Background: Patients undergoing invasive neurosurgical procedures offer researchers unique opportunities to study the brain. Deep brain stimulation patients, for example, may participate in research during the surgical implantation of the stimulator device. Although this research raises many ethical concerns, little attention has been paid to basic studies, which offer no therapeutic benefits, and the value of patient-participant perspectives.Methods: Semi-structured interviews were conducted with fourteen individuals across two studies who participated in basic intraoperative research during their deep brain stimulator surgery. Interviews (...) explored interpretations of risks and benefits, enrollment motivations, and experiences of participating in awake brain research. Reflexive thematic analysis was conducted.Results: Seven themes were identified from participant narratives, including robust attitudes of trust, high valuations of basic science research, impacts of the surgical context, and mixed experiences of participation.Conclusion: We argue that these narratives raise the potential for a translational misconception and motivate intraoperative re-consent procedures. (shrink)

Ranging from miniaturized biological robots to organoids, multi-cellular engineered living systems (M-CELS) pose complex ethical and societal challenges. Some of these challenges, such as how to best distribute risks and benefits, are likely to arise in the development of any new technology. Other challenges arise specifically because of the particular characteristics of M-CELS. For example, as an engineered living system becomes increasingly complex, it may provoke societal debate about its moral considerability, perhaps necessitating protection from harm or recognition of positive (...) moral and legal rights, particularly if derived from cells of human origin. The use of emergence-based principles in M-CELS development may also create unique challenges, making the technology difficult to fully control or predict in the laboratory as well as in applied medical or environmental settings. In response to these challenges, we argue that the M-CELS community has an obligation to systematically address the ethical and societal aspects of research and to seek input from and accountability to a broad range of stakeholders and publics. As a newly developing field, M-CELS has a significant opportunity to integrate ethically responsible norms and standards into its research and development practices from the start. With the aim of seizing this opportunity, we identify two general kinds of salient ethical issues arising from M-CELS research, and then present a set of commitments to and strategies for addressing these issues. If adopted, these commitments and strategies would help define M-CELS as not only an innovative field, but also as a model for responsible research and engineering. (shrink)

In “Regulating social media as a public good: Limiting epistemic segregation” (2022), Toby Handfield tackles a well-known problematic aspect of widespread social media use: the formation of ideologically monotone and insulated social networks. Handfield argues that we can take some cues from economics to reduce the extent to which echo chambers grow up around individual users. Specifically, he argues that tax incentives to encourage network heterophily may be levied at any of three different groups: individual social media users, social media (...) sites/companies, or advertisers who use social media to promote their products and material. In this response, I examine the plausibility of using such incentives on each of the these groups. I argue, first, that using tax incentives on either (1) social media companies or (2) advertisers would be ineffective as these incentives could not feasibly be made strong enough to override the enormous financial gain of the standard social media algorithms. Next, I argue that levying the incentives/penalties on individual users would be a hazard, due to the risk of what is called the epistemic “backfire effect”. Finally, I argue that the problem lies in relying on incentives and disincentives—rather than direct regulation—to increase network heterophily. (shrink)

Opioid use disorder rarely presents as a unitary psychiatric condition, and the comorbid symptoms likely depend upon the diverse risk factors and mechanisms by which OUD can arise. These factors are heterogeneous and include genetic predisposition, exposure to prescription opioids, and environmental risks. Crucially, one key environmental risk factor for OUD is early life adversity. OUD and other substance use disorders are widely considered to derive in part from abnormal reward circuit function, which is likely also implicated in comorbid mental (...) illnesses such as depression, bipolar disorder, and schizophrenia. ELA may disrupt reward circuit development and function in a manner predisposing to these disorders. Here, we describe new findings addressing the effects of ELA on reward circuitry that lead to OUD and comorbid disorders, potentially via shared neural mechanisms. We discuss some of these OUD-related problems in both humans and animals. We also highlight the increasingly apparent, crucial contribution of biological sex in mediating the range of ELA-induced disruptions of reward circuitry which may confer risk for the development of OUD and comorbid neuropsychiatric disorders. (shrink)

