This is the first article in a two-part series describing subject and family perspectives from the central thalamic deep brain stimulation for the treatment of traumatic brain injury using the Medtronic PC + S first-in-human invasive neurological device trial to achieve cognitive restoration in moderate to severe traumatic brain injury, with subjects who were deemed capable of providing voluntary informed consent. In this article, we report on interviews conducted prior to surgery wherein we asked participants about their experiences recovering from (...) brain injury and their perspectives on study enrollment and participation. We asked how risks and benefits were weighed, what their expectations and fears were, and how decisions were reached about trial participation. We found that informed consent and enrollment decisions are fraught. Subjects and families were often split, with subjects more focused on putative benefits and families concerned about incremental risk. Both subjects and families viewed brain injury as disruptive to personal identity and relationships. As decisions were made about study enrollment, families struggled with recognizing the re-emergent agency of subjects and ceding decision-making authority to subjects who had previously been dependent upon them for protection and guidance. Subjects and family members reported a hope for the relief of cognitive disabilities, improved quality of life, normalization of interpersonal interactions, and a return to work or school as reasons for study participation, along with altruism and a desire to advance science. Despite these aspirations, both subjects and families appreciated the risks of the intervention and did not suffer from a therapeutic misconception. A second essay to be published in the next issue of Cambridge Quarterly of Healthcare Ethics—Clinical Neuroethics will describe interviews conducted after surgery, the effects of cognitive restoration for subjects, families, and challenges presented to the social structures they will call upon to support them through recovery. This subsequent article will be available online prior to its formal publication in October 2023. (shrink)

This is the second paper in a two-part series describing subject and family perspectives from the CENTURY-S (CENtral Thalamic Deep Brain Stimulation for the Treatment of Traumatic Brain InjURY-Safety) first-in-human invasive neurological device trial to achieve cognitive restoration in moderate to severe traumatic brain injury (msTBI). To participate, subjects were independently assessed to formally establish decision-making capacity to provide voluntary informed consent. Here, we report on post-operative interviews conducted after a successful trial of thalamic stimulation. All five msTBI subjects met (...) a pre-selected primary endpoint of at least a 10% improvement in completion time on Trail-Making-Test Part B, a marker of executive function. We describe narrative responses of subjects and family members, refracted against that success. Interviews following surgery and the stimulation trial revealed the challenge of adaptation to improvements in cognitive function and emotional regulation as well as altered (and restored) relationships and family dynamics. These improvements exposed barriers to social reintegration made relevant by recoveries once thought inconceivable. The study’s success sparked concerns about post-trial access to implanted devices, financing of device maintenance, battery replacement, and on-going care. Most subjects and families identified the need for supportive counseling to adapt to the new trajectory of their lives. (shrink)

Introduction.--Aristotle.--The seventeenth century.--The eighteenth century.--Biology.--Nature.--Evolution.--The problem.--The three elements.--The teleological order.--Appendix: Clerk Maxwell on determinism and free will. Fechner on the tendency to stability.

Background: Neurotypical young adults show task-based modulation and stability of their eye movements across tasks. This study aimed to determine whether persons with aphasia (PWA) modulate their eye movements and show stability across tasks similarly to control participants. Methods: Forty-eight PWA and age-matched control participants completed four eye-tracking tasks: scene search, scene memorization, text-reading, and pseudo-reading. Results: Main effects of task emerged for mean fixation duration, saccade amplitude, and standard deviations of each, demonstrating task-based modulation of eye movements. Group by (...) task interactions indicated that PWA produced shorter fixations relative to controls. This effect was most pronounced for scene memorization and for individuals who recently suffered a stroke. PWA produced longer fixations, shorter saccades, and less variable eye movements in reading tasks compared to controls. Three-way interactions of group, aphasia subtype, and task also emerged. Text-reading and scene memorization were particularly effective at distinguishing aphasia subtype. Persons with anomic aphasia showed a reduction in reading saccade amplitudes relative to their respective control group and other PWA. Persons with conduction/Wernicke’s aphasia produced shorter scene memorization fixations relative to controls or PWA of other subtypes, suggesting a memorization specific effect. Positive correlations across most tasks emerged for fixation duration and did not significantly differ between controls and PWA. Conclusions: PWA generally produced shorter fixations and smaller saccades relative to controls particularly in scene memorization and text-reading respectively. The effect was most pronounced recently after a stroke. Selectively in reading tasks, PWA produced longer fixations and shorter saccades relative to controls, consistent with reading difficulty. PWA showed task-based modulation of eye movements, though the pattern of results was somewhat abnormal relative to controls. All subtypes of PWA also demonstrated task-based modulation of eye movements. However, persons with anomic aphasia showed reduced modulation of saccade amplitude and smaller reading saccades, possibly to improve reading comprehension. Controls and PWA generally produced stabile fixation durations across tasks and did not differ in their relationship across tasks. Overall, these results suggest there is potential to differentiate among PWA with varying subtypes and from controls using eye movement measures of task-based modulation, especially reading and scene memorization tasks. (shrink)

