Based upon the Decision Field Theory (Busemeyer and Townsend 1993), we tested a model of dynamic reasoning to predict the effect of time pressure on analytical and experiential processing during decision-making. Forty-six participants were required to make investment decisions under four levels of time pressure. In each decision, participants were presented with experiential cues which were either congruent or incongruent with the analytical information. The congruent/incongruent conditions allowed us to examine how many decisions were based upon the experiential versus the (...) analytical information, and to see if this was affected by the varying degrees of time pressure. As expected, the overall accuracy was reduced with greater time pressure and accuracy was higher when the experiential and analytical cues were congruent than when they were incongruent. Of great interest was the data showing that under high time pressure participants used more experiential cues than at other time pressures. We suggest that the dynamic reasoning paradigm has some future potential for predicting the effects of experiential biases in general, and specifically under time pressure. (shrink)

Technological change is often seen as something that follows its own logic -- something we may welcome, or about which we may protest, but which we are unable to alter fundamentally. This reader challenges that assumption and its distinguished contributors demonstrate that technology is affected at a fundamental level by the social context in which it develops. General arguments are introduced about the relation of technology to society and different types of technology are examined: the technology of production: domestic and (...) reproductive technology; and military technology. The book draws on authors from Karl Marx to Cynthia Cockburn to show that production technology is shaped by social relations in the workplace. It moves on to the technologies of the household and biological reproduction, which are topics that male-dominated social science has tended to ignore or trivialise -- though these are actually of crucial significance where powerful shaping factors are at work, normally unnoticed. The final section asks what shapes the most frightening technology of all -- the technology of weaponry, especially nuclear weapons. The editors argue that social scientists have devoted disproportionate attention to the effects of technology on society, and tended to ignore the more fundamental question of what shapes technology in the first place. They have drawn both on established work in the history and sociology of technology and on newer feminist perspectives to show just how important and fruitful it is to try to answer that deeper question. The first edition of this reader, published in 1985, had a considerable influence on thinking about the relationship between technology andsociety. This second edition has been thoroughly revised and expanded to take into account new research and the emergence of new theoretical perspectives. (shrink)

The purpose of this study was to assess the presence of ethics committees in rural critical access hospitals across the United States. Several studies have investigated the presence of ethics committees in rural health care facilities. The limitation of these studies is in the definition of ‘rural hospital’ and a regional or state focus. These limitations have created large variations in the study findings. In this nation-wide study we used the criteria of a critical access hospital (CAH), as defined by (...) the Medicare Rural Hospital Flexibility Program (Flex Program, 2007), to bring consistency and clarity to the assessment of the presence of ethics committees in rural hospitals. The Flex Monitoring Team conducted a national telephone survey of 381 CAH administrators throughout the United States. The survey covered a wide variety of questions concerning hospitals’ community benefit, impact activities, and whether the hospital had a formally established an ethics committee. About 230 (60%) of the respondents indicated they had a formally established ethics committee or ethics consultation program at their CAH. The prevalence of ethics committees declined as the CAH location became increasingly rural along a rural–urban continuum. Unlike CAHs, all rural Department of Veterans Affairs Medical Centers have ethics committees. The results of this study provide an understanding of the limited presence of ethics committee in rural America and the need to consider new approaches for providing ethics assistance. A virtual ethics committee network may be the most efficient and effective way of providing rural hospitals access to a knowledgeable ethics committee or consultant. (shrink)

Covid-19 lockdown restrictions constitute a population-wide “life-change event” disrupting normal daily routines. It was proposed that as a result of these lockdown restrictions, physical activity levels would likely decline. However, it could also be argued that lifestyle disruption may result in the formation of increased physical activity habits. Using a longitudinal design, the purpose of this study was to investigate changes in physical activity of different intensities, across individuals who differed in activity levels prior to lockdown restrictions being imposed, and (...) across three time periods: pre-, during- and post-lockdown. This study also examined the extent to which the experience of daily hassles explained any changes in physical activity. A convenience sample recruited through social media, provided data from an online survey administered during weeks 2–3 of a 5-week lockdown and 231 participants provided complete data again 6 weeks post-lockdown. Participants completed the International Physical Activity Questionnaire–Short Form and the Daily Hassles Scale. Results showed that vigorous and moderate intensity PA were significantly lower during- and post-lockdown compared to pre-lockdown in those individuals who had been highly active pre-lockdown. In contrast, for moderately active individuals pre-lockdown, vigorous and moderate intensity PA was significantly higher during-lockdown compared to pre-lockdown, and these increased levels of vigorous PA were maintained post-lockdown. Participants experienced daily hassles due to inner concerns, time pressures, family, and financial concerns to the same extent during- and post-lockdown. Those daily hassles had a small negative predictive effect on post-lockdown PA. It appears that to understand the effect of COVID-19 restrictions on PA, the activity status of individuals pre-lockdown needs to be taken into account. The daily hassles appeared to play a role in post-lockdown PA behavior, but future research should investigate why these results occurred. (shrink)

