Abstract:This paper, presented as the 2019 Cambridge Quarterly Neuroethics NetworkCharcot Lecture, traces the nosology of disorders of consciousness in light of 2018 practice guidelines promulgated by the American Academy of Neurology, the American College of Rehabilitation Medicine and the National Institute on Disability, Independent Living and Rehabilitation Research. By exploring the ancient origins of Jennett and Plum’s persistent vegetative state and subsequent refinements in the classification of disorders of consciousness—epitomized by the minimally conscious state, cognitive motor dissociation, and the (...) recently described chronic vegetative state—the author argues that there is a counter-narrative to the one linking these conditions to the right to die. Instead, there is a more nuanced schema distinguishing futility from utility, informed by technical advances now able to identify covert consciousness contemplated by Jennett and Plum. Their prescience foreshadows recent developments in the disorders of consciousness literature yielding a layered legacy with implications for society’s normative and legal obligations to these patients. (shrink)

While neuroethics is generally thought to be a modern addition to the broader field of bioethics, this subdiscipline has existed in clinical practice throughout the course of the 20th century. In this essay, Fins describes an older tradition of clinical neuroethics that featured such physician-humanists as Sir William Osler, Wilder Penfield, and Fred Plum, whose work and legacy exploring disorders of consciousness is highlighted. Their normative work was clinically grounded and focused on the needs of patients, in contrast (...) to modern neuroethics, which is more speculative and distant from the lived reality of the clinic. Using recent developments in the diagnosis and treatment of disorders of consciousness, and the history of the vegetative and minimally conscious states, Fins asks why modern neuroethics has taken this turn and what can be done to restore clinical neuroethics to a more proportionate place in the field. (shrink)

Ford, Norman In 1972 Brian Jennett and Fred Plum recommended the term 'persistent vegetative state' to describe a state of continuing 'wakefulness without awareness', which can follow a variety of severe insults to the brain. Their description of the syndrome has stood the test of time, but PVS continues to be a source of medical, legal, and ethical debate.

In lieu of an abstract, here is a brief excerpt of the content:Minding Brain Injury, Consciousness, and Ethics: Discourse and DeliberationsJoseph J. Fins (bio) and James Giordano (bio)The annual John Collins Harvey Lecture at the Georgetown University’s Pellegrino Center for Clinical Bioethics is a forum for addressing contemporary topics at the intersection of medicine and bioethics. This year, in marking the decadal anniversary of the launch of the Brain Research through Advancing Innovative Neurotechnology (BRAIN) Initiative, the Harvey Lecture provided an (...) interactive discussion with renowned clinician, researcher, scholar, and author, Joseph J. Fins, MD—who is the E. William Davis, Jr., MD Professor of Medical Ethics, Chief of the Division of Medical Ethics, and a Professor of Medicine at Weill Cornell Medical College—conducted by James Giordano, PhD, MPhil—who is a Professor of Neurology and Biochemistry, and Chief of the Pellegrino Center’s Neuroethics Studies Program at the Georgetown University Medical Center. The discourse focused upon the topic of covert consciousness, and the ways in which current and developing brain science technologies, together with revised practices of medicine, in general, may afford new opportunities in patient care, but may also give rise to issues, questions, challenges, and opportunities for neuroethics.Prof. James GIORDANO:Prof. Fins, your most recent book, Rights Come to Mind: Brain Injury, Ethics, and the Struggle for Consciousness (Fins 2015), addresses your ongoing work to employ current and emerging neurological approaches to reveal conscious functions in patients with profound brain injury and disease. To be sure, the destination—if you will—is to talk about covert consciousness. But in commencing this discussion, I’d like to propose a route, which traces your professional journey to this point in your career, and how it led you on your search to reveal consciousness in those patients who lack expressive capability. You went into palliative care first, and that brought you to where you are today. [End Page 227]Prof. Joseph J. FINS:First, let me thank you and the Pellegrino Center for the honor of giving the John Harvey Collins Lecture in such an interactive manner. The forefront of neurological care—and the neuroethical issues and methods focal to such practice—wasn’t what I initially intended to do professionally, but I think that therein is a good lesson for young people’s career aspirations. Simply put, one doesn’t always know where they’ll end up at the beginning of the journey, and as Kierkegaard said, life is lived forward, but is understood backwards (Kierkegaard 1843).In the nineties and the early 2000s, I was trying to help improve the quality of care of people at the end of life, and I wrote a book, entitled The Palliative Ethic of Care: Clinical Wisdom at Life’s End (Fins 2006), in which I addressed notions of phronesis—practical wisdom—in integrating theory and practice toward improving how people die. I became interested in the Quinlan case (Quinlan 1976), and the right to die, and around the same time, I ran into a colleague of mine at Cornell: Dr. Nicholas D. Schiff. Dr. Schiff is a neurologist, who was a protégé of Fred Plum, who was the originator of the concept of the vegetative state with Bryan Jennett, back in 1972. Fred was both of our teachers here at Cornell. Niko (Dr. Schiff) was interested in patients with disorders of consciousness, and was beginning to envision doing work—that ultimately, we did—using deep brain stimulation (DBS) to try to treat patients in the minimally conscious state, a category that was subsequently codified in 2002.I realized that a whole population of people—with these disorders of consciousness—had been somewhat marginalized, and their neglect essentially devolves back to the considerations of the right to die. The right to die was established in the Quinlan case because Judge Hughes—the presiding chief judge of the New Jersey Supreme Court—talked about Ms. Quinlan’s loss of a cognitive, sapient state as being the moral warrant for her right to die, given the fact that it was viewed as a futile situation. I recognized, over the ensuing years—from my background in palliative and end-of-life care—[1] that we had over-generalized notions of futility... (shrink)

