I respond to David Shoemaker's arguments for the conclusion that personal identity is irrelevant for death. I contend that we can accept Shoemaker's claim that loss of personal identity is not sufficient for death while nonetheless maintaining that there is an important theoretical relationship between death and personal identity. I argue that this relationship is also of practical importance for physicians' decisions about organ reallocation.

The economically successful model of industrial agriculture that is currently expanding throughout Argentina is leading to deep social, economic, environmental, and logistical changes that are seriously restricting the sustainability of the rural, urban and environmental systems. The transformation of activities, the arrival of new technologies, the arrival of organizations with large financial and technological capabilities, the displacement of hundreds of thousands of small-scale and medium-scale farmers and their reallocation to new productive functions are not only affecting the social sustainability (...) of the rural sector but are affecting the urban communal plots of villages and towns located on the Chacopampeana Plain. Now, the production of agrofuels as a response to international global demand will promote the ecological and social depletion that Argentina has been facing from the beginning of the 1990s. We argue in terms of ecological economics that externalities should be included in the costs of companies, not just economic costs. (shrink)

This article draws on the history of automobile safety in the United States to illustrate how technical design has been used to promote or maintain duties, values, and ethics. It examines two specific episodes: the debates over the “crash avoidance” and “crash-worthiness” approaches in the 1960s and the responses to the accusation that air bags were killing dozens of people in the mid-1990s. In each of these debates, certain auto safety advocates promoted the development of technologies designed to circumvent, replace, (...) or compensate for “irresponsible” human actions because they believed that devices and techniques would be considerably more obedient and reliable than the American public. Other organizations, however, contested such reallocations because they also involved a shift in responsibilities throughout the rest of the sociotechnical network of auto safety. This article argues that those who controlled the precise definition of risk in auto safety had the upper hand in constructing both the solution to the problem and the distribution of responsibilities the solution entailed. (shrink)

This article reviews the effects of malnutrition on early brain development using data generated from animal experiments and human clinical studies. Three related processes, each with their own functional consequences, are implicated in the alteration of brain development. (1) Maternal undernutrition at the start of pregnancy results in reduced transfer of nutrients across the placenta, allowing the conservation of effort for future reproductive episodes. (2) Differential allocation to growing organs by the fetus in response to nutritional stress spares the brain (...) to a large though still limited degree, reflecting the organ’s relative contribution to survival and reproductive success. (3) Prenatal malnutrition disrupts developing neurotransmitter systems, which results in the expression of specific cognitive and affective traits. It is argued that the increasing size and therefore cost of the brain, in conjunction with increasing ecological instability and marginality, reinforced selection for maternally controlled growth suppression of offspring, reallocation of organ growth rates by offspring, and behavioral changes related to development of neurotransmitter systems. (shrink)

In the last forty years, significant developments in neuroscience, psychology, and robotic technology have been cause for major trend changes in the philosophy of mind. One such shift has been the reallocation of focus from entirely brain-centered theories of mind to more embodied, embedded, and even extended answers to the questions, what are cognitive processes and where do we find such phenomena? Given that hypotheses such as Clark and Chalmers‘ (1998) Extended Mind or Hutto‘s (2006) Radical Enactivism, systematically undermine (...) the organism-bound, internal, and static pictures of minds and allow instead for the distribution of cognitive processes among brains, bodies, and worlds, a worry that arises is that the very subject of cognitive science, the ‗cognizer‘ will be hopelessly opaque, its mind leaking out into the world all over the place, thereby making it impossible to rein in and properly study. A seemingly unrelated and yet parallel trend has also taken place in feminist theorizing about the body over the last forty years. Whereas feminism of the 1970s and early 1980s tended to view ‗the body‘ as the site and matter of biological sex, while gender was a more fluid and socially constituted mode of existence, more recent feminist theory has questioned the givenness of bodies themselves. In other words, rather than seeing gender categories as manifestations of the already given sexed body, thinkers such as Butler (2000) and Lorber (1992) argue that the very notion of a body is often a product of scientific inquiry, which is itself a product of the power structures aiming to maintain a rigid binary between feminine and masculine gender roles. If the world at large plays such a constitutive role in determining who we are, then this implies that the tools we use, the language we speak, and the power relationships in which we are enmeshed are components of what it means to be embodied in any genuine sense. For thinkers like Haraway (1988) the image of the cyborg is most fitting for this new understanding of embodied subjects, as the cyborg is a coupling of machine and human. Gender and even biological sex will always be a technologically hybridized ‗monster‘ consisting of matter, machine, and mind. The overall aim of my project is thus to bring the two concurrent developments in theorizing about embodied subjects into discourse. As the cyborg features largely in recent feminist thought about embodiment, so too has it been a prominent metaphor in philosophy of mind, ever since Clark (2003) claimed that we ought to think of our ‗selves‘ more appropriately as Natural-Born Cyborgs. I therefore focus on this imagery as I go on to make the argument that this distributed account of cognition as well as of sexual identity is more fruitful for making progress in understanding ‗the human‘ more generally. Likewise, I argue that bringing the discussion of sex and gender into the arena of an otherwise asexual philosophy of mind, will shed light on some important facets of embodiment that have been overlooked but that ought to be addressed if we are to have an adequate account of ‗the proper subject of cognitive science.‘ My chapters include 1) a survey of the discourse between science and philosophy of mind leading to these embodied and extended approaches, 2) a first attempt at defending the extended mind thesis, 3) a discussion of how even the supposed resolution to the objections raised against extended cognition fails to properly take into account just how problematic subjectivity is, regardless of its being defined entirely organismic or not, as organisms themselves are highly malleable and socially constituted, 4) an explanation concerning how the same problematization of embodied subjectivity is ongoing in feminist theory, especially considering the phenomenology of transgendered embodiment, intersex, and technologically mediated bodies, 5) further elaboration on technologically enhanced bodies, exposing what I see as a continuum between bodies modified by ‗hard‘ technologies, such as implants, prostheses or surgeries, and those modified by ‗soft‘ technologies, such as gender norms, the social gaze, and technologically mediated metacognition, and last, 6) an argument for the image of the cyborg to replace ‗organism‘ in cognitive science, along with the corollary argument that cyborgs ought to represent not just embodied minds, but should also be the metaphor in attempting to understand ‗embodiment‘ more generally, which must, at its roots, be underpinned by gender and sexual identity. I argue that the imagery is fitting for the proper study of cognitive subjects as well as sexed and gendered bodies, but moreover, that just as the cyborg suggests a blending and hybridizing of seemingly unrelated elements, so too should the two areas of inquiry, philosophy of mind and feminist theory, pay heed to one another‘s use of this imagery and themselves begin to be more integrative in their approaches. (shrink)