In the preface of the 2006 edition ofJust and Unjust Wars, Michael Walzer makes an important distinction between, on the one hand, “measures short of war,” such as imposing no-fly zones, pinpoint air/missile strikes, and CIA operations, and on the other, “actual warfare,” typified by a ground invasion or a large-scale bombing campaign. Even if the former are, technically speaking, acts of war according to international law, he proffers that “it is common sense to recognize that they are very different (...) from war.” While they all involve “the use of force,” Walzer distinguishes between the level of force used: the former, being more limited in scope, lack the “unpredictable and often catastrophic consequences” of a “full-scale attack.” Walzer calls the ethical framework governing these measuresjus ad vim, and he applies it to state-sponsored uses of force against both state and nonstate actors outside a state's territory that fall short of the quantum and duration associated with traditional warfare. Compared to acts of war,jus ad vimactions present diminished risk to one's own troops, have a destructive outcome that is more predictable and smaller in scale, severely curtail the risk of civilian casualties, and entail a lower economic and military burden. These factors makejus ad vimactions nominally easier for statesmen to justify compared to conventional warfare, though this does not necessarily mean these actions are morally legitimate or that they do not have potentially nefarious consequences. (shrink)

: In this brief commentary, we reflect on the recent study by Siminoff, Burant, and Youngner of public attitudes toward "brain death" and organ donation, focusing on the implications of their findings for the rules governing from whom organs can be obtained. Although the data suggest that many seem to view "brain death" as "as good as dead" rather than "dead" (calling the dead donor rule into question), we find that the study most clearly demonstrates that understanding an individual's definition (...) of death is neither a straightforward task nor a good predictor of views about donation. Reflecting on the implications for ongoing debates over the dead donor rule, we suggest that perhaps it is not a change in policy that is warranted, but rather a change in the priorities that have garnered such intense focus on this issue within the field of bioethics. (shrink)

The aim of this article is to explore how the brief history of drone warfare thus far affects and potentially alters the parameters of ad bellum and in bello just war principles.

In this paper, we explore the recent creation of “iBlastoids,” which are 3-D structures that resemble early human embryos prior to implantation which formed via self-organization of reprogrammed ad...

Entre los múltiples legados de la filosofía de Agustín de Hipona se detecta un reconocimiento muy atento al lenguaje. Su aproximación trata de una variedad de encuadres que exhiben que la lengua debe entenderse en relación a una cierta noción de praxis. No solo porque sus escritos sintetizan un rico recorrido propio de exploraciones lingüísticas teóricas y empíricas. Sino también porque es a través de una efervescente implicación en el discurso en donde Agustín construye su posición gestualmente. Lo hace escribiendo, (...) predicando, corrigiendo, contestando, discutiendo, enseñando. Incesantemente sumergido en algún acto verbal que incita a que en su obra se pueda respirar una original simbiosis entre lenguaje y acción. Sus advertencias sobre la blasfemia y de la maledicencia resultan fundamentales para comprender la postura lingüística sobre el lenguaje de reniego de toda una tradición posterior. (shrink)

Marshall and colleagues (2024) contribute to the literature on autonomy and decision-making capacity by focusing on the case of individuals with opioid use disorder who refuse to remain in the hosp...

Esta investigación se emprende motivada por la necesidad de desentrañar la progresión delos modelos de aprendizaje, los cuales se han ido adaptando para responder a las demandas de lasociedad en su dinámica constante de fluctuación y transformaciones. El objetivo de este trabajo es examinar de forma sistemática la evolución de los modelos de aprendizaje, destacando los cambios paradigmáticos que han favorecido la transición de enfoques de aprendizaje tradicionales hacia propuestas más innovadoras y transdisciplinarias. Para lograrlo, se lleva a cabo un (...) análisis bibliográfico apoyado en el método hermenéutico para la interpretación contextual de la literatura y los discursos, a fin de desentrañar las complejidades inherentes en la evolución de los modelos de aprendizaje. Los resultados resaltan la influencia limitante del paradigma de la simplicidad en laformación educativa tradicional y la necesidad de un giro hacia la dialogicidad y la colaboración eintegración disciplinaria para avanzar hacia la complejidad. Se concluye argumentando a favor de la adopción del paradigma de la complejidad, abogando por una epistemología transdisciplinariay un enfoque de aprendizaje interestructurante, que permitan el desarrollo humano integral.El reconocimiento de la complejidad humana en la enseñanza y el aprendizaje exige una transformación radical de la educación hacia prácticas más holísticas y transformadoras, esenciales para construir una sociedad equitativa y justa. (shrink)

