Objective: Even when critically ill patients are almost certain to die from their illnesses, there is generally an element of prognostic uncertainty. Little is known about how physicians handle this uncertainty in conversations with surrogate decision makers. We sought to evaluate whether and how physicians discuss prognostic uncertainty with surrogate decision makers of patients who are highly likely, but not certain, to die. Design: We audiotaped and transcribed discussions between clinicians and surrogate decision makers at two major California teaching hospitals (...) from 2006 through 2008. Physicians completed a questionnaire addressing their prognostic estimates for patients' survival to hospital discharge. Participants: We included physicians and surrogates of 12 incapacitated, critically ill patients. Measurements: We analyzed transcripts of discussions in which physicians' estimates of patients' chances of hospital survival were 1% to 5%; we coded whether physicians disclosed the prognostic uncertainty and, if so, how they conveyed that death was highly likely but not certain. Results: Physicians' estimates of short-term survival were 1% to 5% for 12 of the 70 patients enrolled in the original study. In 8 of 12 cases, physicians conveyed prognostic uncertainty by using probabilistic language or by an explicit mention of uncertainty. In four cases, physicians made at least one statement that either implied or was ambiguous about whether death was certain. Conclusion: We observed variability in how physicians handle prognostic uncertainty in their discussions with surrogates of patients who are highly likely, but not certain, to die, including some circumstances in which physicians stated or implied that death was certain. (shrink)

Iris Murdoch’s The Black Prince is narrated by a convicted felon named Bradley Pearson, looking back on his former adventures culminating in the death of the author Arnold Baffin. Bradley writes while in prison for Arnold’s murder, and between various speculative and philosophical remarks on Love and Art, Bradley relates a story that, if true, would make his conviction a miscarriage of justice. According to Bradley, Arnold was a victim of domestic violence, killed by his wife, (...) class='Hi'>Rachel. The fact that the police discovered Bradley standing by Arnold’s corpse and holding the murder weapon is apt to mislead, according to Bradley.For simple readers, the verdict of those who heard all the evidence in court might be.. (shrink)

This book derives from Annas’s 1997 Townsend Lectures at Cornell University, and it retains the invigorating clarity and fast pace of a first-rate lecture series. In it Annas discusses assorted topics in Plato’s ethics and their ancient interpretation: her unifying theme is that we have much to learn from ancient readings of Plato, and those of the Middle Platonists in particular.

Through the thickets of recent debates, I take two facts as clear enough starting points. The first is that Heidegger’s participation in National Socialism, and especially his remarks and pronouncements after the war, were, and remain, horrifying. The second is that Heidegger remains of the essential philosophers of our century; Maurice Blanchot testifies for several generations when he refers to the “veritable intellectual shock” that the reading of Being and Time produced in him.5 And Emmanuel Levinas, not hesitating to express (...) his reservations about Heidegger, can nevertheless bring himself to say that a person “who undertakes to philosophize in the twentieth century cannot not have gone through Hiedegger’s philosophy, even to escape it.”6 In this century, perhaps only Ludwig Wittgenstein has had a comparable impact and influence on philosophy. I do not mean to deny that one can reject the over seventy volumes of Heidegger’s Gesamtausgabe as worthless, that one can, as with Wittgenstein, find that his work is obscure, indulgent, impossible to read, that nothing in it contributes to philosophy. But both Heidegger and Wittgenstein write in anticipation of this reaction, recognizing that their desires, differently articulated, to overcome philosophy will help to determine how their writing is received. Stanley Cavell’s characterization of Wittgenstein’s Philosophical Investigations describes Heidegger as well:Philosophical Investigations, like the major modernist works of the past century at least, is, logically speaking, esoteric. That is, such works seek to split their audience into insiders and outsiders ; hence they create the particular unpleasantness of cults ; hence demand for their sincere reception the shock of conversion.7When combined with Heidegger’s political engagement, the particular unpleasantness of cults and indifference are more than joined. Thus it can seem as though one must either exculpate Heidegger, explain away his relation to Nazism as an aberration from the outside, or reject his thought entirely, declare that his books should no longer be read. In an attempt to begin to confront these issues, Critical Inquiry is publishing this symposium. 5. Maurice Blanchot, “Thinking the Apocalypse: A Letter from Maurice Blanchot to Catherine David,” trans. Paula Wissing, p. 479 of this issue.6. Emmanuel Levinas, Ethics and Infinity: Conversations with Philippe Nemo, trans. Richard A. Cohen , p. 42. See also the last line of Gadamer, “ ‘Back from Syracuse?’ “ p. 430.7. Stanley Cavell, The Claim of Reason: Wittgenstein, Skepticism, Morality, and Tragedy , p. xvi; hereafter abbreviated CR. Arnold I. Davidson, a coeditor of Critical Inquiry, is associate professor of philosophy and member of the Committees on General Studies in the Humanities and on the Conceptual Foundations of Science at the University of Chicago. His most recent contribution to Critical Inquiry is “Sex and the Emergence of Sexuality”. (shrink)

