Mentalizing refers to our ability to read the mental states of other agents and engages many neural processes. The brain's mirror system allows us to share the emotions of others. Through perspective taking, we can infer what a person currently believes about the world given their point of view. Finally, the human brain has the unique ability to represent the mental states of the self and the other and the relationship between these mental states, making possible the communication of ideas.

The approach adopted by Posner & Raichle in this book, with its strong emphasis on the cognitive level of description, is ideally suited to the study of psychotic illnesses. However, their discussion of depression and schizophrenia is based on a very small number of studies and involves ad hoc arguments derived largely from neuroanatomy. Their conclusions are almost certainly wrong.

Gray has expanded his account of schizophrenia to explain consciousness as well. His theory explains neither phenomenon adequately because he treats individual minds (and brains) in isolation. The primary function of consciousness is to permit high level interactions with other conscious beings. The key symptoms of schizophrenia reflect a failure of this mechanism.

Patients with delusions of control are abnormally aware of the sensory consequences of their actions and have difficulty with on-line corrections of movement. As a result they do not feel in control of their movements. At the same time they are strongly aware of the action being intentional. This leads them to believe that their actions are being controlled by an external agent. In contrast, the normal mark of the self in action is that we have very little experience of (...) it. Most of the time we are not aware of the sensory consequences of our actions or of the various subtle corrections that we make during the course of goal-directed actions. We know that we are agents and that we are successfully causing the world to change. But as actors we move through the world like shadows glimpsed only occasional from the corner of an eye. (shrink)

Like any discipline, bioethics is a developing field of academic inquiry; and recent trends in scholarship have been towards more engagement with empirical research. This ‘empirical turn’ has provoked extensive debate over how such ‘descriptive’ research carried out in the social sciences contributes to the distinctively normative aspect of bioethics. This paper will address this issue by developing a practical research methodology for the inclusion of data from social science studies into ethical deliberation. This methodology will be based on a (...) naturalistic conception of ethical theory that sees practice as informing theory just as theory informs practice – the two are symbiotically related. From this engagement with practice, the ways that such theories need to be extended and developed can be determined. This is a practical methodology for integrating theory and practice that can be used in empirical studies, one that uses ethical theory both to explore the data and to draw normative conclusions. (shrink)

Over the last 20 years the comparator model for delusions of control has received considerable support in terms of empirical studies. However, the original version clearly needs to be replaced by a model with a much greater degree of sophistication and specificity. Future developments are likely to involve the specification of the role of dopamine in the model and a generalisation of its explanatory power to the whole range of positive symptoms. However, we will still need to explain why symptoms (...) can be so variable and we still do not understand the origin of the most mysterious symptom of all: thought insertion. (shrink)

Humans have been shown capable of performing many cognitive tasks using information of which they are not consciously aware. This raises questions about what role consciousness actually plays in cognition. Here, we explored whether participants can learn cue-target contingencies in an attentional learning task when the cues were presented below the level of conscious awareness, and how this differs from learning about conscious cues. Participants’ manual (Experiment 1) and saccadic (Experiment 2) response speeds were influenced by both conscious and unconscious (...) cues. However, participants were only able to adapt to reversals of the cue-target contingencies (Experiment 1) or changes in the reliability of the cues (Experiment 2) when consciously aware of the cues. Therefore, although visual cues can be processed unconsciously, learning about cues over a few trials requires conscious awareness of them. Finally, we discuss implications for cognitive theories of consciousness. (shrink)

Humans, like other primates, are intensely social creatures. One of the major functions of our brains must be to enable us to be as skilful in social interactions as we are in our interactions with the physical world. Furthermore, any differences between human brains and those of our nearest relatives, the great apes, are likely to be linked to our unique achievements in social interaction and communication rather than our motor or perceptual skills. Unique to humans is the ability to (...) mentalise, that is to perceive and communicate mental states, such as beliefs and desires. A key problem facing science is to uncover the biological mechanisms underlying our ability to read other minds and to show how these mechanisms evolved. To solve this problem we need to do experiments in which people interact with one another rather than behaving in isolation. Such experiments are now being conducted in increasing numbers and many of the leading exponents of such experiments have contributed to this volume. 'The Neuroscience of Social Interactions' will be an important step in uncovering the biological mechanisms underlying social interactions - undoubtedly one of the major programmes for neuroscience in the 21st century. (shrink)

