Rationale Treatment guidelines recommend a more conservative surgical approach than mastectomy for early stage breast cancer and a stronger emphasis on adjuvant therapy. Registry data at South Australian teaching hospitals have been used to monitor survivals and treatment in relation to these guidelines.Aims and objectives To use registry data to: (1) investigate trends in survival and treatment; and (2) compare treatment with guidelines.Methods Registry data from three teaching hospitals were used to analyse trends in primary courses of treatment of breast (...) cancers during 1977–2003 (n = 4671), using univariate analyses and multiple logistic regression. Disease-specific survivals were analysed using Kaplan–Meier product limit estimates and multivariable Cox proportional hazards regression.Results The 5-year survival was 79.9%, but with a secular increase, reaching 83.6% in 1997–2003. The relative risk of death (95% confidence limits) was 0.74 (0.62, 0.88) for 1997–2003, compared with previous diagnoses, after adjusting for tumour node metastasis stage, grade, age and place of residence. Treatment changes included an increase in conservative surgery (as opposed to mastectomy) from 51.7% in 1977–1990 to 76.8% in 1997–2003 for stage I (P < 0.001) and from 31.1% to 52.2% across these periods for stage II (P < 0.001). Adjuvant radiotherapy also became more common (P < 0.001), with 20.6% of patients receiving this treatment in 1977–1990 compared with 60.7% in 1997–2003. Radiotherapy generally was more prevalent when conservative surgery was provided, although also relatively common in mastectomy patients when tumour diameters exceeded 50 mm or when there were four or more involved nodes. The proportion of patients receiving chemotherapy increased (P < 0.001), from 19.6% in 1977–1990 to 36.9% in 1997–2003, and the proportion having hormone therapy also increased (P < 0.001), from 34.3% to 59.4% between these periods.Conclusions Survivals appear to be increasing and treatment trends are broadly consistent with guideline directions, and the earlier research on which these recommendations were based. (shrink)

The social and legal practices of blaming, praising, punishing and rewarding are inextricably linked with the process of ‘holding responsible’. Blame, praise, and the like exist as means of holding agents to account that is distinct from, but reliant upon, attributions of responsible agency. When claims of accountability are made without access to an underlying shared attribution of responsibility, the communicative role of accountability is undermined. Disagreement over blame and praise is reduced to disparity: able to hear only that something (...) is a bad or good thing, we are left unable to understand what the bad thing is, or why it is bad. Responsibility as we employ it offers the basis for our evaluations of agents. However, conceptions of responsibility that focus on agent capacities, namely control and rationality, fail to give responsibility a meaning capable of fulfilling this purpose. The retrospective responsibility of agents for events does not result from the capacities of those agents. It is at.. (shrink)

Automated vehicles promise much in the way of both economic boons and increased personal safety. For better or worse, the effects of automating personal vehicles will not be felt for some time. In contrast, the effects of automated work vehicles, like semi-trucks, will be felt much sooner—within the next decade. The costs and benefits of automation will not be distributed evenly; while most of us will be positively affected by the lower prices overall, those losing their livelihoods to the automated (...) semi-trucks and other similar work vehicles will be much worse off. This sets up a classic distributive justice problem: how do we balance the harms and benefits of automation? In this paper, the authors recommend work alternatives: policies that the government would enact in order to ensure that each person could live a decent life even if one could not work, especially for reasons like having one’s job automated. After arguing for this position, we propose some policy guidelines. (shrink)

Justice and Leadership in Early Islamic Courts Edited by Intisar A. Rabb and Abigail Krasner Balbale, xvii + 241 pp. Price HB $45.00. EAN 978–0674984219.

