Most donated organs in the United States come from brain dead donors, while a small percentage come from patients who die in “controlled,” or expected, circumstances, typically after the family or surrogate makes a decision to withdraw life support. The number of organs available for transplant could be substantially if donations were permitted in “uncontrolled” circumstances–that is, from people who die unexpectedly, often outside the hospital. According to projections from the Institute of Medicine, establishing programs permitting “uncontrolled donation after circulatory (...) determination of death,” or uDCDD, throughout the United States has the potential to provide 22,000 more donation opportunities annually. In contrast, U.S. controlled donation after circulatory determination of death, or cDCDD, cases have increased progressively over the past decade from 87 to 848 donors, but currently account for only 10.6 percent of all deceased donors. Following the IOM recommendations, several projects exploring the feasibility of uDCDD were funded by the federal government, including a grant from the Health Resources and Services Administration that supported a pilot project in New York City in which the authors of this article participated.A key feature of our protocol, and indeed of many uDCDD protocols, is the initiation of preservation methods such as chest compressions and extracorporeal membrane oxygenation shortly after death in order to perfuse and preserve the donor's organs. Critics of uDCDD argue that the means of determining death deviates from generally ascribed principles. They assert that reinstituting circulation in order to preserve organs has the effect of “undoing” the prior determination of death. The result is that cDCDD is widely accepted and practiced routinely even though it only marginally increases the number of organs available for transplantation, and uDCDD is widely considered unacceptable despite being ethically embraced and proven to significantly increase organ donation opportunities in other countries. This article explores the evolution of this counterintuitive state of affairs and calls for a policy that, in line with the IOM report, allows for both cDCDD and uDCDD protocols. (shrink)

DBS Think Tank IX was held on August 25–27, 2021 in Orlando FL with US based participants largely in person and overseas participants joining by video conferencing technology. The DBS Think Tank was founded in 2012 and provides an open platform where clinicians, engineers and researchers can freely discuss current and emerging deep brain stimulation technologies as well as the logistical and ethical issues facing the field. The consensus among the DBS Think Tank IX speakers was that DBS expanded in (...) its scope and has been applied to multiple brain disorders in an effort to modulate neural circuitry. After collectively sharing our experiences, it was estimated that globally more than 230,000 DBS devices have been implanted for neurological and neuropsychiatric disorders. As such, this year’s meeting was focused on advances in the following areas: neuromodulation in Europe, Asia and Australia; cutting-edge technologies, neuroethics, interventional psychiatry, adaptive DBS, neuromodulation for pain, network neuromodulation for epilepsy and neuromodulation for traumatic brain injury. (shrink)

The sciences aim to get at the truth about the nature of the world. Do the humanities have a similar goal—namely, to get at the truth about things like novels, paintings, and historical events? I consider a few different ways in which the humanities aim at the truth about their objects, in the process giving rise to epistemic goods such as knowledge and understanding. Two works in the humanities are used as test cases: the historian Tyler Stovall’sParis Noir (1996) and (...) the musicologist Susan McClary’s article, ‘The Blasphemy of Talking Politics During Bach Year’ (1987). (shrink)

Among philosophers of science there seems to be a general consensus that understanding represents a species of knowledge, but virtually every major epistemologist who has thought seriously about understanding has come to deny this claim. Against this prevailing tide in epistemology, I argue that understanding is, in fact, a species of knowledge: just like knowledge, for example, understanding is not transparent and can be Gettiered. I then consider how the psychological act of "grasping" that seems to be characteristic of understanding (...) differs from the sort of psychological act that often characterizes knowledge. Zagzebski's account Kvanvig's account Two problems Comanche cases Unreliable sources of information The upper-right quadrant So is understanding a species of knowledge? A false choice. (shrink)

