Whole genome sequencing is quickly becoming more affordable and accessible, with the prospect of personal genome sequencing for under $1,000 now widely said to be in sight. The ethical issues raised by the use of this technology in the research context have received some significant attention, but little has been written on its use in the clinical context, and most of this analysis has been futuristic forecasting. This is problematic, given the speed with which whole genome sequencing technology is likely (...) to be incorporated into clinical care. This paper explores one particular subset of these issues: the implications of adopting this technology in the prenatal context without a good understanding of when and how it is useful. Prenatal whole genome sequencing differs from current prenatal genetic testing practice in a number of ethically relevant ways. Most notably, whole genome sequencing would radically increase the volume and scope of available prenatal genetic data. The wealth of new data could enhance reproductive decision‐making, promoting parents' freedom to make well‐informed reproductive decisions. We argue, however, that there is potential for prenatal whole genome sequencing to alter clinical practice in undesirable ways, especially in the short term. We are concerned that the technology could (1) change the norms and expectations of pregnancy in ways that complicate parental autonomy and informed decision‐making, (2) exacerbate the deleterious role that genetic determinism plays in child rearing, and (3) undermine children's future autonomy by removing the option of not knowing their genetic information without appropriate justification. (shrink)

This book offers a fundamentally new account of the arguments and concepts which define Heidegger's early philosophy, and locates them in relation to both contemporary analytic philosophy and the history of philosophy. Drawing on recent work in the philosophy of mind and on Heidegger's lectures on Plato and Kant, Sacha Golob argues against existing treatments of Heidegger on intentionality and suggests that Heidegger endorses a unique position with respect to conceptual and representational content; he also examines the implications of (...) this for Heidegger's views on truth, realism and 'being'. He goes on to explore Heidegger's work on the underlying issue of normativity, and focuses on his theory of freedom, arguing that it is freedom that links the existential concerns of Being and Time to concepts such as reason, perfection and obligation. His book offers a distinctive new perspective for students of Heidegger and the history of twentieth-century philosophy. (shrink)

This article presents conceptual bridges that exist between the philosophy of G.W.F Hegel and a feminist ethics of care. To do so, it engages with Slavoj Žižek’s contemporary reading of Hegel in concert with existing feminist interpretations of Hegel’s thought. The goal of doing so is to demonstrate how both Žižek and a selection of critical feminist thinkers interpret Hegel’s perspective on the nature of subjectivity, intersubjective relations and the relationship between the subject and the world it inhabits, in a (...) way that can further our thinking on the feminist ethics of care as a relational and contextualist ethics that foregrounds vulnerability as a condition of existence. These readings of Hegel highlight the radical contingency of human subjectivity, as well as the relationship between human subjectivity and the external world, in a way that is compatible with the feminist ethics of care’s emphasis on the particularity, fluidity, and interdependency of human relationships. I argue that this confrontation between care ethics and mainstream philosophy is valuable because it offers mutual contributions to both care ethics as a moral and political theory and the philosophy of Hegel and Žižek. (shrink)

`This is an exceptionally good textbook. It covers an unusually wide range of issues in an up-to-date and balanced fashion, and is clearly written. It would be invaluable for all students, both undergraduates and postgraduates, who take a genuine interest in the nature of psychology and the theoretical issues it faces' - Professor Graham Richards, Director, British Psychological Society History of Psychology Centre Psychology is understood by many as the `science of the mind', but what is `mind' and what have (...) modern psychology and philosophy to say about its nature? What is `science' and what is a scientific approach to mind? This thoroughly revised edition o the classic textbook explores a wide range of problems in psychology, philosophy, cognitive and brains sciences identifying the major topics, debates and controversies and presenting them in a balanced and accessible manner for students. Key features of this Second Edition include: } A new, ten chapter structure making it ideal for a lecture course; } Contains new content on advances in cognitive psychology and neuroscience, including neural networks, dynamics systems and situated cognition; } Final chapter focuses on `hot issues' at the interface of psychology and philosophy - making attempts to look forward. } Pedagogical features including chapter summaries and further readings. Brought fully up-to-date with advances in computational, cognitive and neuroscience work on the one hand, and links with philosophy on the other, this book is essential reading for all students needing an understanding of these issues. (shrink)

Reviews of Heidegger on Concepts, Freedom and Normativity, Sacha Golob (Cambridge University Press) • Crowell (Rice), Philosophy in Review, pages 2-7. • Cregan (Oxford), International Journal of Philosophical Studies, pages 8-13. • Campbell (Nazareth College of Rochester), Notre Dame Philosophical Reviews, pages 14-18. • Keiling (Freiburg), Zeitschrift für philosophische Forschung, pages 19-21.

