In spite of ethical analyses assimilating the palliative deactivation of pacemakers to commonly accepted withdrawings of life-sustaining therapy, many clinicians remain ethically uncomfortable with pacemaker deactivation at the end of life. Various reasons have been posited for this discomfort. Some cardiologists have suggested that reluctance to deactivate pacemakers may stem from a sense that the pacemaker has become part of the patient’s “self.” The authors suggest that Daniel Sulmasy is correct to contend that any such identification of the (...) pacemaker is misguided. The authors argue that clinicians uncomfortable with pacemaker deactivation are nevertheless correct to see it as incompatible with the traditional medical ethics of withdrawal of support. Traditional medical ethics is presently taken by many to sanction pacemaker deactivation when such deactivation honors the patient’s right to refuse treatment. The authors suggest that the right to refuse treatment applies to treatments involving ongoing physician agency. This right cannot underwrite patient demands that physicians reverse the effects of treatments previously administered, in which ongoing physician agency is no longer implicated. The permanently indwelling pacemaker is best seen as such a treatment. As such, its deactivation in the pacemaker-dependent patient is best seen not as withdrawal of support but as active ending of life. That being the case, clinicians adhering to the usual ethical analysis of withdrawal of support are correct to be uncomfortable with pacemaker deactivation at the end of life. (shrink)

The question of whether it is permissible to deactivate a pacemaker at the end of life has been addressed in medical journals but rarely in ethics journals. The ethics of pacemaker deactivation is especially challenging because of the disparate ways the devices are viewed by both medical professionals and patients. Some consider pacemakers replacement therapy, and some consider them substitutive therapy. If they are the former, then deactivation would not be permitted, since a replacement device is considered a (...) part of the body, akin to a new heart. Some ask whether pacemakers are natural or artificial; if pacemakers are artificial, deactivation would be permissible. Another factor is whether a patient is pacemaker dependent. Some medical experts decide the issue of deactivation on the basis of patient autonomy. Others weigh in on whether pacemakers are ordinary or extraordinary means of care. This paper examines each proposal and concludes tentatively that pacemaker deactivation is not permissible at the end of life. National Catholic Bioethics Quarterly 15.1 : 39–51. (shrink)

A 68-year-old patient who suffered from gastric cancer diagnosed 8 months earlier presented with multiple peritoneal and hepatic metastasis, despite several rounds of chemo- and radiotherapy. After admission to hospital, his general condition quickly became severely compromised. He was nearly emaciated, despite being on partial parenteral feeding. Four years earlier, due to a cardiac arrhythmia that was refractory to medication, the patient had a cardiac pacemaker implanted, regulated to go off at frequencies of below 70 beats per minute. Given the (...) patient's terminal situation, the team started developing some doubts about the pacemaker's effects during his dying process. The patient had mentioned his intention to donate his pacemaker after his death, but had not asked for its deactivation. The specialists were not sure about the effect of the pacemaker in unnecessarily prolonging the patient's final hour. Nevertheless, they opposed deactivation, which they considered ethically uncertain. The family, who had been initially for the deactivation, decided against it. The patient's condition was progressively deteriorating, as he was falling into a state of sopor and, later, into a coma. (shrink)

In their analyses of the neural correlates of discrete emotionality, Lindquist et al. do not consider the numerous drawbacks to inferring psychological processes based on currently available cognitive neurometric technology. The authors also disproportionately emphasize the relevance of neuronal activation over deactivation, which, in our opinion, limits the scope and utility of their conclusions.

It is widely believed to be permissible for a physician to discontinue any treatment upon the request of a competent patient. Many also believe it is never permissible for a physician to intentionally kill a patient. I argue that the prospect of deactivating a patient’s artificial heart presents us with a dilemma: either the first belief just mentioned is false or the second one is. Whichever horn of the dilemma we choose has significant implications for contemporary medical ethics.

