Patient narratives from two investigational deep brain stimulation trials for traumatic brain injury and obsessive‐compulsive disorder reveal that injury and illness rob individuals of personal identity and that neuromodulation can restore it. The early success of these interventions makes a compelling case for continued post‐trial access to these technologies. Given the centrality of personal identity to respect for persons, a failure to provide continued access can be understood to represent a metaphorical identity theft. Such a loss recapitulates the pain of (...) an individual's initial injury or illness and becomes especially tragic because it could be prevented by robust policy. A failure to fulfill this normative obligation constitutes a breach of disability law, which would view post‐trial access as a means to achieve social reintegration through this neurotechnological accommodation. (shrink)

When the COVID-19 surge hit New York City hospitals, the Division of Medical Ethics at Weill Cornell Medical College, and our affiliated ethics consultation services, faced waves of ethical issues sweeping forward with intensity and urgency. In this article, we describe our experience over an eight-week period (16 March through 10 May 2020), and describe three types of services: clinical ethics consultation (CEC); service practice communications/interventions (SPCI); and organizational ethics advisement (OEA). We tell this narrative through the prism of time, (...) describing the evolution of ethical issues and trends as the pandemic unfolded. We delineate three phases: anticipation and preparation, crisis management, and reflection and adjustment. The first phase focused predominantly on ways to address impending resource shortages and to plan for remote ethics consultation, and CECs focused on code status discussions with surrogates. The second phase was characterized by the dramatic convergence of a rapid increase in the number of critically ill patients, a growing scarcity of resources, and the reassignment/ redeployment of staff outside their specialty areas. The third phase was characterized by the recognition that while the worst of the crisis was waning, its medium- and long-term consequences continued to pose immense challenges. We note that there were times during the crisis that serving in the role of clinical ethics consultant created a sense of dis-ease as novel as the coronavirus itself. In retrospect we learned that our activities far exceeded the familiar terrain of clinical ethics consultation and extended into other spheres of organizational life in novel ways that were unanticipated before this pandemic. To that end, we defined and categorized a middle level of ethics consultation, which we have termed service practice communication intervention (SPCI). This is an underappreciated dimension of the work that ethics consult services are capable of in times of crisis. We believe that the pandemic has revealed the many enduring ways that ethics consultation services can more robustly contribute to the ethical life of their institutions moving forward. (shrink)

This is the first article in a two-part series describing subject and family perspectives from the central thalamic deep brain stimulation for the treatment of traumatic brain injury using the Medtronic PC + S first-in-human invasive neurological device trial to achieve cognitive restoration in moderate to severe traumatic brain injury, with subjects who were deemed capable of providing voluntary informed consent. In this article, we report on interviews conducted prior to surgery wherein we asked participants about their experiences recovering from (...) brain injury and their perspectives on study enrollment and participation. We asked how risks and benefits were weighed, what their expectations and fears were, and how decisions were reached about trial participation. We found that informed consent and enrollment decisions are fraught. Subjects and families were often split, with subjects more focused on putative benefits and families concerned about incremental risk. Both subjects and families viewed brain injury as disruptive to personal identity and relationships. As decisions were made about study enrollment, families struggled with recognizing the re-emergent agency of subjects and ceding decision-making authority to subjects who had previously been dependent upon them for protection and guidance. Subjects and family members reported a hope for the relief of cognitive disabilities, improved quality of life, normalization of interpersonal interactions, and a return to work or school as reasons for study participation, along with altruism and a desire to advance science. Despite these aspirations, both subjects and families appreciated the risks of the intervention and did not suffer from a therapeutic misconception. A second essay to be published in the next issue of Cambridge Quarterly of Healthcare Ethics—Clinical Neuroethics will describe interviews conducted after surgery, the effects of cognitive restoration for subjects, families, and challenges presented to the social structures they will call upon to support them through recovery. This subsequent article will be available online prior to its formal publication in October 2023. (shrink)