RESUMO O artigo analisa o modo como Malebranche apresenta o conhecimento que possuímos de nossa própria alma a partir da noção de sentimento interior. Para tanto, tomamos como ponto de partida a concepção malebrancheana do argumento do cogito, opondo-a à de Descartes, tomando-o como uma constatação imediata da existência de algo que sente, sem, no entanto, poder afirmar algo sobre sua essência. O conhecimento da alma torna-se assim algo puramente afetivo, sem nenhum conteúdo positivo, e por natureza distinto do conhecimento (...) propriamente dito. Buscamos desse modo mostrar como, na filosofia de Malebranche, cria-se um campo propriamente humano do sentimento cujo conteúdo é irredutível a qualquer ciência clara e distinta, ao mesmo tempo que é constatado pela experiência vivida.: The article aims to analyze the way by which Malebranche presents the knowledge that we possess of our own soul through the notion of inner sentiment. Therefore, we take as our starting point the Malebranchean notion of the cogito argument, contrasting it with that of Descartes, taking it to be the immediate ascertainment of the existence of something that feels without, however, being able to assert anything about its essence. The knowledge of the soul becomes therefore something purely affective, deprived of a positive content, and by its nature distinguished from knowledge properly understood. We aim thus to show how, in Malebranche's philosophy, a properly human domain of the feeling, irreducible to a clear and distinct science, but ascertained by experience, is created. (shrink)

Critical Notice of Kant's Transcendental Deduction, by Henry Allison. Oxford: Oxford University Press, 2015. Pp. Xv + 477.

This article addresses three questions concerning Kant’s views on non-rational animals: do they intuit spatio-temporal particulars, do they perceive objects, and do they have intentional states? My aim is to explore the relationship between these questions and to clarify certain pervasive ambiguities in how they have been understood. I first disambiguate various nonequivalent notions of objecthood and intentionality: I then look closely at several models of objectivity present in Kant’s work, and at recent discussions of representational and relational theories of (...) intentionality. I argue ultimately that, given the relevant disambiguations, the answers to all three questions will likely be positive. These results both support what has become known as the nonconceptualist reading of Kant, and make clearer the price the conceptualist must pay to sustain her position. (shrink)

In the current career landscape and labor market, career transitions have become a critical aspect of career development and are significant for Human Resource Development research and practice. Our research examines the type of support used during different career transitions and who can provide that support to women in career transition. We investigated four types of social support—emotional, appraisal, informational, and instrumental—and their roles in five types of career transitions: school-to-work transition, upward mobility transition, transition to a new profession, transition (...) to entrepreneurship, career re-entry transition, and transition to retirement. We analyzed 80 journal articles using directed content analysis, cross-tabulation, and nonparametric statistical tests. Instrumental support appears to be the most commonly documented type of social support in this career transition literature. Appraisal support was consistently documented least for each type of career transition. Our results may highlight the importance of personal connections and internal resources in successful career transitions for women. Based on our findings, we offer a model of women's social support network for career transitions and advocate for expanded networks of social support for women anticipating and during career transitions. The results of our study contain insights for how women can be supported in transitioning to the next career experience. We conclude with suggestions for future research. (shrink)

Background Achieving meaningful consent can be challenging, particularly in contexts of diminished literacy, yet is a vital part of participant protection in global health research. Method We explored the challenges and potential solutions of achieving meaningful consent through a qualitative study in a predominantly hill tribe ethnic minority population in northern Thailand, a culturally distinctive population with low literacy. Semi-structured interviews were conducted with 37 respondents who had participated in scrub typhus clinical research, their family members, researchers and other key (...) informants. A thematic analysis was conducted. Results Our analysis identified four interrelated themes surrounding participants’ ability to give consent: varying degrees of research understanding, limitations of using informal translators, issues impacting decisions to join research, and voluntariness of consent. Suggestions for achieving more meaningful consent included the use of formal translators and community engagement with research populations. Conclusions Participant’s agency in decision making to join research should be supported, but research information needs to be communicated to potential participants in a way that they can understand. We found that improved understanding about the study and its potential benefits and harms goes beyond literacy or translation and requires attention to social and cultural factors. (shrink)

We agree with Cushman that rationalizations are the product of biological adaptations, but we disagree about their function. The data available do not show that rationalizations allow us to reason better and make better decisions. The data suggest instead that rationalizations serve reputation management goals, and that they affect our behaviors because we are held accountable by our peers.

