BackgroundSevere brain injury is a leading cause of death and disability. Diagnosis and prognostication are difficult, and errors occur often. Novel neuroimaging methods can improve diagnostic and prognostic accuracy, especially in patients with prolonged disorders of consciousness (PDoC). Yet it is currently unknown how family caregivers understand this information, raising ethical concerns that disclosure of neuroimaging results could result in therapeutic misconception or false hope.MethodsTo examine these ethical concerns, we conducted semi-structured interviews with caregivers of patients with PDoC who were (...) enrolled in a concurrent neuroimaging research program designed to detect covert consciousness following severe brain injury. Caregivers held surrogate decision-making status for a patient. Interviews were conducted at two time points for each caregiver. The first interview occurred before the disclosure of neuroimaging results. The second occurred after disclosure. Descriptive analysis was applied to the data of four interview topics: (1) expectations for neuroimaging; (2) reactions to evidence of preserved cognition; (3) reactions to null results; and (4) understanding of the results and study.ResultsTwelve caregivers participated in the study; two caregivers shared surrogate decision-making status for one patient with PDoC. Twenty-one interviews were completed; one caregiver declined to participate in the post-disclosure interview. Three patients with PDoC associated with the study displayed evidence of covert consciousness. Overall, caregivers understood the neuroimaging research and results. Caregivers who received results of covert consciousness were generally pleased. However, there was some variation in expectations and reactions to these data and null results.ConclusionThis study, for the first time, reveals caregiver expectations for and reactions to neuroimaging evidence of covert consciousness in patients with PDoC. Caregivers understood the neuroimaging research and results, casting doubt on speculative ethical concerns regarding therapeutic misconception and false hope. However, disclosure of neuroimaging result could be improved. Pre-disclosure consultations might assist professionals in shaping caregiver expectations. Standardization of disclosure might also improve comprehension of the results. (shrink)

Patient outcome after serious brain injury is highly variable. Following a period of coma, some patients recover while others progress into a vegetative state (unresponsive wakefulness syndrome) or minimally conscious state. In both cases, assessment is difficult and misdiagnosis may be as high as 43%. Recent advances in neuroimaging suggest a solution. Both functional magnetic resonance imaging and electroencephalography have been used to detect residual cognitive function in vegetative and minimally conscious patients. Neuroimaging may improve diagnosis and prognostication. These techniques (...) are beginning to be applied to comatose patients soon after injury. Evidence of preserved cognitive function may predict recovery, and this information would help families and health providers. Complex ethical issues arise due to the vulnerability of patients and families, difficulties interpreting negative results, restriction of communication to “yes” or “no” answers, and cost. We seek to investigate ethical issues in the use of neuroimaging in behaviorally nonresponsive patients who have suffered serious brain injury. The objectives of this research are to: (1) create an approach to capacity assessment using neuroimaging; (2) develop an ethics of welfare framework to guide considerations of quality of life; (3) explore the impact of neuroimaging on families; and, (4) analyze the ethics of the use of neuroimaging in comatose patients. (shrink)

After severe brain injury, one of the key challenges for medical doctors is to determine the patient’s prognosis. Who will do well? Who will not do well? Physicians need to know this, and families need to do this too, to address choices regarding the continuation of life supporting therapies. However, current prognostication methods are insufficient to provide a reliable prognosis. -/- Functional Magnetic Resonance Imaging (MRI) holds considerable promise for improving the accuracy of prognosis in acute brain injury patients. Nonetheless, (...) research on functional MRI in the intensive care unit context is ethically challenging. These studies raise several ethical issues that have not been addressed so far. In this article, Prof. Charles Weijer and his co-workers provide a framework for researchers and ethics committees to design and review these studies in an ethically sound way. (shrink)

Drawing out literal and metaphorical meanings of 'foreignness' this wide-ranging volume offers much to scholars of postcolonial, gender, and cultural studies seeking new approaches to the study of alterity.