In this case report, we describe a woman with advancing dementia who still retained decisional capacity and was able to clearly articulate her request for deactivation of her implanted cardiac pacemaker—a scenario that would result in her death. In this case, the patient had the autonomy to make her decision, but clinicians at an outside hospital refused to deactivate her pacemaker even though they were in unanimous agreement that the patient had capacity to make this decision, citing personal discomfort (...) and a belief that her decision seemed out of proportion to her suffering. We evaluated her at our hospital, found her to have decision-making capacity, and deactivated her pacer resulting in her death about 9 days later. While some clinicians may be comfortable discussing patient preferences for device deactivation in patients who are imminently dying, we can find no reports in the literature of requests for device deactivation from patients with terminal diagnoses who are not imminently dying. (shrink)

In this paper, the ethical and legal issues raised by the deactivation of implantable cardioverter-defibrillators in patients with terminal cancer is considered. It is argued that the ICD cannot be well described either as a treatment or as a non-treatment option, and thus raises complex questions regarding how rules governing deactivation should be framed. A new category called “integral devices” is proposed. Integral devices require their own special rules, reflecting their position as a “halfway house” between a form (...) of treatment and a part of the body. The practical problems faced by doctors working in palliative medicine with regard to the deactivation of ICDs are also considered. (shrink)

Unpriming is a decrease in the influence of primed knowledge following a behavior expressing that knowledge. The authors investigated strategies for unpriming the knowledge of an answer that is activated when people are asked to consider a simple question. Experiment 1 found that prior correct answering eliminated the bias people normally show toward correct responding when asked to answer yes–no questions randomly. Experiment 2 revealed that prior answering intended to be random did not unprime knowledge on subsequent attempts to answer (...) randomly. Experiment 3 found that exposure to the correct answer did not influence the knowledge bias but that exposure to the incorrect answer increased bias. Experiment 4 revealed that merely expressing the answer for oneself was sufficient to unprime knowledge. Experiment 5 found that each item of activated knowledge needs to be unprimed specifically, in that correctly answering 1 question does not reduce the knowledge bias in randomly answering another. (shrink)

The purpose of this study was to extend the knowledge about why procedural justice has behavioral implications within organizations. Since prior studies show that PJ leads to legitimacy, the author suggests that, when formal regulations are unfairly implemented, they lose their validity or efficacy. This “rule deactivation,” in turn, leads to two proposed destructive work behaviors, namely, workplace deviance and decreased citizenship behaviors. The results support this mediating role of RD, thus suggesting that it forms part of the generative (...) mechanism through which unfair procedures influence ethical behavior within organizations. The author ends the article by discussing behavioral ethics and managerial implications as well as suggestions for future research. (shrink)

In this article, I argue that there is a moral difference between deactivating an implantable cardioverter defibrillator and turning off a cardiac pacemaker. It is, at least in most cases, morally permissible to deactivate an ICD. It is not, at least in most cases, morally permissible to turn off a pacemaker in a fully or significantly pacemaker-dependent patient. After describing the relevant medical technologies—pacemakers and ICDs—I continue with contrasting perspectives on the issue of deactivation from practitioners involved with these (...) devices: physicians, nurses, and allied professionals. Next, I offer a few possible analyses of the situation, relying on recent work in medical ethics. Considerations of intention, responsibility, and replacement support my distinguishing between ICDs and CPs. I conclude by recommending a change in policy of one of the leading cardiac societies. (shrink)

Based on Nathan Goldstein’s case report, “But I have a pacer…there is no point in engaging in hypothetical scenarios”: A Non-imminently Dying Patient’s Request for Pacemaker Deactivation, it is reasonable to conclude that it was, all-things-considered, ethically appropriate to grant the patient’s request to deactivate her pacemaker. Philosophically, and as a clinical bioethicist, I support the team’s decision to honor the patient’s request for pacemaker deactivation. However, it is worth exploring a bit further whether the distress on the (...) part of the outside hospital’s ethics committee and providers—who declined to honor the patient’s request for pacemaker deactivation—may actually track something of moral significance. Might their discomfort around deactivation be “truth-tracking” in moral terms? (shrink)

