Unresponsive wakefulness syndrome (UWS, previously known as vegetative state) occurs after patients survive a severe brain injury. Patients suffering from UWS have lost awareness of themselves and of the external environment and do not retain any trace of their subjective experience. Current data demonstrate that neuronal functions subtending consciousness are not completely reset in UWS; however, they are reduced below the threshold required to experience consciousness. The critical factor that determines whether patients will recover consciousness is the distance of their (...) neuronal functions from this threshold level. Recovery of consciousness occurs through functional and/or structural changes in the brain, i.e., through neuronal plasticity. Although some of these changes may occur spontaneously, a growing body of evidence indicates that rehabilitative interventions can improve functional outcome by promoting adaptive functional and structural plasticity in the brain, especially if a comprehensive neurophysiological theory of consciousness is followed. In this review we will focus on the pathophysiological mechanisms involved in UWS and on the plastic changes operating on the recovery of consciousness. (shrink)

In this report, we describe the case of a patient who has remained in a comatose state for more than one year after a traumatic and hypoxic brain injury. This state, which we refer to as long-lasting coma (LLC), may be a disorder of consciousness with significantly different features from those of conventional coma, the vegetative state, or brain death. On the basis of clinical, neurophysiological and neuroimaging data, we hypothesize that a multilevel involvement of the ascending reticular activating system (...) is required in LLC. This description may be useful for the identification of other patients suffering from this severe disorder of consciousness, which raises important ethical issues. (shrink)

Although several studies propose that the integrity of neuronal assemblies may underlie a phenomenon referred to as awareness, none of the known studies have explicitly investigated dynamics and functional interactions among neuronal assemblies as a function of consciousness expression. In order to address this question EEG operational architectonics analysis (Fingelkurts and Fingelkurts, 2001, 2008) was conducted in patients in minimally conscious (MCS) and vegetative states (VS) to study the dynamics of neuronal assemblies and operational synchrony among them as a function (...) of consciousness expression. We found that in minimally conscious patients and especially in vegetative patients neuronal assemblies got smaller, their life-span shortened and they became highly unstable. Furthermore, we demonstrated that the extent/volume and strength of operational synchrony among neuronal assemblies was smallest or even absent in VS patients, intermediate in MCS patients and highest in healthy fully-conscious subjects. All findings were similarly observed in EEG alpha as well as beta1 and beta2 frequency oscillations. The presented results support the basic tenets of Operational Architectonics theory of brain-mind functioning and suggest that EEG operational architectonics analysis may provide an objective and accurate means of assessing signs of (un)consciousness in patients with severe brain injuries. Therefore this methodological approach may complement the existing “gold standard” of behavioral assessment of this population of challenging patients and inform the diagnostic and treatment decision-making processes. (shrink)

It has been argued that complex subjective sense of self is linked to the brain default-mode network (DMN). Recent discovery of heterogeneity between distinct subnets (or operational modules - OMs) of the DMN leads to a reconceptualization of its role for the experiential sense of self. Considering the recent proposition that the frontal DMN OM is responsible for the first-person perspective and the sense of agency, while the posterior DMN OMs are linked to the continuity of ‘I’ experience (including autobiographical (...) memories) through embodiment and localization within bodily space, we have tested in this study the hypothesis that heterogeneity in the operational synchrony strength within the frontal DMN OM among patients who are in a vegetative state (VS) could inform about a stable self-consciousness recovery later in the course of disease (up to six years post-injury). Using EEG operational synchrony analysis we have demonstrated that among the three OMs of the DMN only the frontal OM showed important heterogeneity in VS patients as a function of later stable clinical outcome. We also found that the frontal DMN OM was characterized by the process of active uncoupling (stronger in persistent VS) of operations performed by the involved neuronal assemblies. (shrink)

The value of resting electroencephalogram (EEG) in revealing neural constitutes of consciousness (NCC) was examined. We quantified the dynamic repertoire, duration and oscillatory type of EEG microstates in eyes-closed rest in relation to the degree of expression of clinical self-consciousness. For NCC a model was suggested that contrasted normal, severely disturbed state of consciousness and state without consciousness. Patients with disorders of consciousness were used. Results suggested that the repertoire, duration and oscillatory type of EEG microstates in resting condition quantitatively (...) related to the level of consciousness expression in brain-damaged patients and healthy-conscious subjects. Specifically, results demonstrated that (a) decreased number of EEG microstate types was associated with altered states of consciousness, (b) unawareness was associated with the lack of diversity in EEG alpha-rhythmic microstates, and (c) the probability for the occurrence and duration of delta-, theta- and slow-alpha-rhythmic microstates were associated with unawareness, whereas the probability for the occurrence and duration of fast-alpha-rhythmic microstates were associated with consciousness. In conclusion, resting EEG has a potential value in revealing NCC. This work may have implications for clinical care and medical–legal decisions in patients with disorders of consciousness. (shrink)

