The aim of this paper was to explore the issue of consent when considering the use of a life saving but not necessarily restorative surgical intervention for severe traumatic brain injury. A previous study has investigated the issue amongst 500 healthcare workers by using a two-part structured interview to assess opinion regarding decompressive craniectomy for three patients with varying injury severity. A visual analogue scale was used to assess the strengths of their opinions both before and after being shown objective (...) outcome data. Opinions were assessed in a number of scenarios, one of which was that the participants themselves were the injured party. The implication, which was clearly stated, was whether they would provide consent for the procedure to be performed. The study demonstrated that participants were relatively risk aversive in regards to survival with severe disability especially when the injury was severe and there was high probability of that outcome occurring. This finding was not however universal and a minority of participants would provide consent even when the possibility of survival with severe disability was very high. The obvious difficulty comes when considering consent in patients who are unable to express their wishes. In order to address this issue we propose a model of consent based on a balance of the various factors that seem to be of material relevance. These include the severity of the injury, the willingness or otherwise to accept survival with severe disability and the willingness to “risk” the possibility of an unacceptable outcome in order to achieve an acceptable outcome. (shrink)
The concept of futility is sometimes regarded as a cloak for medical paternalism in that it rolls together medical and value judgments. Often, despite attempts to disambiguate the concept, that is true and it can be applied in such a way as to marginalize the real interests of a patient. I suggest we replace it with a conceptual toolkit that includes physiological futility, substantial benefit (SB), and the risk of unacceptable badness (RUB) in that these concepts allow us to articulate (...) what is at stake in ethical judgments where outcomes are crucial in determining what should be done. (shrink)
Walter Freeman, the self styled neurosurgeon, became famous (or infamous) for psychosurgery. The operation of frontal leucotomy swept through the world (with Freeman himself performing something like 18,000 cases) but it has tainted the whole idea of psychosurgery down to the present era. Modes of psychosurgery such as Deep Brain Stimulation and other highly selective neurosurgical procedures for neurological and psychiatric conditions are in ever-increasing use in current practice. The new, more exciting techniques are based in a widely held philosophical (...) position on the relationship between the mind, brain and soul, which is the key to ethical debates in this area. Psychosurgery has always posed questions of responsibility, personality, character, identity, spirit, relationship, integrity, and human flourishing and they do not go away when we enter the brave new world of neuroethics and Deep Brain Stimulation. (shrink)
Informed consent is the practical expression of the doctrine of autonomy. But the very idea of autonomy and conscious free choice is undercut by the view that human beings react as their unconscious brain centres dictate, depending on factors that may or may not be under rational control and reflection. This worry is, however, based on a faulty model of human autonomy and consciousness and needs close neurophilosophical scrutiny. A critique of the ethics implied by the model takes us towards (...) a 'care of the self' view of autonomy and the subject's attunement to the truth as the crux of reasoning rather than the inner mental/neural state views of autonomy and human choice on offer at present. (shrink)
The first edition of The Mind and its Discontents was a powerful analysis of how, as a society, we view mental illness. In the ten years since the first edition, there has been growing interest in the philosophy of psychiatry, and a new edition of this text is more timely and important than ever. -/- In The Mind and its Discontents, Grant Gillett argues that an understanding of mental illness requires more than just a study of biological models of mental (...) processes and pathologies. As intensely social animals, he argues, we need to look for the causes of human mental disorders in our interactions with others; in social rule-following and its role in the organization of mental content; in the power relations embedded within social structures and cultural norms; in the way that our mental life is inscribed by a cumulative life of encounters with others. Drawing upon work from within the philosophy of mind, epistemology, post-modern continental philosophy, and philosophy of language, he tries to elucidate the nature of psychiatric phenomena involving disorders of thought, perception, emotion, moral sense, and action. Within this framework, a series of chapters analyse important psychiatric disorders such as depression, attention deficiency, autism, schizophrenia, and anorexia. Along the way, Gillett explores the nature of memory and identity; of hysteria and what constitutes rational behaviour; and of what causes us to label someone a psychopath or deviant. -/- Updated, available in paperback, and more accessible than before, the new edition of this fascinating book will provide readers with important insights into the causes and nature of psychosis. In addition, Gillett's arguments have considerable implications for the way in which we understand and treat people suffering from psychiatric disorders. The Mind and its Discontents will be read by researchers and postgraduate students in a range of academic areas, including psychiatry, bioethics, philosophy of mind, social theory, and clinical psychology. It will also be of considerable interest to practising psychiatrists. (shrink)