Based on the case report of Nathan Goldstein et al., “But I have a pacer…there is no point in engaging in hypothetical scenarios”: A Non-imminently Dying Patient’s Request for Pacemaker Deactivation, it is reasonable to conclude that it was, all-things-considered, ethically appropriate to grant the patient’s request to deactivate her pacemaker. Philosophically, and as a clinical ethicist, I support the team’s decision to honor the patient’s request for pacemaker deactivation. However, it is worth exploring a bit further whether (...) the distress on the part of the outside hospital’s ethics committee and providers—who declined to honor the patient’s request for pacemaker deactivation—may actually track something of moral significance. In this commentary, I argue that there are reasonable grounds for holding that deactivation of a ‘biofixture’ such as a pacemaker may be more analogous in moral terms to medical aid in dying than it is to standard cases of withdrawal of life support at the end of a patient’s life. (shrink)

Substantial evidence indicates that cognitive training can be efficacious for older adults, but findings regarding training-related brain plasticity have been mixed and vary depending on the imaging modality. Recent years have seen a growth in recognition of the importance of large-scale brain networks on cognition. In particular, task-induced deactivation within the default mode network is thought to facilitate externally directed cognition, while aging-related decrements in this neural process are related to reduced cognitive performance. It is not yet clear whether (...) task-induced deactivation within the DMN can be enhanced by cognitive training in the elderly. We previously reported durable cognitive improvements in a sample of healthy older adults who completed 6 weeks of process-based object-location memory training compared to an active control training group. The primary aim of the current study is to evaluate whether these cognitive gains are accompanied by training-related changes in task-related DMN deactivation. Given the evidence for heterogeneity of the DMN, we examine task-related activation/deactivation within two separate DMN branches, a ventral branch related to episodic memory and a dorsal branch more closely resembling the canonical DMN. Participants underwent functional magnetic resonance imaging while performing an untrained object-location memory task at four time points before, during, and after the training period. Task-induced activation values were extracted for the ventral and dorsal DMN branches at each time point. Relative to visual fixation baseline: the dorsal DMN was deactivated during the scanner task, while the ventral DMN was activated; the object-location memory training group exhibited an increase in dorsal DMN deactivation relative to the active control group over the course of training and follow-up; changes in dorsal DMN deactivation did not correlate with task improvement. These results indicate a training-related enhancement of task-induced deactivation of the dorsal DMN, although the specificity of this improvement to the cognitive task performed in the scanner is not clear. (shrink)

In the last decades, new technologies have improved the survival of patients affected by chronic illnesses. Among them, left ventricular assist device has represented a viable solution for patients with advanced heart failure. Even though the LVAD prolongs life expectancy, patients’ vulnerability generally increases during follow up and patients’ request for the device withdrawal might occur. Such a request raises some ethical concerns in that it directly hastens the patient’s death. Hence, in order to assess the ethical acceptability of LVAD (...) withdrawal, we analyse and examine an ethical argument, widely adopted in the literature, that we call the “descriptive approach”, which consists in giving a definition of life-sustaining treatment to evaluate the ethical acceptability of treatment withdrawal. Focusing attention on LVAD, we show criticisms of this perspective. Finally, we assess every patient’s request of LVAD withdrawal through a prescriptive approach, which finds its roots in the criterion of proportionality. (shrink)

Placed in the first chapter of the Zhuangzi, the dialogue between Huizi and Zhuangzi about a giant gourd is a celebrated anecdote that, both for its structure and for the ideas it seems to mobilize, has aroused the interest of readers and, consequently, has also generated a wide variety of interpretations. While some scholars argue that the message is part of a framework of epistemological discussion, others point to perspectivism as the hermeneutical key to the passage, while others refer to (...) the idea of anti-anthropocentrism. Based on an analysis of the biographical elements that can be extracted from the story, the way in which the metaphor of useless gourds is used in the philosophical literature of the time and the central role played in it by the figure of the thinker-counsellor, this article reconsiders the story from an alternative angle that privileges a political perspective. (shrink)

J Med Philos, 2020; 45: 28–41; doi:_ 10.1093/jmp/jhz031 _.

