An online world exists in which businesses have become burdened with managerial and legal duties regarding the seeking of informed consent and the protection of privacy and personal data, while growing public cynicism regarding personal data collection threatens the healthy development of marketing and e-commerce. This research seeks to address such cynicism by assisting organisations to devise ethical consent management processes that consider an individual’s attitudes, their subjective norms and their perceived sense of control during the elicitation of consent. It (...) does so by developing an original conceptual model for online informed consent, argued through logical reasoning, and supported by an illustrative example, which brings together the autonomous authorisation (AA) model of informed consent and the theory of planned behaviour (TPB). Accordingly, it constructs a model for online informed consent, rooted in the ethic of autonomy, which employs behavioural theory to facilitate a mode of consent elicitation that prioritises users’ interests and supports ethical information management and marketing practices. The model also introduces a novel concept, the informed attitude, which must be present for informed consent to be valid. It also reveals that, under certain tolerated conditions, it is possible for informed consent to be provided unwillingly and to remain valid: this has significant ethical, information management and marketing implications. (shrink)

I work every day in the Cornell College Library. Usually on the ground floor level, where the fast computers are. The other day I took an early afternoon break, and went up to the second floor reading room to get a copy of The Times and relax. As I passed through the reading room I saw a Japanese student sitting at the long reading table, studying his physics text. He was sitting up straight; the hard back book was standing vertical (...) in front of him on the table, three feet away. The room was pretty silent and the boy was concentrating. I got my paper and took it back to the lower level to read. I read for twenty minutes, then returned to my computer, where I worked for an hour and a half. I finished my online teaching for the day, I packed up my stuff, climbed back up the stairs to the reading room, crossed the room to exit. At that point, tired and stretching, I usually don’t observe much. But this time I noticed the same Japanese student. He was still in the same position, sitting upright looking at his book, balancing it firmly in both hands. He seemed still to be in the same position of attention: nothing had changed, I felt, except the design on the page: a different graph of a different color. I went out through the main door of the Library, and went home. (shrink)

The idea that deep brain stimulation (DBS) induces changes to personality, identity, agency, authenticity, autonomy and self (PIAAAS) is so deeply entrenched within neuroethics discourses that it has become an unchallenged narrative. In this article, we critically assess evidence about putative effects of DBS on PIAAAS. We conducted a literature review of more than 1535 articles to investigate the prevalence of scientific evidence regarding these potential DBS-induced changes. While we observed an increase in the number of publications in theoretical neuroethics (...) that mention putative DBS-induced changes to patients’ postoperative PIAAAS, we found a critical lack of primary empirical studies corroborating these claims. Our findings strongly suggest that the theoretical neuroethics debate on putative effects of DBS relies on very limited empirical evidence and is, instead, reliant on unsubstantiated speculative assumptions probablyin lieuof robust evidence. As such, this may reflect the likelihood of a speculative neuroethics bubble that may need to be deflated. Nevertheless, despite the low number of first-hand primary studies and large number of marginal and single case reports, potential postoperative DBS changes experienced by patients remain a critical ethical concern. We recommend further empirical research in order to enhance theoretical neuroethics work in the area. In particular, we call for the development of better instruments capable of capturing potential postoperative variations of PIAAAS. (shrink)

Scheinerman (2023) proposes a Citizen’s Jury on human germline genome editing (HGGE) to promote more inclusive public engagement, agenda setting and governance. She argues these juries should work...

The phenomenological effects of deep brain stimulation (DBS) on the self of the patient remains poorly understood and under described in the literature, despite growing evidence that a significant number of patients experience postoperative neuropsychiatric changes. To address this lack of phenomenological evidence, we conducted in-depth, semistructured interviews with 17 patients with Parkinson's disease who had undergone DBS. Exploring the subjective character specific to patients' experience of being implanted gives empirical and conceptual understanding of the potential phenomenon of DBS-induced self-estrangement. (...) Our study concluded that (1) the more patients preoperatively felt alienated by their illness, the more they experienced postoperative self-estrangement, and (2) the notion of self-estrangement seems to exist in association with certain common qualitative characters, namely, loss of control, which reflects a deteriorative estrangement, and distorted perception of capacities, which reveals a restorative estrangement. These findings indicate that subjective self-reports help us to understand some aspects of the potential phenomenon of DBS-induced self-estrangement. (shrink)

