The number of children with chronic critical illness (CCI) is a growing population in the United States. A defining characteristic of this population is a prolonged hospital stay. Our study assessed the proportion of pediatric patients with chronic critical illness in U.S. hospitals at a specific point in time, and identified a subset of children whose hospital stay lasted for months to years. The potential harms of a prolonged hospitalization for children with CCI, which include over treatment, infection, disruption of (...) family life, and the intensive utilization of resources—combined with the moral distress experienced by the clinicians who care for the children, suggest the need for ethical analysis of this growing issue to identify actions that could be taken at the clinical and health systems levels to reduce the harms associated with prolonged hospital stay.In this article we present three real cases from our study that involved a very long hospital stay. We applied a framework developed by Mackenzie, Rogers, and Dodds to analyze inherent, situational, and pathogenic vulnerabilities to examine the ways that interventions intended to remedy one source of harm for the children in our cohort inadvertently created other harms. We examined the complex ways that children with protracted hospitalization are vulnerable to the choices made by their family and clinicians, as well as by healthcare systems and communities. Finally, we used this analysis to summarize actions and ethical responses to this growing patient population. Such an understanding is essential to making clinical and ethical decisions that arise for children who are at risk for a very long stay in the hospital. (shrink)

In every philosopher’s career, there comes a time to look back on accomplishments, assess achievements, evaluate one’s place in a canon that dates to an era when Ancient Greeks still roamed the Earth. Perhaps many of you have wondered when I’d finally get around to doing this. Sadly, this is not the night for that splendid occasion. Do not pretend to hide your disappointment. Also, do not hesitate to point fingers. Believe me when I tell you that I would take (...) great delight in reporting to you my accomplishments, achievements, and place in the canon. If you don’t believe me, ask anyone who knows me well, or, at any rate, has spent a few minutes in conversation with me, or, maybe, has simply observed me in conversation with someone else. They’ll tell you that I am uniquely suited to fete myself, and take obvious pleasure spreading the good word to others. Alas, I have been enlisted to concentrate my philosophical powers on a topic less interesting than myself. My focus? A woman named Ruth Millikan. For philosophers, mention of the Book of Ruth directs thoughts not to the Old Testament, but to LTOBC. This is a shame, because Ruth’s Old Testament book is quite short, as books go, and tells a heartwarming story of redemption and devotion – virtues that receive hardly any mention in LTOBC. Now that I think about it, Ruth’s later books and articles mark a significant departure from the plot line in that first Book of Ruth’s. Gone are references to Bethlehem and Moab, and in their place lurk hoverflies and push me pull yous, but more on these matters in a moment. I want first to turn my finely tuned and oft picked philosophical nose to LTOBC – unquestionably Professor Millikan’s magnum opus . Here’s a little known fact. Originally, LTOBC had a different title, requiring a different acronym. If she hadn’t taken her editor’s advice, we’d be speaking of BLTOBC, which stood for Bacon, Lettuce, and Tomato on Blueberry Cobbler. There’s something down home and grannyish about this title, and Ruth deserves credit for trying to entice readers with the promise of good old fashioned, feather plucked, farm food, but, as her editor was quick to note, bacon, lettuce, and tomato have no more place on blueberry cobbler than they do on cherry cobbler, and so BLTOBC might as well be BLTOCC, and with no reason to prefer one title to the other, best just to forget about the bacon.. (shrink)

Hartry Field has proposed a fundamental division of theories of linguistic and mental content into those that do, and those that don’t, give a central role to ‘that’-clause ascriptions. Here I investigate the commitments of theories that (in accord with Field’s position) deny ‘that’-clause ascriptions a central role, but (in contrast to Field’s position) give truth conditions a central role. Such non-oblique truth-conditionalism promises significant advantages. However, the stance is costlier than it may appear. Non-oblique truth-conditionalists, I argue, must renounce (...) a priori entitlement to schemas of disquotation that are presupposed when theories of content are put to metaphysical or epistemological use. As case studies, I discuss two theories that might seem to exemplify non-oblique truth-conditionalism: David Chalmers’s two-dimensionalist theory of content and Ruth Millikan’s teleosemantics. (shrink)