In this provocative book, Fred Dretske argues that to achieve an understanding of the mind it is not enough to understand the biological machinery by means of...

Some puzzles about happiness -- Pt. I. Some things that happiness isn't. Sensory hedonism about happiness -- Kahneman's "objective happiness" -- Subjective local preferentism about happiness -- Whole life satisfaction concepts of happiness -- Pt. II. What happiness is. What is this thing called happiness? -- Attitudinal hedonism about happiness -- Eudaimonism -- The problem of inauthentic happiness -- Disgusting happiness -- Our authority over our own happiness -- Pt. III. Implications for the empirical study of happiness. Measuring happiness -- (...) Empirical research; philosophical conclusions -- The central points of the project as a whole. (shrink)

Causal theories of mental content attempt to explain how thoughts can be about things. They attempt to explain how one can think about, for example, dogs. These theories begin with the idea that there are mental representations and that thoughts are meaningful in virtue of a causal connection between a mental representation and some part of the world that is represented. In other words, the point of departure for these theories is that thoughts of dogs are about dogs because dogs (...) cause the mental representations of dogs. (shrink)

Inter-cultural dialog is frequently treated as either unnecessary or else impossible. It is said to be unnecessary, because we all are the same or share the same ‘human nature'; it is claimed to be impossible because cultures seen as language games or forms or life are so different as to be radically incommensurable. The paper steers a course between absolute universalism and particularism by following the path of dialog and interrogation - where dialog does not mean empty chatter but the (...) exploration of the ‘otherness’ of interlocutors on the far side of either assimilation or exclusion. Such dialog is the heart of hermeneutics as formulated by Hans-Georg Gadamer. The paper explores the question whether hermeneutical interpretation can be transferred from textual readings to the domain of cross-cultural encounters. After discussing both the historical development and the basic meaning of contemporary hermeneutics, the paper draws attention to the intimate linkage between interpretive understanding and ‘application’, or ‘practical philosophy.’ Drawing on the insights of Gadamer and some more overtly political thinkers, the paper then shows the relevance of hermeneutics for cross-cultural studies, as an antidote to the looming ‘clash of civilizations.’ It turns to some writings by Maurice Merleau-Ponty in order to emphasize the necessary linkage between interactive dialog and concrete embodied engagement. Undercutting purely mentalist or ‘idealist’ misconstruals of dialog, this linkage shows the mutual compatibility between Gadamerian hermeneutics and existential phenomenology. Keywords: hermeneutics; dialogue; praxis; cross-cultural understanding; Gadamer; Merleau-Ponty (Published: 10 March 2009) Citation: Ethics & Global Politics. DOI: 10.3402/egp.v2i1.1937. (shrink)

The central dilemma concerning randomized clinical trials (RCTs) arises out of some simple facts about causal methodology (RCTs are the best way to generate the reliable causal knowledge necessary for optimally-informed action) and a prima facie plausible principle concerning how physicians should treat their patients (always do what it is most reasonable to believe will be best for the patient). A number of arguments related to this in the literature are considered. Attempts to avoid the dilemma fail. Appeals to informed (...) consent and mechanisms for minimizing the resulting harm are important for policy, but informed consent is problematic and mechanisms for minimization of harm do not address the dilemma. Appeals to some sort of contract model of justification are promising and illuminating. Keywords: randomized clinical trials, ethics CiteULike Connotea Del.icio.us What's this? (shrink)