This is the second paper in a two-part series describing subject and family perspectives from the CENTURY-S (CENtral Thalamic Deep Brain Stimulation for the Treatment of Traumatic Brain InjURY-Safety) first-in-human invasive neurological device trial to achieve cognitive restoration in moderate to severe traumatic brain injury (msTBI). To participate, subjects were independently assessed to formally establish decision-making capacity to provide voluntary informed consent. Here, we report on post-operative interviews conducted after a successful trial of thalamic stimulation. All five msTBI subjects met (...) a pre-selected primary endpoint of at least a 10% improvement in completion time on Trail-Making-Test Part B, a marker of executive function. We describe narrative responses of subjects and family members, refracted against that success. Interviews following surgery and the stimulation trial revealed the challenge of adaptation to improvements in cognitive function and emotional regulation as well as altered (and restored) relationships and family dynamics. These improvements exposed barriers to social reintegration made relevant by recoveries once thought inconceivable. The study’s success sparked concerns about post-trial access to implanted devices, financing of device maintenance, battery replacement, and on-going care. Most subjects and families identified the need for supportive counseling to adapt to the new trajectory of their lives. (shrink)

As improvements in neuroscience have enabled a better understanding of disorders of consciousness as well as methods to treat them, a hurdle that has become all too prevalent is the denial of coverage for treatment and rehabilitation services. In 2011, a settlement emerged from a Vermont District Court case, Jimmo v. Sebelius, which was brought to stop the use of an “improvement standard” that required tangible progress over an identifiable period of time for Medicare coverage of services. While the use (...) of this standard can have deleterious effects on those with many chronic conditions, it is especially burdensome for those in the minimally conscious state, where improvements are unpredictable and often not manifested through repeatable overt behaviors. Though the focus of this paper is on the challenges of brain injury and the minimally conscious state, which an estimated 100,000 to 200,000 individuals suffer from in the United States, the post-Jimmo arguments presented can and should have a broad impact as envisioned by the plaintiffs who brought the case on behalf of multiple advocacy groups representing patients with a range of chronic care conditions. (shrink)

Objective Although patients exercise greater autonomy than in the past, and shared decision making is promoted as the preferred model for doctor-patient engagement, tensions still exist in clinical practice about the primary locus of decision-making authority for complex, scarce, and resource-intensive medical therapies: patients and their surrogates, or physicians. We assessed physicians’ attitudes toward decisional authority for adult venoarterial extracorporeal membrane oxygenation (VA-ECMO), hypothesizing they would favor a medical locus. Design, Setting, Participants A survey of resident/fellow physicians and internal medicine (...) attendings at an academic medical center, May to August 2013. Measurements We used a 24-item, internet-based survey assessing physician-respondents’ demographic characteristics, knowledge, and attitudes regarding decisional authority for adult VA-ECMO. Qualitative narratives were also collected. Main Results A total of 179 physicians completed the survey (15 percent response rate); 48 percent attendings and 52 percent residents/ fellows. Only 32 percent of the respondents indicated that a surrogate’s consent should be required to discontinue VA-ECMO; 56 percent felt that physicians should have the right to discontinue VA-ECMO over a surrogate’s objection. Those who self-reported as “knowledgeable” about VA-ECMO, compared to those who did not, more frequently replied that there should not be presumed consent for VA-ECMO (47.6 percent versus 33.3 percent, p = 0.007), that physicians should have the right to discontinue VAECMO over a surrogate’s objection (76.2 percent versus 50 percent, p = 0.02) and that, given its cost, the use of VA-ECMO should be restricted (81.0 percent versus 54.4 percent, p = 0.005). Conclusions Surveyed physicians, especially those who self-reported as knowledgeable about VA-ECMO and/or were specialists in pulmonary/ critical care, favored a medical locus of decisional authority for VA-ECMO. VA-ECMO is complex, and the data may (1) reflect physicians’ hesitance to cede authority to presumably less knowledgeable patients and surrogates, (2) stem from a stewardship of resources perspective, and/or (3) point to practical efforts to avoid futility and utility disputes. Whether these results indicate a more widespread reversion to paternalism or a more circumscribed usurping of decisional authority occasioned by VA-ECMO necessitates further study. (shrink)

Hastings Center Report, Volume 52, Issue 2, Page 21-31, March‐April 2022.

