Recent developments in the field of neurosurgery, specifically those dealing with the modification of mood and affect as part of psychiatric disease, have led some researchers to discuss the ethical implications of surgery to alter personality and personal identity. As knowledge and technology advance, discussions of surgery to alter undesirable traits, or possibly the enhancement of normal traits, will play an increasingly larger role in the ethical literature. So far, identity and enhancement have yet to be explored in a neurosurgical (...) context, despite the fact that 1) neurological disease and treatment both potentially alter identity, and 2) that neurosurgeons will likely be the purveyors of future enhancement implantable technology. Here, we use interviews with neurosurgical patients to shed light on the ethical issues and challenges that surround identity and enhancement in neurosurgery. The results provide insight into how patients approach their identity prior to potentially identity-altering procedures and what future ethical challenges lay ahead for clinicians and researchers in the field of neurotherapeutics. (shrink)
Brain implants, such as Deep Brain Stimulation (DBS), which are designed to improve motor, mood and behavioural pathology, present unique challenges to our understanding of identity, agency and free will. This is because these devices can have visible effects on persons' physical and psychological properties yet are essentially undetectable when operating correctly. They can supplement and compensate for one's inherent abilities and faculties when they are compromised by neuropsychiatric disorders. Further, unlike talk therapy or pharmacological treatments, patients need not ‘do’ (...) anything for the treatment to take effect. If one accepts, as we argue here, that brain implants are unique among implantable types of devices, then this can have significant implications for what it means to persist as the same person and be the source of one's thoughts and actions. By examining two of the most common indications for DBS in current use, namely in the motor (Parkinson's Disease) and psychiatric (Major Depression) domains, we further argue that although DBS, as it is currently applied, does not necessarily represent a unique threat to personal identity and agency per se, it introduces an unprecedented ‘third party’ into the debate on these concepts. In this way, DBS can be used as a tool to begin probing, both conceptually and empirically, some of philosophy's most perennial metaphysical questions. (shrink)
The Harvard University Program in Ethics and Health, 651 Huntington Avenue, 6th floor c/o HSPH, François Xavier Bagnoud Building Boston, MA 02115, USA. Email: Nir_Eyal{at}hms.harvard.edu ' + u + '@' + d + ' '//--> Abstract Access to medicines, vaccination and care in resource-poor settings is threatened by the emigration of physicians and other health workers. In entire regions of the developing world, low physician density exacerbates child and maternal mortality and hinders treatment of HIV/AIDS. This article invites philosophers to (...) help identify ethical and effective responses to medical brain drain. It reviews existing proposals and their limitations. It makes a case that, in resource-poor countries, ‘locally relevant medical training’—teaching primarily locally endemic diseases and practice in scarcity conditions, training in rural communities and admitting rural students preferentially—could help improve retention. Locally relevant training would arguably diminish medical brain drain in five ways. It would (i) make graduates less attractive for Western employers, (ii) align graduates’ expectations with actual practice, diminishing ‘burn-out’, (iii) enhance the professional prestige of local practice, (iv) hold rotations in, and recruit applicants from, rural areas, which is known to improve retention there, and (v) create local career development options that attract practitioners to stay. Such educational reform may raise worries about poor-quality care, breach of the freedom of education and occupation, breach of the freedom of movement, unequal distribution of opportunities among students, hypocrisy and resistance from influential actors. We address these worries. CiteULike Connotea Del.icio.us What's this? (shrink)
The article begins by reconstructing the just distribution of the social bases of self-respect, a principle of justice that is covert in Rawls’s writing. I argue that, for Rawls, justice mandates that each social basis for self-respect be equalized (and, as a second priority, maximized). Curiously, for Rawls, that principle ranks higher than Rawls’s two more famous principles of justice - equal liberty and the difference principle. I then recall Rawls’s well-known confusion between self-respect and another form of self-appraisal, namely, (...) confidence in one’s determinate plans and capacities. Correcting that confusion forces Rawls to accept objectionable and illiberal politics. Surprisingly, a consistent Rawls must endorse absolute economic equality, deny liberty any priority whatsoever, or sponsor still other illiberal political views - evidence of a flaw in the ethical basis of Rawls’s politics. -/- Key Words: self-respect • self-esteem • distributive justice • Rawls • maximin • primary goods • liberty • equality • lexicographical order. (shrink)
This article argues that, in its standard formulation, luck-egalitarianism is false. In particular, I show that disadvantages that result from perfectly free choice can constitute egalitarian injustice. I also propose a modified formulation of luck-egalitarianism that would withstand my criticism. One merit of the modification is that it helps us to reconcile widespread intuitions about distributive justice with equally widespread intuitions about punitive justice.
