In this article I argue against the claim that “actual entity” and “actual occasion” are synonymous in Whitehead. My examination of these terms will help to illuminate the role of “society” in Whitehead’s philosophy and to prepare the way for a fruitful comparison of process thought and contemporary systems theory in the sciences.

The ‘death’ of German Idealism has been decried innumerable times since its revolutionary inception, whether it be by the 19th-century critique of Western metaphysics, phenomenology, contemporary French philosophy, or analytic philosophy. Yet in the face of two hundred years of sustained, extremely rigorous attempts to leave behind its legacy, German Idealism has resisted its philosophical death sentence. For this exact reason it is timely ask: What remains of German Idealism? In what ways does its fundamental concepts and texts still speak (...) to us? Drawing together new and established voices from scholars in Kant, Fichte, Hegel, and Schelling, this volume offers a fresh look on this time-honoured tradition. It uses myriad of recently developed conceptual tools to present new and challenging theories of its now canonical figures. (shrink)

Hastings Center Report, Volume 52, Issue 2, Page 21-31, March‐April 2022.

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Memory in Augustine’s Theological Anthropology by Paige E. HochschildJoseph T. Lienhard, S.J.Memory in Augustine’s Theological Anthropology. By Paige E. Hochschild. Oxford: Oxford University Press, 2012. Pp. 251. $125.00 (cloth). ISBN 978-0-19-964302-8.When students of St. Augustine consider his teaching on memory, they turn instinctively to the Confessions, book 10, and to On the Trinity, books 11 and 12. The lyrical passage in the Confessions is easy to teach and (...) intriguing in its contents. Paige Hochschild paints a much larger picture, drawing on far more sources. She also sees memory as a central category in Augustine’s thought. In the opening paragraph of the introduction, she describes memory (for Augustine) as the way the mind meets the world, as the way things external to the body are apprehended, as the way intelligible objects are known, and as what it means to be constituted in the image of God. This is a big order. And “order,” in Augustine’s sense, is key: the mind, as memory, brings order to the natural world, but also brings to light a providential order that is implicit in the sensible.The book is divided into three parts: (1) the philosophical tradition (Plato, Aristotle, and Plotinus), (2) Augustine’s earlier writings (from the Cassiciacum dialogues up to De magistro and De musica), and (3) the Confessions and De trinitate. The conclusion of this complex study is that memory is salvific: it accounts for the soul’s progress by the dialectical play of the knowledge and love of what is possessed, yet not possessed. The lifelong process of healing in which memory functions is fulfilled in contemplation.Two characteristics of Hochschild’s book can be mentioned at the outset. First, she studies each author diachronically, measuring progress and growth in the author’s thought, and particularly in his understanding of memory. Second, she readily invokes a wide range of categories to explain and illuminate her main topic. The book is anything but an extended encyclopedia article on “memoria in Augustine.” The two principal terms in the title, “memory” and “theological anthropology,” are richly developed and elaborated.Chapter 1 begins with a short note on Augustine’s knowledge of Plato. It is generally admitted that Augustine read some of the dialogues of Plato in translation: the Timaeus, the Republic (albeit only parts of it), the Phaedo, and the Phaedrus. Some of these works, at least, may have come down to him through doxographers. But Plato’s influence on Augustine remains shadowy. It is “Platonism,” and particularly Plotinus, that influences him so clearly, a point made memorably in Confessions 7.9.13-15, and its intriguing reference to the libri Platonicorum. Before all else, Platonism delivers Augustine from the bondage of materialism.Hochschild treats Plato’s doctrine of memory under four headings: sense perception, knowledge as recollection, divisions in the ways of knowing, and the practice of dialectic. In regard to sense perception, the sharp distinction (found in the Republic) between opinion (doxa) and knowledge (epistêmê) [End Page 144] needs to be refined, Hochschild avers. At least in some later works, the sensible is an image of the intelligible, and hence some sense perception can be infallible. On the next topic, Plato invokes recollection to explain direct apprehension of the forms, but recollection does not recall what was perceived in the past but is a restoration of a clear, logical relationship. The Republic introduces a new element, “the illuminative power of the Good” (21). The final section of chapter 1 treats dialectic, concluding that “knowledge is fulfilled in virtue, and the art of dialectic is not merely an exercise in definition, but a hexis, and a way of living” (27).Chapter 2, on Aristotle, begins with the observation that, if Plato’s influence on Augustine was indirect, Aristotle’s was even more indirect, reaching Augustine through Plotinus. Most familiar, of course, are Augustine’s account of reading Aristotle’s Categories during his days at Carthage (Confessions 4.16.28-31) and his later use of the categories of substance and relation in his understanding of the Trinity, creating the category of “substantial relation,” which would... (shrink)