This essay deals with property rights in body parts that can be exchanged in a market. The inquiry arises in the following context. With some exceptions, the laws of many countries permit only the donation, not the sale, of body parts. Yet for some years there has existed a shortage of body parts for transplantation and other medical uses. It might then appear that if more sales were legally permitted, the supply of body parts would increase, because people would have (...) more incentive to sell than they currently have to donate. To allow sales is to recognize property rights in body parts. To allow sales, however, makes body parts into “commodities”—that is, things that can be bought and sold in a market. And some view it as morally objectionable to treat body parts as commodities. (shrink)

In this foundational work on the theory of linguistic and mental representation, Stephen Schiffer surveys all the leading theories of meaning and content in the philosophy of language and finds them lacking. He concludes that there can be no correct, positive philosophical theory or linguistic or mental representation and, accordingly advocates the deflationary "no-theory theory of meaning and content." Along the way he takes up functionalism, the nature of propositions and their suitability as contents, the language of thought and (...) other sententialist theories of belief, intention based semantics, and related issues in ontology. Stephen Schiffer is Professor of Philosophy at the City University of New York Graduate Center. A Bradford Book. (shrink)

Reprinted in Aristotle's Ethics, edited by T. Irwin, Garland Press, 1995; revised in Essays on Aristotle's Rhetoric, edited by A. Rorty, University of California Press, 1996.

Object files (OFs) are hypothesized mid-level representations which mediate our conscious perception of persisting objects—e.g. telling us ‘which went where’. Despite the appeal of the OF framework, not previous research has directly explored whether OFs do indeed correspond to conscious percepts. Here we present at least one case wherein conscious percepts of ‘which went where’ in dynamic ambiguous displays diverge from the analogous correspondence computed by the OF system. Observers viewed a ‘bouncing/streaming’ display in which two identical objects moved such (...) that they could have either bounced off or streamed past each other. We measured two dependent variables: (1) an explicit report of perceived bouncing or streaming; and (2) an implicit ‘object-specific preview benefit’ (OSPB), wherein a ‘preview’ of information on a specific object speeds the recognition of that information at a later point when it appears again on the same object (compared to when it reappears on a different object), beyond display-wide priming. When the displays were manipulated such that observers had a strong bias to perceive streaming (on over 95% of the trials), there was nevertheless a strong OSPB in the opposite direction—such that the object files appeared to have ‘bounced’ even though the percept ‘streamed’. Given that OSPBs have been taken as a hallmark of the operation of object files, the five experiments reported here suggest that in at least some specialized (and perhaps ecologically invalid) cases, conscious percepts of ‘which went where’ in dynamic ambiguous displays can diverge from the mapping computed by the object-file system. (shrink)

This paper offers and analysis of Ernest Sosa's Virtue Perspectivism. Although Sosa has been credited with fathering the influential contemporary movement known as Virtue Epistemology, I argue that Sosa imprudently abandons the reliabilist-based insights of Virtue Epistemology in favor of a reflection-based, "perspectival"' view. Sosa's mixed allegiance to reliabilist-based and reflection-based views of knowledge, in fact, leads to an unwelcome tension in his thought which can be relieved by recognizing that his reflection-based view is in fact an account of the (...) cognitive state of understanding, rather than an account of knowledge. Sosa makes matters difficult for himself because he expects too much, as it were, from the concept of knowledge, and in the process burdens his view with elements of reflection it does not require. To solve the problem, I suggest that Sosa needs to develop a two-tiered epistemology which recognizes that knowledge, on the one hand, and understanding, on the other, both have necessary and sufficient conditions unique to themselves. (shrink)

After summarizing the content of my book, Kant and Mysticism, I warn against four preliminary misconceptions. The book never argues that Kant viewed himself as a mystic, fully acknowledges Kant’s negative view of mysticism, offers no comprehensive overview of mystical traditions, and aims to initiate a dialogue, not to have the final word. I then respond to the foregoing essays by the five critics.

