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)

Emotion regulation is one of the major foci of study in the fields of emotion and emotional development. This article proposes that to properly study emotion regulation, one must consider not only an intrapersonal view of emotion, but a relational one as well. Defining properties of intrapersonal and relational approaches are spelled out, and implications drawn for how emotion regulation is conceptualized, how studies are designed, how findings are interpreted, and how generalizations are drawn. Most research to date has been (...) conducted from an intrapersonal perspective, and the shortcomings of this approach for understanding emotion regulation are highlighted. The article emphasizes major conceptual and methodological steps required for a fuller description of the process of emotion regulation. (shrink)

Although clinical ethics consultation is a high-stakes endeavor with an increasing prominence in health care systems, progress in developing standards for quality is challenging. In this article, we describe the results of a pilot project utilizing portfolios as an evaluation tool. We found that this approach is feasible and resulted in a reasonably wide distribution of scores among the 23 submitted portfolios that we evaluated. We discuss limitations and implications of these results, and suggest that this is a significant step (...) on the pathway to an eventual certification process for clinical ethics consultants. (shrink)

Edmund Husserl EDMUND GUSTAVE ALBRECHT HUSSERL was born in Prossnitz, Moravia, on April 8, 1859. After receiving his secondary education in Vienna, ...

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)

In November of 1050 Agnes of Poitou, wife of Emperor Henry III, gave birth to their first son. The birth of a son and heir was always an important event, and in this instance especially so. Henry had been seriously ill several times, including that very year. Although he had four daughters, there was a danger that he might die without male issue. Henry's ill health and lack of a male heir encouraged political instability and even conspiracy. When Henry was (...) seriously ill at Frankfurt in October 1045, ecclesiastical and lay magnates actually discussed whom they would choose as his successor. In 1047 at Xanten, perhaps in the presence of the emperor, Archbishop Hermann of Cologne exhorted his congregation that “along with him they should beg from the heavenly clemency that a son be given to the emperor in order to dispose properly the peace of the realm.”. (shrink)

Invisible Hand accounts of the operations of the competitive market are often thought to have two implications for morality as it confronts economic life. First, explanations of agents economic activities eschew constitutive appeal to moral notions; and second, such moralism is pernicious insofar as it tends to undermine the operations of a socially valuable social process. This is the Mandevillean Conceit. The Conceit rests on an avarice-only reading of the profit-motive that is mistaken. The avarice-only reading is not the only (...) way of characterising the profit-motive, and there are some positive grounds for thinking the benefits of profit pursuit are better attributed to the "lucrephile", and not the avarice-only "lucrepath". (shrink)

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)

On January 5, 2019, the Associated Press reported that a woman thought to have been in the vegetative state for over a decade gave birth at a Hacienda HealthCare facility. Until she delivered, the staff at the Phoenix center had not noticed that their patient was pregnant. The patient was also misdiagnosed.Misdiagnosis of patients with disorders of consciousness in institutional settings is more the norm than the exception. Misdiagnosis is also connected to a broad and extremely significant change in the (...) understanding of the vegetative state—a change that the field of bioethics has not yet fully taken into account. In September 2018, the American Academy of Neurology, the American College of Rehabilitation Medicine, and the National Institute on Disability, Independent Living, and Rehabilitation Research issued a comprehensive evidence‐based review on disorders of consciousness and an associated practice guideline on the care of these patients. These landmark publications update the 1994 Multi‐Society Task Force Report on the Vegetative State, which subcategorized the persistent vegetative state as either persistent (once the vegetative state lasted one month) or permanent (once the vegetative state lasted three months after anoxic injury or twelve months after traumatic injury). Noting that 20 percent of patients thought to be permanently unconscious might regain some level of consciousness, the new guideline has eliminated the permanent vegetative state as a diagnostic category, replacing it with the chronic vegetative state. (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)

: This paper presents a method of moral problem solving in clinical practice that is inspired by the philosophy of John Dewey. This method, called "clinical pragmatism," integrates clinical and ethical decision making. Clinical pragmatism focuses on the interpersonal processes of assessment and consensus formation as well as the ethical analysis of relevant moral considerations. The steps in this method are delineated and then illustrated through a detailed case study. The implications of clinical pragmatism for the use of principles in (...) moral problem solving are discussed. (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)

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)

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)

Many theories of complex cognitive-motor skill learning are built on the notion that basic cognitive processes group actions into easy-to-perform sequences. The present work examines predictions derived from laboratory-based studies of motor chunking and motor preparation using data collected from the real-time strategy video game StarCraft 2. We examined 996,163 action sequences in the telemetry data of 3,317 players across seven levels of skill. As predicted, the latency to the first action is delayed relative to the other actions in the (...) group. Other predictions, inspired by the memory drum theory of Henry and Rogers, received only weak support. (shrink)

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

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...

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)

While neuroethics is generally thought to be a modern addition to the broader field of bioethics, this subdiscipline has existed in clinical practice throughout the course of the 20th century. In this essay, Fins describes an older tradition of clinical neuroethics that featured such physician-humanists as Sir William Osler, Wilder Penfield, and Fred Plum, whose work and legacy exploring disorders of consciousness is highlighted. Their normative work was clinically grounded and focused on the needs of patients, in contrast to modern (...) neuroethics, which is more speculative and distant from the lived reality of the clinic. Using recent developments in the diagnosis and treatment of disorders of consciousness, and the history of the vegetative and minimally conscious states, Fins asks why modern neuroethics has taken this turn and what can be done to restore clinical neuroethics to a more proportionate place in the field. (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)

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)