Why and how do norms emerge? Which norms emerge and why these ones in particular? Such questions belong to the ‘problem of the emergence of norms’, which consists of an inquiry into the production of norms in social collectives. I address this question through the ethnographic study of the emergence of ‘norms against violence’ in the political collective Occupy Geneva. I do this, first, empirically, with the analysis of my field observations; and, second, theoretically, by discussing my findings. In consequence (...) of two episodes categorized as sexual assaults that occurred in their camp, the members of Occupy Geneva decided to tackle those issues in a general assembly. Their goal was to amend their first charter of good conduct in order to reform its norms and complete it with norms aiming to regulate ‘facts’ of ‘unjustified violence’. During a collective deliberation, new norms were devised, debated and consensually adopted. The writing of the new charter took place in a second general assembly during which the wording of the written norms was collectively decided. I show that indignation over the sexual assaults was the main motive that led to the collective deliberation, and that the entire process of the making of these norms was characterized by different collective emotions. Indeed, indignation, contempt and fear played major roles in the emergence of norms prohibiting violence, allowing punishment and exclusion of wrongdoers, and prescribing collective intervention against an aggressor to neutralize the threat represented. These findings prompt me to hypothesize that social norms emerge from emotions thanks to the latters’ internal structure; and that emotions provide causal and grounding explanations for this emergence. Thus, emotions allow us to answer the questions: ‘Why do norms emerge?’ and ‘Why do they have their specific forms?’ In short, I argue that social norms have emotional foundations. (shrink)

We argue that a fashionable interpretation of the theory of natural selection as a claim exclusively about populations is mistaken. The interpretation rests on adopting an analysis of fitness as a probabilistic propensity which cannot be substantiated, draws parallels with thermodynamics which are without foundations, and fails to do justice to the fundamental distinction between drift and selection. This distinction requires a notion of fitness as a pairwise comparison between individuals taken two at a time, and so vitiates the interpretation (...) of the theory as one about populations exclusively. (shrink)

Cet article s’intéresse au problème de la maintenance, c’est-à-dire au moment où les membres d’un collectif social tentent d’assurer dans le temps l’existence de leur collectif en instituant des règles pour réguler leurs comportements. Ce problème se pose avec acuité lorsque certains membres ne respectent pas ces règles communes. Pour maintenir la coopération sociale, les membres peuvent décider d’instituer des règles secondaires visant à sanctionner les transgressions des règles primaires déjà établies. La maintenance d’un collectif peut ainsi reposer sur l’émergence (...) de pouvoirs déontiques qui donnent aux membres l’autorité de légitimement punir et expulser les transgresseurs. Mais d’où viennent ces règles ? On peut penser qu’elles émergent des émotions éprouvées par les membres envers les transgresseurs. Je le démontre à l’aide d’une étude de cas qui établit que, dans le collectif Occupy Geneva, l’institutionnalisation de normes pour punir, exclure et réintégrer les déviants s’ancraient respectivement dans l’indignation, le mépris et le pardon. -/- This article focuses on the problem of maintenance; that is the moment when the members of a social collective attempt to ensure the existence of their collective over time by instituting rules to regulate their behavior. This problem becomes critical when certain members do not respect the common rules. To maintain social cooperation, members can decide to institute secondary rules aimed at sanctioning the transgressions of the already established primary rules. The maintenance of a collective can thus rely on the emergence of deontic powers that give members the authority to legitimately punish and expel transgressors. But where do these rules come from? The hypothesis is that they emerge from the emotions felt by the members towards the transgressors. I show this with the help of a case study, which establishes that the institutionalization of norms allowing the punishment, the exclusion, and the reintegration of deviants within the “Occupy Geneva” collective, was grounded in indignation, contempt, and forgiveness respectively. (shrink)

At the phenomenal level, consciousness can be described as a singular, unified field of recursive self-awareness, consistently coherent in a particualr way; that of a subject located both spatially and temporally in an egocentrically-extended domain, such that conscious self-awareness is explicitly characterized by I-ness, now-ness and here-ness. The psychological mechanism underwriting this spatiotemporal self-locatedness and its recursive processing style involves an evolutionary elaboration of the basic orientative reference frame which consistently structures ongoing spatiotemporal self-location computations as i-here-now. Cognition computes action-output (...) in the midst of ongoing movement, and consequently requires a constant self-locating spatiotemporal reference frame as basis for these computations. Over time, constant evolutionary pressures for energy efficiency have encouraged both the proliferation of anticipative feedforward processing mechansims, and the elaboration, at the apex of the sensorimotor processing hierarchy, of self-activating, highly attenuated recursively-feedforward circuitry processing the basic orientational schema independent of external action output. As the primary reference frame of active waking cognition, this recursive i-here-now processing generates a zone of subjective self-awareness in terms of which it feels like something to be oneself here and now. This is consciousness. (shrink)

