Interoception can be broadly defined as the sense of signals originating within the body. As such, interoception is critical for our sense of embodiment, motivation, and well-being. And yet, despite its importance, interoception remains poorly understood within modern science. This paper reviews interdisciplinary perspectives on interoception, with the goal of presenting a unified perspective from diverse fields such as neuroscience, clinical practice, and contemplative studies. It is hoped that this integrative effort will advance our understanding of how interoception determines well-being, (...) and identify the central challenges to such understanding. To this end, we introduce an expanded taxonomy of interoceptive processes, arguing that many of these processes can be understood through an emerging predictive coding model for mind–body integration. The model, which describes the tension between expected and felt body sensation, parallels contemplative theories, and implicates interoception in a variety of affective and psychosomatic disorders. We conclude that maladaptive construal of bodily sensations may lie at the heart of many contemporary maladies, and that contemplative practices may attenuate these interpretative biases, restoring a person’s sense of presence and agency in the world. (shrink)

Enhancing body awareness has been described as a key element or a mechanism of action for therapeutic approaches often categorized as mind-body approaches, such as yoga, TaiChi, Body-Oriented Psychotherapy, Body Awareness Therapy, mindfulness based therapies/meditation, Feldenkrais, Alexander Method, Breath Therapy and others with reported benefits for a variety of health conditions. To better understand the conceptualization of body awareness in mind-body therapies, leading practitioners and teaching faculty of these approaches were invited as well as their patients to participate in focus (...) groups. The qualitative analysis of these focus groups with representative practitioners of body awareness practices, and the perspectives of their patients, elucidated the common ground of their understanding of body awareness. For them body awareness is an inseparable aspect of embodied self awareness realized in action and interaction with the environment and world. It is the awareness of embodiment as an innate tendency of our organism for emergent self-organization and wholeness. The process that patients undergo in these therapies was seen as a progression towards greater unity between body and self, very similar to the conceptualization of embodiment as dialectic of body and self described by some philosophers as being experienced in distinct developmental levels. (shrink)

Objectives - To explore the wvay ethical principles develop during a medical education course for three groups of medical students - in their first year, at the beginning of their penultimate (fifth) year and towards the end of their final (sixth) year. Design - Survey questionnaire administered to medical students in their first, fifth and final (sixth) year. Setting - A large medical school in Queensland, Australia. Survey sample - Approximately half the students in each of three years (first, fifth (...) and sixth) provided data on a voluntary basis, a total of 385 students. Results - At the point of entry, minor differences were found between medical students and first year law and psychology students. More striking were differences between male and female medical students, suggesting early socialization had a substantial impact here. Conclusions - Results indicate that substantial changes in attitude have developed by the beginning of fifth year with little change thereafter. Gender difference persisted. Some difference in ethical attitudes were found when groups of different ethnic backgrounds were compared. The impact of a move to a graduate medical course, which gives high priority to ethics within a professional development domain, can now be evaluated. (shrink)

It has been 35 years since the publicationMelzack and Wall's Gate Control Theory whichhypothesized that nociceptive information wassubject to dynamic regulation by mechanismslocated in the spinal cord dorsal horn thatcould ultimately lead to hyperalgesic orhypoalgesic states. This paper examines GateControl Theory in light of our currentunderstanding of the neuroanatomical,neurophysiological and neurochemical substratesof nociception and antinociception. Despiteits initial controversies, no one has proposeda more comprehensive overall theory of painmodulation or has successfully refuted most ofthe basic tenets of this theory.

