A recent commentary defends 1) the concept of 'brain arrest' to explain what brain death is, and 2) the concept that death occurs at 2–5 minutes after absent circulation. I suggest that both these claims are flawed. Brain arrest is said to threaten life, and lead to death by causing a secondary respiratory then cardiac arrest. It is further claimed that ventilation only interrupts this way that brain arrest leads to death. These statements imply that brain arrest is not death (...) itself. Brain death is a devastating state that leads to death when intensive care, which replaces some of the brain's vital functions such as breathing, is withdrawn and circulation stops resulting in irreversible loss of integration of the organism. Circulatory death is said to occur at 2–5 minutes after absent circulation because, in the context of DCD, the intent is to not attempt reversal of the absent circulation. No defense of this weak construal of irreversible loss of circulation is given. This means that paents in identical physiologic states are dead (in the DCD context) or alive (in the resuscitation context); the current state of death (at 2–5 minutes) is contingent on a future event (whether there will be resuscitation) suggesting backward causation; and the commonly used meaning of irreversible as 'not capable of being reversed' is abandoned. The literature supporting the claim that autoresuscitation does not occur in the context of no cardiopulmonary resuscitation is shown to be very limited. Several cases of autoresuscitation are summarized, suggesting that the claim that these cases are not applicable to the current debate may be premature. I suggest that brain dead and DCD donors are not dead; whether organs can be harvested before death from these patients whose prognosis is death should be debated urgently. (shrink)

This paper examines the affective disorders plaguing many young people and the problem of attention-deficit hyperactivity disorder in particular. It aims to define the limits of the critique of British educationalist Sir Ken Robinson in terms of his philosophy of ‘creativity’ through a consideration of the ideas of French philosopher Bernard Stiegler, especially the notions of ‘industrial temporal objects’ and stupidity. It makes the case for adopting elements of each distinct research paradigm as a prolegomena to forging a social critique (...) of capitalist-dominated, market-led educational institutions. The former, it will be seen, identifies some of the problems facing teachers in terms of the use and application of technology, the false divide between arts and the humanities, but falls short of explaining the root of the structural and psychic malaise in neo-liberal regimes regarding classroom breakdown in general. The latter, despite the apocalyptic tone of some his pronouncements provides an update and radicalization of Deleuze’s societies of control thesis in terms of what Stiegler designates ‘uncontrollable societies’. Stiegler, it will be seen, presents a critique of technology that is all the more pressing in an age in which the loss of expectation in the lives of young people can lead to a corresponding fall off or destruction in ‘deep attention’. I want to test the hyperbole of Stiegler’s assertion that young people today suffer from a ‘colossal’ attention deficit disorder of unprecedented scale and magnitude. (shrink)

My intention is to consider Bernard Stiegler’s concept of ‘journeys of knowledge’. Open Humanities Press, 2020) and to explore how one might rethink the knowledge-creating potentialities of information itself. This has become all the more apparent in the time of lockdowns, physical distancing during the pandemic but the primary purpose of the paper is to look at the distinction between knowledge/information and the role of the teacher in using technology pharmacologically to safeguard the savoirs and to stem the proletarianization of (...) knowledge or stupidity as such. The point is that the pandemic is bringing home the question of the role of the teacher, the role of the school and the necessity of the co-production and co-creation of knowledge. It seems essential to understand the concept of ‘journeys of knowledge’ in the time of the pandemic as students are left at home without a journey to voyage upon. As such, there is a lack of futurally-bound collective protentions, an absence of any vision projection into the future. What is there in the concept of ‘journeys of knowledge’ that demonstrates how to use the Internet in bifurcatory ways, to produce what Stiegler calls negentropic knowledge or new forms of knowledge, or what I want to designate as experiments with truth-telling. What does it mean to produce negentropic knowledge without the teacher to guide, curate and care? With the above in mind, and by writing out of the wound of thinking, it is by rethinking the concept of curation in a different way that it is hoped one can contribute to educational research to produce unheard-of bifurcations of knowledge, to invoke Deleuze’s sense of the incomprehensible and Stiegler’s sense of the impossible, the improbable and the incalculable in educational concerns, to pave a path out of the aporia of the present—a present which is without decision and epoch. (shrink)

