The application of neuroimaging technology to the study of the injured brain has transformed how neuroscientists understand disorders of consciousness, such as the vegetative and minimally conscious states, and deepened our understanding of mechanisms of recovery. This scientific progress, and its potential clinical translation, provides an opportunity for ethical reflection. It was against this scientific backdrop that we convened a conference of leading investigators in neuroimaging, disorders of consciousness and neuroethics. Our goal was to develop an ethical frame to move (...) these investigative techniques into mature clinical tools. This paper presents the recommendations and analysis of a Working Meeting on Ethics, Neuroimaging and Limited States of Consciousness held at Stanford University during June 2007. It represents an interdisciplinary approach to the challenges posed by the emerging use of neuroimaging technologies to describe and characterize disorders of consciousness. (shrink)

In the care of patients with disorders of consciousness (DOC), some ethical difficulties stem from the challenges of accurate diagnosis and the uncertainty of prognosis. Current neuroimaging research on these disorders could eventually improve the accuracy of diagnoses and prognoses and therefore change the context of end-of-life decision making. However, the perspective of healthcare professionals on these disorders remains poorly understood and may constitute an obstacle to the integration of research. We conducted a qualitative study involving healthcare professionals from an (...) acute care university medical center. A short questionnaire captured demographic data as well as the experience of participants with DOC patients. A semi-structured interview was used to explore attitudes toward ethical issues identified in a previous literature review. Qualitative content analysis of interviews was conducted with the NVivo software. Accurate diagnosis among DOC is often regarded as a challenge, but this was generally not the case for our participants because most reported high confidence in DOC diagnoses. However, participants reported struggling with prognosis, especially because of its essential role for end-of-life decision making and communication with families. Variability of opinion between healthcare professionals was reported and identified by some as a minor issue while others stressed how families struggle with different medical opinions. End-of-life decision making encompassed a large proportion of ethical challenges in these patients, and the removal of artificial nutrition and hydration created significant discomfort in a minority of participants. The concept of futility was subject to wide-ranging understandings with both favorable and unfavorable opinions. Our data suggest that to ensure the incorporation of new evidence-based advances, attention should be directed to the real-world practices and challenges of accurate diagnosis and prognosis. Given pervasive challenges in end-of-life care, we recommend improved training of healthcare professionals in the care of patients with DOC, particularly in end-of life care, understanding the context of decision making, and determining how to optimally integrate new neuroscience research on the care of patients with DOC. (shrink)

Death in the Clinic fills a gap in contemporary medical education by explicitly addressing the concrete clinical realities about death with which practitioners, patients, and their families continue to wrestle. Visit our website for sample chapters!

The application of neuroimaging technology to the study of the injured brain has transformed how neuroscientists understand disorders of consciousness, such as the vegetative and minimally conscious states, and deepened our understanding of mechanisms of recovery. This scientific progress, and its potential clinical translation, provides an opportunity for ethical reflection. It was against this scientific backdrop that we convened a conference of leading investigators in neuroimaging, disorders of consciousness and neuroethics. Our goal was to develop an ethical frame to move (...) these investigative techniques into mature clinical tools. This paper presents the recommendations and analysis of a Working Meeting on Ethics, Neuroimaging and Limited States of Consciousness held at Stanford University during June 2007. It represents an interdisciplinary approach to the challenges posed by the emerging use of neuroimaging technologies to describe and characterize disorders of consciousness. (shrink)

The traditional verbal/nonverbal dichotomy is inadequate for completely describing cerebral lateralization. Musical functions are not necessarily mediated by the right hemisphere; evidence for a specialist left-hemisphere mechanism dedicated to the encoded speech signal is weakening, and the right hemisphere possesses considerable comprehensional powers. Right-hemisphere processing is often said to be characterized by holistic or gestalt apprehension, and face recognition may be mediated by this hemisphere partly because of these powers, partly because of the right hemisphere's involvement in emotional affect, and (...) possibly through the hypothesized existence of a specialist face processor or processors in the right. The latter hypothesis may, however, suffer the same fate as the one relating to a specialist encodedness processor for speech in the left. Verbal processing is largely the province of the left because of this hemisphere's possession of sequential, analytic, time-dependent mechanisms. Other distinctions are special cases of an analytic/holistic dichotomy. More fundamentally, however, the left hemisphere is characterized by its mediation of discriminations involving duration, temporal order, sequencing, and rhythm, at thesensory level, and especially at themotorlevel. Spatial aspects characterize the right, the mapping of exteroceptive body space, and the positions of fingers, limbs, and perhaps articulators, with respect to actual and target positions. Thus there is a continuum of function between the hemispheres, rather than a rigid dichotomy, the differences being quantitative rather than qualitative, of degree rather than of kind. (shrink)