The neuropsychology of religious activity in normal and selected clinical populations is reviewed. Religious activity includes beliefs, experiences, and practice. Neuropsychological and functional imaging findings, many of which have derived from studies of experienced meditators, point to a ventral cortical axis for religious behavior, involving primarily the ventromedial temporal and frontal regions. Neuropharmacological studies generally point to dopaminergic activation as the leading neurochemical feature associated with religious activity. The ventral dopaminergic pathways involved in religious behavior most closely align with the (...) action-extrapersonal system in the model of 3-D perceptual–motor interactions proposed by Previc . These pathways are biased toward distant space and also mediate related extrapersonally dominated brain functions such as dreaming and hallucinations. Hyperreligiosity is a major feature of mania, obsessive-compulsive disorder, schizophrenia, temporal-lobe epilepsy and related disorders, in which the ventromedial dopaminergic systems are highly activated and exaggerated attentional or goal-directed behavior toward extrapersonal space occurs. The evolution of religion is linked to an expansion of dopaminergic systems in humans, brought about by changes in diet and other physiological influences. (shrink)

Are there universal values of right and wrong, good and bad, shared by virtually every human? The tradition of natural law argues that there is. Drawing on the work of psychoanalyst Melanie Klein, whose analyses have touched upon issues related to original sin, trespass, guilt, and salvation through reparation, in this 2006 book C. Fred Alford adds an extra dimension to this argument: we know natural law to be true because we have hated before we have loved and have (...) wished to destroy before we have wanted to create. Natural law is built upon the desire to make reparation for the goodness we have destroyed, or have longed to destroy. Through reparation, we earn salvation from the most hateful part of ourselves, that which would destroy what we know to be good. (shrink)

Abstract: Luciano Floridi has impressively applied the concept of information to problems in semantics and epistemology, among other areas. In this essay, I briefly review two areas where I think one may usefully raise questions about some of Floridi's conclusions. One area is in the project to naturalize semantics and Floridi's use of the derived versus nonderived notion of semantic content. The other area is in the logic of information and knowledge and whether knowledge based on information necessarily supports closure, (...) in every instance. I suggest that it does not and, thereby, raise a challenge to Floridi's logic of being informed. (shrink)

Multitrait-multimethod (MTMM) analysis is one of the most frequently employed methods to examine the validity of psychological measures. Confirmatory factor analysis (CFA) is a commonly used analytic tool for examining MTMM data through the specification of trait and method latent variables. Most contemporary CFA-MTMM models either do not allow estimating correlations between the trait and method factors or they are restricted to linear trait-method relationships. There is no theoretical reason why trait and method relationships should always be linear, and quadratic (...) relationships are frequently proposed in the social sciences. In this article, we present two approaches for examining quadratic relations between traits and methods through extended latent difference and latent means CFA-MTMM models (Pohl et al., 2008; Pohl and Steyer, 2010). An application of the new approaches to a multi-rater study of the nine inattention symptoms of attention-deficit/hyperactivity disorder in children (N = 752) and the results of a Monte Carlo study to test the applicability of the models under a variety of data conditions are described. (shrink)

While there has been a resurgence in Malebranche scholarship in the anglophone world over the last twenty years, most of it has focused on Malebranche’s theory of ideas, and little attention has been paid to his philosophy of mind. Schmaltz’s book thus comes as a welcome addition to the Malebranche literature; that he has given us such a well-researched and carefully argued study is even more welcome. The focus of this work is Malebranche’s split with Descartes on the question of (...) our knowledge of the nature of the mind; the book concentrates specifically on Malebranche’s rejection of the claim that we know the nature of the mind better than we know the nature of body. Schmaltz maintains that Malebranche’s arguments for his position are, for the most part, successful against the Cartesians who opposed him, though he claims—and this is perhaps the central claim of the book—that “Malebranche took his negative thesis concerning our knowledge of the soul to involve not so much a rejection of Cartesianism as an internal correction of it”. While acknowledging that Augustine was “the primary inspiration for [Malebranche’s] view of the ideas that are the objects of perception”, Schmaltz’s interpretation of Malebranche’s theory of the soul “presents it as fundamentally Cartesian”. According to Schmaltz, not only is Malebranche closer to Descartes in this regard than is generally thought, he is closer to him than are many other Cartesians. Part 1 of the book examines Malebranche’s position that while we have certain knowledge of the soul’s existence, we have only confused knowledge of its nature. Part 2 focuses on Arnauld’s objection that if in fact we had no clear idea of the soul, we could not, despite Malebranche’s claims to the contrary, know anything of its immortality, spirituality, or freedom. (shrink)

Our concerns fall into three areas: (1) Barsalou fails to make clear what simulators are (vs. what they do); (2) activation of perceptual areas of the brain during thought does not distinguish between the activation's being constitutive of concepts or a mere causal consequence (Barsalou needs the former); and (3) Barsalou's attempt to explain how modal symbols handle abstraction fails.