ABSTRACT:Daniel Callahan died on July 16, 2019, just short of his 89th birthday. In the years since, we have seen the overturning of abortion rights, a concern central to his scholarship and musings about the place of religion in American civic life. Callahan’s journey from lay Catholic journalist and commentator at Commonweal to a co-founder of the Hastings Center, during his decade of doubt, is especially relevant today as America revisits established precedent governing a woman’s right to choose. His life-long (...) struggle with faith and the secularization of bioethics is a story worth telling, as it may foster dialogue across a divide between religious and laical thinkers that has fractured our political discourse. We recall Callahan’s misgivings about the marginalization of religious perspectives in public life; he sought not the denial of complexity nor of difference in views, but rather the importance of free and honest debate around deeply held beliefs, contextualized in the realities of the contemporary world. Callahan’s ambivalence about his faith remains a part of the fabric of American life, a story that Callahan chronicled to our collective benefit for over a half-century. (shrink)

_John Dewey and Continental Philosophy_ provides a rich sampling of exchanges that could have taken place long ago between the traditions of American pragmatism and continental philosophy had the lines of communication been more open between Dewey and his European contemporaries. Since they were not, Paul Fairfield and thirteen of his colleagues seek to remedy the situation by bringing the philosophy of Dewey into conversation with several currents in continental philosophical thought, from post-Kantian idealism and the work of Friedrich Nietzsche (...) to twentieth-century phenomenology, hermeneutics, and poststructuralism. This unique volume includes discussions comparing and contrasting Dewey with the German philosophers G. W. F. Hegel, Friedrich Nietzsche, Martin Heidegger, and Hans-Georg Gadamer on such topics as phenomenology, naturalism, organicism, contextualism, and poetry. Others investigate a series of connections between Dewey and contemporary French philosophy, including the notions of subjectivity, education, and the critique of modernity in Michel Foucault; language and politics in Jacques Derrida; and the concept of experience in Gilles Deleuze. Also discussed is the question of whether we can identify traces of _Bildung_ in Dewey’s writings on education, and pragmatism’s complex relation to twentieth-century phenomenology and hermeneutics, including the problematic question of whether Heidegger was a pragmatist in any meaningful sense. Presented in intriguing pairings, these thirteen essays offer different approaches to the material that will leave readers with much to deliberate. _ John Dewey and Continental Philosophy_ demonstrates some of the many connections and opportunities for cross-traditional thinking that have long existed between Dewey and continental thought, but have been under-explored. The intersection presented here between Dewey’s pragmatism and the European traditions makes a significant contribution to continental and American philosophy and will spur new and important developments in the American philosophical debate. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Christianity and Secular Reason: Classical Themes and Modern Developments ed. by Jeffrey BloechlJoseph W. Koterski, S.J.Christianity and Secular Reason: Classical Themes and Modern Developments. Edited by Jeffrey Bloechl. Notre Dame, Ind.: University of Notre Dame Press, 2012. Pp. vii + 288. $40.00 (paper). ISBN: 978-0-268-02228-0.It does not bode well for a collection of essays when the introduction needs to make a concession like the one found here: “This (...) volume brings together a plurality of approaches to a loosely related set of questions, themes, and phenomena” (6). Yet, surely, truth in advertising is an uncommon virtue. The frank honesty of Jeffrey Bloechl, the editor of this volume, is much to be commended.What unifies the essays in this volume is not a common topic or a common approach but a common concern with the problem of understanding the relation between Christianity and secular reason. The issue in play is how much respect a religion that claims to be the recipient of divine revelation owes to autonomous reasoning in any particular age. The problem is exacerbated in those periods of history that are marked by strong claims for the powers of human reasoning.Bloechl’s introduction is particularly helpful due to its distinction between secular reason and secularized reason. Unless a believer takes the fideist position of holding that only claims grounded in faith are valid knowledge-claims, there is no reason to deny or cast skeptical aspersions on secular reason. The term simply names the use of reason according to its proper governing principles on any topic where the justifications for various truth-claims are drawn only from this-worldly experience and, for disciplinary reasons, make no use of divine revelation. It is the type of reasoning that is done within a saeculum, that is, within a given period of time, according to the canons of sound reasoning operative in that epoch. The term “secularized reason,” by contrast, names the view of reason that is hostile to the legitimacy of any knowledge-claim that involves the testimony of divine self-disclosure as its warrant. The proponents of secularized reason often conveniently overlook the likelihood that such hostility risks begging the question by disallowing any form of divinely backed testimony in principle, while allowing human testimony in such spheres as history or courts or law. If one is prepared in general to accept testimony as a justification for a truth-claim, then the proper criterion is the credibility of the source. But then there is no principled way to preclude in advance the possibility that testimony that originates with God might provide the strongest possible type of warrant for certain knowledge-claims. It is mere prejudice to decide in advance that this alternative is simply beyond the pale of consideration.Threaded through the essays in this volume is the perennial problem of the relationship of faith and reason. Earlier ages posed the problem on their own terms, sometimes quite different from modern assumptions. Readers unfamiliar with the thought of Thomas Aquinas, for instance, might well be [End Page 141] surprised to learn that the very first question of the Summa theologiae asks whether any sort of sacra doctrina is necessary beyond the philosophical sciences. Such a stance does not raise a question about whether faith can be a genuine source of knowledge, but merely asks if there is need for the sort of knowledge that is grounded in faith. Aquinas answers the question not only by reflecting on the difficulties that arise from expecting that everyone will have the necessary time, interest, and intellectual resources to figure out for themselves the things that they need to know for the sake of salvation; he also notes certain areas that are entirely beyond the scope of unaided reason, such as knowledge about the triune nature of God.By contrast, the proponents of secularized reason tend to cast doubt on the very possibility that any truth-claim based on religious faith could even be counted as knowledge. Brad Gregory’s recent book, The Unintended Reformation: How a Religious Revolution Secularized Society (Harvard University Press, 2012) does a masterful job in tracing the unforeseen... (shrink)

