Patient outcome after serious brain injury is highly variable. Following a period of coma, some patients recover while others progress into a vegetative state (unresponsive wakefulness syndrome) or minimally conscious state. In both cases, assessment is difficult and misdiagnosis may be as high as 43%. Recent advances in neuroimaging suggest a solution. Both functional magnetic resonance imaging and electroencephalography have been used to detect residual cognitive function in vegetative and minimally conscious patients. Neuroimaging may improve diagnosis and prognostication. These techniques (...) are beginning to be applied to comatose patients soon after injury. Evidence of preserved cognitive function may predict recovery, and this information would help families and health providers. Complex ethical issues arise due to the vulnerability of patients and families, difficulties interpreting negative results, restriction of communication to “yes” or “no” answers, and cost. We seek to investigate ethical issues in the use of neuroimaging in behaviorally nonresponsive patients who have suffered serious brain injury. The objectives of this research are to: (1) create an approach to capacity assessment using neuroimaging; (2) develop an ethics of welfare framework to guide considerations of quality of life; (3) explore the impact of neuroimaging on families; and, (4) analyze the ethics of the use of neuroimaging in comatose patients. (shrink)

There is no systematic knowledge about how individuals with Locked-in Syndrome experience their situation. A phenomenology of LIS, in the sense of a description of subjective experience as lived by the ill persons themselves, does not yet exist as an organized endeavor. The present article takes a step in that direction by reviewing various materials and making some suggestions. First-person narratives provide the most important sources, but very few have been discussed. LIS barely appears in bioethics and neuroethics. Research on (...) Quality of Life provides relevant information, one questionnaire study explores the sense of personal continuity in LIS patients, and LIS has been used as a test case of theories in “embodied cognition” and to explore issues in the phenomenology of illness and communication. A systematic phenomenology of LIS would draw on these different areas: while some deal directly with subjective experience, others throw light on its psychological, sociocultural and materials conditions. Such an undertaking can contribute to the improvement of care and QOL, and help inform philosophical questions, such as those concerning the properties that define persons, the conditions of their identity and continuity, or the dynamics of embodiment and intersubjectivity. (shrink)

BackgroundFunctional neurodiagnostics could allow researchers and clinicians to distinguish more accurately between the unresponsive wakefulness syndrome and the minimally conscious state. It remains unclear how it informs surrogate decision-making.ObjectiveTo explore how the next of kin of patients with disorders of consciousness interpret the results of a functional neurodiagnostics measure and how/why their interpretations influence their attitudes towards medical decisions.Methods and SampleWe conducted problem-centered interviews with seven next of kin of patients with DOC who had undergone a functional HD-EEG examination at (...) a neurological rehabilitation center in Germany. The examination included an auditory oddball paradigm and a motor imagery task to detect hidden awareness. We analyzed the interview transcripts using structuring qualitative content analysis.ResultsRegardless of the diagnostic results, all participants were optimistic of the patients’ meaningful recovery. We hypothesize, that participants deal with the results of examinations according to their belief system. Thus, an unfavorable evaluation of the patient’s state had the potential to destabilize the participant’s belief system. To re-stabilize or to prevent the destabilization of their belief system, participants used different strategies. Participants accepted a “positive” HD-EEG result since it stabilized their belief system.ConclusionWe hypothesize, that a group of next of kin of patients with DOC deals with functional neurodiagnostics results on the basis of the result’s value and their high hope that the patient will recover meaningfully. A psychological mechanism seems to moderate the impact of functional neurodiagnostics on surrogate treatment decisions. (shrink)