During a climate of strong disenchantment toward systematic thought, the French philosopher Martial Gueroult (1891–1976) applied the concept of a system to the field of history of philosophy. His ‘dianometics’ is, among other aspects, a philosophy of the history of philosophy that considers each philosophical work as an autonomous system. This article proposes a critical reading of Gueroult’s work (which is rarely discussed outside of the French–speaking community) and aims to demonstrate that his dianoematics offers a new insightful method for (...) approaching and understanding the history of philosophy. First, I will reconstruct Gueroult’s argument to demonstrate how he justifies the possibility of a philosophical history of philosophy. I will then present Gueroult’s conception of system and how it can be used as an analysis technique for the history of philosophy. However, Gueroult’s project sometimes betrays some of its promises. A critical account will be presented as well. (shrink)

This paper argues for a fundamental overhaul of the current competence constellation in the EU, which is necessary to address the problem that the current arrangement does not respect the important values that it is supposed to uphold, namely those of democracy, subsidiarity and national diversity. While pretending otherwise, it effectively contains neither negative nor positive EU integration in areas of Member State competence. Furthermore, it enables European integration of these areas through even less accountable intergovernmental mechanisms. It will be (...) argued that the root cause of this problem is that demarcation of competences as a method to contain the EU does not work, because such an approach of ‘categorical federalism’ is bound to fail, especially in the EU context since it is incompatible with the functionality that is written in the legal order’s DNA. It is therefore proposed to dispose of demarcation as a way to contain EU action and instead to openly recognise the inevitable broadness of the EU’s powers while containing the exercise of these powers through a democratisation of the legislative process. The paper tables a number of proposals that on the one hand enhance the EU’s formal legislative powers, while on the other hand strengthen national parliaments in their powers politically to review proposed EU legislation. (shrink)

A guide to the everyday decisions about right and wrong faced by physical scientists and research engineers. This book offers the first comprehensive guide to ethics for physical scientists and engineers who conduct research. Written by a distinguished professor of chemistry and chemical engineering, the book focuses on the everyday decisions about right and wrong faced by scientists as they do research, interact with other people, and work within society. The goal is to nurture readers' ethical intelligence so that they (...) know an ethical issue when they see one, and to give them a way to think about ethical problems. After introductions to the philosophy of ethics and the philosophy of science, the book discusses research integrity, with a unique emphasis on how scientists make mistakes and how they can avoid them. It goes on to cover personal interactions among scientists, including authorship, collaborators, predecessors, reviewers, grantees, mentors, and whistle-blowers. It considers underrepresented groups in science as an ethical issue that matters not only to those groups but also to the development of science, and it examines human participants and animal subjects. Finally, the book examines scientifically relevant social issues, including public policy, weapons research, conflicts of interest, and intellectual property. Each chapter ends with discussion questions and case studies to encourage debate and further exploration of topics. The book can be used in classes and seminars in research ethics and will be an essential reference for scientists in academia, government, and industry. (shrink)

'The Laws of Evolution' questions our current understanding of the laws that govern our universe and its evolution.

The debate on the ethics of involuntary treatment for Anorexia Nervosa (AN) is dominated by biomedical ethics approaches to the issues. In keeping with the biomedical ethics emphasis on objectively balancing ethical principles, the debate centres on how to respect the autonomy of persons with AN who refuse treatment whilst protecting these persons from harm. Commentators discuss this at a normative ethics level. Thus, the debate does not address the moral relevance of how knowledge is constructed in the practice environment (...) and the impact this has on how professional values are applied during treatment decision making. Social work ethics highlights the need for professionals to account for the authority of professional knowledge and for patients to participate in treatment decisions. However, in the practice environment, questioning medical hegemony and supporting patient participation, empowerment and self-determination (core social work values) is complicated by a lack of treatment efficacy, the high level of risk that patients present to themselves and uncertainty around the autonomy and competence of the patient to refuse treatment. This paper argues that postmodern ethics can support practitioners in managing these issues. In doing so, this paper makes a social work contribution to the debate. (shrink)