Panentheism has become a familiar term in contemporary Christian systematic theology and philosophy, for it is widely believed to be an appropriate way to overcome the alleged dualism found in the classical God-world relationship. But what is meant by the term panentheism, and how does it work so as to avoid becoming still another form of pantheism or cosmic monism? In 2004 Philip Clayton and the late Arthur Peacocke published a set of papers on the topic of panentheism that came (...) from a conference in England on that topic in 2001.1 Yet, while there were certain broad affinities in approach and content among many of the papers, none of them used precisely the same conceptual model for analysis of the concept. As.. (shrink)

Traditional Christian belief in the existence of human life after death within a transformed material universe should be capable of rational justification if one chooses carefully the philosophical scheme underlying those claims. One should not have to appeal simply to the power of a loving God to justify one's beliefs. A revision of Whitehead's metaphysical scheme is proposed that allows one to render these classical Christian beliefs at least plausible to a broad range of contemporary thinkers as a consequence of (...) a cosmology based on the principle of universal intersubjectivity and the need for a common ground between opposing subjectivities. (shrink)

Having declared that metaphysics had come to its demise in the technologized sciences, Heidegger tried a new way to reopen the question of being. For Blanchette, that Heidegger never got beyond the analysis of Dasein to such an ambitious project is not merely the result of the distractions of other career requirements at the university or of other entanglements along his life’s path. The problem was that the road he took was a road to nowhere, metaphysically speaking.

This volume is a comprehensive study of the basic questions of philosophy of religion. What is distinctive about its approach is the author’s encyclopedic command of the actual practices of the eleven major world religions now extant.

Parallel to the perennial questions about the adequacy of any human language when used of God are questions about the proper interpretation of any divine self-disclosure in revelation. By the theoretical exploration of the latter in this book, Jorge Gracia also sheds a certain light on the former.

The objectives of this study were to develop a high-density chromosome bin map of homoeologous group 7 in hexaploid wheat, to identify gene distribution in these chromosomes, and to perform comparative studies of wheat with rice and barley. We mapped 2148 loci from 919 EST clones onto group 7 chromosomes of wheat. In the majority of cases the numbers of loci were significantly lower in the centromeric regions and tended to increase in the distal regions. The level of duplicated loci (...) in this group was 24% with most of these loci being localized toward the distal regions. One hundred nineteen EST probes that hybridized to three fragments and mapped to the three group 7 chromosomes were designated landmark probes and were used to construct a consensus homoeologous group 7 map. An additional 49 probes that mapped to 7AS, 7DS, and the ancestral translocated segment involving 7BS also were designated landmarks. Landmark probe orders and comparative maps of wheat, rice, and barley were produced on the basis of corresponding rice BAC/PAC and genetic markers that mapped on chromosomes 6 and 8 of rice. Identification of landmark ESTs and development of consensus maps may provide a framework of conserved coding regions predating the evolution of wheat genomes. (shrink)