It is traditionally believed that cerebral activation (the presence of low voltage fast electrical activity in the neocortex and rhythmical slow activity in the hippocampus) is correlated with arousal, while deactivation (the presence of large amplitude irregular slow waves or spindles in both the neocortex and the hippocampus) is correlated with sleep or coma. However, since there are many exceptions, these generalizations have only limited validity. Activated patterns occur in normal sleep (active or paradoxical sleep) and during states of (...) anesthesia and coma. Deactivated patterns occur, at times, during normal waking, or during behavior in awake animals treated with atropinic drugs. Also, the fact that patterns characteristic of sleep, arousal, and waking behavior continue in decorticate animals indicates that reticulo-cortical mechanisms are not essential for these aspects of behavior. (shrink)

Entrepreneurs sometimes make unethical decisions that have devastating effects on their companies, stakeholders, and themselves. We suggest that insights into the origins of such actions can be acquired through attention to personal motives and their impact on moral disengagement—a cognitive process that deactivates moral self-regulation, thus enabling individuals to behave in ways inconsistent with their own values. We hypothesize that entrepreneurs’ motivation for financial gains is positively related to moral disengagement, while their motivation for self-realization is negatively related to this (...) process. Results obtained with a sample of founding entrepreneurs offered support for the first prediction, as well as support for the prediction that moral disengagement is positively related to the tendency to make unethical decisions. (shrink)

Based on the theoretical analysis of self-consciousness concepts, we hypothesized that the spatio-temporal pattern of functional connectivity within the default-mode network (DMN) should persist unchanged across a variety of different cognitive tasks or acts, thus being task-unrelated. This supposition is in contrast with current understanding that DMN activated when the subjects are resting and deactivated during any attention-demanding cognitive tasks. To test our proposal, we used, in retrospect, the results from our two early studies ([Fingelkurts, 1998] and [Fingelkurts et al., (...) 2003]). In both studies for the majority of experimental trails we indeed found a constellation of operationally synchronized cortical areas (indexed as DMN) that was persistent across all studied experimental conditions in all subjects. Furthermore, we found three major elements comprising this DMN: two symmetrical occipito-parieto-temporal and one frontal spatio-temporal patterns. This new data directly supports the notion that DMN has a specific functional connotation – it provides neurophysiologic basis for self-processing operations, namely first-person perspective taking and an experience of agency. (shrink)

While this ‘extraordinary’ book appears as an intermezzo within the Homo Sacer series (Negri, 2008), it supports two fundamental theses with its own philological, epigraphic, liturgical and religious-historical research, and a close reading of figures such as Ernst Kantorowicz and Marcel Mauss. These theses concern political power first as an articulation of sovereign reign and economic government and, secondly, as constituted by acclamations and glorification. These can be approached theoretically through its author’s engagement with Michel Foucault’s genealogy of governmentality and (...) with the Erik Peterson/Carl Schmitt debate on the closure of political theology. Agamben’s reformulation of power and his derivation of liberal governmentality from the theological oikonomia prove convincing. A renewed analytics of power and politics of resistance should be possible, however, without recourse to a project seeking to deactivate all profane powers including those of public bureaucracies. (shrink)

Two lines of evidence indicate that there exists a reciprocal inhibitory relationship between opposed brain networks. First, most attention-demanding cognitive tasks activate a stereotypical set of brain areas, known as the task-positive network and simultaneously deactivate a different set of brain regions, commonly referred to as the task negative or defaultmode network. Second, functional connectivity analyses show that these same opposed networks are anti-correlated in the resting state. Wehypothesize that these reciprocally inhibitory effects reflect two incompatible cognitive modes, each of (...) which may be directed towards understanding the external world. Thus, engaging onemode activates one set of regions and suppresses activity in the other.Wetest this hypothesis by identifying two types of problem-solving task which, on the basis of prior work, have been consistently associated with the task positive and task negative regions: tasks requiring social cognition, i.e., reasoning about the mental states of other persons, and tasks requiring physical cognition, i.e., reasoning about the causal/mechanical properties of inanimate objects. Social and mechanical reasoning tasks were presented to neurologically normal participants during fMRI. Each task type was presented using both text and video clips. Regardless of presentation modality, we observed clear evidence of reciprocal suppression: social tasks deactivated regions associated with mechanical reasoning and mechanical tasks deactivated regions associated with social reasoning. These findings are not explained by self-referential processes, task engagement, mental simulation,mental time travel or external vs. internal attention, all factors previously hypothesized to explain default mode network activity. Analyses of resting state data revealed a close match between the regions our tasks identified as reciprocally inhibitory and regions of maximal anti-correlation in the resting state. These results indicate the reciprocal inhibition is not attributable to constraints inherent in the tasks, but is neural in origin. Hence, there is a physiological constraint on our ability to simultaneously engage two distinct cognitive modes. Furtherwork is needed tomore precisely characterize these opposing cognitive domains. (shrink)

