-determination. (shrink)