BackgroundThe worsening COVID-19 pandemic in South Africa poses multiple challenges for clinical decision making in the context of already-scarce ICU resources. Data from national government and the last published national audit of ICU resources indicate gross shortages. While the Critical Care Society of Southern Africa (CCSSA) guidelines provide a comprehensive guideline for triage in the face of overwhelmed ICU resources, such decisions present massive ethical and moral dilemmas for triage teams. It is therefore important for the health system to provide (...) clinicians and critical care facilities with as much support and resources as possible in the face of impending pandemic demand. Following a discussion of the ethical considerations and potential challenges in applying the CCSSA guidelines, the authors propose a framework for regional triage committees adapted to the South African context.DiscussionBeyond the national CCSSA guidelines, the clinician has many additional ethical and clinical considerations. No single ethical approach to decision-making is sufficient, instead one which considers multiple contextual factors is necessary. Scores such as the Clinical Frailty Score and Sequential Organ Failure Assessment are of limited use in patients with COVID-19. Furthermore, the clinician is fully justified in withdrawing ICU care based on medical futility decisions and to reallocate this resource to a patient with a better prognosis. However, these decisions bear heavy emotional and moral burden compounded by the volume of clinical work and a fear of litigation.ConclusionWe propose the formation of Provincial multi-disciplinary Critical Care Triage Committees to alleviate the emotional, moral and legal burden on individual ICU teams and co-ordinate inter-facility collaboration using an adapted framework. The committee would provide an impartial, broader and ethically-sound viewpoint which has time to consider broader contextual factors such as adjusting rationing criteria according to different levels of pandemic demand and the latest clinical evidence. Their functioning will be strengthened by direct feedback to national level and accountability to a national monitoring committee. The potential applications of these committees are far-reaching and have the potential to enable a more effective COVID-19 health systems response in South Africa. (shrink)

Using the term world to mean a creative response to objective reality, this book considers the ways in which Eastern and Western peoples construct their natural, social, aesthetic, and religious worlds. It points the way to a view of Eastern and Western as complementary, rather than contradictory, descriptions.

Invites the reader to examine the concept of the One in several complex cultural and philosophical mileux. The uniqueness of the study is its collation of Eastern and Western sources and systems.

Essays originally published ca. 1949-1989.

While solid organ transplantation for patients with substance use issues has attracted ethical discussion, a typology of the ethics themes has not been articulated in the literature. We conducted a scoping review of peer-reviewed literature on solid organ transplantation and substance use published between January 1997 and April 2016. We aimed to identify and develop a typology of the main ethical themes discussed in this literature and to identify gaps worthy of future research. Seventy articles met inclusion criteria (...) and underwent inductive content analysis. Four main ethical themes were identified: (1) personal responsibility; (2) utility; (3) moral character; and (4) fairness. Each theme had multiple sub-themes and there was substantial overlap between themes. This scoping review identified a disproportionate emphasis in the literature regarding personal responsibility, which was referenced by each of the other themes, and a narrow focus on alcohol and liver. We recommend future research further investigate these connections between ethical themes and focus on ethical issues associated with transplants from organ groups other than liver for patients who use substances other than alcohol. (shrink)

In March 2010, China launched a pilot programme of deceased donor organ donation in 10 provinces and cities. However, the deceased donor donation rate in China remains significantly lower than in Spain and other Western countries. In order to provide incentive for deceased donor organ donation, five pilot provinces and cities have subsequently launched a financial compensation policy. Financial compensation can be considered to include two main forms, the ‘thank you’ form and the ‘help’ form. The ‘thank you’ (...) form is an expression of gratitude on behalf of the Red Cross Society of China for consenting to donation. The ‘help’ form is social welfare support for needy families. (shrink)