We introduce a natural generalization of Borel's Conjecture. For each infinite cardinal number $\kappa$, let ${\sf BC}_{\kappa}$ denote this generalization. Then ${\sf BC}_{\aleph_0}$ is equivalent to the classical Borel conjecture. Assuming the classical Borel conjecture, $\neg{\sf BC}_{\aleph_1}$ is equivalent to the existence of a Kurepa tree of height $\aleph_1$. Using the connection of ${\sf BC}_{\kappa}$ with a generalization of Kurepa's Hypothesis, we obtain the following consistency results: 1. If it is consistent that there is a 1-inaccessible cardinal then it is (...) consistent that ${\sf BC}_{\aleph_1}$.2. If it is consistent that ${\sf BC}_{\aleph_1}$, then it is consistent that there is an inaccessible cardinal.3. If it is consistent that there is a 1-inaccessible cardinal with $\omega$ inaccessible cardinals above it, then $\neg{\sf BC}_{\aleph_{\omega}} + (\forall n < \omega){\sf BC}_{\aleph_n}$ is consistent.4. If it is consistent that there is a 2-huge cardinal, then it is consistent that ${\sf BC}_{\aleph_{\omega}}$.5. If it is consistent that there is a 3-huge cardinal, then it is consistent that ${\sf BC}_{\kappa}$ for a proper class of cardinals $\kappa$ of countable cofinality. (shrink)

Addis (1981) has criticized a proposal of ours (Wilson [1969b]) for analysing disposition predications in terns of the horseshoe of material implication, and has proposed a related but significantly different analysis. This paper restates the original proposal, and defends it against Addis's criticisms. It is further argued that his proposal will not do as a general account of disposition predications; that, however, if it is suitably qualified, then it does account for certain special sorts of disposition predication; but that so (...) understood, it can be seen to be but a special case of ours. (shrink)

In 1996, the U.S. Congress passed the Personal Responsibility and Work Opportunities Reconciliation Act that ended the entitlement of poor families to government assistance. The debate leading up to that transformation in welfare policy occurred in the shadow of Speenhamland—an episode in English Poor Law history. This article revisits the Speenhamland episode to unravel its tangled history. Drawing on four decades of recent scholarship, the authors show that Speenhamland policies could not have had the consequences that have been attributed to (...) them. The article ends with an alternative narrative that seeks to explain how the Speenhamland story became so deeply entrenched. (shrink)

In two recent books, Jerry Fodor has developed a set of sufficient conditions for an object “X” to non-naturally and non-derivatively mean X. In an earlier paper we presented three reasons for thinking Fodor's theory to be inadequate. One of these problems we have dubbed the “Pathologies Problem”. In response to queries concerning the relationship between the Pathologies Problem and what Fodor calls “Block's Problem”, we argue that, while Block's Problem does not threatenFodor's view, the Pathologies Problem does.

This paper examines ethical, legal and economic dimensions of the decision facing employers regarding whether it is appropriate to monitor the electronic mail (e-mail) communications of its employees. We review the question of whether such monitoring is lawful. Recent e-mail monitoring cases are viewed as a progression from cases involving more established technologies (i.e., phone calls, internal memoranda, faxes and voice mail).The central focus of the paper is on the extent to which employer monitoring of employee e-mail presents a structure (...) of costs and benefits to the employer which are unlikely to make such a practice profitable or practical to the employer. The practice of employer monitoring to detect illicit employee behavior (e.g., fraud, harassment of fellow employees, industrial espionage) is considered. (shrink)

Some philosophers argue that the state and its citizens stand in a morally privileged position vis-à-vis one another but not towards other states or citizens. However, many of those people, particularly philosophical liberals, also hold that morally insignificant differences, such as place of birth, sex, or ethnicity, should not affects rights, liberties, and life prospects. On the face of it, these two sets of ideas appear incompatible and point to a conflict in some liberal thought. Liberal philosophers, like John Rawls, (...) have attempted to reconcile these conflicting ideas. His attempt has attracted a great deal of criticism, especially from those liberals attracted to a more cosmopolitan point of view. In this paper, we use Aristotelian virtue ethics as the basis upon which to reconcile liberalism and patriotism. We argue that the state should be understood as an agent that stands in a special relationship to its citizens (of philia). The state’s virtue depends, in part, on it giving those citizens preferential treatment with regard to justice compared to citizens of other countries. Similarly, if the citizen is to be just in her relations with her own state, she must behave in special ways towards that state as compared to other states. Certain forms of justice only arise in relationships of particular kinds. (shrink)