This essay investigates the structure of fiduciary obligations, specifically the obligation of loyalty. Fiduciary obligations differ from promissory obligations with respect to the possibility of “accidental compliance.” Promissory obligations can be satisfied through behavior that conforms to a promise, even if that behavior is done for inappropriate reasons. By contrast, fiduciary loyalty necessarily has an intentional dimension, one that prevents satisfaction through accidental compliance. The intentional dimension of fiduciary loyalty is best described by what we call the “shaping” account. This (...) account both explains the conscientiousness that loyalty demands and improves on other accounts of the intentional dimension of loyalty. Our analysis challenges two of the most prominent ways of conceptualizing fiduciary obligations. “Contractarianism” configures fiduciary obligations as a species of contractual duties. The view that we call “proscriptivism” reduces fiduciary obligations to the juridical prohibitions that apply to fiduciaries. Neither of these approaches is satisfactory, because each neglects the intentional dimension of fiduciary loyalty. (shrink)

This is a revised version of a paper that was originally presented at the first Kant in Asia international conference (on the theme "The Unity of Human Personhood") in May of 2009. It was published as Chapter 64 in Cultivating Personhood: Kant and Asian Philosophy, ed. Stephen R. Palmquist (Berlin: Walter de Gruyter, 2010), pp.811-821. I argue that Kant and the Yijing both employ a form of architectonic reasoning, though their respective understandings of the logical structure of human reasoning (...) are incommensurable. A more thoroughly revised version of the paper was later published in the Journal of Chinese Philosophy and was followed by a series of several other articles arguing that there is a way of arranging the Yijing's 64 hexagrams such that their form is compatible with the form of Kant's table of categories. (shrink)

The claim that animals, as well as people, ‘have rights’ may often mean only that their interests ought to be given some moral weight: they should not be treated ‘cruelly’ or ‘inconsiderately’. The more demanding claim may also be made that animals should not be subjected to simple-mindedly utilitarian calculation: their choices, their liberty, should sometimes be respected even if this prevents the realization of some notionally ‘greater good’. Finally, talk of rights may have a clearly political context: if, and (...) only if, animals have rights, governments are entitled to legislate on how they should be treated. If they do not, then any laws on the subject are merely moralistic, and such as to be regretted by any sincere liberal. It is this last doctrine that I shall be investigating in this paper, with particular attention to the writings of Regan and McCloskey. Only in this context, so it seems to me, does much hang upon the question of whether animals ‘really’ have rights: for those outside the liberal, or libertarian, tradition it is enough to know that we ought not to disregard the suffering of our fellow-creatures, nor treat it merely ‘aggregatively’. (shrink)

Every country's law permits medical experimentation on animals. While some countries protect particular kinds of animals from being subject to experimentation—notably great apes and endangered species—very few place concrete limitations on what researchers may cause animals to suffer, given sufficient scientific justification. What laws do, instead, is establish standards for the humane treatment and housing of animals in labs, and they encourage researchers to limit or seek alternatives to the use of animals, when doing that is consistent with the scientific (...) goals of their research.The system that has evolved in the United States combines elements of sometimes competing regulatory philosophies. The result is a complex, multilayered system that addresses the most important concerns, but, partly because of historical accident, also leaves some gaps. Even proponents of medical research on animals can see obvious ways in which the regulatory structure could be changed to benefit animals. Perhaps more important, though, is the fact that the existing regulatory structure, imperfect though it may be, is elastic enough to accommodate substantial changes that could reduce unnecessary animal suffering. (shrink)

We welcome and applaud Wilkinson’s impressive and subtle exploration of the possible considerations of frailty as a criterion for triage in times of pandemic-dr...

We agree with Nielsen Busch and Mjaaland’s (2023) assessment that the Dead Donor Rule (DDR) should be viewed as an essential requirement of the organ donation process, and that the essence of the r...

