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)

BackgroundSevere brain injury is a leading cause of death and disability. Diagnosis and prognostication are difficult, and errors occur often. Novel neuroimaging methods can improve diagnostic and prognostic accuracy, especially in patients with prolonged disorders of consciousness (PDoC). Yet it is currently unknown how family caregivers understand this information, raising ethical concerns that disclosure of neuroimaging results could result in therapeutic misconception or false hope.MethodsTo examine these ethical concerns, we conducted semi-structured interviews with caregivers of patients with PDoC who were (...) enrolled in a concurrent neuroimaging research program designed to detect covert consciousness following severe brain injury. Caregivers held surrogate decision-making status for a patient. Interviews were conducted at two time points for each caregiver. The first interview occurred before the disclosure of neuroimaging results. The second occurred after disclosure. Descriptive analysis was applied to the data of four interview topics: (1) expectations for neuroimaging; (2) reactions to evidence of preserved cognition; (3) reactions to null results; and (4) understanding of the results and study.ResultsTwelve caregivers participated in the study; two caregivers shared surrogate decision-making status for one patient with PDoC. Twenty-one interviews were completed; one caregiver declined to participate in the post-disclosure interview. Three patients with PDoC associated with the study displayed evidence of covert consciousness. Overall, caregivers understood the neuroimaging research and results. Caregivers who received results of covert consciousness were generally pleased. However, there was some variation in expectations and reactions to these data and null results.ConclusionThis study, for the first time, reveals caregiver expectations for and reactions to neuroimaging evidence of covert consciousness in patients with PDoC. Caregivers understood the neuroimaging research and results, casting doubt on speculative ethical concerns regarding therapeutic misconception and false hope. However, disclosure of neuroimaging result could be improved. Pre-disclosure consultations might assist professionals in shaping caregiver expectations. Standardization of disclosure might also improve comprehension of the results. (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)

This book taps the best American thinkers to answer the essential American question: How do we sustain our experiment in government of, by, and for the people? Authored by an extraordinary and politically diverse roster of public officials, scholars, and educators, these chapters describe our nation's civic education problem, assess its causes, offer an agenda for reform, and explain the high stakes at risk if we fail.

Institutional review board delays may hinder the successful completion of federally funded research in the U.S. military. When this happens, time-sensitive, mission-relevant questions go unanswered. Research participants face unnecessary burdens and risks if delays squeeze recruitment timelines, resulting in inadequate sample sizes for definitive analyses. More broadly, military members are exposed to untested or undertested interventions, implemented by well-intentioned leaders who bypass the research process altogether. To illustrate, we offer two case examples. We posit that IRB delays often appear in (...) the service of managing institutional risk, rather than protecting research participants. Regulators may see more risk associated with moving quickly than risk related to delay, choosing to err on the side of bureaucracy. The authors of this article, all of whom are military-funded researchers, government stakeholders, and/or human subject protection experts, offer feasible recommendations to improv... (shrink)

It is argued that a chief obstacle to a naturalistic explanation of the origins of mind is human exceptionalism, as exempli fi ed in the seventeenth century by René Descartes and in the twentieth century by Noam Chomsky. As an antidote to human exceptionalism, we turn to the account of aesthetic judgment in Charles Darwin’s Descent of Man , according to which the mental capacities of humans differ from those of lower animals only in degree, and not in kind. (...) Thoroughgoing naturalistic explanation of these capacities is made easier by shifting away from the substance-metaphysical implications of the search for an account of mind , toward a dispositional account of the origins of mindfulness . (shrink)

One of the greatest merits of Dr. Sherover's excellent book is that it enables us to see Heidegger's thought- in one direction, at least- as an organic outgrowth from his reading of Kant. It thus helps to remove on common misapprehension that Heidegger's thought is odd, idiosyncratic, and not rooted- as in fact it is- in the mainstream of philosophy. Dr. Sherover is able to remove this misunderstanding in great part through the admirable clarity of his exposition; he has succeeded (...) in conveying Heidegger's most abstruse points into plain and understandable English, and so has overcome the formidable barrier of terminology that has blocked so many Heideggerian interpreters. This book is in fact the clearest exposition that I have read of Heidegger's thought at one states of its development. But beyond this valuable job of clarification, by bringing the light of Heidegger to bear upon Kant, this book is also a significant contribution to Kantian scholarship. And that means, of course, a contribution to philosophy itself. (shrink)