Deals with the question of whether there is a use of ‘is true’ that is the primary or generic name for that which at bottom we are always saying ‘is true’. Austin discusses the views that truth is primarily a property of beliefs and of true statements. He goes on to argue that the word ‘true’ denotes the validity of an intended correspondence between a representation and what it represents, and dismantles confusions about the meaning of the words that underlie (...) such a view, such as ‘fact that’ and ‘corresponds’. (shrink)

Here we focus on two questions: What is the proper semantics for deontic modal expressions in English? And what is the connection between true deontic modal statements and normative reasons? Our contribution towards thinking about the first, which makes up the bulk of our paper, considers a representative sample of recent challenges to a Kratzer-style formal semantics for modal expressions, as well as the rival views—Fabrizio Cariani’s contrastivism, John MacFarlane’s relativism, and Mark Schroeder’s ambiguity theory—those challenges are thought to motivate. (...) These include the Professor Procrastinate challenge to Inheritance (the principle that ‘If ought p and p entails q, then ought q), as well as Parfit’s miners puzzle regarding information-sensitive deontic modals. Here we argue that a Kratzer-style view is able to meet all of the challenges we’ll consider. In addition, we’ll identify challenges for each of those rival views. Our overall conclusion is that a Kratzer-style semantics remains the one to beat. With this assumption in place, we then ask how we should understand the relationship between true deontic modal statements and normative reasons. Should, for example, we hold that the truth of such a statement entails the existence of a normative reason for some agent to comply? Here we argue that, in many cases, acceptance of Kratzer’s semantics for deontic modals leaves open for substantive normative theorizing the question of whether an agent has a normative reason to comply with what she ought to do. (shrink)

A. Either God can create a stone which He cannot lift, or He cannot create a stone which He cannot lift. If God can create a stone which He cannot lift, then He is not omnipotent. If God cannot create a stone which He cannot lift, then He is not omnipotent. Therefore, God is not omnipotent.In a paper published in Analysis I tried to show that any attempt to find something wrong with all arguments of the general form of A (...) above, any attempt to resolve the “paradox,” must fail, that the reason these attempts must fail is that at least some arguments of this form are essentially sound, and that the only thing which makes these arguments seem paradoxical, their conclusion to the effect that God is not omnipotent, is, like at least some versions of the arguments to this conclusion, quite correct. (shrink)

This paper critically evaluates Jonathan Lowe's arguments for his non-Cartesian substance dualism. Sections 1 and 2 set out the principal claims of NCSD. The unity argument proposed in Lowe is discussed in Section 3. Throughout his career Lowe offered spirited attacks on reductionism about the self. Section 4 evaluates the anti-reductionist argument that Lowe offers in Subjects of Experience, an argument based on the individuation of mental events. Lowe offers an inventive proposal that the semantic distinction between direct and indirect (...) reference delineates the metaphysical boundary between self and world, and uses this as a further argument against reductionism about the self. This proposal is discussed in Sections 5 and 6. (shrink)

We are witnessing at present a substantial efflorescence of the view that there are and must necessarily be fundamental differences between the methods—and especially the types of explanation—appropriate to the social sciences on the one hand and those appropriate to the natural sciences on the other. New and ever more subtle arguments seeking to re-establish a Geisteswissenschaften vs. Naturwissenschaften distinction are flowing from scholarly presses in ever greater volume. The works cited in footnote one are a mere sample just of (...) recent books which, while diverse to the point of contradiction in some respects, have as their common underlying theme the defense of such a methodological duality. (shrink)