The traditional international law of self-defense provides little indication about how far states should be willing to defend. That choice is better understood as constrained, beyond the jus in bello and the jus ad bellum, by human rights norms that implicate responsibilities of the sovereign vis-à-vis its own population. Different conceptions of human rights, however, underscore different possible theories of the extent of self-defense. The main polarity is between a conception of self-defense as protecting bare life and a conception of (...) self-defense as protecting collective self-determination. In the practice of justifying particular uses of self-defense, these foundations are constantly and dynamically rearticulated to justify fighting on, surrendering, or negotiating. This raises questions about the impact of conditions of uncertainty, different conceptions of agency, and the role of the international community. Ultimately, the article suggests that self-defense radicalizes anxieties about the foundation and finality of rights. (shrink)

This is an important new book about human motivation, about the reasons people have for their actions. What is distinctively new about it is its focus on how people see or understand their situations, options, and prospects. By taking account of people's understandings, Professor Schick is able to expand the current theory of decision and action. The author provides a perspective on the topic by outlining its history. He defends his new theory against criticism, considers its formal structure, and shows (...) at length how it resolves many currently debated problems: the problems of conflict and weakness of will, Allais' problem, Kahneman and Tversky's problems, Newcomb's problem, and others. The book will be of special interest to philosophers, psychologists, and economists. (shrink)

In this article, we explore the implications of a Rawlsian theory for intergenerational issues. First, we confront Rawls's way of locating his `just savings' principle in his Theory of Justice with an alternative way of doing so. We argue that both sides of his intergenerational principle, as they apply to the accumulation phase and the steady-state stage, can be dealt with on the bases, respectively, of the principle of equal liberty and of the difference principle. We then proceed by focusing (...) on the implications of applying maximin to his steady-state stage. One central claim is that, in principle, Rawlsians should consider not only generational dissavings, but also generational savings, as unfair. This principle suffers a series of exceptions on which we focus in the fourth section of the article. In some cases, growth can be maximin compatible. (shrink)

Although an invasive medical intervention, Deep Brain Stimulation (DBS) has been regarded as an efficient and safe treatment of Parkinson’s disease for the last 20 years. In terms of clinical ethics, it is worth asking whether the use of DBS may have unanticipated negative effects similar to those associated with other types of psychosurgery. Clinical studies of epileptic patients who have undergone an anterior temporal lobectomy have identified a range of side effects and complications in a number of domains: psychological, (...) behavioural, affective and social. In many cases, patients express difficulty adjusting from being chronically ill to their new status as ‘treated’ or ‘seizure free’. This postoperative response adjustment has been described in the literature on epilepsy as the ‘Burden of Normality’ (BoN) syndrome. Most of the discussion about DBS postoperative changes to self is focused on abnormal side effects caused by the intervention (ie, hypersexuality, hypomania, etc). By contrast, relatively little attention is paid to the idea that successfully ‘treated’ individuals might experience difficulties in adjusting to becoming ‘normal’. The purpose of this paper is (1) to articulate the postoperative DBS psychosocial adjustment process in terms of the BoN syndrome, (2) to address whether the BoN syndrome illustrates that DBS treatment poses a threat to the patient’s identity, and (3) to examine whether the current framework for rehabilitation after DBS procedures should be updated and take into account the BoN syndrome as a postoperative self-change response. (shrink)

Two different kinds of collections have been used to anticipate influenza pandemics: viral strains and bird specimens. These collections have been organized in museums and data banks to fill the gaps when specimens were decaying or when viral strains were missing. This article asks how collecting practices changed when such collections integrated specimens from China, considered a reservoir of influenza viruses and bird species, following a recurrent critical trope that Chinese specimens were missing. The article shows that techniques for hunting (...) viruses and birds were used to accumulate information so as to mitigate the global threat of species extinction. It suggests that in sentinel territories, museums transform samples and specimens into signs and images of future catastrophic events. (shrink)