This paper explores relationships between environment and education after the Covid-19 pandemic through the lens of philosophy of education in a new key developed by Michael Peters and the Philosophy of Education Society of Australasia. The paper is collectively written by 15 authors who responded to the question: Who remembers Greta Thunberg? Their answers are classified into four main themes and corresponding sections. The first section, ‘As we bake the earth, let's try and bake it from scratch’, gathers wider philosophical (...) considerations about the intersection between environment, education, and the pandemic. The second section, ‘Bump in the road or a catalyst for structural change?’, looks more closely into issues pertaining to education. The third section, ‘If you choose to fail us, we will never forgive you’, focuses to Greta Thunberg’s messages and their responses. The last section, ‘Towards a new normal’, explores future scenarios and develops recommendations for critical emancipatory action. The concluding part brings these insights together, showing that resulting synergy between the answers offers much more then the sum of articles’ parts. With its ethos of collectivity, interconnectedness, and solidarity, philosophy of education in a new key is a crucial tool for development of post-pandemic education. (shrink)

When experienced in-person, engagement with art has been associated—in a growing body of evidence—with positive outcomes in wellbeing and mental health. This represents an exciting new field for psychology, curation, and health interventions, suggesting a widely-accessible, cost-effective, and non-pharmaceutical means of regulating factors such as mood or anxiety. However, can similar impacts be found with online presentations? If so, this would open up positive outcomes to an even-wider population—a trend accelerating due to the current COVID-19 pandemic. Despite its promise, this (...) question, and the underlying mechanisms of art interventions and impacts, has largely not been explored. Participants were asked to engage with one of two online exhibitions from Google Arts and Culture. With just 1–2 min exposure, both improved negative mood, state-anxiety, loneliness, and wellbeing. Stepdown analysis suggested the changes can be explained primarily via negative mood, while improvements in mood correlated with aesthetic appraisals and cognitive-emotional experience of the exhibition. However, no difference was found between exhibitions. We discuss the findings in terms of applications and targets for future research. (shrink)

Descartes with his sharp separation of the mental and the physical set the stage for the philosophy of mind for the next 350 years. Philosopher Patrick T. Mackenzie finds in the later writings of Wittgenstein the suggestion that Descartes got off on the wrong foot. Following Wittgenstein's lead, Mackenzie argues that instead of analyzing our human nature as a composite of mind and body, we should view ourselves as whole persons. One of the dividends of this approach to (...) the mind-body problem is that it provides us with a resolution to the problem of human freedom—i.e., how can a human being be free if his or her body (including the brain) belongs to a deterministic world? Mackenzie here argues that the person is largely free even though the movements of the body are determined by neurophysiological events. He takes the same approach to the philosophy of mind as that taken by M.R.Bennett and P.M.S.Hacker in their recent and controversial book, The Philosophical Foundations of Neuroscience. Mackenzie's approach is, however, much more accessible. Students of philosophy and philosophers interested in the problem of human freedom will welcome Mackenzie's fresh approach, especially those disenchanted by the present list of mind-body "isms.". (shrink)

Patients in the vegetative state are wholly unaware of themselves, or their surroundings. However, a minority of patients diagnosed as vegetative are actually aware. What is the well-being of these patients? How are their lives going, for them? It has been argued that on a reasonable conception of well-being, these patients are faring so poorly that it may be in their best interests not to continue existing. I argue against this claim. Standard conceptions of well-being do not clearly support the (...) conclusion that these patients would be better off having life-sustaining treatment withdrawn, and in fact, it may be possible for these patients to retain a passable level of well-being. I suggest that further research into the subjective experiences of these patients will allow us to better promote their well-being. (shrink)

