In transplant medicine, the use of normothermic regional perfusion (NRP) in donation after circulatory determination of death raises ethical difficulties. NRP is objectionable because it restores the donor's circulation, thus invalidating a death declaration based on the permanent cessation of circulation. NRP's defenders respond with arguments that are tortuous and factually inaccurate and depend on introducing extraneous concepts into the law. However, results comparable to NRP's—more and higher‐quality organs and more efficient allocation—can be achieved by removing organs from deceased donors (...) and using normothermic machine perfusion (NMP) to support the organs outside the body, without jeopardizing confidence in transplantation's legal and ethical foundations. Given the controversy that NRP generates and the convoluted justifications made for it, we recommend a prudential approach we call “ethical parsimony,” which holds that, in the choice between competing means of achieving a result, the ethically simpler one is to be preferred. This approach makes clear that policy‐makers should favor NMP over NRP. (shrink)

“Brain death,” the determination of human death by showing the irreversible loss of all clinical functions of the brain, has become a worldwide practice. A biophilosophical account of brain death requires four sequential tasks: agreeing on the paradigm of death, a set of preconditions that frame the discussion; determining the definition of death by making explicit the consensual concept of death; determining the criterion of death that proves the definition has been fulfilled by being both necessary and sufficient for death; (...) and determining the tests of death for physicians to employ at the patient's bedside to demonstrate that the criterion of death has been fulfilled. The best definition of death is “the cessation of functioning of the organism as a whole.” The whole-brain criterion is the only criterion that is both necessary and sufficient for death. Brain death tests are used only in the unusual case in which a patient's ventilation is being supported. Brain death critics have identified weaknesses in its formulation. But despite its shortcomings, the whole-brain death formulation comprises a concept and public policy that make intuitive and practical sense and that has been well accepted by many societies. (shrink)

Organ donation after the circulatory determination of death requires the permanent cessation of circulation while organ donation after the brain determination of death requires the irreversible cessation of brain functions. The unified brain-based determination of death connects the brain and circulatory death criteria for circulatory death determination in organ donation as follows: permanent cessation of systemic circulation causes permanent cessation of brain circulation which causes permanent cessation of brain perfusion which causes permanent cessation of brain function. The relevant circulation that (...) must cease in circulatory death determination is that to the brain. Eliminating brain circulation from the donor ECMO organ perfusion circuit in thoracoabdominal NRP protocols satisfies the unified brain-based determination of death but only if the complete cessation of brain circulation can be proved. Despite its medical and physiologic rationale, the unified brain-based determination of death remains inconsistent with the Uniform Determination of Death Act. (shrink)

Lewis emphasizes the role of theta oscillations in emergent coupling among neural subsystems during emotionally relevant tasks or situations. Here I present some recent data on the relationship of rhythmic neuronal discharge in the supramammillary nucleus and the large-scale theta oscillations in the limbic system which provide support to many of his ideas regarding vertical integration in dynamic systems.

A supplemental document for "Metalinguistic Gradability".

Although death statutes permitting physicians to declare brain death are relatively uniform throughout the United States, academic debate persists over the equivalency of human death and brain death. Alan Shewmon showed that the formerly accepted integration rationale was conceptually incomplete by showing that brain-dead patients demonstrated a degree of integration. We provide a more complete rationale for the equivalency of human death and brain death by defending a deeper understanding of the organism as a whole and by using a novel (...) strategy with shared objectives to justify death determination criteria. Our OaaW account describes different types of OaaW, defining human death as the loss of status as a human OaaW. We defend human death as similar to nonhuman death in terms of wakefulness, but also distinct in terms of the sui generis properties, particularly conscious awareness. We thereby defend the equivalency of brain death and human death using a resulting neurocentric rationale. (shrink)

