No one really believes that literally all functions of the entire brain must be lost for an individual to be dead. A better definition of death involves a higher brain orientation.

In its October 2001 issue, this journal published a series of articles questioning the Whole-Brain-based definition of death. Much of the concern focused on whether somatic integration - a commonly understood basis for the whole-brain death view - can survive the brain's death. The present article accepts that there are insurmountable problems with whole-brain death views, but challenges the assumption that loss of somatic integration is the proper basis for pronouncing death. It examines three major themes. (...) First, it accepts the claim of the "disaggregators" that some behaviors traditionally associated with death can be unbundled, but argues that other behaviors (including organ procurement) must continue to be associated. Second, it rejects the claims of the "somaticists," that the integration of the body is critical, arguing instead for equating death with the irreversible loss of "embodied consciousness," that is, the loss of integration of bodily and mental function. Third, it defends higher-brain views against the charge that they are necessarily "mentalist," that is, that they equate death with losing some mental function such as consciousness or personhood. It argues, instead, for the integration of bodily and mental function as the critical feature of human life and that its irreversible loss constitutes death. (shrink)

The dead donor rule (DDR) governs procuring life-prolonging organs. They should be taken only from deceased donors. Miller and Truog have proposed abandoning the rule when patients have decided to forgo life-sustaining treatment and have consented to procurement. Organs could then be procured from living patients, thus killing them by organ procurement. This proposal warrants careful examination. They convincingly argue that current brain or circulatory death pronouncement misidentifies the biologically dead. After arguing convincingly that physicians already cause death by (...) withdrawing treatment, they claim no bright-line differences preclude organ removal from the living. The argument fails for those who accept the double effect doctrine or other grounds for distinguishing forgoing life support from active, intentional killing. If the goal is determining irreversible loss of somatic function, they correctly label current death pronouncement a “legal fiction.” Recognizing a second, public policy meaning of the term death provides grounds for maintaining the DDR without jeopardizing procurement. (shrink)

When a new, brain-based definition of death was proposed fifty years ago, no one realized that the issue would remain unresolved for so long. Recently, six new controversies have added to the debate: whether there is a right to refuse apnea testing, which set of criteria should be chosen to measure the death of the brain, how the problem of erroneous testing should be handled, whether any of the current criteria sets accurately measures the death of the (...) class='Hi'>brain, whether standard criteria include measurements of all brain functions, and how minorities who reject whole-brain-based definitions should be accommodated. These controversies leave little hope of consensus on how to define death for social and public policy purposes. Rather, there is persistent disagreement among proponents of three major groups of definitions of death: whole-brain, cardiocirculatory or somatic, and higher-brain. Given the persistence and reasonableness of each of these groups of definitions, public policy should permit individuals and their valid surrogates to choose among them. (shrink)

_Minds, Brains, Computers_ serves as both an historical and interdisciplinary introduction to the foundations of cognitive science.

The current definition of death used for donation after cardiac death relies on a determination of the irreversible cessation of the cardiac function. Although this criterion can be compatible with transplantation of most organs, it is not compatible with heart transplantation since heart transplants by definition involve the resuscitation of the supposedly "irreversibly" stopped heart. Subsequently, the definition of "irreversible" has been altered so as to permit heart transplantation in some circumstances, but this is unsatisfactory. There are three available strategies (...) for solving this "irreversibility problem": altering the definition of death so as to rely on circulatory irreversibility, rather than cardiac; defining death strictly on the basis of brain death (either whole-brain or more pragmatically some higher brain criteria); or redefining death in traditional terms and simultaneously legalizing some limited instances of medical killing to procure viable hearts. The first two strategies are the most ethically justifiable and practical. (shrink)

: Research by Siminoff and colleagues reveals that many lay people in Ohio classify legally living persons in irreversible coma or persistent vegetative state (PVS) as dead and that additional respondents, although classifying such patients as living, would be willing to procure organs from them. This paper analyzes possible implications of these findings for public policy. A majority would procure organs from those in irreversible coma or in PVS. Two strategies for legitimizing such procurement are suggested. One strategy would be (...) to make exceptions to the dead donor rule permitting procurement from those in PVS or at least those who are in irreversible coma while continuing to classify them as living. Another strategy would be to further amend the definition of death to classify one or both groups as deceased, thus permitting procurement without violation of the dead donor rule. Permitting exceptions to the dead donor rule would require substantial changes in law—such as authorizing procuring surgeons to end the lives of patients by means of organ procurement—and would weaken societal prohibitions on killing. The paper suggests that it would be easier and less controversial to further amend the definition of death to classify those in irreversible coma and PVS as dead. Incorporation of a conscience clause to permit those whose religious or philosophical convictions support whole-brain or cardiac-based death pronouncement would avoid violating their beliefs while causing no more than minimal social problems. The paper questions whether those who would support an exception to the dead donor rule in these cases and those would support a further amendment to the definition of death could reach agreement to adopt a public policy permitting organ procurement of those in irreversible coma or PVS when proper consent is obtained. (shrink)