At first glance a Russian anarchist’s revolutionary address to the youth of his day made in the late 19th century and the address to youth made by a contemporary French philosopher may appear to have little in common as their context and era are ostensibly very different. How would Petr Kropotkin’s address be understood in our time? Are Kropotkin’s concerns the same as those raised by Bernard Stiegler? Could Kropotkin speak of universal concerns, a sense of elevation and sublimation not (...) governed, undermined or circumvented by digital relations, calculation or algorithmic determination? I find a mutual concern with the coming into maturity of youth, but, I am concerned that as we are passing through an epochal and revolutionary transformation driven by digital and cognitive capitalism and in our toxic and crisis-ridden milieu, Kropotkin’s rhetoric would inevitably fall on deaf ears? Is his rhetoric on revolution anachronistic? How would his rhetoric be crafted for a youth seemingly indifferent to the plight of fellow brethren? Is it conceivable that the humanist-inflected prospects of youth so vaunted by Kropotkin have now been devastated by the inhuman and nihilistic tendencies of the so-called miscreant, ‘blank generation’ as described by Stiegler? True, while it is difficult to calibrate the vision of youth affirmed in Kropotkin with the fear of youth in Stiegler, and, despite differences in episteme, tradition and political orientation, both thinkers I think are concerned with the trials and tribulations of youth and both hold out the prospect of the not-yet of youth, of the coming into being of the maturity of youth, of Aufklärung. It is this shared focus I wish to examine further. (shrink)

According to international scientific medical consensus, death is a biological, unidirectional, ontological state of an organism, the event that separates the process of dying from the process of disintegration. Death is not merely a social contrivance or a normative concept; it is a scientific reality. Using this paradigm, the international consensus is that, regardless of context, death is operationally defined as “the permanent loss of the capacity for consciousness and all brainstem function. This may result from permanent cessation of circulation (...) or catastrophic brain injury. In the context of death determination, ‘permanent’ refers to loss of function that cannot resume spontaneously and will not be restored through intervention.” The word “permanent” replaces “irreversible” (used in the United States’ 1980 Uniform Declaration of Death Act) in this new definition, arguably invented to allow donation after circulatory determination of death (DCDD) while still complying with the dead donor rule. I will show that this invention fails, for at least four reasons. (shrink)

Brain death is accepted in most countries as death. The rationales to explain why brain death is death are surprisingly problematic. The standard rationale that in brain death there has been loss of integrative unity of the organism has been shown to be false, and a better rationale has not been clearly articulated. Recent expert defences of the brain death concept are examined in this paper, and are suggested to be inadequate. I argue that, ironically, these defences demonstrate the lack (...) of a defensible rationale for why brain death should be accepted as death itself. If brain death is death, a conceptual rationale for brain death being equivalent to death should be clarified, and this should be done urgently. (shrink)

This paper sets out to analyze how causation works by focusing on biology, as represented by epidemiology and by scientific information on how the body works (“physiology”). It starts by exploring the specificity of evolved physiological systems, in which evolutionary, developmental and proximal causes all fit together, and the concept of function is meaningful; in contrast, this structure does not apply in epidemiology (or outside biology). Using these two contrasting branches of biology, I examine the role both of mechanism and (...) of difference making in causation. I find that causation necessarily involves both mechanism and difference making, and that they play complementary roles. Both are seen as ontologically necessary, even if the evidence is not always available for both. Influential monist accounts that focus on one of these, at the expense of ignoring the other, are found to be inadequate on these and on other grounds. Recent attempts to combine them are reviewed, notably that of Russo and Williamson (Int Stud Philos Sci 21:157–170, 2007), and it is argued that their epistemic view requires there to be a source of the different types of evidence that a rational agent would consider, and that this source must be ontic. I then analyze how causal relationships work in evolved physiological systems and in those studied by epidemiology, with a particular focus on how mechanism interacts with input. Finally, I consider this concept of causation from the perspective of everyday language, and of its possible generalisability outside biology. (shrink)

