Although informed consent is important in clinical research, questions persist regarding when it is necessary, what it requires, and how it should be obtained. The standard view in research ethics is that the function of informed consent is to respect individual autonomy. However, consent processes are multidimensional and serve other ethical functions as well. These functions deserve particular attention when barriers to consent exist. We argue that consent serves seven ethically important and conceptually distinct functions. The first four functions pertain (...) principally to individual participants: (1) providing transparency; (2) allowing control and authorization; (3) promoting concordance with participants' values; and (4) protecting and promoting welfare interests. Three other functions are systemic or policy focused: (5) promoting trust; (6) satisfying regulatory requirements; and (7) promoting integrity in research. Reframing consent around these functions can guide approaches to consent that are context sensitive and that maximize achievable goals. (shrink)

As sharing and secondary research use of biospecimens increases, IRBs and researchers face the challenge of protecting and respecting donors without comprehensive regulations addressing the human subject protection issues posed by biobanking. Variation in IRB biobanking policies about these issues has not been well documented.

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

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

This is the first book to undertake an applied postmedia and philosophical approach to the work of Felix Guattari. It provides a way to understand philosophically issues in contemporary technology, social life and consumer culture in Asia.

Some patients who have been diagnosed as “dead by neurologic criteria” continue to exhibit certain brain functions, most commonly, neuroendocrine functions. This preservation of neurologic function after the diagnosis of “brain death” or “brainstem death” is an ongoing source of controversy and concern in the medical, bioethics, and legal literatures. Most obviously, if some brain function persists, then it is not the case that all functions of the entire brain have ceased and hence, declaring such a patient to be “dead” (...) would be a false positive, in any nation with so-called “whole brain death” laws. Furthermore, and perhaps more concerning, the preservation of any brain function necessarily entails the preservation of some amount of brain perfusion, thereby raising the concern as to whether additional areas of neural tissue may remain viable, including areas in the brainstem. These and other considerations cast significant doubt on the reliability of diagnosing either “brain death” or “brainstem death.”. (shrink)

French philosopher Bernard Stiegler’s teacher, the great Jacques Derrida, when speaking of the nature of the life of Aristotle, questioned the need for biography and anecdote. Philosophy excludes b...

Here presented are three singular, philosophical perspectives on the Delhi student protests which took place in 2019 and 2020, before the coronavirus pandemic. The writers hail from India, England...

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

We are living in and beyond two massive changes in the world, both of which must be addressed by education, the caretaker of memory. First is the geological era of the Anthropocene—a crisis...

Medical ethics assumes a clear boundary between clinical research and clinical medicine: one produces knowledge for the benefit of future patients, while the other provides optimal care to individuals right now. It also assumes that the two cannot be integrated without sacrificing the needs of the current patient to those of future patients. But integration could allow us to provide better care to everyone, now and in the future.

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

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

In thinking the passage from the “all-human cerebrum” to what one might call the contemporary “all-too-human” cerebrum in neo-liberal societies and beyond to the “all-too-transhuman” cerebrum in the cybernetic society, in contrasting Wells’s idea of a new world order with the dystopia of the disordering un-world, in considering the prospects of a “world brain” faced with the realities of the “global mnemotechnical system”, in highlighting the differences between the global and authoritarian instrument of “control” in Wells and the descriptions of (...) the control society by Deleuze, and finally, in critiquing the “unifying of the general intelligence services of the world” in Wells and the capturing of the “general intellect”, this paper maps the contemporary prospects of the “world brain” against the backdrop of the worldweariness of the present. (shrink)

The shift away from paternalistic decision-making and toward patient-centered, shared decision-making has stemmed from the recognition that in order to practice medicine ethically, health care professionals must take seriously the values and preferences of their patients. At the same time, there is growing recognition that minor and seemingly irrelevant features of how choices are presented can substantially influence the decisions people make. Behavioral economists have identified striking ways in which trivial differences in the presentation of options can powerfully and predictably (...) affect people's choices. Choice-affecting features of the decision environment that do not restrict the range of choices or significantly alter the incentives have come to be known as “nudges.” Although some have criticized conscious efforts to influence choice, we believe that clinical nudges may often be morally justified. The most straightforward justification for nudge interventions is that they help people bypass their cognitive limitations—for example, the tendency to choose the first option presented even when that option is not the best for them—thereby allowing people to make choices that best align with their rational preferences or deeply held values. However, we argue that this justification is problematic. We argue that, if physicians wish to use nudges to shape their patients’ choices, the justification for doing so must appeal to an ethical and professional standard, not to patients’ preferences. We demonstrate how a standard with which clinicians and bioethicists already are quite familiar—the best-interest standard—offers a robust justification for the use of nudges. (shrink)

