A simple argument against Lewisian modal realism as portrayed in On the Plurality of World arises from its treatment of doxastic modalities. It is easily shown that if it is true, it is impossible to doubt the theory on ontological grounds, or, that, if it is possible to maintain doubt about modal realism’s existential postulate, it has to be false. The argument hinges on the fact that modal realism’s main ontological hypothesis, if true, is necessarily true.

When information on a coma patient’s expected outcome is uncertain, a moral dilemma arises in clinical practice: if life-sustaining treatment is continued, the patient may survive with unacceptably poor neurological prospects, but if withdrawn a patient who could have recovered may die. Continuous electroencephalogram-monitoring is expected to substantially improve neuroprognostication for patients in coma after cardiac arrest. This raises expectations that decisions whether or not to withdraw will become easier. This paper investigates that expectation, exploring cEEG’s impacts when it becomes (...) part of a socio-technical network in an Intensive Care Unit. Based on observations in two ICUs in the Netherlands and one in the USA that had cEEG implemented for research, we interviewed 25 family members, healthcare professionals, and surviving patients. The analysis focuses on the way patient outcomes are constructed, the kind of decision support these outcomes provide, and how cEEG affects communication between professionals and relatives. We argue that cEEG can take away or decrease the intensity of the dilemma in some cases, while increasing uncertainty for others. It also raises new concerns. Since its actual impacts furthermore hinge on how cEEG is designed and implemented, we end with recommendations for ensuring responsible development and implementation. (shrink)

Aim: To elicit preferences for prognostic information, attitudes towards withdrawal of life-sustaining treatment (WLST) and perspectives on acceptable quality of life after post-anoxic coma within the adult general population of Germany, Italy, the Netherlands and the United States of America. Methods: A web-based survey, consisting of questions on respondent characteristics, perspectives on quality of life, communication of prognostic information, and withdrawal of life-sustaining treatment, was taken by adult respondents recruited from four countries. Statistical analysis included descriptive analysis and chi2-tests for (...) dierences between countries. Results: In total, 2012 respondents completed the survey. In each country, at least 84% indicated they would prefer to receive early prognostic information. If a poor outcome was predicted with some uncertainty, 37-54% of the respondents indicated that WLST was not to be allowed. A conscious state with severe physical and cognitive impairments was perceived as acceptable quality of life by 17–44% of the respondents. Clear differences between countries exist, including respondents from the U.S. being more likely to allow WLST than respondents from Germany (OR = 1.99, p < 0.001) or the Netherlands (OR = 1.74, p < 0.001) and preferring to stay alive in a conscious state with severe physical and cognitive impairments more than respondents from Italy (OR = 3.76, p < 0.001), Germany (OR = 2.21, p < 0.001), or the Netherlands (OR = 2.39, p < 0.001). Conclusions: Over one-third of the respondents considered WLST unacceptable when there is any remaining prognostic uncertainty. Respondents had a more positive perspective on acceptable quality of life after coma than what is currently considered acceptable in medical literature. This indicates a need for a closer look at the practice of WLST based on prognostic information, to ensure responsible use of novel prognostic tests. (shrink)

Background: Patient participation in clinical ethics support services has been marked as an important issue. There seems to be a wide variety of practices globally, but extensive theoretical or empirical studies on the matter are missing. Scarce publications indicate that, in Europe, patient participation in CESS varies from region to region, and per type of support. Practices vary from being non-existent, to patients being a full conversation partner. This contrasts with North America, where PP seems more or less standard. While (...) PP seems to be on the rise in Europe, there is no data to confirm this. This study sought a deep understanding of both habits and the attitudes towards PP in the Netherlands, including respondents’ practical and normative perspectives on the matter. Methods and Results: We developed a national survey on PP for Dutch CESS staff. Our survey comprised a total of 25 open and close-ended questions, focused on four topics related to PP goals of CESS, status quo of PP, ideas and ideals concerning PP, and obstacles for PP. Discussion: The four most important findings were that: Patient participation in Dutch CESS is far from standard. Views on patient participation are very much intertwined with the goals of ethics support. Hesitations, fears and perceived obstacles for PP were not on principle and Most respondents see PP as a positive opportunity, yet requiring additional training, practical guidance and experience. Conclusions: Various normative reasons require PP. However, PP seems far from standard and somewhat rare in Dutch CESS settings. Our respondents did not raise many principled objections to PP. Instead, reasons for the lack of PP are intertwined with viewpoints on the goals of CESS, which seemingly focus on supporting health care professionals. Training and practical guidance was thought to be helpful for gaining experience for both CESS staff and HCPs. (shrink)

In 2012, choreographer and dancer Jill Sigman of jill sigman/thinkdance and visual artist Janine Antoni collaborated to produce Wedge, a live performance at the Albright-Knox Gallery. In this essay, I describe the collaboration and the resulting work and examine the benefits and challenges of the collaboration. The discussion touches on broader issues pertaining to collaboration, co-authorship, artists' intentions, and interpretation.

The philosophy of biomimicry, I argue, consists of four main areas of inquiry. The first, which has already been explored by Freya Mathews, concerns the “deep” question of what Nature ultimately is. The second, third, and fourth areas correspond to the three basic principles of biomimicry as laid out by Janine Benyus. “Nature as model” is the poetic principle of biomimicry, for it tells us how it is that things are to be “brought forth”. “Nature as measure” is the (...) ethical principle of biomimicry, for it tells us that Nature places ethical limits or standards on what it is possible for us to accomplish. And “Nature as mentor” is the epistemological principle of biomimicry, for it affirms that Nature is the ultimate source of truth, wisdom, and freedom from error. Within this overall framework, I argue that seeing Nature as physis—understood as “self-production” or “self-placing-into-the-open”—constitutes the requisite ground for the poetic, ethical, and epistemological principles of biomimicry, and that biomimicry thus conceived involves a new philosophical paradigm, which I call “enlightened naturalism”. (shrink)

Among others, the recent work of Janine Idziak presents Andrew of Neufchateau (†1400) as a fervent advocate of “divine command ethics,” a promoter of radical voluntarism, according to which moral values depend solely on the divine will. One example that illustrates this theory is the “hatred of God” (odium Dei ), often discussed in the fourteenth century. Since moral values depend on the divine will, it can be morally good to hate God if that is his command. Andrew has (...) been seen and is still seen today as a supporter of this view. The present paper aims to reconsider this interpretation. (shrink)

An extensive literature about pictorial representation discusses what is involved when a two-dimensional image represents some specific object or type of object. A smaller literature addresses parallel issues in sculptural representation. But little has been said about the role played by the sculptural material itself in determining the meanings of the sculptural work. Appealing to Nelson Goodman and Catherine Elgin’s discussions of literal and metaphorical exemplification, I argue that the material of which a sculpture is constituted plays key roles in (...) what is represented and how it is represented, in part because we have bodily and emotional responses to the real possibilities the sculptural material creates for us. I discuss examples of contemporary artworks by Melvin Edwards, Kara Walker, Willie Cole, Marc Quinn, Ai Weiwei, Janine Antoni, El Anatsui, Zoe Leonard, and others. (shrink)