When an individual is comatose while parts of her brain remain functional, the question arises as to whether any mental characteristics are still associated with this brain, that is, whether the person still exists. Settling this uncertainty requires that one becomes clear about two issues: the type of functional loss that is associated with the respective profile of brain damage and the persistence conditions of persons. Medical case studies can answer the former question, but they are not concerned with (...) the latter. Conversely, in the philosophical literature, various accounts of personal identity are discussed, but usually detached from any empirical basis. Only uniting the two debates and interpreting the real-life configurations of brain damage through the lens of the philosophical concepts enables one to make an informed judgment regarding the persistence of comatose persons. Especially challenging are cases in which three mental characteristics that normally occur together—wakefulness, awareness and memory storage—come apart. These shall be the focus of this paper. (shrink)

In this paper I address three problems posed by modern medical technology regarding comatose dying patients. The first is that physicians sometimes hide behind the tests for whole-brain death rather than make the necessary human decision. The second is that the tests themselves betray a metaphysical judgment about death that may be ontologically faulty. The third is that discretion used by physicians and patients and/or family in deciding to cease treatment when the whole-brain death criteria may not be met (...) are sometimes open to challenge. In each of these problems I find that the operative concept of death relates to life itself. This point is expanded by examining the uses of the word death in our language and culture. From these I formulate an initial ontology of death. In it, death is described through a relationship with life, rather than as an absence of life, of consciousness, awareness, or sensation. This ontology then leads to a proposal for an ethics of discretion about the discontinuation of treatment for comatose patients. (shrink)

In the case of the irreversibly comatose patient, though no personal consciousness remains, some moral duty is owed the remaining biological life. Such an ending to human life, if pathetic, is also both intelligible and meaningful in a biological and evolutionary perspective. By distinguishing between the human subjective life and the spontaneous objective life, we can recognize a naturalistic principle in medical ethics, contrary to a current tendency to defend purely humanistic norms. This principle has applications in clinical care (...) in the definition of death, in the use of life support therapy, in distinguishing ordinary from extraordinary therapy, in evaluating euthanasia, and in the extent of appropriate medical intervention in terminal cases. CiteULike Connotea Del.icio.us What's this? (shrink)

In lieu of an abstract, here is a brief excerpt of the content:FEEDING THE COMATOSE AND THE COMMON GOOD IN THE CATHOLIC TRADITION ROBERT BARRY, O.P. University of Illinois Ohampaign-Urbana, IlUnoi8 AA RECENT convention :sponsored by the Catholic Health Associaition in Boston, Laurence J. O'Connell, vice-president for ethics and theology, ma.de the following comments: I am concerned that some of those who are legitimately alarmed by the potential abuses associated with the public policy that authorizes the withholding and withdrawing (...) of mechanical means of nutrition and hydration are sometimes publicly misrepresenting the Catholic moral tradition. In other words, in their well-intentioned and perfectly legitimate efforts to avoid the slippery-slope-that is, the wrongful withholding or withdrawing of nutrition or hydration from vulnerable dasses of patients-those advocates are placing the Roman Catholic moral tradition itself on the slippery slope. It is mistaken to say it is the church's teaching that we may never withhold or withdraw artificial nutrition and hydration. It is mistaken to uncritically refer to the removal of medically engineered nutrition in all cases as starvation-that is, the willful withholding of nutrition as morally obligatory. It is mistaken to say that the ethical standards of a single Catholic hospital are necessarily coextensive with the ethical standards of the Catholic Church. Just because an individual Catholic facility, for whatever reason, uniformly refuses to allow the withholding or withdrawing of technological feeding, does not mean that the Church itself disallows such withholdings or withdrawals.1 It is not clear how the Catholic moral tradition can be put on the " slippery slope " by opposing certain forms of with1 "Church and State Overlap in Ethical Debate", American Medicai News. February 27, 1987. p. I. 1 ROBERT BARRY, O.P. drawal of feeding from specific classes of patients. Dr. O'Connell has misrepresented the thought of most of those who oppose the recent American Medical Association's new opinion which holds that artificially administered nutrition and fluids can be removed from terminally ill patients, even when they are not imminently dying.2 There are no Catholic moralists who claim that it is always and everywhere morally wrong to withhold or withdraw feeding from patients. However, there are a number of moralists as well as bishops who now hold it to be wrong to withhold or withdraw feeding in those cases where the withholding or withdrawal becomes the fundamental and underlying cause of death. O'Connell is p11obably correct in saying that the policies of one hospital do not necessarily deteJ1IDine the moral doctrines of the universal Church, but neither does one national organization such as the Catholic Health Association with only a loose affiliation with the magisterial hierarchy of the Church necessarily do this either. The debate over the provision of,aissisted feeding is a debate over whether iit is morally legitimate ito withdraw feeding so 1tihat.t:he primary and fundamental reason why the person dies is that withdrawal. It is a debate over whether those with a certain " quality of life " can be permitted to be killed by omission. It is a debate over whether feeding provided by routine nursing measures that can significantly sustain the life is a medical treatment that should he governed by the criteria governing other treatments, or whether it is an 2 "Withholding or Withdrawing Life Prolonging :Medical Treatment" adopted by the Council on Ethical and Judicial.Affairs of the.Amercian Medical.Association on March 15, 1987, In its pertinent parts, it stated: The social commitment of the physician is to sustain life and relieve suffering. Where the performance of one duty conflicts with the other, the choice of the patient, or his family or legal representative if the·patient to act in his own behalf, should prevail. Life prolonging medical treatment includes medication and artificially or technologically supplied respiration, nutrition or hydration. In treating a terminally ill or irreversibly comatose patient, the physician should determine whether the benefits of treatment outweigh its burdens..At all times, the dignity of the patient should be maintained.•. FEEDING THE COMATOSE 8 aspect of normal care, like protection from exposure or hygienic care, that is to be accorded to all patients. In this piece, I wish to review the thoughts of some... (shrink)

Behaviorally assessing residual consciousness of acutely comatose patients involves a high rate of false-negatives. That is, long-term behavioral assessment shows that 41% of vegetative state patients in fact have residual consciousness. Nonetheless, surrogates need to remove ventilation before the acute-phase passes away if they want to induce medico-legal death due to pragmatic factors, such as financial costs. So, surrogate decision-making regarding behaviorally nonresponsive acutely comatose patients involves a moral dilemma: should we ignore the chance that patients have residual (...) consciousness for the sake of pragmatic factors? This paper examines whether neural methods can resolve the moral dilemma. Neural methods are used to assess residual consciousness of behaviorally nonresponsive postcomatose patients. For instance, by instructing a vegetative state patient to imagine wiggling all of her toes, conscious- ness is ascribed if brain activities are localized in the supplementary motor area. Since the most extensive application of neural methods has been in chronic population, it is unclear whether such methods can resolve the moral dilemma. I argue that neural methods also involve a high rate of false-negatives because current tasks of neural methods are structurally misguided. Given the argument, there is no significant difference between behavioral and neural methods regarding the moral dilemma. (shrink)