The use of human tissue raises ethical issues of great concern to health care professionals, biomedical researchers, ethics committees, tissue banks and policy makers because of the heightened importance given to informed consent and patient autonomy. The debate has been intensified by high profile scandals such as the “baby hearts” debacle and revelations about the retention of human brains in neuropathology laboratories worldwide. Respect for patient’s rights seems, however, to impede research and development of clinical knowledge in contemporary health care. (...) The Common clinical endeavour argument and a Presumption for beneficial use argument suggest that the use of tissues for research and teaching in contemporary health care can respect patients and their values in multicultural communities where there are provisions for oversight and for opting not to contribute, both of which should respect the diverse views of different ethnic or cultural groups. (shrink)
Cara sui (care of the self) is a guiding thread in Foucault's later writings on ethics. Following Foucault in that inquiry, we are urged beyond our fairly superficial conceptions of consequences, harms, benefits, and the rights of persons, and led to examine ourselves and try to articulate the sense of life that animates ethical reasoning. The result is a nuanced understanding with links to virtue ethics and post-modern approaches to ethics and subjectivity. The approach I have articulated draws on the (...) phenomenology of Levinas and Heidegger, the Virtue ethics of Baier, and the post-structuralist writing of Michel Foucault. The subject is seen as negotiable, embodied, provisional and able to be transformed in a way that denies essentialism about human beings, their moral status, and the idea of the good. The human being emerges as responsible because, properly, responsive to the context of discourse in which morality becomes articulated. When we import this style of thinking into bioethics we find that it reaches beyond issues of policy or right conduct and allows us to use the biomedical sciences and the clinical world to revise and interrogate our understanding of ourselves and the theoretical foundations of health care ethics. (shrink)
Philosophical accounts of thought crucially involve an array of abilities to identify general properties or features of the world (corresponding to concepts) and objects that instantiate those general properties. Abilities of both types can be grounded in a naturalistic account of the usefulness of cognitive structures in adaptive behaviour. Language enhances these abilities by multiplying the experience bases giving rise to them and helping to overcome subjective biases.
Wittgenstein shifted from a picture theory of meaning to a use-based theory of meaning in his philosophical work on language. The latter picture is deeply congenial to the view that language and the use of our hands in practical activity are closely related. Wittgenstein's theory therefore offers philosophical support for Corballis's suggestion that the development of spoken language is the basis of dominance phenomena.
In European philosophical psychology, the work of Jacques Lacan has exerted a great deal of influence but it has received little attention from analytic philosophers. He is famous for the view that the unconscious is a repository of influences arising from language and the meanings it captures, but the presentation of his ideas is sometimes perplexing and impenetrable and its conceptual links with analytic philosophers like Frege and Wittgenstein are not easily discerned. In fact, there are a number of such (...) links and they are worth pursuing for those interested in language, mind, and the unconscious. If we explore Lacan's claim about the link between signification and the tuchè (the encounter with the real) we find that the mental content of the subject is essentially tied to the external world both causally and linguistically. The means of tying the two together arise in the context of human interactions and therefore are charged with personal and emotive content as well as the semantic content with which we are normally concerned in philosophy of language. When we pursue the implications of his view it becomes plausible both that the unconscious is structured like a language and that language borrows much of its meaning and significance to a subject from the interpersonal medium through which it has been inscribed on that subject. His approach is therefore illuminating both for linguistics (especially psycholinguistics) and for the psychology of the unconscious. (shrink)
This book considers questions such as these and argues for a conception of consciousness, mental content and intentionality that is anti-Cartesian in its major...