This paper aims to examine the notion of representation that emerges from development of Malebranche’s thesis of the vision of ideas in God. To do so, we turn to the progressive clarification made by the author to the term idea, seeking to highlight the radically representative character of the concept. We then analyze how this representative idea, in the philosophy of the Oratorian, does not require some correspondence with existence. Finally, we show how this primacy of representation is articulated with (...) the thesis of vision in God. Thus, it becomes possible to conceive how these representative ideas can give the foundation to a true science. (shrink)

Tradução do opúsculo "A Natureza em si Mesma".

This volume examines the problems of legal and linguistic diversity in the EU legal system. In a union of 27 member states, with 23 different languages, how can the coherence of EU law be guaranteed? Is there a common understanding between lawyers from different national backgrounds as to the meaning and domestic application of EU law? The volume addresses these central questions from a range of theoretical and practical perspectives.

Kant’s account of the sublime makes frequent appeals to infinity, appeals which have been extensively criticised by commentators such as Budd and Crowther. This paper examines the costs and benefits of reconstructing the account in finitist terms. On the one hand, drawing on a detailed comparison of the first and third Critiques, I argue that the underlying logic of Kant’s position is essentially finitist. I defend the approach against longstanding objections, as well as addressing recent infinitist work by Moore and (...) Smith. On the other hand, however, I argue that finitism faces distinctive problems of its own: whilst the resultant theory is a coherent and interesting one, it is unclear in what sense it remains an analysis of the sublime. I illustrate the worry by juxtaposing the finitist reading with analytical cubism. -/- . (shrink)

In 1982, without waiting for the findings of the National Hospice Study, Congress passed legislation enabling certified hospices to receive Medicare reimbursement. What emerged is a reimbursement program that differs substantially from the movement that spawned it. Hospices now face many dilemmas, among them shifting the burden of care to the family, determining who controls the course of patient care, and breaking even financially.

Proceedings of the Aristotelian Society, Volume 115, Issue 3pt3, Page 235-253, December 2015.

This article advances a new account of Kant’s views on conceptualism. On the one hand, I argue that Kant was a nonconceptualist. On the other hand, my approach accommodates many motivations underlying the conceptualist reading of his work: for example, it is fully compatible with the success of the Transcendental Deduction. I motivate my view by providing a new analysis of both Kant’s theory of perception and of the role of categorical synthesis: I look in particular at the categories of (...) quantity. Locating my interpretation in relation to recent research by Allais, Ginsborg, Tolley and others, I argue that it offers an attractive compromise on this important theoretical and exegetical issue. (shrink)

Between 1927 and 1936, Martin Heidegger devoted almost one thousand pages of close textual commentary to the philosophy of Immanuel Kant. This article aims to shed new light on the relationship between Kant and Heidegger by providing a fresh analysis of two central texts: Heidegger’s 1927/8 lecture course Phenomenological Interpretation of Kant’s Critique of Pure Reason and his 1929 monograph Kant and the Problem of Metaphysics. I argue that to make sense of Heidegger’s reading of Kant, one must resolve two (...) questions. First, how does Heidegger’s Kant understand the concept of the transcendental? Second, what role does the concept of a horizon play in Heidegger’s reconstruction of the Critique? I answer the first question by drawing on Cassam’s model of a self-directed transcendental argument, and the second by examining the relationship between Kant’s doctrine that ‘pure, general logic’ abstracts from all semantic content and Hume’s attack on metaphysics. I close by sketching the implications of my results for Heidegger’s own thought. Ultimately, I conclude that Heidegger’s commentary on the Critical system is defined, above all, by a single issue: the nature of the ‘form’ of intentionality. (shrink)

This article advances a new analysis of stupidity as a distinctive form of cognitive failing. Section 1 outlines some problems in explicating this notion and suggests some desiderata. Section 2 sketches an existing model of stupidity, found in Kant and Flaubert, which serves as a foil for my own view. In section 3, I introduce my theory: I analyse stupidity as form of conceptual self-hampering, characterised by a specific aetiology and with a range of deleterious effects. In section 4, I (...) show how this proposal meets the desiderata and I clarify how it diverges from existing accounts. My position is close to a 'public health approach', in contrast to the virtue/vice framework employed by Engel or Mulligan. (shrink)