Functional MRI shows promise as a candidate prognostication method in acutely comatose patients following severe brain injury. However, further research is needed before this technique becomes appropriate for clinical practice. Drawing on a clinical case, we investigate the process of obtaining informed consent for this kind of research and identify four ethical issues. After describing each issue, we propose potential solutions which would make a patient’s participation in research compatible with her rights and interests. First, we defend the need (...) for traditional proxy consent against two alternative approaches. Second, we examine the impact of the intensive care unit environment on the informed consent process. Third, we discuss the therapeutic misconception and its potential influence on informed consent. Finally, we deal with issues of timing in recruiting participants and related factors which may affect the risks of participation. (shrink)

Post-comatose patients are classified as being in a minimally conscious state when they have executive functions. Because traditional behavioral assessments may not capture signs of executive functions in post-comatose patients, clinicians look to localized brain activities in response to task instructions, such as imagining wiggling toes, to diagnose minimal consciousness. This paper critically assesses the assumption underlying such alternative methods: that brain activities are neural signals conveying information about minimal consciousness. Based on a Shannon-inspired idea of information, I (...) distinguish between informational and engineering aspects of clinical tasks. The informational aspect concerns the conditional probability that, for example, given activity in the motor areas of the brain in response to task instructions, a patient is imagining wiggling toes. The engineering aspect concerns efficient activation of the relevant brain areas in a patient under the task conditions. This distinction shows that the current alternative methods are not informationally problematic, but are structurally “ill-formed.” For instance, the toe-imagery task requires the capacity to comprehend syntactically complex sentences, which can be dissociated from minimal consciousness. I propose a misrepresentation task, which tests the capacity to misconceptualize lukewarm water as melting wax, as a supplement to the current alternative methods. This task is as informationally reliable as these methods, but is structurally “well-formed,” as it does not rely methodologically on prerequisites such as language comprehension. (shrink)

The patient was a 19-year-old man who was the victim of an accidental head injury. The attending neurosurgeon felt that, due to uncontrollable and repeated elevated intracranial pressures, the patient would die within 48 hours. The patient's mother requested that the neurosurgeon contact a urologist to collect the patient's sperm for implantation into the patient's girlfriend. The neurosurgeon felt that the situation raised a number of ethical issues and requested that the hospital's bioethics committee consider the case.

AimThe functional prognosis of patients after coma following either cardiac arrest or acute structural brain injury is often uncertain. These patients are associated with high mortality and disability. N20 and N70 somatosensory evoked potentials are used to predict prognosis. We evaluated the utility of SSEP as an early indicator of long-term prognosis in these patients.MethodsThis was a retrospective cohort study of patients admitted to the intensive care unit with a diagnosis of coma after CA or ABI. An SSEP study was (...) performed, including N20 and N70 at 24–72 h, after coma onset. Functional recovery was assessed 6–12 months later using the modified Glasgow scale. The study was approved by our local research ethics committee.ResultsIn the CA and ABI groups, the absence of N20 or N70 was a strong indicator of poor outcome. Conversely, the presence of N70 was an indicator of a good outcome.ConclusionSomatosensory evoked potentials are useful early prognostic markers with high specificity and sensitivity. Moreover, N70 has additional potential value for improving the prediction of good long-term functional outcomes.Clinical Trial Registration:[https://clinicaltrials.gov/], identifier [2018/01/001]. (shrink)

After severe brain injury, one of the key challenges for medical doctors is to determine the patient’s prognosis. Who will do well? Who will not do well? Physicians need to know this, and families need to do this too, to address choices regarding the continuation of life supporting therapies. However, current prognostication methods are insufficient to provide a reliable prognosis. -/- Functional Magnetic Resonance Imaging (MRI) holds considerable promise for improving the accuracy of prognosis in acute brain injury patients. Nonetheless, (...) research on functional MRI in the intensive care unit context is ethically challenging. These studies raise several ethical issues that have not been addressed so far. In this article, Prof. Charles Weijer and his co-workers provide a framework for researchers and ethics committees to design and review these studies in an ethically sound way. (shrink)

Determining whether or not noncommunicative patients are phenomenally conscious is a major clinical and ethical challenge. Clinical assessment is usually limited to the observation of these patients' motor responses. Recent neuroimaging technology and brain computer interfaces help clinicians to assess whether patients are conscious or not, and to avoid diagnostic errors.

Comatose survivors of cardiac arrest may die following withdrawal of life-sustaining therapy (WLST) due to poor neurologic prognosis. Family members, acting as surrogate decision makers, are frequently asked to decide whether the patient should continue to receive ongoing life-sustaining therapy such as mechanical ventilation in this context of risk of death following removal. Sometimes, physicians and family members disagree about what is in the patient's best interest, and this conflict causes distress for both families and medical personnel. This article (...) examines themes recorded in the medical records of 24 cardiac arrest patients at Columbia University Medical Center (CUMC) whose families chose to pursue continued life support despite physician recommendations for withdrawal. In documented conversations between patients' families and their providers, the most prominent themes included faith in miracles, the inappropriateness of "playing God," the value of more time with the patient, and differences in how providers and family members perceived the patient's status. (shrink)

The publication of this book is an event in the making. All over the world scientists, psychologists, and philosophers are waiting to read Antonio Damasio's new theory of the nature of consciousness and the construction of the self. A renowned and revered scientist and clinician, Damasio has spent decades following amnesiacs down hospital corridors, waiting for comatose patients to awaken, and devising ingenious research using PET scans to piece together the great puzzle of consciousness. In his bestselling Descartes' Error, (...) Damasio revealed the critical importance of emotion in the making of reason. Building on this foundation, he now shows how consciousness is created. Consciousness is the feeling of what happens-our mind noticing the body's reaction to the world and responding to that experience. Without our bodies there can be no consciousness, which is at heart a mechanism for survival that engages body, emotion, and mind in the glorious spiral of human life. A hymn to the possibilities of human existence, a magnificent work of ingenious science, a gorgeously written book, The Feeling of What Happens is already being hailed as a classic. (shrink)

