Circumscribed delusional beliefs can follow brain injury. We suggest that these involve anomalous perceptual experiences created by a deficit to the person's perceptual system, and misinterpretation of these experiences due to biased reasoning. We use the Capgras delusion (the claim that one or more of one's close relatives has been replaced by an exact replica or impostor) to illustrate this argument. Our account maintains that people voicing this delusion suffer an impairment that leads to faces being perceived as drained (...) of their normal affective significance, and an additional reasoning bias that leads them to put greater weight on forming beliefs that are observationally adequate rather than beliefs that are a conservative extension of their existing stock. We show how this position can integrate issues involved in the philosophy and psychology of belief, and examine the scope for mutually beneficial interaction. (shrink)
Psychiatric patients may try (or express a desire) to injure themselves in hospital in order to cope with overwhelming emotional pain. Some health care practitioners and patients propose allowing a controlled amount of self-injury to occur in inpatient facilities, so as to prevent escalation of distress. Is this approach an example of professional assistance with harm? Or, is the approach more likely to minimise harm, by ensuring safer self-injury? In this article, I argue that health care practitioners who (...) use harm-minimisation can be considered to be helping physical injury to occur, although they do not encourage the act. I consider why there are compelling reasons to believe that a patient who self-injures is not maximally autonomous in relation to that choice. However, I then move onto argue that allowing a degree of self-injury may enable engagement with psychotherapy (enhancing autonomy) and behavioural change. In these circumstances, allowing injury (with precautions) may not be harm, all things considered. (shrink)
To what extent is imagination dependent on embodied experience? In attempting to answer such questions I consider the experiences of those who have to come to terms with altered neurological function, namely those with spinal cord injury at the neck. These people have each lost all sensation and movement below the neck. How might these new ways of living affect their imagination?
This paper explicates a conception of injury as right-violation, which allows us to distinguish between setbacks to interests that should, and should not, be the concern of theories of justice. It begins by introducing a hybrid theory of rights, grounded in (a) the mobilisation of our moral equality to (b) protect our most important interests, and shows how violations of rights are the concern of justice, while setbacks where one of the twin grounds of rights is defeated are not. (...) It then looks more closely at the substantive moral components of injury, namely harm—damage to one’s interests—and wrong—disrespect for one’s moral equality. It argues that, on the hybrid conception of rights, harm and wrong are individually necessary and jointly sufficient components of injury, and the disvalue of neither is reducible to the other—in particular, it is a mistake to construe the disrespect identified by wrong as another damaged interest. Finally, it distinguishes between the public and private dimensions of harm and wrong, and makes some preliminary suggestions as to whether the remedy for these different dimensions should lie in criminal, distributive, or corrective justice. (shrink)
Traumatic brain injury (TBI) patients typically respond more slowly and with more variability than controls during tasks of attention requiring speeded reaction time. These behavioral changes are attributable, at least in part, to diffuse axonal injury (DAI), which affects integrated processing in distributed systems. Here we use a multivariate method sensitive to distributed neural activity to compare brain activity patterns of patients with chronic phase moderate-to-severe TBI to those of controls during performance on a visual feature-integration task assessing (...) complex attentional processes that has previously shown sensitivity to TBI. The TBI patients were carefully screened to be free of large focal lesions that can affect performance and brain activation independently of DAI. The task required subjects to hold either one or three features of a target in mind while suppressing responses to distracting information. In controls, the multi-feature condition activated a distributed network including limbic, prefrontal, and medial temporal structures. TBI patients engaged this same network in the single-feature and baseline conditions. In multi-feature presentations, TBI patients alone activated additional frontal, parietal, and occipital regions. These results are consistent with neuroimaging studies using tasks assessing different cognitive domains, where increased spread of brain activity changes was associated with TBI. Our results also extend previous findings that brain activity for relatively moderate task demands in TBI patients is similar to that associated with of high task demands in controls. (shrink)
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)