The basic principles of scientific research from the great French physiologist whose contributions in the 19th century included the discovery of vasomotor nerves; nature of curare and other poisons in human body; more.

This is a new edition of Joseph Fletcher's 1966 work that ignited a firestorm of controversy at the time of its publication.

In "Epistemic Norms and the 'Epistemic Game' They Regulate", we advance a general case for the idea that epistemic norms regulating the production of beliefs might usefully be understood as social norms. There, we drew on the influential account of social norms developed by Cristina Bicchieri, and we managed to give a crude recognizable picture of important elements of what are recognizable as central epistemic norms. Here, we consider much needed elaboration, suggesting models that help one think about epistemic communities (...) and, ultimately, the temptations confronted in one's epistemic life. We suggest that once "the epistemic game" is embedded into a wider set of gains and losses, one can understand the epistemic choice situation as a form of mixed-motive game. This allows one to understand epistemic games more straightforwardly using Bicchieri's framework for thinking about social norms. That is, once the choice situation denominated only in terms of classical epistemic gains and losses is embedded in a wider accounting of goods that may compete with the production of true beliefs, one can see how an agent's individual and community epistemic project can be furthered by social norms regulating epistemic practices. We recommend thinking of epistemic norms as analogous to social norms for hygiene. (shrink)

Bottlenecks introduces a powerful new way of understanding equal opportunity. Rather than literal equalization, Joseph Fishkin argues that Americans ought to aim to broaden the range of opportunities open to people, at every stage in life, to pursue different paths.

Background The ethical governance of Artificial Intelligence (AI) in health care and public health continues to be an urgent issue for attention in policy, research, and practice. In this paper we report on central themes related to challenges and strategies for promoting ethics in research involving AI in global health, arising from the Global Forum on Bioethics in Research (GFBR), held in Cape Town, South Africa in November 2022. Methods The GFBR is an annual meeting organized by the World Health (...) Organization and supported by the Wellcome Trust, the US National Institutes of Health, the UK Medical Research Council (MRC) and the South African MRC. The forum aims to bring together ethicists, researchers, policymakers, research ethics committee members and other actors to engage with challenges and opportunities specifically related to research ethics. In 2022 the focus of the GFBR was “Ethics of AI in Global Health Research”. The forum consisted of 6 case study presentations, 16 governance presentations, and a series of small group and large group discussions. A total of 87 participants attended the forum from 31 countries around the world, representing disciplines of bioethics, AI, health policy, health professional practice, research funding, and bioinformatics. In this paper, we highlight central insights arising from GFBR 2022. Results We describe the significance of four thematic insights arising from the forum: (1) Appropriateness of building AI, (2) Transferability of AI systems, (3) Accountability for AI decision-making and outcomes, and (4) Individual consent. We then describe eight recommendations for governance leaders to enhance the ethical governance of AI in global health research, addressing issues such as AI impact assessments, environmental values, and fair partnerships. Conclusions The 2022 Global Forum on Bioethics in Research illustrated several innovations in ethical governance of AI for global health research, as well as several areas in need of urgent attention internationally. This summary is intended to inform international and domestic efforts to strengthen research ethics and support the evolution of governance leadership to meet the demands of AI in global health research. (shrink)

This study examines the cognitive resources underlying the attribution of stigma in substance use and misuse. A cultural model of substance misuse risk was elicited from students at a major U.S. state university. We found a contested cultural model, with some respondents adopting a model of medical risk while others adopted a model of moral failure; agreeing that moral failure primarily defined risk led to greater attribution of stigma. Here we incorporate general beliefs about moral decision-making, assessed through Moral Foundations (...) Theory. Specifically, we examined commitment to each moral foundation in relation to stigma attribution while controlling for the specific model of substance misuse risk. We found an interaction between the purity moral foundation and the cultural model of risk. This suggests that broad moral orientations, along with more specific understandings of substance misuse risk, combine to orient an individual with respect to stigma attribution. (shrink)