This essay examines the relationship between Eric Voegelin and Leo Strauss in order to show the central themes necessary to elucidate their philosophical positions. The essay reveals the centrality of the figure of Plato as a point of departure to understand the agreement and the disagreement concerning fundamental questions (such as the way of reading ancient texts, the importance of the historical perspective or the importance of the study of the past in order to orient the modern science) which revolves (...) around the issue of the relation between revelation and philosophy. The work concludes with an identification of the common core of both thinkers that allows us to understand their differences (homogeneity or heterogeneity of reality and the human) and, moreover, identifies both perspectives with a «foundational» (Voegelin) or «negative» (Strauss) interpretation of Plato’s thought. (shrink)

Multiple states are at risk of becoming uninhabitable due to climate change, forcing their populations to flee. While the 1951 Refugee Convention provides the gold standard of international protection, it is only applied to a limited subset of people fleeing their countries, those who suffer persecution, which most people fleeing climate change cannot establish. While many journalists and non-lawyers freely use the term “climate refugees,” governments, and courts, as well as UNHCR and many refugee experts, have excluded most climate refugees (...) from the Convention as a matter of legal interpretation. In our 2015 paper, “Unable to Return in the 1951 Refugee Convention: Stateless Refugees and Climate Change”, we sought to reopen the debate on “climate refugees” by arguing that some climate refugees qualify under the 1951 Convention as it is currently written (even if they are not persecuted): those who are stateless and are unable to return to their country of origin because climate change has rendered it uninhabitable. Our interpretation, however, has been rejected by Goodwin-Gill and McAdam (2021) and by Foster and Lambert (2019), which explicitly responds to our paper. Here, we address and respond to their arguments, and develop a new supplementary one, drawing on the principle of systemic integration, as enshrined in Article 31(3)(c) of the Vienna Convention on the Law of Treaties. (shrink)

When is a belief or judgment justified? One might be forgiven for thinking the search for single answer to this question to be hopeless. The concept of justification is required to fulfil several tasks: to evaluate beliefs epistemically, to fill in the gap between truth and knowledge, to describe the virtuous organization of one’s beliefs, to describe the relationship between evidence and theory (and thus relate to confirmation and probabilification). While some of these may be held to overlap, the prospects (...) for fulfilling all may well seem poor. Furthermore the internalist requires that justification be an introspectible property of beliefs and a fundamental epistemic concept, while the externalist is often happy to ignore the concept altogether or at best regard it as an embarrassing add-on to their epistemology. In the light of this one might reasonably give up on justification altogether or adopt pluralist approach, denying that justification is any single property of beliefs of judgments. (shrink)

In this paper we discuss how Causal Decision Theory should be modified to handle a class of problematic cases involving deterministic laws. Causal Decision Theory, as it stands, is problematically biased against your endorsing deterministic propositions (for example it tells you to deny Newtonian physics, regardless of how confident you are of its truth). Our response is that this is not a problem for Causal Decision Theory per se, but arises because of the standard method for assessing the truth of (...) certain counterfactuals. The truth of deterministic laws is `modally fragile' on the standard semantics for counterfactuals: if determinism is true and you were to do otherwise, the laws would be different. We provide two ways of avoiding this problem: 1) supplement the standard semantics for counterfactuals with impossible worlds, or 2) introduce rigid designators into the description of problematic decision situations. We argue that both of these approaches are well-motivated and can be readily incorporated into Lewisian Causal Decision Theory. (shrink)

This paper studies how Europe conceived America, not only as a place inhabited by monsters, but also as a monstrous space in itself, as soon as its mere appearance meant an alteration of the previous ontological order. By way of illustration we analyze how the Europeans imagined projected on America each of the different theratologic currents that dominated during the 16TH and 17TH centuries.

Two sources of possible disagreement in bioethics may be associated with pessimism about what bioethics can achieve. First, pluralism implies that bioethics engages with interlocutors who hold divergent moral beliefs. Pessimists might believe that these disagreements significantly limit the extent to which bioethics can provide normatively robust guidance in relevant areas. Second, the interdisciplinary nature of bioethics suggests that interlocutors may hold divergent views on the nature of bioethics itself—particularly its practicality. Pessimists may suppose that interdisciplinary disagreements could frustrate the (...) goals of bioethics. In this article, I explore how wonder may alleviate the concerns of the first group of pessimists regarding problems associated with pluralism, provided that we are willing to accept some interdisciplinary frustrations. Then, I invite readers of this issue of The Journal of Medicine & Philosophy to test these intuitions by considering the role of wonder in these articles. (shrink)