Ecological fitness has been suggested to provide a unifying definition of fitness. However, a metric for this notion of fitness was in most cases unavailable except by proxy with differential reproductive success. In this article, I show how differential persistence of lineages can be used as a way to assess ecological fitness. This view is inspired by a better understanding of the evolution of some clonal plants, colonial organisms, and ecosystems. Differential persistence shows the limitation of an ensemblist noncausal understanding (...) of evolution. Causal explanations are necessary to understand the evolution by natural selection of these biological systems. †To contact the author write to: Department of Philosophy, University of Montreal, P.O. Box 6128, Station Centre‐Ville, Montreal, Quebec, H3C 3J7 Canada; e‐mail: [email protected]. (shrink)

Despite growing evidence that a significant number of patients living with Parkison’s disease experience neuropsychiatric changes following Deep Brain Stimulation treatment, the phenomenon remains poorly understood and largely unexplored in the literature. To shed new light on this phenomenon, we used qualitative methods grounded in phenomenology to conduct in-depth, semi-structured interviews with 17 patients living with Parkinson’s Disease who had undergone DBS. Our study found that patients appear to experience postoperative DBS-induced changes in the form of self-estrangement. Using the insights (...) from patients’ subjective perceptions of postoperative self-change provides a potent explanation of potential DBS-induced self-estrangement. (shrink)

Michel Henry has renewed our understanding of life as immanent affectivity: life cannot be reduced to what can be made visible; it is – as immanent and as affectivity – radically invisible. However, if life (la vie) is radically immanent, the living (le vivant ) has nonetheless to relate to the world: it has to exist . But, since existence requires and includes intentional components, human reality – being both living and existing – implies that immanence and intentionality be related (...) to one another, even though they are conceived at the same time as radically distinct modes of appearing in Henry’s phenomenology of life. Following this line of thought, we are faced with at least two questions: First, what reality does immanent appearing have for us as existing and intentional beings? And second, from an ethical point of view, what does Henry’s opposition of “barbarism” and “second birth” mean in terms of existence? As will be shown, it follows from the standpoint of radical phenomenology itself that immanent affectivity has reality for us only insofar as it finds its expression or translation in the realm of the intentionally visible and that, with regard to ethics, both “barbarism” and its overcoming in “second birth” are effective only insofar as they are mediated through representations. Henry’s critique of representation and intentionality needs therefore to be revised, especially in the field of practical philosophy, where the essential role played by intentionality has to be acknowledged even by radical phenomenology. (shrink)

From an evolutionary perspective, both atavism and somatic evolution/convergent evolution theories can account for the consistent occurrence, and astounding attributes of cancers: being able to evolve from a single cell to a complex organized system, and malignant transformations showing significant similarities across organs, individuals, and species. Here, we first provide an overview of these two hypotheses, including the possibility of them not being mutually exclusive, but rather potentially representing the two extremes of a continuum in which the diversity of cancers (...) can emerge. In reviewing the current literature, we also discuss the criteria that should be applied to discriminate between the two competing theories and to determine their relevant contributions to oncogenesis and cancer progression. Finally, we deliberate on the potential applications of this conceptual framework in developing novel treatment strategies. (shrink)

The goal of this article is to shed light on Deep Brain Stimulation (DBS) postoperative suicidality risk factors within Treatment Resistant Depression (TRD) patients, in particular by focusing on the ethical concern of enrolling patient with history of self-estrangement, suicide attempts and impulsive–aggressive inclinations. In order to illustrate these ethical issues we report and review a clinical case associated with postoperative feelings of self-estrangement, self-harm behaviours and suicide attempt leading to the removal of DBS devices. Could prospectively identifying and excluding (...) patients with suicidality risk factors from DBS experimental trials—such as history of self-estrangement, suicide attempts and impulsive–aggressive inclinations—lead to minimizing the risk of suicidality harm? (shrink)

Following Wallace’s suggestion, Darwin framed his theory using Spencer’s expression “survival of the fittest”. Since then, fitness occupies a significant place in the conventional understanding of Darwinism, even though the explicit meaning of the term ‘fitness’ is rarely stated. In this paper I examine some of the different roles that fitness has played in the development of the theory. Whereas the meaning of fitness was originally understood in ecological terms, it took a statistical turn in terms of reproductive success throughout (...) the 20th Century. This has lead to the ever-increasing importance of sexually reproducing organisms and the populations they compose in evolutionary explanations. I will argue that, moving forward, evolutionary theory should look back at its ecological roots in order to be more inclusive in the type of systems it examines. Many biological systems can only be satisfactorily accounted for by offering a non-reproductive account of fitness. This argument will be made by examining biological systems with very small or transient population structures. I argue this has significant consequences for how we define Darwinism, increasing the significance of survival over that of reproduction. (shrink)