Hud Hudson presents an innovative view of the metaphysics of human persons according to which human persons are material objects but not human organisms. In developing his account, he formulates and defends a unique collection of positions on parthood, persistence, vagueness, composition, identity, and various puzzles of material constitution. The author also applies his materialist metaphysics to issues in ethics and in the philosophy of religion. He examines the implications for ethics of his metaphysical views for standard arguments addressing the (...) moral permissibility of our treatment of human persons and their parts, fetuses and infants, the irreversibly comatose, and corpses. He argues that his metaphysics provides the best foundation in the philosophy of religion for the Christian doctrine of the resurrection of the body. Hudson addresses a broad range of metaphysical issues, but among his most strikingly original contributions are his defense of the "Partist" view and his argument for the compatibility of Christianity with a materialistic theory of human persons. (shrink)

A comprehensive study of the ethics of killing in cases in which the metaphysical or moral status of the individual killed is uncertain or controversial. Among those beings whose status is questionable or marginal in this way are human embryos and fetuses, newborn infants, animals, anencephalic infants, human beings with severe congenital and cognitive impairments, and human beings who have become severely demented or irreversibly comatose. In an effort to understand the moral status of these beings, this book develops (...) and defends distinctive accounts of the nature of personal identity, the evaluation of death, and the wrongness of killing. The central metaphysical claim of the book is that we are neither nonmaterial souls nor human organisms but are instead embodied minds. In ethical theory, one of the central claims is that the morality of killing is not unitary; rather, the principles that determine the morality of killing in marginal cases are different from those that govern the killing of persons who are self‐conscious and rational. Another important theme is that killing in marginal cases should be evaluated in terms of the impact it would have on the victim at the time rather than on the value of the victim's life as a whole. What primarily matters is how killing would affect that which would be rational for the victim to care about at the time of death. By appealing to various foundational claims about identity, death, and the morality of killing, this book yields novel conclusions about such issues as abortion, prenatal injury, infanticide, the killing of animals, the significance of brain death, the termination of life support in cases of persistent vegetative state, the use of anencephalic infants as sources of organs for transplantation, euthanasia, assisted suicide, and advance directives in cases of dementia. In particular, the book defends the moral permissibility of abortion, infanticide, and euthanasia in certain cases and argues that brain death is not the appropriate criterion of death either for a person or a human organism. (shrink)

From dogs to gods, the science of understanding mysterious minds--including your own. Nothing seems more real than the minds of other people. When you consider what your boss is thinking or whether your spouse is happy, you are admitting them into the "mind club." It's easy to assume other humans can think and feel, but what about a cow, a computer, a corporation? What kinds of mind do they have? Daniel M. Wegner and Kurt Gray are award-winning psychologists who have (...) discovered that minds--while incredibly important--are a matter of perception. Their research opens a trove of new findings, with insights into human behavior that are fascinating, frightening and funny. The Mind Club explains why we love some animals and eat others, why people debate the existence of God so intensely, how good people can be so cruel, and why robots make such poor lovers. By investigating the mind perception of extraordinary targets--animals, machines, comatose people, god--Wegner and Gray explain what it means to have a mind, and why it matters so much. Fusing cutting-edge research and personal anecdotes, The Mind Club explores the moral dimensions of mind perception with wit and compassion, revealing the surprisingly simple basis for what compels us to love and hate, to harm and to protect. (shrink)

Lockean views of personal identity maintain that we are essentially persons who persist diachronically by virtue of being psychologically continuous with our former selves. In this article, I present a novel objection to this variant of psychological accounts, which is based on neurophysiological characteristics of the brain. While the mental states that constitute said psychological continuity reside in the cerebral hemispheres, so that for the former to persist only the upper brain must remain intact, being conscious additionally requires that a (...) structure originating in the brainstem—the ascending reticular activating system—be functional. Hence, there can be situations in which even small brainstem lesions render individuals irreversibly comatose and thus forever preclude access to their mental states, while the neural correlates of the states themselves are retained. In these situations, Lockeans are forced to regard as fulfilled their criterion of diachronic persistence since psychological continuity, as they construe it, is not disrupted. Deeming an entity that is never again going to have any mental experiences to be a person, however, is an untenable position for a psychological account to adopt. In their current form, Lockean views of personal identity are therefore incompatible with human neurophysiology. (shrink)

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)

Patients are usually granted autonomy rights, including the right to consent to or refuse treatment. These rights are commonly attributed to patients if they fulfil certain conditions. For example, a patient must sufficiently understand the information given to them before making a treatment decision. On the one hand, there is a large group of patients who meet these conditions. On the other hand, there is a group that clearly does not meet these conditions, including comatose patients or patients in (...) the late stages of Alzheimer’s disease. Then there is a group of patients who fall into the range in between. At the lower end of this range are so-called ‘marginal agents,’ which include young children and patients in the middle stages of Alzheimer’s disease. They also do not meet the typical requirements for autonomy, which is why they are usually granted fewer autonomy rights. However, some of them are capable of ‘pre-forms’ of autonomy that express what is important to them. These pre-forms differ from mere desires and reflect the identification/authenticity condition of autonomy. They have something in common with autonomous attitudes, choices, and actions – namely, they express the _value_ of autonomy. As I will argue, autonomy is a value worthy of protection and promotion – even in its non-reflexive forms. Against this background, it becomes clear _why_ we have autonomy duties, more precisely positive, autonomy-enabling duties, towards marginal agents and why we should give them as much attention as autonomy duties towards competent patients. (shrink)