The literature on patient public involvement and engagement (PPIE) in health research has grown significantly in the last decade, with a diverse range of definitions and topologies promulgated. This has led to disputes over what the central functions and purpose of PPIE in health research is, and this in turn makes it difficult to assess and evaluate PPIE in practice. This paper argues that the most important function of PPIE is the attempt to make health research more democratic. Bringing this (...) function to the fore and locating PPIE in the wider context of changes in contemporary forms of democratic engagement provides greater conceptual clarity over what PPIE in research should be trying to achieve. Conceptualizing PPIE as a form of democratization has a number of benefits. First, theories of what are appropriate, normatively justifiable and workable criteria for PPIE practices can be developed, and this can provide tools to address the legitimacy and accountability questions that have troubled the PPIE community. Second, this work can be used to form the basis of a research agenda to investigate how PPIE in health research operates, and how it can facilitate and/or improve democratic processes in health research. (shrink)

In this paper, we attempt to make a distinction between egocentrism and allocentrism in social cognition, based on the distinction that is made in visuo-spatial perception. We propose that it makes a difference to mentalizing whether the other person can be understood using an egocentric (‘‘you'') or an allocentric (‘‘he/ she/they'') stance. Within an egocentric stance, the other person is represented in relation to the self. By contrast, within an allocentric stance, the existence or mental state of the other person (...) needs to be represented as independent from the self. We suggest here that people with Asperger syndrome suffer from a disconnection between a strong naı¨ve egocentric stance and a highly abstract allocentric stance. We argue that the currently used distinction between first-person and third-person perspective-taking is orthogonal to the distinction between an egocentric and an allocentric stance and therefore cannot serve as a critical test of allocentrism. (shrink)

We challenge the notion that differences in spatial ability are the best or only explanation for observed sex differences in mathematical word problems. We suggest two ideas from the study of autism: sex differences in theory of mind and in central coherence.

Autism provides a model for exploring the nature of self‐consciousness: self‐consciousness requires the ability to reflect on mental states, and autism is a disorder with a specific impairment in the neurocognitive mechanism underlying this ability. Experimental studies of normal and abnormal development suggest that the abilities to attribute mental states to self and to others are closely related. Thus inability to pass standard ‘theory of mind’ tests, which refer to others’ false beliefs, may imply lack of self‐consciousness. Individuals who persistently (...) fail these tests may, in the extreme, be unable to reflect on their intentions or to anticipate their own actions. In contrast, individuals with high‐functioning autism or Asperger syndrome often possess a late‐acquired, explicit theory of mind, which appears to be the result of effortful learning. An experimental study with three people with Asperger syndrome suggested that level of performance on standard theory of mind tasks was strongly related to the ability to engage in introspection. Qualitative differences in the introspections of high‐functioning people with autism are also reflected in autobiographical accounts which may give a glimpse of what it is like to be autistic. (shrink)

This article considers John Harris’ work on autonomy, specifically reproductive autonomy, outlined in The Value of Life and developed throughout his career. Harris often used the concept of reproductive autonomy to make the case for liberal approaches to developments in reproductive and genetic technologies. Harris argued that reproductive autonomy should be highly valued, and therefore we need compelling arguments to justify limiting it in anyway. When discussing reproductive autonomy, Harris focused mainly on restrictions on the potential users of reproductive technologies (...) autonomy, that is, prospective parents. This article extends the discussion of autonomy and the appropriate limits to individuals exercising their autonomy to medical professionals working in this area. Given reproductive technologies have become part of routine medical practice, this article considers whether the current restrictions on both patients and clinicians, as imposed by regulators and professional guidelines, remain ethically justified. (shrink)

Antti Revonsuo has given us an engaging and deliberately provocative paper discussing the value of brain imaging in the search for the neural basis of consciousness. In some places, however, his enthusiasm for the controversial nature of the topic has led him to overstate or misdirect his case.

McCoy et al. (2020) give a finely tuned analysis of the role and responsibilities of non-elected or self-appointed representatives in public policy. They take the example of autism activism to illu...