One of the largest ongoing debates in scholarship on Avicenna concerns his epistemology of the first acquisition of intelligible forms or concepts. “Emanationists” hold that intelligibles are emanated by the separate Active Intellect directly into human minds. “ionists” hold that intelligibles are abstracted by the human intellect from sensory images. Neither of these positions has a satisfactory grip on Avicenna’s philosophy. I propose that the two positions can be reconciled because Avicenna states in many texts that what the AI emanates (...) is a power, and not the various intelligible forms. I argue that this can only be the power of abstraction itself. This new interpretation does greater justice to Avicenna’s system and reveals his unique place in the history of epistemology. (shrink)

Kant and Mysticism interprets Kant’s early criticism of Swedenborg’s mysticism as the fountainhead of the Critical philosophy. Kantian Critique revolutionizes not only traditional metaphysics, but also our understanding of mysticism: Critical mysticism is a unitive experience that impels us to lay bare all human pretensions to reason’s light.

Words have determinable sense only within a complex of unstated assumptions, and all interpretation must therefore go beyond the given material. This book addresses what is man's place in the Aristotelian world. It also describes man's abilities and prospects in managing his life, and considers how far Aristotle's treatment of time and history licenses the sort of dynamic interpretation of his doctrines that have been given. The ontological model that explains much of Aristotle's conclusions and methods is one of life-worlds, (...) in which the material universe of scientific myth is no more than an abstraction from lived reality, not its transcendent ground. (shrink)

Explanatory inquiry characteristically begins with a certain puzzlement about the world. But why do certain situations elicit our puzzlement while others leave us, in some epistemically relevant sense, cold? Moreover, what exactly is involved in the move from a state of puzzlement to a state where one's puzzlement is satisfied? In this paper I try to answer both of these questions. I also suggest ways in which our account of scientific rationality might benefit from having a better sense of the (...) kind of epistemic goal we are trying to realize, when we engage in our explanatory inquiries. Two Senses The Need for Explanation An Example Proto-understanding Conclusion CiteULike Connotea Del.icio.us What's this? (shrink)

In the article “Principled Conscientious Provision: Referral Symmetry and Its Implications for Protecting Secular Conscience,” Abram L. Brummett, Tanner Hafen, and Mark C. Navin reject what they call the “referral asymmetry” in U.S. conscientious objection law in medicine, which recognizes rights of conscientiously objecting physicians to withhold referrals for medical interventions but does not (yet) recognize rights of physicians to make referrals for medical interventions to which they are morally committed but to which their health care institutions are morally opposed. (...) This commentary concentrates on a second asymmetry, namely, the relationship of a health care provider's referral or nonreferral to the medical standard of care. The commentary argues that this second asymmetry seems to require action more appropriately recognized as civil disobedience than conscientious provision of referral. (shrink)