When The Ad Hoc Committee of Harvard Medical School to Examine the Definition of Brain Death began meeting in 1967, I was a graduate student, with committee member Ralph Potter and committee chair Henry Beecher as my mentors. The question of when to stop life support on a severely compromised patient was not clearly differentiated from the question of when someone was dead. A serious clinical problem arose when physicians realized that a patient's condition was hopeless but life support (...) perpetuated body function. Thus, the committee stated that its first purpose was to deal with the burdens on patients and families as well as on hospitals and on patients needing hospital beds occupied by comatose patients. They intuited the strategy of “defining” these patients as dead, thus legitimating treatment stoppage. They noted that this would also serve a second purpose. Although the dead donor rule had not yet been clearly articulated, they claimed that defining patients as dead would also address controversy over obtaining organs for transplant.My mentors’ discussions related to my interest in the intersection between questions primarily of medical fact (When has a human brain irreversibly ceased functioning?) and nonmedical questions of social policy (Should we treat individuals with dead brains and beating hearts as dead humans?). It quickly became clear that most committee members did not appreciate the interplay of these questions. (shrink)

Optogenetics is being optimistically presented in contemporary media for its unprecedented capacity to control cell behavior through the application of light to genetically modified target cells. As such, optogenetics holds obvious potential for application in a new generation of invasive medical devices by which to potentially provide treatment for neurological and psychiatric conditions such as Parkinson's disease, addiction, schizophrenia, autism and depression. Design of a first-in-human optogenetics experimental trial has already begun for the treatment of blindness. Optogenetics trials involve a (...) combination of highly invasive genetic and electronic interventions that results in irreversible and permanent modifications of an individual's nervous system. Given its novelty, its uncertain benefit to patients, and its unique risk profile of irreversible physiological alteration, optogenetics requires a reassessment of the ethical challenges for protecting human participants in clinical trials, particularly at formative stages of clinical evaluation. This study explores the evolving ethical issues surrounding optogenetics’ potential harm to participants within trial design, especially focusing on whether Phase 1 trials should incorporate efficacy as well as safety endpoints in ways that are fair and respectful to research trial participants. (shrink)

The Middle Way is the practical principle of avoiding both positive and negative absolutes, so as to develop provisional beliefs accessible to experience. Although inspired initially by the Buddha’s Middle Way, in Middle Way Philosophy Robert M Ellis has developed it as a critical universalism: a way of separating the helpful from the unhelpful elements of any tradition. In this book, the Middle Way is applied to the Christian tradition in order to argue for a meaningful and positive interpretation (...) of it, without the absolute beliefs that many assume to be essential to Christianity. Faith as an embodied, provisional confidence is distinguished from dogmatic belief. Recent developments in embodied meaning, brain lateralization from neuroscience, Jungian archetypes and the Jungian model of psychological integration are drawn on to support an account of how Christian faith is not only possible without ‘belief’ in God or Christ, but indeed puts us in a better position to access inspiration, moral purpose, responsibility and the basis of peace. (shrink)

The Jungian concept of archetypes is of immense value for critically distinguishing what is potentially of universal practical value in religious and other cultural traditions, and separating this from the dogmatic elements. However, Jung encumbered the concept of archetypes with debatable constructions like the 'collective unconscious' that are unnecessary for understanding their practical function. This book puts forward a far-reaching new theory of archetypes that is functional without being reductive. At the centre of this is the idea that archetypes are (...) adaptations to help us maintain inspiration over time. Humans are such distractable beings that they need constant reminders to maintain integration with their most sustainable intentions: reminders using the profound power of symbol linked to embodied experience. This multi-disciplinary book weaves together religious studies, ethical philosophy, the psychology of bias, the neuroscience of brain lateralisation, the linguistics of embodied meaning, the feedback loops of systems theory, with a lifetime's experience of Buddhist practice and appreciation of symbolism in the arts: all with the aim of producing a fresh understanding of the role of archetypes in religion and beyond, that can also be directly applied in practice. (shrink)

A recent study showed physicians' reasoning about a realistic case to be ignorant of base rate. It also showed physicians interpreting information pertinent to base rate differently, depending on whether it was presented early or late in the case. Although these adult reasoners might do better if given hints through talk of relative frequencies, this would not prove that they had no problem of base rate neglect.

