The rubber hand paradigm is used to create the illusion of self-touch, by having the participant administer stimulation to a prosthetic hand while the Examiner, with an identical stimulus , administers stimulation to the participant’s hand. With synchronous stimulation, participants experience the compelling illusion that they are touching their own hand. In the current study, the robustness of this illusion was assessed using incongruent stimuli. The participant used the index finger of the right hand to administer stimulation to a prosthetic (...) hand while the Examiner used a paintbrush to administer stimulation to the participant’s left hand. The results indicate that this violation of tactile expectations does not diminish the illusion of self-touch. Participants experienced the illusion despite the use of incongruent stimuli, both when vision was precluded and when visual feedback provided clear evidence of the tactile mismatch. (shrink)

The nonvisual self-touch rubber hand paradigm elicits the compelling illusion that one is touching one’s own hand even though the two hands are not in contact. In four experiments, we investigated spatial limits of distance and alignment on the nonvisual self-touch illusion and the well-known visual rubber hand illusion. Common procedures and common assessment methods were used. Subjective experience of the illusion was assessed by agreement ratings for statements on a questionnaire and time of illusion onset. The nonvisual self-touch illusion (...) was diminished though never abolished by distance and alignment manipulations, whereas the visual rubber hand illusion was more robust against these manipulations. We assessed proprioceptive drift, and implications of a double dissociation between subjective experience of the illusion and proprioceptive drift are discussed. (shrink)

Inattentional blindness studies have shown that an unexpected object may go unnoticed if it does not share the property specified in the task instructions. Our aim was to demonstrate that observers develop an attentional set for a property not specified in the task instructions if it allows easier performance of the primary task. Three experiments were conducted using a dynamic selective-looking paradigm. Stimuli comprised four black squares and four white diamonds, so that shape and colour varied together. Task instructions specified (...) shape but observers developed an attentional set for colour, because we made the black–white discrimination easier than the square–diamond discrimination. None of the observers instructed to count bounces by squares reported an unexpected white square, whereas two-thirds of observers instructed to count bounces by diamonds did report the white square. When attentional set departs from task instructions, you may fail to see what you were told to look for. (shrink)

Ever so often in the UK, there is a flurry of activity around the information requirements of donor-conceived individuals. In April 2013, it was the launch of a report from the Nuffield Council on Bioethics that brought the issue back to public consciousness.1Since 1991, information about treatment with donor gametes or embryos has been collected by the Human Fertilisation and Embryology Authority . Since then, over 35 000 donor-conceived individuals have been born through treatment in licensed clinics. Medical information and (...) information about donors’ appearance are collected by clinics, and donors are encouraged to put together a ‘pen portrait’ giving information about themselves for any resulting children. One focus of the new report is on improving the quality and quantity of information available about donors.Traditionally, gamete and embryo donations were practised on an anonymous basis, so that those born as a result of such donation may receive only non-identifying information about the donor when they reach the age of 18 . This changed in 2005 when donor anonymity was removed so that anyone donating after that time could be identified to individuals born as a result of the treatment. Those who have donated in the past are also able to reregister as identifiable donors. Much concern was expressed at the time that this would exacerbate the shortage of donors although the Nuffield Council on Bioethics reports that, 8 years on, those clinics that actively recruit donors appear to be successful in finding sufficient donors. The report recommends that the option of anonymous donation should not be reintroduced.A big issue of debate in the UK has been, and continues to be, whether parents should tell their …. (shrink)

A simple experimental paradigm creates the powerful illusion that one is touching one’s own hand even when the two hands are separated by 15 cm. The participant uses her right hand to administer stimulation to a prosthetic hand while the Examiner provides identical stimulation to the participant’s receptive left hand. Change in felt position of the receptive hand toward the prosthetic hand has previously led to the interpretation that the participant experiences self-touch at the location of the prosthetic hand, and (...) experiences a sense of ownership of the prosthetic hand. Our results argue against this interpretation. We assessed change in felt position of the participant’s receptive hand but we also assessed change in felt position of the participant’s administering hand. Change in felt position of the administering hand was significantly greater than change in felt position of the receptive hand. Implications for theories of ownership are discussed. (shrink)