In what follows I distinguish «postmodern animism» from my preferred term «postmedia animism», which I propose is a better term to express a minor, virtual, contrarian art and media. In the time of planetary trauma, ecological devastation and collapse, this term will serve as a heuristic concept to trace the passage from pandemic, panic, catastrophe and crisis to the series pandemonium, delirium and the carnivalesque. My gambit is to invoke a rebellious and affirmative Yōkai imaginary (妖怪, ghost, phantom, strange apparition) (...) in order to contest passive forms of «transcendental narcissism» or «transcendental miserabilism».This we shall designate s an aesthetics of existence. In particular, I will analyse the relationship between natural disasters and politics within the Japanese imagination through reference to Namazu-e (鯰絵, woodblock prints depicting catfish), and their political effects in the aftermath of the earthquake of October 1855 (安政江戸地震, Ansei Edo Jishin) in the Edo period of Japanese history (FIG 1). My intention is to show that this historic art form, which grew out of trauma, demonstrates a fabulatory, dissensual and political aesthetics of resistance and creativity. It is an imaginary which appears conspicuously absent in our contemporary moment. (shrink)

In this experimental piece of writing I want to think about the pedagogy of contact and the plight of the hikikomori or social recluse in Japan. I am interested in exploring how the hikikomori practices a kind of contactlessness or what I will call a deadly ipseity of desire. What does it mean to resist contact, to be without contact, to be without desire? What does it mean to risk contact, to risk being tactile with the other, to risk affirming (...) one’s desires? I want to generate a discussion about what has happened to desire, to its promise and possibility and why it is so difficult to anticipate or forecast what is to come. For me the BwO of hikikomori is the ruin of desire, the collapse of desire, a disaster of desire. I am pursuing a line of thought which highlights the loss of the possibility of processual schizophrenic breakthrough and in its place the becoming-autistic of the self, the perilous breakdown of the self. (shrink)

Here, I wish to pursue an analysis of the potential link between the thinkers Félix Guattari and Bernard Stiegler as I see in both thinkers a profound rumination of the question of therapeutic care and curation at the institutional level. My concern is with the institutional object and its deadly repetitions. By and through agitating the coefficient of transversality, my argument is that this might problematize the dyadic and sometimes dysfunctional transindividual relationships between doctor and patient, teacher and pupil. My (...) concern is with the passage from the machinic objet petit ‘a’ in Lacan to Winnicott’s transitional object (objet petit ‘b’), and then beyond their functions to the institutional object itself which Guattari idiosyncratically calls the objet petit ‘c’. The rationale behind this move is to consider how the mediating third object needs to be recast in light of the poisonous and addictive nature of transitional objects such as smartphone technology. My point is that we must rethink the pharmacological possibility of the incorporation of the transitional object at the institutional level, which is to say, to understand the relationship between institutional objects such as the therapeutic club and the transitional object (digital technologies) in order to appreciate critically the toxic effects of the latter. Yet we also must understand the pharmacological or therapeutic aspects of the transitional object in itself, which is to say to understand its precise curative usage at the institutional level. (shrink)

Building upon previous research on the therapeutic object, specifically the objet re-petit-ive abc, which draws from Lacan, Winnicott, and Guattari, I explore the generation, contribution, and erosion of knowledge in the so-called smart city. I will investigate how digital pedagogical objects, functioning as transitional objects, can serve as therapeutic purposes both within and outside institutional settings. I examine the notions of the dérive and psychogeography and compare them with Bernard Stiegler’s concept of the “journey of knowledge” and then delve into (...) the curation of “negentropic forms of knowledge” and the mnemonic technique of the dérive. Taking ecological and ecosophical perspectives into account, I consider mnemonic techniques as a means to critically reflect upon the urban landscape and its transformation into a technical milieu. My overall goal is to contemplate the possibility of a Stieglerian and/or Guattarian détournement (philosophical hijacking) of the smart city. (shrink)

Drawing on an array of sources, from Deleuze and Guattari’s philosophy through to non-philosophy, this paper concerns itself with the manifestation of the concepts of hope and despair in utopian thought and continental philosophy and the experience of hopelessness, despair and exhaustion in the contemporary moment. I aim to demonstrate such pressing concerns through a comparison of Japanese philosopher Kojin Karatani and Japanese fiction writer Ryū Murakami with the American science fiction-thriller film directed by Michael Bay, The Island. What is (...) explored in these works is the dialectic of exhaustion and possibility. The focus of the paper is on the fecund moment inhering in the incapacity of thought to think the possibility of utopia. In terms of the philosophy of education, this hones in on the perceived lack of vision of such a possibility among youth and the failure of the university qua institution to proffer an alternative world to its cohort. To demon... (shrink)

Ariane Lewis reviewed medicolegal challenges to Death by Neurologic Criteria (DNC) in the United Kingdom in order to identify and discuss the ethical issues raised (Lewis 2024). Here I briefly clar...