Despite an increasing amount of specific correlation studies between structural and functional connectivity, there is still a need for combined studies, especially in pathological conditions. Impairments of brain white matter and diffuse axonal injuries are commonly suspected to be responsible for the disconnection hypothesis in traumatic brain injury (TBI) patients. Moreover, our previous research on TBI patients shows a strong relationship between abnormalities in topological organization of brain networks and behavioral deficits. In this study, we combined task-related functional connectivity (...) (using event-related fMRI) with structural connectivity (derived from fiber tractography using diffusion MRI data) estimates in the same participants (17 adults with TBI and 16 controls), allowing for direct comparison between graph metrics of the different imaging modalities. Connectivity matrices were computed covering the switching motor network, which includes the basal ganglia, anterior cingulate cortex/supplementary motor area, and anterior insula/inferior frontal gyrus. The edges constituting this network consisted of the partial correlations between the fMRI time series from each node of the switching motor network. The interregional anatomical connections between the switching-related areas were determined using the fiber tractography results. We found that graph metrics and hubs obtained showed no agreement in both groups. The topological properties of brain functional networks could not be solely accounted for the properties of the underlying structural networks. However, combining complementary information from both different imaging modalities could improve accuracy in prediction of switching performance. Direct comparison between functional task-related and anatomical structural connectivity, presented here for the first time in TBI patients, links two powerful approaches to map the patterns of brain connectivity that may underlie behavioral deficits in brain. (shrink)
Plasticity is the mechanism underlying brain’s potential capability to compensate injury. Recently several studies have shown that functional connections among brain areas are severely altered by brain injury and plasticity leading to a reorganization of the networks. This new approach studies the impact of brain injury by means of alteration of functional interactions. The concept of functional connectivity refers to the statistical interdependencies between physiological time series simultaneously recorded in various brain areas and it could be an (...) essential tool for brain function studies, being its deviation from healthy reference an indicator for damage. In this article, we review studies investigating functional connectivity changes after brain injury and subsequent recovery, providing an accessible introduction to common mathematical methods to infer functional connectivity, exploring their capabilities, future perspectives and clinical uses in brain injury studies. (shrink)
Traumatic brain injury often involves focal cortical injury and white matter (WM) damage that can be measured shortly after injury. Additionally, slowly evolving WM change can be observed but there is a paucity of research on the duration and spatial pattern of long-term changes several years post-injury. The current study utilized diffusion tensor imaging to identify regional WM changes in 12 TBI patients and 9 healthy controls at three time points over a four-year period. Neuropsychological testing (...) was also administered to each participant at each time point. Results indicate that TBI patients exhibit longitudinal changes to white matter indexed by reductions in fractional anisotropy (FA) in the corpus callosum, as well as FA increases in bilateral regions of the superior longitudinal fasciculus (SLF) and portions of the optic radiation. FA changes appear to be driven by changes in radial (not axial) diffusivity, suggesting that observed longitudinal FA changes may be related to changes in myelin rather than to axons. Neuropsychological correlations indicate that regional FA values in the corpus callosum and sagittal stratum correlate with performance on finger tapping and visuomotor speed tasks (respectively) in TBI patients, and that longitudinal increases in FA in the sagittal stratum (SS), SLF and optic radiation (OR) correlate with improved performance on the visuomotor speed (SS) task as well as a derived measure of cognitive control (SLF, OR). The results of this study showing progressive WM deterioration for several years post-injury contribute to a growing literature supporting the hypothesis that TBI should be viewed not as an isolated incident but as a prolonged disease state. The observations of long-term neurological and functional improvement provide evidence that some ameliorative change may be occurring concurrently with progressive degeneration. (shrink)
Individuals with traumatic brain injury (TBI) exhibit deficits in executive control, which may impact their reasoning abilities. Analogical reasoning requires working memory and inhibitory abilities. In this study, we tested adolescents with moderate to severe TBI and typically-developing (TD) controls on a set of picture analogy problems. Three factors were varied: complexity (number of relations in the problems), distraction (distractor item present or absent), and animacy (living or non-living items in the problems). We found that TD adolescents performed significantly (...) better overall than TBI adolescents. There was also an age effect present in the TBI group where older participants performed better than younger ones. This age effect was not observed in the TD group. Performance was affected by complexity and distraction. Further, TBI participants exhibited lower performance with distractors present than TD participants. The reasoning deficits exhibited by the TBI participants were correlated with measures of executive function that required working memory updating, attention, and attentional screening. Using MRI-derived measures of cortical thickness, correlations were carried out between task accuracy and cortical thickness. The TD adolescents showed negative correlations between thickness and task accuracy in frontal and temporal regions consistent with cortical maturation in these regions. This study demonstrates that adolescent TBI results in impairments in analogical reasoning ability. Further, TBI youth have difficulty effectively screening out distraction, which may lead to failures in comprehension of the relations among items in visual scenes. Lastly, TBI youth fail to show robust cortical-behavior correlations as observed in TD individuals. (shrink)