Although being generally safe, the use of Deep Brain Stimulation has been associated with a significant number of patients experiencing postoperative psychological and neurological harm within experimental trials. A proportion of these postoperative severe adverse effects have lead to the decision to medically prescribe device deactivation or removal. However, there is little debate in the literature as to what is in the patient’s best interest when device removal has been prescribed; in particular, what should be the conceptual approach to ethically (...) guide the decision to remove or maintain implants. The purpose of this article is to examine the ethical issues raised when patients refuse brain device explantation despite medical prescription. In order to illustrate these issues, we report and discuss a clinical case involving a patient suffering from treatment resistant depression who experienced forms of postoperative self-estrangement, as well as suicidal attempts, but who resists giving consent to device explantation. (shrink)

This article discusses the concept of joint attention and the different skills underlying its development. Research in developmental psychology clearly states that the development of skills to understand, manipulate and coordinate attentional behavior plays a pivotal role for imitation, social cognition and the development of language. However, beside the fact that joint attention has recently received an increasing interest in the robotics community, existing models concentrate only on partial and isolated elements of these phenomena. In the line of Tomasello’s research, (...) we argue that joint attention is much more than simultaneous looking because it implies a shared intentional relation to the world. This requires skills for attention detection, attention manipulation, social coordination and, most importantly, intentional understanding. After defining joint attention and its challenges, the current state-of-the-art of robotic and computational models relevant for this issue is discussed in relation to a developmental timeline drawn from results in child studies. From this survey, we identify open issues and challenges that still need to be addressed to understand the development of the various aspects of joint attention and conclude with the potential contribution of robotic models. (shrink)

Deep brain stimulation has been regarded as an efficient and safe treatment for Parkinson’s disease since being approved by the Food and Drug Administration in 1997. It is estimated that more than 150 000 patients have been implanted, with a forecasted rapid increase in uptake with population ageing. Recent longitudinal follow-up studies have reported a significant increase in postoperative survival rates of patients with PD implanted with DBS as compared with those not implanted with DBS. Although DBS tends to increase (...) life expectancy for most patients with PD, this medical benefit does not come without attendant negative consequences. For example, emerging forms of iatrogenic harms are sometimes induced—harms which were not initially expected when clinicians proposed neurosurgery and patients or their guardians consented to the treatment. We report and discuss the clinical case of a patient who was implanted with DBS more than 20 years ago and is now experiencing unexpected stages of PD. This case illustrates how extending the life span without improving quality of life may introduce a burden of harms for patients and families. As well, this case shows why we should prepare for the expanding numbers of PD-implanted patients experiencing a gain of longevity but with severe stages of disease leading to diminution in quality of life. This newly observed effect of DBS treatment requires us to explore ethical questions related to iatrogenic harms, informed consent, end of life and caregivers’ burden. (shrink)

Phaedo of Elis was well-known as a writer of Socratic dialogues, and it seems inconceivable that Plato could have been innocent of intertextuality when, excusing himself on the grounds of illness, he made him the narrator of one of his own: the "Phaedo". In fact the psychological model outlined by Socrates in this dialogue converges with the evidence we have (especially from fragments of the Zopyrus) for Phaedo's own beliefs about the soul. Specifically, Phaedo seems to have thought that non-rational (...) desires were ineliminable epiphenomena of the body, that reason was something distinct, and that the purpose of philosophy was its 'cure' and 'purification'. If Plato's intention with the "Phaedo" is to assert the separability and immortality of reason (whatever one might think about desire and pleasure), then Phaedo provides a useful standpoint for him. In particular, Phaedo has arguments that are useful against the 'harmony-theorists' (and are the more useful rhetorically speaking since it is only over the independence of reason that Phaedo disagrees with them). At the same time as allying himself with Phaedo, however, Plato is able to improve on him by adding to the demonstration that reason is independent a proof that it is actually immortal. (shrink)

