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)

With tumultuous changes occurring in the former Soviet Union, a unique opportunity exists to examine the implications of unethical behavior in what is,de facto, a totally unregulated market. Recent legalization of commodity trading in Moscow carried with it no legal structure to ensure swift compliance with contract terms. This paper demonstrates that in the absence of legal remedies, a free marketplace appropriately punishes unethical conduct.

The laboratory animal environment: room for concern.

The method of reflective equilibrium (MRE) is a method of justification popularized by John Rawls and further developed by Norman Daniels, Michael DePaul, Folke Tersman, and Catherine Z. Elgin, among others. The basic idea is that epistemic agents have justified beliefs if they have succeeded in forming their beliefs into a harmonious system of beliefs which they reflectively judge to be the most plausible. Despite the common reference to MRE as a method, its mechanisms or rules are typically expressed (...) in a metaphorical or simplified manner and are therefore criticized as too vague. Recent efforts to counter this criticism have been directed towards the attempt to provide formal explications of MRE. This paper aims to supplement these efforts by providing an informal working definition of MRE. This approach challenges the view that MRE can adequately be characterized only in the negative as a set of anti-essentialisms. I argue that epistemic agents follow MRE iff they follow four interconnected rules, which are concerned with a minimalistic form of foundationalism, a minimalistic form of fallibilism, a moderate form of holism, and a minimalistic form of rationality. In the critical spirit of MRE, the corresponding working definition is, of course, provisional and revisable. In general, the aim is to contribute to a reflective equilibrium (RE) concerning MRE. If it is successful, this working definition provides a better grasp of the most basic elements of the method and thereby enhances our understanding of it. (shrink)

The question of when or if a nation should intervene in another country’s affairs is one of the most important concerns in today’s volatile world. Taking John Stuart Mill’s famous 1859 essay “A Few Words on Non-Intervention” as his starting point, international relations scholar Michael W. Doyle addresses the thorny issue of when a state’s sovereignty should be respected and when it should be overridden or disregarded by other states in the name of humanitarian protection, national self-determination, or national (...) security. In this time of complex social and political interplay and increasingly sophisticated and deadly weaponry, Doyle reinvigorates Mill’s principles for a new era while assessing the new United Nations doctrine of responsibility to protect. In the twenty-first century, intervention can take many forms: military and economic, unilateral and multilateral. Doyle’s thought-provoking argument examines essential moral and legal questions underlying significant American foreign policy dilemmas of recent years, including Libya, Iraq, and Afghanistan. (shrink)

Machine learning algorithms pervade contemporary society. They are integral to social institutions, inform processes of governance, and animate the mundane technologies of daily life. Consistently, the outcomes of machine learning reflect, reproduce, and amplify structural inequalities. The field of fair machine learning has emerged in response, developing mathematical techniques that increase fairness based on anti-classification, classification parity, and calibration standards. In practice, these computational correctives invariably fall short, operating from an algorithmic idealism that does not, and cannot, address systemic, Intersectional (...) stratifications. Taking present fair machine learning methods as our point of departure, we suggest instead the notion and practice of algorithmic reparation. Rooted in theories of Intersectionality, reparative algorithms name, unmask, and undo allocative and representational harms as they materialize in sociotechnical form. We propose algorithmic reparation as a foundation for building, evaluating, adjusting, and when necessary, omitting and eradicating machine learning systems. (shrink)

Michael W. Fox, the respected Vice President of the Humane Society of the United States, here looks at the biogenetic controversy and draws some troubling conclusions. Biogenetic research is capable of producing new life forms whose effects may alter the intricate balance of Nature in ways no one can foretell. "Superpigs" that grow larger than any pig before, cows that breed on an accelerated cycle, "new" vegetables, tomatoes that won't freeze - such new life forms can now be patented, (...) making them potential sources of enormous profits for biotech companies. And the record of government, academia, and industry is spotty at best at protecting the earth - yet these same forces are in control of the biogenetic future. Superpigs and Wondercorn is at once an eye-opening survey of a dramatic, sometimes frightening new technology and an impassioned plea to use these new tools in the long-term interests of the global ecosystem. (shrink)