Just about every theorist holds that vague terms are context-sensitive to some extent. What counts as ?tall?, ?rich?, and ?bald? depends on the ambient comparison class, paradigm cases, and/or the like. To take a stock example, a given person might be tall with respect to European entrepreneurs and downright short with respect to professional basketball players. It is also generally agreed that vagueness remains even after comparison class, paradigm cases, etc. are fixed, and so this context sensitivity does not solve (...) the problems with vague terms. In this paper, I briefly sketch the main features of my broadly contextualist account of vagueness, that of the late Ruth Manor, and that of Agustín Rayo, showing how the three accounts relate to, and reinforce, each other, noting a seeming difference. A key item used to articulate my own view is David Lewis's notion of conversational score. This is used to track which borderline cases have been called in the course of a conversation. Manor alludes to Lewis's notion of accommodation, a key aspect of the kinematics of conversation, and Rayo invokes Stalnaker's notion of common ground. I'll show how the conversational score could be employed to develop and extend their views, showing how vague terms, as they construe them, are (or can be) deployed in conversation, consistent with both the underlying indeterminacy of the terms and normal communicative goals. To help develop all three views further, I invoke Craige Roberts's notion of Retrievability, a tool developed to show how definites, such as definite descriptions, singular pronouns, and proper names, are deployed in conversation, in a Lewis-style scorekeeping framework. This, I think, is exactly the right way to understand conversations in what Manor calls non-sorities situations and, to invoke my own view, in sorites situations as well. (shrink)

The commitment to evidence-based practice in clinical psychology requires scientific investigation of the effects of treatment and mechanisms of change. Empirical evidence suggests that mindfulness-based treatments provide clinically meaningful improvement for people suffering from many important problems, including depression, anxiety, pain, and stress. However, the processes of change that produce these beneficial outcomes are not entirely clear. Central questions include whether mindfulness training leads to increases in the general tendency to respond mindfully to the experiences of daily life, and if (...) so, whether these changes are responsible for the improvements in mental health that are often observed. Answering these questions requires methods for assessing mindfulness. Several tools for this purpose are now available and early evidence suggests that they are useful and informative, despite shortcomings that require additional work. This paper summarizes the rationale for mindfulness questionnaires, the methods used to construct them, and research findings on their utility. Challenges related to maintaining consistency with Buddhist conceptions of mindfulness while applying psychological research methods to the study of its assessment are discussed. (shrink)

The recent Minnesota case of In re Emergency Guardianship of Albert Barnes illustrates an emerging class of cases where a dispute between a family proxy and a hospital over “medical futility” requires legal resolution. The case was further complicated by the patient’s spouse who fraudulently claimed to be the patient’s designated health care proxy and who misrepresented the patient’s previously expressed treatment preferences. Barnes demonstrates the degree of significant administrative and institutional support to the health care team, ethics consultants, and (...) futility committees that is required when a futility dispute escalates to the need for judicial resolution. An institutional futility policy, especially one that is endorsed by other regional medical centers and organizations, is an important foundation for a hospital that seeks judicial support in a dispute over medical futility in end of life care. (shrink)

This article presents a sociological analysis of the changing role of women in the Catholic church over the past twenty years. The theoretical framework is drawn from The Social Construction of Reality by Peter Berger and Thomas Luckmann. Data are derived from the documents of Vatican II, the revised Code of Canon Law, research from 1965 to the present, and exploratory interviews with Catholic women recently appointed as church administrators. The article concludes with a discussion of future prospects regarding the (...) new social reality for Catholic women. (shrink)

Translations of Karl Jaspers' work into the English language have so far not been uniform in their choice of technical terminology. This scholarly renditionof Jaspers' ´Introduction´ to his seminal work "The Great Philosophers" stays to theoriginal German text as true possible by upholding its idiomatic cultural expressions, complex sentence structure, and nuanced particularities provided that clarity of communication can be maintained. The substantive contents and the significance of this text, whose principal topic is greatness, are outlined here. Communication with the (...) great philosophers can bring insight into their thought and can enable humans to transcend toward possible authentic Existenz. (shrink)

In the ´Introduction´ to "The Great Philosophers" Karl Jaspers explores the criteria for recognizing human greatness in general and in philosphers in particular. He comments on the historical process related to the selection and grouping of great philosophers. Jaspers acknowledges the questionable aspect of greatness, yet he affirms that such distinction is indispensable. The 1957 English translation by Ralph Mannheim and Hannah Arendt of Jaspers' Die Grossen Philosophen and all its subsequent editions did not include this Introduction. The translation offered (...) here redresses this omission and is the first ever published English translation of Jaspers' extended Introduction. (shrink)