I develop an expressivist account of verbal disagreements as practical disagreements over how to use words rather than factual disagreements over what words actually mean. This account enjoys several advantages over others in the literature: it can be implemented in a neo-Stalnakerian possible worlds framework; it accounts for cases where speakers are undecided on how exactly to interpret an expression; it avoids appeals to fraught notions like subject matter, charitable interpretation, and joint-carving; and it naturally extends to an analysis of (...) metalinguistic negotiations. (shrink)

A common objection to the very idea of conceptual engineering is the topic continuity problem: whenever one tries to “reengineer” a concept, one only shifts attention away from one concept to another. Put differently, there is no such thing as conceptual revision: there’s only conceptual replacement. Here, I show that topic continuity is compatible with conceptual replacement. Whether the topic is preserved in an act of conceptual replacement simply depends on what is being replaced (a conceptual tool or a conceptual (...) role) and what the topic under discussion is. Thus, the topic continuity problem only arises from a failure to specify these two things. (shrink)

Eric Voegelin's Political Readings fills a critical void by providing a original approach to studying the work of Eric Voegelin, one of the major political philosophers of the twenty first century. Across six chapters a group of experts guide the reader from classical to modern times presenting six political philosophers who have had an impact on the life and philosophical production of Eric Voegelin. Philosophers examined include Plato, Aristotle, Saint Augustine, Hobbes, Weber and Kelsen. Through this innovative structure the chapters (...) collectively illustrate how Voegelin was an exceptional thinker through his engagement with political philosophers both modern and antique. The plurality of unique, academic perspectives and voices enriches our understanding of Voegelin's own thought while also encouraging a re-think of ancient and modern thinkers, and the transformation and continuity between these. Designed for students and scholars alike, Eric Voegelin's Political Readings will appeal to all those with an interest in Voegelin as well as readers familiar with classical and modern political philosophers. (shrink)

The concept of whole‐brain death is under attack again. Scholars are arguing that the concept of brain death per se—regardless of the focus on “higher,” “stem” or “whole”—is fundamentally flawed. These scholars have identified what they believe are serious discrepancies between the definition and criterion of brain death, and have pointed out that medical professionals and lay persons remain confused about its meaning. Yet whole‐brain death remains the standard for determining death in much of the Western world and its defenders (...) believe this concept best maps onto our everyday conception of death. (shrink)

This paper commences by making a case for a naturalized approach to knowledge‐first epistemology. On this basis it then goes on to describe and defend a naturalized, functionalist account of group knowledge. It then contrasts this with Jennifer Lackey's (2021) account of the epistemological status of groups.

The definition of death is one of the oldest and most enduring problems in biophilosophy and bioethics. Serious controversies over formally defining death began with the invention of the positive-pressure mechanical ventilator in the 1950s. For the first time, physicians could maintain ventilation and, hence, circulation on patients who had sustained what had been previously lethal brain damage. Prior to the development of mechanical ventilators, brain injuries severe enough to induce apnea quickly progressed to cardiac arrest from hypoxemia. Before the (...) 1950s, the loss of spontaneous breathing and heartbeat were perfect predictors of death because the functioning of the brain and of all other organs ceased rapidly and nearly simultaneously thereafter, producing a unitary death phenomenon. In the pretechnological era, physicians and philosophers did not have to consider whether a human being who had lost certain “vital functions” but had retained others was alive, because such cases were technically impossible. (shrink)