Consciousness and its relation to the unconscious mind have long been debated in philosophy. I develop the thesis that consciousness and its contents reflect the highest elaboration of a set of abilities to respond to the environment realized in more primitive organisms and brain circuits. The contents of the states lesser than consciousness are, however, intrinsically dubious and indeterminate as it is the role of the discursive skills we use to construct conscious contents that lends articulation and clarity to the (...) mental acts which cumulatively make up our mental lives. I lay out a tripartite structure for the formation of mind in which the ongoing interaction between brain and world, the formative effect of socio-cultural context and the self production of a relatively coherent narrative all play an important part in making a mind. The latter two influences clearly transcend biological science and suggest that human minds have features which broadly align with certain Freudian insights but do not support the reification of the causally structured unconscious that Freud envisaged. (shrink)
The idea of cultural evolution, coined by Daniel Dennett, suggests we might be able to formulate a Darwinian type of explanation for the adaptive 'tricks' we learn as human beings. The proposed explanation makes use of the idea of memes. That idea is examined and related to semantic units linked to the terms in a natural language. It is agreed with Dennett that these are of pivotal significance in understanding the structure of human cognition. The alternative is then explored to (...) the chaos of worddemons that Dennett appeals to in explaining why and how we think and enter into discursive relations. Beginning with certain thoughts about language games the essay moves on to consider the relations of power and knowledge that shape discursive reality and explain our subjectivities and actions. This leads to a sketch of Foucaultian theory as an advance in the philosophy of mind required to move beyond fairly gestural accounts of psychological explanation to be found in the standard biologically motivated approaches. (shrink)
The Snark is an intentional object. I examine the general philosophical characteristics of thoughts of objects from the perspective of Husserl's, hyle, noesis, and noema and show how this meets constraints of opacity, normativity, and possible existence as generated by a sensitive theory of intentionality. Husserl introduces terms which indicate the normative features of intentional content and attempts to forge a direct relationship between the norms he generates and the actual world object which a thought intends. I then attempt to (...) relate Husserl's account to Fregean insights about the sense and reference of a term. Neither Husserl nor Frege suggest plausible routes to a naturalistic account of intentionality and I turn to Wittgenstein to provide a naturalistic reading of the crucial terms involved in the analysis of intentional content. His account is normative in a way required by both Husserl and Frege and yet manages a kind of Aristotelian naturalism which avoids crude biologism. (shrink)
Since the time of Hippocrates, medical science sought to develop a practice based on "knowledge rather than opinion". However, in the light of recent alternative approaches to healing and a philosophy of science that, through thinkers like Kuhn, Rorty, and Foucault, is critical of claims to objective truth, we must reappraise the way in which medical interventions can be based on proven pathophysiological knowledge rather than opinion. Developing insights in Foucault, Lacan, and Wittgenstein, this essay argues for a recovery of (...) the Aristotelian idea of a techne, where there is a dynamic interplay between praxis and conceptualization. The result is a post-Kuhnian epistemology for medical science that recognizes the evaluative dimension of knowledge, but that also looks to a Platonic conception of the good as the ultimate constraint on human thought, thus avoiding the radically self-contained accounts of truth found in some post-modern thinkers. Keywords: normal science, power, truth, virtue CiteULike Connotea Del.icio.us What's this? (shrink)
Libet's experiments, supported by a strict one-to-one identity thesis between brain events and mental events, have prompted the conclusion that physical events precede the mental events to which they correspond. We examine this claim and conclude that it is suspect for several reasons. First, there is a dual assumption that an intention is the kind of thing that causes an action and that can be accurately introspected. Second, there is a real problem with the method of timing the mental events (...) concerned given that Libet himself has found the reports of subjects to be unreliable in this regard. Third, there is a suspect assumption that there are such things as timable and locatable mental and brain events accompanying and causing human behaviour. For all these reasons we reject the claim that physical events are prior to and explain mental events. (shrink)
This collection examines prevalent assumptions in moral reasoning which are often accepted uncritically in medical ethics. It introduces a range of perspectives from philosophy and medicine on the nature of moral reasoning and relates these to illustrative problems, such as New Reproductive Technologies, the treatment of sick children, the assessment of quality of life, genetics, involuntary psychiatric treatment and abortion. In each case, the contributors address the nature and worth of the moral theories involved in discussions of the relevant issues, (...) and focus on the types of reasoning which are employed. 'Medical ethics is in danger of becoming a subject kept afloat by a series of platitudes about respect for persons or the importance of autonomy. This book is a bold and imaginative attempt to break away from such rhetoric into genuine informative dialogue between philosophers and doctors, with no search after consensus.' Mary Warnock. (shrink)