Proposals to use organs from anencephalic infants to meet the growing need for transplantable ogans are well‐meaning but misguided. It would be unwise to amend the Uniform Determination of Death Act to classify anencephalics as “dead.” They are in the same situation as other patients (such as the permanently comatose). Likewise, amending the Anatomical Gin Act to permit organs to be removed from anencephalics would be unjust would set a bad precedent and would likely reduce overall success in this (...) field. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Proof and Persuasion in the Philosophical Debate about AbortionChris KaposyPhilosophers involved in debating the abortion issue often assume that the arguments they provide can offer decisive resolution.1 Arguments on the prolife side of the debate, for example, usually imply that it is rationally mandatory to view the fetus as having a right to life, or full moral standing.2 Such an account assumes that philosophical argument can compel the reader (...) to see the fetus in a certain way and that dissent risks irrationality.I wish to question this image of the use of philosophical argument in the abortion debate. I focus on the question of fetal moral standing, which is one of the subproblems in the debate. I am especially concerned with prolife arguments for fetal moral standing, since the prolife side must argue for a position that is compulsory. The prochoice side, in contrast, typically holds that people are entitled to believe what they want about the fetus’s moral standing.My position is that philosophical arguments should be understood as tools for persuasion in the abortion debate rather than as a method for discovering decisive proofs about the morality of abortion. I argue that because any one position on the moral standing of fetuses cannot be established decisively, law and policy should favour the prochoice position. In support of these conclusions, I present two common argumentative strategies used to suggest that the prolife view of the fetus is rationally [End Page 139] mandatory, and I illustrate why arguments involving these strategies do not compel us to view the fetus as having full moral standing.Framing the IssueIn order to show that abortion is wrong (in cases in which it is considered wrong), one must first establish that fetuses have full moral standing.3 It is a serious moral wrong to take the life of someone with full moral standing—this is part of what it means to have this status. The possessor of full moral standing is entitled to have his or her life protected. If abortion is wrong, then the fetus must have full moral standing, because without such standing, killing a fetus could be justified by the pregnant woman’s strong interest in ending an unwanted pregnancy. Those arguing against the moral permissibility of abortion must show that it is mandatory (in some way) to view the fetus as having full moral standing. There are a range of positions one could take with regard to the fetus’s status, from viewing the fetus as an incipient organism with no moral standing to seeing the fetus as gaining moral standing as the pregnancy progresses. But if it is mandatory to view the fetus as having full moral standing, all other positions must then be mistaken, incorrect, or somehow unjustified.This paper analyzes why philosophers opposed to abortion think it is mandatory to attribute full moral standing to fetuses. There are two popular argumentative strategies offering different accounts of the source of this obligation. The first strategy suggests that fetal full moral standing derives from morally relevant facts about the fetus. According to this line of argument, we are rationally obligated to view the fetus as having full moral standing because we cannot deny (without courting irrationality) that there are properties, characteristics, or attributes of the fetus that entitle it to this status.The second strategy is to claim that the fetus has full moral standing because this position is most consistent with our intuitions in cases unrelated to abortion. Philosophers taking this approach are fond of analogies comparing fetuses to comatose adults or to people at the end of life, for example. This strategy of appealing to your interlocutor’s sense of consistency I call the “shared-value” strategy.The two strategies map very well onto the distinction some have made between argumentum ad rem and argumentum ad hominem. The philosopher of rhetoric Henry Johnstone Jr. draws this distinction in very clear terms, and others in the history of philosophy make note of the difference [End Page 140] between these two types of arguments as well.4 The appeal to the facts (or argumentum ad rem) seeks to establish the truth of its... (shrink)

A patient arrives in the emergency room apparently in a comatose state. But is he really unconscious or just faking? The young doctors on duty are skeptical. Failing to get a reaction with a chest rub, they try a variety of methods that become increasingly sadistic—pressing on the patient's fingernail with a ballpoint pen, spraying his testicles with a skin‐freezing compound, announcing an imminent eye injection to scare the patient awake.I first encountered those chilling pen‐and‐ink images in a 2012 (...) comic book, Disrepute, authored by Thom Ferrier, the nom de plume for British general practitioner Ian Williams. Disrepute is part of a young but growing genre that Williams helped dub "graphic medicine" when he founded a website by that name in 2007. Using the graphic novel form, doctors, nurses, and patients are producing accounts that often reveal the dark underbelly of the world of medicine. From patients and their families, these include portraits of imperious and insensitive physicians or nurses; from doctors, explorations of the doubt that racks them when their treatment ends in a mistake or a patient's death. While the form is also referred to as “comics,” the work, as in Williams's strip, is bleak just as often as it is humorous. (shrink)

In his interesting commentary, Joshua Shepherd raises two points—one related to epistemology, the other to ethics—about our article on human cerebral organoids.1 2 From the epistemological standpoint, he calls into question the need for a theory of consciousness. A theory of consciousness, for him, is not necessary because of the lack of consensus about the very nature of consciousness. Shepherd suggests that ‘given widespread disagreement, applying a theory of consciousness may not be helpful when attempting to diagnose the presence of (...) consciousness in cerebral organoids’. In Shepherd’s view, it would be better to transfer ‘concepts already under development in work on the presence and structure of consciousness in difficult marginal cases involving traumatic brain injury’.2 We could not agree more on this last point; detecting a minimal capacity for consciousness in the brain of comatose patients is a very similar challenge to inferring the presence of consciousness in cerebral organoids. Every day, as a by-product of saving many lives, intensive care medicine artificially produces thousands of brains that may remain isolated, split or fragmented; in the worst case, cortical islands, or an archipelago of islands, may survive while being disconnected from the outside world. Can these islands host some form of consciousness? That is, does it feel like anything to be a large piece of human cortex? Addressing this difficult question requires the development of general, objective brain-based indices of consciousness that are independent of sensory processing, executive functions and motor outputs.3 Consider, for example, a patient showing reflexive spontaneous behaviour, no response to command and no ability to communicate. In her brain, afferent pathways are damaged, thereby impairing the recruitment of cortical areas in response to sensory stimulation; basal ganglia, as well as other frontal structures supporting executive functions, are impaired. However, resting metabolism and significant electroencephalography …. (shrink)

Alongside a revival of interest in Thomism in philosophy, scholars have realised its relevance when addressing certain contemporary issues in bioethics. This book offers a rigorous interpretation of Aquinas's metaphysics and ethical thought, and highlights its significance to questions in bioethics. Jason T. Eberl applies Aquinas’s views on the seminal topics of human nature and morality to key questions in bioethics at the margins of human life – questions which are currently contested in the academia, politics and the media such (...) as: When does a human person’s life begin? How should we define and clinically determine a person’s death? Is abortion ever morally permissible? How should we resolve the conflict between the potential benefits of embryonic stem cell research and the lives of human embryos? Does cloning involve a misuse of human ingenuity and technology? What forms of treatment are appropriate for irreversibly comatose patients? How should we care for patients who experience unbearable suffering as they approach the end of life? _Thomistic Principles and Bioethics_ presents a significant philosophical viewpoint which will motivate further dialogue amongst religious and secular arenas of inquiry concerning such complex issues of both individual and public concern. (shrink)