In our digital world, we are confused by privacy – what is public, what is private? We are also challenged by it, the conditions of privacy so uncertain we become unsure about our rights to it. We may choose to share personal information, but often do so on the assumption that it won't be re-shared, sold, or passed on to other parties without our knowing. In the eighteenth century, philosopher Jeremy Bentham wrote about a new model for a prison called (...) a Panopticon, where inmates surrounded the jailers, always under watch. Have we built ourselves a digital Panopticon? Are we the guards or the prisoners, captive or free? Can we be both? When Kim Kardashian makes the minutiae of her life available online, which is she? With great rigour, this important book draws on a Kantian philosophy of ethics and legal frameworks to examine where we are and to suggest steps – conceptual and practical – to ensure the future is not dystopian. Privacy is one of the defining issues of our time; this lively book explains why this is so, and the ways in which we might protect it. (shrink)

Transnational politics and labor markets are undermining national industrial relations systems in Europe. This article examines the construction industry, where the internationalization of the labor market has gone especially far. To test hypotheses about di ferences between “national systems,” the authors examine the United Kingdom, Finland, and Germany, alongside European-level policy making. Regardless of overall national institutional framework, employers seek to avoid industrial relations rules, while unions attempt to relocalize labor relations. Both use shop-floor, national, and European power resources. The (...) authors argue that comparative industrial relations should take seriously the connection between action at the national and transnational levels. (shrink)

One of the strongest motivations for conceptualist readings of Kant is the belief that the Transcendental Deduction is incompatible with nonconceptualism. In this article, I argue that this belief is simply false: the Deduction and nonconceptualism are compatible at both an exegetical and a philosophical level. Placing particular emphasis on the case of non-human animals, I discuss in detail how and why my reading diverges from those of Ginsborg, Allais, Gomes and others. I suggest ultimately that it is only by (...) embracing nonconceptualism that we can fully recognise the delicate calibration of the trap which the Critique sets for Hume. (shrink)

Augustine’s first conversion is to the Christian Platonism of his day, which brought along with it a free-will defence to the problem of evil. Formative as this philosophical influence was, however, Augustine’s own experience of sin combines with his sense of God’s sovereignty to lead him to modify the views he inherited in significant ways. This transformation is demonstrated by setting Augustine’s evolving position against that of Gregory of Nyssa.

This paper presents an extensional account of manyand few that explains data that have previously motivated intensional analyses of these quantifiers :599–620, 2000). The key insight is that their semantic arguments are themselves set intersections: the restrictor is the intersection of the predicates denoted by the N’ or the V’ and the restricted universe, U, and the scope is the intersection of the N’ and V’. Following Cohen, I assume that the universe consists of the union of alternatives to the (...) nominal and verbal predicates, where an alternative to a property ψ is one that shares a pragmatic presupposition with ψ, and a pragmatic presupposition is one that is selected by context from a set of potential presuppositions associated with the sentence. A many/few-quantified sentence is then true iff the proportion of the scope to the restrictor is greater/less than some threshold, n. In addition to explaining various problematic cases from the literature, the analysis shows how the readings of a many/few-quantified sentence can be derived from the same syntactico-semantic structure, it being unnecessary to claim lexical or structural ambiguity. The analysis also provides strong support for the idea that natural language quantification is always purely extensional. (shrink)

This paper examines Heidegger’s position on a foundational distinction for Kantian and post-Kantian philosophy: that between acting ‘in the light of’ a norm and acting ‘merely in accordance with it’. In section 1, I introduce the distinction and highlight several relevant similarities between Kant and Heidegger on ontology and the first-person perspective. In section 2, I press the Kantian position further, focusing on the role of inferential commitments in perception: this provides a foil against which Heidegger’s account can be In (...) section 3, I contrast this Kantian approach with Crowell’s highly sophisticated reading of Heidegger on care: I argue that, subject to certain conditions on how we view explanation, the two approaches are compatible and indeed mutually supporting. I close in section 4 by addressing an importantly distinct dimension of normativity, that marked by critique, broadly construed. I argue that we ultimately need to locate Heidegger in a context that. (shrink)