Individual identity and the multiplicity of cultural factors that “influence” the individual obviously raise the question of who we are as persons. But it is equally obvious that such individual reality is temporal, thereby constituting individual history. The latter seems to be like a Heraclitean flux where change is the only constant. In other words, since we never cease to change—even imperceptibly—shouldn’t we conclude that we never remain identical to ourselves in such a process of becoming? To use a concept (...) put forward by Ricœur, Idem-Identity, as stable and substantial sameness, appears to be an illusion, as we are the history of our actions and experiences, a history that continues to shape... (shrink)

The mystery surrounding consciousness as subjectivity dissipates dramatically when understood in its biological context. The core characteristics of consciousness can be seen to derive from its functionality, and the fundamental function of cognition, given the equivalence of mental activity and brain process, is to advance the survival and thus the self-regulative capacity of the organism of which the brain is a part. These core elements of consciousness are comprised of a self-locational data structure which serves to configure ongoing experience in (...) terms of controllable spatial and temporal parameters, and a processing regime for this orientational schema which has evolved from the feedback architecture necessary for regulating behavior in relation to homeostatic needs. These two self-regulative constituents yield a primitive form of consciousness as subjectivity — simple reflexive awareness — which provides the basis for the subsequent development of metacognitive mechanisms which monitor and control the cognitive processes which regulate behavior in relation to metabolic requirements. (shrink)

One of intuitions driving the acceptance of a neat structured tree of life is the assumption that organisms and the lineages they form have somewhat stable spatial and temporal boundaries. The phenomenon of symbiosis shows us that such ‘fixist’ assumptions does not correspond to how the natural world actually works. The implications of lateral gene transfer (LGT) have been discussed elsewhere; I wish to stress a related point. I will focus on lateral function transfer (LFT) and will argue, using examples (...) of what many would call ‘superorganisms’, that the emergence of symbiotic individuals revives the importance of functional and adaptationist thinking in how we conceptualize the lineages of biological individuals. The consequence of the argument is that, if we really want to hold onto tree of life thinking, we had better accept that new saplings appear and disappear all the time. (shrink)

Is there anything else but everything?--The religion of no-religion.--In search of a meaning to life.--Why man is utterly lost without art.--Alchemy as a way of salvation.

Building upon a non-standard understanding of evolutionary process focusing on variation and persistence, I will argue that communities and ecosystems can evolve by natural selection as emergent individuals. Evolutionary biology has relied ever increasingly on the modeling of population dynamics. Most have taken for granted that we all agree on what is a population. Recent work has reexamined this perceived consensus. I will argue that there are good reasons to restrict the term “population” to collections of monophyletically related replicators and (...) interactors, which explains why many existing models in population biology exclude by definition many genuine evolving biological individuals such as communities and ecosystems. By studying a case of community evolution, we will see that it is variation that is important to evolutionary processes, not populations. Variation within a population is only one of many types of variation that can lead to evolution by natural selection. The upshot of focusing on variation is that cases of community and ecosystem adaptive change become tractable in evolutionary terms. I will show that complex emergent individuals such as communities and ecosystems cannot be fully accommodated by conventional population/reproduction models but can be accommodated by variation/persistence models. (shrink)

To conclude that there is enough or not enough evidence demonstrating that deep brain stimulation causes unintended postoperative personality changes is an epistemic problem that should be answered on the basis of established, replicable, and valid data. If prospective DBS recipients delay or refuse to be implanted because they are afraid of suffering from personality changes following DBS, and their fears are based on unsubstantiated claims made in the neuroethics literature, then researchers making these claims bear great responsibility for prospective (...) recipients' medical decisions and subsequent well-being. Our article “Deflating the ‘DBS causes personality’ bubble” reported an increase in theoretical neuroethics publications suggesting putative DBS-induced changes to personality, identity, agency, autonomy, authenticity and/or self and a critical lack of supporting primary empirical studies. This special issue of Neuroethics brings together responses to our initial publication, with our own counter-responses organized according to common themes. We provide a brief summary for each commentary and its main criticisms as well as a discussion of the way in which these responses can: 1) help clarify the meaning of PIAAAS, suggesting supplementary frameworks for understanding the impact of DBS on PIAAAS; 2) provide further empirical evidence of PIAAAS by presenting results from the researchers’ own work; and/or 3) offer a critique of our research approach and/or findings. Unintended postoperative putative changes to PIAAAS remain a critical ethical concern. It is beyond dispute that we need to develop reliable empirical and conceptual instruments able to measure complex cognitive, affective, and behavioural changes in order to investigate whether they are attributable to DBS alone. (shrink)