In Anglo-American society, virtually every moral theory of any note, including any plausible form of utilitarianism, places great stress upon autonomy, treats it as intimately bound up with morality, and regards it as of considerable moral significance to normal adult humans and to the value of their lives. In these respects, Kantianisms, contracturalisms, rightstheories, and utilitarianisms are very alike. They are also alike in that their emphasis upon autonomy inevitably sets up fully autonomous beings as something of a special or (...) privileged class, against which the lives of nonautonomous beings, such as infants, the very severely mentally-enfeebled, the seriously brain-damaged, the irreversibly comatose, and animals are viewed and their value assessed. The attempts theorists of all stripes make to squeeze as many beings as possible into the autonomous class illustrate the special or privileged caracter of that class in our moral thinking. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:“We Need to Cut the Neck!”Confronting Psychological and Moral Distress during Emergency Cricothyrotomy1Stephanie CooperEnoughYou didn’t die in the ER, but rather, began your inexorable demise. The last, first, and only words I ever heard you utter was the weak mewl “tight, tight” as the blood pressure cuff constricted your left arm. You were 98–years–old, bed–bound, at the end. Your world was already partitioning itself from us, your brain tunneling (...) down the uneven corridors of consciousness. A concretion of otoliths muffled your hearing, and fatigue burdened your ancient heart.Your name–band encircled your skinny ankle like a bird. Deformed by arthritis, you were caged within yourself, imprisoned by senescence. You could not declare yourself to us. Words disintegrated into moans and your grimace became animal.When you came back from x–ray—hypotensive with multiple neck fractures confirmed—you could speak no more. Your pulse slowed, your blood pressure plummeted. I jammed a gloved finger against your femoral pulse, faint and tired. [End Page E5]“What’s her DNR status?” I gravely asked your nurse.The DNR paperwork for once had arrived with the patient. “No CPR” she said with relief. But then the paperwork went on, forcing me—the waitress of tragedy—to serve up the hash of an impossible menu.As health care providers, we are all often tasked with performing contradictory actions: the pain of IV insertion followed by the morphine push, drilling deeper into broken bone in order to plate it, the inadvertent cracking of ribs during chest compressions. We sometimes must perform violent action in the hope of sustaining and resurrecting life. We are asked to perform the impossible, the contradictory, the painful. And sometimes the actions we must take catalyze an inexorable chain reaction of actions, which can end in death–prolonging and painful interventions that we did not intend.Although our culture may imagine that one can choose one’s meal at the end–of–life fast–food franchise of death, such is not the case. You can’t suddenly decide you’re a vegetarian. You can’t order the cheeseburger without the cheese—and we all are getting the burger, in the end. Ordering the heart–squeezing drugs without the CPR to circulate them, or the antibiotics without the fluid to counter dehydration, is like ordering the burger without the bun. Sometimes the possible choices are not necessarily realistic choices. You get served what you get served, and perhaps we should question the assumption that we have the ability to choose at all.Your DNR form proclaimed no CPR but then said that antibiotics and intubation were okay—the cheeseburger without the cheese. An unfortunate choice for you, me, and the rest of us, as your death menu led to a very unhappy meal.You were comatose. I stuck a tongue blade deep into your desiccated throat. You did not gag. This means I should have intubated you, but morally, I couldn’t. To what end? You were 98 years old, broken, moribund. If you hadn’t suffered multiple neck fractures, or if you were a vibrant elder who had just walked off Mt. Rainier, maybe the story would have been different. But you? I doubted that you truly had a chance of ever feeling joy again. You were somebody’s wife, somebody’s mother. I knew this step would lead to the domino of unstoppable steps. I refused to flog your corpse.I called your daughter Kay on her cell phone, told her that you were in critical condition and that she should come to the ER immediately. But how to begin to tell a daughter her mother is dying, let alone over a cell phone? Gentle but surreal and impersonal, my voice tried to tell your daughter that the interventions you needed would likely kill you. I have seen enough human suffering to know. To me, the choices were clear: death by nature’s irrefutable course, versus a more painful, protracted, and violent death by what we’d do to you.Kay arrived in a wheelchair and scooted up to your bedside. Like all daughters, she wasn’t ready for you... (shrink)

Many discussions of the moral status of “mindless beings” such as the permanently comatose, the dead, trees, and human fetuses seem to take for granted the thesis that it is improper to appeal to emotions to establish the fundamental distinction between “persona” (beings capableof rights “in their own right”) and “things” (beings not capable of rights except in some fictional or iIlusory sense). Persons are persons, however we may feel about them.That thesis seems to be a major obstacle to (...) any nonutilitarian account of the personhood of mindless beings.I argue that the thesis of independence is true, if at aIl, only for one class of persons (“rational agents”). Beyond that class, our emotional response to a being can be relevant to its moral status. Acting on some consideration (or believing something in virtue of it) can be rational inthe “constitutive”, “regulative”, or “associative” sense. A consideration is a good reason if it is rational in any of these senses. The importance of this claim is shown by briefly examining Feinberg’s weIl-known argument that it is a conceptual truth that mindless beings are incapable ofrights. His argument assumes that our emotions cannot be rational in the appropriate sense and coIlapses without that assumption. (shrink)

Mrs. P is a seventy‐six‐year old woman with osteoporosis and a failed left hip prosthesis. In addition, she has severe chronic asthmatic bronchitis. The management of her lung disease has been hampered by her allergy to theophylline, which is one of the mainstays of treatment. As a result, she has had increasing difficulty walking and confinement to a wheelchair is imminent. When surgery to replace the prosthesis was recommended, Mrs. P expressed concern about the possibility of ending up after the (...) operation dependent on a ventilator, possibly comatose. She feared that her resources would be depleted for medical expenses. Little or nothing would be left to pass on to her children. She was willing to have an operation only if she could prepare a legal document that, in the event of prolonged ventilator dependence, would require her physician to remove her from the ventilator after a specified time (for example, two weeks). Should the surgeon agree to be bound by Mrs. P's instructions, or should he refuse her request even if doing so means that she will not have the surgery that might prevent increasing disability? (shrink)

Don't you just know it. It's a relatively peaceful day and you are getting some quality work done when the phone rings. The caller requests help in the form of an ethics consult. When you first hear about it you think someone is pulling your leg, but no, this is the real world. A case like this exemplifies many of the twists and turns of fact, and belief, that accompany many clinical ethics consultations. Several of the facts of the case (...) generate an immediate emotional response that tempts the mind to run with them down enticing and confusing paths of thought. The age 19, is a minor in some states, but not in many. This introduces the whole notion of decisionmaking by parents or designated surrogates. Additional information suggests the comatose victim's mother is the prime motivator behind the request. The various motivations for the mother are revealed, primarily her desire to have a grandchild. The patient's own feelings are portrayed as ambivalent and the potential recipient, after the patient's sisters had been excluded because of consanguinity, is a 16-year-old girl who didn't even show up at the care conference. You are also told that the technical feasibility of the medical procedure under consideration is questionable and, of course, your legal department can't give you a straight answer—just hazard a guess. (shrink)

From the start, I followed the case of Jahi McMath with great interest. In December 2013, she clearly fulfilled the diagnostic criteria for brain death. As a neurologist with a special interest in chronic brain death, I was not surprised that, after she was flown to New Jersey, where she became statutorily resurrected and was treated as a comatose patient, Jahi's condition quickly improved. In 2014, her family reported that she sometimes responded to simple motor commands. I shared the (...) general skepticism regarding these reports, assuming that the family was in denial and was misinterpreting spinal myoclonus (a rapid, involuntary twitch generated by the spinal cord) as volitional. The family had noticed that when Jahi's heart rate was above eighty beats per minute, she was more likely to respond, as though the heart rate reflected some sort of inner level of arousal. So they began to make video recordings. I have been privileged to be entrusted with copies of these recordings, forty‐eight of which proved suitable for assessing alleged responsiveness. All have been certified by a forensic video expert as unaltered. The first thing that struck me was that the great majority of the alleged responses were not spinal myoclonus. In fact, they did not resemble any type of spontaneous, involuntary movement described in patients paralyzed from high spinal cord lesions. (shrink)