Disagreement about the nature of ‘addiction’, such as whether it is a brain disease, arises in part because the label is applied to a wide range of phenomena. This creates conceptual and definitional confusions and misunderstandings, often leading to researchers talking past one another. Ontologies have been successfully implemented in other fields to help solve these problems by creating unifying frameworks that can accommodate divergence while clarifying the basis for it. We argue that ontologies can help transform the way (...) we think and communicate about addiction as well, providing a basis for a shared understanding of the domain and a shared means for communicating and achieving that understanding. -/- We introduce the use of ontologies in science and medicine and show how they can unify differing perspectives on addiction. We also show how ontologies provide a practical tool for organizing our collective knowledge in this field, even, and especially, when that knowledge is garnered through distinct disciplinary approaches adopting disparate methodologies or perspectives (e.g., neurobiological, psychological, sociological, etc.). In the end, we believe that ontologies can help to avoid letting questions like “Is addiction a brain disease?” divide the field, hamper communication, or otherwise disrupt the ability to make meaningful progress. (shrink)

To the Editor: Before using brain criteria, pronouncing death in humans was based on irreversible loss of something vaguely thought of as respiration or circulation or cardiac function. We have always known the loss had to be irreversible. We have also long known that "irreversible" was ambiguous. In his article ("Are DCD Donors Dead?" May-June 2010), Don Marquis captures this ambiguity when he contrasts irreversibility and permanence. Defenders of cardiocirculatory criteria have known that, in some cases, these functions physiologically (...) could be reversed, but won't be because advance directives or surrogate refusal would make intervention illegal and immoral. When intervening is illegal and immoral, we claim the .. (shrink)

What new implications does the dynamical hypothesis have for cognitive science? The short answer is: None. The _Behavior and Brain Sciences _target article, “The dynamical hypothesis in cognitive science” by Tim Van Gelder is basically an attack on traditional symbolic AI and differs very little from prior connectionist criticisms of it. For the past ten years, the connectionist community has been well aware of the necessity of using (and understanding) dynamically evolving, recurrent network models of cognition.

The wealth of important and convergent evidence discussed in the target article contrasts with the poorly conceived theory put forward to explain it. The simulation theory does a better job of explaining how automatic “mirroring” mechanisms might work together with high-level cognitive processes. It also explains what the authors' PAM theory merely stipulates.

Although their thesis is generally sound, Barresi & Moore give insufficient attention to the need for a methodology, whether simulation based or theory-based, for choosing among alternative possible matches of first person and third person information. This choice must be sensitive to contextual information, including past behavior. Moreover, apart from simulation or theory, first person information would not help predict future behavior.

Given Heyes's construal of there is still no convincing evidence of theory of mind in human primates, much less nonhuman. Rather than making unfounded assumptions about what underlies human social competence, one should ask what mechanisms other primates have and then inquire whether more sophisticated elaborations of those might not account for much of human competence.