In the paper, a detailed analysis of some new logical aspects of Cantor’s diagonal proof of the uncountability of continuum is presented. For the first time, strict formal, axiomatic, and algorithmic definitions of the notions of potential and actual infinities are presented. It is shown that the actualization of infinite sets and sequences used in Cantor’s proof is a necessary, but hidden, condition of the proof. The explication of the necessary condition and its factual usage within the framework of Cantor’s (...) proof makes, Cantor’s proof invalid. It’s shown that traditional Cantor’s proof has a second necessary, but hidden as well, condition which is teleological by its nature, i.e., is not mathematical. The explication of the second necessary condition makes Cantor’s statement on the uncountability of continuum unprovable from the point of view of classical logic.One of the most dramatic facts in history of science is connected just with the notion of actual infinity and consists in the following. On the one hand, Aristotle, Berkeley, Locke, Descartes, Spinoza, Gauss, Kant, Cauchy, Kronecker, Hermite, Poincaré, Bair, Borel, Brouwer, Quine, Wittgenstein, Weyl, Luzin, and a lot of other outstanding creators of classical logic and classical mathematics, during millenniums, stated categorically and insistently warned about that the actual infinity is a self-contradictory notion and its usage in mathematics is inadmissible (e.g., according to Poincare, “There is no actual infinity. - Cantorians forgot that and fell into contradictions. Later generations will regard Mengenlehre (set theory) as a disease from which one has recovered”). On the other hand, a lot of outstanding scientists of the XX c.c., such as Hilbert, Church, Turing, Gödel, etc., and modern axiomatic set theory as a whole ignored this (intuitive though) opinion of genii and accepted Cantor’s “transfinite paradise”, based on the actual infinity. In the paper some logical, philosophical, and psychological aspects of this historical “favorable opposition” are analyzed, and the fact that the scientific intuition of genii has won the historical battle against the mytho-’logic’ of Cantor’s transfinite ‘paradise’ is explained and logically justified. (shrink)

In the paper, a detailed analysis of some new logical aspects of Cantor’s diagonal proof of the uncountability of continuum is presented. For the first time, strict formal, axiomatic, and algorithmic definitions of the notions of potential and actual infinities are presented. It is shown that the actualization of infinite sets and sequences used in Cantor’s proof is a necessary, but hidden, condition of the proof. The explication of the necessary condition and its factual usage within the framework of Cantor’s (...) proof makes, Cantor’s proof invalid. It’s shown that traditional Cantor’s proof has a second necessary, but hidden as well, condition which is teleological by its nature, i.e., is not mathematical. The explication of the second necessary condition makes Cantor’s statement on the uncountability of continuum unprovable from the point of view of classical logic.One of the most dramatic facts in history of science is connected just with the notion of actual infinity and consists in the following. On the one hand, Aristotle, Berkeley, Locke, Descartes, Spinoza, Gauss, Kant, Cauchy, Kronecker, Hermite, Poincaré, Bair, Borel, Brouwer, Quine, Wittgenstein, Weyl, Luzin, and a lot of other outstanding creators of classical logic and classical mathematics, during millenniums, stated categorically and insistently warned about that the actual infinity is a self-contradictory notion and its usage in mathematics is inadmissible (e.g., according to Poincare, “There is no actual infinity. - Cantorians forgot that and fell into contradictions. Later generations will regard Mengenlehre (set theory) as a disease from which one has recovered”). On the other hand, a lot of outstanding scientists of the XX c.c., such as Hilbert, Church, Turing, Gödel, etc., and modern axiomatic set theory as a whole ignored this (intuitive though) opinion of genii and accepted Cantor’s “transfinite paradise”, based on the actual infinity. In the paper some logical, philosophical, and psychological aspects of this historical “favorable opposition” are analyzed, and the fact that the scientific intuition of genii has won the historical battle against the mytho-’logic’ of Cantor’s transfinite ‘paradise’ is explained and logically justified. (shrink)

A combination of emerging life support technologies and entrenched organ donation practices are complicating the physician's task of determining death. On the one hand, technologies that support or replace ventilation and circulation may render the diagnosis of death ambiguous. On the other, transplantation of vital organs requires timely and accurate declaration of death of the donor to keep the organs as healthy as possible. These two factors have led to disagreements among physicians and scholars on the precise moment of death. (...) In this article, I suggest that the debate about exactly when a person dies can benefit from distinguishing the strict biological concept of death from the medical standards for determining human death, and I show how an appreciation of the difference between the permanent and irreversible cessation of circulation is helpful in understanding the reasons for the two approaches to determining when death should be declared. (shrink)