Numerous philosophers in recent decades have argued that a partial explanation for how the blessed in heaven are impeccable while remaining free and responsible is that they have cultivated or developed such a virtuous character prior to heaven that once in heaven they are incapable of acting contrary to their virtuously cultivated characters. Further, because the agents are at least partially responsible for the construction of their characters, they can be considered free and responsible with regard to the choices or (...) actions such virtuous characters allow. In what follows I will argue that the impeccability of the blessed is not achieved through a character-development process performed by the blessed themselves. (shrink)

It is commonly thought that there is some tension between the second law of thermodynam- ics and the time reversal invariance of the microdynamics. Recently, however, Jos Uffink has argued that the origin of time reversal non-invariance in thermodynamics is not in the second law. Uffink argues that the relationship between the second law and time reversal invariance depends on the formulation of the second law. He claims that a recent version of the second law due to Lieb and Yngvason (...) allows irreversible processes, yet is time reversal invariant. In this paper, I attempt to spell out the traditional argument for incompatibility between the second law and time reversal invariant dynamics, making the assumptions on which it depends explicit. I argue that this argument does not vary with different versions of the second law and can be formulated for Lieb and Yngvason's version as for other versions. Uffink's argument regarding time reversal invariance in Lieb and Yngvason is based on a certain symmetry of some of their axioms. However, these axioms do not constitute the full expression of the second law in their system. (shrink)

Disagreement affords humans as members of epistemic communities important opportunities for refining or improving their epistemic situations with respect to many of their beliefs. To get such epistemic gains, one needs to explore and gauge one’s own epistemic situation and the epistemic situations of others. Accordingly, a fitting response to disagreement regarding some matter, p, typically will turn on the resolution of two strongly interrelated questions: (1) whether p, and (2) why one’s interlocutor disagrees with oneself about p. When one (...) has high intellectual respect for one’s interlocutor, answering question (2) involves arriving at a sympathetic explanatory understanding of the interlocutor’s own epistemic attitude toward p. Sorting out (2) is an abductive matter. Further, so far as the abductive explanation conditions one’s epistemic take regarding (1), there will be an abductive character to one’s epistemic position with respect to whether p—even where one’s initial purchase on whether p was not an abductive matter. We explain here how this can be managed naturally and tractably. (shrink)

As human beings age, they become weak, fragile, and feeble. It is a slowly progressing yet complex syndrome in which old age or some disabilities are not prerequisites; neither does loss of human parts lead to frailty among the physically fit older persons. This paper aims to describe the influences of transhumanist perspectives on human‐technology enhancements and replacements in the transcendence of human frailties, including those of older persons, in which technology is projected to deliver solutions toward transcending these frailties. (...) Through technologies including genetic screening and other technological manipulations, intelligent machines and augmented humans improve, maintain, and remedy human‐linked susceptibilities. Furthermore, other technologies replace parts fabricated through inorganic‐mechanical processes such as 3D‐printing. Advancing technologies are reaching the summit of technological sophistication contributing to the transhumanist views of being human in a technological world. Technologies enhance the transcendence of human frailties as essential expressions of the symbiosis between human beings and technology in a transcendental world. (shrink)

The controversy over the equivalence of continuous sedation until death (CSD) and physician-assisted suicide/euthanasia (PAS/E) provides an opportunity to focus on a significant extended use of CSD. This extension, suggested by the equivalence of PAS/E and CSD, is designed to promote additional patient autonomy at the end-of-life. Samuel LiPuma, in his article, “Continuous Sedation Until Death as Physician-Assisted Suicide/Euthanasia: A Conceptual Analysis” claims equivalence between CSD and death; his paper is seminal in the equivalency debate. Critics contend that sedation follows (...) proportionality protocols for which LiPuma’s thesis does not adequately account. Furthermore, sedation may not eliminate consciousness, and as such LiPuma’s contention that CSD is equivalent to neocortical death is suspect. We not only defend the equivalence thesis, but also expand it to include additional moral considerations. First, we explain the equivalence thesis. This is followed by a defense of the thesis against five criticisms. The third section critiques the current use of CSD. Finally, we offer two proposals that, if adopted, would broaden the use of PAS/E and CSD and thereby expand options at the end-of-life. (shrink)