Christopher Frith is a research professor at the Functional Imaging Laboratory of the Wellcome Department of Imaging Neuroscience at University College, London. He explores, experimentally, using the techniques of functional brain imaging, the relationship between human consciousness and the brain. His research focuses on questions pertaining to perception, attention, control of action, free will, and awareness of our own mental states and those of others. As the following discussion makes clear, Frith investigates brain systems involved in the choice (...) of one action over another and in the understanding of other people. Such investigations are aimed at understanding brain basis of autism and schizophrenia. In his widely cited study of schizophrenia, The Cognitive Neuropsychology of Schizophrenia , Frith argues that many of the positive symptoms of schizophrenia, such as delusions of control, auditory hallucinations, and thought insertion, involve problems of self-monitoring. Patients, in effect, lose track of their own intentions and mistakenly attribute agency for their own actions to someone else. Frith employs models of motor control, involving comparator mechanisms and efference copy, not only to explain delusions that involve movement, but also to develop a neurocognitive explanation of delusional cognition. (shrink)

Autism: Mind and Brain provides a comprehensive overview of the latest research on autism and highlights new techniques that will progress future understanding. With contributions from leaders in autism research, the book describes the latest advances, discusses ways forward for future research, and presents new techniques for understanding this complex disorder.

The use of rights based arguments to justify claims that donor offspring should have access to information identifying their gamete donor has become increasingly widespread. In this paper, I do not intend to revisit the debate about the validity of such rights. Rather, the purpose is to examine the way that such alleged rights have been implemented by those legislatures that have allowed access to identifying information. I will argue that serious inconsistencies exist between the claim that donor offspring have (...) a right to know the identity of their gamete donor and the way such a right is currently met in practice. I hope to show that in systems where non‐anonymous donation is practised, an understanding of the proclaimed right of donor offspring to know their genetic identity is one composed of two different rights – the right to know the circumstances of their conception and the right to information identifying the gamete donor – can provide important insights into this important area of public policy. (shrink)

We have only limited awareness of the system by which we control our actions and this limited awareness does not seem to be concerned with the control of action. Awareness of choosing one action rather than another comes after the choice has been made, while awareness of initiating an action occurs before the movement has begun. These temporal differences bind together in consciousness the intention to act and the consequences of the action. This creates our sense of agency. Activity in (...) the anterior cingulate cortex and medial prefrontal cortex is associated with awareness of our own actions and also occurs when we think about the actions of others. I propose that the mechanism underlying awareness of how our own intentions lead to actions can also be used to represent the intentions that underlie the actions of others. This common system enables us to communicate mental states and thereby share our experiences. (shrink)

It is nearly 20 years since Tony Hope wrote an editorial in this journal on Empirical Medical Ethics,1 arguing for both a recognition of the increasing amount of work being done in ‘empirical ethics’ and for its importance as a new direction for medical ethics research. Since then empirical ethics has flourished, with debates over the role of ‘empirical’ data in ethical reasoning producing a growing body of literature and the JME and other bioethics journals regularly publishing empirical studies. While (...) bio/medical ethics has grappled with ‘incorporating’ or using more empirical data in ethical analysis, with varying degrees of success, and some criticism, there has not been a corresponding willingness of more empirical disciplines to embrace ethical analysis. This is a particular lack for applied research areas that see their role as predominately influencing policy and practice, such as health services research. Health services research ‘is the integration of epidemiological, sociological, economic, and other analytic sciences in the study of health services.’ Whose ‘main goals … are to identify the most effective ways to organize, manage, finance, and deliver high quality care; reduce medical errors; and improve patient safety’.2 Health services research brings together a wide variety of disciplines and would seem ideally placed to include ethics. However, if you search health services research journals and conference programmes there is very little consideration of ethics as a substantive topic and often scant attention paid to the ethical issues that might be raised by an intervention or policy. Ethics and ethical issues are generally confined to discussions over priority setting, and occasionally health technology assessment, with other areas of health service research seldom engaging in ethical debate. In the Encyclopaedia of Health Services Research,3 ethics …. (shrink)