Views of the self may be plotted on a set of coordinates. On the axis that runs from fragmentation to unity, Rorty and Rorty's Freud champion the decentered self while Wallwork, Taylor, and Ricoeur argue for a sovereign, unified self. On the other axis, which runs from the disengaged, inward-turning self to the engaged and "sedimented" self, Wallwork, would be positioned near Rorty, defending self-creation against the narrative identity affirmed by Taylor and Ricoeur. Despite his skepticism concerning the communitarian agenda (...) of the narrativists, Flanagan grants that the self is social and relational--a position further explored by Oliver, Stendahl, Deutsch, and Mack in "Selves, People, and Persons". (shrink)

Introduction.--pt. I. The demonology of Thomas Aquinas.--pt. II. Thomas Aquinas as mediator between earlier and later beliefs.--Conclusion.--Bibliography (p. 185-188).

Over the past decade, we have witnessed some early signs of progress in the battle against international bribery and corruption, a problem that throughout the history of commerce had previously been ignored. We present a model that we then use to assess progress in reducing bribery. The model components include both hard law and soft law legislation components and enforcement and compliance components. We begin by summarizing the literature that convincingly argues that bribery is an immoral and unethical practice and (...) that the economic harm it causes falls most heavily on those least able to absorb it. The next section summarizes the main provisions of anti-bribery legislation including the Foreign Corrupt Practices Act (FCPA), the Organization for Eco nomic Development's Convention on Combating Bribery of Foreign Officials in International Business Transactions, the United Nations Convention Against Corruption and the laws of selected countries. We conclude this section with a discussion of the "moral imperialism" argument for not imposing Western laws and values on other cultures. The next section focuses on the roles played by NGOs including Transparency International (TI), the World Economic Forum (WEF), and the International Chamber of Commerce. We review trends in enforcement and prosecution, including a review of the United States' enforcement processes, mechanisms for cross-border legal assistance, a discussion of the distinctive nature of FCPA cases, and an assessment of what the future holds for enforcement. The final section focuses on compliance processes for corporations aimed at reducing the risk of FCPA and related violations. This section also addresses the ethics of gift giving and "grease" payments. The article concludes with a summary and suggestions for further research. Throughout the article, we reference important bribery cases and include comments from several authorities who are on the front lines of the battle against international bribery. (shrink)

Functional MRI shows promise as a candidate prognostication method in acutely comatose patients following severe brain injury. However, further research is needed before this technique becomes appropriate for clinical practice. Drawing on a clinical case, we investigate the process of obtaining informed consent for this kind of research and identify four ethical issues. After describing each issue, we propose potential solutions which would make a patient’s participation in research compatible with her rights and interests. First, we defend the need for (...) traditional proxy consent against two alternative approaches. Second, we examine the impact of the intensive care unit environment on the informed consent process. Third, we discuss the therapeutic misconception and its potential influence on informed consent. Finally, we deal with issues of timing in recruiting participants and related factors which may affect the risks of participation. (shrink)

1 Evidence-based policy requires researchers to provide the answers to ecological questions that are of interest to policy makers. To find out what those questions are in the UK, representatives from 28 organizations involved in policy, together with scientists from 10 academic institutions, were asked to generate a list of questions from their organizations. 2 During a 2-day workshop the initial list of 1003 questions generated from consulting at least 654 policy makers and academics was used as a basis for (...) generating a short list of 100 questions of significant policy relevance. Short-listing was decided on the basis of the preferences of the representatives from the policy-led organizations. 3 The areas covered included most major issues of environmental concern in the UK, including agriculture, marine fisheries, climate change, ecosystem function and land management. 4 The most striking outcome was the preference for general questions rather than narrow ones. The reason is that policy is driven by broad issues rather than specific ones. In contrast, scientists are frequently best equipped to answer specific questions. This means that it may be necessary to extract the underpinning specific question before researchers can proceed. 5 Synthesis and applications. Greater communication between policy makers and scientists is required in order to ensure that applied ecologists are dealing with issues in a way that can feed into policy. It is particularly important that applied ecologists emphasize the generic value of their work wherever possible. (shrink)

Charles Hodge engaged the leading thinkers of his day to defend the human ability to know God. This involved him in affirming the importance of both orthodoxy and piety in the life of a Christian. His work involved expanding on the insights of the Westminster Confession of Faith as it applied to the theory of salvation and the role of Christ.