This paper makes the case for a wider acceptance of a probabilistic approach to causation in negligence. This acceptance would help to remove much of the incoherence which has come to afflict the English law of personal injury law. This incoherence can also be found in other common law jurisdictions (notably those of the United States, Canada and Australia). Concentrating upon recent UK case law, the argument opposes the contention that ‘naked statistics’ can play no role in establishing causation. (...) The argument is controversial but it can be reduced to three unremarkable grounds: (1) With its acceptance (albeit in certain carefully prescribed circumstances) of liability for a negligently increased risk which has eventuated, the common law has already embraced a probabilistic conception of causation; (2) The English common law already employs a probabilistic (frequentist) approach to identifying coincidences; and (3) With the ‘balance of probabilities’ as the standard of proof in civil cases, the common law has long had a probabilistic (epistemic) concept at its core. Probabilistic approaches (at both the type and token level) are shown to be consistent with laypersons’ understanding of the concepts such as risk, chance, odds and likelihood. Moreover, a wider acceptance of a probabilistic perspective on causation would entail no major challenge to the fundamental aims of tort, viz. deterrence and corrective justice. (shrink)
Many people who believe that abortion may often be justiﬁed by appeal to the pregnant woman’s interests also believe that a woman’s inﬂiction of signiﬁcant but nonlethal injury on her fetus can seldom be justiﬁed by appeal to her interests. Yet the second of these beliefs can seem to cast doubt on the ﬁrst. For the view that the inﬂiction of prenatal injury is seriously morally objectionable may seem to presuppose a view about the status of the fetus (...) that challenges the permissibility of abortion. The fear of being interpreted as implicitly endorsing such a view has thus led some defenders of abortion to be reluctant for tactical reasons to condemn the inﬂiction of prenatal injury. In this they are encouraged by those who exploit the issue of prenatal injury in their campaign against abortion. When, for example, the House and Senate in 2004 passed legislation recognizing two victims of an assault against a pregnant woman, many viewed this as a tactic in a larger strategy to restrict access to abortion. This tactic is potentially effective. For people may ﬁnd it compelling to infer that, if injuring a fetus is seriously objectionable, abortion must be even more objectionable, since killing is normally more seriously objectionable than merely injuring. (shrink)
This study examined more than 2,500 war images from U.S. television news, newspapers, news magazines, and online news sites during the first five weeks of the U.S.-led invasion of Iraq in 2003 and found that only 10% showed injury or death. The paper analyzes which media platforms were most willing to show casualties and offers insights on when journalists should use gruesome war images or keep them secret.
Informed by the critical humanisms of Hannah Arendt, Frantz Fanon, and Paul Gilroy, the authors argue for an orientation to teaching and learning that troubles the continuing effects of dehumanizing race logic. Reflecting on Paul Haggis's Oscar award winning film Crash from 2004, they suggest that the metaphor of racial 'crashing' captures what happens when we act out from experiences of racial injury instead of being touched by it. They propose a psychoanalytic pedagogy of emotions as a method for (...) reading representation beyond the limits of detached rational critique. Learning from the affect of racial injury as it is made manifest in representation, they suggest, is an important ethical starting point for generating new insights into what it might mean to live within and beyond contemporary legacies of racial hatred. (shrink)
Recent research suggests that spiritual experiences are related to increased physiological activity of the frontal and temporal lobes and decreased activity of the right parietal lobe. The current study determined if similar relationships exist between self-reported spirituality and neuropsychological abilities associated with those cerebral structures for persons with traumatic brain injury (TBI). Participants included 26 adults with TBI referred for neuropsychological assessment. Measures included the Core Index of Spirituality (INSPIRIT); neuropsychological indices of cerebral structures: temporal lobes (Wechsler Memory Scale-III), (...) right parietal lobe (Judgment of Line Orientation), and frontal lobes (Trail Making Test, Controlled Oral Word Association Test). As hypothesized, spirituality was significantly negatively correlated with a measure of right parietal lobe functioning and positively correlated (nonsignificantly) with measures of left temporal lobe functioning. Contrary to hypotheses, correlations between spirituality and measures of frontal lobe functioning were zero or negative (and nonsignificant). The data support a neuropsychological model that proposes that spiritual experiences are related to decreased activity of the right parietal lobe, which may be associated with decreased awareness of the self (transcendence) and increased activity of the left temporal lobe, which may be associated with the experience of specific religious archetypes (religious figures and symbols). (shrink)