Objective: The value of spontaneous EEG oscillations in distinguishing patients in vegetative and minimally conscious states was studied. Methods: We quantified dynamic repertoire of EEG oscillations in resting condition with closed eyes in patients in vegetative and minimally conscious states (VS and MCS). The exact composition of EEG oscillations was assessed by the probability-classification analysis of short-term EEG spectral patterns. Results: The probability of delta, theta and slow-alpha oscillations occurrence was smaller for patients in MCS than for VS. Additionally, only (...) patients in MCS demonstrated fast-alpha oscillation occurrence. Depending on the type and composition of EEG oscillations, the probability of their occurrence was either aetiology dependent or independent. The probability of EEG oscillations occurrence differentiated brain injuries with different aetiologies. Conclusions: Spontaneous EEG oscillations have a potential value in distinguishing patients in VS and MCS. Significance: This work may have implications for clinical care, rehabilitative programs and medical–legal decisions in patients with impaired consciousness states following coma due to acute brain injuries. (shrink)

Electroencephalogram (EEG) recordings are increasingly used to evaluate patients with disorders of consciousness (DOC) or assess their prognosis outcome in the short-term perspective. However, there is a lack of information concerning the effectiveness of EEG in classifying long-term (many years) outcome in chronic DOC patients. Here we tested whether EEG operational architectonics parameters (geared towards consciousness phenomenon detection rather than neurophysiological processes) could be useful for distinguishing a very long-term (6 years) clinical outcome of DOC patients whose EEGs were registered (...) within 3 months post-injury. The obtained results suggest that EEG recorded at third month after sustaining brain damage, may contain useful information on the long-term outcome of patients in vegetative state: it could discriminate patients who remain in a persistent vegetative state from patients who reach a minimally conscious state or even recover a full consciousness in a long-term perspective (6 years) post-injury. These findings, if confirmed in further studies, may be pivotal for long-term planning of clinical care, rehabilitative programs, medical-legal decisions concerning the patients, and policy makers. (shrink)

Background: Patients in a vegetative state pose problems in diagnosis, prognosis and treatment. Currently, no prognostic markers predict the chance of recovery, which has serious consequences, especially in end-of-life decision-making. Objective: We aimed to assess an objective measurement of prognosis using advanced electroencephalography (EEG). Methods: EEG data (19 channels) were collected in 14 patients who were diagnosed to be persistently vegetative based on repeated clinical evaluations at 3 months following brain damage. EEG structure parameters (amplitude, duration and variability within quasi-stationary (...) segments, as well as the spatial synchrony between such segments and the strength of this synchrony) were used to predict recovery of consciousness 3 months later. Results: The number and strength of cortical functional connections between EEG segments were higher in patients who recovered consciousness (P < .05 – P < .001) compared with those who did not recover. Linear regression analysis confirms that EEG structure parameters are capable of predicting (P = .0025) recovery of consciousness 6 months post-injury, whereas the same analysis failed to significantly predict patient outcome based on aspects of their clinical history alone (P = .629) or conventional EEG spectrum power (P = .473). Conclusions: The result of this preliminary study demonstrates that structural strategy of EEG analysis is better suited for providing prognosis of consciousness recovery than existing methods of clinical assessment and of conventional EEG. Our results may be a starting point for developing reliable prognosticators in patients who are in vegetative state, with the potential to improve their day-to-day management, quality of life, and access to early interventions. (shrink)

The thesis of mental fragmentation has recently attracted increased attention as a way of explaining facts about mind and language. This volume provides an accessible introduction and essays on foundations and applications of fragmentation.