The issue of directed donation of organs from deceased donors for transplantation has recently risen to the fore, given greater significance by the relatively stagnant rate of deceased donor donation in the UK. Although its status and legitimacy is explicitly recognized across the USA, elsewhere a more cautious, if not entirely negative, stance has been taken. In England, Wales and Northern Ireland, the Human Tissue Act 2004, and in Scotland the Human Tissue (Scotland) Act 2006, are both silent in this (...) regard. Although so-called conditional donation, donation to (or perhaps withheld from) a specific class, has been outlawed as a product of guidance issued by the Secretary of State for Health issued in the wake of the controversial incident occurring in the North of England in 1998, its intended application to ‘directed’ donation is less certain. Directed and conditional donations challenge the traditional construct of altruistic donation and impartial (equitable) allocation in a very immediate and striking fashion. They implicitly raise important questions as to whether the body or parts of the body are capable of being owned, and by whom. This paper attempts to explore the notion of donor ownership of body parts and its implications for both directed and conditional donation. (shrink)

This study examines the use of a modified form of the theory of planned behavior in understanding the decisions of undergraduate students in engineering and humanities to engage in cheating. We surveyed 527 randomly selected students from three academic institutions. Results supported the use of the model in predicting ethical decision-making regarding cheating. In particular, the model demonstrated how certain variables (gender, discipline, high school cheating, education level, international student status, participation in Greek organizations or other clubs) and moral constructs (...) related to intention to cheat, attitudes toward cheating, perceptions of norms with respect to cheating, and ultimately cheating behaviors. Further the relative importance of the theory of planned behavior constructs was consistent regardless of context, whereas the contributions of variables included in the study that were outside the theory varied by context. Of particular note were findings suggesting that the extent of cheating in high school was a strong predictor of cheating in college and that engineering students reported cheating more frequently than students in the humanities, even when controlling for the number of opportunities to do so. (shrink)

Mosher and Bond (this issue) suggest experimental designs that are not appropriate for the research purposes they criticize. In defending their own research, they make contradictory statements about the realism of their guided imagery procedure for simulating rape. They present data that we believe provide evidence for the possibility that wrongful harm occurred in their previous research. We assert our right to study the ethics of research and object to specious charges of having threatened sexual freedom and being associated with (...) ideologues of the right and left. (shrink)

BackgroundSocio-cultural perceptions surrounding death have profoundly changed since the 1950s with development of modern intensive care and progress in solid organ transplantation. Despite broad support for organ transplantation, many fundamental concepts and practices including brain death, organ donation after circulatory death, and some antemortem interventions to prepare for transplantation continue to be challenged. Attitudes toward the ethical issues surrounding death and organ donation may influence support for and participation in organ donation but differences between and among diverse populations have not (...) been studied.ObjectivesIn order to clarify attitudes toward brain death, organ donation after circulatory death and antemortem interventions in the context of organ donation, we conducted a scoping review of international English-language quantitative surveys in various populations.Study appraisalA search of literature up to October 2020 was performed, using multiple databases. After screening, 45 studies were found to meet pre-specified inclusion criteria.Results32 studies examined attitudes to brain death, predominantly in healthcare professionals. In most, around 75% of respondents accepted brain death as equivalent to death of the person. Less common perspectives included equating death with irreversible coma and willingness to undertake organ donation even if it caused death. 14 studies examined attitudes to organ donation following circulatory death. Around half of respondents in most studies accepted that death could be confidently diagnosed after only 5 min of cardiorespiratory arrest. The predominant reason was lack of confidence in doctors or diagnostic procedures. Only 6 studies examined attitudes towards antemortem interventions in prospective organ donors. Most respondents supported minimally invasive procedures and only where specific consent was obtained.ConclusionsOur review suggests a considerable proportion of people, including healthcare professionals, have doubts about the medical and ethical validity of modern determinations of death. The prognosis of brain injury was a more common concern in the context of organ donation decision-making than certainty of death. (shrink)

BackgroundAustralian health and medical research funders support substantial research efforts, and incentives within grant funding schemes influence researcher behaviour. We aimed to determine to what extent Australian health and medical funders incentivise responsible research practices.MethodsWe conducted an audit of instructions from research grant and fellowship schemes. Eight national research grants and fellowships were purposively sampled to select schemes that awarded the largest amount of funds. The funding scheme instructions were assessed against 9 criteria to determine to what extent they incentivised (...) these responsible research and reporting practices: publicly register study protocols before starting data collection, register analysis protocols before starting data analysis, make study data openly available, make analysis code openly available, make research materials openly available, discourage use of publication metrics, conduct quality research, collaborate with a statistician, and adhere to other responsible research practices. Each criterion was answered using one of the following responses: “Instructed”, “Encouraged”, or “No mention”.ResultsAcross the 8 schemes from 5 funders, applicants were instructed or encouraged to address a median of 4 of the 9 criteria. Three criteria received no mention in any scheme. Importantly, most incentives did not seem strong as applicants were only instructed to register study protocols, discourage use of publication metrics and conduct quality research. Other criteria were encouraged but were not required.ConclusionsFunders could strengthen the incentives for responsible research practices by requiring grant and fellowship applicants to implement these practices in their proposals. Administering institutions could be required to implement these practices to be eligible for funding. Strongly rewarding researchers for implementing robust research practices could lead to sustained improvements in the quality of health and medical research. (shrink)