This paper looks at the ethics of opt-in vs. opt-out of organ donation as Scotland has transitioned its systems to promote greater organ availability. We first analyse studies that compare the donation rates in other regions due to such a system switch and find that organ increase is inconclusive and modest at best. This is due to a lack of explicit opt-out choices resulting in greater resistance and family override unless there are infrastructures and greater awareness to (...) support such change. The paper then looks at the difference between informed consent of the opt-in vs. presumed consent in the opt-out approaches. Patient autonomy and dignity are better reflected with informed consent. Eighteen months have passed since the new organ donation policy has come into effect, this paper recommends more research into organ donors’ psychological motivations to help governments and the healthcare profession obtain more organs for transplantation. (shrink)

: Moral frameworks for evaluating non-donation strategies to increase the supply of cadaveric human organs for transplantation and ways to overcome barriers to organ donation are explored. Organ transplantation is a very complex area, because the human body evokes various beliefs, symbols, sentiments, and emotions as well as various rituals and social practices. From a rationalistic standpoint, some policies to increase the supply of transplantable organs may appear to be quite defensible but then turn out to be ineffective (...) and perhaps even counterproductive because of inadequate attention to these rich and complex features of human body parts. Excessively rationalistic policies neglect deep beliefs, symbols, sentiments, and emotions and the like, and that deficiency marks many actual and proposed policies. In addition, policies are often too individualistic and too legalistic. (shrink)

Due to the shortage of organs, it has been proposed that the ban on organ sales is lifted and a market-based procurement system introduced. This paper assesses four prominent proposals for how such a market could be arranged: unregulated current market, regulated current market, payment-for-consent futures market, and the family-reward futures market. These are assessed in terms of how applicable prominent concerns with organ sales are for each model. The concerns evaluated are that organ markets will crowd (...) out altruistic donation, that consent to sell organs is invalid, that sellers will be harmed, and that commodification of organs will affect human relationships in a negative way. The paper concludes that the family-reward futures market fares best in this comparison but also that it provides the weakest incentive to potential buyers. There is an inverse relationship between how applicable prominent critiques are to organ market models and the increase in available organs they can be expected to provide. (shrink)

: Although "brain death" and the dead donor rule—i.e., patients must not be killed by organ retrieval—have been clinically and legally accepted in the U.S. as prerequisites to organ removal, there is little data about public attitudes and beliefs concerning these matters. To examine the public attitudes and beliefs about the determination of death and its relationship to organ transplantation, 1351 Ohio residents ≥18 years were randomly selected and surveyed using random digit dialing (RDD) sample frames. The (...) RDD telephone survey was conducted using computer-assisted telephone interviews. The survey instrument was developed from information provided by 12 focus groups and a pilot study of the questionnaire. Three scenarios based on hypothetical patients were presented: "brain dead," in a coma, or in a persistent vegetative state (PVS). Respondents provided personal assessments of whether the patient in each scenario was dead and their willingness to donate that patient's organs in these circumstances. More than 98 percent of respondents had heard of the term "brain death," but only one-third (33.7%) believed that someone who was "brain dead" was legally dead. The majority of respondents (86.2%) identified the "brain-dead" patient in the first scenario as dead, 57.2 percent identified the patient in a coma as dead (Scenario 2), and 34.1 percent identified the patient in a PVS as dead (Scenario 3). Nearly one-third (33.5%) were willing to donate the organs of patients they classified as alive for at least one scenario, in seeming violation of the dead donor rule. Most respondents were not willing to violate the dead donor rule, although a substantial minority was. However, the majority of respondents were unaware, misinformed, or held beliefs that were not congruent with current definitions of "brain death." This study highlights the need for more public dialogue and education about "brain death" and organ donation. (shrink)

I argue that a policy of presumed consent for cadaveric organ procurement, which assumes that people do want to donate their organs for transplantation after their death, would be a moral improvement over the current American system, which assumes that people do not want to donate their organs. I address what I take to be the most important objection to presumed consent. The objection is that if we implement presumed consent we will end up removing organs from the bodies (...) of people who did not want their organs removed, and that this situation is morally unacceptable because it violates the principle of respect for autonomy that underlies our concept of informed consent. I argue that while removing organs from the bodies of people who did not want them removed is unfortunate, it is morally no worse that not removing organs from the bodies of people who did want them removed, and that a policy of presumed consent will produce fewer of these unfortunate results than the current system. (shrink)

Organ shortage is a major survival issue for millions of people worldwide. Globally 1.2 million people die each year from kidney failure. In this paper, we critically examine and find lacking extant proposals for increasing organ supply, such as opting in and opt out for deceased donor organs, and parochial altruism and paired kidney exchange for live organs. We defend two ethical solutions to the problem of organ shortage. One is to make deceased donor organs automatically available (...) for transplant without requiring consent from the donor or their relatives. The other is for society to buy nonvital organs in a strictly regulated market and provide them to people in need for free. (shrink)