Bioethicists who seek to defend commercial transactions that intuitively seem exploitative, such as organ sales and commercial surrogacy, typically pair a liberal analysis of exploitation with a libertarian analysis of autonomy. In this paper, I argue that the liberal analysis of exploitation, which focuses primarily on two party transactions between individuals, occludes the structural dimensions of exploitation. This occlusion then paves the way for the transaction to be understood in terms of libertarian autonomy. I propose that a vulnerability analysis paired (...) with a multidimensional and relational theory of autonomy highlights the structural dimensions of exploitation and exposes the myth-making that underlies claims that these forms of exploitation are autonomy-enhancing. (shrink)

When the COVID-19 surge hit New York City hospitals, the Division of Medical Ethics at Weill Cornell Medical College, and our affiliated ethics consultation services, faced waves of ethical issues sweeping forward with intensity and urgency. In this article, we describe our experience over an eight-week period (16 March through 10 May 2020), and describe three types of services: clinical ethics consultation (CEC); service practice communications/interventions (SPCI); and organizational ethics advisement (OEA). We tell this narrative through the prism of time, (...) describing the evolution of ethical issues and trends as the pandemic unfolded. We delineate three phases: anticipation and preparation, crisis management, and reflection and adjustment. The first phase focused predominantly on ways to address impending resource shortages and to plan for remote ethics consultation, and CECs focused on code status discussions with surrogates. The second phase was characterized by the dramatic convergence of a rapid increase in the number of critically ill patients, a growing scarcity of resources, and the reassignment/ redeployment of staff outside their specialty areas. The third phase was characterized by the recognition that while the worst of the crisis was waning, its medium- and long-term consequences continued to pose immense challenges. We note that there were times during the crisis that serving in the role of clinical ethics consultant created a sense of dis-ease as novel as the coronavirus itself. In retrospect we learned that our activities far exceeded the familiar terrain of clinical ethics consultation and extended into other spheres of organizational life in novel ways that were unanticipated before this pandemic. To that end, we defined and categorized a middle level of ethics consultation, which we have termed service practice communication intervention (SPCI). This is an underappreciated dimension of the work that ethics consult services are capable of in times of crisis. We believe that the pandemic has revealed the many enduring ways that ethics consultation services can more robustly contribute to the ethical life of their institutions moving forward. (shrink)

The significance of big data for driving health research and improvements in patient care is well recognised. Along with these potential benefits, however, come significant challenges, including those concerning the sharing and linkage of health and social care records. Recently, there has been a shift in attention towards a paradigm of data sharing centred on the ‘trusted research environment’ (TRE). TREs are being widely adopted by the UK’s health data initiatives including Health Data Research UK (HDR UK),1 Our Future Health2 (...) and Genomics England.3 A recent review commissioned by the UK’s Department of Health and Social Care (hereafter referred to as the ‘Goldacre Review’) places TREs at the heart of its recommendations around the future of National Health Service (NHS) health data sharing for research, describing them as the ‘clear path forward’ to a health data system in which trust is ‘earned’ through ‘provable, credible steps to protect patient privacy, and by being transparent with everyone about everything that is done with their deepest medical secrets’.4 We argue that rather than building public trust, the TRE model actually reduces the need for trust in the use and sharing of patient health data. This is because trust is importantly connected to vulnerability and uncertainty; an essential part of trusting someone is accepting that one’s trust could be disappointed or betrayed. In attempting to provide assurances or guarantees of data privacy and security, TREs strive to remove this vulnerability, and so remove the need for trust. We do not see this as a problem and are broadly supportive of this kind of data sharing model because of the increased security and oversight it provides. However, having argued that TREs are not actually concerned with trust, we consider the importance of being precise about the words that we use …. (shrink)

Powered by ‘big health data’ and enormous gains in computing power, artificial intelligence and related technologies are already changing the healthcare landscape. Harnessing the potential of these technologies will necessitate partnerships between health institutions and commercial companies, particularly as it relates to sharing health data. The need for commercial companies to be trustworthy users of data has been argued to be critical to the success of this endeavour. I argue that this approach is mistaken. Our interactions with commercial companies need (...) not, and should not, be based on trust. Rather, they should be based on confidence. I begin by elucidating the differences between trust, reliability, and confidence, and argue that trust is not the appropriate attitude to adopt when it comes to sharing data with commercial companies. I argue that what we really should want is confidence in a system of data sharing. I then provide an outline of what a confidence-worthy system of data sharing with commercial companies might look like, and conclude with some remarks about the role of trust within this system. (shrink)