Geron recently announced that it had begun enrolling patients in the world's first-in-human clinical trial involving cells derived from human embryonic stem cells (hESCs). This trial raises important questions regarding the future of hESC-based therapies, especially in spinal cord injury (SCI) patients. We address some safety and efficacy concerns with this research, as well as the ethics of fair subject selection. We consider other populations that might be better for this research: chronic complete SCI patients for a safety trial, (...) subacute incomplete SCI patients for an efficacy trial, and perhaps primary progressive multiple sclerosis (MS) patients for a combined safety and efficacy trial. (shrink)
Next SectionExperiencing a spinal cord injury (SCI) and becoming disabled through sport is a major disruptive life event that instigates a multiplicity of difficult and complex issues that the person has to deal with. One of these problems is how to restory a life and construct new body/self relationships and identities over time. To explore this process, we focus on the life stories of a small group of men (n = 14) who have suffered SCI and become disabled through (...) playing rugby football. We illustrate the ways in which certain metaphors, notions of time, and kinds of hope, congregate and coalesce within three specific narrative types and how these operate to shape the individual experiences of these men following SCI. The implications of this dynamic process for the storied body/self and identity construction are highlighted throughout. (shrink)
(2010). Insult to Injury: Ethical Confusion in American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. The American Journal of Bioethics: Vol. 10, No. 1, pp. 68-70.
The principle of non-injury toward all living beings (ahimsā) in India was originally a rule restraining human interaction with the natural environment. I compare two discourses on the relationship between humans and the natural environment in ancient India: the discourse of the priestly sacrificial cult and the discourse of the renunciants. In the sacrificial cult, all living beings were conceptualized as food. The renunciants opposed this conception and favored the ethics of non-injury toward all beings (plants, animals, etc.), (...) which meant that no living being should be food for another. The first represented an ethics modeled on the power that the eater has over the eaten while the second attempted to overturn this food chain ethics. The ethics of non-injury ascribed ultimate value to every individual living being. As a critique of the individualistic ethics of noninjury, a holistic ethics was developed that prescribed the unselfish performance of one’s duties for the sake of the functioning of the natural system. Vegetarianismbecame a popular adaptation of the ethics of non-injury. These dramatic changes in ethics in ancient India are suggestive for the possibility of dramatic changes in environmental ethics today. (shrink)
: The effects of head injury, even mild traumatic brain injury, are wide-ranging and profound. Persons with adult-onset head injury offer feminist philosophers important perspectives for philosophical methodology and philosophical research concerning personal identity, mind-body theories, and ethics. The needs of persons with head injury require the expansion of typical teaching strategies, and such adaptations appear beneficial to both disabled and non-disabled students.
We show that the existence of a recursively enumerable set whose Turing degree is neither low nor complete cannot be proven from the basic axioms of first order arithmetic (P -) together with Σ 2 -collection (BΣ 2 ). In contrast, a high (hence, not low) incomplete recursively enumerable set can be assembled by a standard application of the infinite injury priority method. Similarly, for each n, the existence of an incomplete recursively enumerable set that is neither low n (...) nor high n - 1 , while true, cannot be established in P - + BΣ n + 1 . Consequently, no bounded fragment of first order arithmetic establishes the facts that the high n and low n jump hierarchies are proper on the recursively enumerable degrees. (shrink)
Adolescent risk-taking behaviour has potentially serious injury consequences and school-based behaviour change programmes provide potential for reducing such harm. A well-designed programme is likely to be theory-based and ecologically valid; however, it is rare that the operationalisation process of theories is described. The aim of this paper is to outline how the theory of planned behaviour and cognitive behavioural therapy informed intervention design in a school setting. Teacher interviews provided insights into strategies that might be implemented within the curriculum (...) and provided detail used to operationalise theory constructs. Benefits and challenges in applying both theories are described with examples from an injury prevention programme, Skills for Preventing Injury in Youth. (shrink)