The publicity surrounding the recent McMath and Muñoz cases has rekindled public interest in brain death: the familiar term for human death determination by showing the irreversible cessation of clinical brain functions. The concept of brain death was developed decades ago to permit withdrawal of therapy in hopeless cases and to permit organ donation. It has become widely established medical practice, and laws permit it in all U.S. jurisdictions. Brain death has a biophilosophical justification as a standard for determining human (...) death but remains poorly understood by the public and by health professionals. The current controversies over brain death are largely restricted to the academy, but some practitioners express ambivalence over whether brain death is equivalent to human death. Brain death remains an accepted and sound concept, but more work is necessary to establish its biophilosophical justification and to educate health professionals and the public. (shrink)

A new speculative ontology of aesthetics. In Aesthesis and Perceptronium, Alexander Wilson presents a theory of materialist and posthumanist aesthetics founded on an original speculative ontology that addresses the interconnections of experience, cognition, organism, and matter. Entering the active fields of contemporary thought known as the new materialisms and realisms, Wilson argues for a rigorous redefining of the criteria that allow us to discriminate between those materials and objects where aesthesis (perception, cognition) takes place and those where it doesn't. Aesthesis (...) and Perceptronium negotiates between indiscriminately pluralist views that attribute mentation to all things and eliminative views that deny the existence of mentation even in humans. By recasting aesthetic questions within the framework of "epistemaesthetics," which considers cognition and aesthetics as belonging to a single category that can neither be fully disentangled nor fully reduced to either of its terms, Wilson forges a theory of nonhuman experience that avoids this untenable dilemma. Through a novel consideration of the evolutionary origins of cognition and its extension in technological developments, the investigation culminates in a rigorous reevaluation of the status of matter, information, computation, causality, and time in terms of their logical and causal engagement with the activities of human and nonhuman agents. (shrink)

Over the past quarter century, organ donation after the circulatory determination of death (DCD) has grown in acceptance and prevalence throughout the world (Domínguez-Gil et al. 2021). Notwithstan...

Nair-Collins and Joffe (2023) highlighted the noncongruence between the language of the Uniform Determination of Death Act (UDDA) and the accepted brain death bedside testing standard by showing th...

This is the second part of a two-part series on the logic of hyperlogic, a formal system for regimenting metalogical claims in the object language (even within embedded environments). Part A provided a minimal logic for hyperlogic that is sound and complete over the class of all models. In this part, we extend these completeness results to stronger logics that are sound and complete over restricted classes of models. We also investigate the logic of hyperlogic when the language is enriched (...) with hyperintensional operators such as counterfactual conditionals and belief operators. (shrink)

Notwithstanding these wise pronouncements, my project here is to characterize the biological phenomenon of death of the higher animal species, such as vertebrates. My claim is that the formulation of “whole- brain death ” provides the most congruent map for our correct understanding of the concept of death. This essay builds upon the foundation my colleagues and I have laid since 1981 to characterize the concept of death and refine when this event occurs. Although our society's well-accepted program of multiple (...) organ procurement for transplantation requires the organ donor first to be dead, the concept of brain death is not merely a social contrivance to permit us to obtain the benefits of organ procurement. Rather, the concept of whole- brain death stands independently as the most accurate biological representation of the demise of the human organism. (shrink)

This paper studies the role of literature and rethorics as a tool of philosophical practice within the classical tradition of «spiritual exercises». The aim of this study is to propose new ways of thinking the relations among philosophy and literature as formative or psicagogic disciplines, as well as for stand up for the role of philosophy and literature in our society.

Este trabajo estudia el concepto de “lo sublime” en la cultura barroca, con el objetivo de demostrar que, aunque no fue teorizado sistemáticamente hasta el siglo XVIII, este cobró durante el siglo XVII una centralidad y, sobre todo, un significado filosófico semejantes a los que se impondrían posteriormente y que, según veremos, está estrechamente ligado con el concepto de “nihilismo”.