This paper deals with the question: how is computation best individuated? -/- 1. The semantic view of computation: computation is best individuated by its semantic properties. 2. The causal view of computation: computation is best individuated by its causal properties. 3. The functional view of computation: computation is best individuated by its functional properties. -/- Some scientific theories explain the capacities of brains by appealing to computations that they supposedly perform. The reason for that is usually that computation is individuated (...) semantically. I criticize the reasons in support of this view and its presupposition of representation and semantics. Furthermore, I argue that the only justified appeal to a representational individuation of computation might be that it is partly individuated by implicit intrinsic representations. (shrink)
This paper deals with the question: What are the criteria that an adequate theory of computation has to meet? (1) Smith’s answer: it has to meet the empirical criterion (i.e. doing justice to computational practice), the conceptual criterion (i.e. explaining all the underlying concepts) and the cognitive criterion (i.e. providing solid grounds for computationalism). (2) Piccinini’s answer: it has to meet the objectivity criterion (i.e. identifying computation as a matter of fact), the explanation criterion (i.e. explaining the computer’s behaviour), the (...) right things compute criterion, the miscomputation criterion (i.e. accounting for malfunctions), the taxonomy criterion (i.e. distinguishing between different classes of computers) and the empirical criterion. (3) Von Neumann’s answer: it has to meet the precision and reliability of computers criterion, the single error criterion (i.e. addressing the impacts of errors) and the distinction between analogue and digital computers criterion. (4) “Everything” computes answer: it has to meet the implementation theory criterion by properly explaining the notion of implementation. (shrink)
What is a disability? What sorts of limitations do persons with disabilities or impairments experience? What is there about having a disability or impairment that makes it disadvantageous for the individuals with it? Are persons with severe cognitive impairments capable of making autonomous decisions? What role should disability play in the construction of theories of justice? Is it ever ethical for parents to seek to create a child with an impairment? This anthology addresses these and other questions and is a (...) valuable addition to a growing interdisciplinary literature exploring issues at the intersection of disability studies, philosophy, and bioethics. Most of the authors are well-known from their previous work in the disability field and have already made significant philosophical contributions to it. (shrink)
Commentators on the ethics of translational research find it morally problematic. Types of translational research are said to involve questionable benefits, special risks, additional barriers to informed consent, and severe conflicts of interest. Translational research conducted on the global poor is thought to exploit them and increase international disparities. Some commentators support especially stringent ethical review. However, such concerns are grounded only in pre-approval translational research (now called T1 ). Whether or not T1 has these features, translational research beyond approval (...) ( T2 : phase IV, health services, and implementation research) is unlikely to and, when conducted on the global poor, may support development. Therefore, insofar as T1 is morally problematic, and no independent objections to T2 exist, the ethics of translational research is diverse: while some translational research is problematic, some is not. Funding and oversight should reflect this diversity, and T2 should be encouraged, particularly when conducted among the global poor. (shrink)
What is a disability? What sorts of limitations do persons with disabilities or impairments experience? What is there about having a disability or impairment that makes it disadvantageous for the individuals with it? Are persons with severe cognitive impairments capable of making autonomous decisions? What role should disability play in the construction of theories of justice? Is it ever ethical for parents to seek to create a child with an impairment? This anthology addresses these and other questions and is a (...) valuable addition to a growing interdisciplinary literature exploring issues at the intersection of disability studies, philosophy, and bioethics. Most of the authors are well-known from their previous work in the disability field and have already made significant philosophical contributions to it. (shrink)
This paper deals with the question: what are the key requirements for a physical system to perform digital computation? Time and again cognitive scientists are quick to employ the notion of computation simpliciter when asserting basically that cognitive activities are computational. They employ this notion as if there was or is a consensus on just what it takes for a physical system to perform computation, and in particular digital computation. Some cognitive scientists in referring to digital computation simply adhere to (...) Turing’s notion of computability . Classical computability theory studies what functions on the natural numbers are computable and what mathematical problems are undecidable. Whilst a mathematical formalism of computability may perform a methodological function of evaluating computational theories of certain cognitive capacities, concrete computation in physical systems seems to be required for explaining cognition as an embodied phenomenon . There are many non-equivalent accounts of digital computation in physical systems. I examine only a handful of those in this paper: (1) Turing’s account ; (2) The triviality “account”; (3) Reconstructing Smith’s account of participatory computation ; (4) The Algorithm Execution account . My goal in this paper is twofold. First, it is to identify and clarify some of the underlying key requirements mandated by these accounts. I argue that these differing requirements justify a demand that one commits to a particular account when employing the notion of computation in regard to physical systems. Second, it is to argue that despite the informative role that mathematical formalisms of computability may play in cognitive science, they do not specify the relationship between abstract and concrete computation. (shrink)