Since its launch in November 2022, ChatGPT has become a global phenomenon, sparking widespread public interest in chatbot artificial intelligences (AIs) generally. While not approved for medical use, it is capable of passing all three United States medical licensing exams and offers diagnostic accuracy comparable to a human doctor. It seems inevitable that it, and tools like it, are and will be used by the general public to provide medical diagnostic information or treatment plans. Before we are taken in by (...) the promise of a golden age for chatbot medical AIs, it would be wise to consider the implications of using these tools as either supplements to, or substitutes for, human doctors. With the rise of publicly available chatbot AIs, there has been a keen focus on research into the diagnostic accuracy of these tools. This, however, has left a notable gap in our understanding of the implications for health outcomes of these tools. Diagnosis accuracy is only part of good health care. For example, crucial to positive health outcomes is the doctor–patient relationship. This paper challenges the recent focus on diagnostic accuracy by drawing attention to the causal relationship between doctor–patient relationships and health outcomes arguing that chatbot AIs may even hinder outcomes in numerous ways including subtracting the elements of perception and observation that are crucial to clinical consultations. The paper offers brief suggestions to improve chatbot medical AIs so as to positively impact health outcomes. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy and Rhetoric 37.1 (2004) 72-91 [Access article in PDF] Passing Theories through Topical Heuristics: Donald Davidson, Aristotle, and the Conditions of Discursive Competence Stephen R. Yarbrough Department of English The University of North Carolina at Greensboro What are the conditions of discursive competence? In "A Nice Derangement of Epitaphs" Donald Davidson explains how it is possible that in practice we can, with little effort, understand and appropriately (...) respond to linguistic anomalies such as the malapropism—anomalies because, by definition, the "language" cannot account for how we understand them. Such anomalies, Davidson concludes, are the exceptions that do not prove but refute the traditional rule that antecedent linguistic systems govern discursive meaning. If that is so, then meanings are not a property of a linguistic system and are not "governed by learned conventions or regularities" (1986, 436); therefore, learning and sharing such conventions, what we traditionally call "language," is not a necessary condition of successful communication. He shows this by arguing that two conditions must be met for successful interlocution and that meeting these sufficiently allows successful interlocution to take place. A third condition—that the interlocutors share a language, an organized set of learned conventions or regularities "learned in advance of occasions of interpretation" (436) for which phenomena such as malapropisms would be anomalous—is neither a necessary nor sufficient condition of discursive competence.What I hope to show in this paper is that the two conditions Davidson argues interlocution must meet in order to succeed both involve the interlocutor's implicit knowledge of what since Aristotle the rhetorical tradition has called topical heuristics. Although Davidson himself seems unaware of it, his philosophy places invention in a new light, one that allows us to understand that the invention process is not merely a supplement to discourse, useful only for professional speakers and writers, but intrinsic to all intercourse, and that the topics are not merely formal but pragmatic relations that develop from the processes of our interactions with others and with objects of our common concern in a world we can come to share. [End Page 72] Inferential method Davidson argues that the first condition necessary for successful interlocution is that "the interpreter can learn the semantic role of each of a finite number of words or phrases and can learn the semantic consequences of a finite number of modes of expression" (1986, 437). "For this to be possible," says Davidson, "there must be systematic relations between the meanings of utterances" (436). Here he is not talking about grammatical systems but about systematic relations between and among the interlocutors' discursive actions and the world with its objects to which their actions refer. As I'll explain more fully shortly, these are topical relations. What makes these relations possible, Davidson argues, is that the interlocutors share, not a set of learned conventions, but a "recursive characterization of the truth conditions of all possible utterances of the speaker" (437).Such a theory of truth can be something like a Tarski truth definition, the explanation of which can be extremely convoluted (see Davidson 1984), but it boils down to saying that an utterance is true if the anticipations raised by a belief in an interpreted utterance are met by the consequences of believing the utterance; or, to put it another way, if the utterance is an answer to the question that solicited it or a solution to the problem to which it responds. Thus, an example of such a truth definition would be "The grass is green (an utterance made by someone, somewhere, somewhen, under certain conditions) is true if and only if the grass is green (to that person, at that place, at that time, under those conditions)." The force of a Tarski truth definition is that to understand what an utterance means is to understand the conditions that make it true (to the speaker). This, in turn, implies that in order for the interpreter to learn the semantic roles of the speaker's words and phrases and the semantic consequences of her modes of expression, the... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.2 (2003) 157-159 [Access article in PDF] Constructing Persons:The Psychopathology of Identity Stephen R. L. Clark Keywords identity, legal fictions, materialism, psychopathology. Steve Matthews argues that the criteria proposed by Stephen Behnke and Walter Sinnott-Armstrong for establishing personal identity in cases of Dissociative Identity Disorder (DID) are flawed. Neither brain identity nor memory convergence are adequate grounds for ascribing identity, even in the (...) absence of DID. Someone suffering from DID is no less responsible than a drunkard for the crimes she commits when not in her right—or at least her usual—mind, and perhaps no more responsible than someone suffering from some other mental disorder. We may decide to punish someone suffering from DID for her crimes only when she and her presumed alter both share a brain (as obviously they do) and might—at least after therapy—have memories in common, and only when the alternate personality that led to the crime is herself sane. But we should not pretend to ourselves that this judgment rests upon a clear and uncontentious notion of identity.It may be that Matthews still shares too much of his opponents' attitude: namely, that there is some matter of fact about identity, or at least some fact about the central principles by which we ascribe or recognize identity. This, at first sight, is the force of his counterexamples: that the Behnke/Sinnott-Armstrong criteria give counterintuitive results and so cannot exactly map the notion that we have in mind. Just so Socrates was able to prove that Justice did not consist in Paying One's Debts, because we would all at once acknowledge that it was not Just (or Right) to restore his sword to a homicidal maniac (or at least that there were real doubts about who it was that really owned the sword). But neither Socrates' nor Matthews' conclusion need be referred to any simple fact. It would not be sensible to say that the maniac had a right to have his sword, or that its keeper had a duty to return it, because we recognize implicitly that the very point of Justice is to do Good. Correspondingly, maybe the real effect of Matthews's counterexamples is to remind us what the point of Judgment is. Is there any matter of fact about identity, or is identity simply a way of saying who it is that should now be held responsible? Joe is not to be held responsible because he is the same person as the one who committed the crime: he is reckoned the same person because he is the one who is here now to be held responsible. That is what it is to be the same person: to be held responsible for what is personally done. [End Page 157]Someone who is not a person at all is not the same person as anyone (although they may be the same creature). And a person is a creature who holds herself responsible, or can do so: who has memories and anticipations to which she lays claim, appropriates as her own. This in turn is possible because (or so it seems) she has acquired the necessary words and customs: because she sees people being held responsible she can also hold herself responsible—or sometimes disclaim all responsibility. She will not always be allowed to escape all blame or credit, merely because her memories are of a self that no longer makes much sense to her, nor even because she has no memories at all of what was done. But this need not be because she is objectively the very same person as the sometime agent; rather, the person she is taken to be is constructed by the legal and moral attitudes of those who judge her. Those attitudes are not necessarily determinate: how exactly the ordinary rules apply in novel cases may be a matter of decision rather than discovery. The connections that ordinarily ground or specify identity are not robust enough to rely upon in DID patients (that, after all, is the trouble). We have to make... (shrink)