In Edmund Husserl's Phenomenology, Joseph J. Kockelmans provides the reader with a biographical sketch and an overview of the salient features of Husserl's thought. Kockelmans focuses on the essay for the Encyclopedia Britannica of 1928, Husserl's most Important effort to articulate the aims of phenomenology for a more general audience. Included are Husserl's text -- in the original German and in English translation on facing pages -- a synopsis, and an extensive commentary that relates Husserl's work as a whole (...) to the essay for the Encyclopedia. (shrink)

Byrne's approach to the semifactual conditional captures the reasoning data. However, we argue that it does not account for the processes or principles by which people arrive at representations of even-if conditionals, upon which their reasoning is said to be based. Drawing upon recent work on the suppositional conditional we present such an account.

ABSTRACT:Daniel Callahan died on July 16, 2019, just short of his 89th birthday. In the years since, we have seen the overturning of abortion rights, a concern central to his scholarship and musings about the place of religion in American civic life. Callahan’s journey from lay Catholic journalist and commentator at Commonweal to a co-founder of the Hastings Center, during his decade of doubt, is especially relevant today as America revisits established precedent governing a woman’s right to choose. His life-long (...) struggle with faith and the secularization of bioethics is a story worth telling, as it may foster dialogue across a divide between religious and laical thinkers that has fractured our political discourse. We recall Callahan’s misgivings about the marginalization of religious perspectives in public life; he sought not the denial of complexity nor of difference in views, but rather the importance of free and honest debate around deeply held beliefs, contextualized in the realities of the contemporary world. Callahan’s ambivalence about his faith remains a part of the fabric of American life, a story that Callahan chronicled to our collective benefit for over a half-century. (shrink)

In Wittgenstein on Meaning, Colin McGinn argues that the skeptical argument that Kripke distills from Wittgenstein's rule-following considerations generates at most what might be called meaning skepticism (the non-factuality view of meaning), and not concept skepticism (the non-factuality view of concepts). If correct, this would mean the skeptical reasoning is far less significant than Kripke thinks. Others have seemed to agree with McGinn. I argue that McGinn is wrong here--that, in fact, Kripke's skeptical reasoning has a straightforward extension to concepts. (...) Whether the reasoning succeeds, however, is another matter, which I do not address here. (shrink)

As scholars envision a new regulatory or statutory neurorights schema it is important to imagine unintended consequences if reforms are implemented before their implications are fully understood. This paper critically evaluates provisions proposed for a new Chilean Constitution and evaluates this movement against efforts to improve the diagnosis of, and treatment for, individuals with disorders of consciousness within the broader context of disability law, international human rights, and a capabilities approach to health justice as advanced by Amartya Sen and Martha (...) Nussbaum. Framed in this way, any neurorights regime would need to satisfy several criteria. First it would be obliged to balance both positive and negative rights in the furtherance of human capabilities. Second, it would need to be future oriented and informed about the science it sought to regulate and not fall prey to science fiction fantasies that remain ungrounded in reality. Third, it would need to be specific and avoid generalizations that would lead to conceptual confusion and litigation that could delay scientific progress. Finally, it would need to harmonize novel neurorights with long-established norms in international disability and human rights law. A failure to meet these criteria will destine any novel neurorights regime to the periphery. At this juncture Chile’s nascent constitutional venture into neurorights fails to satisfy these criteria. While there yet may be a role for a more capacious and bivalent articulation of neurorights that account for capabilities and precedent, the current Chilean neurorights reforms are vague and premature. As such they should undergo additional scholarly scrutiny and should not be adopted by other jurisdictions. (shrink)

Jacques Rancière: An Introduction offers the first comprehensive introduction to the thought of one of today's most important and influential theorists. Joseph Tanke situates Rancière's distinctive approach against the backdrop of Continental philosophy and extends his insights into current discussions of art and politics. Tanke explains how Rancière's ideas allow us to understand art as having a deeper social role than is customarily assigned to it, as well as how political opposition can be revitalized. The book presents Rancière's body (...) of work as a coherent whole, tracing key notions such as the distribution of the sensible, the aesthetics of politics, and the supposition of equality from his earliest writings through to his most recent interventions. Tanke concludes with a series of critical questions for Rancière's work, indicating how contemporary thought might proceed after its encounter with him. The book provides readers new to Rancière with a clear overview of his enormous intellectual output. Engaging with many un-translated and unpublished sources, the book will also be of interest to Rancière's long-time readers. (shrink)