Philosophers and psychologists have experimentally explored various aspects of people’s understandings of subjective experience based on their responses to questions about whether robots “see red” or “feel frustrated,” but the intelligibility of such questions may well presuppose that people understand robots as experiencers in the first place. Departing from the standard approach, I develop an experimental framework that distinguishes 20 between “phenomenal consciousness” as it is applied to a subject (an experiencer) and to an (experiential) mental state and experimentally test (...) folk understandings of both subjective experience and experiencers. My findings (1) reveal limitations in experimental approaches using “artificial experiencers” like robots, (2) indicate that the standard philosophical conception of subjective experience in terms of qualia is distinct from that of the folk, and (3) show that folk intuitions do support a conception of qualia that departs from the philosophical conception in that it is physical rather than metaphysical. These findings have implications for the “hard problem” of consciousness. (shrink)

Over the last several decades, there has been a wealth of illuminating work on processes implicated in social cognition. Much less has been done in articulating how we learn the contours of particular concepts deployed in social cognition, like the concept MENTALISTIC AGENT. Recent developments in learning theory afford new tools for approaching these questions. In this article, I describe some rudimentary ways in which learning theoretic considerations can illuminate philosophically important aspects of the MENTALISTIC AGENT concept. I maintain that (...) MENTALISTIC AGENT is an essentialized concept and that learning-theoretic considerations help explain why the concept is not tied to particular traits. (shrink)

This research examined how and why group membership diminishes the attribution of mind to individuals. We found that mind attribution was inversely related to the size of the group to which an individual belonged . Mind attribution was affected by group membership rather than the total number of entities perceived at once . Moreover, mind attribution to an individual varied with the perception that the individual was a group member. Participants attributed more mind to an individual that appeared distinct or (...) distant from other group members than to an individual that was perceived to be similar or proximal to a cohesive group . This effect occurred for both human and nonhuman targets, and was driven by the perception of the target as an entitative group member rather than by the knowledge that the target was an entitative group member. (shrink)

Our recent publication in Neuroethics re-constructed the perspectives of family caregivers of patients with disorders of consciousness on functional neurodiagnostics. Two papers criticized some of our methodological decisions and commented on some conclusions. In this commentary, we would like to further explain our methodological decisions. Despite the limitations of our findings, which we readily acknowledged, we continue to think they entail valid hypotheses that need further investigation. We conclude that some caregivers with high hopes for the recovery of their loved (...) ones with DOC will most likely not consider results of functional neuroimaging as guiding information for treatment decisions, despite efforts taken to deliver information to them. Caregivers of that type might argue that such test-results are not a reliable source of information for the judgement of whether their loved one is likely going to recover or not. We introduce the concept of epistemic beliefs to formulate this hypothesis and suggest that future qualitative studies in this area should be aware of such beliefs when investigating the effects of functional neurodiagnostics on knowledge communication and shared decision making for patients with DOC. (shrink)

In this article we will be arguing in favour of legislating to protect doctors who bring about the deaths of PVS patients, regardless of whether the death is through passive means or active means. We will first discuss the ethical dilemmas doctors and lawmakers faced in the more famous PVS cases arising in the US and UK, before exploring what the law should be regarding such patients, particularly in Australia. We will continue by arguing in favour of allowing euthanasia in (...) the interests of PVS patients, their families, and finally the wider community, before concluding with some suggestions for how these ethical arguments could be transformed into a set of guidelines for medical practice in this area. (shrink)

Several types of inferences are employed in the diagnosis and prognosis of patients with brain injuries and disorders of consciousness. These inferences introduce unavoidable uncertainty, and can be evaluated in light of inductive risk: the epistemic and nonepistemic risks of being wrong. This article considers several ethically significant inductive risks generated by and interacting with inferences about patients with disorders of consciousness, and argues for prescriptive measures to manage and mitigate inductive risk in the context of disorders of consciousness.