Our ability to generate genomic data is currently well ahead of our ability to understand what they mean, raising challenges about how best to engage with them. This article considers ethical aspects of work with such data, focussing on research contexts that are intertwined with clinical care. We discuss the identifying nature of genomic data, the medical information intrinsic within them, and their linking of people within a biological family. We go on to consider what this means for consent, the (...) importance of thoughtful sharing of genomic data, the challenge of constructing meaningful findings, and the legacy of unequal representation in genomic datasets. We argue that the ongoing success of genomic data research relies on public trust in the enterprise: to justify this trust, we need to ensure robust stewarding, and wide engagement about the ethical issues inherent in such practices. (shrink)

Paradigmatically, natural kinds are the kinds of thing or stuff that are classified by the natural sciences. The periodic table provides perhaps the best example of the potential importance of natural kinds for science. In the philosophy of psychiatry, debates over whether mental disorders can be natural kinds emerge because kinds of mental disorder are manifestly different from chemical kinds in various ways. While chemical kinds are precise, psychiatric kinds are fuzzy. While chemical kinds are objective, the identification of psychiatric (...) kinds is value-laden. Psychiatric classification involves classifying people, and unlike chemical elements, those people can respond to being classified in various ways. This chapter goes through these differences, one-by-one, and argues that despite them, mental disorders may be natural kinds. (shrink)

In this paper, we explore the philosophical and theological issues that arise when a ‘religious’ process of decision-making, which is normally taken to require specific theological commitments both for its successful use and for its coherent explanation, is transferred into ‘secular’ contexts in which such theological commitments are not shared. Using the example of Quaker Business Method, we show how such a move provokes new theological questions, as well as questions for management studies.

This study offers a ckomprehensive new interpretation of one of Plato's dialogues, the _Cratylus_. Throughout, the book combines analysis of Plato's arguments with attentiveness to his philosophical method.

This study focuses on the concept of a 'model organism' in the biomedical sciences through an historical and philosophical examination of research with the nematode Caenorhabditis elegans. I explore the choice of C. elegans in the mid-1960s, showing a rich context existed within which the organism was selected as the focus for a molecular biological research program, including an experimental life prior to Sydney Brenner's work. I argue that this choice can be seen as an obvious outcome of what was (...) a complex search procedure, and that the success of the 'worm project' depended not only on organismal choice but also on the conceptual and institutional framework at the Laboratory of Molecular Biology in Cambridge within which it was pursued. Examination of C. elegans work in the late 1960s through the early 1980s illuminates several additional theses. Although development and behavior were the general areas of interest for the project, the original goals and proposed methodology were extremely vague. As the project evolved, which investigations proved to be tractable using the worm depended not only on which methodologies were fruitful but also on the interests and skills of early workers. Much of the power of C. elegans as a model organism can be traced historically to the investment of resources which resulted in an unprecedented, complete description of the organism, and represented a return to a more naturalistic biological tradition. In light of the historical study, I develop a philosophical analysis of C. elegans as a model organism through exploration of the three kinds of modeling with the worm: modeling of structures, processes, and information. I expand the notion of a descriptive model, arguing that C. elegans is best understood as a prototype of the metazoa, and that C. elegans as a model organism has been not only heuristically valuable, but also essential to this research project particularly in its pre-explanatory stages. I conclude by suggesting that more investigation of descriptive prototypes such as those in the worm project must be done to capture important aspects of the biomedical sciences that will be neglected if explanatory models are the sole focus in the philosophy of science. (shrink)

The logic of singular terms that refer to nothing, such as ‘Santa Claus,’ has been studied extensively under the heading of free logic. The present essay examines expressions whose reference is defective in a different way: they signify more than one entity. The bulk of the effort aims to develop an acceptable formal semantics based upon an intuitive idea introduced informally by Hartry Field and discussed by Joseph Camp; the basic strategy is to use supervaluations. This idea, as it stands, (...) encounters difficulties, but with suitable refinements it can be salvaged. Two other options for a formal semantics of multiply signifying terms are also presented, and I discuss the relative merits of the three semantics briefly. Finally, possible modifications to the standard logical regimentation of the notion of existence are considered. (shrink)

I present and evaluate Johann Gottfried Herder's criticisms of Kant's account of the sublime and Herder's own theory of the sublime, as presented in his work, Kalligone. Herder's account and criticisms ought to be taken seriously, I argue, as (respectively) a non-reductive, naturalist aesthetics of the sublime, and as illuminating the metaphysical, moral, and political presuppositions underlying Kant's (and Burke's) accounts of the sublime.

This study uses the theory of dyadic morality to analyze construction of cyberbullying as a contested social issue in U. S. newspaper opinion pieces. The theory of dyadic morality posits that when...