Yemeni writer Ahmed Qāsim al-Arīqī, in addition to his profession as a pharmacist, is a writer who has made a name for himself in the country's literary field, especially in the last fifteen years. A prolific writer, al-Arīqī is the author of poetry collections as well as stories and novels that emphasise awareness of the traditional issues of the Yemeni people. He has published "Maḳāmāt al-'Arīḳī" (2006), "Ġalṭṭetu Ḳalem" (2012), "Qurāt al-S̱-S̱elj" (2017), "Ta'riyya" (2018), "Zurbet al-Yumnā" (2018), "Da'wat al-Ḥuḳūl" (2019), (...) "Zuhr al-Ġarām" and "Sīret al-Kūbī" (2022). His novel "Yawma Māta al-Shaytan" (The Day Satan Died) was published electronically by Hindāwī Publishing House in 2022. The novel, which is approximately 120 pages, is written in six chapters. There are eleven passages in the first and fourth chapters, thirteen in the second and sixth chapters, twelve in the third chapter, and eight in the fifth chapter. The novel is about the adventures of a member of the army named Marwan Naji, who was wounded in the war between the Houthi militia and the Yemeni army, and after nine months in a coma, opens his eyes in a perfect world dominated by biological and technological advances. Symbolising the treatment of selfishness and various narcissisms with advanced vaccines through the death of Satan, the author describes Marwan's adventures in his world, which he sometimes describes as the realm of the jinn, in a very simple language, while not failing to criticise reality in its various political, social and religious dimensions. In fact, Marwan's world of imagination and fantasy is the main story of the novel, but not the only one. The author also includes the stories of family members in Marwan's world of turmoil, destruction, massacre, war and victory, giving the reader the opportunity to compare both worlds. While his mother Gusoun, his wife Hamide and his daughter Fatma, who later got engaged in time after being widowed, are the female characters of his real world, Professor Mari and Mariana, one of his seven wives, are the other important characters of his imaginary world. Gusûn is a devoted mother who does not leave the bedside of her comatose son, prays for him day and night and tries to do everything she can for his recovery. Gusûn, who is listened to at home to a certain extent, scolds her grandchildren to prevent the breakup of her son's home because of inheritance, defends that the existing wealth still belongs to her son and reminds them that she will not hesitate to spend money for his recovery. Gusûn's daughter-in-law Hamide also takes care of her husband, who shows no signs of recovery. Hamide, who is not as patient as her mother-in-law, is also a jealous woman. On the other hand, although both of them display false religious tendencies that have no relation with real life, Gusûn is more prone to the superstitious approaches put forward and adopted in the name of religion. Fatma is also a widow who, although she has the will to take care of her children and live her life alone, has been engaged for a long time to her uncle's son Münir, who, like her, took part in anti-regime demonstrations and whose love she believes in. Fatma, who is more conscious than her grandmother and mother, is not alien to the issues that society complains about and often participates in women's movements organised against the government. Professor Mari, one of the two important characters belonging to Marwan's imaginary world, is a psychologist and the chief physician of a large hospital who treats jealousy, anger, lying and selfishness, which are considered dangerous viruses, with vaccines developed by scientists. Professor Mari, who is personally involved in Marwan's treatment, also chairs the committee that records his memory and projects all his memories on a giant screen. Mariana, on the other hand, monitors Marwan's behaviour and thoughts through a biological chip to control the effect of the vaccines given to him, criticises him through the tragic images projected on the screen and provides information that will facilitate his adaptation to his new world. In the article, in which the author's main published works are briefly introduced along with a broad summary of the novel, the social messages that an author, who is not indifferent to the realities of the geography he lives in, tries to give directly and indirectly with a language far from locality, are tried to be determined through the mentioned female characters. It is seen that the desire to become a single nation by making; love, brotherhood, friendship and peace dominant lies behind the author's novelisation of the dream of an ideal world symbolised by the death of Satan. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Proof and Persuasion in the Philosophical Debate about AbortionChris KaposyPhilosophers involved in debating the abortion issue often assume that the arguments they provide can offer decisive resolution.1 Arguments on the prolife side of the debate, for example, usually imply that it is rationally mandatory to view the fetus as having a right to life, or full moral standing.2 Such an account assumes that philosophical argument can compel the reader (...) to see the fetus in a certain way and that dissent risks irrationality.I wish to question this image of the use of philosophical argument in the abortion debate. I focus on the question of fetal moral standing, which is one of the subproblems in the debate. I am especially concerned with prolife arguments for fetal moral standing, since the prolife side must argue for a position that is compulsory. The prochoice side, in contrast, typically holds that people are entitled to believe what they want about the fetus’s moral standing.My position is that philosophical arguments should be understood as tools for persuasion in the abortion debate rather than as a method for discovering decisive proofs about the morality of abortion. I argue that because any one position on the moral standing of fetuses cannot be established decisively, law and policy should favour the prochoice position. In support of these conclusions, I present two common argumentative strategies used to suggest that the prolife view of the fetus is rationally [End Page 139] mandatory, and I illustrate why arguments involving these strategies do not compel us to view the fetus as having full moral standing.Framing the IssueIn order to show that abortion is wrong (in cases in which it is considered wrong), one must first establish that fetuses have full moral standing.3 It is a serious moral wrong to take the life of someone with full moral standing—this is part of what it means to have this status. The possessor of full moral standing is entitled to have his or her life protected. If abortion is wrong, then the fetus must have full moral standing, because without such standing, killing a fetus could be justified by the pregnant woman’s strong interest in ending an unwanted pregnancy. Those arguing against the moral permissibility of abortion must show that it is mandatory (in some way) to view the fetus as having full moral standing. There are a range of positions one could take with regard to the fetus’s status, from viewing the fetus as an incipient organism with no moral standing to seeing the fetus as gaining moral standing as the pregnancy progresses. But if it is mandatory to view the fetus as having full moral standing, all other positions must then be mistaken, incorrect, or somehow unjustified.This paper analyzes why philosophers opposed to abortion think it is mandatory to attribute full moral standing to fetuses. There are two popular argumentative strategies offering different accounts of the source of this obligation. The first strategy suggests that fetal full moral standing derives from morally relevant facts about the fetus. According to this line of argument, we are rationally obligated to view the fetus as having full moral standing because we cannot deny (without courting irrationality) that there are properties, characteristics, or attributes of the fetus that entitle it to this status.The second strategy is to claim that the fetus has full moral standing because this position is most consistent with our intuitions in cases unrelated to abortion. Philosophers taking this approach are fond of analogies comparing fetuses to comatose adults or to people at the end of life, for example. This strategy of appealing to your interlocutor’s sense of consistency I call the “shared-value” strategy.The two strategies map very well onto the distinction some have made between argumentum ad rem and argumentum ad hominem. The philosopher of rhetoric Henry Johnstone Jr. draws this distinction in very clear terms, and others in the history of philosophy make note of the difference [End Page 140] between these two types of arguments as well.4 The appeal to the facts (or argumentum ad rem) seeks to establish the truth of its... (shrink)