In the Journal of Medical Ethics, Joffe et al recently published an article titled “What do patients value in their hospital care? An empirical perspective on autonomy centred bioethics”.1 This empirical study evaluates whether patients’ willingness to recommend their hospital to others is more strongly associated with their belief that they were treated with respect and dignity than with their belief that they had an adequate say in their treatment.* Joffe et al go on to suggest that confirmation (...) of these empirical hypotheses would constitute a prescription for elevating the principle of respect for persons to the level that the principle of respect for autonomy currently enjoys in our model of the ideal patient–physician relationship .1 In other words, they suggest that by some means empirical findings could influence our ranking of the normative principles. Earlier in the article, they make an even stronger claim about the influence of empirical data on our acceptance of normative principles. They suggest that, if it were demonstrated empirically that some patients prefer to delegate medical decisions to health care professionals, a serious challenge would be levied against the normative assumptions underlying the principle of respect for autonomy, at least under the mandatory autonomy view, which holds that patients not only have a right but also an obligation to act autonomously .1 In the light of many recent empirical studies challenging the centrality of patient autonomy and shared decision making in bioethical theory, I think it is instructive to evaluate the means by which empirical findings, like those offered in Joffe et al, strengthen or weaken our arguments for ethical principles. In particular, I would be interested in how these authors propose that their data led them to the normative conclusions they reached.In the last …. (shrink)

Motivated by Lord Joffe’s Assisted Dying for the Terminally Ill Bill, but with one eye on any possible future legislation, I consider the justifications that might be offered for limiting assistance in dying to those who are suffering unbearably from terminal illness. I argue that the terminal illness criterion and the unbearable suffering criterion are not morally defensible separately: that a person need be neither terminally ill (or ill at all), nor suffering unbearably (or suffering at all) to have (...) a right to assisted dying. Indeed: I shall suggest that the unbearable suffering criterion undermines the Bill (or any proposal like it) wholesale. On the other hand, the criteria taken together are defensible, and this defence would be built on a concern for the protection of the vulnerable. However, I also claim that this implies that the law might justifiably—and maybe even properly—aim to prevent a person from gaining access to that to which they have a serious moral right. This seems paradoxical, and, towards the end of the paper, I seek to tease apart the paradox. (shrink)

The classification of preserved hypothalamic activity in brain death and brainstem death as functional or non-functional has become a subject of debate. While proponents of the neurological criterion claim that these activities lack functional significance (Shemie et al. 2014), Nair-Collins and Joffe (2023) argue for their functional physiological role. However, the interpretation of the term "function" within the medico-legal framework, where death is characterized by the irreversible cessation of all brain functions, remains unclear. -/- My intention here is not (...) to engage in a debate over the validity of different viewpoints regarding the functional significance of preserved activities in the hypothalamus or the heart. Rather, I aim to highlight the critical importance of exploring and defining the concept of function in medicine, which currently lacks clarity. My point is that, whatever our position in the brain death debate, reaching a consensus on this conceptual matter would minimize misunderstandings and establish a robust foundation for further insightful analysis. (shrink)

Since its introduction in 1987, Benjamin Freedman’s principle of clinical equipoise has enjoyed widespread uptake in bioethics discourse. Recent years, however, have witnessed a growing consensus that the principle is fundamentally flawed. One of the most vocal critics has undoubtedly been Franklin Miller. In a 2008 paper, Steven Joffe and Miller build on this critical work, offering a new conception of clinical research ethics based on science, taking what they call a “scientific orientation” toward the ethics of clinical research. (...) Though there is much to recommend Joffe and Miller’s scientifically oriented conception of clinical research ethics, I believe that both the critical and constructive projects suffer from the same basic mistake: inattention to context. The internal norms of science cannot be fully specified, let alone satisfied, independently of contextual (external) factors that only come into view when we are attentive to the particular context of that form of inquiry. (shrink)