Prior research on citizenship behavior has mainly focused on its voluntary side—organizational citizenship behavior. Unfortunately, although compulsory behavior is a global organizational phenomenon, the involuntary side of CB—compulsory citizenship behavior, defined as employees’ involuntary engagement in extra-role work activities that are beneficial to the organization : 77–93, 2006)—has long been neglected and very little is known about its potential negative consequences. Particularly, research on CCB–counterproductive work behavior association is still in its nascent stage. Therefore, drawing on moral disengagement theory and (...) social exchange theory, we firstly attempt to systematically investigate how and when CCB leads to CWB. Specifically, we see employee silence as a critical form of passive CWB and propose a moderated mediation model. In the model, CCB predicts silence through MD—a set of cognitive mechanisms that deactivate moral self-regulatory processes, with the Chinese culture-specific concept of supervisor–subordinate guanxi, which captures the supervisor–subordinate non-work-related personal ties, acting as the contextual condition. Two-wave data collected from a sample of 293 employees in 17 manufacturing firms in China supported our hypotheses. The results revealed that the more employees experienced compulsory feelings caused by CCB, the more they morally disengaged and, in turn, resorted to avoidant or passive responses as a coping strategy. Further, s–s guanxi serves as a reverse moderator in that high s–s guanxi mitigates the destructive impact of CCB, makes employees less inclined to morally disengage, and thereby largely prevents them from practicing workplace silence behavior. Implications for theory and intervention strategies for practice are discussed. We also propose several promising avenues for future research. (shrink)

The “default system” of the brain has been described as a set of regions which are ‘activated’ during rest and ‘deactivated’ during cognitively effortful tasks. To investigate the reliability of task-related deactivations, we performed a meta-analysis across 12 fMRI studies. Our results replicate previous findings by implicating medial frontal and parietal brain regions as part of the “default system”.However, the cognitive correlates of these deactivations remain unclear. In light of the importance of social cognitive abilities for human beings and their (...) propensity to engage in such activities, we relate our results to findings from neuroimaging studies of social cognition. This demonstrates a remarkable overlap between the brain regions typically involved in social cognitive processes and the “default system”.We, henceforth, suggest that the physiological ‘baseline’ of the brain is intimately linked to a psychological ‘baseline’: human beings have a predisposition for social cognition as the default mode of cognizing which is implemented in the robust pattern of intrinsic brain activity known as the “default system”. (shrink)

Cognitive theories claim, whereas non-cognitive theories deny, that cognitive access is constitutive of phenomenology. Evidence in favor of non-cognitive theories has recently been collected by Block and is based on the high capacity of participants in partial-report experiments compared to the capacity of the working memory. In reply, defenders of cognitive theories have searched for alternative interpretations of such results that make visual awareness compatible with the capacity of the working memory; and so the conclusions of such experiments remain controversial. (...) Instead of entering the debate between alternative interpretations of partial-report experiments, this paper offers an alternative line of research that could settle the discussion between cognitive and non-cognitive theories of consciousness. Here I relate the neural correlates of cognitive access to empirical research into the neurophysiology of dreams; cognitive access seems to depend on the activity of the dorsolateral prefrontal cortex. However, that area is strongly deactivated during sleep; a period when we entertain conscious experiences: dreams. This approach also avoids the classic objection that consciousness should be inextricably tied to reportability or it would fall outside the realm of science. (shrink)