Ariane Lewis provided an insightful review of several controversial cases of death by neurologic criteria (“brain death”) in the UK, focusing on Archie Battersbee, a boy whose tragic illness provok...

The Uniform Determination of Death Act (UDDA) provides that “an individual who has sustained either (1) irreversible cessation of circulatory and respiratory functions or (2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead.” We show that the UDDA contains two conflicting interpretations of the phrase “cessation of functions.” By one interpretation, what matters for the determination of death is the cessation of spontaneous functions only, regardless of their generation by artificial means. By the (...) other, what matters is the cessation of both spontaneous and artificially supported functions. Because each UDDA criterion uses a different interpretation, the law is conceptually inconsistent. A single consistent interpretation would lead to the conclusion that conscious individuals whose respiratory and circulatory functions are artificially supported are actually dead, or that individuals whose brain is entirely and irreversibly destroyed may be alive. We explore solutions to mitigate the inconsistency. (shrink)

The distinction between the "permanent" (will not reverse) and "irreversible" (cannot reverse) cessation of functions is critical to understand the meaning of a determination of death using circulatory–respiratory tests. Physicians determining death test only for the permanent cessation of circulation and respiration because they know that irreversible cessation follows rapidly and inevitably once circulation no longer will restore itself spontaneously and will not be restored medically. Although most statutes of death stipulate irreversible cessation of circulatory and respiratory functions, the accepted (...) medical standard is their permanent cessation because permanence is a perfect surrogate indicator for irreversibility, and using it permits a more timely declaration. Therefore, patients properly declared dead in donation after circulatory death (DCD) protocols satisfy the requirements of death statutes and do not violate the dead donor rule. The acronym DCD should represent organ "donation after circulatory death" to clarify that the death standard is the permanent cessation of circulation, not heartbeat. Heart donation in DCD does not retroactively negate the donor's death determination because circulation has ceased permanently. (shrink)

Among the old and new controversies over brain death, none is more fundamental than whether brain death is equivalent to the biological phenomenon of human death. Here, I defend this equivalency by offering a brief conceptual justification for this view of brain death, a subject that Andrew Huang and I recently analyzed elsewhere in greater detail. My defense of the concept of brain death has evolved since Bernard Gert, Charles Culver, and I first addressed it in 1981, a development that (...) paralleled advances in intensive care unit treatment. The century‐old concept of the organism as a whole provides the fundamental justification for the equivalency of brain death and human death. In our technological age, in which increasing numbers of components and systems of an organism can be kept alive, and for longer intervals, the permanent cessation of functioning of the organism as a whole is the phenomenon that best corresponds to its death. (shrink)

The fundamental determinant of death in donation after circulatory determination of death is the cessation of brain circulation and function. We therefore propose the term donation after brain circulation determination of death [DBCDD]. In DBCDD, death is determined when the cessation of circulatory function is permanent but before it is irreversible, consistent with medical standards of death determination outside the context of organ donation. Safeguards to prevent error include that: 1] the possibility of auto-resuscitation has elapsed; 2] no brain circulation (...) may resume after the determination of death; 3] complete circulatory cessation is verified; and 4] the cessation of brain function is permanent and complete. Death should be determined by the confirmation of the cessation of systemic circulation; the use of brain death tests is invalid and unnecessary. Because this concept differs from current standards, consensus should be sought among stakeholders. The patient or surrogate should provide informed consent for organ donation by understanding the basis of the declaration of death. In cases of circulatory cessation, such as occurs in DBCDD, death can be defined as the permanent cessation of brain functions, determined by the permanent cessation of brain circulation. (shrink)

Abstract:Disturbing cases continue to be published of patients declared brain dead who later were found to have a few intact brain functions. We address the reasons for the mismatch between the whole-brain criterion and brain death tests, and suggest solutions. Many of the cases result from diagnostic errors in brain death determination. Others probably result from a tiny amount of residual blood flow to the brain despite intracranial circulatory arrest. Strategies to lessen the mismatch include improving brain death determination training (...) for physicians, mandating a test showing complete intracranial circulatory arrest, or revising the whole-brain criterion. (shrink)