Recent history makes clear that the quantum leaps being made in technology are the leading edge of a groundswell of paradigm shifts taking place in science, politics, economics, social institutions, and the expression of cultural values. Indeed it is the simultaneity and interdependence of these changes occurring in every dimension of human experience and endeavor that makes the present so historically distinctive. The essays gathered here give voice to perspectives on the always improvised relationship between technology and cultural values from (...) Africa, the Americas, Asia, Australia, Europe, and the Pacific. Contributors: Syed Muhammad Naquib Al-Attas, Roger T. Ames,Yoko Arisaka, Carl Becker, Francesca Bray, James Buchanan, Arindam Chakrabarti, Frank W. Derringh, Rolf Elberfeld, Charles Ess, Andrew Feenberg, Susantha Goonatilake, H. Jiuan Heng, Peter Hershock, Thomas P. Kasulis, George Khushf, David Farrell Krell, Joel J. Kupperman, William R. LaFleur, Lois Ann Lorentzen, David Loy, Joseph Margolis, Hans-Georg Möller, Robert Cummings Neville, Peimin Ni, Monica Atieno Opole, Kuruvilla Pandikattu SJ, Helen Petrovsky, Ramon Sentmartí, Kristin Shrader-Frechette, Vasanthi Srinivasan, Marietta Stepaniants, Vyacheslav S. Stiopin, Henk ten Have, Paul B.Thompson, Mary Tiles, David B.Wong. (shrink)

Updated, expanded, and with a new introduction by the editor, this volume is not only a historical overview but also a dialectical analysis displaying the ...

This volume is a Festschrift dedicated to Charles Kahn comprised of more than 20 papers presented at the conference "Presocratics and Plato: Festschrift Symposium in Honor of Charles Kahn", 3-7 June 2009. The conference was held at the European Cultural Center of Delphi, Greece, and was organized and sponsored by the HYELE Institute for Comparative Studies and Parmenides Publishing, with endorsement from the International Plato Society, and the Dean of the School of Arts and Sciences, University of Pennsylvania. (...) Contributors: Julia Annas - University of Arizona; Sarah Broadie - University of St. Andrews; Lesley Brown - University of Oxford; Tomás Calvo-Martínez - Universidad Complutense de Madrid; Diskin Clay - Duke University; John M. Dillon - Trinity College, Dublin; Dorothea Frede - Humbolt University, Berlin; Arnold Hermann - HYELE Institute for Comparative Studies; Carl A. Huffman - DePauw University; Enrique Hülsz Piccone - Universidad Nacional Autonoma de Mexico; D.M. Hutchinson - St. Olaf College; Paul Kalligas - National and Kapodistrian University, Athens; Vassilis Karasmanis - National Technical University, Athens; Aryeh Kosman - Haverford College; Anthony A. Long - University of California, Berkeley; Richard McKirahan - Pomona College; Susan Sauvé Meyer - University of Pennsylvania; Alexander P.D. Mourelatos - University of Texas at Austin; Satoshi Ogihara - Tohoku University, Japan; Richard Patterson - Emory University; Christopher J. Rowe - Durham University; David Sedley - University of Cambridge; Richard Sorabji - University of Oxford. (shrink)

Battle Hall Davies' brother Nick ran away from home when she was in high school. Now he has found her and she is going to stay with him for the summer before starting college. Battle discovers that neither she nor her brother is the person she thought they were.

In Relativism and Religion five prominent philosophers from widely divergent perspectives have confronted fundamental questions about the epistemology and semantics of religious claims. Such questions in the philosophy of religion have become a matter of critical importance for anyone concerned about the status of religious claims to knowledge and truth. Is there any way, apart from a particular religious tradition, of knowing that the distinctive claims of a religious tradition are true or closer to truth than those of any other (...) religion? Does 'God' in religious speech and texts refer to the same Being as does philosophical theism? Would the disappearance of theistic belief and practice mean the death of the gods - or God? Or does this question assume a mistaken concept of truth or reference in religion? Included in this collection of essays is a spirited response by each contributor to the others' treatment of these issues. (shrink)

This paper concerns the character of Emerson's philosophy, and his general attitude toward life, in relationship to the human tendency to become isolated or compartmentalized, in view and attitude, by the specifics of work, career and particular perspectives.