We analyse three moral dilemmas involving resource allocation in care for HIV-positive patients. Ole Norheim and Kjell Arne Johansson have argued that these cases reveal a tension between egalitarian concerns and concerns for better population health. We argue, by contrast, that these cases reveal a tension between, on the one hand, a concern for equal *chances*, and, on the other hand, both a concern for better health and an egalitarian concern for equal *outcomes*. We conclude that, in these cases, there (...) is much less tension than Norheim and Johansson claim between egalitarian concerns and concerns for better population health. (shrink)
There are currently considerable confusion and disarray about just how we should view computationalism, connectionism and dynamicism as explanatory frameworks in cognitive science. A key source of this ongoing conflict among the central paradigms in cognitive science is an equivocation on the notion of computation simpliciter. ‘Computation’ is construed differently by computationalism, connectionism, dynamicism and computational neuroscience. I claim that these central paradigms, properly understood, can contribute to an integrated cognitive science. Yet, before this claim can be defended, a better (...) understanding of ‘computation’ is required. ‘Digital computation’ is an ambiguous concept. It is not just the classical dichotomy between analogue and digital computation that is the basis for the equivocation on ‘computation’ simpliciter in cognitive science, but also the diversity of extant accounts of digital computation. There are many answers on what it takes for a system to perform digital computation. Answers to this problem range from Turing machine computation, through the formal manipulation of symbols, the execution of algorithms and others, to the strong-pancomputational thesis, according to which every physical system computes every Turing-computable function. Despite some overlap among them, extant accounts of concrete digital computation are non-equivalent, thus, rendering ‘digital computation’ ambiguous. The objective of this dissertation is twofold. First, it is to promote a clearer understanding of concrete digital computation. Accordingly, my main thesis is that not only are extant accounts of concrete digital computation non-equivalent, but most of them are inadequate. I show that these accounts are not just intensionally different (this is quite trivially the case), but also extensionally distinct. In the course of examining several key accounts of concrete digital computation, I propose the instructional information processing account, according to which digital computation is the processing of discrete data in accordance with finite instructional information. The second objective is to establish the foundational role of computation in cognitive science whilst rejecting the purported representational nature of computation. (shrink)
It is common in cognitive science to equate computation (and in particular digital computation) with information processing. Yet, it is hard to find a comprehensive explicit account of concrete digital computation in information processing terms. An information processing account seems like a natural candidate to explain digital computation. But when ‘information’ comes under scrutiny, this account becomes a less obvious candidate. Four interpretations of information are examined here as the basis for an information processing account of digital computation, namely Shannon (...) information, algorithmic information, factual information and instructional information. I argue that any plausible account of concrete computation has to be capable of explaining at least the three key algorithmic notions of input, output and procedures. Whist algorithmic information fares better than Shannon information, the most plausible candidate for an information processing account is instructional information. (shrink)
This article responds to Nir Eisikovits’ recent book Sympathizing with the Enemy: Reconciliation, Transitional Justice, Negotiation (Martinus Nijhoff Publishers, 2010).
We examine carefully the rationale underlying the approaches to belief change taken in the literature, and highlight what we view as methodological problems. We argue that to study belief change carefully, we must be quite explicit about the ontology or scenario underlying the belief change process. This is something that has been missing in previous work, with its focus on postulates. Our analysis shows that we must pay particular attention to two issues that have often been taken for granted: the (...) first is how we model the agent's epistemic state. (Do we use a set of beliefs, or a richer structure, such as an ordering on worlds? And if we use a set of beliefs, in what language are these beliefs are expressed?) We show that even postulates that have been called beyond controversy are unreasonable when the agent's beliefs include beliefs about her own epistemic state as well as the external world. The second is the status of observations. (Are observations known to be true, or just believed? In the latter case, how firm is the belief?) Issues regarding the status of observations arise particularly when we consider iterated belief revision, and we must confront the possibility of revising by and then by ¬. (shrink)
In many countries worldwide, especially in Sub-Saharan Africa, a shortage of physicians limits the provision of lifesaving interventions. One existing strategy to increase the number of physicians in areas of critical shortage is conditioning medical school scholarships on a precommitment to work in medically underserved areas later. Current practice is usually to demand only one year of service for each year of funded studies. We show the effectiveness of scholarships conditional on such precommitment for increasing physician supplies in underserved areas. (...) Then we defend these scholarships against ethical worries that they constitute slavery contracts; rely on involuntary, biased, or unauthorized early consent by a young signatory; put excessive strains on signed commitments; give rise to domination; and raise suspicion of slavery contracts. Importantly, we find that scholarships involving far longer commitment than current practice allows would also withstand these worries. Policymakers should consider introducing conditional scholarships, including long-term versions, as a means to increasing the supply of physicians to medically underserved areas. (shrink)
Wolf and White address different aspects of the paper and in this present reply space only permits making two brief remarks. One concerns White’s intriguing observation that digital computation without erasing information is possible. The second concerns the importance of control information in digital computing systems.
“Without good brain function, living to age 100 is not an attractive proposition,” said Nir Barzilai, director of the college’s Institute for Ageing Research. “We’ve shown that the same gene variant that helps people live to exceptional ages has the added benefit of helping them think clearly.