The idea that there is an inherent incentive in moral judgment or, in Classical terms, that there is an essential relationship between virtue and well?being is sharply criticized in contemporary moral theory. The associated theses that there is a way of living which is objectively good for human beings and that living that way is part of understanding moral truth are equally problematic. The Aristotelian argument proceeded via the premise that a human being was a rational social being. The present (...) reworking of that thesis builds on the internal connection between rationality and concept use. Moral judgment is linked to the grasp of moral concepts and thereby to an appreciation of how it is with other persons. The judgment that another person instances a morally relevant ascription is grounded on an empathic grasp of how it is with that person and thus tied to the thought that one ought to act in such and such a way or. in other words, to a disposition to act. Because the empathically grasped content of moral concepts is related to a number of mental ascriptions and reactive attitudes, the grasp of that content is interwoven deeply in the structure of human mental life and any attempt systematically to devalue or undermine it is threatening to one's mental integrity as a rational social being. Thus there is a deep link between moral sense or the disposition to act morally and an adequately grounded conception of human well?being. (shrink)
The legalisation of euthanasia creates a certain tension when it is compared with those traditional medical principles that seem to embody respect for the sanctity of life. It also creates a real need for us to explore what we mean by harm in relation to dying patients. When we consider that we must train physicians so that they not only understand ethical issues but also show the virtues in their clinical practice, it becomes important for us to strive to train (...) them in virtue rather than mere knowledge. We can only do this by conveying a real sense of the needs of the patient and an ability to relate to patients as people not problems. Such attitudes take shape in a training programme in which practical situations are explored and discussed and the limits of scientific medical responses to those challenges are exposed. Keywords: bioethics education, euthanasia, moral judgment, training, virtue CiteULike Connotea Del.icio.us What's this? (shrink)
The psychopathic personality disorder historically has been thought to include an insensitivity to morality. Some have thought that the psychopath's insensitivity indicates that he does not understand morality, but the relationship between the psychopath's defects and moral understanding has been unclear. We attempt to clarify this relationship, first by arguing that moral understanding is incomplete without concern for morality, and second, by showing that the psychopath demonstrates defects in frontal lobe activity which indicate impaired attention and adaptation to environmental conditions (...) which are relevant to the formation of complex intentions. We argue that these frontal lobe defects can help to explain both the psychopath's apparent insensitivity to morality and his characteristic imprudence. (shrink)
This study examines the relationship between thought and language by considering the views of Kant and the later Wittgenstein along with many strands of contemporary debate in the area of mental content. Building on an analysis of the nature of concepts and conceptions of objects, Gillett provides an account of psychological explanation and the subject of experience, offers a novel perspective on mental representation and linguistic meaning, looks at the difficult topics of cognitive roles and singular thought, and concludes with (...) an outline of certain considerations relevant to skeptical arguments and the nature of perception. The resulting synthesis demonstrates interesting correlations with current work in cognitive and developmental psychology, and is directly relevant to continuing work in epistemology, philosophy of mind, and philosophical psychology. (shrink)
Abstract Experience is structured by thoughts which are composed of general concepts and conceptions of objects. Both of these elements of thought are rule?governed and rest on norms which are shared by thinkers. Concepts and conceptions of objects as the elements of thoughts whose content is essentially communicable plausibly rest on abilities tied to the use of linguistic terms. This suggests that language plays an active part in structuring human experience and cognition as suggested by both Vygotsky and Luria. The (...) role of language in thought implies that the human brain which is the information processing structure realizing thoughts is itself subject to shaping by the social milieu. Neural network theory suggests that this might proceed via the use of cue stimuli based on the responses of other human beings and, therefore, supports the view that cognitive neuroscience may be radically mistaken in thinking that it can provide an individualistic analysis of human mental life. (shrink)