Proposals for a universal basic income have reemerged in public discourse for a variety of reasons. Marx’s critique of exploitation suggests two apparently opposed positions on a basic income. On the one hand, a basic income funded from taxes on labor would appear to be exploitative of workers. On the other hand, a basic income liberates everyone from the vulnerable condition in which one is forced to sell one’s labor in order to survive, and so seems to be one way (...) of abolishing exploitation at its root. This paper will develop a conception of exploitation that resolves the conflict in favor of basic income. The conception of exploitation is grounded in a liberal egalitarian conception of justice rather than in Marx’s labor theory of value or an exclusive focus on the worker-capitalist relation. This position is not premised on an acceptance of the basic institutions of capitalism, but rather is a standpoint from which to evaluate them. It is not necessary to downsize our ideas of freedom and equality. But it is less obvious than it appeared in classic Marxist formulations that socialism is necessary for social justice. To quote the title of a famous article, there could be a ‘capitalist road to communism’, if a substantial basic income is feasible in a capitalist society. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Journal of the History of Philosophy 39.4 (2001) 584-585 [Access article in PDF] Phillip Cary. Augustine's Invention of the Inner Self: The Legacy of a Christian Platonist. New York: Oxford University Press, 2000. Pp. xvii + 214. Cloth, $45.00. In a gloss on the well-known gospel text, G. K. Chesterton noted that it is precisely because salt is unlike the foods it preserves that it is able to do (...) its distinctive work of preservation. Likewise, according to the thesis of this book, it is precisely because Augustine of Hippo invented his distinctive approach to interiority that he has done so much to preserve for the Western tradition the Platonic conception of the soul. Yet Augustine's contribution to the philosophy of the inner self is not simply one of inventio in the classical sense of a discovery of the Platonic self, it is also an innovation pointing philosophy in a new direction.Using a series of provocative images, Phillip Cary outlines the history of the idea of the private inner self in a way that highlights Augustine's distinctive contribution. He begins with Plato's Allegory of the Cave wherein the soul or self is an eye that has escaped the lower darkness to gaze upward away from itself toward the sun achieving intellectual vision. This idea is developed by Plotinus, for whom the soul is like a sphere revolving around the inner source of intelligibility at the center of things. This soul can look out toward the darkness or inward toward the intelligible light. In a further development, Augustine pictures the self as an inner palace with large courtyards open to the intelligible light of the sun such that the eye of the soul must turn inward and then upward to be enlightened. The final modern development is represented by Locke's picture of the self as a dark room where nothing but images are projected within through windows out of which the self cannot see, the intelligible light of the sun being kept out. Introducing the notion of the private inner life, Augustine is the forerunner of modern philosophy and all that has followed from the Cartesian turn. Yet Augustine is also a Platonist seeking the source of intelligibility that enlightens the inner self taking it beyond itself. This dual thesis is defended by Cary through a study of Augustine's place in the Platonic tradition of inner divinity. The task takes up the [End Page 584] first half of the book and builds on the well-known studies of Augustine's Platonism by J. J. O'Meara, R. J. O'Connell, and others. The second part of the book is devoted to Augustine's innovations of privacy and the inward-upward turn and yields some surprising discoveries that will interest the historian of philosophy.One surprise concerns Augustine's expressionist semiotics according to which signs are outward expressions of what is within. As a Platonist, however, Augustine also holds that signs signify intelligible things that nonetheless fail to be made truly intelligible by signs. The knower, then, does not grasp the intelligible thing from its being signified by the sign, but grasps the significance of a sign by knowing the intelligible thing it signifies. Thus, according to the De Doctrina Christiana, the correct interpreter of scripture is the one who already knows the spiritual things the words of scripture signify and, therefore, is not a slave to a literal interpretation of these words.Another surprise is Augustine's notion of grace as a sort of Platonic eros. Operating by attraction rather than coercion, grace is as much directed at the reason as the will. Thus, the discussions of grace as inward teaching in the anti-Pelagian works is a development of Christ, the inner teacher of the De Magistro, and Reason, the inner teacher of the Soliloquies.Yet another surprise concerns the traditional faith-reason problem. Rather than seeing faith and reason as contrasting modes of inner cognition of outward objects, Augustine associates faith with authority as external... (shrink)

Page is to be congratulated for challenging some misconceptions about neural representation. However, his target article, and the commentaries to it, highlight that the terms “local” and “distributed” are open to misinterpretation. These terms provide a poor description of neural coding strategies and a better taxonomy might resolve some of the issues.