John Wilkins and Malte Ebach respond to the dismissal of classification as something we need not concern ourselves with because it is, as Ernest Rutherford suggested, mere ‘‘stamp collecting.’’ They contend that classification is neither derivative of explanation or of hypothesis-making but is necessarily prior and prerequisite to it. Classification comes first and causal explanations are dependent upon it. As such it is an important (but neglected) area of philosophical study. Wilkins and Ebach reject Norwood Russell Hanson’s thesis that classification (...) relies on observation that is theory-laden and deny the need for aetiological assumptions and historical reconstruction to justify its arrangement. What they offer instead is a significant (albeit controversial) contribution to the philosophical literature on classification, a pre-theoretic natural classification based on the observation of patterns in data of ready-made phenomena. Their notion of ready-made phenomena rests on a conception of tacit knowledge or know-how. This is evident in their distinction between strong Theory-dependence and na ̈ıve theory-dependence. Their small t-theory-dependence permits patterns of observation that facilitate know-how but does not rely on a domain-specific explanatory theory of their aetiology. Wilkins and Ebach suggest classification differs from theory building in that it is passive (whereas theory building is active). Classification is possible just because it does not require the sieve of theory to capture classes that are ‘‘handed to you by your cognitive dispositions and the data that you observe’’ (p. 18). Finding regularities sans-theory is just something we do and can do without any prior theory about the underlying causes or origins of the resultant regularities. Luke Howard’s classification of clouds serves as an exemplar of a passive, theory-free classification system and the periodic table and the DSM help to illustrate this type of non-aetiological patterning. A recurrent theme is the nature of naturalness. For Wilkins and Ebach, the conception of naturalness is not one that is based on the generation or discovery of natural kind categories popular in both the traditional metaphysics of Mill and Wittgenstein as well as updated notions within philosophy of biology such as Boyd’s Homeostatic Property Cluster kinds. Instead, Wilkins and Ebach define the naturalness of classification as the falling into hierarchical patterns, aligning the search for natural arrangement with the aim of systematics, and as something that is grounded in a cognitive task or activity. However, they leave the question of realism v. antirealism open. ‘‘In natural classification...we must have real relations no matter how we might interpret ‘real’’’ (p. 70). There is tension with regard to their ontological commitments as they vacillate between constructive, operationalist, and realist approaches. Wilkins and Ebach initially define real as that which is causal and important (pp. 70–71), and later as that which ‘‘depends in no way upon a mind or observer’’ (p. 122). This makes their claim that there was ‘‘no real theory involved [in the pre-Darwinian classifications of Jussieu and Adanson]’’ (p. 64) difficult to interpret. Cont’d……. (shrink)

Various political realists claim the superior ‘action-guiding’ qualities of their way of approaching normative political theory, as compared to ‘liberal moralism’. This paper subjects that claim to critique. I first clarify the general idea of action-guidance, and identify two types of guidance that a political theory might try to offer – ‘prescriptive action-guidance’ and ‘orienting action-guidance’ – together with the conditions that must be met before we can understand such guidance as having been successfully offered. I then go on to (...) argue that if we take realist understandings of political psychology seriously, then realist attempts to offer action-guidance appear to fail by realism’s own lights. I demonstrate this by means of engagement with a variety of different realist theorists. (shrink)

David DeGrazia’s stated purposes for Taking Animals Seriously are to apply a coherentist methodology to animal ethics, to do the philosophical work necessary for discussing animal minds, and to fill in some of the gaps in the existing literature on animal ethics.

First published in 1995. Routledge is an imprint of Taylor & Francis, an informa company.

Scholars have long been aware of striking similarities between a crucial passage in Book II of Plato’s Republic and the longest papyrus fragment surviving from Antiphon’s On Truth. Previous scholarship has identified some views common to both texts but has not explained how these views hang together in a unified and coherent ethical outlook. A deeper investigation into these two texts turns up a blueprint for Greek immoralist arguments, a finding which should be of considerable interest to scholars of ancient (...) Greek ethics and political philosophy. The paper argues that both texts include an argument whose demonstrandum is that it is by nature good or advantageous to commit injustice when one can do so undetected; that this argument in each case involves a set of background premises that constitute a blueprint for immoralist arguments in Classical Athens; and that the immoralist ethical theory of Republic II is an outline distilled from several more detailed theories, including the one belonging to On Truth. (shrink)