We have only limited awareness of the system by which we control our actions and this limited awareness does not seem to be concerned with the control of action. Awareness of choosing one action rather than another comes after the choice has been made, while awareness of initiating an action occurs before the movement has begun. These temporal differences bind together in consciousness the intention to act and the consequences of the action. This creates our sense of agency. Activity in (...) the anterior cingulate cortex and medial prefrontal cortex is associated with awareness of our own actions and also occurs when we think about the actions of others. I propose that the mechanism underlying awareness of how our own intentions lead to actions can also be used to represent the intentions that underlie the actions of others. This common system enables us to communicate mental states and thereby share our experiences. (shrink)

This paper will take as its starting point the premise that developing translational bioethics is a worthwhile endeavour. I will develop an account of translational bioethics and discuss what implications this would have for the wider discipline of bioethics and argue that this would be a useful development for bioethics. The paper will conduct a form of ‘translational meta‐bioethics analysis’, in the words of Bærøe. I will argue that if we are serious about instituting translational bioethics, then it will need (...) to look and be organised in a very different way from current bioethics research, this will be a radically different form of bioethics from what we currently have. In this paper I will sketch what translational bioethics might look like. My proposal here is not that translational bioethics should supplant existing ways of doing bioethics, but rather that it should be an addition to it, another subdiscipline of bioethics. (shrink)

In their paper Hortonet alargue that it is acceptable to contact an anonymous egg-donor to facilitate diagnostic genetic testing for the donor conceived child, despite the donor, ‘indicating on a historical consent form that she did not wish to take part in future research, and that she did not wish to be informed if she was found to be a carrier of a “harmful inherited condition”’. There are a number of claims embedded in Hortonet al’s position that it is acceptable (...) to contact the donor and request that she at least think about participating in genetic testing. In this response. I will go through their main claims and argue that the area of genomic medicine does not justify exceptions to general consent conditions as the authors suppose and conclude that the donor should not be contacted. I will then go on to suggest a policy change that would address Hortonet al’s concerns but would not involve over-riding any previously expressed wishes. (shrink)

Who's better? Billie Holiday or P. J. Harvey? Blur or Oasis? Dylan or Keats? And how many friendships have ridden on the answer? Such questions aren't merely the stuff of fanzines and idle talk; they inform our most passionate arguments, distil our most deeply held values, make meaning of our ever-changing culture. In Performing Rites, one of the most influential writers on popular music asks what we talk about when we talk about music. What's good, what's bad? What's high, what's (...) low? Why do such distinctions matter? (shrink)

The JME editorial team selects its feature articles from the best papers accepted for publication based on their quality, novelty and capacity to move debate forward on a specific issue. Feature articles are made freely available and are published alongside reviewed and submitted commentaries. We do this partly to promote and acknowledge excellent work in medical ethics, but also to encourage authors to submit their best papers to the JME. JME feature articles have deepened the analysis of some central issues (...) for medical ethics. ‘Common morality’ is one way of underpinning general ethical principles and it is a concept that is central to the justification that Beauchamp and Childress give in their classic articulation of the four principles. 1 Rhodes’ critical discussion of common morality in her feature article 2 has been well cited since then, which is a good thing from the perspective of the author... (shrink)

A step towards a theory of consciousness would be to characterise the effect of consciousness on information processing. One set of results suggests that the effect of consciousness is to interfere with computations that are optimally performed non-consciously. Another set of results suggests that conscious, system 2 processing is the home of norm-compliant computation. This is contrasted with system 1 processing, thought to be typically unconscious, which operates with useful but error-prone heuristics. -/- These results can be reconciled by separating (...) out two different distinctions: between conscious and non-conscious representations, on the one hand, and between automatic and deliberate processes, on the other. This pair of distinctions is used to illuminate some existing experimental results and to resolve the puzzle about whether consciousness helps or hinders accurate information processing. This way of resolving the puzzle shows the importance of another category, which we label ‘type 0 cognition’, characterised by automatic computational processes operating on non-conscious representations. (shrink)

The NHS in England is an organisation undergoing substantial change. The passage of the Health and Social Care Act 2012, consolidates and builds on previous health policies and introduces further ‘market-style’ reforms of the NHS. One of the main aspects of these reforms is to encourage private and third sector providers to deliver NHS services. The rationale for this is to foster a more competitive market in healthcare to encourage greater efficiency and innovation. This changing healthcare environment in the English (...) NHS sharpens the need for attention to be paid to the ethical operation of healthcare organisations. All healthcare organisations need to consider the ethical aspects of their operation, whether state or privately run. However, the changes in the type of organisations used to provide healthcare (such as commercial companies) can create new relationships and ethical tensions. This paper will chart the development of organisational ethics as a concern in applied ethics and how it arose in the USA largely owing to changes in the organisation of healthcare financing and provision. It will be argued that an analogous transition is happening in the NHS in England. The paper will conclude with suggestions for the development of organisational ethics programmes to address some of the possible ethical issues raised by this new healthcare environment that incorporates both private and public sector providers. (shrink)