This paper explores how phenomenology facilitates people’s grasp of unfamiliar artworks. When avant-garde artworks lack handy categories, meaning-makers unwittingly deploy Edmund Husserl’s phenomenological method to avail interpretive concepts. Curators and critics engaged in the challenging process of determining the significance of artworks or performances deploy his reductions to identify relevant concepts that facilitate their ability to qualitatively differentiate indiscernible artworks and performances. Even if contemporary art curators and critics have never heard of Husserl, let alone studied his brand of philosophical (...) phenomenology, his “phenomenological epoché” epitomizes the way curators and critics deactivate their beliefs. Doing so guides curators and critics to observe as comprehensively as possible in order to generate novel, albeit fitting “potential” interpretations. Unbeknownst to most curators and critics, Husserl’s tools also guide their decision-making processes when selecting and positioning artworks within the context of an exhibition or article. What make phenomenology an especially useful tool for curators and critics is Husserl’s insight, contra Gottlob Frege, that Sinn (sense) expands Bedeutung (meaning), rather than contracts or fixes meaning to some referent. As this paper demonstrates, Husserl’s generative approach arises from his triadic system for meaning making, namely the active relationship between noema, noesis, and hyle, as opposed to Frege’s standard duo of Sinn and Bedeutung. For Husserl, identification, significance, and meaning-making prove imaginative, and thus exemplify world-making. To tease out phenomenology’s advantage over analytic aesthetics, I refer to MoMA’s “Picasso: Guitars, 1912-1914” (2011) to show how his method “radiates,” or opens-up meanings, rather than closes them down. (shrink)

The distinction between causal role and selected effect functions is typically framed in terms of their respective explanatory roles. However, much of the controversy over functions in genomics takes place in an investigative, not an explanatory context. Specifically, the process of component-driven functional investigation begins with the designation of some genetic or epigenetic element as functional —i.e. not junk— because it possesses properties that, arguably, suggest some biologically interesting organismal effect. The investigative process then proceeds, in a bottom-up fashion, to (...) search for those effects. I argue that this process encounters a problem reminiscent of one that Gould and Lewontin associated with the adaptationist program. Just as their stereotypical adaptationst became trapped in the myopic pursuit of one selectionist hypothesis after another, so can the investigation of CR functions in genomics lead to an unending series putative organism-level CR functions for junk DNA. This is an acute problem for genomics, because eukaryotic genomes are littered with transposable elements and their deactivated descendants which often masquerade as interesting CR-functional components and it is experimentally onerous to determine whether they lack such a function. I further argue that selectionist reasoning about TE-host coevolutionary dynamics can greatly streamline the investigative process. Importantly, selectionist hypotheses need not be well confirmed to be illuminating in this context. Informed selectionist reasoning about the strategic roles of TEs in the genome offers a corrective to the idea that most of our DNA is somehow CR functional for the organism. (shrink)

Social boundaries separate us fromthem. Explaining the formation, transformation, activation, and suppression of social boundaries presents knotty problems. It helps to distinguish two sets of mechanisms: (1) those that precipitate boundary change and (2) those that constitute boundary change. Properly speaking, only the constitutive mechanisms produce the effects of boundary change as such. Precipitants of boundary change include encounter, imposition, borrowing, conversation, and incentive shift. Constitutive mechanisms include inscription–erasure, activation–deactivation, site transfer, and relocation. Effects of boundary change include attack–defense (...) sequences. These mechanisms operate over a wide range of social phenomena. Key Words: social boundary • mechanisms. (shrink)

According to the conflict monitoring hypothesis, conflict monitoring and inhibitory control in cognitive control mainly cause activity in the anterior cingulate cortex and control-related prefrontal cortex in many cognitive tasks. However, the role of brain regions in the default mode network in cognitive control during category induction tasks is unclear. To test the role of the ACC, PFC, and subregions of the DMN elicited by cognitive control during category induction, a modified category induction task was performed using simultaneous fMRI scanning. (...) The results showed that the left middle frontal gyrus and bilateral dorsal ACC/medial frontal gyrus were sensitive to whether conflict information appears, but not to the level of conflict. In addition, the bilateral ventral ACC, especially the right vACC, a part of the DMN, showed significant deactivation with an increase in cognitive effort depending on working memory. These findings not only offer further evidence for the important role of the dorsolateral PFC and dorsal ACC in cognitive control during categorization but also support the functional distinction of the dorsal/ventral ACC in the category induction task. (shrink)