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

By tracing the genealogy of Lawrence Ferlinghetti's outlandish notion of the fourth person singular and its appropriation in The Logic of Sense, several keys concepts in Deleuze's thought such as the nonpersonal and pre-individual subjectivity can be rendered clearer to the understanding. While there is poetic licence in the use of the term by Ferlinghetti, the fourth person singular is heuristic for exploring the notion of free indirect speech and, more speculatively, the ideas of impersonal death and suicide. The fourth (...) person singular is thus a trope that sheds light on the ideas of humour, irony, lightness and becoming ‘without a verb’ in Deleuze's thought. Under close scrutiny is what Ferlinghetti designates as the ‘cool’ eyes of the fourth person singular. We shall work to differentiate these from so-called mad, Dada-esque ‘unblinking’ eyes. We shall ask how the poet in ‘obscenely seeing’ the impossible possibility of life can envision – perspicaciously – the immanent sense of death-in-life. From what standpoint does the poet gain access to the real? To consider this fully it is necessary to follow the Deleuzian interpretation of singularities as true transcendental events so as to clarify what gives life a ‘non-personal power, above individuals’. (shrink)

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

Classic statements of research ethics advise against permitting physician-investigators to obtain consent for research participation from patients with whom they have preexisting treatment relationships. Reluctance about “dual-role” consent reflects the view that distinct normative commitments govern physician–patient and investigator–participant relationships, and that blurring the research–care boundary could lead to ethical transgressions. However, several features of contemporary research demand reconsideration of the ethics of dual-role consent. Here, we examine three arguments advanced against dual-role consent: that it creates role conflict for the (...) physician-investigator; that it can compromise the voluntariness of the patient-participant’s consent; and that it promotes therapeutic misconceptions. Although these concerns have merit in some circumstances, they are not dispositive in all cases. Rather, their force—and the ethical acceptability of dual-role consent—varies with features of the particular study. As research participation more closely approximates usual care, it becomes increasingly acceptable, or even preferable, for physicians to seek consent for research from their own patients. It is time for a more nuanced approach to dual-role consent. (shrink)

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

Many believe that the ethical problems of donation after cardiocirculatory death (DCD) have been "worked out" and that it is unclear why DCD should be resisted. In this paper we will argue that DCD donors may not yet be dead, and therefore that organ donation during DCD may violate the dead donor rule. We first present a description of the process of DCD and the standard ethical rationale for the practice. We then present our concerns with DCD, including the following: (...) irreversibility of absent circulation has not occurred and the many attempts to claim it has have all failed; conflicts of interest at all steps in the DCD process, including the decision to withdraw life support before DCD, are simply unavoidable; potentially harmful premortem interventions to preserve organ utility are not justifiable, even with the help of the principle of double effect; claims that DCD conforms with the intent of the law and current accepted medical standards are misleading and inaccurate; and consensus statements by respected medical groups do not change these arguments due to their low quality including being plagued by conflict of interest. Moreover, some arguments in favor of DCD, while likely true, are "straw-man arguments," such as the great benefit of organ donation. The truth is that honesty and trustworthiness require that we face these problems instead of avoiding them. We believe that DCD is not ethically allowable because it abandons the dead donor rule, has unavoidable conflicts of interests, and implements premortem interventions which can hasten death. These important points have not been, but need to be fully disclosed to the public and incorporated into fully informed consent. These are tall orders, and require open public debate. Until this debate occurs, we call for a moratorium on the practice of DCD. (shrink)

This article proffers a critical reading of multiliteracy pedagogy and a materialism of the multimodal and machinic. A critical stance is taken against the mesmerising modes of representation that run rampant across our ocular territories. The article assesses the dangers of fetishizing technologies. To this end, Multiple Literacies Theory (MLT) is read through a Guattarian theoretical prism to emphasise four chief points: (1) the role of the unconscious, (2) the role of affect (affectus in the Spinozian sense; contrary to feeling (...) which immobilises, affect moves us), (3) the apparent becoming cyborg of the human race and (4) the desire to desire repression. The author contends that while qualitative multiplicities play a central role for MLT, it is neither inconsistent nor contradictory to consider the role of the machinic in greater detail. It is argued that more research must be directed into the cartographic, ethological and noological mechanisms at work in plastic universes of reference (new technologies and the arts) which transform the virtual and transfigure the dynamic of affect. (shrink)

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

One of the central ethical tenets of research in developing countries is the sponsor's obligation to benefit host participants and communities. Two known models of benefits provision dominate the ethical discourse of research in developing countries. The first model, known as the “reasonable availability,” endorses the obligation to provide interventions proven to be effective at the end of a study. This contrasts with the second model, known as “fair benefits,” which endorses other forms of benefits that host communities may deem (...) as fair beyond those derived directly from the study's findings. This paper explores a third benefit model consistent with the writings of the Human Hereditary and Health in Africa research initiative. The H3Africa—a North-South collaborative initiative predicated by U.S. National Institutes of Health, the Wellcome Trust and the African Society of Human Genetics upholds a benefit model that endorses capacity building as the primary obligation of its research agenda. This is evident by the endorsement of mechanisms to strengthen capacity building in its research projects. While capacity building remains a plausible means of improving the expertise, quality and independence of research in Africa, sustainable measures are needed to realizing the full potential for African-led research on the continent. (shrink)