Brain–Computer Interface (BCI) technology is a promising research area in many domains. Brain activity can be interpreted through both invasive and non-invasive monitoring devices, allowing for novel, therapeutic solutions for individuals with disabilities and for other non-medical applications. However, a number of ethical issues have been identified from the use of BCI technology. In this paper, we review the academic discussion of the ethical implications of BCI technology in the last five years. We conclude that some emerging applications of BCI (...) technology—including commercial ventures that seek to meld human intelligence with AI—present new and unique ethical concerns. Further, we seek to understand how academic literature on the topic of BCIs addresses these novel concerns. Similar to prior work, we use a limited sample to identify trends and areas of concern or debate among researchers and ethicists. From our analysis, we identify two key areas of BCI ethics that warrant further research: the physical and psychological effects of BCI technology. Additionally, questions of BCI policy have not yet become a frequent point of discussion in the relevant literature on BCI ethics, and we argue this should be addressed in future work. We provide guiding questions that will help ethicists and policy makers grapple with the most important issues associated with BCI technology. (shrink)

There is increased enthusiasm about the use of Artificial Intelligence (AI) technologies in psychotherapy. Notably, AI psychotherapy chatbots are increasing in popularity, especially since the US Food and Drug Administration (FDA) gave one of these apps breakthrough device designation. This article raises concerns about the lack of consideration of potential harms of this technology for clinical trial participants, and current and future users. We outline what these harms might be, by turning to the Belmont Report and the existing literature on (...) harms of (typical) psychotherapy and conclude with two recommendations. Note that our goal is not to articulate doomsday fears regarding the use of AI in psychotherapy contexts; rather we offer a constructive proposal in thinking about the potential harms of these tools and invite clinicians, patients, developers, researchers, policymakers and funding agencies to work together to augment the benefits of these tools and minimize their potential harms. (shrink)

Essential reading for students and researchers of existentialism and phenomenology, and also of interest to those studying ethics, philosophy and gender, philosophy of race, the emotions and philosophical issues in health and illness as well as related disciplines such as Literature, Sociology, and Political Theory.

The narratives that emerging adults wrote about a time when they learned an important moral, value or lesson were explored in order to determine the characteristics of events that lead to internalized values as well as to compare the way different kinds of moral values are socialized. Lessons resulting from misbehavior were reported most frequently. Those involving direct teaching of values were most highly internalized, with internalization assessed by importance and current impact. Self-reflection and self-generation of values was identified as (...) a key means to value learning and was reported more frequently than any other source of values (e.g., parents, peers). Finally, it appears that a framework for understanding socialization that involves different domains can reflect how individuals categorize their value-learning experiences. (shrink)

This essay examines how C. S. Lewis, in Till We Have Faces, illustrates the Christian’s journey of sanctification through the pre-Christian story of his main character, Orual. She must gain two ‘faces’ in this process that correspond to the two books she writes. First, she must gain the face of self-knowledge through humility. The key components to this face are her memory and the act of writing of her first book, which together create a mirror to reflect her sin back (...) to her. Second, Orual must gain the face of transformation through divine agape love. The humility she learned from her first face now allows her to enter what Lewis describes as the dance of self-giving, which is a crucial element to the second face of transformation in its mortification of Orual’s sin and selfishness. In the second face, Orual gains access to an ‘actual language’ that transcends merely verbal words and involves worshipping the god with her whole being, as do we in being transformed to reflect Christ more clearly. Orual’s writing is a form of this ‘actual language’, and her second book that shares her personal encounter with the god of the mountain reflects to others the beauty of the divine. Similarly, Christians should reflect Jesus with their lives and their art, which are inextricably intertwined because a life lived for Him is the highest form of artwork they can create. (shrink)