In June 2021, the BMA published its report on moral distress and moral injury in UK doctors.1 The report includes definitions of the terms ‘moral distress’ and ‘moral injury’ as well as a summary of how the concepts have developed over time. There is also an analysis of the BMA’s pan-profession survey of moral distress and moral injury of doctors in the UK, the first of its kind. The impact of COVID-19 and recommendations for tackling moral distress also feature. Many (...) may be unfamiliar with the concepts of ‘moral distress’ and ‘moral injury’. These terms are relatively new, and debate is ongoing in academic circles on the best way to understand them.2 Some use the terms interchangeably. The BMA defines moral distress as the psychological unease generated where professionals identify an ethically correct action to take but are constrained in their ability to take that action. Even without an understanding of the morally correct action, moral distress can arise from the sense of a moral transgression. More simply, it is the feeling of unease stemming from situations where institutionally required behaviour does not align with moral principles. This can be as a result of a lack of power or agency, or structural limitations, such as insufficient staff, resources, training or time. The individual suffering from moral distress need not be the one who has acted or failed to act; moral distress can be caused by witnessing moral transgressions by others. Moral injury can arise where sustained moral distress leads to impaired function or longer-term psychological harm. Moral injury can produce profound guilt and shame, and in some cases also a sense of betrayal, anger and profound ‘moral disorientation’. It has also been linked to severe mental health issues. There is increasing recognition across the UK of the problem …. (shrink)

On 7 April 2022 – coinciding with World Health Day – the British Medical Association launched its new report, Health and human rights in the new world order.1 Written during the global upheaval triggered by the COVID-19 pandemic, and published just weeks after the Russian invasion of Ukraine, the report responds to a range of emerging and intensifying threats to health-related human rights globally. As the report establishes, human rights in health and healthcare matter because human suffering, and its relief, (...) are fundamental moral issues. As relief of human suffering is the primary purpose of medicine, it follows that doctors and other health professionals are often active in times of human challenge and extremity. During conflict, humanitarian crises, and, as we have so recently seen, global public health emergencies, health professionals are essential to the response. But these crises – and the response to them – can put fundamental human rights and interests under pressure. The Russian invasion of Ukraine has seen sustained indiscriminate shelling of civilian infrastructure. Whether health facilities were directly targeted is moot – the indiscriminate nature of the assault means they will inevitably be hit. Not only is this a violation of the Geneva Conventions, it undermines fundamental human rights, not least of which the right to health. Destroying health infrastructure drives further suffering and delays post-conflict recovery. Public heath emergencies can rightly require draconian measures – social distancing, enforced isolation, location tracking, economic shutdown. Although we saw their necessity during the COVID-19 outbreak, concerns were raised about disproportionate restrictions on basic rights, including rights to privacy and liberty. Human Rights Watch drew attention to the way governments unlawfully exploited COVID-19 to crack down on fundamental rights.2 Although conflicts and public health emergencies are not new, the report also tracks a number of …. (shrink)

In a recent judgment1 the Court of Protection was highly critical of health professionals for continuing to provide clinically-assisted nutrition and hydration in the face of disagreement about the patient’s best interests, without seeking to resolve the issue. This hearing had been set up specifically to consider whether GU’s dignity had been properly protected, and if not why not, given concerns raised by the Official Solicitor about what she considered to be “a complete abrogation of responsibility to consider properly or (...) at all, and to determine whether it was in GU’s best interests and therefore lawful to continue to give him an invasive medical treatment, CANH.” In April 2014, at 63 years old and living in Thailand, GU sustained severe injuries after suffering from an electrocution accident. He sustained a cardiorespiratory arrest with a significant delay before cardiopulmonary resuscitation was started and was unconscious and unresponsive. In September 2014 he was transferred to the UK. In August 2018, GU’s brother made a request for a best interests decision concerning the continuation of CANH. The family met to discuss this and all except GU’s son, agreed that continuing CANH was not in GU’s best interests. In view of the fact that there was not unanimity among the family, a decision was made that CANH should continue. Commenting on this decision, Mr Justice Hayden said ‘the apparent assumption that in the face of family disagreement ‘ therefore will continue to be cared for by nursing staff ” is a troubling non sequitur’ and stressed that ‘family dissent to a medical consensus should never stand in the way of an incapacitated patients’ best interests being properly identified’. He also made clear that the responsibility for ensuring that a best interests assessment is undertaken rests with the …. (shrink)