Growing concern has been expressed that we have entered a “post-truth” era in which each of us willfully believes whatever we choose, aided and abetted by alternative and social media that spin alternative realities for boutique consumption. A prime example of the belief in alternative realities is said to be acceptance of “conspiracy theories”—a term that is often used as a pejorative to indict claims of conspiracy that are so obviously absurd that only the unhinged could believe them. The epistemological (...) standard often involved in this indictment, however—the standard of “obvious” falsity—invites subjectivity in its application, because what is obviously false to one person can be common sense to another. This is not just a truism; considerable research suggests that people’s political beliefs, in general, and their acceptance or rejection of conspiracy theories in particular, tends in large part to be determined by partisan, ideological, and other priors. (shrink)

The number of clinical trials for experimental brain implants continues to grow, and with this growth comes an increased reliance upon patients with treatment-refractory conditions to volunteer as...

As scholars envision a new regulatory or statutory neurorights schema it is important to imagine unintended consequences if reforms are implemented before their implications are fully understood. This paper critically evaluates provisions proposed for a new Chilean Constitution and evaluates this movement against efforts to improve the diagnosis of, and treatment for, individuals with disorders of consciousness within the broader context of disability law, international human rights, and a capabilities approach to health justice as advanced by Amartya Sen and Martha (...) Nussbaum. Framed in this way, any neurorights regime would need to satisfy several criteria. First it would be obliged to balance both positive and negative rights in the furtherance of human capabilities. Second, it would need to be future oriented and informed about the science it sought to regulate and not fall prey to science fiction fantasies that remain ungrounded in reality. Third, it would need to be specific and avoid generalizations that would lead to conceptual confusion and litigation that could delay scientific progress. Finally, it would need to harmonize novel neurorights with long-established norms in international disability and human rights law. A failure to meet these criteria will destine any novel neurorights regime to the periphery. At this juncture Chile’s nascent constitutional venture into neurorights fails to satisfy these criteria. While there yet may be a role for a more capacious and bivalent articulation of neurorights that account for capabilities and precedent, the current Chilean neurorights reforms are vague and premature. As such they should undergo additional scholarly scrutiny and should not be adopted by other jurisdictions. (shrink)

El cuidado de sí es cuidado de lo más humano de cada uno de nosotros. La convicción nuclear que lo rige es siempre la misma: que lo humano puede intensificarse y crecer. Y que el peligro reside siempre en la degeneración. Intensificar lo humano es ir hacia lo “más humano”. En absoluto se busca la “superación” o el “más allá” de lo humano. Este artículo es un intento de relacionar la lectura que hace Foucault del tema del cuidado de sí (...) con la urgente necesidad de repensar hoy el lugar de lo educativo como lugar propio para ese cuidado. Para tal fin, se propone el concepto de altertopía educativa, como lugar, no solo de resistencia al dominio de la banalidad contextual, sino de gestación de la fuerza revolucionaria. (shrink)

The drive to describe cultural history as an evolutionary process has two sources. One from within social theory is part of the impetus to convert social studies into "social sciences" providing them with the status accorded to the natural sciences. The other comes from within biology and biological anthropology in the belief that the theory of evolution must be universal in its application to all functions of all living organisms. The social scientific theory of cultural evolution is pre-Darwinian, employing a (...) developmental model of unfolding characterized by intrinsic directionality, by definable stages that succeed each other and by some criterion of progress. It is arbitrary in its definitions of progress and has had the political problem that a diachronic claim of cultural progress implies a synchronic differential valuation of present-day cultures. The biological scheme creates an isomorphism between the Darwinian mechanism of evolution and cultural history, postulating rules of cultural "mutation", cultural inheritance and some mechanism of natural selection among cultural alternatives. It uses simplistic ad hoc notions of individual acculturation and of the differential survival and reproduction of cultural elements. It is unclear what useful work is done by substituting the metaphor of evolution for history. (shrink)

By a macro-level feature, I understand any feature that supervenes on, and is thus realized in, lower-level features. Recent discussions by Kim have suggested that such features cannot be causally relevant insofar as they are not classically reducible to lower-level features. This seems to render macro-level features causally irrelevant. I defend the causal relevance of some such features. Such features have been thought causally relevant in many examples that have underpinned philosophical work on causality. Additionally, in certain typical biological cases, (...) we conceive of causally relevant features at various compatible levels of analysis. When elaborated, these points make a strong prima facie case for macro-level causal relevance. However, we might abandon both the philosophical guideposts and the corresponding explanatory practice in the special sciences were we convinced that no reflective philosophical account could provide for the causal relevance there supposed. I show that such drastic measures are not necessary, for we can make sense of macro-level causal relevance by drawing on Paul Humphreys' recent work in ways suggested by the concrete examples considered here. (shrink)

Algebraic Art explores the invention of a peculiarly Victorian account of the nature and value of aesthetic form, and it traces that account to a surprising source: mathematics. Drawing on literature, art, and photography, it explores how the Victorian mathematical conception of form still resonates today.