Mackie famously argued for a moral error theory on the basis that objective moral values, if they existed, would be very queer entities. Unfortunately, his argument is very brief and it is not totally obvious from what he says exactly where the queerness of moral values is supposed to lie. In this paper I will firstly show why a typical interpretation of Mackie is problematic and secondly offer a new interpretation. I will argue that, whether or not we have reason (...) to live in the morally correct way, what seems queer about moral properties is that there is a morally correct way in which to live in the first place. This interpretation makes sense of Mackie’s claim that theism might be able to solve the queerness problem; the notion of an objectively correct way to live may make sense if theism is true, but not otherwise. (shrink)

[Abstract and PDF at the Pittsburgh PhilSci Archive] A slightly shorter version of this paper is to appear in a volume edited by Jonathan Barrett, Adrian Kent, David Wallace and Simon Saunders, containing papers presented at the Everett@50 conference in Oxford in July 2007, and the Many Worlds@50 meeting at the Perimeter Institute in September 2007. The paper is based on my talk at the latter meeting (audio, video and slides of which are accessible here).

How do we show what we know? How do the models used to interpret, build understanding and sustain relationships with the world, work? Artificial intelligence models – particularly those characterized as ‘deep’ learning models – provoke a reframing of, and renewed attention to, these basic questions. Machines designed to learn through continuous, embedded use give rise to a form of automated intersubjectivity premised on normative notions of continuity, completeness and repair that are often opaque. A turn to poetic practice may (...) revivify supple categories of human and non-human, with attentive connection across multiple worlds, discursively explaining these models even as they enfold us. A companion video to this text can be viewed at: https://vimeo.com/525096901. (shrink)

This study reassesses the concept of the Anthropocene as a new geological age as it is influencing contemporary debates in social theory. As a unit of geological time whose changes are allegedly caused, directly and indirectly, by human beings, this scientific concept challenges the existing constructions of theoretical binaries, such as nature/culture, environment/society, objectivity/subjectivity or happenstance/design, in social theory. The analysis suggests many understandings of the Anthropocene in social theory are politicized over-interpretations of natural events, and these moves appear to (...) be developing moral rhetorics of, and operational plans for, managing the Anthropocene to create specific outcomes for those who are the managers as well as the managed. The fact that human beings do not, in fact, have this measure of technical control is ignored by advocates of Anthropocenarian politics to advance their policy agendas. (shrink)

It is standard practice to appeal to libertarian free will to explain how God’s existence might be compatible with much of the evil we see in the actual world. Libertarian free will has also been important to certain responses to the argument for atheism from divine hiddenness. But what is often neglected in appealing to libertarian free will, as others have pointed out, is an explanation of why God would create us with such free will in the first place. Laura (...) Ekstrom argues that free will is simply not worth its cost. J.L. Schellenberg goes a step further and argues that, if it turns out we have libertarian free will, that is actually evidence against God’s existence. In this paper I discuss a couple reasons God might have for creating libertarian free will. (shrink)

Background Speaking up to safeguard patients is a crucial ethical and moral obligation for nurses, but it is also a difficult and potentially dangerous component of nursing work. Health advocacy is gaining impetus in the medical literature, despite being hampered by barriers resulting in many nurses in Ghana remaining mute when faced with advocacy-required situations. We explored situations that thwart nurses from performing their health advocacy role. Research question What would cause nurses to take no action when they witness situations (...) that require them to act as health advocates for their clients or communities? Research Design An inductive, descriptive qualitative design was used to collect and analyse data on barriers that prevent nurses from practising their health advocacy role in Ghana. Individual one-on-one in-depth interviews were conducted using a semi-structured interview guide. The data were analysed using qualitative content analysis. Participants and research context Twenty-four professional nurses and midwives registered with the Nursing and Midwifery Council were recruited from three regional hospitals in Ghana. These public hospitals were chosen from the upper, middle and coastal regions. Ethical considerations The UKZN Ethics Review Committee in South Africa and the GHS Ethics Review Committee in Ghana both gave their approval for this study. Findings Intrapersonal barriers, interpersonal barriers, and structural barriers emerged as major obstacles that nurses experience when performing their health advocacy role. Conclusions Barriers to health advocacy have undermined nurses' ability to function as health advocates and are preventing them from utilising their health advocacy position in nursing practise. Giving nursing students positive role models in the classroom and in the clinic can help them become more effective health advocates. (shrink)