This paper argues that there is a relationship between understandings of anorexia nervosa (AN) and how the ethical issues associated with involuntary treatment for AN are identified, framed, and addressed. By positioning AN as a construct/discourse (hereinafter “AN: the diagnosis”) several ethical issues are revealed. Firstly, “AN: the diagnosis” influences how the autonomy and competence of persons diagnosed with AN are understood by decision-makers in the treatment environment. Secondly, “AN: the diagnosis” impacts on how treatment and treatment efficacy are defined (...) and the ethical justifiability of paternalism. Thirdly, “AN: the diagnosis” can limit the opportunity for persons with AN to construct an identity that casts them as a competent person. “AN: the diagnosis” can thus inherently affirm professional knowledge and values. Postmodern professional ethics can support professionals in managing these issues by highlighting the importance of taking responsibility for professional knowledge, values, and power and embracing moral uncertainty. (shrink)

MacIntyre characterises liberal societies as suffering distinctive, structural forms of malaise: they are a ‘disaster’, a ‘moral calamity’, sites of ‘barbarism and darkness’. I argue that, whilst we well understand why MacIntyre thinks liberalism is false, it is unclear why this falsity should imply such moral catastrophe. I begin by motivating the question and distinguishing it from the classic liberal-communitarian debates (§§1-2). In particular, I highlight liberalism’s ability to offer ‘workarounds’, accommodating at least some of MacIntyre’s commitments and so forestalling (...) the prospect of moral disaster. I then introduce two arguments which supply the missing premises, in each case juxtaposing MacIntyre with other critics of liberalism. First, I argue that liberalism’s conception of the private sphere systematically marginalizes MacIntyre’s vision of pedagogy (§3). I compare the argument and the attendant conception of privacy with Adorno’s (§4). In §5, I introduce the second premise: I argue that liberalism espouses a conception of maturity that actively undermines MacIntyre’s model of development, subverting liberal ‘workarounds’. I contrast this claim with recent attacks on liberalism by Deneen. I close with some methodological implications: MacIntyre’s case against liberalism should be seen as a form of external, not immanent, critique. (shrink)

The phenomenological tradition developed sophisticated techniques to draw attention to pre-theoretic or pre-reflective experience. This article examines how one of the most famous, Heidegger’s ‘broken tool’, might work in a pedagogical context. I contend that it can be highly effective there, fleshing out his vision of teaching as ‘letting learn’ with a distinctive educational method. At the same time, that context suggests fundamental changes to the standard reading of the ‘broken tool’, shifting the focus towards what I call ‘information tools’. (...) My conclusions link to recent research stressing disruption in the learning process, and I close by contrasting my position with ‘bricolage’ theories and work by Applebaum and others. (shrink)

Engaging in a chronological retrospection of my professional and personal transdisciplinary practice of walking-based research over the past decade, and embedding some elements of arts-based writin...

This paper addresses a number of closely related questions concerning Kant's model of intentionality, and his conceptions of unity and of magnitude [Gröβe]. These questions are important because they shed light on three issues which are central to the Critical system, and which connect directly to the recent analytic literature on perception: the issues are conceptualism, the status of the imagination, and perceptual atomism. In Section 1, I provide a sketch of the exegetical and philosophical problems raised by Kant's views (...) on these issues. I then develop, in Section 2, a detailed analysis of Kant's theory of perception as elaborated in both the Critique of Pure Reason and the Critique of Judgment; I show how this analysis provides a preliminary framework for resolving the difficulties raised in Section 1. In Section 3, I extend my analysis of Kant's position by considering a specific test case: the Axioms of Intuition. I contend that one way to make sense of Kant's argument is by juxtaposing it with Russell's response to Bradley's regress; I focus in particular on the concept of ‘unity’. Finally, I offer, in Section 4, a philosophical assessment of the position attributed to Kant in Sections 2 and 3. I argue that, while Kant's account has significant strengths, a number of key areas remain underdeveloped; I suggest that the phenomenological tradition may be read as attempting to fill precisely those gaps. (shrink)

The cost of health care at the end of life accounts for a high proportion of total health care costs in the United States. The percentage of Medicare payments attributable to patients in their last year of life was 28.3% in 1978 and has remained substantially the same at 25.1% in 2006. This indicates how little progress has been made in containing these costs, though doing so will be important to promote a financially sustainable health care system. These expenditures also (...) highlight the prospect that efforts to reduce health care costs overall are likely to disproportionately affect the care patients receive at the end of life. (shrink)