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)

In ‘The Complex Case of Ellie Anderson’, Joona Rasanen and Anna Smajdor raise several ethical questions about the case. One question asks, but does not answer, whether Ellie faced discrimination for being transgender when her mother was not allowed access to Ellie’s sperm following her death. In raising the question, the authors imply anti-trans bias may have influenced this determination. However, this inference is not supported by current ethical and legal guidance for posthumous use of gametes, with which Ellie’s (...) case is consistent. We consider the authors’ responses to their other ethical queries, and how their suggestions for what options might have been available to Ellie and her family are instructive for addressing attempts in the USA and UK to restrict minors’ access to gender-affirming medical treatment, including puberty-blocking therapy. (shrink)

Trata-se de mostrar como a “colisão” da lógica com sua aplicação, no cenário do Tractatus Logico-Philosophicus de Wittgenstein, pode ser enxergada a partir do problema da incompatibilidade das cores. Exploraremos algumas soluções nos moldes tractarianos, verificando em que medida elas não satisfazem algumas exigências da obra. Também apresentaremos uma tentativa de solução do próprio Wittgenstein para o problema, mostrando como o filósofo percebe que tal solução não é satisfatória.

Leading scholars explore how different forms of ignorance are produced and sustained, and the role they play in knowledge practices.

R. Lanier Anderson presents a new account of Kant's distinction between analytic and synthetic judgments, and provides it with a clear basis within traditional logic. He reconstructs compelling claims about the syntheticity of elementary mathematics, and re-animates Kant's arguments against traditional metaphysics in the Critique of Pure Reason.

While gender and race often are considered socially constructed, this book argues that they are physiologically constituted through the biopsychosocial effects of sexism and racism. This means that to be fully successful, critical philosophy of race and feminist philosophy need to examine not only the financial, legal, political and other forms of racist and sexism oppression, but also their physiological operations. Examining a complex tangle of affects, emotions, knowledge, and privilege, The Physiology of Sexist and Racist Oppression develops an understanding (...) of the human body whose unconscious habits are biological. On this account, affect and emotion are thoroughly somatic, not something "mental" or extra-biological layered on top of the body. They also are interpersonal, social, and can be transactionally transmitted between people.Ranging from the stomach and the gut to the hips and the heart, from autoimmune diseases to epigenetic markers, Sullivan demonstrates the gastrointestinal effects of sexual abuse that disproportionately affect women, often manifesting as IBS, Crohn's disease, or similar functional disorders. She also explores the transgenerational effects of racism via epigenetic changes in African American women, who experience much higher pre-term birth rates than white women do, and she reveals the unjust benefits for heart health experienced by white people as a result of their racial privilege. Finally, developing the notion of a physiological therapy that doesn't prioritize bringing unconscious habits to conscious awareness, Sullivan closes with a double-barreled approach for both working for institutional change and transforming biologically unconscious habits. The Physiology of Sexist and Racist Oppression skillfully combines feminist and critical philosophy of race with the biological and health sciences. The result is a critical physiology of race and gender that offers new strategies for fighting male and white privilege. (shrink)

This article examines how people of color can biologically inherit the deleterious effects of white racism. Drawing primarily on the field of epigenetics, I demonstrate how transgenerational racial disparities are in fact racist disparities that can be manifest physiologically, helping constitute the chemicals, hormones, cells, and fibers of the human body. Epigenetics can be used to demonstrate how white racism can have durable effects on the biological constitution of human beings that are not limited to the specific person who is (...) the target of white racism, but instead extend to that person's offspring. In this way, the field of epigenetics can help philosophers and others understand the transgenerational biological impact of social forces such as white racism. It reveals that the damage done by white racism is more extensive than critical philosophers of race might have realized, and also that interventions against white racism must address not just the economic, geographical, social, and psychological, but also the biological aspects of human existence. In particular, the article examines racist disparities in preterm birth rates and argues that the scope and significance of prenatal care for African American women must be expanded intergenerationally and include wide-scale forms of racial justice. (shrink)

Extended cognition is the view that some cognitive processes extend beyond the brain. One prominent strategy of arguing against extended cognition is to offer necessary conditions on cognition and argue that the proposed extended processes fail to satisfy these conditions. I argue that this strategy is misguided and fails to refute extended cognition. I suggest a better way to evaluate the case for extended cognition that should be acceptable to all parties, captures the intuitiveness of previous objections, and avoids the (...) problems with the strategy of offering necessary conditions on cognition. I conclude that extended cognition theorists have failed to establish the truth of extended cognition. (shrink)

Este ensaio explora de maneira breve as sugestões dos pragmatistas americanos com relação ao desenvolvimento do pensamento filosófico. Entre estas, estão incluídas a necessidade de aprender de outras disciplinas os modos úteis de investigação para o entendimento da experiência humana, a necessidade de manter um diálogo com a história das ideias tanto para prevenir a repetição quanto para sugerir novas direções do pensamento, bem como a travessia das fronteiras culturais para evitar a arrogância dogmática encontrada no interior das fronteiras de (...) muitas culturas dominantes. (shrink)

Chapter 4 demonstrates how white domination helps constitute the bodies of white people, focusing on white people’s stomachs and hearts in particular. Returning to the example of undergraduate student Brittney from the book’s Introduction, this chapter locates unconscious habits of white privilege in the clenching muscles of white people’s stomachs. It also argues that white people’s relatively good cardio health should be viewed a physiological effect of white privilege, rather than as a neutral or normal health condition. In the case (...) of both white stomachs and white hearts, a racialized knowledge grounded in white ignorance helps structure contemporary white physiology. (shrink)

Social cognition is the capacity to understand and interact with others. The mainstream account of social cognition is mindreading, the view that we humans understanding others by interpreting their behavior in terms of mental states. Recently theorists from philosophy, psychology, and neuroscience have challenged the mindreading account, arguing for a more deflationary account of social cognition. In this paper I examine a deflationary account of social cognition, embodied simulation, which is inspired by recent neuroscientific findings. I argue that embodied simulation (...) fails to present an adequate alternative to mindreading accounts of social cognition. I defend a philosophically and empirically plausible two-systems account of social cognition, which holds that even very young children are capable of mindreading. (shrink)

Beginning with the experience of a white woman's stomach seizing up in fear of a black man, this essay examines some of the ethical and epistemological issues connected to white ignorance. In conversation with Charles Mills on the epistemology of ignorance, I argue that white ignorance primarily operates physiologically, not cognitively. Drawing critically from psychology, neurocardiology, and other medical sciences, I examine some of the biological effects of racism on white people's stomachs and hearts. I argue for a nonideal medical (...) theory focused on improving wellness in a society that systematically has damaged the health of people of color. The essay concludes that to be fully successful, critical philosophy of race must examine not just the financial, legal, political, and other forms of racism, but also its biological and physiological operations. (shrink)

Embodied social cognition (ESC) aims to explicate how our embodiment shapes our knowledge of others, and in what this knowledge of others consists. Although there is much diversity amongst ESC accounts, common to all these accounts is the idea that our normal everyday interactions consist in non-mentalistic embodied engagements. In recent years, several theorists have developed and defended innovative and controversial accounts of ESC. These accounts challenge, and offer deflationary alternatives to, the standard cognitivist accounts of social cognition. As ESC (...) accounts grow in number and prominence, the time has come for a dedicated, sustained debate on ESC and its most controversial and innovative elements. The goal of this special issue is to host such a debate with the aim of bringing clarity to the discussion of social cognition. (shrink)