In his recent book Reflective Democracy, Robert Goodin argues that 'external-collaborative' models of democratic deliberation procedures need to be supplemented by 'internal-reflective' deliberation. The exercise of the moral imagination plays a central role in Goodin's account of 'democratic deliberation within'. By imaginatively putting ourselves in the place of a range of others, he argues, including those who maybe not be able to represent their own interests, we can make their points of view 'communicatively present' in deliberation. Goodin's argument emphasizes the (...) role of art and other forms of cultural representation in helping to bring about this expansion of moral imagination. Drawing on debates in philosophy of mind concerning the scope and limits of our capacities to simulate other minds, I argue that Goodin's analysis of 'democratic deliberation within' conflates different kinds of imaginative project. In doing so, it underestimates both the difficulties of imaginatively putting ourselves in the place of others and the political risks in doing so. I argue, alternatively, that moral engagement with others involves the capacity for sympathy and that art and other forms of cultural representation can enlarge the scope of our sympathies, by assisting us to overcome imaginative resistance to alien points of view. In developing this argument, I provide a qualified defense of Iris Young's claim that respect for others involves 'asymmetrical reciprocity'. (shrink)

Unresponsive wakefulness syndrome is a disorder of consciousness wherein a patient is awake, but completely non-responsive at the bedside. However, research has shown that a minority of these patients remain aware, and can demonstrate their awareness via functional neuroimaging; these patients are referred to as having ‘cognitive motor dissociation’. Unfortunately, we have little insight into the subjective experiences of these patients, making it difficult to determine how best to promote their well-being. In this paper, I argue that the capacity to (...) experience pain or pleasure is a key component of well-being for these patients. While patients with unresponsive wakefulness syndrome are believed to be incapable of experiencing pain or pleasure, I argue that there is evidence to support the notion that CMD patients likely can experience pain and pleasure. I analyze current neuroscientific research into the mechanisms of pain experience in patients with disorders of consciousness, and provide an explanation for why CMD patients likely can experience physical pain. I then do the same for physical pleasure. I conclude that providing these patients with pleasurable experiences, and avoiding subjecting them to pain, are viable means of promoting their well-being. (shrink)

Concern for human vulnerability seems to be at the heart of bioethical inquiry, but the concept of vulnerability is under-theorized in the bioethical literature. The aim of this article is to show why bioethics needs an adequately theorized and nuanced conception of vulnerability. We first review approaches to vulnerability in research ethics and public health ethics, and show that the bioethical literature associates vulnerability with risk of harm and exploitation, and limited capacity for autonomy. We identify some of the challenges (...) emerging from this literature: in particular, how to reconcile universal human vulnerability with a context-sensitive analysis of specific kinds and sources of vulnerability; and how to reconcile obligations to protect vulnerable persons with obligations to respect autonomy. We then briefly survey some of the theoretical resources available within the philosophical literature to address these challenges, and to assist in understanding the conceptual connections between vulnerability and related concepts such as harm, exploitation, needs, and autonomy. We also sketch out a taxonomy of sources and kinds of vulnerability. Finally, we consider the implications for policy evaluation of making vulnerability an explicit and central focus of bioethics. Our investigation is in the form of a broad survey motivating a research agenda rather than a detailed analysis. (shrink)

Neuroimaging research regularly yields “incidental findings”: observations of potential clinical significance in healthy volunteers or patients, but which are unrelated to the purpose or variables of the study.

An important goal of ethical investment is to influence companies to improve their ethical and environmental performance. The principal means that many ethical funds employ is passive market signalling, which may not, on its own, have a significant effect. A much more promising approach may be active engagement. This paper reports on a questionnaire study of a sample of 1146 ethical investors in order to assess whether U.K. ethical investors would support more activist ethical investment and whether they would be (...) prepared to invest in companies which are failing ethically in order to do so. The results show general support for the current practice of passive signalling accompanied by "soft" engagement in the form of lobbying and the development of dialogue in order to improve corporate practice. The "harder" options of investing in companies that err in order to change them is, however, favoured by consistent minorities. (shrink)

The aim of this article is to give an account of a methodological link between drama and political theory. This account is drawn primarily from the early philosophical work of Deleuze. Following Deleuze, we will refer to it as ‘the method of dramatization’. We will argue that dramatization is a method aimed at determining the quality of political concepts by ‘bringing them to life’, in the way that dramatic performances bring to life the characters and themes of a play-script. We (...) demonstrate that this can be specified in relation to the development of this method in Deleuze's early philosophical work as a practical, critical and artistic method and, in relation to the ontological assumptions he articulated and defended in Difference and Repetition, as a process of intensification of the Idea of the political. By way of example, we discuss how the dramatization of the concept of ideology functions in Deleuze and Guattari's Anti-Oedipus and A Thousand Plateaus. We conclude with some lines of inquiry that could be pursued by political theorists looking to investigate further the dramatic nature of method in political theory. (shrink)