What could be more dull than the idea of a symposium? The word conjures up associations with dusty dons, tedious academic papers on deservedly obscure facts and theories. In universities these days, what used to be called ‘symposia’ are often called ‘workshops’ – perhaps in a feeble attempt to make the symposium sound more exciting. If this is your view of the symposium, you may be surprised to learn that the original ancient Greek symposium was a drinking party: the word (...) derives from the Greek for ‘drinking together’. A Greek symposium was a ritualised and often debauched affair. The master of the symposium would begin by drinking a small ‘libation’ of undiluted wine – the Greeks normally mixed their wine with water – and he would then decide in what proportion the wine was to be diluted to determine what kind of evening it was going to be. Plato’s Symposium, a dialogue on the nature of love, describes the most famous symposium of all. The great philosopher Socrates dominates the discussion (as he normally did), drinks more than anyone else, and leaves the symposium sober in the early morning, with the inferior thinkers and drinkers comatose. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:THE MOB AND THE VICTIM IN THE PSALMS AND JOB Robert Hamerton-Kelly Woodside Church IrecaiI a passage from Elie Wiesel's novel, Night, where, looking at the frail body of a young boy writhing on the gallows—his body weight was too light to kill him outright when he dropped through the trap door—someone asksthe narrator, "Where is nowyourGod?" This question is often on my mind, not least because for the (...) last seven years ofmy tenure at Stanford I studied ethnic conflict and filled my mind with the most discouraging images. I found myselfsaying on occasion that I felt ashamed to be a human being, which was only a slight exaggeration. I noted with wry amusement that a few years ago it was reported that the wolves were fleeing from the Caucasus in great numbers because ofthe human violence there, a sad irony in the light of Thomas Hobbes' motto, Homo homini lupus. I had long suspected thatthat was an insult to wolves, and now I had the proof. Lately we have Philip Gourewitch's new book on the Rwanda holocaust of 1994, where they killed one million people in ten weeks, not with weapons ofmass destruction butwith machetes and clubs primedwith six-inch nails, and Rwanda is a Christian country. The voice ofconscience cries out, "Where is our God?" in all this; why does He spend his time causing statues to ooze oil in suburban Massachusetts rather than defending the children of Kosovo against depraved nationalists.1 It is some comfort that the psalmist cried the same question and thus provides a convenient way into a meditation on violence in the Psalms. It occurs first in 42,3: "I have no food but tears / day and 1I refer to the phenomena reported in connection with the comatose teenage girl, Audrey Sosa, who is believed by some to be a channel for miracles. 152Robert Hamerton-Kelly night:/ and all day long men say to me,/ Where is now your God?" and again at 42,10, "Nearly breaking my bones / my oppressors insult me / as all day long they ask me / Where is now your God?" In 79, 10 it occurs in a national lament, "Why should the pagans ask, Where is their God?" and this recalls two prophetic oracles, in Joel 2,9, "Spare yourpeople Yahweh!/ Do not make your heritage a thing of shame, a byword for the nations./ Why should it be said amongthe nations,/ Where is their God?" and Micah 7,10 "When my enemy sees it (my vindication)/ she will be covered with shame,? she who said to me: Where is Yahweh your God?" So there are two classes of such sayings, one by an individual and one by the nation. Much ink has been spilled on the questions, Who is the victim?, and Who are the enemies? The answers have canvassed all the possibilities from the lone individual beset by spiritual temptations, or David himselfin his days and nights as a fugitive, to the nation beset by rival nations.2 The victim surrounded by persecutors is clearly a major category in the Psalms, present in two thirds ofthe collection; one hundred out ofthe one hundred and fifty explicitly or implicitly refer to a victim surrounded by enemies.3 Let me cut to the chase and recall that according to René Girard's mimetic theory, which I take as a point of departure, the situation of the victim surrounded by a mob ofenemies is a structural not an historical situation.4 The deep structure ofhuman history is a victim surrounded by the mob, a lamb slain since the foundation ofthe world. This deep structure controls the shape of emergent history but that emergence conceals its deep structure by turning history into myth. Myth covers up the blood stains and stifles the voice of the victim, myth accuses the victim, presents the victim as guilty or willing and the persecutors as innocent. To this day much that claims to be history is really myth. History happens only when the voice ofthe victim comes to word, and for that reason the gospel is irreducibly history and not myth. The 2Raymund Schwager (53ff) gives the following information... (shrink)

BackgroundEach individual’s unique health-related beliefs can greatly impact the patient-clinician relationship. When there is a conflict between the patient’s preferences and recommended medical care, it can create a serious ethical dilemma, especially in an emergency setting, and dramatically alter this important relationship.Case presentationA 56-year-old man, who remained comatose after out-of-hospital cardiac arrest, was rushed to our hospital. The patient was scheduled for emergency coronary angiography when his adolescent daughter reported that she and her father held sincere beliefs against radiation (...) exposure. We were concerned that she did not fully understand the potential consequences if her father did not receive the recommended treatment. A physician provided her with in depth information regarding the risks and benefits of the treatment. While we did not want to disregard her statement, we opted to save the patient’s life due to concerns about the validity of her report.ConclusionsVariations in beliefs regarding medical care force clinicians to incorporate patient beliefs into medical practice. However, an emergency may require a completely different approach. When faced with a patient in a life-threatening condition and unconscious, we should take action to prioritize saving their life, unless we are highly certain about the validity of their advance directives. (shrink)

When The Ad Hoc Committee of Harvard Medical School to Examine the Definition of Brain Death began meeting in 1967, I was a graduate student, with committee member Ralph Potter and committee chair Henry Beecher as my mentors. The question of when to stop life support on a severely compromised patient was not clearly differentiated from the question of when someone was dead. A serious clinical problem arose when physicians realized that a patient's condition was hopeless but life support perpetuated (...) body function. Thus, the committee stated that its first purpose was to deal with the burdens on patients and families as well as on hospitals and on patients needing hospital beds occupied by comatose patients. They intuited the strategy of “defining” these patients as dead, thus legitimating treatment stoppage. They noted that this would also serve a second purpose. Although the dead donor rule had not yet been clearly articulated, they claimed that defining patients as dead would also address controversy over obtaining organs for transplant.My mentors’ discussions related to my interest in the intersection between questions primarily of medical fact (When has a human brain irreversibly ceased functioning?) and nonmedical questions of social policy (Should we treat individuals with dead brains and beating hearts as dead humans?). It quickly became clear that most committee members did not appreciate the interplay of these questions. (shrink)

Drawing on a recent case report of a pregnant, brain‐dead woman who gave birth to a healthy child after over seven months of intensive care treatment, this essay rejects the established doctrine in medicine that brain death constitutes the biological death of the human being. The essay describes three policy options with respect to determination of death and vital organ transplantation in the case of patients who are irreversibly comatose but remain biologically alive.

