The good, the right & the exigencies of life: John Dewey & the value of moral disagreement

The crucial demarcation of John Dewey’s ethical theory was to advocate a shift from promoting particular moral views to emphasising a process of reflective moral enquiry that is equipped to incorporate plurality and difference. I have attempted to revisit Dewey’s relevance to the present by setting his ideas within a broader historical context than he is normally located in Pragmatist literature. Hence, an important methodological aspect of the thesis is deriving the conceptual framework through a historical analysis of David Hume’s particular brand of sentimentalism, Immanuel Kant’s unification of sentimentalism and rationalism in the third Critique and John Stuart Mill’s notion of community under the rubrics of two terms, namely Dewey’s ‘experience’ and ‘inquiry’. I demonstrate that understanding each philosopher as building on the ideas of the previous philosopher’s ethical theory provides a background to Dewey’s pragmatist ethics. This allows me to reconfigure the tendency of standard contemporary analyses of Dewey that continue to evaluate his work in terms of the very alternatives that Dewey sought to overcome, for example, objective and subjective, cognitive and non-cognitive, plural and monist. Finally, I show how Dewey’s pragmatist ethics bear upon the value of disagreement as illustrated in three case studies from the present day. This reveals Dewey’s theory in practice. Dewey’s particular conceptions of experience and enquiry, rather than any particular set of norms or principles, are employed to define his conception of the ethical. Dewey’s pragmatic proceduralism is neither normative nor meta-theoretical. Rather it describes the basis upon which one can demonstrate that one is a part of a community of ethical progress.Thesis (Ph.D.) -- University of Adelaide, School of Humanities, 201

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570