Joseph J. Kockelmans provides a clear and systematic treatment of the central themes and topics of Heidegger's later writings, focusing on the all-important question of the relationship of truth and Being. If we are to understand Heidegger's thought, Kockelmans explains, we must conceive it as a path or way, rather than as a finished system. Adopting this approach himself, Kockelmans leads us with scholarly care through the wide range of issues that Heidegger wrote about between roughly 1935 and 1965. (...) After a discussion of Heidegger's own effort to learn to think, subsequent chapters present Heidegger's views on such matters as the meaning of Being; the ontological difference; heaven and earth; gods and mortals; and language, art, science, technology, ethics, and politics. In conclusion, Kockelmans reflects on the task of thinking in an age when classical philosophy has reached its logical end. (shrink)

If ever I summon before me my highest ideals of men and medicine, I find them sprung from the spirit of Osler. —Wilder Penfield, M.D. Neuroethics is a recently coined term that is shaping our cultu...

Husserl's Original View on Phenomenological Psychology* JOSEPH J.KOCKELMANS Some forty years ago Edmund Husserl spoke publicly for the first time of a ...

Language, meaning, and ek-sistence, by J. J. Kockelmans.--Heidegger's conception of language in Being and time, by J. Aler.--Poetry and language in Heidegger, by W. Biemel.--Heidegger's topology of being, by O. Pöggeler.--Thinking and poetizing in Heidegger, by H. Birault.--Hermeneutic and personal structure of language, by H. Ott.--Ontological difference, hermeneutics, and language, by J. J. Kockelmans.--The world in another beginning: poetic dwelling and the role of the poet, by W. Marx.--Panel discussion.--Heidegger's language: metalogical forms of thought and grammatical specialties, by E. Schöfer.--M. (...) Heidegger's "ontological difference" and language, by J. Lohmann.--Bibliography (p. 365-368). (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Why Rancière Now?Joseph J. Tanke (bio)I. IntroductionAs philosophy's representative at an art college, a question is put to me by my colleagues, students, and other art-world types frequently enough that it is worth considering systematically: Why Rancière now? The query is in large part prompted by a recent issue of Artforum devoted to the work of the French philosopher Jacques Rancière, the publication of which caps a seemingly (...) overnight ascendance within discussions of art and politics. The very temporality of the question indicates that the discovery of Rancière by art professionals is a relatively recent development. Why is this taking place now? To begin to answer this question, we must first understand something about the current relationship between theoretical discourse and artistic practice.That Rancière is only now beginning to be discussed within the art world is indeed surprising, given the long-standing reliance upon theoretical approaches and the fact that Baudrillard, Derrida, and Deleuze now function as standard reference points. While it would be incorrect to say that Rancière was an unknown quantity in the Anglophone world until recently, the sense of revelation suggested by the query "Why now?" must be understood in terms of the ongoing exchange between European theory and contemporary art. This is a conversation that, independent of one's perspective as to whether it has had positive or negative consequences, cannot be denied. With this relationship between Continental philosophy, art making, and critical discourses, one is justified in asking, Why is Rancière only now coming to be read with any seriousness in art circles? The point is sharpened when we note that Rancière's work, unlike that of some of the more [End Page 1] celebrated names, is more readily suited for an interface with critical art discourse, concerned as it is with aesthetic issues and the analysis of contemporary art.One might be tempted to find lurking behind our question a certain amount of suspicion about further incursions by theory and detect a sense of exasperation at having yet another French name to pronounce. Those of us who find this interaction between art and theory edifying, however, should not simply shrug off this question and attribute it to an aversion to philosophy, or to a backlash against the excess of the past two decades. Understanding the context in which the question is posed allows us to expand it. And, while not all would agree, I think it is safe to say that there is a tacit consensus that fruitful arrangements between art and philosophy can be forged. With this situation in mind, we might, therefore, transform our question into something like the following: What might Rancière contribute to the work of the nonphilosopher, placed, for good or ill, within a dispositif wherein art and European theory discourse about many of the same phenomena, but in different idioms? The advantage of this formulation, of course, is that it allows us to avoid many of the facile responses to our initial question, variations on a theme suggesting that Rancière is simply one of the few members of that esteemed generation of thinkers still living and that the turning to his work is indicative of a generalized anxiety about the future of theoretical developments. We might also, in thus expanding our question, sketch an answer directed at those working at the edges of their respective disciplines: philosophers, artists, critics, historians—in short, all those interested in questions of contemporary culture. In accordance with what Rancière describes as the fortuitous breakdown of specializations, my efforts in this essay are intended as a contribution to an interdisciplinary conversation that is grappling with the intellectual issues raised by works of art, their reception, and the historical discourses that are created around them.II. To Avoid Two Discourses of MourningThe temporality of our question, why now?, is hinted at by Rancière at various points throughout his own work and pertains to what might be characterized as the default theoretical position of art, that of "mourning." For Rancière, this mourning takes two major forms: spectacle and the impossible. The former finds its genesis... (shrink)