In February of 2007, the Responsible Conduct of Research Education Committee of the Association for Practical and Professional Ethics convened a mini-conference at the Association’s annual meeting. The purpose of the mini-conference was to examine underserved areas of education in research ethics. The mini-conference consisted of panel discussions for two topics: authorship and social responsibility. Representatives from diverse academic disciplines were invited to participate in each of the two panels. This Special Section of Science and Engineering Ethics consists of the (...) papers based on presentations in the authorship panel. The papers illustrate similarities and differences in authorship and publication practices in various disciplines including engineering, the life sciences, and the social sciences. (shrink)

Michael W. Tkacz - Quaestiones super librum Posteriorum - Journal of the History of Philosophy 40:3 Journal of the History of Philosophy 40.3 392-393 Book Review Quaestiones super librum Posteriorum Walter Burley. Quaestiones super librum Posteriorum. Edited by Mary Catherine Sommers. Toronto: Pontifical Institute of Mediaeval Studies, 2000. Pp. x + 214. Cloth, $34.95. In his monumental Le Système du Monde, Pierre Duhem notes that it is difficult to link the fourteenth-century scholastic Walter Burley to any particular school on (...) account of his eclecticism. Indeed, throughout much of the twentieth century, Burley has.. (shrink)

abstract In this paper, I first develop a neo-Aristotelian account of the virtue of magnanimity. I then apply this virtue to ethical issues that arise in sport, and argue that the magnanimous athlete will rightly use sport to foster her own moral development. I also address how the magnanimous athlete responds to the moral challenges present in sport by focusing on the issue of performance-enhancing drugs, and conclude that athletic excellence as it is conventionally understood, without moral excellence, has very (...) little value. (shrink)

Examines political philosophies of the classic theorists as a means to understand international dilemmas in the post-Cold War world.

Sport builds character. If this is true, why is there a consistent stream of news detailing the bad behavior of athletes? We are bombarded with accounts of elite athletes using banned performance-enhancing substances, putting individual glory ahead of the excellence of the team, engaging in disrespectful and even violent behavior towards opponents, and seeking victory above all else. We are also given a steady diet of more salacious stories that include various embarrassing, immoral, and illegal behaviors in the private lives (...) of elite athletes. Elite sport is not alone in this; youth sport has its own set of moral problems. Parents assault officials, undermine coaches, encourage a win-at-all costs mentality, and in many cases ruin sport for their children. (shrink)

This paper examines the critical role that organizational leaders play in establishing a values based climate. We discuss seven mechanisms by which leaders convey the importance of ethical values to members, and establish the expectations regarding ethical conduct that become engrained in the organizations climate. We also suggest that leaders at different organizational levels rely on different mechanisms to transmit values and expectations. These mechanisms then influence members practices and expectations, further increase the salience of ethical values and result in (...) the shared perceptions that form the organizations climate. The paper is organized in three parts. Part onebegins with a brief discussion of climates regarding ethics and the critical role of values. Part two provides discussion on the mechanisms by which leaders and members transmit values and create climates related to ethics. Part three provides a discussion of these concepts with implications for theory, research, and practice. (shrink)

Globalisation impacts every aspect of modern society and today's law graduates are expected to deal with complex legal problems that require knowledge and training that goes beyond domestic law. This textbook provides an overview of how law is becoming increasingly transnational, facilitating theoretical and practical engagement with transnational legal institutions and phenomena. It advances an analytic framework that will help students to understand what to look for when they encounter transnational legal institutions and practices, and what are the practical and (...) normative implications of their findings. By considering both the theory and practice of transnational law and taking a discursive approach to the material, students are encouraged to arrive at their own conclusions. Adopting interdisciplinary techniques and using case studies from around the world, this book offers a holistic, balanced exploration of a new and emerging discipline. This title is also available as Open Access on Cambridge Core. (shrink)