Although considerable research indicates that mental energy is an important factor in many domains, including athletic performance (Cook & Davis, 2006), athletic mental energy (AME) has never been conceptualized and measured. Therefore, the aim of this study was to conceptualize and develop a reliable and valid instrument to assess athletic mental energy. In Study 1, a focus group interview established the initial framework of athletic mental energy. Study 2 used a survey to collect athletes’ experiences of athletic mental energy and (...) develop a scale draft titled “Athletic Mental Energy Scale (AMES).” In Study 3, we examined the psychometric properties and the underlying structure of AMES via item analysis, internal consistency, and exploratory factor analysis (EFA). In Study 4, we used confirmatory factor analysis (CFA) to examine AMES’s factorial validity; and examined concurrent and discriminant validity by examining correlations with athletes’ life stress, positive state of mind, and burnout. In study 5, we examined the measurement invariance of the 6-factor, 18-item AMES with Taiwanese and Malaysian samples. Study 6 examined the predictive validity by comparing AMES scores of successful and unsuccessful martial artists. Across these phases, results showed a 6-factor, 18-item AMES had adequate content validity, factorial structure, nomological validity, discriminant validity, predictive validity, measurement invariance, and reliability. We suggest future studies may use AMES to examine its relationships with athletes’ cognition, affect, and performance. The application of AMES in sport psychology was also discussed. (shrink)

Peter Abelard (1079–1142 ce) was the most wide‐ranging philosopher of the twelfth century. He quickly established himself as a leading teacher of logic in and near Paris shortly after 1100. After his affair with Heloise, and his subsequent castration, Abelard became a monk, but he returned to teaching in the Paris schools until 1140, when his work was condemned by a Church Council at Sens. His logical writings were based around discussion of the “Old Logic”: Porphyry's Isagoge, aristotle'S Categories and (...) On Interpretation and boethius'S textbook on topical inference. They comprise a freestanding Dialectica (“Logic”; probably c.1116), a set of commentaries (known as the Logica [Ingredientibus], c. 1119) and a later (c. 1125) commentary on the Isagoge (Logica Nostrorum Petititoni Sociorum or Glossulae). In a work Abelard called his Theologia, issued in three main versions (between 1120 and c.1134), he attempted a logical analysis of trinitarian relations and explored the philosophical problems surrounding God's claims to omnipotence and omniscience. The Collationes (“Debates,” also known as “Dialogue between a Christian, a Philosopher and a Jew”; probably c.1130) present a rational investigation into the nature of the highest good, in which the Christian and the Philosopher (who seems to be modeled on a philosopher of pagan antiquity) are remarkably in agreement. The unfinished Scito teipsum (“Know thyself,” also known as the “Ethics”; c.1138) analyses moral action. (shrink)

ABSTRACTIn ‘Universals’, Ramsey declares that we do not, and cannot, know the forms of atomic propositions. A year later, in a symposium with Braithwaite and Joseph, he announces a change of mind: atomic propositions may, after all, be discoverable by analysis. It is clear from the 1926 paper that Ramsey intends this to be a revision of the 1925 claim. Puzzlingly, however, Ramsey does not mention analysis in 1925. My task in this article is to provide a justification for (...) that change of mind. My argument consists of two parts. I first show what relation holds between the negative 1925 assertion and the more positive 1926 assertion which allows us to read the latter claim as a retraction of the former, as Ramsey appears to have intended it. Then I shall argue that the retraction of the 1925 claim is forced upon Ramsey by reflection on the fact that three theses, all of which he held in or around the relevant period, are, rather surprisingly, revealed to be inconsistent. (shrink)

Joseph Bracken examines key writings of process-oriented philosophers like Alfred North Whitehead along with systems-oriented thinkers such as Ludwig von Bertalanffy to create a systems-oriented understanding of the God-world relation that serves as a complement to Pope Francis’s reflections on the environmental crisis.