Las traducciones al inglés de la obra de Karl Jaspers no han sido hasta el momento uniformes en su elección de la terminología técnica. Esta interpretación especializada de la Introducción de Jaspers a su obra seminal "The Great Philosophers" ("Los Grandes Filósofos", nota de la traductora) se mantiene fiel al texto original en alemán tanto como es posible, protegiendo sus expresiones idiomáticas culturales, la estructura compleja de la oración y los matices particulares, con la condición de que la claridad de (...) la comunicación se conserve. Los contenidos sustanciales y la significación de este texto, cuyo principal tema es la grandeza, se bosquejan aquí. La comunicación con los grandes filósofos puede aportar una visión de su pensamiento, haciendo posible el trascender hacia una posible Existenz auténtica. (shrink)

The aim of this contribution is to critically explore the understanding, the goals and the meaning of education in the philosophy of education by Jean-Jacques Rousseau. In his educational novel Emile: or On Education [Emile ou De l’éducation] (1762) he depicts his account of the natural education. Rousseau argues that all humans share one and the same development process which is independent of their social background. He regards education as an active process of perfection which is curiosity-driven and intrinsic to (...) each child. Rousseau’s educational goals are autarky, happiness and freedom. (shrink)

Successful athletic performance requires precision in many respects. A batter stands behind home plate awaiting the arrival of a ball that is less than three inches in diameter and moving close to 100 mph. His goal is to hit it with a ba­­t that is also less than three inches in diameter. This impressive feat requires extraordinary temporal and spatial coordination. The sweet spot of the bat must be at the same place, at the same time, as the ball. A (...) basketball player must keep a ball bouncing as she speeds from one end of the court to another, evading defensive players. She may never break pace as she lifts from the ground, throwing the ball fifteen feet toward a hoop that is eighteen inches in diameter. One task facing a psychologist involves explaining how the body does such things within the sometimes very demanding spatial and temporal constraints that a given task imposes. Part of the goal of this chapter is to sketch the commitments of an embodied approach to such an explanation. We shall see that an embodied account of motor skills draws concepts that depart radically from more traditional cognitivist theories of motor activity. Similarly, because an embodied approach to cognition introduces new ways to understand the human capacity for social interaction, it also promises to shed new light on how athletes coordinate their actions with each other. (shrink)

ABSTRACT Recruitment into the scientific community is one oft-stated goal of science education—in the post-Sputnik United States, for example—but this obscures the fact that science textbooks are often read by people who will never be scientists. It cannot be presupposed that science textbooks for younger audiences, students in primary and secondary schools, function in this way. For this reason, precollegiate-level science textbooks are sometimes discussed as a subset of literature popularizing science. The high school science classroom and the textbook are (...) forums for exposing the public to science. The role of governments and educational institutions in regulating the consumption of these texts not only determines which books are used; it influences how they are written, read, and deemed authoritative. Therefore such science textbooks should not be seen as (at best) the disjunction of texts-for-training and books-for-popularization. A changing sense of what “textbooks” are compels a different understanding of their use in the history of science. (shrink)

Taking Parenting Public makes a compelling case that parenting has become dangerously undervalued in America today. It calls for a new investment—both personal and public—into the work of raising children and argues that we are all "stockholders" in the next generation. With a foreword by Sylvia Ann Hewlett and Cornel West, Taking Parenting Public crosses boundaries to bring together thinkers from diverse fields spanning the political spectrum. It features contributions from distinguished experts in economics, political science, public policy, child development, (...) public health, history, and the media. While recent books have focused on working mothers or absent fathers, Taking Parenting Public is the first volume to take a comprehensive look at the common struggles of parents. These essays go beyond the usual chest-beating about busy parents torn between work and family demands to suggest bold solutions. Instead of the typical call for "parent replacement"—more child care, more after school programs and more mentors—the contributors offer fresh strategies for "parent replenishment," ways to put mothers and fathers back into the lives of their children not only as economic providers, but also as emotional and moral providers. (shrink)

The mechanisms governing anterior‐posterior and dorsal‐ventral polarity in Drosophila melanogaster had previously been considered as independent processes. However, two papers(1,2) now reveal that both axes are initiated during oogenesis by the same pathway, and also clearly demonstrate that one is dependent on the other.