At the time of writing the COVID-19 pandemic was entering its ninth month, with nearly 800 000 recorded fatalities and 22 million infections in 188 countries and territories.1 In previous ethics briefings2 we raised concerns about the possibility that demand for life-sustaining treatment would overwhelm supply, with a consequent requirement for health professionals to make challenging triage decisions. Fortunately, to date, these have largely not been realised, although there is a possibility that countries in which containment measures have been less-successful, (...) such as South Africa, may still be required to triage.3 Despite the successful ‘flattening of the curve’ in many countries, there is a wide consensus that we remain firmly within the pandemic. Enormous practical challenges remain. It is unclear whether the pandemic will ultimately take the form of two or more successive waves, or whether the patchwork of global responses will lead to a sustained slow ‘burn’ with sporadic flare-ups.4 Areas of uncertainty include whether infection confers some immunity, how long any such immunity might last, whether effective vaccines can be developed and if seasonal temperature fluctuations alter the spread of the virus. The pandemic will also be fundamentally shaped by the decisions that governments make and the extent to which their diktats are complied with by citizens. With the – possibly temporary – retreat of urgent clinical ethics issues, such as triage, opportunities have arisen to reflect on some of the ethical questions that underlie and structure the demanding policy decisions that governments are wrestling with. One of the early questions was how to balance the complex constellation of costs and benefits associated with lockdown. Countries that …. (shrink)

In December, the National Data Guardian 1 for health and care in England, Dame Fiona Caldicott, published the outcomes of a public consultation about the Caldicott Principles and the role of Caldicott Guardians.1 The Caldicott Principles are good practice guidelines which have been used by health and social care organisations in the UK since 1997 to ensure that people’s data are kept safe and used in an ethical way.2 The role of the Caldicott Guardian is well-established in the UK. Caldicott (...) Guardians are senior people which support the upholding of the Caldicott Principles within organisations. In response to views expressed during the consultation the NDG has added an eighth Caldicott Principle to the existing seven and will use her statutory powers to issue guidance about the appointment of Caldicott Guardians for health and adult social care organisations. The new eighth Caldicott Principle is: ‘Inform patients and service users about how their confidential information is used’. It provides that: > A range of steps should be taken to ensure no surprises for patients and service users, so they can have clear expectations about how and why their confidential information is used, and what choices they have about this. These steps will vary depending on the use: as a minimum, this should include providing accessible, relevant and appropriate information - in some cases, greater engagement will be required. The NDG explains that the introduction of the new principle was prompted by consideration of the role that the legal concept of ‘reasonable expectations’ should play in shaping the circumstances under which health and care data may be legitimately shared. The NDG does not envisage that this principle will establish reasonable expectations as a legal basis in its own right …. (shrink)

INTRODUCTION: Capgras delusion is sometimes defined as believing that close relatives have been replaced by strangers. But such replacement beliefs also occur in response to encountering an acquaintance, or the voice of a familiar person, or a pet, or some personal possession. All five scenarios involve believing something familiar has been replaced by something unfamiliar. METHODS: We evaluate the proposal that these five kinds of delusional belief should count as subtypes of the same delusion. RESULTS: Personally familiar stimuli activate the (...) sympathetic nervous system (SNS) much more strongly than unfamiliar stimuli. In Capgras delusion, this difference is absent, prompting the delusional idea that a familiar person is actually a stranger. We suggest this absence of an effect of familiarity on SNS response will occur in all five scenarios and will prompt the idea that the familiar has been replaced by the unfamiliar. CONCLUSIONS: We propose that: (a) all five scenarios be referred to as subtypes of Capgras delusion; (b) in all five, ideas about replacement are prompted by weakness of SNS responses to familiar stimuli; (c) this is insufficient to generate delusion. For a delusional idea to become a belief, a second factor (impaired hypothesis evaluation) must also be present. (shrink)

In 1934 Alonzo Church, Kurt Gödei, S. C. Kleene, and J. B. Rosser were all to be found in Princeton, New Jersey. In 1936 Church founded The Journal of Symbolic Logic. Shortly thereafter Alan Turing arrived for a two year visit. The United States had become a world center for cutting-edge research in mathematical logic. In this brief survey1 we shall examine some of the writings of American logicians during the 1920s, a period of important beginnings and remarkable insights as (...) well as of confused gropings.The publication of Whitehead and Russell's monumental Principia Mathematica [18] during the years 1910-1913 provided the basis for much of the research that was to follow. It also provided the basis for confusion that remained a factor during the period we are discussing. In 1908, Henri Poincaré, a famous skeptic where mathematical logic was concerned, wrote pointedly :It is difficult to admit that the word if acquires, when written ⊃, a virtue it did not possess when written if.Principia provided no very convincing answer to Poincaré. Indeed the fact that the authors of Principia saw fit to place their first two “primitive propositions”*1.1: Anything implied by a true proposition is true.*1.2: ⊢ p ⋁ p ⊃ punder one and the same heading suggest that they had thought of what they were doing as just such a translation as Poincare had derided. (shrink)

