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With advances in medical technology and increasing numbers of elderly patients surviving acute intensive care unit admissions, otolaryngologic consultation regarding tracheostomy for ventilator-dependent patients is expected to continue increasing. However, established treatment guidelines and defined outcomes in terms of health status, quality of life, and medical costs are lacking in this emotionally delicate setting. A retrospective case review of the outcomes of 19 elderly patients who underwent tracheostomy for ventilator dependence revealed that 14 had died within 40 days of surgery. The high number of deaths—which were caused by multiple organ failure, sepsis, and/or cardiopulmonary arrest—so soon after tracheostomy demands the implementation of outcomes research. In this article, we introduce outcomes analysis as a means of assessing the utility of tracheostomy for ventilator dependence in the elderly and to advocate the establishment of a multidisciplinary palliative-care unit for this group of patients.

Musical performance has not found a home in traditional aesthetics, perhaps for as many practical as philosophical reasons. The world of the professional musician is a rather closed society, populated by individuals not typically given to verbalizing about their work. In rehearsal, smaller-scale decisions about particular passages are often resolved through the physical gestures of the conductor or leader, with perhaps only brief comments. There is usually little need for extensive conversation in rehearsal, since general knowledge of musical style resolves many large questions of interpretation for an ensemble without discussion and since musicians often feel that a performance speaks for itself in a way that language cannot enhance. In fact, many interpretational decisions closely associated with refining a performance (much of the actual music making) occur most appropriately in the moment, on stage, in the course of the piece. Performers typically make final adjustments to the shape and proportion of many musical materials without verbal communication and without rehearsal. Unfortunately, these details of musical practice remain somewhat shrouded, and exquisite performances are too often set aside as "good ensemble playing." From a philosophical point of view, musical performances are elusive creatures. They beg the difficult aesthetic question of the nature of musical interpretation itself, and they also require that we account for the physical involvement of the performer(s) in producing musical sounds. Part of the problem may be that, as Hilda Hein has noted, static features such as those found in the art of painting or sculpture are easier to discuss than is process, which often remains unacknowledged.1 Several contemporary philosophers