In this paper we examine the functional anatomy of volition, as revealed by modern brain imaging techniques, in conjunction with neuropsychological data derived from human and non-human primates using other methodologies. A number of brain regions contribute to the performance of consciously chosen, or ‘willed', actions. Of particular importance is dorsolateral prefrontal cortex , together with those brain regions with which it is connected, via cortico-subcortical and cortico-cortical circuits. That aspect of free will which is concerned with the voluntary selection (...) of one action rather than another critically depends upon the normal functioning of DLPFC and associated brain regions. Disease, or dysfunction, of these circuits may be associated with a variety of disorders of volition: Parkinson's disease, ‘utilization’ behaviour, ‘alien’ and ‘phantom’ limbs, and delusions of ‘alien control’ . Brain imaging has allowed us to gain some access to the pathophysiology of these conditions in living patients. At a philosophical level, the distinction between ‘intentions to act', and ‘intentions in action’ may prove particularly helpful when addressing these complex disturbances of human cognition and conscious experience. The exercise and experience of free will depends upon neural mechanisms located in prefrontal cortex and associated brain systems. (shrink)

People should be allowed to decide how and where they wish to be tested for HIV without there being a formal requirement for pretest counsellingIn his paper, Ethics of HIV testing in general practice without informed consent, Fraser argues that pretest counselling and informed consent are pillars of the ethical conduct of HIV testing. In my response I want to look critically at these contentions. While I will agree with Fraser that it is always necessary to get informed consent from (...) a patient for an HIV test I will argue that an emphasis on pretest counselling as a prerequisite for testing can actually undermine a patient’s autonomy, the very principle that informed consent seeks to promote.This response will start with an analysis of Case Two as this highlights the fundamental importance of informed consent. It will then go on to look at Case One and show how the special application of informed consent in the field of HIV testing can, in certain circumstances, lead to a reduction in patient autonomy.CASE TWOIn Fraser’s second case a 43 year old married clergyman presented with a recurrent infection of his little toe and the preliminary lab reports queried Kaposi’s sarcoma. The general practitioner thought that because of the patient’s lifestyle there was little risk of HIV infection, “suggesting the possibility of HIV, when it is unexpected and the risk low, can in itself cause anxiety and distress”. On these grounds the GP did not call the patient in for an HIV test.Some might argue that the GP should have tested the clergyman. This could have been done in one of two ways: by seeking his explicit consent for an HIV test, or by getting blanket consent for a range of tests, including HIV, without HIV being explicitly mentioned. …. (shrink)

There are substantial numbers of frozen embryos in storage that will not be used by those who produced them for their own fertility treatment. One option for such embryos is to donate them to others to use in their fertility treatment. There has been considerable debate about how this process should be organized. In the US, there are embryo adoption programmes that mediate between those relinquishing embryos and potential recipients. This is a form of conditional embryo donation, where the relinquishing (...) couple can choose the recipient of their embryo. This article examines the ethical debate over conditional embryo donation for family building and explores the question of whether those who have unused frozen embryos should be able to determine who receives their embryos. The main objections to conditional embryo donation are examined: first, the embryo is not a person and therefore such concern over the placement of an embryo is unwarranted; secondly, potential donors might impose morally problematic conditions on who should receive their embryo; and thirdly, there are practical difficulties regarding organizational arrangements and the associated costs involved. It will be concluded that these objections can be countered and that if people wish to donate and receive embryos in this way there is no ethical objection to them doing so. (shrink)

The two leading cognitive accounts of consciousness currently available concern global workspace (a form of working memory) and metacognition. There is relatively little interaction between these two approaches and it has even been suggested that the two accounts are rival and separable alternatives. Here, we argue that the successful function of a global workspace critically requires that the broadcast representations include a metacognitive component.