The classical utilitarian legacy of Jeremy Bentham, J. S. Mill, James Mill, and Henry Sidgwick has often been charged with both theoretical and practical complicity in the growth of British imperialism and the emerging racialist discourse of the nineteenth century. But there has been little scholarly work devoted to bringing together the conflicting interpretive perspectives on this legacy and its complex evolution with respect to orientalism and imperialism. This volume, with contributions by leading scholars in the field, represents the first (...) attempt to survey the full range of current scholarly controversy on how the classical utilitarians conceived of 'race' and the part it played in their ethical and political programs, particularly with respect to such issues as slavery and the governance of India. The book both advances our understanding of the history of utilitarianism and imperialism and promotes the scholarly debate, clarifying the major points at issue between those sympathetic to the utilitarian legacy and those critical of it. (shrink)

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)

In lieu of an abstract, here is a brief excerpt of the content:Beyond Ratzinger's Republic:Communio's Postliberal TurnSam Zeno Conedera S.J. and Vincent L. Strand S.J.Is the political future of the West a postliberal one? For the past decade, numerous prominent thinkers in America and Europe have been debating this question. Matters that not long ago were merely of historical interest, such as Pope Gelasius I's understanding of the relation between sacral authority and royal power, Thomas Aquinas's thought on monarchy and (...) Robert Bellarmine's theory of the pope's indirect authority in temporal matters are now increasingly studied for their potential answers to contemporary political questions. This development, which would have been nearly unimaginable just a decade earlier, unsurprisingly has been led by Catholics. We say "unsurprisingly" in view of the long pre-modern tradition of Catholic political thought, as well as the Church's long struggle against liberalism during the nineteenth and early twentieth centuries. Some of the current postliberal writers explicitly connect themselves to both of these aspects by using the term "integralist" to describe their position.1 [End Page 889]This "new integralism" represents a radical departure from the mainstream of Catholic political discourse of the last half century, which has largely sought rapprochement with Western liberalism. A group of writers, led by John Courtney Murray, George Weigel, Michael Novak, and Robert George, have held that the American constitutional order is rooted in the natural law tradition, and therefore is basically friendly to Catholic political thought. The Church's role in American life, they say, is upholding the natural law as a public moral philosophy, while embracing the non-establishment clause of the First Amendment as a matter of principle, in accordance with the teachings of the Second Vatican Council. This "Whig Thomism," which for decades represented the predominant outlook of conservative American Catholics, must now face the challenge of a different sort of Thomism represented by the integralists.2While the engagement between Whig Thomists and integralists has received most of the attention from scholars and journalists alike, another postliberal option has emerged in recent years. Its source is a group of Catholic thinkers associated with the Communio theological movement. Their political vision, which has no single name or label, has a complex and subtle relationship with the thought of earlier Communio writers, most of whom shared the Whig Thomist desire for reconciliation with Western liberalism. [End Page 890] The appearance of a Communio postliberalism therefore represents a significant development within this intellectual tradition. The most important representative of the earlier Communio perspective on political questions is Joseph Ratzinger / Pope Benedict XVI, who has recently been lauded as the "most important Catholic thinker of the twentieth century" on matters at the intersection of theology and politics.3In an article titled "Ratzinger's Republic" that appeared in these pages in 2020, we identified a significant tension in his thought about the Church's contribution to political life.4 Exploring Ratzinger's writings on natural law, we demonstrated that two currents are present. In accord with his fundamental theological commitments about nature and grace and about faith and reason, Ratzinger often questioned the effectiveness of arguments from natural law. He claimed that, since reason is historically conditioned, and therefore in the current order marked by sin, reason needs grace and faith to function properly. Yet, on other occasions, Ratzinger strongly endorsed arguments from natural law, highlighting its role as the foundation of a just democratic political order. We traced this ambivalence about natural law back to a dilemma at the heart of Ratzinger's political thought. On the one hand, in accord with his thinking about the relations of nature and grace and faith and reason, Ratzinger argued that the state needs the Church to supply moral values that the state cannot furnish on its own. On the other hand, he believed it belongs to the very nature of the Church to be separate from the state, and he endorsed nonconfessional, religiously pluralistic states.5 In light of these two commitments, Ratzinger argued that the contribution Christians are to make to the state is to supply moral values that were discerned under the influence of grace and divine revelation but... (shrink)

Patient narratives from two investigational deep brain stimulation trials for traumatic brain injury and obsessive‐compulsive disorder reveal that injury and illness rob individuals of personal identity and that neuromodulation can restore it. The early success of these interventions makes a compelling case for continued post‐trial access to these technologies. Given the centrality of personal identity to respect for persons, a failure to provide continued access can be understood to represent a metaphorical identity theft. Such a loss recapitulates the pain of (...) an individual's initial injury or illness and becomes especially tragic because it could be prevented by robust policy. A failure to fulfill this normative obligation constitutes a breach of disability law, which would view post‐trial access as a means to achieve social reintegration through this neurotechnological accommodation. (shrink)

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

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)