We conducted focus groups to assess patient attitudes toward research on medical practices in the context of usual care. We found that patients focus on the implications of this research for their relationship with and trust in their physicians. Patients view research on medical practices as separate from usual care, demanding dissemination of information and in most cases, individual consent. Patients expect information about this research to come through their physician, whom they rely on to identify and filter associated risks. (...) In general, patients support this research, but worry that participation in research involving randomization may undermine individualized care that acknowledges their unique medical histories. These findings suggest the need for public education on variation in practice among physicians and the need for a collaborative approach to the governance of research on medical practices that addresses core values of trust, transparency, and partnership. (shrink)

In this issue of the Hastings Center Report, Moti Gorin, Steven Joffe, Neal Dickert, and Scott Halpern offer a comprehensive defense of the use of nudging techniques in the clinical context, with the aim of promoting the best interests of patients. Their argument is built on three important claims: Nudging is ubiquitous and inescapable in clinical choice situations, and there is no neutral way of informing patients about their treatment choices; many patients do not have authentic preferences concerning their (...) treatment choices, and those that do can easily resist nudging; and, finally, since many people lack authentic preferences and those that do can still act on their preferences, nudging in the patients’ best interest is justified. I agree with the authors that if these three claims stand up to scrutiny, then they will provide a justification for many types of clinical nudging. I am, however, skeptical as to whether the claims can be sustained, despite the valiant efforts of Gorin and colleagues. (shrink)

The use of patient restrictions (e.g. involuntary admission, seclusion, restraint) is a complex ethical dilemma in psychiatric care. The present study explored nurses’ (n = 22) and physicians’ (n = 5) perceptions of what actually happens when an aggressive behaviour episode occurs on the ward and what alternatives to seclusion and restraint are actually in use as normal standard practice in acute psychiatric care. The data were collected by focus group interviews and analysed by inductive content analysis. The participants believed (...) that the decision-making process for managing patients’ aggressive behaviour contains some in-built ethical dilemmas. They thought that patients’ subjective perspective received little attention. Nevertheless, the staff proposed and appeared to use a number of alternatives to minimize or replace the use of seclusion and restraint. Medical and nursing staff need to be encouraged and taught to: (1) tune in more deeply to reasons for patients’ aggressive behaviour; and (2) use alternatives to seclusion and restraint in order to humanize patient care to a greater extent. (shrink)

ObjectiveTo evaluate the relationship between recently trained paediatricians' ethics knowledge and exposure to a formal ethics or professionalism curriculum during residency.MethodsWe conducted a cross-sectional survey of recently trained paediatricians which included a validated 23-item instrument called the Test of Residents' Ethics Knowledge for Pediatrics. The sample included paediatricians who completed medical school in 2006–2008, whose primary specialty was paediatrics or a paediatric subspecialty, and who completed paediatric residency training in 2010–2011. This sample was stratified based on residency programme variables: presence (...) of a formal curriculum in ethics or professionalism, programme size and American Board of Pediatrics certifying exam passage rate. Paediatricians were randomly selected from each stratum for survey participation.ResultsAmong the 370 responding paediatricians (55%), the mean knowledge score was 17.3 (SD 2.2) out of a possible 23. Presence of a formal curriculum in ethics and/or professionalism was not significantly associated with knowledge. Knowledge was lowest on items about parental requests for a child to undergo genetic testing (2 items, 44% and 85% incorrect), preserving patient confidentiality over email (55% incorrect), decision-making regarding life-sustaining technologies (61% incorrect), and decision-making principles such as assent and parental permission (2 items, 47% and 49% incorrect).ConclusionsThis study highlights several areas in which paediatricians' knowledge may be low and that are amenable to targeted educational interventions. These findings should prompt discussion and research among ethicists and educators about how ethics and professionalism curricula can more consistently influence paediatricians' knowledge. (shrink)