Abstract The phenomenology of Multiple Personality (MP) syndrome is used to derive an Aristotelian explanation of the failure to achieve rational integration of mental content. An MP subject is best understood as having failed to master the techniques of integrating conative and cognitive aspects of her mental life. This suggests that in irrationality the subject may lack similar skills basic to the proper articulation and use of mental content in belief formation and control of action. The view that emerges centres (...) mind on the activity of a subject rather than a structured causal nexus. (shrink)
The relationship between "causal" and "meaningful" (Jaspers) influences on behavior is explored. The nature of meaning essentially involves rules and the human practices in which they are imparted to a person and have a formative influence on that person's thinking. The meanings that come to be discerned in life experience are then important in influencing the shape of that person's conduct. The reasoning and motivational structures that develop on this basis are realized by the shape of the neural processing networks (...) that constitute the mature human brain. This implies that meaning is not only realized by brain micro-structure but, in part, explains its workings. This in turn entails that in psychiatry we must continue to avail ourselves both of neuropsychology/neurobiology and of dynamic/meaningful explanation. Keywords: brain and mind, causality and meaning, cognitive models, meaning, mind and brain, neuropsychology and meaning CiteULike Connotea Del.icio.us What's this? (shrink)
Perception is often analysed as a process in which causal events from the environment act on a subject to produce states in the mind or brain. The role of the subject is an increasing feature of neuroscientific and cognitive literature. This feature is linked to the need for an account of the normative aspects of perceptual competence. A holographic model is offered in which objects are presented to the subject classified according to rules governing concepts and encoded in brain function (...) in that form. This implies that the analysis of perception must consider not only the fact that there is an interaction between the perceiving subject and the perceived object but also that the interaction is shaped by a system of concepts which the subject uses in thought and action. (shrink)
?Representation? is a concept which occurs both in cognitive science and philosophy. It has common features in both settings in that it concerns the explanation of behaviour in terms of the way the subject categorizes and systematizes responses to its environment. The prevailing model sees representations as causally structured entities correlated on the one hand with elements in a natural language and on the other with clearly identifiable items in the world. This leads to an analysis of representation and cognition (...) in terms of formal symbols and their relations. But human perception and cognition use multiple informational constraints and deal with unsystematic and messy input in a way best explained by Parallel Distributed Processing models. This undermines the claim that a formal representational theory of mind is ?the only game in town?. In particular it suggests a radically different model of brain function and its relation to epistemology from that found in current representational theories. (shrink)
Abstract The language of consciousness and that of brain function seem vastly different and incommensurable ways of approaching human mental life. If we look at what we mean by consciousness we find that it has a great deal to do with the sensitivity and responsiveness shown by a subject toward things that happen. Philosophically, we can understnd ascriptions of consciousness best by looking at the conditions which make it true for thinkers who share the concept to say that one of (...) them is conscious. This depends on consciousness being manifest. When we also note that manifest, flexible and exploratory responses to one's environment are the basis of concept use, an a priori link between concepts and consciousness is forged. The brain structures subserving such responses are complex but crucially involve the multi?tracked and cross?linked information processing to be found in the neocortex. This function draws on the motivational and orienting activity arising in lower brain systems but orchestrates that into an articulated structure of behaviour control. The conclusion is that human consciousness is an umbrella term for complex and animated mental activity which makes extensive use of many different perceptual systems and also of the social milieu within which human cognition develops. (shrink)
Concepts are basic elements of thought. Piaget has a conception of the nature of concepts as informational or computational operations performed in an inner milieu and enabling the child to understand the world in which it lives and acts. Concepts are, however, not merely logico?mathematical but are also conceptually linked to the mastery of language which itself involves the appropriate use of words in social and interpersonal settings. In the light of Vygotsky's work on the social and interactive nature of (...) children's thinking and the nature of language as an essentially public currency of rule?governed signs, we are led to reconstrue conceptual mastery as the acquisition of an interactive and interpersonal repertoire of tools which introduces the child to the world of those who educate it. In this way we come to see the elements of mind as constitutively involving that activity in which the determinants of meaning constrain and direct the child's linguistic development. (shrink)