People acquire new beliefs in various ways. One of the most important of these is that new beliefs are acquired as a response to experiencing events that one did not expect. This involves a form of inference distinct from both deductive and inductive inference: abductive inference. The concept of abduction is due to the American pragmatist philosopher C. S. Peirce. Davies and Coltheart elucidated what Peirce meant by abduction, and identified two problems in his otherwise promising account requiring solution (...) if that account were to become fully workable. Here we propose solutions to these problems and offer an explicit cognitive model of how people derive new beliefs from observations of unexpected events, based on Peirce's work and Sokolov's ideas about prediction error triggering new beliefs. We consider that this model casts light not only upon normal processes of belief formation but also upon the formation of delusional beliefs. (shrink)

As the COVID-19 vaccine roll out continues apace, in the higher-income countries at least, concerns remain about the level of vaccine coverage in some health and social care settings. Although most countries have seen a relatively high uptake of vaccination against COVID-19 among staff, there continue to be some pockets of hesitancy. The risk of outbreaks in settings with potentially very vulnerable patients has led some governments across Europe to consider, or to introduce, measures compelling healthcare staff to be vaccinated. (...) The justifiability of mandating the vaccination of healthcare professionals is a longstanding question but it has come to the fore in recent months following a resurgence of cases of COVID-19 and the prevalence of the more transmissible Delta variant. In deciding whether the introduction of a mandate is appropriate, states have to balance a range of ethical and practical considerations. A voluntary approach, backed up with education, respects healthcare workers’ autonomy to make private healthcare decisions, which is valued highly in liberal democracies. However, healthcare professionals also have an obligation to ensure that they do not present a risk of harm to their patients. Similarly, healthcare providers have a responsibility to take appropriate steps to minimise the risk of infection. Alongside balancing these rights and responsibilities, governments must also consider the potential consequences and risks of enforcing vaccine uptake. For example, there are concerns that a coercive approach could deepen mistrust and resentment among people who are genuinely fearful or hesitant. Moreover, a large number of refusals and the subsequent imposition of sanctions, such as suspension or redeployment, could affect the ability of providers to staff necessary services. In the UK, Wales, Northern Ireland and Scotland have all ruled out the introduction of compulsory vaccination. However, in July, the English Parliament voted through …. (shrink)

Martin Luther King, Jr drew upon his early grounding in family and church to forge a praxis of egalitarian justice in the rigidly segregated American South of his youth. King?s ethical outlook was eclectic, reflecting the influence of such figures as Mays, Davis, Rauschenbusch, Niebuhr, Thurman and Gandhi, alongside such doctrines as personalism and liberalism, nationalism and realism. Yet King?s subsequent academic study more nearly enhanced than restructured his early, formative exposure to black church and community. King became committed (...) to nonviolence, not as passive resistance, but as an active, aggressive, individual and self?improving solution to problems of gross injustice in society. Nonviolence for King was not an end, but a means, to the achievement of what he called ?Beloved Community? (shrink)

This article considers various approaches used in complementary and alternative medicine research, and discusses the challenges that reviewing such research poses for Human Research Ethics Committees. Drawing on our experience with the University of Technology Sydney HREC, we offer some suggestions about how ethical principles governing conventional medical research can be applied in the context of research in complementary and alternative medicine. We argue that effective HREC review requires members to gain familiarity with such research, which helps ensure that such (...) research is conducted rigorously and ethically. (shrink)

What are the most fundamental features of the world? Do minds stand outside the natural order? Is a unified picture of mental and physical reality possible? The Mind in Nature provides a staunchly realist account of the world as a unified system incorporating both the mental and the physical.

IT IS SHOWN IN DETAIL THAT RECENT ACCOUNTS FAIL TO DISTINGUISH BETWEEN INTENTIONALITY AND MERELY CAUSALLY DISPOSITIONAL STATES OF INORGANIC PHYSICAL OBJECTS—A QUICK ROAD TO PANPSYCHISM. THE CLEAR NEED TO MAKE SUCH A DISTINCTION GIVES DIRECTION FOR FUTURE WORK. A BEGINNING IS MADE TOWARD PROVIDING SUCH AN ACCOUNT.