Giant bones unearthed throughout the Mesoamerican countryside provoked early modern thinkers to grapple with the earth’s ages, partially syncretizing Nahua histories of human conquest with Spanish colonial medicinal and natural historical knowledge. European naturalists’ willingness to accept the giant remains required them to embrace localized Mesoamerican cosmologies. The fossilized landscape provided evidence that conquest and eradication had happened before at the hands of the peoples whom the Spaniards had conquered in turn. Lost from early modern collections and failing to translate (...) far beyond New Spain during the sixteenth century, the giant remains highlight the possibilities and challenges of integrating Mesoamerican knowledge into the global history of science, with an emphasis on emplaced thinking, medicine and the body, and deeper temporal frameworks. Moving beyond itinerary histories to globalizing cosmologies in the history of science can better explain the compromises Europeans and Mesoamericans were required to make to enter into a syncretic intellectual contract, as well as the non-European concept of time that came with local reckonings with the human and more-than-human natural world. (shrink)

Patients with disorders of consciousness after severe brain injury need surrogate decision makers to guide treatment decisions on their behalf. Formal guidelines for surrogate decisionmaking generally instruct decision makers to first appeal to a patient’s written advance directive, followed by making a substituted judgment of what the patient would have chosen, and lastly, to make decisions according to what seems to be in the patient’s best medical interests. Substituted judgment is preferable because it is taken to preserve patient autonomy, by (...) using a patient’s past wishes and values to reconstruct what they would have chosen for themselves. In this paper, the author argues that for a certain population of patients, the standard interpretation of substituted judgment cannot ensure the preservation of patient autonomy. Patients with “covert awareness” may continue to have values and an authentic sense of self, which may differ from their past values and wishes. Accordingly, surrogate decision makers should make decisions based on how the patient is likely to experience their condition in the present, rather than their past wishes and values. (shrink)

The essays collected in this volume address a range of issues that arise when the focus of philosophical reflection on identity is shifted from metaphysical to practical and evaluative concerns. They also explore the usefulness of the notion of narrative for articulating and responding to these issues. The chapters, written by an outstanding roster of international scholars, address a range of complex philosophical issues concerning the relationship between practical and metaphysical identity, the embodied dimensions of the first-personal perspective, the kind (...) of reflexive agency involved in the self-constitution of one’s practical identity, the relationship between practical identity and normativity, and the temporal dimensions of identity and selfhood. In addressing these issues, contributors engage with debates in the literatures on personal identity, phenomenology, moral psychology, action theory, normative ethical theory, and feminist philosophy. (shrink)

For a period in the middle of the present century moral philosophy was dominated by the debate between prescriptivists and descriptivists. Prescriptivists proclaimed a gap between ‘is’ and ‘ought’, between facts and values, and cheerfully accepted the sceptical consequence that morals, and values generally, could not be objects of knowledge.

What happens when neuroscientific knowledges move from laboratories and clinics into therapeutic settings concerned with the care of children? ‘Brain-based parenting’ is a set of discourses and practices emerging at the confluence of attachment theory, neuroscience, psychotherapy and social work. The neuroscientific knowledges involved understand affective states such as fear, anger and intimacy as dynamic patterns of coordination between brain localities, as well as flows of biochemical signals via hormones such as cortisol. Drawing on our own attempts to adopt brain-based (...) parenting, and engaging with various strands and critiques of new materialism and affect theory, we explore the ways in which the social sciences and humanities might fruitfully engage with neuroscientific concepts and affects. How does science-affected indeterminacy, with all its promises of ontological and experiential agency, help us to observe, wait, bind or hold together volatile mixtures of habit, speech and action? (shrink)