The “standard position” on organ donation is that the donor must be dead in order for vital organs to be removed, a position with which we agree. Recently, Robert Truog and Walter Robinson have argued that brain death is not death, and even though “brain dead” patients are not dead, it is morally acceptable to remove vital organs from those patients. We accept and defend their claim that brain death is not death, and we argue against both the US “whole (...) brain” criterion and the UK “brain stem” criterion. Then we answer their arguments in favour of removing vital organs from “brain dead” and other classes of comatose patients. We dispute their claim that the removal of vital organs is morally equivalent to “letting nature take its course”, arguing that, unlike “allowing to die”, it is the removal of vital organs that kills the patient, not his or her disease or injury. Then, we argue that removing vital organs from living patients is immoral and contrary to the nature of medical practice. Finally, we offer practical suggestions for changing public policy on organ transplantation. (shrink)

Many people are strongly opposed to the intentional destruction of human embryos, whether it be for purposes scientific, reproductive, or other. And it is not uncommon for such people to argue against the destruction of human embryos by invoking the claim that the destruction of human embryos is morally on par with killing the following humans: (A) the standard infant, (B) the suicidal teenager, (C) the temporarily comatose individual, and (D) the standard adult. I argue here that this claim (...) is false and do so as follows. First, I provide an account of the prima facie wrongness of killing individuals (A) – (D). Briefly, I contend that individuals (A) – (D) have a certain property in common, that of having a future of value. An individual who has a future of value has the potential to (i) value goods of consciousness when he will (or would) experience them and (ii) do so as a psychologically continuous individual. And depriving an individual of a future of value is prima facie wrong. Killing an individual deprives him of a future of value. Thus, killing an individual who has a future of value is prima facie wrong. Since individuals (A) – (D) have futures of value, killing them is prima facie wrong. Second, I argue that, given this account of the prima facie wrongness of killing individuals (A) – (D), the destruction of individual (E), the standard embryo, is not morally on par with killing individuals (A) – (D). For, unlike individuals (A) – (D), the standard embryo does not have a future of value. Specifically, I argue that having a future of value involves having the second-order potential for psychological continuity, a potential that individuals (A) – (D) have but that individual (E) does not. For possessing the second-order potential for psychological continuity requires the possession of psychological states, something individuals (A) – (D) have but that individual (E) lacks. Hence, individual (E) does not share with individuals (A) – (D) the property of having a future of value and, in turn, is not deprived of one when it is killed. Thus, given my proposed account of the prima facie wrongness of killing individuals (A) – (D), killing individual (E) is not morally on par with killing individuals (A) – (D). (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)

Very few data exist in France on: nurses’ knowledge and behaviour concerning ethical decisions in clinical practice; and their knowledge of ethical rules in clinical research. This questionnaire-based audit tried mainly to assess these questions in a large French university teaching hospital. Of the 257 questionnaires distributed to nurses in 23 clinical units of the hospital, 206 were returned. When responding to the vignette describing a clinical situation requiring an ethical decision to be made, most nurses acted as the patient’s (...) advocate although they have had no formal training in ethics. Indeed, 66% of nurses responding considered that the patients themselves should be the primary decision makers in situations that relate to their health and medical care. For children or comatose patients, the decision should be left to the relatives according to 72% of the responses. The results indicated that the role of health care professionals in ethical decisions made for a given patient should be marginal. Nurses’ knowledge concerning research protocols, particularly their ethical requirements and consequences, is poor at present and information from and communication with doctors should be improved. (shrink)

Many discussions of the moral status of “mindless beings” such as the permanently comatose, the dead, trees, and human fetuses seem to take for granted the thesis that it is improper to appeal to emotions to establish the fundamental distinction between “persona” (beings capableof rights “in their own right”) and “things” (beings not capable of rights except in some fictional or iIlusory sense). Persons are persons, however we may feel about them.That thesis seems to be a major obstacle to (...) any nonutilitarian account of the personhood of mindless beings.I argue that the thesis of independence is true, if at aIl, only for one class of persons (“rational agents”). Beyond that class, our emotional response to a being can be relevant to its moral status. Acting on some consideration (or believing something in virtue of it) can be rational inthe “constitutive”, “regulative”, or “associative” sense. A consideration is a good reason if it is rational in any of these senses. The importance of this claim is shown by briefly examining Feinberg’s weIl-known argument that it is a conceptual truth that mindless beings are incapable ofrights. His argument assumes that our emotions cannot be rational in the appropriate sense and coIlapses without that assumption. (shrink)

This book aims to show why a proper ontology of persons has paramount importance for our understanding of the nature of consciousness and its relation to the phenomenon of unconsciousness and artificial intelligence. Contemporary discussions on consciousness often focus on seeking solutions for a wide range of issues that revolve around questions related to what sort of role the brain plays in the existence of consciousness. These questions raise multi-layered and diverse metaphysical (especially, ontological), personal, medical, moral, and legal issues. (...) In navigating through such a complex web of issues, it has been said that the central problems philosophers and scientists face are establishing the nature and origin of consciousness. For example, is consciousness nothing but a brain process? If not, how is it related to brain activities? Can consciousness exist without depending on the brain and its activities? What are the neural correlates of consciousness, unconsciousness, and persons? Can we make an advance on the science of consciousness by investigating what happens to the brain during general anesthesia? Is there a relation between consciousness and unconsciousness? What is the bearer of consciousness and unconsciousness? Can consciousness exist without being someone’s consciousness? Is consciousness reproducible in computers or digital machines? If consciousness is not in all things, then what conditions must be satisfied for its emergence? Is it ethical to take someone’s vital organs without any prior consent from a person in an irreversible comatose state? The beginning and end of life issues also bring up their own complicated ethical conundrums involving consciousness. (shrink)