Resumen: El etiquetamiento escinde la vida común entre aquellas dignas de ser vividas y las inmeritorias de cualquier consideración sensible, en tanto culpables y condenadas al eterno retorno del pronóstico y la repetición criminal. Este hecho exige repensar la vida humana, a través de otros marcos perceptuales, que desactiven progresivamente los efectos inmunizantes de la estigmatización de aquellas existencias “peligrosas” y, en consecuencia, “indeseables” e “intolerables” para la comunidad. Esta composición tiene como urdimbre teórica los planteamientos del paradigma inmunitario, el (...) etiquetamiento criminal y la crítica como apropiación de la vida humana. Entre las conclusiones que arroja esta reflexión se encuentra que la narración de la existencia constituye una reacción frente a la estigmatización, y, en consecuencia, una inversión del lenguaje inmunitario, en tanto libera al sujeto del devenir monstruoso contenido en la etiqueta criminal, revelando así una humanidad no vista, ni oída, todavía.: Labelling separates the common life between those worthy of being lived and the others of any sensitive consideration, both guilty and condemned to the eternal return of the prognosis and criminal repetition. This fact requires rethinking the human, through other perceptual frameworks progressively deactivating the immunizing effects of stigmatization of those “dangerous” lives and, consequently, “undesirable” and “intolerable” for the community. This article is based on the immune paradigm, criminal labelling, and criticism as appropriation of human life. Among the conclusions that this reflection throws is that the narration of existence constitutes a reaction against stigmatization, and, consequently, an inversion of the immune language, while freeing the subject from the monstrous becoming contained in the criminal label, thus revealing a humanity not seen or heard yet. (shrink)

Shortly after the Presidential Commission for the Study of Bioethical Issues was constituted in 2010 and days before the commission members were to join a conference call to discuss possible topics for their deliberation, Craig Venter held a press conference announcing that his lab had created a synthetic chromosome for a species of mycoplasma and had inserted this genetic material into organisms of another species of mycoplasma (the genes of which had been deactivated), transforming the host species into the donor (...) species. While not overtly claiming to have “created life in the test tube,” Venter's publicity seemed cleverly designed to provoke the media into reporting his discovery in just that way. The resulting uproar caused President Obama to give his new bioethics commission the assignment of investigating the ethics of the emerging field of synthetic biology. The commission went right to work. It formed working groups to deliberate about parts of the report, feeding ideas and language to the staff members who would do the actual writing, and then present the working group suggestions to the commission as a whole for public deliberation at open meetings. One of those working groups was charged with coming up with ethical principles that would guide the analysis. Having served as a member of that working group, I report here on the process by which these principles emerged and reflect upon the suitability of that process for the work of public bioethics commissions. (shrink)

Background: In modern society, death has become ‘forbidden’ fed by the medical technology to conquer death. The technological paradigm is challenged by a social-liberal political ideology in postmodern Western societies. The question raised in this study was as follows: Which arguments, attitudes, values and paradoxes between modern and postmodern tendencies concerning treatment and care of older persons with an implantable cardioverter defibrillator appear in the literature? Aims: The aim of this study was to describe and interpret how the field of (...) tension concerning older persons with an implantable cardioverter defibrillator – especially end-of-life issues – has been expressed in the literature throughout the last decade. Methods: Paul Ricoeur’s reflexive interpretive approach was used to extract the meaningful content of the literature involving qualitative, quantitative and normative literature. Analysis and interpretation involved naive reading, structural analysis and critical interpretation. Ethical considerations: The investigation complied with the principles outlined in the Declaration of Helsinki. Findings and discussions: The unifying theme was ‘Normativity under change’. The sub-themes were ‘Death has become legitimate’, ‘The technological imperative is challenged’ and ‘Patients and healthcare professionals need to talk about end-of-life issues’. There seems to be a considerable distance between the normative approach of how practice ought to be and findings in empirical studies. Conclusion: Modern as well as postmodern attitudes and perceptions illustrate contradictory tendencies regarding deactivation of the implantable cardioverter defibrillator and replacement of the implantable cardioverter defibrillator in older persons nearing the end of life. The tendencies challenge each other in a struggle to gain position. On the other hand, they can also complement each other because professionalism and health professional expertise cannot stand alone when the patient’s life is at stake but must be unfolded in an alliance with the patient who needs to be understood and accepted in his vulnerability. (shrink)