We argue that the Standard Model (SM) in the Higgs phase does not suffer from a “hierarchy problem” and that similarly the “cosmological constant problem” resolves itself if we understand the SM as a low energy effective theory emerging from a cutoff-medium at the Planck scale. We actually take serious Veltman’s “The Infrared–Ultraviolet Connection” addressing the issue of quadratic divergences and the related huge radiative correction predicted by the SM in the relationship between the bare and the renormalized theory, usually (...) called “the hierarchy problem” and claimed that this has to be cured. We discuss these issues under the condition of a stable Higgs vacuum, which allows extending the SM up to the Planck cutoff. The bare Higgs boson mass then changes sign below the Planck scale, such that the SM in the early universe is in the symmetric phase. The cutoff enhanced Higgs mass term as well as the quartically enhanced cosmological constant term provide a large positive dark energy that triggers the inflation of the early universe. Reheating follows via the decays of the four unstable heavy Higgs particles, predominantly into top–antitop pairs, which at this stage are massless. Preheating is suppressed in SM inflation since in the symmetric phase bosonic decay channels are absent at tree level. The coefficients of the shift between bare and renormalized Higgs mass as well as of the shift between bare and renormalized vacuum energy density exhibit close-by zeros at about $$7.7 \times 10^{14}\ \hbox {GeV}$$ and $$3.1 \times 10^{15}\ \hbox {GeV}$$, respectively. The zero of the Higgs mass counter term triggers the electroweak phase transition, from the low energy Higgs phase and to the symmetric phase above the transition point. Since inflation tunes the total energy density to take the critical value of a flat universe and all contributing components are positive, it is obvious that the cosmological constant today is naturally a substantial fraction of the total critical density. Thus taking cutoff enhanced corrections seriously the Higgs system provides besides the masses of particles in the Higgs phase also dark energy, inflation and reheating in the early universe. The main unsolved problem in our context remains the origin of dark matter. Higgs inflation is possible and likely even unavoidable provided new physics does not disturb the known relevant SM properties substantially. The scenario highly favors to understand the SM and its main properties as a natural structure emerging at long distance. This in particular concerns the SM symmetry patterns and their consequences. (shrink)

Aristotle, Politics, Books V and VI, trans. David Keyt, Clarendon Aristotle Series , pp. xvii + 265; ?45 and $75 ISBN 0 19 823535 6 ; ?16.99 and $21.95 ISBN 0 19 823536 4.

Edited by Ivette Fred-Rivera and Jessica Leech. What is the relationship between ontology and modality: between what there is, and what there could be, must be, or might have been? Throughout a distinguished career, Bob Hale’s work has addressed this question on a number of fronts, through the development of a Fregean approach to ontology, an essentialist theory of modality, and in his work on neo-logicism in the philosophy of mathematics. This collection of new essays engages with these themes (...) in Hale’s work in order to make further progress in our understanding of ontology, modality, and the relations between them. Some essays directly address questions in modal metaphysics, drawing on ontological concerns. Others raise questions in modal epistemology and its links to matters of ontology, such as the challenge to give an epistemology of essence. There are also several essays engaging with questions of what might be called ‘modal ontology’: the study of whether and what things exist necessarily or contingently. Such issues can be raised and addressed directly, but they also have an important bearing on the kinds of semantic commitments engendered in logic and mathematics, e.g., to the existence of sets, or numbers, or properties, and so on. It is thus explored in some chapters to what extent one’s ontology—and indeed, one’s ontology of necessary beings—interacts with other plausible assumptions and commitments. (shrink)

We consider two categorical syllogisms, valid or invalid, to be equivalent if they can be transformed into each other by certain transformations, going back to Aristotle, that preserve validity. It is shown that two syllogisms are equivalent if and only if they have the same models. Counts are obtained for the number of syllogisms in each equivalence class. For a more natural development, using group-theoretic methods, the space of syllogisms is enlarged to include nonstandard syllogisms, and various groups of transformations (...) on that space are studied. (shrink)

Hans Hahn, mathematician, philosopher and co-founder of the Vienna Circle, attempted to reconcile the validity and applicability of both logic and mathematics with a strict empiricism. This article begins with a review of this attempt, focusing on his view of the relation of language to logic and his answer to the question of why we need logic. I then turn to some recent work by Stephen Yablo in an attempt to show that Yablo's fictionalism, and in particular his use of (...) metaphor, can shed light on Hahn's philosophy of logic. (shrink)