I analyze the “Sportsman’s Code,” arguing that several of its rules presuppose a respect for animals that renders hunting a prima facie wrong. I summarize the main arguments used to justify hunting and consider them in relation to the prima facie case against hunting entailed by the sportsman’s code. Sport hunters, I argue, are in a paradoxical position—the more conscientiously they follow the code, themore strongly their behavior exemplifies a respect for animals that undermines the possibilities of justifying hunting altogether. (...) I consider several responses, including embracing the paradox, renouncing the code, and renouncing hunting. (shrink)

Large‐scale characterization of the human microbiota has largely focused on Western adults, yet these populations may be uncharacteristic because of their diets and lifestyles. In particular, the rise of “Western diseases” may in part stem from reduced exposure to, or even loss of, microbes with which humans have coevolved. Here, we review beneficial microbes associated with pathogen resistance, highlighting the emerging role of complex microbial communities in protecting against disease. We discuss ways in which modern lifestyles and practices may deplete (...) physiologically important microbiota, and explore prospects for reintroducing or encouraging the growth of beneficial microbes to promote the restoration of healthy microbial ecosystems. (shrink)

In this essay I take issue with Derrida's interpretation of Husserl's phenomenology of internal time-consciousness in Speech and Phenomena. Derrida's critique of Husserl's phenomenology of time also forms the basis for what Derrida regards to be an undermining of phenomenological philosophy itself. After first disagreeing with Derrida's interpretation of Husserl's understanding of time I proceed to object to his “undermining” of phenomenology. I attempt to illustrate that his critique of phenomenology is unconvincing.

J.L. Schellenberg argues that one reason to think that God does not exist is that there are people who fail to believe in Him through no fault of their own. If God were all loving, then He would ensure that these people had evidence to believe in Him so that they could enter into a personal relationship with Him. God would not remain ‘hidden’. But in the world, we actually do find people who fail to believe that God exists, and (...) their nonbelief does not seem to be due to their resisting God. I argue that if there are valuable goods brought about by God’s hiddenness, then even if each of those goods might obtain without hiddenness, God would have a sufficient reason for remaining hidden so long as enough of those goods would be made sufficiently more valuable because of God’s hiddenness. If this is the case, then the existence of ‘nonresistant nonbelievers’ in the actual world does not entail that God does not exist. (shrink)

A long encyclopedia entry, sketching his life, analysing his work.

Some have argued that God would not allow some person S to be the victim of an evil for the sake of some good G unless G benefits S in particular, not just someone else. Is this true and, if so, is a similar principle true regarding divine hiddenness? That is, would God remain hidden from some person S for the sake of some good G only if G benefits S? I will argue that this principle has a number of (...) exceptions, even in the context of evil, but particularly in the context of divine hiddenness. (shrink)

There is a surprising absence of systematic theological reflection on what the church’s response to refugees should be and how its response relates to wider debates on the duty of care to refugees. This article situates theological concerns within wider philosophical debate on what the duty of care to refugees consists of. The first section critically reviews the debate on how liberal democracies should respond to refugees. The second section, following Georgio Agamben’s characterisation of refugees as ‘bare life’, argues that (...) refugees unveil a deep contradiction in contemporary patterns of political sovereignty. It closes by arguing that while a theological account of political authority points to some roads beyond the crisis, the first task of the church is to properly order its own duty of care to refugees. The last section consists of an exegesis of the second clause of the Lord’s Prayer as a way of giving an account of what such care involves. (shrink)

A commentary on: The Alleged Coupling-Constitution Fallacy and the Mature Sciences by Ross, D., and Ladyman, J. (2010). The Extended Mind, ed R. Menary (Cambridge, MA: MIT Press), 155–166.