The author introduces and critically analyzes two recent, curious findings and their accompanying explanations regarding how the folk intuits the capabilities of the dead and those in a persistent vegetative state. The dead are intuited to survive death, whereas PVS patients are intuited as more dead than the dead. Current explanations of these curious findings rely on how the folk is said to conceive of death and the dead: either as the annihilation of the person, or that person’s continuation as (...) a disembodied being. The author argues that these two conceptions are incompatible and inconsistent with each other and the evidence. Contrariwise, the author argues that the folk intuition about dead-survivors and the living dead are more easily explained by appealing to cross-culturally established concepts: the folk biological concept of death the existential concept of death, and the concept of social death. (shrink)

Mind perception is the essence of moral judgment. Broadly, moral standing is linked to perceptions of mind, with moral responsibility tied to perceived agency, and moral rights tied to perceived experience. More specifically, moral judgments are based on a fundamental template of two perceived minds—an intentional agent and a suffering patient. This dyadic template grows out of the universal power of harm, and serves as a cognitive working model through which even atypical moral events are understood. Thus, all instances of (...) immorality are perceived to involve both blameworthy agents (i.e., acts) and suffering victims (i.e., consequences). Because moral cognition simultaneously concerns acts and consequences, theories which focus primarily on acts (i.e., deontology) or consequences (i.e., utilitarianism) do not accurately describe moral cognition. Indeed, the phenomenon of dyadic completion suggests that deontological and utilitarian concerns are not only simultaneously active, but also typically compatible and reinforcing: wrong acts have harmful consequences, and harmful consequences stem from wrong acts. The cognitive fusion of acts with consequences suggests that normative conflicts between deontology and utilitarianism are not reflected in everyday moral judgment. This in turn suggests that empirical conclusions drawn from moral dilemmas that pit utilitarianism against deontology—i.e., trolley problems—give an skewed account of moral cognition. (shrink)

In a recent paper, Gray, Knickman, and Wegner present three experiments which they take to show that people perceive patients in a persistent vegetative state to have less mentality than the dead. Following on from Gomes and Parrott, we provide evidence to show that participants' responses in the initial experiments are an artifact of the questions posed. Results from two experiments show that, once the questions have been clarified, people do not ascribe more mental capacity to the dead than to (...) PVS patients. There is no reason to think that people perceive PVS patients as more dead than dead. (shrink)

In a recent paper, Gray, Knickman, and Wegner present three experiments which they take to show that people judge patients in a persistent vegetative state to have less mental capacity than the dead. They explain this result by claiming that people have implicit dualist or afterlife beliefs. This essay critically evaluates their experimental findings and their proposed explanation. We argue first that the experiments do not support the conclusion that people intuitively think PVS patients have less mentality than the dead. (...) And second, we provide an alternative explanation of our ascriptions of mentality to the dead and PVS patients, one which turns on Epicurean considerations about the nature of death. (shrink)

In philosophical thought experiments, as in ordinary discourse, our understanding of verbal case descriptions is enriched by automatic comprehension inferences. Such inferences have us routinely infer what else is also true of the cases described. We consider how such routine inferences from polysemous words can generate zombie intuitions: intuitions that are ‘killed’ (defeated) by contextual information but kept cognitively alive by the psycholinguistic phenomenon of linguistic salience bias. Extending ‘evidentiary’ experimental philosophy, this paper examines whether the ‘zombie argument’ against materialism (...) is built on zombie intuitions. We examine the hypothesis that contextually defeated stereotypical inferences from the noun ‘zombie’ influence intuitions about ‘philosophical zombies’. We document framing effects (‘zombie’ vs ‘duplicate’) predicted by the hypothesis. Findings undermine intuitions about the conceivability of ‘philosophical zombies’ and address the philosophical ‘hard problem of consciousness’. Findings support a deflationary response: The impression that principled obstacles prevent scientific explanation of how physical processes give rise to conscious experience is generated by philosophical arguments that rely on epistemically deficient intuitions. (shrink)

Recent findings support the idea that the belief in free will serves as the basis for moral responsibility, thus promoting the punishment of immoral agents. We theorized that free will extends beyond morality to serve as the basis for accountability and the capacity for change more broadly, not only for others but also for the self. Five experiments showed that people attributed higher freedom of will to negative than to positive valence, regardless of morality or intent, for both self and (...) others. In recalling everyday life situations and in classical decision making paradigms, negative actions, negatives outcomes, and negative framing were attributed higher free will than positive ones. Free will attributions were mainly driven by action or outcome valence, but not intent. These findings show consistent support for the idea that free will underlies laypersons’ sense-making for accountability and change under negative circumstances. (shrink)