In the United States, there is no consensus about who should make decisions in acute but non-emergent situations for incapacitated patients who lack surrogates. For more than a decade, our academic medical center has utilized community volunteers from the hospital ethics committee to engage in shared decision-making with the medical providers for these patients. In order to add a different point of view and minimize conflict of interest, the volunteers are non-clinicians who are not employed by the hospital. Using case (...) examples and interviews with the community members, this paper describes how the protocol has translated into practice over the years since its inception. Members reported comfort with the role as well as satisfaction with the thoroughness of their discussions with the medical team. They acknowledged feelings of moral uncertainty, but expressed confidence in the process. Questions raised by the experience are discussed. Overall, the protocol has provided oversight, transparency, and protection from conflict of interest to the decision-making process for this vulnerable patient population. (shrink)

A new approach to environmental policy analysis is introduced that is designed to mitigate the exacerbation of environmental problems, which can result from the application of traditional approaches in environmental decision making. These approaches are problematic because they tend to rely on technical fixes, a single-discipline focus, and optimality. When such traditional approaches are applied, complex environmental problems are simplified beyond recognition, and the solution produced no longer matches the original problem. An alternative approach has been developed at the U.S. (...) Environmental Protection Agency (EPA) that is designed to improve the utilization of scientific research results and data (social, physical, and biological) through a more inclusive problem-solving process aimed particularly at difficult and complex environmental issues. Using a policy application pertaining to the EPA’s 1995 decision to approve a fuel additive, the authors illustrate how integrated environmental policy decision analysis can be made operational using this new approach. (shrink)

Gilbert and colleagues point out the discrepancy between the limited empirical data illustrating changes in personality following implantation of deep brain stimulating electrodes and the vast number of conceptual neuroethics papers implying that these changes are widespread, deleterious, and clinically significant. Their findings are reminiscent of C. P. Snow’s essay on the divide between the two cultures of the humanities and the sciences. This division in the literature raises significant ethical concerns surrounding unjustified fear of personality changes in the context (...) of DBS and negative perceptions of clinician-scientists engaged in DBS. These concerns have real world implications for funding future innovative, DBS trials aimed to reduce suffering as well as hampering true interdisciplinary scholarship. We argue that the philosophical tradition of pragmatism and the value it places on empirical inquiry, experiential knowledge, and inter-disciplinary scholarship – reflecting diverse ways of knowing – provides a framework to start to address the important questions Gilbert and colleagues raise. In particular, we highlight the importance of expert clinician knowledge in contributing to the neuroethical questions raised by Gilbert and colleagues. Finally, we provide illustrative examples of some of our interdisciplinary empirical research that demonstrate the iterative cycle of inquiry characteristic of pragmatism in which conceptual neuroethics questions have led to empirical studies whose results then raise additional conceptual questions that give rise to new empirical studies in a way that highlights the contributions of the humanities and the sciences. (shrink)