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

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

In the midst of the recent Ebola outbreak, scientific developments involving infection challenge experiments on nonhuman primates (NHPs) sparked hope that successful treatments and vaccines may soon become available. Yet these studies pose a stark ethical quandary. On the one hand, they represent an important step in developing novel therapies and vaccines for Ebola and the Marburg virus, with the potential to save thousands of human lives and to protect whole communities from devastation; on the other hand, they intentionally expose (...) sophisticated animals to severe suffering and a high risk of death. Other studies that infect NHPs with a lethal disease in order to test interventions that may prove beneficial for humans pose the same ethical difficulty. Some advocates have argued that all research on primates should be phased out, and ethicists have questioned whether a moral justification of primate research is possible. A 2010 European Union directive banned virtually all research on great apes, and 2013 guidelines from the National Institutes of Health (NIH), based upon recommendations in an influential 2011 Institute of Medicine (IOM) report, eliminated most biomedical research with chimpanzees in the United States. But studies involving other NHPs face no comparable restrictions.Should research on NHPs other than great apes be subject to tighter restrictions than it currently is? In this article, we explore this general question in the context of one particular type of biomedical research: infection challenge studies. We advocate a presumptive prohibition on infection challenge experiments in NHPs, but we also argue that exceptions to this prohibition are permissible, subject to strict substantive and procedural safeguards, when necessary to avert substantial loss of human life or severe morbidity for a substantial number of people. (shrink)

Here several utopian/dystopian thought experiments are proffered to explore the contemporary sheer dread in thinking otherwise than the contemporary unworld as it is.1 With reference to the 2017 BBC drama Hard Sun and the cosmological horror of a world without a sun, what is demonstrated is the contemporary incapacity of thought to think beyond the utopos of the unworld as it is. Hard Sun, an essentially failed science-fiction TV series, is contrasted with the satirical optimism of Gabriel Tarde’s Underground Man, (...) published in 1905, in which a postapocalypse sunless utopia, and with it utopic forms of telluric life, is envisaged under the Earth. Shaping and guiding these considerations are the different... (shrink)

Brain death has been accepted worldwide medically and legally as the biological state of death of the organism. Nevertheless, the literature has described persistent problems with this acceptance ever since brain death was described. Many of these problems are not widely known or properly understood by much of the medical community. Here we aim to clarify these issues, based on the two intractable problems in the brain death debates. First, the metaphysical problem: there is no reason that withstands critical scrutiny (...) to believe that BD is the state of biological death of the human organism. Second, the epistemic problem: there is no way currently to diagnose the state of BD, the irreversible loss of all brain functions, using clinical tests and ancillary tests, given potential confounders to testing. We discuss these problems and their main objections and conclude that these problems are intractable in that there has been no acceptable solution offered other than bare assertions of an ‘operational definition’ of death. We present possible ways to move forward that accept both the metaphysical problem - that BD is not biological death of the human organism - and the epistemic problem - that as currently diagnosed, BD is a devastating neurological state where recovery of sentience is very unlikely, but not a confirmed state of irreversible loss of all [critical] brain functions. We argue that the best solution is to abandon the dead donor rule, thus allowing vital organ donation from patients currently diagnosed as BD, assuming appropriate changes are made to the consent process and to laws about killing. (shrink)

The World Brain Death Project clarified many aspects of the diagnosis of brain death/death by neurologic criteria. Clearer descriptions than previously published were presented concerning the etiology, prerequisites, minimum clinical criteria, apnea testing targets, and indications for ancillary testing. Nevertheless, there remained many epistemic and metaphysical assertions that were either false, ad hoc, or confused. Epistemically, the project was not successful in explaining away remaining brain functions, complex reflexes as “spinal,” the risk and lack of utility of the apnea test, (...) the ignored and often present confounders of central endocrine dysfunction and high-cervical-spinal-cord injury, the limitations of ancillary tests, or the cases of reversibility of some findings of brain death/death by neurologic criteria. Metaphysically, the World Brain Death Project variously suggested different concepts of death that were not supported with argument. Concepts offered included simply restating the criterion of brain death/death by neurologic criteria; personhood, without recognizing it is a higher-brain concept; and emergent functions of the organism as a whole, without specifying what these might be, if not biologic anti-entropic integration that actually remains after brain death/death by neurologic criteria. The World Brain Death Project only offered confused metaphysical discussion, and gave no reason why the state they described as brain death/death by neurologic criteria should be considered death itself. The main epistemic and metaphysical problems with brain death/death by neurologic criteria remain untouched by the World Brain Death Project. (shrink)