In all fields of clinical medicine, there is an increasing awareness that outcome must be assessed in terms of quality of life and cost effectiveness, rather than merely length of survival. This is especially the case when considering decompressive craniectomy for severe traumatic brain injury. The procedure itself is technically straightforward and involves temporarily removing a large section of the skull vault in order to provide extra space into which the injured brain can expand. A number of studies have (...) demonstrated many patients going on to make a good long-term functional recovery, however, this is not always the case and a significant number survive but are left with severe neurocognitive impairment. Unfortunately, many of these patients are young adults who were previously fit and well and are, therefore, likely to spend many years in a condition that they may feel to be unacceptable, and this raises a number of ethical issues regarding consent and resource allocation. In an attempt to address these issues, we have used the analytical framework proposed by Jonsen, that requires systematic consideration of medical indications, patient preferences, quality of life and contextual features. (shrink)
The rules governing recovery for negligently inflicted psychiatric injury are among the most criticized of all of tort law. However, one area which, to date, has escaped with a minimum of judicial or academic scrutiny concerns the very threshold requirement for these actions: proof of a ‘recognized psychiatric illness’. This article critiques that longstanding requirement of English law from two perspectives. First, it is argued that the international classifications of psychiatric disorders (ICD-10 and DSM-IV) are being misapplied and misconstrued (...) in the English medico-legal context and that the role (and limitations) of these classifications are worthy of far greater judicial examination and critical scrutiny than has typically been the case to date. Secondly, it is contended that the insistence upon a recognized psychiatric illness, as a threshold requirement, is giving rise to inconsistencies and distortions in the law and that the requirement is neither legally nor medically supportable in the modern era. Instead, it is argued that the stage has been reached whereby something lesser than a recognized psychiatric illness should be sufficient to trigger a compensable injury in law. The article concludes by suggesting various legal avenues by which to feasibly and robustly ‘ring-fence’ the number of potential claims in negligence, should the reform-oriented approach of this article be adopted. (shrink)
Working in the language of first-order arithmetic we consider models of the base theory P - . Suppose M is a model of P - and let M satisfy induction for σ 1 -formulas. First it is shown that the Friedberg-Muchnik finite injury argument can be performed inside M, and then, using a blocking method for the requirements, we prove that the Sacks splitting construction can be done in M. So, the "amount" of induction needed to perform the known (...) finite injury priority arguments is Σ 1 -induction. (shrink)
This article describes the Vaccine/Injury Project Corpus, a collection of legal decisions awarding or denying compensation for health injuries allegedly due to vaccinations, together with models of the logical structure of the reasoning of the factfinders in those cases. This unique corpus provides useful data for formal and informal logic theory, for natural-language research in linguistics, and for artificial intelligence research. More importantly, the article discusses lessons learned from developing protocols for manually extracting the logical structure and generating the (...) logic models. It identifies sub-tasks in the extraction process, discusses challenges to automation, and provides insights into possible solutions for automation. In particular, the framework and strategies developed here, together with the corpus data, should allow “top–down” and contextual approaches to automation, which can supplement “bottom-up” linguistic approaches. Illustrations throughout the article use examples drawn from the Corpus. (shrink)
It is the persistence of social suffering in a world in which it could be eliminated that for Adorno is the source of the need for critical reflection, for philosophy. Philosophy continues and gains its cultural place because an as yet unbridgeable abyss separates the social potential for the relief of unnecessary human suffering and its emphatic continuance. Philosophy now is the culturally bound repository for the systematic acknowledgement and articulation of the meaning of the expanse of human suffering within (...) technologically advanced societies that are already committed to liberal ideals of freedom and equality. (shrink)
This paper considers the importance of the body for self-esteem, communication, and emotional expression and experience, through the reflections of those who live with various neurological impairments of movement and sensation; sensory deafferentation, spinal cord injury and Möbius Syndrome (the congenital absence of facial expression). People with severe sensory loss, who require conscious attention and visual feedback for movement, describe the imperative to use the same strategies to reacquire gesture, to appear normal and have embodied expression. Those paralysed after (...) spinal cord injury struggle to have others see them as people rather than as people in wheelchairs and have been active in the disability movement, distinguishing between their medical impairment and the social induced disability others project onto them. Lastly those with Möbius reveal the importance of the face for emotional expression and communication and indeed for emotional experience itself. All these examples explore the crucial role of the body as agent for social and personal expression and self-esteem. (shrink)