People exhibit conflicting intuitions concerning the mind/body links. Here, I explore a novel explanation for these inconsistencies: Dualism is a violable constraint that interacts with Essentialism. Two experiments probe these interactions. In Experiment 1, participants evaluated the emergence of psychological traits in either a replica of one's body, or in the afterlife—after the body's demise. In line with Dualism, epistemic (i.e., disembodied) traits (e.g., knowing the contrast between good/bad) were considered more likely to emerge (relative to sensorimotor/affective traits) only in (...) the afterlife. However, so were innate traits (in line with Essentialism). To further gauge Essentialism, Experiment 2 presented the same traits to innateness judgments. Here, sensorimotor/affective (i.e., embodied) traits were considered more likely to be innate, suggesting that innateness intuitions are informed by embodiment. Moreover, innateness judgments (in Experiment 2) and embodiment intuitions (in Experiment 1) correlated. These results suggest that Dualism tacitly constrains reasoning about one's innate origins and its persistence after death. But since Dualism is “soft” and interacts with Essentialism, supernatural intuitions are chimeric, not purely ethereal. (shrink)

Nichols and Bruno claim that the folk judge that psychological continuity is necessary for personal identity. In this article, we evaluate this claim. First, we argue that it is likely that in thinking about hypothetical cases of transformations, the folk do not use a unitary concept of personal identity, but instead rely on different concepts of ‘person’, ‘identity’, and ‘individual’. Identity can be ascribed even when post-transformation individuals are no longer categorized as persons. Second, we provide new empirical evidence suggesting (...) that the folk do not consider psychological continuity to be necessary for an individual to be categorized as a person or for ascribing identity over time and through transformations. In this, we assume, along with Nichols and Bruno, that folk judgments about identity can be read off the use of proper names. Furthermore, we raise some doubts about the ability of current experimental designs to adequately distinguish between qualitative and numerical identity jud.. (shrink)

This Dissertation argues for a care-centrically grounded account of relational personhood and widely realized diachronic personal identity. The moral distinction between persons and non-persons is arguably one of the most salient ethical lines we can draw since many of our most fundamental rights are delineated via the bounds of personhood. The problem with drawing such morally salient lines is that the orthodox, rationalistic definition of personhood, which is widespread within philosophical, medical, and colloquial spheres, excludes, and thereby de-personifies, a large (...) number and a great variety of human beings such as neonates, young children, the elderly who suffer from dementia, individuals with severe cognitive disabilities, and patients in vegetative states. The reconceptualization of personhood necessary for a more inclusive definition ought to originate with an appropriate moral grounding. To this end, this Dissertation grounds the notion of personhood in the care ethical sphere, thereby emphasizing the role of care relations in the maintenance of the moral consideration of vulnerable individuals. This Dissertation argues that grounding the concept of a person in care relations entails a relational account of personhood, which, along with the insights of the Extended Mind and Social Manifestation Theses, leads to an extended and externalized understanding of diachronic identity, which allows fragile people to be held in their personal identities even if they themselves lack the capacities usually associated with moral personhood. As we trace a person’s identity through time, we track the various relational properties, which constitute personal narratives and thus act as a glue that binds such dynamic and often unique properties into stable, trackable narratives. Since care relations are morally relevant on a care-centric account of personhood, what is lost in cases where such care relating ceases is not merely of sentimental value, but of great moral importance as well. Morally meaningful care relations are not replaceable, and, by extension, neither are the narratives that are constituted by such unique and irreplaceable instances of relating. This Dissertation argues that the constitutive care relational nature of personal narratives makes such narratives irreplaceable and is precisely what makes persons so morally precious. (shrink)