Supported decision making, as outlined by Peterson et al. highlights real-world challenges in the messy context of clinical care. We agree with Peterson et al. that patients...

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)

As clinical trials end, little is understood about how participants exiting from clinical trials approach decisions related to the removal or post-trial use of investigational brain implants, such as deep brain stimulation (DBS) devices. This empirical bioethics study examines how research participants experience the process of exit from research at the end of clinical trials of implanted neural devices. Using a modified grounded theory study design, we conducted semi-structured, in-depth interviews with 16 former research participants from clinical trials of DBS (...) and responsive neurostimulation (RNS). Open-ended questions elicited motivations for joining the trial, understanding of study procedures at the time of initial informed consent, the process of exiting from research, and decisions about device removal or post-trial device use. Thematic analysis identified categories related to: limited preparedness for the end of research participation, straightforwardness of decisions to explant or keep the device, reconciling with the end of research participation, reconciling post-trial expectations, and achieving a sense of closure after exit from research. A preliminary theoretical model describes contextual factors influencing the process and experience of exit from research. Experiences of clinical trial participants should guide research practices to enhance the ethical design and conduct of clinical trials in DBS and other brain devices. (shrink)

Complex clinical ethics cases require a blend of compassion, sensitivity, and tenacity in order to navigate the hard work required of stakeholders. Each person comes to the table with rich historie...

Fox and her colleagues (2007) present an important and foundational study concerning the character of current ethics consultation services (ECSs). Although we have some concerns regarding the gener...

Objective: To examine changes in patients’ desired control of the deep brain stimulator and perception of global life control throughout DBS.Methods: A consecutive cohort of 52 patients with Parkinson’s disease was recruited to participate in a prospective longitudinal study over three assessment points. Semi-structured interviews assessing participants’ desire for stimulation control and perception of global control were conducted at all three points. Qualitative data were coded using content analysis. Visual analog scales were embedded in the interviews to quantify participants’ perceptions (...) of control over time.Results: Participants reported significant increases in their perception of global control over time and significant declines in their desired control of the stimulation. These changes were unrelated to improvements in motor symptoms. Improvements in global control were negatively correlated with a decline in desired stimulation control. Qualitative data indicate that participants have changed, nuanced levels of desired control over their stimulators. Increased global life control following DBS may be attributed to increased control over PD symptoms, increased ability to engage in valued activities, and increased overall self-regulation, while other domains related to global control remained unaffected by DBS.Conclusions: There are few empirical data documenting patients’ desire for stimulation control throughout neuromodulation and how stimulation control is related to other aspects of control despite the growing application of neuromodulation devices to treat a variety of disorders. Our data highlight distinctions in different types of control and have implications for the development of patient-controlled neurostimulation devices. (shrink)

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

The ethical recruitment of participants with neurological disorders in clinical research requires obtaining initial and ongoing informed consent. The purpose of this study is to characterize barriers faced by research personnel in obtaining informed consent from research participants with neurological disorders and to identify strategies applied by researchers to overcome those barriers. This study was designed as a web-based survey of US researchers with an optional follow-up interview. A subset of participants who completed the survey were selected using a stratified (...) purposeful sampling strategy and invited to participate in an in-depth qualitative interview by phone or video conference. Data were analyzed using a mixed methods approach, including content analysis of survey responses and thematic analysis of interview responses. Over 1 year, 113 survey responses were received from US research personnel directly involved in obtaining informed consent from participants in neurological research. Frequently identified barriers to informed consent included: cognitive and communication impairments (e.g. aphasia), unrealistic expectations of research participants, mistrust of medical research, time constraints, literacy barriers, lack of available social support, and practical or resource-related constraints. Strategies to enhance informed consent included: involving close others to support participant understanding of study-related information, collaborating with more experienced research personnel to facilitate training in obtaining informed consent, encouraging participants to review consent forms in advance of consent discussions, and using printed materials and visual references. Beyond conveying study-related information, researchers included in this study endorsed ethical responsibilities to support deliberation necessary to informed consent in the context of misconceptions about research, unrealistic expectations, limited understanding, mistrust, and/or pressure from close others. Findings highlight the importance of training researchers involved in obtaining informed consent in neurological research to address disease-specific challenges and to support the decision-making processes of potential research participants and their close others. (shrink)

This book is a collection of secondary essays on America's most important philosophic thinkers—statesmen, judges, writers, educators, and activists—from the colonial period to the present. Each essay is a comprehensive introduction to the thought of a noted American on the fundamental meaning of the American regime.