In this article, we provide an ethical analysis of the first porcine cardiac xenotransplant, performed in Maryland, USA in early 2022. David Bennett was offered the experimental procedure after he was deemed ineligible for human heart transplantation and mechanical circulatory support, based on a history of non-compliance. It was reported that Mr Bennett’s previous instances of non-compliance were for medically non-life-threatening conditions years earlier, where the risks of non-compliance were not as high. We argue that, in Mr Bennett’s case, a (...) history of non-compliance in a different context, should not necessarily rule him ineligible for a potentially life-saving treatment now. Furthermore, using previous non-compliance to exclude individuals from donor organs may have the unintended effect of placing the burden of testing xenotransplantation on those who are already disadvantaged. We then argue that it is not enough to rely on patient consent to ethically justify xenotransplantation research. Taking a broad ethical perspective is crucial when mapping a clinical pathway for xenotransplantation. (shrink)

Mobile devices with health apps, direct-to-consumer genetic testing, crowd-sourced information, and other data sources have enabled research by new classes of researchers. Independent researchers, citizen scientists, patient-directed researchers, self-experimenters, and others are not covered by federal research regulations because they are not recipients of federal financial assistance or conducting research in anticipation of a submission to the FDA for approval of a new drug or medical device. This article addresses the difficult policy challenge of promoting the welfare and interests of (...) research participants, as well as the public, in the absence of regulatory requirements and without discouraging independent, innovative scientific inquiry. The article recommends a series of measures, including education, consultation, transparency, self-governance, and regulation to strike the appropriate balance. (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 “Developing a Reflexive, Anticipatory, and Deliberative Approach to Unanticipated Discoveries: Ethical Lessons from iBlastoids,” we proposed a RAD approach to meet the challenging issues...

Rather than looking at protest in the ideal case, this book looks at how protest is actually practiced and argues that suitably constrained violent political protest is sometimes justified.

We are grateful to Friesen and colleagues for drawing attention to the tension between the protection of populations that may experience vulnerability with their inclusion in research (Friesen et a...

The use of qualitative research in empirical bioethics is becoming increasingly popular, but its implementation comes with several challenges, such as difficulties in aligning moral epistemology and methods. In this paper, we describe some problems that empirical bioethics researchers may face; these problems are related to a tension between the different poles on the spectrum of scientific paradigms, namely a positivist and interpretive stance. We explore the ideas of narrative construction, ‘genres’ in medicine and dominant discourses in relation to empirical (...) research. We also reflect on the loss of depth and context that may occur with thematic or content analyses of interviews, and discuss the need for transparency about methodologies in empirical bioethics. Drawing on insights from narrative approaches in the social sciences and the clinical-educational discipline of Narrative Medicine, we further clarify these problems and suggest a narrative approach to qualitative interviewing in empirical bioethics that enables researchers to ‘listen (and read) in new ways’. We then show how this approach was applied in the first author’s research project about euthanasia decision-making. In addition, we stress the important ethical task of scrutinizing methodologies and meta-ethical standpoints, as they inevitably impact empirical outcomes and corresponding ethical judgments. Finally, we raise the question whether a ‘diagnostic’, rather than a ‘problem-solving’, mindset could and should be foregrounded in empirical ethics, albeit without losing a commitment to ethics’ normative task, and suggest further avenues for theorizing about listening and epistemic (in)justice in relation to empirical (bio)ethics. (shrink)

Having a confirmation bias sometimes leads us to hold inaccurate beliefs. So, the puzzle goes: why do we have it? According to the influential argumentative theory of reasoning, confirmation bias emerges because the primary function of reason is not to form accurate beliefs, but to convince others that we’re right. A crucial prediction of the theory, then, is that confirmation bias should be found only in the reasoning domain. In this article, we argue that there is evidence that confirmation bias (...) does exist outside the reasoning domain. This undermines the main evidential basis for the argumentative theory of reasoning. In presenting the relevant evidence, we explore why having such confirmation bias may not be maladaptive. (shrink)

We argue that violent political protest is justified in a generally just society when violence is required to send a message about the nature of the injustice at issue, and when it is not ruled out by moral or pragmatic considerations. Focusing on protest as a mode of public address, we argue that its communicative function can sometimes justify or require the use of violence. The injustice at the heart of the Baltimore protests—police brutality against black Americans —is a paradigmatic (...) case of this sort, because of the relationship of the police to the injustice and the protests against it. (shrink)

