Tom Donaldson

In a recent paper, Braun argued for an autonomy-based approach to assisted suicide as a way to avoid the expressivist objection to assisted dying laws. In this paper, I will argue that an autonomy-based approach actually extends the expressivist objection to assisted dying because it is not possible for one agent to assist another in pursuit of a goal without expressing that it would be good for that goal to come about. Braun argued that assisted dying should be viewed purely as an individual’s autonomous action, but this requires the assistance of the medical professional to be understood as that of a non-moral automaton, such as a suicide booth. Instead, it will be argued that a beneficent motivation to promote human flourishing provides moral reasons for both non-interference in the actions, for example, suicide, of competent agents and for considering whether assisting another agent with their goal will promote their flourishing.

This paper has two components. The first, longer component (sec. 1-6) is a critical exposition of Armstrong's views about the metaphysics of mathematics, as they are presented in Truth and Truthmakers and Sketch for a Systematic Metaphysics. In particular, I discuss Armstrong's views about the nature of the cardinal numbers, and his account of how modal truths are made true. In the second component of the paper (sec. 7), which is shorter and more tentative, I sketch an alternative account of the metaphysics of mathematics. I suggest we insist that mathematical truths have physical truthmakers, without insisting that mathematical objects themselves are part of the physical world.

Aristotle’s ethical system was guided by his vision of human flourishing (also, but potentially misleadingly, translated as happiness). For Aristotle, human flourishing was a rich holistic concept about a life lived well until its ending. Both living a long life and dying well were integral to the Aristotelian ideal of human flourishing. Using Aristotle’s concept of human flourishing to inform the goals of medicine has the potential to provide guidance to clinical decision-makers regarding the provision of burdensome treatments, such as intensive care treatment, where pursuing a chance of survival must be balanced against the risk of exposing patients to a negative dying experience. By conceptually uniting potentially competing goals of medicine, such as prolonging life and the promotion of peaceful deaths, Aristotle’s understanding of human flourishing creates an argument for the integration of palliative care considerations into intensive care decision-making and for advanced care planning with healthy patients.

Time-limited trials of intensive care have arisen in response to the increasing demand for intensive care treatment for patients with a low chance of surviving their critical illness, and the clinical uncertainty inherent in intensive care decision-making. Intensive care treatment is reported by most patients to be a significantly unpleasant experience. Therefore, patients who do not survive intensive care treatment are exposed to a negative dying experience. Time-limited trials of intensive care treatment in patients with a low chance of surviving have both a small chance of benefiting this patient group and a high chance of harming them by depriving them of a good death. A ‘rule of rescue’ for the critically unwell does not justify time-limiting a trial of intensive care treatment and overlooks the experiential costs that intensive care patients face. Offering time-limited trials of intensive care to all patients, regardless of their chance of survival, overlooks the responsibility of resource-limited intensive care clinicians for suffering caused by their actions. A patient-specific risk–benefit analysis is vital when deciding whether to offer intensive care treatment, to ensure that time-limited trials of intensive care are not undertaken for patients who have a much higher chance of being harmed, rather than benefited by the treatment. The virtue ethics concept of human flourishing has the potential to offer additional ethical guidance to resource-limited clinicians facing these complex decisions, involving the balancing of a quantifiable survival benefit against the qualitative suffering that intensive care treatment may cause.

McCullough et al ’s article about the professional virtue of civility makes a persuasive case that civility should be a core value in medical education, and that civility facilitates the development of organisational cultures committed to excellence in clinical and scientific reasoning.1 In particular, the negative implications of incivility on the well-being of individuals, on team-working dynamics and on patient safety, creates a strong argument that incivility from healthcare professionals is entirely unacceptable. However, in terms of professional attitudes, civility is the bare minimum that modern clinicians require. Modern healthcare involves complex systems in which patients are likely to encounter multiple different healthcare professionals in the course of their investigation and treatment.2 No one clinician has all of the skills or knowledge that patients need and so the practice of medicine is necessarily collaborative. However, civility can be achieved by individuals who are content to politely and respectfully coexist in …

In the middle of the last century, it was common to explain the notion of necessity in linguistic terms. A necessary truth, it was said, is a sentence whose truth is guaranteed by linguistic rules. Quine famously argued that, on this view, de re modal claims do not make sense. “Porcupettes are porcupines” is necessarily true, but it would be a mistake to say of a particular porcupette that it is necessarily a porcupine, or that it is possibly purple. Linguistic theories of necessity fell out of favour with the publication of Kripke’s Naming and Necessity, and Quine’s arguments were put aside. In her recent book, Norms and Necessity, Amie Thomasson presents her modal normativism, which is an updated version of the mid-century theories just described. Quine’s arguments are thus relevant once again. We recapitulate Quine’s central argument, in the context of modal normativism. We then criticise Amie Thomasson’s discussion of de re modality. We finish by briefly presenting an alternative account of de re modal statements, which is compatible with modal normativism.

This paper has two components. The first, longer component (sec. 1-6) is a critical exposition of Armstrong’s views about the metaphysics of mathematics, as they are presented in Truth and Truthmakers and Sketch for a Systematic Metaphysics. In particular, I discuss Armstrong’s views about the nature of the cardinal numbers, and his account of how modal truths are made true. In the second component of the paper (sec. 7), which is shorter and more tentative, I sketch an alternative account of the metaphysics of mathematics. I suggest we insist that mathematical truths have physical truthmakers, without insisting that mathematical objects themselves are part of the physical world.

The term ‘continuous’ in real analysis wasn’t given an adequate formal definition until 1817. However, important theorems about continuity were proven long before that. How was this possible? In this paper, I introduce and refine a proposed answer to this question, derived from the work of Frank Jackson, David Lewis and other proponents of the ‘Canberra plan’. In brief, the proposal is that before 1817 the meaning of the term ‘continuous’ was determined by a number of ‘platitudes’ which had some special epistemic status

In Writing the Book of the World, Ted Sider argues that David Lewis’s distinction between those predicates which are ‘perfectly natural’ and those which are not can be extended so that it applies to words of all semantic types. Just as there are perfectly natural predicates, there may be perfectly natural connectives, operators, singular terms and so on. According to Sider, one of our goals as metaphysicians should be to identify the perfectly natural words. Sider claims that there is a perfectly natural first-order quantifier. I argue that this claim is not justified. Quine has shown that we can dispense with first-order quantifiers, by using a family of ‘predicate functors’ instead. I argue that we have no reason to think that it is the first-order quantifiers, rather than Quine’s predicate functors, which are perfectly natural. The discussion of quantification is used to provide some motivation for a general scepticism about Sider’s project. Shamik Dasgupta’s ‘generalism’ and Jason Turner’s critique of ‘ontological nihilism’ are also discussed.