Health care is ubiquitous in the industrialized world. Yet, every medical development, technique, and procedure impacts the environment. Green bioethics synthesizes environmental ethics and biomedical ethics, thus creating an interdisciplinary approach to sustainable health care. Notably, green bioethics addresses not the structure of environmental sustainability in health-care institutions but the sustainability of individual health-care offerings. It parallels traditional biomedical ethics by providing four principles for ethical guidance: distributive justice, resource conservation, simplicity, and ethical economics. Through these four principles, green bioethics (...) presents a coherent framework for evaluating the sustainability of medical developments, techniques, and procedures. The future of our world may very well depend on how effectively we halt ecological destruction and conserve our resources in all areas of life. The principles of green bioethics, outlined in this book, will advance sustainability in health care. (shrink)

There is widespread disagreement about whether epistemic akrasia is possible. This paper argues that the possibility of epistemic akrasia follows from a traditional rationalist conception of epistemic critical reasoning, together with considerations about the fallibility of our capacities for reasoning. In addition to defending the view that epistemic akrasia is possible, we aim to shed light on why it is possible. By focusing on critical epistemic reasoning, we show how traditional rationalist assumptions about our core cognitive capacities help to explain (...) the possibility of epistemic akrasia. (shrink)

Griefbots are chatbots designed to assist individuals in coping with the loss of a loved one by offering a digital replica of the departed. Navigating grief is a deeply transformative and vulnerable journey intricately tied to one's well-being. Do griefbots aid in the grieving process, or do they complicate it? To address these questions, this article blends insights from philosophy and neuroscience to explore the nature of grief as a means to clarify the ethical dimensions surrounding the use of griefbots.

L.A. Paul calls “deep” the kind of essentialism according to which the essential properties of objects are determined independently of the context. Deep essentialism opposes “shallow essentialism”, of which David Lewis is said to be a prominent advocate. Paul argues that standard forms of deep essentialism face a range of issues (mainly based on an interpretation of Quinean skepticism) that shallow essentialism does not. However, Paul claims, shallow essentialism eliminates the very heart of what motivates essentialism, so it is better (...) to be deep than shallow. Accordingly, she proposes a very sharp novel account of essentialism, which, while attempting to preserve some of the advantages of shallow essentialism over the classical forms of deep essentialism, can be deemed to be deep. In this paper, I compare Paul’s proposal for a kind of deep essentialism with Lewis’s account, as it is presented by Paul. My aim is to show that the differences between the two approaches are not as significant as Paul takes them to be, and that Paul’s account can be taken to be deeper than Lewis’s only at the cost of sacrificing the very idea at the bottom of deep essentialism. This might be taken to suggest that, if Paul is correct in asserting that shallow essentialism is better equipped to address some skeptical challenges, but it is generally preferable to be deep than shallow, then Lewis’s account should be re-evaluated, since, as shallow as it can be, it might be deeper than it looks. (shrink)

As it emerged from philosophical analyses and cognitive research, most concepts exhibit typicality effects, and resist to the efforts of defining them in terms of necessary and sufficient conditions. This holds also in the case of many medical concepts. This is a problem for the design of computer science ontologies, since knowledge representation formalisms commonly adopted in this field (such as, in the first place, the Web Ontology Language - OWL) do not allow for the representation of concepts in terms (...) of typical traits. The need of representing concepts in terms of typical traits concerns almost every domain of real world knowledge, including medical domains. In particular, in this article we take into account the domain of mental disorders, starting from the DSM-5 descriptions of some specific disorders. We favour a hybrid approach to concept representation, in which ontology oriented formalisms are combined to a geometric representation of knowledge based on conceptual space. As a preliminary step to apply our proposal to mental disorder concepts, we started to develop an OWL ontology of the schizophrenia spectrum, which is as close as possible to the DSM-5 descriptions. (shrink)

Les études réunies et publiés dans ce volume sont d'abord concentrées sur les problèmes relatifs à la nature de l'âme en général, notamment par le biais d'une confrontation avec des penseurs antérieurs a Aristote ou qui leur sont contemporains - spécialement Platon et Xenocrate.

InA Theory of Justice, Rawls claims that “to each according to his threat advantage is not a conception of justice.” Although it may indeed seem intuitively plausible that a principle based on “threat advantage” cannot count as a principle of justice, it is an altogether different matter to explain why this is so. The question is especially pressing if one bears in mind that such a principle of bargaining in fact underlies many institutionally regulated interactions. Moreover, to the extent that (...) morality is thought of as a mechanism for guaranteeing mutual advantage in the resolution of conflicts, it may indeed seem necessary that it reflect the bargaining power of the parties (in order to make sure that it is indeed advantageous for all of them). In fact, there is a prominent tradition of social-contract theories (from Hobbes to Gauthier) that work under this assumption and claim to provide an answer to what justice requires as much as Rawls's theory does. So seen, the burden of proof seems to fall rather on the shoulders of those committed to claim both that morality is a mechanism that works to the advantage of all and that it nevertheless requires neutralizing all differences in bargaining power. (shrink)