The authors outline a theory of conditionals of the form If A then C and If A then possibly C. The 2 sorts of conditional have separate core meanings that refer to sets of possibilities. Knowledge, pragmatics, and semantics can modulate these meanings. Modulation can add information about temporal and other relations between antecedent and consequent. It can also prevent the construction of possibilities to yield 10 distinct sets of possibilities to which conditionals can refer. The mental representation of a (...) conditional normally makes explicit only the possibilities in which its antecedent is true, yielding other possibilities implicitly. Reasoners tend to focus on the explicit possibilities. The theory predicts the major phenomena of understanding and reasoning with conditionals. (shrink)

What makes individuals, groups, or even entire countries vulnerable? And why is vulnerability a concern in bioethics? A simple answer to both questions is that vulnerable individuals and groups are subject to exploitation, and exploitation is morally wrong. This analysis is limited to two areas. First is the context of multinational research, in which vulnerable people can be exploited even if they are not harmed, and harmed even if they are not exploited. Second is the situation of women, who are (...) made vulnerable in cultural settings or in entire countries in which they are oppressed and powerless. (edited). (shrink)

Throughout the biological and biomedical sciences there is a growing need for, prescriptive ‘minimum information’ (MI) checklists specifying the key information to include when reporting experimental results are beginning to find favor with experimentalists, analysts, publishers and funders alike. Such checklists aim to ensure that methods, data, analyses and results are described to a level sufficient to support the unambiguous interpretation, sophisticated search, reanalysis and experimental corroboration and reuse of data sets, facilitating the extraction of maximum value from data sets (...) them. However, such ‘minimum information’ MI checklists are usually developed independently by groups working within representatives of particular biologically- or technologically-delineated domains. Consequently, an overview of the full range of checklists can be difficult to establish without intensive searching, and even tracking thetheir individual evolution of single checklists may be a non-trivial exercise. Checklists are also inevitably partially redundant when measured one against another, and where they overlap is far from straightforward. Furthermore, conflicts in scope and arbitrary decisions on wording and sub-structuring make integration difficult. This presents inhibit their use in combination. Overall, these issues present significant difficulties for the users of checklists, especially those in areas such as systems biology, who routinely combine information from multiple biological domains and technology platforms. To address all of the above, we present MIBBI (Minimum Information for Biological and Biomedical Investigations); a web-based communal resource for such checklists, designed to act as a ‘one-stop shop’ for those exploring the range of extant checklist projects, and to foster collaborative, integrative development and ultimately promote gradual integration of checklists. (shrink)

: Because an influenza pandemic would create the most serious hardships for those who already face most serious hardships, countries should take special measures to mitigate the effect of a pandemic on existing social inequalities. Unfortunately, there is little evidence that anybody is thinking about that.

: Following a long process of revision, a new version of the Declaration of Helsinki was approved by the World Medical Association in 2000. Two provisions of the Declaration address ongoing international controversies regarding research sponsored by industrialized countries and conducted in developing countries. Despite the issuance of the final version of the Declaration, opponents remain locked in debate. Moreover, the Declaration remained silent on other prominent controversies concerning international research. An analysis of these current controversies reveals reasons why they (...) are not likely to be readily resolved, despite apparent agreement by opponents on overarching ethical principles. (shrink)

Political representation lies at the core of modern politics. Democracies, with their vast numbers of citizens, could not operate without representative institutions. Yet relations between the democratic ideal and the everyday practice of political representation have never been well defined and remain the subject of vigorous debate among historians, political theorists, lawyers, and citizens. In this volume, an eminent group of scholars move forward the debates about political representation on a number of fronts. Drawing on insights from political science, history, (...) political theory, economics, and anthropology, the authors provide much-needed clarity to some of the most vexing questions about political representation. They also reveal new and enlightening perspectives on this fundamental political practice. Topics discussed include representation before democracy, political parties, minorities, electoral competition, and ideology. This volume is essential reading for anyone interested in the ideal and the reality of political representation. (shrink)

ABSTRACTComparative effectiveness studies, referred to here as “usual-care” trials, seek to compare current medical practices for the same medical condition. Such studies are presumed to be safe and involve only minimal risks. However, that presumption may be flawed if the trial design contains “unusual” care, resulting in potential risks to subjects and inaccurately informed consent. Three case studies described here did not rely on clinical evidence to ascertain contemporaneous practice. As a result, the investigators drew inaccurate conclusions, misinformed research participants, (...) and subjects’ safety was compromised. Before approving usual-care protocols, IRBs and scientific review committees should evaluate the quality and completeness of information documenting usual-care practices. Guidance from governmental oversight agencies regarding evidence-based documentation of current clinical practice could prevent similar occurrences in future usual-care trials. Accurate information is necessary to ensure that trials comply with government regulations that require minimizing research risks to subjects and accurate informed consent documents. (shrink)

We show that, by choosing definitions carefully, a version of Frege's theorem can be proved in intuitionistic logic.