Institutional guidelines for transgender children and adolescent minors fail to adequately address a critical juncture of care of this population: how to proceed if a minor and their parents have disagreements concerning their gender-affirming medical care. Through arguments based on ethical, paediatric, adolescent and transgender health research, we illustrate ethical dilemmas that may arise in treating transgender and gender diverse youth. We discuss three potential avenues for providing gender-affirming care over parental disagreement: legal carve-outs to parental consent, the mature minor (...) doctrine and state intervention for neglect. Our discussion approaches this parent–child disagreement in a manner that prioritises the developing autonomy of transgender youth in the decision-making process surrounding medically assisted gender affirmation. We base our arguments in the literature surrounding the risks and benefits of gender-affirming therapy in transgender children and the existing legal basis for recognising minors’ decision-making authority in certain medical situations. (shrink)

Philosophers analyze the last of the great rock stars.

According to the PubMed resource from the U.S. National Library of Medicine, over 750,000 scientific articles have been published in the ~5000 biomedical journals worldwide in the year 2007 alone. The vast majority of these publications include results from hypothesis-driven experimentation in overlapping biomedical research domains. Unfortunately, the sheer volume of information being generated by the biomedical research enterprise has made it virtually impossible for investigators to stay aware of the latest findings in their domain of interest, let alone to (...) be able to assimilate and mine data from related investigations for purposes of meta-analysis. While computers have the potential for assisting investigators in the extraction, management and analysis of these data, information contained in the traditional journal publication is still largely unstructured, free-text descriptions of study design, experimental application and results interpretation, making it difficult for computers to gain access to the content of what is being conveyed without significant manual intervention. In order to circumvent these roadblocks and make the most of the output from the biomedical research enterprise, a variety of related standards in knowledge representation are being developed, proposed and adopted in the biomedical community. In this chapter, we will explore the current status of efforts to develop minimum information standards for the representation of a biomedical experiment, ontologies composed of shared vocabularies assembled into subsumption hierarchical structures, and extensible relational data models that link the information components together in a machine-readable and human-useable framework for data mining purposes. (shrink)

This paper introduces the special section on Cora Diamond’s significance for education and educators. The introduction is meant to be the beginning of a conversation, and—to that end—the special section editors suggest lines of connections that philosophers of education might draw between their work and the work of Cora Diamond. Their list is not meant to be exhaustive, but it is meant to suggest Diamond’s far-reaching significance for education and educators.

As improvements in neuroscience have enabled a better understanding of disorders of consciousness as well as methods to treat them, a hurdle that has become all too prevalent is the denial of coverage for treatment and rehabilitation services. In 2011, a settlement emerged from a Vermont District Court case, Jimmo v. Sebelius, which was brought to stop the use of an “improvement standard” that required tangible progress over an identifiable period of time for Medicare coverage of services. While the use (...) of this standard can have deleterious effects on those with many chronic conditions, it is especially burdensome for those in the minimally conscious state, where improvements are unpredictable and often not manifested through repeatable overt behaviors. Though the focus of this paper is on the challenges of brain injury and the minimally conscious state, which an estimated 100,000 to 200,000 individuals suffer from in the United States, the post-Jimmo arguments presented can and should have a broad impact as envisioned by the plaintiffs who brought the case on behalf of multiple advocacy groups representing patients with a range of chronic care conditions. (shrink)

In this article Sophie Haroutunian-Gordon and Megan Jane Laverty discuss Jean-Luc Nancy's conception of listening as presented in his seminal work, À l'écoute. The authors argue that Nancy uses the term “listening” to refer to the experience of coming to an idea of sound(s) initially encountered as puzzling. They illustrate Nancy's conception with teaching/learning situations involving a pianist and teacher, Deborah Sobol, and two aspiring players, Sophie Haroutunian-Gordon and Rosalie Romano. The article has four parts. In part 1, the (...) authors ask: Do we see Deborah trying to make meaning of Sophie's performance on October 2, 1998? In part 2, they ask: Do we see Sophie trying to make meaning of Deborah's words and demonstrations on the same occasion? In parts 3 and 4, they explore Sophie's and Rosalie's listening when they are coached by Deborah on January 15, 1999. In so doing, Haroutunian-Gordon and Laverty illustrate Nancy's conception of listening and demonstrate its usefulness for theorizing about and studying actual situations. (shrink)