The topic of recognition has come to occupy a central place in debates in social and political theory. Developed by George Herbert Mead and Charles Taylor, it has been given expression in the program for Critical Theory developed by Axel Honneth in his book The Struggle for Recognition. Honneth's research program offers an empirically insightful way of reflecting on emancipatory struggles for greater justice and a powerful theoretical tool for generating a conception of justice and the good that enables (...) the normative evaluation of such struggles. This 2007 volume offers a critical clarification and evaluation of this research program, particularly its relationship to the other major development in critical social and political theory; namely, the focus on power as formative of practical identities proposed by Michel Foucault and developed by theorists such as Judith Butler, James Tully, and Iris Marion Young. (shrink)

One of the predominant iterations of the metaphor of entanglement in the nineteenth century is found in the closing paragraph of Charles Darwin’s On the Origin of Species. Darwin’s image of an “entangled bank, clothed with many plants of many kinds, with birds singing on the bushes, with various insects flitting about,” serves as a synecdoche for the patterns of biological interdependence and variation that animate the evolutionary process of natural selection.1 The “entangled bank” is both the scene and (...) the symbolic illustration of creaturely increase and multiplication. We cannot escape the influence of heredity in Darwin’s schema, just as surely as the imagined bank of vegetation will wreathe and entwine.. (shrink)

I provide a précis of The Bodhisattva's Brain: Buddhism Naturalized (), and then respond to three critics, Christian Coseru, Charles Goodman, and Bronwyn Finnigan.

This article examines Nietzsche’s influence on analytic philosophy, focusing on the field of analytic ethics. It presents some key rationales motivating his re-evaluation of values and, in particular, his critique of modern morality. To demonstrate his influence on the work of Charles Taylor, Alasdair Macintyre, and Bernard Williams, the role of Nietzsche’s genealogical method in his re-evaluative project is considered. This is followed by a discussion of Nietzsche’s critique of the value of moral values and its relation to similar (...) objections developed by more recent morality critics. (shrink)

ABSTRACT This article examines the reaction to Owen’s work in the circle associated with the liberal Journal des Économistes. It attempts to reconstruct the liberal argument against utopian socialist schemes of ‘regeneration’ and ‘redistribution’, and against those associated with Robert Owen in particular. It focuses on the works of Louis Reybaud (1799–1879) and Adolphe Blanqui (1798–1854) and their critical engagement with the writings of Saint-Simon, Fourier and Owen. It offers a detailed analysis of Reybaud’s Études sur les (...) réformateurs, ou socialistes modernes (1840), which did much to popularise the term ‘socialist’ in France, and Blanqui’s Histoire de l’économie politique en Europe depuis les anciens jusqu’à nos jours (1837). The article’s central argument is that these works appeared at an inflection point in the history of liberal political economy in France. Both started from the premise, shared with the socialist authors they were analysing, but increasingly suspect to liberal economic opinion, that the solution to the social question lay in the proper harnessing of the spirit of association as opposed to unregulated competition. The question at issue for Blanqui and Reybaud was what form this ‘associationism’ should take. (shrink)

By permission of The Gale Group, this article is reprinted (here on-line) from “Nicholas of Cusa,” pp. 122-125, Volume 9 of the Dictionary of the Middle Ages, edited by Joseph R. Strayer (New York: Charles Scribner’s Sons, 1987 ). The short bibliography at the end of the original article has been omitted; and the page numbers of the article are here changed.

Owen Flanagan's important book The Bodhisattva's Brain presents a naturalized interpretation of Buddhist philosophy. Although the overall approach of the book is very promising, certain aspects of its presentation could benefit from further reflection. Traditional teachings about reincarnation do not contradict the doctrine of no self, as Flanagan seems to suggest; however, they are empirically rather implausible. Flanagan's proposed “tame” interpretation of karma is too thin; we can do better at fitting karma into a scientific worldview. The relationship between (...) eudaimonist and utilitarian strands in Buddhist ethics is more complex than the book suggests. Flanagan is right to criticize incautious and imprecise claims that Buddhism will make practitioners happy. We can make progress by distinguishing between happiness in the sense of a Buddhist version of eudaimonia, and happiness in the sense of attitudinal pleasure. Doing so might result in an interpretation of Buddhist views about happiness that was simultaneously philosophically interesting, historically credible, and psychologically testable. (shrink)