Recovering Reason: Essays in Honor of Thomas L. Pangle is a collection of essays composed by students and friends of Thomas L. Pangle to honor his seminal work and outstanding guidance in the study of political philosophy. These essays examine both Socrates' and modern political philosophers' attempts to answer the question of the right life for human beings, as those attempts are introduced and elaborated in the work of thinkers from Homer and Thucydides to Nietzsche and Charles Taylor.

This collection of essays, offered in honor of the distinguished career of prominent political philosophy professor Clifford Orwin, brings together internationally renowned scholars to provide a wide context and discuss various aspects of the virtue of “humanity” through the history of political philosophy.

This collection of essays, offered in honor of the distinguished career of prominent political philosophy professor Clifford Orwin, brings together internationally renowned scholars to provide a wide context and discuss various aspects of the virtue of “humanity” through the history of political philosophy.

Background: There is little research into medical students’ or doctors’ attitudes to abortion, yet knowing this is important, as policy makers should be aware of the views held by professionals directly involved in abortion provision and changing views may have practical implications for the provision of abortion in the future. Methods: We surveyed 300 medical students about their views on abortion, their beliefs about the status of the fetus and the rights of the mother, their attitude towards UK law and (...) their willingness to be involved in abortion provision as qualified doctors. Results: 62% of medical students were pro-choice, 33% pro-life and 7% undecided. Students’ views correlated with gender, year of study and holding a religious belief. Their beliefs about abortion, the status of the fetus and the rights of women significantly correlated with their attitudes towards the UK law and their willingness to be involved in abortion provision. Students’ willingness to be involved in abortion provision was related to their views on abortion, the extent of participation required, the circumstances of the pregnancy and the stage of pregnancy. Conclusions: The percentage of pro-choice students was lower than that found in research on general practitioners’ attitudes to abortion. It is unclear whether this is because students become more pro-choice as they progress through their medical career or because there is genuinely a change in attitudes to abortion. (shrink)

To all appearances, the basic building blocks of reality tend to keep existing unless something intervenes to destroy them. In other words, basic things seem to have existential inertia. But why might this be? This paper considers a number of arguments for and against existential inertia. It discusses arguments inspired by Aquinas, Descartes, and Spinoza, as well as considerations deriving from Occam’s Razor, entropy, and certain views about the nature of time and change.

There have been a number of attempts to apply mechanism-related concepts to the notion of extended cognition. Such accounts appeal to the idea that extended cognitive routines are realized by mechanisms that transcend some salient border or boundary. The present paper describes some of the challenges confronting the effort to develop a mechanistic account of extended cognition. In particular, it describes five problems that must be resolved if we are to make sense of the idea that extended cognition can be (...) understood via an appeal to extended mechanisms. These problems are intended to guide the philosophical effort to develop a mechanistic account of extended cognition. (shrink)

This article explores the notion of the Web-extended mind, which is the idea that the technological and informational elements of the Web can sometimes serve as part of the mechanistic substrate that realizes human mental states and processes. It is argued that while current forms of the Web may not be particularly suited to the realization of Web-extended minds, new forms of user interaction technology as well as new approaches to information representation do provide promising new opportunities for Web-based forms (...) of cognitive extension. In addition, it is suggested that extended cognitive systems often rely on the emergence of social practices and conventions that shape how a technology is used. Web-extended minds may thus depend on forms of socio-technical co-evolution in which social forces and factors play just as important a role as do the processes of technology design and development. (shrink)

Mandevillian intelligence is a specific form of collective intelligence in which individual cognitive vices are seen to play a positive functional role in yielding collective forms of cognitive success. The present paper introduces the concept of mandevillian intelligence and reviews a number of strands of empirical research that help to shed light on the phenomenon. The paper also attempts to highlight the value of the concept of mandevillian intelligence from a philosophical, scientific and engineering perspective. Inasmuch as we accept the (...) notion of mandevillian intelligence, then it seems that the cognitive and epistemic value of a specific social or technological intervention will vary according to whether our attention is focused at the individual or collective level of analysis. This has a number of important implications for how we think about the design and evaluation of collective cognitive systems. For example, the notion of mandevillian intelligence forces us to take seriously the idea that the exploitation of individual cognitive shortcomings could, in some situations, provide a productive route to collective forms of cognitive and epistemic success. (shrink)

Using astrology as a case study, this paper attempts to establish a criterion for demarcating science from pseudoscience. Numerous reasons for considering astrology to be a pseudoscience are evaluated and rejected; verifiability and falsifiability are briefly discussed. A theory is said to be pseudoscientific if and only if (1) it has been less progressive than alternative theories over a long period of time, and faces many unsolved problems, but (2) the community of practitioners makes little attempt to develop the theory (...) towards solutions of the problems, shows no concern for attempts to evaluate the theory in relation to others, and is selective in considering confirmations and disconfirmations. This criterion has the interesting consequence that a theory can be scientific at one time but pseudoscientific at another. (shrink)