Background: Ethics consultants (ECs) are increasingly expected to possess core knowledge and skills. Few data address whether ECs actually possess recommended core knowledge. We aimed to measure pediatric ECs’ understanding of ethical principles, identify knowledge gaps, and explore associations between experience/training and knowledge in pediatric ethics consultations. Methods: We identified the 2 ECs most knowledgeable in pediatric ethics from each of 45 freestanding children's hospitals and an equal number of general teaching hospitals in the United States. This yielded a sample (...) of 159 eligible pediatric ECs. Pediatric ECs were sent a survey measuring ethics training, characteristics of the ethics consultation service, and EC knowledge, as assessed by a previously validated scale entitled the Test of Residents’ Ethics Knowledge for Pediatrics (TREK-P). Of 102 completed surveys received, 99 were used in the analysis. Results: Seventy-three percent of ECs had completed ≥1 formal training modality, most commonly bioethics mini-courses, master's degrees, or certificate programs (20–30% each). Respondents infrequently received salary support (32%) or had a budget (28%) to support ethics work. The median TREK-P score was 19 (interquartile range [IQR] 17–21). Forty percent of subjects scored ≥20, surpassing the threshold of adequate performance proposed in previous work. Median scores were significantly higher among ECs with formal training in ethics but did not differ significantly by other variables. In secondary analyses, high scores (≥20) were significantly more common among ECs receiving salary support (55% vs. 33%, p = 0.04) and who had formal ethics training (47% vs. 22%, p = 0.02). Items pertaining to privacy, genetic testing, and assent, were answered incorrectly by >33% of ECs. Conclusions: High scores on a validated ethics knowledge scale were more common among ECs with salary support or formal ethics training. The study highlights knowledge gaps that warrant consideration as EC becomes a professionalized endeavor. (shrink)

Medical research is widely thought to have a fundamentally therapeutic orientation, in spite of the fact that clinical research is thought to be ethically distinct from medical care. We need an entirely new conception of clinical research ethics—one that looks to science instead of the doctor‐patient relationship.

In our papers on the rationality of magic, we distinghuished, for purposes of analysis, three levels of rationality. First and lowest (rationalitYl) the goal directed action of an agent with given aims and circumstances, where among his circumstances we included his knowledge and opinions. On this level the magician's treatment of illness by incantation is as rational as any traditional doctor's blood-letting or any modern one's use of anti-biotics. At the second level (rationalitY2) we add the element of rational thinking (...) or thinking which obeys some set of explicit rules, a level which is not found in magic in general, though it is sometimes given to specific details of magical thinking within the magical thought-system. It was the late Sir Edward E. Evans-Pritchard who observed that when considering magic in detail the magician may be as consistent or critical as anyone else; but when considering magic in general, or any system of thought in general, the magician could not be critical or even comprehend the criticism. Evans-Pritchard went even further: he was sceptical as to whether it could be done in a truly consistent manner: one cannot be critical of one's own system, he thought. On this level (rationalitY2) of discussion we have explained (earlier) why we prefer to wed Evans Pritchard's view of the magician's capacity for piece-meal rationality to Sir James Frazer's view that magic in general is pseudo-rational because it lacks standards of rational thinking. (shrink)

Analysis of various Buddhist philosophical views.

Objective: Contemporary ethical accounts of the patient-provider relationship emphasise respect for patient autonomy and shared decision making. We sought to examine the relative influence of involvement in decisions, confidence and trust in providers, and treatment with respect and dignity on patients’ evaluations of their hospital care.Design: Cross-sectional survey.Setting: Fifty one hospitals in Massachusetts.Participants: Stratified random sample of adults discharged from a medical, surgical, or maternity hospitalisation between January and March, 1998. Twelve thousand six hundred and eighty survey recipients responded.Main outcome (...) measure: Respondent would definitely be willing to recommend the hospital to family and friends.Results: In a logistic regression analysis, treatment with respect and dignity 3.4, 99% confidence interval 2.8 to 4.2) and confidence and trust in providers were more strongly associated with willingness to recommend than having enough involvement in decisions . Courtesy and availability of staff , continuity and transition , attention to physical comfort , and coordination of care were also significantly associated with willingness to recommend.Conclusions: Confidence and trust in providers and treatment with respect and dignity are more closely associated with patients’ overall evaluations of their hospitals than adequate involvement in decisions. These findings challenge a narrow emphasis on patient autonomy and shared decision making, while arguing for increased attention to trust and respect in ethical models of health care. (shrink)

Introduction : La philosophie en Égypte -- La philosophie chretienne arabe contemporaine : Kanawati et Youssef Karam -- Le discours éthique en Égypte -- Naguib Mahfouz et la philosophie -- La philosophie et la revolution en Égypte.