Research in education and cognitive development suggests that explaining plays a key role in learning and generalization: When learners provide explanations—even to themselves—they learn more effectively and generalize more readily to novel situations. This paper proposes and tests a subsumptive constraints account of this effect. Motivated by philosophical theories of explanation, this account predicts that explaining guides learners to interpret what they are learning in terms of unifying patterns or regularities, which promotes the discovery of broad generalizations. Three experiments provide (...) evidence for the subsumptive constraints account: prompting participants to explain while learning artificial categories promotes the induction of a broad generalization underlying category membership, relative to describing items (Exp. 1), thinking aloud (Exp. 2), or free study (Exp. 3). Although explaining facilitates discovery, Experiment 1 finds that description is more beneficial for learning item details. Experiment 2 additionally suggests that explaining anomalous observations may play a special role in belief revision. The findings provide insight into explanation’s role in discovery and generalization. (shrink)

"This fine work's ample documentation should gladden the scholarly reader while its accessible prose & well-organized presentation will make it useful for ...

In Heidegger's "Being and Time", the author locates the main themes of Heidegger's seminal work within their historical context and, in the process, familiarizes the reader with the terminology and background information relevant to understanding Heidegger's text. This study of what is arguably the greatest philosophical text of the century takes the ontological view of Heidegger's work. Here the author presents a precise formulation of the genuine problem of the meaning of Being, an explanation of the fact that Being is (...) for us problematic and should be so, and a precise determination and articulation of the mode of Being of man (using the hermeneutical and transcendental analytic of Dasein). Contents: I. The Preparatory Fundamental nalysis of Dasein II. Dasein and Temporality. Bibliography. Index. Co-published with The Center for Advanced Research in Phenomenology. (shrink)

As philosophy's representative at an art college, a question is put to me by my colleagues, students, and other art-world types frequently enough that it is worth considering systematically: Why Rancière now? The query is in large part prompted by a recent issue of Artforum devoted to the work of the French philosopher Jacques Rancière, the publication of which caps a seemingly overnight ascendance within discussions of art and politics. The very temporality of the question indicates that the discovery of (...) Rancière by art professionals is a relatively recent development. Why is this taking place now? To begin to answer this question, we must first understand something about the current relationship between .. (shrink)

This paper discusses the relationship between Kantian idealism and Marxian materialism. Part I examines the reasons this relationship is misconstrued to be predominantly a matter of practical philosophy and turns to the neglected works of Alfred Sohn-Rethel and Richard Seaford to outline the importance of money for understanding Kant’s theoretical work. Part II considers an objection that Kant confuses the commodity form for the transcendental object of experience. I am ultimately concerned with defusing the accusation that the identity of the (...) commodity with a Kantian thing renders Kantian idealism “bourgeois” in the pejorative sense. Money is implicated, historically and conceptually, in the very intelligibility of metaphysics. In that case, Kantian idealism and Marxian materialism are two sides of the same coin. (shrink)