Gilbert and colleagues point out the discrepancy between the limited empirical data illustrating changes in personality following implantation of deep brain stimulating electrodes and the vast number of conceptual neuroethics papers implying that these changes are widespread, deleterious, and clinically significant. Their findings are reminiscent of C. P. Snow’s essay on the divide between the two cultures of the humanities and the sciences. This division in the literature raises significant ethical concerns surrounding unjustified fear of personality changes in the context (...) of DBS and negative perceptions of clinician-scientists engaged in DBS. These concerns have real world implications for funding future innovative, DBS trials aimed to reduce suffering as well as hampering true interdisciplinary scholarship. We argue that the philosophical tradition of pragmatism and the value it places on empirical inquiry, experiential knowledge, and inter-disciplinary scholarship – reflecting diverse ways of knowing – provides a framework to start to address the important questions Gilbert and colleagues raise. In particular, we highlight the importance of expert clinician knowledge in contributing to the neuroethical questions raised by Gilbert and colleagues. Finally, we provide illustrative examples of some of our interdisciplinary empirical research that demonstrate the iterative cycle of inquiry characteristic of pragmatism in which conceptual neuroethics questions have led to empirical studies whose results then raise additional conceptual questions that give rise to new empirical studies in a way that highlights the contributions of the humanities and the sciences. (shrink)

Gilbert and colleagues point out the discrepancy between the limited empirical data illustrating changes in personality following implantation of deep brain stimulating electrodes and the vast number of conceptual neuroethics papers implying that these changes are widespread, deleterious, and clinically significant. Their findings are reminiscent of C. P. Snow’s essay on the divide between the two cultures of the humanities and the sciences. This division in the literature raises significant ethical concerns surrounding unjustified fear of personality changes in the context (...) of DBS and negative perceptions of clinician-scientists engaged in DBS. These concerns have real world implications for funding future innovative, DBS trials aimed to reduce suffering as well as hampering true interdisciplinary scholarship. We argue that the philosophical tradition of pragmatism and the value it places on empirical inquiry, experiential knowledge, and inter-disciplinary scholarship – reflecting diverse ways of knowing – provides a framework to start to address the important questions Gilbert and colleagues raise. In particular, we highlight the importance of expert clinician knowledge in contributing to the neuroethical questions raised by Gilbert and colleagues. Finally, we provide illustrative examples of some of our interdisciplinary empirical research that demonstrate the iterative cycle of inquiry characteristic of pragmatism in which conceptual neuroethics questions have led to empirical studies whose results then raise additional conceptual questions that give rise to new empirical studies in a way that highlights the contributions of the humanities and the sciences. (shrink)

Recently, Hosmer (1994a) proposed a model linking right, just, and fair treatment of extended stakeholders with trust and innovation in organizations. The current study tests this model by using Victor and Cullen''s (1988) ethical work climate instrument to measure the perceptions of the right, just, and fair treatment of employee stakeholders.In addition, this study extends Hosmer''s model to include the effect of right, just, and fair treatment on employee communication, also believed to be an underlying dynamic of trust.More specifically, the (...) current study used a survey of 111 managers to test (1) whether right, just, and fair treatment influences trust, both directly as well as indirectly via communication, and (2) whether trust influences perceptions of commitment and innovation. Strong support for the study''s hypotheses and Hosmer''s (1994a) model was found. Such findings support those who argue that moral management may be good management. (shrink)

Research has established that exposure to a combination of diagnostic (i.e., relevant) and nondiagnostic (i.e., irrelevant) information results in predictions that are more regressive than predictions based on diagnostic information (Hackenbrack, 1992; Hoffman and Patton, 1997). This phenomenon has been labeled the dilution effect (e.g., Tetlock and Boettger, 1989) and has been documented when individuals make predictions. This study tests for the dilution effect when small groups make predictions, and examines the effect of using a procedure designed to reduce the (...) dilution effect. Results indicate that group predictions are influenced by nondiagnostic information in the same manner as are individual predictions, and allowing participants to rate the diagnosticity of information prior to making predictions does not reduce the dilution effect. (shrink)

Research has established that exposure to a combination of diagnostic (i.e., relevant) and nondiagnostic (i.e., irrelevant) information results in predictions that are more regressive than predictions based on diagnostic information (Hackenbrack, 1992; Hoffman and Patton, 1997). This phenomenon has been labeled the dilution effect (e.g., Tetlock and Boettger, 1989) and has been documented when individuals make predictions. This study tests for the dilution effect when small groups make predictions, and examines the effect of using a procedure designed to reduce the (...) dilution effect. Results indicate that group predictions are influenced by nondiagnostic information in the same manner as are individual predictions, and allowing participants to rate the diagnosticity of information prior to making predictions does not reduce the dilution effect. (shrink)