InA Theory of Justice, Rawls claims that “to each according to his threat advantage is not a conception of justice.” Although it may indeed seem intuitively plausible that a principle based on “threat advantage” cannot count as a principle of justice, it is an altogether different matter to explain why this is so. The question is especially pressing if one bears in mind that such a principle of bargaining in fact underlies many institutionally regulated interactions. Moreover, to the extent that (...) morality is thought of as a mechanism for guaranteeing mutual advantage in the resolution of conflicts, it may indeed seem necessary that it reflect the bargaining power of the parties (in order to make sure that it is indeed advantageous for all of them). In fact, there is a prominent tradition of social-contract theories (from Hobbes to Gauthier) that work under this assumption and claim to provide an answer to what justice requires as much as Rawls's theory does. So seen, the burden of proof seems to fall rather on the shoulders of those committed to claim both that morality is a mechanism that works to the advantage of all and that it nevertheless requires neutralizing all differences in bargaining power. (shrink)

This book offers a collection of reflective essays on current testimonial production by researchers and practitioners working in multifaceted fields such as art and film performance, public memorialization, scriptotherapy, and fictional and non-fictional testimony. 0The inter-disciplinary approach to the question of testimony offers a current account of testimony's diversity in the twenty-first century as well as its relevance within the fields of art, storytelling, trauma, and activism. The range of topics engage with questions of genre and modes of representation, ethical (...) and political concerns of testimony, and the flaws and limitations of testimonial production giving testament to some of the ethical concerns of our present age. (shrink)

Our lives are commonly involved with fictionality, an activity that adults share with children. After providing a brief reconstruction of the most important cognitive theories on pretence, we will argue that pretence has to do with metarepresentations, albeit in a rather weakened sense. In our view, pretending entails being aware that a certain representation does not fit in the very same representational model as another representation. This is a minimal metarepresentationalism, for normally metarepresentationalism on pretense claims that pretending is or (...) entails representing a representation qua representation, i.e. as conceptualised as a representation, in its very content. In the final section we will try to draw some consequences of our view as to the debate in cognitive science on mindreading. Given this minimal metarepresentationalism, the two main positions on mindreading, the ‘theory theory’ and the ‘simulation theory’, turn out to be closer than one would have originally supposed. (shrink)

In Norms in the Wild, distinguished philosopher Cristina Bicchieri argues that when it comes to human behavior, social scientists place too much stress on rational deliberation. In fact, she says, many choices occur without much deliberation at all. Two people passing in a corridor automatically negotiate their shared space; cars at an intersection obey traffic signals; we choose clothing based on our instincts for what is considered appropriate. Bicchieri's theory of social norms accounts for these automatic components of coordination, (...) where individuals react automatically to cues that focus their attention on what the norm is in that situation. Social norms thus act as rules for making choices in a social world where people expect others -- often unconsciously -- to follow the same rule. Some norms enable seamless social co-operation, while others are less beneficial to human flourishing.Bicchieri is famous for her interdisciplinary work on game theory and most recently her work on social norms, and Norms in the Wild represents her latest challenge to many of the fundamental assumptions of the social sciences. Bicchieri's work has broad implications not only for understanding human behavior, but for changing it for better outcomes. People have a strongly conditioned preference for following social norms, but that also means that manipulating their expectations can cause major behavioral changes. Bicchieri has been working recently with UNICEF and other NGO's to explore the applicability of her views to issues of human rights around the world. Is it possible to change social expectations around forced marriage, genital mutilations, and public health practices like vaccinations and sanitation? If so, how? What tools might we use? This short book explores how social norms work, and how changing them - changing preferences, beliefs, and especially social expectations - can potentially improve lives all around the world. It will appeal to an unusually broad range of readers including philosophers, psychologists and others in behavioral sciences, and anyone involved in public policy or at NGOs. (shrink)

In The Grammar of Society, first published in 2006, Cristina Bicchieri examines social norms, such as fairness, cooperation, and reciprocity, in an effort to understand their nature and dynamics, the expectations that they generate, and how they evolve and change. Drawing on several intellectual traditions and methods, including those of social psychology, experimental economics and evolutionary game theory, Bicchieri provides an integrated account of how social norms emerge, why and when we follow them, and the situations where we are (...) most likely to focus on relevant norms. Examining the existence and survival of inefficient norms, she demonstrates how norms evolve in ways that depend upon the psychological dispositions of the individual and how such dispositions may impair social efficiency. By contrast, she also shows how certain psychological propensities may naturally lead individuals to evolve fairness norms that closely resemble those we follow in most modern societies. (shrink)