While many publications have reported brain hemodynamic responses to decision-making under various conditions of risk, no inventory management scenarios, such as the newsvendor problem, have been investigated in conjunction with neuroimaging. In this study, we hypothesized that NP stimulates the dorsolateral prefrontal cortex and the orbitofrontal cortex joined with frontal polar area significantly in the human brain, and that local brain network properties are increased when a person transits from rest to the NP decision-making phase. A 77-channel functional near infrared (...) spectroscopy system with wide field-of-view was employed to measure frontal cerebral hemodynamics in response to NP in 27 healthy human subjects. NP-induced changes in oxy-hemoglobin concentration, Δ[HbO], were investigated using a general linear model and graph theory analysis. Significant activation induced by NP was shown in both DLPFC and OFC+FPA across all subjects. Specifically, higher risk NP with low-profit margins activated left-DLPFC but deactivated right-DLPFC in 14 subjects, while lower risk NP with high-profit margins stimulated both DLPFC and OFC+FPA in 13 subjects. The local efficiency, clustering coefficient, and path length of the network metrics were significantly enhanced under NP decision making. In summary, multi-channel fNIRS enabled us to identify DLPFC and OFC+FPA as key cortical regions of brain activations when subjects were making inventory-management risk decisions. We demonstrated that challenging NP resulted in the deactivation within right-DLPFC due to higher levels of stress. Also, local brain network properties were increased when a person transitioned from the rest phase to the NP decision-making phase. (shrink)

In the past years motor imagery turned out to be also an innovative and effective tool for motor learning and improvement of sports performance. Whereas many studies investigating sports MI focusing on upper or lower limbs involvement, knowledge about involved neural structures during whole-body movements is still limited. In the present study we investigated brain activity of climbers during a kinesthetic motor imagery climbing task with different difficulties by means of functional near infrared spectroscopy. Twenty healthy participants were split into (...) two groups according to their climbing skill level. The aim of the current study is investigating neural correlates of a whole-body sports MI task with an additional focus on skill level dependency. Climbing experts and non-experts imagined bouldering an “easy” and “difficult” route from a first-person perspective while hemodynamic responses were recorded simultaneously. We found significant differences between the two climbing routes, easy and difficult within participants as well as between the two groups of different climbing skill levels. Overall beginners showed increased hemodynamic responses compared to experts in all defined regions of interest supporting the claim of the neural efficiency hypothesis. Even though climbing is a complex, coordinated movement of upper and lower limbs we found a stronger activation focus of the upper limbs, especially of the dominant hand-area, while the foot area seems to be deactivated or inhibited simultaneously. Summarizing, these findings provide novel insights into brain activation during the imagery of a whole-body movement and its relation to climbing expertise. (shrink)

Agamben’s notion of the ‘paradigm’ has far-reaching implications for educational thinking, curriculum design and pedagogical conduct. In his approach, examples—or paradigms—deeply engage our powers of analogy, enabling us to discern previously unseen affinities among singular objects by stepping outside established systems of classification. In this way we come to envision novel groupings, new patterns of connection—that nonetheless do not simply reassemble those singular objects into yet another rigidly fixed set or class. Agamben sees this sort of ‘paradigmatic understanding’ as our (...) richest source of intelligibility. For Agamben the paradigm is ultimately about learning to see again, starting not with already perfectly known and categorized objects (or ideas), but rather with a fresh experience of one individual object and the analogical relations it may have to others, and to novel groupings that may arise. The paradigm is a method, a way in which educators might respond to a wide range of educational challenges. For a paradigmatic relation suspends while exposing, deactivates while revealing, complicates while clarifying. But articulating the enigmatic paradigmatic relation between example and class is far more than a method. It is epistemological (a way of knowing and conception of knowledge), ethical (a fostering of freedom from presupposed categories and reified principles) and ontological (a type of being that exposes the potential of knowing and communicating—their intelligibility and communicability). In these qualities, paradigms exhibit to educators a free, a new use of singularities. (shrink)