This article argues that the foundational separation between psychoanalysis and experimental psychology was challenged in important ways by psychoanalytic infant researchers. Through a close examination of American psychoanalyst René Spitz (1887–1974), it extends John Forrester’s conception of reasoning in cases outside classic psychoanalytic practices. Specifically, the article interrogates the foundations of reasoning in cases—the individual, language, and the doctor–patient relationship—to show how these are reimagined in relation to the structures of American developmental psychology. The article argues that the staunch separation (...) of experimental psychology and psychoanalysis, reiterated by philosophers and historians of psychology, is flimsy at best—and, conversely, that the maintenance of these boundaries enabled the production of a cinematic case study. Spitz created films that used little language and took place outside the consulting room with institutionalized infants. Yet key aspects of the psychoanalytic case, as put forth by John Forrester, were depicted visually. These visual displays of transference, failure, and interpersonal emotions highlight the foundations of what Forrester means by reasoning in cases. The article concludes that Spitz failed at creating classic psychoanalytic evidence, but in so doing stretched the epistemology of the case. (shrink)

This work has been selected by scholars as being culturally important, and is part of the knowledge base of civilization as we know it. This work was reproduced from the original artifact, and remains as true to the original work as possible. Therefore, you will see the original copyright references, library stamps (as most of these works have been housed in our most important libraries around the world), and other notations in the work. This work is in the public domain (...) in the United States of America, and possibly other nations. Within the United States, you may freely copy and distribute this work, as no entity (individual or corporate) has a copyright on the body of the work. As a reproduction of a historical artifact, this work may contain missing or blurred pages, poor pictures, errant marks, etc. Scholars believe, and we concur, that this work is important enough to be preserved, reproduced, and made generally available to the public. We appreciate your support of the preservation process, and thank you for being an important part of keeping this knowledge alive and relevant. (shrink)

The question that this paper sets out to answer is: How do political processes within the firm structure corporate political strategy? In answering this question thepaper starts to address the research problem of the congruence between processes of consensus building and conflict resolution within the firm and on the other hand corporate attempts to influence political processes taking place outside the firm. The paper argues that power-dependence relations between firm-internal stakeholders are an explanatory factor in examining empirical variation in corporate (...) political behavior. (shrink)

A medical student's ability to present a case history is a critical skill that is difficult to teach. Case histories presented without theatrical engagement may fail to catch the attention of their intended recipients. More engaging presentations incorporate ‘stage presence’, eye contact, vocal inflection, interesting detail and succinct, well organised performances. They convey stories effectively without wasting time. To address the didactic challenge for instructing future doctors in how to ‘act’, the Mayo Medical School and The Mayo Clinic Center for (...) Humanities in Medicine partnered with the Guthrie Theater to pilot the programme ‘Telling the Patient's Story’. Guthrie teaching artists taught storytelling skills to medical students through improvisation, writing, movement and acting exercises. Mayo Clinic doctors participated and provided students with feedback on presentations and stories from their own experiences in patient care. The course's primary objective was to build students' confidence and expertise in storytelling. These skills were then applied to presenting cases and communicating with patients in a fresher, more engaging way. This paper outlines the instructional activities as aligned with course objectives. Progress was tracked by comparing pre-course and post-course surveys from the seven participating students. All agreed that the theatrical techniques were effective teaching methods. Moreover, this project can serve as an innovative model for how arts and humanities professionals can be incorporated for teaching and professional development initiatives at all levels of medical education. (shrink)

The COVID-19 pandemic has, of necessity, demanded the rapid incorporation of virtual technologies which, suddenly, have superseded the physical medical encounter. These imperatives have been implemented in advance of evaluation, with unclear risks to patient care and the nature of medical practice that might be justifiable in the context of a pandemic but cannot be extrapolated as a new standard of care. Models of care fit for purpose in a pandemic should not be generalized to reconfigure medical care as virtual (...) by default, and personal by exception at the conclusion of the emergency. (shrink)

In this essay, we explore consequences of the systemic failure to track and to publicize the prevalence of patient‐safety threats in American medicine. Tens of millions of Americans lose trust in medical care every year due to safety shortfalls. Because this loss of trust is long‐lasting, the corrosive effects build up over time, yielding a collective maelstrom of mistrust among the American public. Yet no one seems to notice that patient safety is a root cause, because no one is counting. (...) In addition to identifying the origins of this purblindness, we offer an alternative policy approach. This would call for government to transparently track safety threats through the systematic collection and reporting of patients’ experiences. This alternative strategy offers real promise for stemming the erosion of trust that currently accompanies patient‐safety shortfalls while staying consistent with Americans’ preferences for a constrained government role with respect to medical care. (shrink)

This study examined whether the stability of highly relevant animate and inanimate information predicted encoding. Participants viewed audiovisual media and completed a change detection task of screenshots taken from the viewing session. The screenshots were either left as originally viewed or a factor was altered. The factors were all motivationally and story relevant. Half were part of an animal and half were part of other environmental information. This was crossed with whether the information was stable or fleeting in the scene. (...) Changes to animals were more recognized than inanimate information. Changes to fleeting inanimate information were better recognized than changes to stable inanimate information. These findings indicate potential for relevant change in environmental threat and opportunity is adaptively significant and likely to increase attention and encoding across animate and inanimate categories of information. (shrink)