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One reason why we find the causal theory of reference so interesting is because it provides an account of de re necessity. Necessity is not only predicated of statements but also of objects. It is not only discovered by means of linguistic analysis but also by means of empirical investigation. And this means that truths we once described as contingent turn out to be necessary after all. We may think that this account of de re necessity is due to the (...) causal theorists' open acceptance of essentialism. Certainly essentialism provides an account of de re necessity. The problem, however, is that the causal theorists do not prove essentialism so much as presuppose it. Nevertheless, they still provide an account of de re necessity - an account of de re necessity that owes nothing to essentialism. And it is this account of necessity that I plan to discuss in this paper. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Two Stories in One: Literature as a Hidden Door to the History of Seventeenth-Century FranceChristian Jouhaud (bio)Translated by Cynthia J. Koepp (bio)I would like to take you into the history of seventeenth-century France through a narrow door—a door that is not only narrow but hidden. Why should we struggle to squeeze through this passage? Well, there are at least two reasons. First, it is an attempt to experience (...) a disorienting perspective on a landscape that we believe we already know completely; and second, the narrowness of the path underlines its particularity and in that way elicits a comparison with other paths elsewhere. This narrow passage is a text, perhaps an insignificant one, written by a seventeenth-century author. After making a few observations concerning its mechanics, I will use this text as a model to interpret something else, to understand it as something that stimulates thinking about historiographical hypotheses: as a convenient tool to shake up the political history of seventeenth-century France. In other words, I propose to utilize literature as a hidden door in order to enter the arena of political history, where we usually do not find any door at all.Deux histoires en une, or Two Stories in One, is a brief text by Jean-Louis Guez de Balzac, a work of uncertain status, published among dozens of other pieces in a collection known by two titles: Moral Treatises and Conversations. Guez de Balzac, who lived between 1595 and 1654, does not appear on the short list of the most celebrated writers of seventeenth-century France: Molière, Racine, Corneille, La Fontaine, Sévigné, Bossuet. At the time, however, he occupied center stage in French literary life. He was perhaps the first author recognized as a grand écrivain; he was widely admired, celebrated, criticized. At the center of protracted literary debates, Guez de Balzac exercised an immense critical authority in the world of belles lettres.Since I first began working on the question of the birth of literature as a specific social space in seventeenth-century France, I have not stopped reading and rereading Balzac’s Two Stories in One. This text resists interpretation—even comprehension. It gives the reader the feeling—to be honest, an exasperating feeling—of extraordinary richness and also of an extraordinary capacity to steal away from view. The importance of this text for the comprehension of something other than itself, however, has become clear to me. This leapt out at me, by chance, when I was reading it for the nth time—at nearly the same time that I was rereading several pages of Marcel Proust. Not that the author of À la recherche du temps perdu had any connection at all to Guez de Balzac. Rather, it was Proust’s evoking, in his way, two stories in one—or rather one story in two parts—that for me rendered suddenly palpable something of the force of Balzac’s text.At the beginning of À l’ombre des jeunes filles en fleurs, Proust meditates on the story of Swann before and after his marriage. He emphasizes our incapacity to think of two successive states in the history of our life at the same time: for example, that of a jealous lover and that of an appeased husband. If one succeeds in thinking both things at once, the two moments then cease to appear distinct to us, and are mixed up one in the other. If the [End Page 92] mind wants to distinguish them, it loses the ability to think them both at once. I would like to propose an hypothesis that the import of Balzac’s Two Stories in One, contrary to Proust, is an attempt to open up to speculation an improbable space, a space imperceptible to sensory experience. This space lies at the interstice of “both at once” and “separately.” Thus Balzac attempts to escape the dilemma of superimposition (that is to say, fusion) or of succession (that is, separation). He attempts to subvert the elementary rule of logic that states that “a” is either different from “b” or is the same as “b.”What is striking when one first reads Two Stories in... (shrink)