In lieu of an abstract, here is a brief excerpt of the content:Back to the Future:Obtaining Organs from Non-Heart-Beating CadaversRobert M. Arnold (bio) and Stuart J. Youngner (bio)Organ Transplantation requires viable donor organs. This simple fact has become the Achilles' heel of transplantation programs. Progress in immunology and transplant surgery has outstripped the supply of available organs. Between 1988 and 1991, for example, the number of transplant candidates on waiting lists increased by about 55 percent, while the number of donors (...) increased only about 16 percent.1 By the end of March 1993, more than 30,000 potential recipients awaited transplantation (United Network for Organ Sharing Database (UNOS) 1993). Every day six of these patients die prior to receiving a heart or liver transplant, while patients needing kidney transplants must tolerate a lower quality of life on dialysis (Grenvik 1992; Evans, Orians, and Ascher 1992).This scarcity is likely to get worse. As transplantation becomes more successful, it is being offered to sicker and older patients. Attempts to transplant other solid organs, such as small bowel and pancreas, will only fuel the demand for donors. However, the current source of organs is unlikely to grow. Most organs come from patients who have been declared dead by neurologic criteria (commonly referred to as "brain dead" or heart-beating cadaver donors (HBCDs) because their hearts are beating at the time of procurement). Estimates of the potential pool of HBCDs have been revised downward from 20,000-27,000 to roughly 10,000-12,000 (Nathan et al. 1991). Improvements in automobile safety and handgun legislation will likely lead to further reductions. Moreover, the rate of procurement from HBCDs has remained relatively flat despite extensive public awareness campaigns and legislation requiring hospitals to routinely request donation from families of dead patients (Caplan et al. 1992).If organ transplantation is going to continue to flourish, alternative [End Page 103] sources of organs must be found. Recently the University of Pittsburgh Medical Center (UPMC) proposed procuring organs from patients who have been declared dead by traditional cardiopulmonary rather than brain-oriented criteria after they or their families have decided to forgo life-sustaining treatment—hereafter referred to as the Pittsburgh protocol (UPMC Policy 1993). These patients are typically referred to as non-heart-beating cadaver donors (NHBCDs) because their hearts are no longer beating at the time of organ procurement.Although NHBCDs were a major source of transplantable kidneys prior to the institution of death by neurologic criteria, their usefulness was limited by "warm ischemia time." This term refers to the injury to tissues that occurs when the blood supply is interrupted and before the organs are cooled and reperfused. Under the Pittsburgh protocol, therapy is withdrawn in the operating room where a waiting surgical team removes organs immediately after death is declared. By controlling the place and time of death, it has been possible to minimize warm ischemia time and thus solve the technical problems previously associated with procurement from NHBCDs.The potential contribution of NHBCD organs is significant. Nathan (1992), using data from Delaware Valley Transplant Program, concludes that the use of severely brain injured, but not "brain dead" patients, would increase the donor pool by 20-25 percent. Moreover, unpublished data from the Pittsburgh organ procurement organization, the Center for Organ Recovery and Education (CORE), suggests that these organs, particularly kidneys, function as well as those procured from HBCDs (Broznick 1993).This volume is devoted to the ethical, psychosocial, and public policy implications of procuring organs from non-heart-beating cadaver donors after a discussion to forgo life-sustaining treatment. The genesis of this volume was a project in which we invited leading experts in transplantation, ethics, and public policy to use the Pittsburgh protocol as a starting point for exploring a broad range of issues associated with attempts to procure organs from NHBCDs. The issues raised by NHBCDs turned out to have important implications about the fundamental conceptual and moral assumptions underlying organ procurement.Although each of the papers in this volume can be read separately, we intend the volume to be read as a whole. Many of the latter pieces on the ethical implications of the policy are best understood in light of the earlier background papers... (shrink)

Word class-specific differences in brain evoked potentials (EP) are discussed for connotative meaning and for function versus content words. A well-controlled experiment found matching lexical decision times for function and content words, but clear EP differences (component with maximum near 550 msec) among function words, content words, and nonwords that depended on brain site. Another EP component, with a 480 msec maximum, differentiated words (either function or content) from nonwords.

Relational priming is argued to be a deeply inadequate model of analogy-making because of its intrinsic inability to do analogies where the base and target domains share no common attributes and the mapped relations are different. Leech et al. rely on carefully handcrafted representations to allow their model to make a complex analogy, seemingly unaware of the debate on this issue fifteen years ago. Finally, they incorrectly assume the existence of fixed, context-independent relations between objects.

Pickering & Garrod's (P&G's) mechanistic theory of dialogue attempts to detail the psychological processes involved in communication that are lacking in Clark's theory. By relying on automatic priming and alignment processes, however, the theory falters when it comes to explaining much of dialogic interaction. We argue for the inclusion of less automatic, though not completely conscious and deliberate, processes to explain such phenomena.

Over the years, many theories have been proposed to account for the aberrant behavior of drug dependent individuals. Heyman posits that the existing theories of drug dependence are inadequate to explain the complex processes inherent in human drug-taking. He proposes that incongruous behaviors that comprise addiction, such as continued drug use in spite of adverse consequences, can be explained by application of the matching law approach. While the matching law theory of addiction explains certain aspects of human behavior, its application (...) to the area of addiction must be subjected to experimental verification. (shrink)

To conclude that language evolved from vocalizations, through gestures, then back to vocalizations again, one must first reject the simpler hypothesis that language evolved from prelinguistic vocalizations. There is no reason to do so. Many studies – not cited by Arbib – document continuities in behavior, perception, cognition, and neurophysiology between human speech and primate vocal communication.

Among monkeys and apes, both the recognition and classification of individuals and the recognition and classification of vocalizations constitute discrete combinatorial systems. One system maps onto the other, suggesting that during human evolution kinship classifications and language shared a common cognitive precursor.

This book is an excellent manifesto for future work in child development. It presents a multidisciplinary approach that clearly demonstrates the value of integrating modeling, neuroscience, and behavior to explore the mechanisms underlying development and to show how internal context-dependent representations arise and are modified during development. Its only major flaw is to have given short shrift to the study of the role of genetics on development.

The fixed-feature viewpoint Schyns et al. are opposing is not a widely held theoretical position but rather a working assumption of cognitive psychologists – and thus a straw man. We accept their demonstration of new-feature acquisition, but question its ubiquity in category learning. We suggest that new-feature learning (at least in adults) is rarer and more difficult than the authors suggest.