"Evidence of a flight from reason is as old as human record-keeping: the fact of it certainly goes back an even longer way. Flight from science specifically, among the forms of rational inquiry, goes back as far as science itself... But rejection of reason is now a pattern to be found in most branches of scholarship and in all the learned professions."--from the introduction In the widely acclaimed Higher Superstition: The Academic Left and Its Quarrels with Science, Paul R. (...) Gross and Norman Levitt offered a spirited response to the "science bashers," raising serious questions about the growing criticism of scientific practice from humanists and social scientists on the academic left. Now, in The Flight from Science and Reason, Gross and Levitt are joined by Martin W. Lewis to bring together a diverse and distinguished group of scholars, scientists, and experts to engage these questions from a wide variety of perspectives. The authors take on critics of science whose views range from moderate to extreme, from social constructivists to deconstructionists, from creationists and feminists to Afro-centrists. They discuss the rise of "alternative medicine" and radical environmentalism (here skewered as "ecosentimentalism"). They explain why the "uncertainty principle" does not work as a metaphor for ambiguity, and why "chaos theory" cannot be invoked without an understanding of mathematics. Throughout, they grapple with the paradox inherent in arguing with opponents who contend that reason itself, and thus logic, is suspect. Distributed for the New York Academy of Sciences. (shrink)

Objective: To determine the views of people with multiple sclerosis (MS) and professionals in relation to confidentiality, consent and access to data within a proposed MS register in the UK. Design: Qualitative study using focus groups (10) and interviews (13). Setting: England and Northern Ireland. Participants: 68 people with MS, neurologists, MS nurses, health services management professionals, researchers, representatives from pharmaceutical companies and social care professionals. Results: People with MS expressed open and altruistic views towards the use of their personal (...) information to facilitate service provision and research, placing trust in responsible guardianship and legitimate use of their information. Participant’s proposed that people with MS should be able to select their individual level of involvement in a register using levels of consent. It was agreed that access to the register should be governed by a guardianship committee composed of a range of stakeholders. People with MS did not wish their details to be used by marketing agencies and did not consider this a legitimate use of their data. Whilst participants were positive of the role a register could play in promoting research, participants felt that access to data by pharmaceutical industries should be administered by the guardianship committee. People with MS are concerned should their employers be able to access their personal information. Professionals were more cautious than people with MS in their approach to the use of patient personal data within a register. Conclusions: Whilst all stakeholders were positive of the benefits of an MS register, development of such a resource must incorporate robust data security and guardianship measures in order to ensure that, whilst opportunities are maximised, risks to the privacy of individuals and legal challenges to professionals are avoided. (shrink)

The U.S. Constitution provides a framework for our laws, but what does it have to say about morality? Paul DeHart ferrets out that document’s implicit moral assumptions as he revisits the notion that constitutions are more than merely practical institutional arrangements. In _Uncovering the Constitution’s Moral Design_, he seeks to reveal, elaborate, and then evaluate the Constitution’s normative framework to determine whether it is philosophically sound—and whether it makes moral assumptions that correspond to reality. Rejecting the standard approach of (...) the intellectual historian, DeHart for the first time in constitutional theory applies the method of inference to the best explanation to ascertaining our Constitution’s moral meaning. He distinguishes the Constitution’s intention from the subjective intentions of the framers, teasing out presuppositions that the document makes about the nature of sovereignty, the common good, natural law, and natural rights. He then argues that the Constitution constrains popular sovereignty in a way that entails a real common good, transcendent of human willing and promotive of human well-being, but he points out that while the Constitution presupposes a real common good, it also implies a natural law that prescribes the common good. In critiquing previous attempts at describing and evaluating the Constitution’s normative framework, DeHart demonstrates that the Constitution’s moral framework corresponds largely to classical moral theory. He challenges the logical coherency of modern moral philosophy, normative positivism, and other theories that the Constitution has been argued to embody and offers a groundbreaking methodology that can be applied to uncovering the normative framework of other constitutions as well. This cogently argued study shows that the Constitution presupposes a natural law to which human law must conform, and it takes a major step in resolving current debates over the Constitution’s normative framework while remaining detached from the social issues that divide today’s political arena. _Uncovering the Constitution’s Moral Design_ is an original approach to the Constitution that marks a significant contribution to understanding the moral underpinnings of our form of government. (shrink)