Georges Canguilhem s’est opposé à la médecine positiviste qui cherche à établir la normalité une fois pour toutes. Il a en revanche mis au centre de la médecine les individus, avec leurs variations et leurs subjectivités. D’un côté, il s’est concentré sur l’individu dans sa globalité, par opposition à ses organes et tissus ; d’un autre côté, il a soutenu qu’un individu n’est normal que par rapport à un milieu donné. Dans cet article, je soutiens que la conception de Canguilhem (...) du normal comme relatif à un individu et à son milieu est toujours d’une grande actualité. En même temps, je soutiens qu’il a négligé de développer certaines questions soulevées par sa propre philosophie. Notamment, il n’a pas pleinement analysé comment les individus en viennent à juger de leur propre normalité ni les conséquences sociales de leurs jugements. De même, il n’a pas considéré que tous les individus et groupes n’ont pas le même pouvoir de façonner leur milieu et le milieu des autres. L’approche holistique de Canguilhem à l’égard des êtres humains et de leur milieu fait que la question des jugements des individus sur leur propre normalité est plus complexe qu’il ne l’a reconnu. (shrink)

The aim of this article is to contribute detailed ethnographic material to broaden the scope of what we mean by reproductive technology. Technology can be defined not only by a series of laboratory techniques (such as artificial insemination and embryo transfer) that are drafted into the daily management of the animal body, but also by a range of on-farm management strategies and working routines, as well as the cultural dispositions, social networks and tacit knowledge of the actors involved. RT is (...) communicated to lay operators and disseminated amongst semi-professional figures such as breed experts, herd inspectors and technical consultants. The practical contexts in which reproductive knowledge is popularized and applied provide ample scope for local negotiations, resistance and conflict. Professional knowledge about breed-improvement is personalised and appropriated by operators and plays a role in power relations and the exercise of personal charisma as well as being specific to context, in particular the nuances of pre-existing relationships of trust, friendship, kinship or hierarchy. No wonder then that many ambivalences and compromises coexist in the practice of applying ‘reproductive knowledge’ to breed selection. (shrink)

The paper addresses the methodology used by the teacher-KEYWORDS: facilitator to plan P4C sessions. The classic method consists of identifying the guidelines of the dialogue from a provisional mapping of the text, but this can be supplemented or replaced by other tools‡. GrupIREF and the Filosofía Lúdica movement§ use an approach that focuses on thinking skills. The P4C session is planned from the choice of the thinking skills to be trained - or possibly the attitudes and ethical values that appear (...) in the stimulus used. This article proposes an alternative to the classical planning approach, examining the basis of the model considered and offering a practical example. ITA_Focus dell’articolo è la modalità di pianificazione delle sessioni di Philosophy for Children, P4C, da parte del docente-facilitatore. Il metodo classico consiste nell’individuazione di linee-guida del dialogo a partire da una mappatura orientativa del testo-pretesto, ma ciò può essere integrato, o sostituito da altre modalità*. Il GrupIREF e il movimento della Filosofía Lúdica† utilizzano un approccio che privilegia le abilità di pensiero. La sessione P4C viene pianificata a partire dalla scelta dell’abilità di pensiero da allenare – o eventualmente dell’atteggiamento etico e dei valori legati al pre-testo utilizzato. Il presente lavoro suggerisce un’alternativa alla progettazione classica, attraverso una disamina delle basi del modello considerato, e ne offre un esempio pratico. (shrink)

We report the results of an experiment designed to determine the effects of psychological proximity—proxied by awareness of pain and friendship—on moral reasoning. Our study tests the hypotheses that a moral agent’s emphasis on justice decreases with proximity, while his/her emphasis on care increases. Our study further examines how personality, gender, and managerial status affect the importance of care and justice in moral reasoning. We find support for the main hypotheses. We also find that care should be split into two (...) components, one related to protection and the other to the preservation of relationships. Although gender does not affect moral reasoning directly, we find that it does so indirectly via personality, controlling for age, professional status, and professional background. We do not find a significant effect of managerial status on ethics of justice, but do find that holding a managerial position has a negative impact on ethics of care. Regarding personality, we detect significant positive effects of conscientiousness on ethics of justice and of neuroticism on ethics of care. (shrink)