Understanding the nature of pain at least partly depends on recognizing its inherent first person epistemology and on using a first person experiential and third person experimental approach to study it. This approach may help to understand some of the neural mechanisms of pain and consciousness by integrating experiential–phenomenological methods with those of neuroscience. Examples that approximate this strategy include studies of second pain summation and its relationship to neural activities and brain imaging-psychophysical studies wherein sensory and affective qualities of (...) pain are correlated with cerebral cortical activity. The experiential paradigm of Price and Barrell offers the possibility of improved designs and methods for investigating neural mechanisms underlying pain and consciousness. (shrink)

To extend the hypothesis that bizarre discontinuities in dreams result from the interaction of chaotic, "bottom-up" brainstem activation with "top-down" cortical synthesis, we have performed a detailed analysis of dream discontinuities using a new methodology that allows for objective characterization of this formal dream feature. Transformations of characters and objects in dream reports were found to follow definite associational rules. While there were 11 examples of character–character transformation and 7 of inanimate object–inanimate object transformation, transformations of characters into inanimate objects (...) and vice versa were never observed. Judges′ scores on a transformation-matching task further showed that the nature of the transformed character or object is highly constrained by the features of the initial character or object . We conclude that despite the threat to dream coherence posed by bizarre discontinuities, significant coherence is maintained by associational constraints, especially in the case of object and character transformations. (shrink)

This article argues that Durkheim's theory of suicide is deficient because of its monocausal reasoning, its conception of suicide as an action without subjects, and its characterization of preliterate societies as harmonious, self-contained, and morphologically static. It shows that these deficiencies can be overcome by including cultural and social-psychological considerations in the analysis of suicide-specifically by including culture as a causal force in its own right and drawing links between social circumstances, cultural beliefs and values, and individual dispositions. The authors (...) make their case by analyzing ethnographic and quantitative data on the preliterate Guarani-Kaiowá of southwestern Brazil, one of the most suicide-prone groups in the world. (shrink)

The article Pragmatismand the Importance of Interdisciplinary Teams in Investigating Personality Changes Following DBS.

Persons with serious and disabling medical conditions have traveled abroad in search of stem cell treatments in recent years. However, weak or nonexistent oversight systems in some countries provide insufficient patient protections against unproven stem cell treatments, raising concerns about exposure to harm and exploitation. The present article, the first of two, describes and analyzes stem cell tourism in Russia and India and addresses several scientific/medical, ethical, and policy issues raised by the provision of unproven stem cell-based treatments within them. (...) The distinction between treatment based on proven clinical research and "innovative treatment" is addressed and the authors conclude that the innovations at issue constitute neither. Regulatory measures need to be developed or strengthened in accord with internationally accepted standards in such countries to protect those seeking stem cell treatments. (shrink)

Understanding the nature of pain at least partly depends on recognizing its inherent first person epistemology and on using a first person experiential and third person experimental approach to study it. This approach may help to understand some of the neural mechanisms of pain and consciousness by integrating experiential–phenomenological methods with those of neuroscience. Examples that approximate this strategy include studies of second pain summation and its relationship to neural activities and brain imaging-psychophysical studies wherein sensory and affective qualities of (...) pain are correlated with cerebral cortical activity. The experiential paradigm of Price and Barrell offers the possibility of improved designs and methods for investigating neural mechanisms underlying pain and consciousness. (shrink)

Clinics and hospitals around the globe are offering stem cell treatments to persons with serious conditions for whom no effective therapies are available in their home countries. Many of these treatments, which are touted as cures for such conditions as Parkinson's and Alzheimer's Diseases, multiple sclerosis, and spinal cord injuries, have not gone through clinical trials that establish their safety and efficacy. Indeed, it is unclear whether some of them even utilize stem cells. State regulation of these therapies tends to (...) be weak or nonexistent in some of the countries in which they are offered. This puts those who believe they must travel abroad for stem cell treatments at risk of injury from procedures that .. (shrink)

Issues-driven shareholder activism suggests that specific issue characteristics brought by shareholders, a group to which firms are obligated to respond, interact in a way that affects the materiality of the issue in the eyes of the modern corporation. Relevant issue characteristics include: issue type, social significance, and issue life cycle stage.