The concept of dignity plays a foundational role in the more recent versions of Martha Nussbaum’s capabilities theory. However, despite its centrality to her theory, Nussbaum’s conception of dignity remains under-theorised. In this paper we critically examine the role that dignity plays in Nussbaum’s theory by, first, developing an account of the concept of dignity and introducing a distinction between two types of dignity, status dignity and achievement dignity. Next, drawing on this account, we analyse Nussbaum’s conception of dignity and (...) contrast it with Kant’s conception of dignity. On the basis of this comparison between Nussbaum and Kant, we highlight tensions between Nussbaum’s Aristotelianism, which is central to her conception of dignity, and her commitment to political liberalism. This leads us to conclude that Nussbaum’s claim that her conception of dignity is only a partial political conception is implausible and that her conception of dignity seems to commit her to a satisficing form of perfectionist liberalism. (shrink)

Patients with severe disorders of consciousness are thought to be unaware of themselves or their environment. However, research suggests that a minority of patients diagnosed as having a disorder of consciousness remain aware. These patients, designated as having “cognitive motor dissociation”, can demonstrate awareness by imagining specific tasks, which generates brain activity detectable via functional neuroimaging. The discovery of consciousness in these patients raises difficult questions about their well-being, and it has been argued that it would be better for these (...) patients if they were allowed to die. Conversely, I argue that CMD patients may have a much higher level of well-being than is generally acknowledged. It is far from clear that their lives are not worth living, because there are still significant gaps in our understanding of how these patients experience the world. I attempt to fill these gaps, by analyzing the neuroscientific research that has taken place with these patients to date. Having generated as comprehensive a picture as possible of the capacities of CMD patients, I examine this picture through the lens of traditional philosophical theories of well-being. I conclude that the presumption that CMD patients do not have lives worth living is not adequately supported. (shrink)

Rho GTPases are critically important and are centrally positioned regulators of the actomyosin cytoskeleton. By influencing the organization and architecture of the cytoskeleton, Rho proteins play prominent roles in many cellular processes including adhesion, migration, intra‐cellular transportation, and proliferation. The most important method of Rho GTPase regulation is via the GTPase cycle; however, post‐translational modifications (PTMs) also play critical roles in Rho protein regulation. Relative to other PTMs such as lipidation or phosphorylation that have been extensively characterized, protein oxidation is (...) a regulatory PTM that has been poorly studied. Protein oxidation primarily occurs from the reaction of reactive oxygen species (ROS), such as hydrogen peroxide (H2O2), with amino acid side chain thiols on cysteine (Cys) and methionine (Met) residues. The versatile redox modifications of cysteine residues exemplify their integral role in cell signalling processes. Here we review prominent members of the Rho GTPase family and discuss how lipidation, phosphorylation, and oxidation on conserved cysteine residues affects their regulation and function. (shrink)

Prognosis after severe brain injury is highly uncertain, and decisions to withhold or withdraw life‐sustaining treatment are often made prematurely. These decisions are often driven by a desire to avoid a situation where the patient becomes ‘trapped’ in a condition they would find unacceptable. However, this means that a proportion of patients who would have gone on to make a good recovery, are allowed to die. I propose a shift in practice towards the routine provision of aggressive care, even in (...) cases where the probability of survival and acceptable recovery is thought to be low. In conjunction with this shift, I argue in favour of a presumption towards withdrawing life‐sustaining treatment, including artificial nutrition and hydration, when it becomes clear that a patient will not recover to a level that would be acceptable to them. I then respond to three potential objections to this proposal. (shrink)

The ethical debate about neurotechnologies—including both drugs and implanted devices—has been largely framed around the questions of whether and when these technologies could damage or promote authenticity. Patients can experience changes in mood, behavior, emotion, or preferences—seemingly, changes in character or personality. Some describe such changes by saying they feel like different people; that they have become either more or less themselves; or that they feel as though some of their moods, behaviors, emotions or preferences are not their own. These (...) kinds of statements are used to describe both changes that a drug or device is... (shrink)

:Long-term patient outcomes after severe brain injury are highly variable, and reliable prognostic indicators are urgently needed to guide treatment decisions. Functional neuroimaging is a highly sensitive method of uncovering covert cognition and awareness in patients with prolonged disorders of consciousness, and there has been increased interest in using it as a research tool in acutely brain injured patients. When covert awareness is detected in a research context, this may impact surrogate decisionmaking—including decisions about life-sustaining treatment—even though the prognostic value (...) of covert consciousness is currently unknown. This paper provides guidance to clinicians and families in incorporating individual research results of unknown prognostic value into surrogate decisionmaking, focusing on three potential issues: Surrogate decisionmakers may misinterpret results; Results may create false hope about the prospects of recovery; There may be disagreement about the meaningfulness or relevance of results, and appropriateness of continued care. (shrink)