Leibovich et al. challenge the prevailing view that non-symbolic number sense is innate, that detection of numerosity is distinct from detection of continuous magnitude. In the present commentary, the authors' viewpoint is discussed in light of the integrative theory of numerical development along with implications for understanding mathematics disabilities.

Bell’s theorem requires the assumption that hidden variables are independent of future measurement settings. This independence assumption rests on surprisingly shaky ground. In particular, it is puzzlingly time-asymmetric. The paper begins with a summary of the case for considering hidden variable models which, in abandoning this independence assumption, allow a degree of ‘backward causation’. The remainder of the paper clarifies the physical significance of such models, in relation to the issue as to whether quantum mechanics provides a complete description of (...) physical reality. (shrink)

A brief, opinionated summary of the papers in the Ratio special edition on incommensurability and vagueness.

ABSTRACT The demand for sublimation of one's primitive and “evil” instincts plays a crucial role in Nietzsche's ethics. But prominent misreadings of Nietzsche's concept of sublimation have led to errors in interpreting his view of the highest type of man. I argue that Nietzsche's view of sublimation is that it is the elevation of the objects of a drive through reinterpretation or reimagining them in such a way that the attainment of these new objects achieves a greater potency of expression (...) for the drive while retaining its intrinsic aims. I also clarify the function of sublimation in his ethics. (shrink)

. The author first engages the problem of defining the value of a photograph, not in terms of its commercial or monetary value but of its actual or potential use. Walter Benjamin's influential writings on photography are discussed, notably his complex metaphor of "aura" as applied to both handmade art and the photograph, with the author challenging Benjamin's contention that works of art do not require titles, whereas photographs do.

Richard Boyd and Robert Adams have both developed semantic accounts of moral terms based on Hilary Putnam's causal regulation theory for natural kind terms, according to which the terms in question refer to the properties which predominantly causally regulated the terms. However, Terence Horgan and Mark Timmons have mounted an objection to Boyd's semantics—their Moral Twin Earth argument. If this argument is successful against Boyd then it might be thought that it should also be successful against Adams, given the similarity (...) between their semantic accounts. I will argue in this essay that Adams's semantics is sufficiently different from Boyd's to enable him to survive Moral Twin Earth, but that he is vulnerable to a modified version of Moral Twin Earth that I describe. (shrink)

Expressivism is supposed to have an advantage over moral realism, in that it can explain why it is a conceptual truth that the moral supervenes on the natural, even though the natural does not entail the moral. I develop an analogy between expressivism and a version of theistic moral realism, and argue that this version of theistic moral realism shares any advantage that expressivism might have. It may be that the alleged advantage that expressivism has over moral realism is overstated. (...) Nevertheless, possible analogies between expressivism and theistic moral realism have received very little attention in the past, and are worth considering for their own sake. (shrink)

In recent years, attempts to reconcile God's exhaustive providential control over the future and human freedom frequently appeal to Molinism. Through the theory of Middle Knowledge, it is claimed, God can exercise meticulous providence over free creatures while preserving the libertarian agency of those creatures. Historically, both Thomist and Reformed theologians have critiqued the theory of Middle Knowledge for effectively eliminating God's aseity, making God's knowledge in some sense dependent on some non-God reality. In this paper, I aim to push (...) the discussion forward by integrating Thomist, Molinist, and Reformed perspectives in the view I call Molinist Thomist Calvinism. By resourcing each of these views, I try to offer a coherent way to affirm God's meticulous providence, including God's unconditional election of some and not others, and morally significant human freedom. (shrink)

State governments provide preprinted advance directive forms to the general public. However, many adults in the United States (US) lack the skills necessary to read and comprehend health care-related materials. In this study, we sought to determine the readability of state government-sponsored advance directive forms.