Accounts of theistic faith according to which it does not involve referring to or believing in God as existing independently of the life of faith are instances of theistic reductionism. Theistic reductionism, in holding that ‘God’ does not refer to reality outside the life of believers, holds thereby that theism is not rightly to be regarded as true or false. Such accounts may be proposed or used as defenses of theistic faith. They ‘defend’ faith insofar as they describe the form (...) of life faith involves and show that the human and cultural functions it performs are valuable. Examining several reductionist accounts, ordered from weaker to stronger, I argue that they fail as defenses of theistic life and language. Whereas the reductionist views claim to leave the practice of theism as it is, I argue that in fact they imply a different form of life from the one theism actually is. Thus reductionist defenses of religious practice fail and fail precisely where they insist on treating God in some way other than as existing outside of religious life. From this I infer that theism as it exists can only be defended in ways that include taking ‘God’ as referring to a God who is real outside the life which recognizes him. The religious reductionists discussed include R.B. Braithwaite, P.F. Schmidt, Paul Holmer, Paul van Buren, Gordon Kaufman, and D.Z. Phillips. (shrink)

Yoshida considers two broad understandings of how social scientists can and should “describe and explain other cultures or their aspects under concepts of rationality” . In the one corner is a family of approaches that Yoshida finds deeply flawed: cultural interpretivist approaches. Five authors representative of this family are given fine chapter length examinations: Winch, Taylor, Geertz, Sahlins, and Obeyesekere. In the other corner is Yoshida’s favored approach: critical rationalism. This approach is associated with the intellectual descendants of Karl Popper—notably (...) Jarvie and Agassi. It is presented in outline and treated as the clear winner. By virtue of not having the defects that are diagnosed in the interpretivist approaches, critical rationalism is presented as the fitting approach in the social sciences. This dialectical structure has two notable weaknesses: First, showing that one item, A, lacks the problems found in another item, B, should not be take .. (shrink)

Volume 19, Issue 11, November 2019, Page 42-44.

The word “beautiful” plays a surprisingly unimportant part in the language of sophisticated artistic appreciation; I mean in the informed criticism and comparison of specific works of art. Though in ordinary conversation it can be used naturally and easily, it does not serve readily as a technical term in expert writing or discussion. To become a technical term of this kind it would have to be definable, and definable in terms which commanded sufficient agreement: but attempts to define “beauty” and (...) “beautiful” may well have become restrained by the popularity of philosophical discussion about the significance of these words. No philosophical question is discussed more commonly or from more firmly held opposite positions than the question whether beauty is “objective” or not. Discussion of this and related topics, however, not being the monopoly of professed philosophers but being familiar amongst artists and art critics themselves, tends to remove all shadow of technicality from the crucial terms discussed. Other terms come to serve for the “objective” features of works of art, and others again for the impressions which works of art may make upon us: “beauty” and “beautiful” tend to fall away between these two classes. (shrink)

In 1963 Duchamp described his vertical installation of three Readymades at the Pasadena Art Museum as “readymade talk of what goes on in the Large Glass.” Elsewhere, he spoke of the Readymades as “vehicles for unloading ideas,” and during the years 1912-15 his mind was filled with ideas as he invented the “playful physics” for his techno-scientific allegory of quest, The Bride Stripped Bare by Her Bachelors, Even [The Large Glass]. This essay argues that the “ideas” being unloaded in the (...) Readymades were rooted in his extensive study of contemporary science and technology as well as the biographical experience of his stay at Herne Bay on the English seacoast during August 1913. Readymades addressed include the Bicycle Wheel, With Hidden Noise, Paris Air, and Fresh Widow. Central themes include string or thread, traced from his preoccupation with tennis during his holiday, and the impact of the electrical spectacle of the illuminated Pier Pavilion at Herne Bay. (shrink)