While the dominant approaches to the current study of political philosophy are various, with some friendlier to religious belief than others, almost all place constraints on the philosophic and political role of revelation. Mainstream secular political theorists do not entirely disregard religion. But to the extent that they pay attention, their treatment of religious belief is seen more as a political or philosophic problem to be addressed rather than as a positive body of thought from which we might derive important (...) insights about the nature of politics and the truth of the human condition. In a one-of-a-kind collection, DeHart and Holloway bring together leading scholars from various fields, including political science, philosophy, and theology, to challenge the prevailing orthodoxy and to demonstrate the role that religion can and does play in political life. Contributing authors include such important thinkers as Peter Augustine Lawler, Robert C. Koons, J. Budziszewski, Francis J. Beckwith, and James Stoner. (shrink)

We argue that mereological essentialism for events is independent of mereological essentialism for objects, and that the philosophical fallout of embracing mereological essentialism for events is minimal. We first outline what we should consider to be the parts of events, and then highlight why one would naturally be inclined to think that the object-question and the event-question are linked. Then, we argue that they are not. We also diagnose why this is the case and emphasize the upshot. In particular, we (...) argue that the way we evaluate modal claims which concern events differs from the way we evaluate modal claims which concern objects. Ultimately, then, to our title question we say: the answer does not matter as much as you might think. (shrink)

This peer reviewed reference article is an annotated online bibliography on mereology with 80+ entries. It's aim is to provide a selective and balanced guide to the subject. It contains thematic headings with commentaries. The reader should come away cognizant of what the most influential work in mereology are. Topics highlighted herein include, but are not limited to: the history of mereology, classical extensional mereology and its challenges, parthood, connections with location relations, mereological simples and gunk, composition as identity, as (...) well as mereological essentialism, nihilism, and universalism. (shrink)

The difficulty about the naive realism which most people take for granted and which some empirical philosophers try to defend is that its proponents, in seeking to preserve the objective world of common sense, virtually read out of the picture the contribution of the perceiving subject and all that is involved in the relatedness of sense experience. The visual phenomena of perspective, distortion and hallucination, and the dependence of all other sense experience upon varying physiological factors in the percipient make (...) it well nigh impossible to believe that everything is just what we observe it to be; and the physicist's account of a world of electrical charges symbolized by mathematical formulae deals in conceptual terms which transcend sensual imagery. The resort to the sense-datum theory was but a desperate attempt on the part of philosophers to preserve the plain man's view of reality, though it left wholly obscure the relationship between the world of common sense experience and that of physical science, as well as positing a fantastic multiplication of entities corresponding to everything that could be observed under any circumstances. (shrink)

In The Langoliers, passengers on an airline flight wake to find that they’ve mysteriously travelled a few minutes back in time… a few minutes behind everyone else. They find that the world still exists, after ‘the present’ has moved on, but only for a short duration before the Langoliers—the timekeepers of eternity—arrive to remove it permanently from existence. This story prompts two interesting questions: How should we understand the nature of time in The Langoliers? Could the nature of time in (...) our world be the same as in The Langoliers? And, are the characters in The Langoliers really time travellers? In answering these questions, we can gain a greater understanding of the world depicted in The Langoliers, as well as of our own world. (shrink)

Early modern theorists linked the idea of sovereign power to a conception of absolute power developed during the medieval period. Ockham had reframed the already extant distinction between God's absolute and ordained powers in order to argue that God was free of moral constraint in ordaining natural law for human beings. Thus, the natural law could command the opposite of what God had ordained if He wished to make it so. Bodin extended Ockham's argument to earthly sovereigns, who do not (...) (he argued) have to obey civil law. However, Bodin undermined his absolutism by maintaining that civil law has to be consistent with natural and divine law. Hobbes more consistently argued that while mortal sovereigns are accountable to God, the power of sovereigns to command is not subject to moral constraints. Underlying Ockham's view of God's sovereignty, and Bodin's and Hobbes's view of earthly sovereigns, is a notion of the will's unconstrained power. But this notion is self-referentially incoherent. This incoherence, in turn, infects the very notion of sovereignty. (shrink)

H. L. A. Hart famously claimed that part of the appeal of natural law “doctrine” is the “independence” of natural law from divine and human authority. God, according to Hart, is not necessary to natural law. By way of contrast, J. Budziszewski argues that natural law really is law and that law qua law requires an enactor. Moreover, the only plausible candidate for the enactor of natural law as law is the author of nature—that is, God. In this essay I (...) argue that Budziszewski is right and Hart wrong. Law imposes obligations upon those under it, and obligations qua obligation are categorical rather than hypothetical imperatives. Categorical imperatives, in turn, require prescription. Consequently, prescription is necessary to any intelligible account of moral obligation. And prescription, finally, requires an authoritative prescriber. (shrink)