Let’s face it, the humanities are in trouble. Last year, in The Chronicle of Higher Education, Thomas H. Benton warned prospective graduate students to avoid doctoral studies in the humanities. His rationale: a job market down 40%, the improbability of tenure, the more certain prospect of life as an adjunct, and eventual outright exile from one’s chosen field. Benton, the pen name of William Pannapacker, an associate professor of English at Hope College in Holland, Michigan, pulled no punches. His piece (...) was entitled, “Graduate School in the Humanities: Just Don’t Go.”. (shrink)

From mid-March through May 2020, New York City was the world’s epicenter of the COVID-19 pandemic, and its hospitals faced an unparalleled surge of patients who were critically ill with the virus. In addition to putting an enormous strain on medical resources, the pandemic presented many ethical issues to emotionally and physically stressed clinicians and hospital administrators. Analyses of the challenges faced by the ethics consultation services of the two campuses of New York Presbyterian Hospital, and how they assisted their (...) clinician and administrative colleagues, is the subject of the following four articles. (shrink)

In this presentation I take a close look at Kant’s notion of “orientation” as it arises in a minor essay of 1786 in order to show how this relatively obscure moment forces us to reconsider the central division between epistemology and aesthetics. What makes Kant’s notion orientation difficult to place in a critical system that separates conceptually grounded cognition from the affective nature of aesthetics is that orientations turn out to be claims to knowledge which can not be had without (...) an irreducible aesthetic or “felt” discrimination. So what is philosophically at issue in examining Kant’s notion of orientation is the question of whether there are indeed some features of objects or states of affairs which are not properly recognized prior to or independently of feeling a certain way about them. In other words, are our feelings epistemologically relevant? The official Kantian answer is, of course, a resounding “no”. By reconstructing the logic of “orientation” as deployed in the 1786 essay I show where the attempt to separate cognition from feelings leads into a vicious “Kantian Circle”. This logical circularity anticipates similar problems in the third critique’s explanation of beauty and life. I end by returning to the notion of “orientation” in order to suggest a way out of this “Kantian Circle”. (shrink)

Introduction -- The stirrings of modernity -- Rupture -- Non-affirmative painting -- Anti-platonism -- The cynical legacy.

In this essay an effort is made to answer the question of what function psychology and psychiatry have in merleau-ponty's ``the structure of behavior and phenomenology of perception''. it is argued that in his first book merleau-ponty tried to present a philosophical critique of the behaviorist and gestaltist interpretations of empirical psychology, whereas ``phenomenology of perception'' attempts to make a contribution to philosophical anthropology which in many instances employs analyses which belong to phenomenological psychology, the regional ontology of psychic phenomena.

In Heidegger's "Being and Time", the author locates the main themes of Heidegger's seminal work within their historical context and, in the process, familiarizes the reader with the terminology and background information relevant to understanding Heidegger's text. This study of what is arguably the greatest philosophical text of the century takes the ontological view of Heidegger's work. Here the author presents a precise formulation of the genuine problem of the meaning of Being, an explanation of the fact that Being is (...) for us problematic and should be so, and a precise determination and articulation of the mode of Being of man . Contents: I. The Preparatory Fundamental nalysis of Dasein II. Dasein and Temporality. Bibliography. Index. Co-published with The Center for Advanced Research in Phenomenology. (shrink)

This book argues that the philosophical significance of Kant’s aesthetics lies not in its explicit account of beauty but in its implicit account of intentionality. Kant’s account is distinct in that feeling, affect, or mood must be operative within the way the mind receives the world. Moreover, these modes of receptivity fall within the normative domain so that we can hold each other responsible for how we are "struck" by an object or scene. Joseph Tinguely composes a series of (...) investigations into the philosophically rich but regrettably neglected topics at the intersection of Kant’s aesthetics and epistemology, such as how we orient ourselves in the world, whether tonality is a property of the subject or object, and what we hope to accomplish when we quarrel about taste. Taken together, these investigations offer a robust and defensible picture of mind, which not only resolves tensions in a Kantian account of intentionality but also offers a timely intervention into contemporary debates about the "aesthetic" nature of the way the mind is in touch with the world. Kant and the Reorientation of Aesthetics will appeal to scholars and students of Kant, as well as those working at the intersection of aesthetics and philosophy of mind. (shrink)