The common saying, “it is better to give than to receive”, is so widespread that its truth is often merely assumed. But can this ethical maxim withstand a careful philosophical analysis? The relevant concepts (“giving”, “receiving”, and “better”)can be interpreted in too many ways to discuss thoroughly in a single essay. Instead, this essay classifies the various ways of interpreting the distinction between giving and receiving, then explores in depth one of the options, based on a pivotal distinction between active (...) and passive types of both giving and receiving. I defend the controversial claim that there is at least one important sense (arguably the most important, for ethical purposes) in which it is not better to give than receive, but that in this sense precisely the opposite holds true. Indeed, the survival of the human race may depend on our willingness to receive. (shrink)

The notion that metaphorical statements are strictly false suggests that all statements, even those that seemed ‘literal’, are false, as none can ‘literally’ reflect reality. Statements about what we perceive or could perceive rely on evoking sensory images of such ‘visibles’, even though we have no direct access to what others, may perceive. In addition to what is visible, we must also deal with ‘invisibilia’ (both the fantasms that respectable moderns now reject and the realities that lie beyond or before (...) all sentient experience). Talking about such distant or long-ago realities must always be ‘metaphorical’, as they cannot have any of the merely ‘subjective’ properties of experience, nor do they explain those latter properties. Is there some way of confirming the brute conviction that there is a ‘real and intelligible world’, and that we can find it out or describe it ‘literally’? May ‘Reason’ be a route to understanding? But this too is an illusion: we seem never in practice to escape contradictions and had perhaps better turn again to consider the worlds of experience to which we are confined. What we experience is conditioned by our imagination: whether that metaphorical imagination points beyond experience remains uncertain. (shrink)