We describe and analyze 13 cases handled by our ethics consultation service (ECS) in which families requested continuation of physiological support for loved ones after death by neurological criteria (DNC) had been declared. These ethics consultations took place between 2005 and 2013. Patients’ ages ranged from 14 to 85. Continued mechanical ventilation was the focal intervention sought by all families. The ECS’s advice and recommendations generally promoted “reasonable accommodation” of the requests, balancing compassion for grieving families with other ethical and (...) moral concerns such as stewardship of resources, professional integrity, and moral distress. In cases we characterized as finitegoal accommodation, a “reasonable accommodation” strategy proved effective in balancing stakeholders’ interests and goals, enabling steady progress toward resolution. When a family objected outright to a declaration of DNC and asked for an indefinite accommodation, the “reasonable accommodation” approach offered clinicians little practical direction, and resolution required definitive action by either the family or the clinical team. Based on our analysis and reflections on these 13 cases, we propose ethically justified and practical guidelines to assist healthcare professionals, administrators, and ECSs faced with similar cases. (shrink)

This is a unique book. It is excellently written, crammed with information, wise and a pleasure to read.' ---Daniel C. Dennett, Tufts University.

Progress in the neurosciences is profoundly changing our conception of ourselves. Contrary to time-honored intuition, the mind turns out to be a complex of brain functions. And contrary to the wishful thinking of some philosophers, there is no stemming the revolutionary impact that brain research will have on our understanding of how the mind works. Brain-Wise is the sequel to Patricia Smith Churchland's Neurophilosophy, the book that launched a subfield. In a clear, conversational manner, this book examines old (...) questions about the nature of the mind within the new framework of the brain sciences. What, it asks, is the neurobiological basis of consciousness, the self, and free choice? How does the brain learn about the external world and about its own introspective world? What can neurophilosophy tell us about the basis and significance of religious and moral experiences? Drawing on results from research at the neuronal, neurochemical, system, and whole-brain levels, the book gives an up-to-date perspective on the state of neurophilosophy—what we know, what we do not know, and where things may go from here. (shrink)

Beginning with Thomas Nagel, various philosophers have propsed setting conscious experience apart from all other problems of the mind as ‘the most difficult problem’. When critically examined, the basis for this proposal reveals itself to be unconvincing and counter-productive. Use of our current ignorance as a premise to determine what we can never discover is one common logical flaw. Use of ‘I-cannot-imagine’ arguments is a related flaw. When not much is known about a domain of phenomena, our inability to imagine (...) a mechanism is a rather uninteresting psychological fact about us, not an interesting metaphysical fact about the world. Rather than worrying too much about the meta-problem of whether or not consciousness is uniquely hard, I propose we get on with the task of seeing how far we get when we address neurobiologically the problems of mental phenomena. (shrink)

A remarkable hypothesis has recently been advanced by Libet and promoted by Eccles which claims that there is standardly a backwards referral of conscious experiences in time, and that this constitutes empirical evidence for the failure of identity of brain states and mental states. Libet's neurophysiological data are critically examined and are found insufficient to support the hypothesis. Additionally, it is argued that even if there is a temporal displacement phenomenon to be explained, a neurophysiological explanation is most likely.

Philosophy, in its traditional guise, addresses questions where experimental science has not yet nailed down plausible explanatory theories. Thus, the ancient Greeks pondered the nature of life, the sun, and tides, but also how we learn and make decisions. The history of science can be seen as a gradual process whereby speculative philosophy cedes intellectual space to increasingly wellgrounded experimental disciplines—first astronomy, but followed by physics, chemistry, geology, biology, archaeology, and more recently, ethology, psychology, and neuroscience. Science now encompasses plausible (...) theories in many domains, including large-scale theories about the cosmos, life, matter, and energy. The mind’s turn has now come. The classical ‘‘mind’’ questions center on free will, the self, consciousness, how thoughts can have meaning and ‘‘aboutness,’’ and how we learn and use knowledge. All these matters interlace with questions about morality: where values come from, the roles of reason and emotion in choice, and the wherefore of responsibility and punishment. The vintage mind/body problem is a legacy of Descartes: if the mind is a completely nonphysical substance, as he thought, how can it interact causally with the physical brain? Since the weight of evidence indicates that mental processes actually are processes of the brain, Descartes’ problem has disappeared. The classical mind/ body problem has been replaced with a range of questions: what brain mechanisms explain learning, decision making, self-deception, and so on. The replacement for ‘‘the mind-body problem’’ is not a single problem; it is the vast research program of cognitive neuroscience. The dominant methodology of philosophy of mind and morals in the twentieth.. (shrink)

A medical information commons is a networked data environment utilized for research and clinical applications. At three deliberations across the U.S., we engaged 75 adults in two-day facilitated discussions on the ethical and social issues inherent to sharing data with an MIC. Deliberants made recommendations regarding opt-in consent, transparent data policies, public representation on MIC governing boards, and strict data security and privacy protection. Community engagement is critical to earning the public's trust.

We review Potts' influential book on the semantics of conventional implicature , offering an explication of his technical apparatus and drawing out the proposal's implications, focusing on the class of CIs he calls supplements. While we applaud many facets of this work, we argue that careful considerations of the pragmatics of CIs will be required in order to yield an empirically and explanatorily adequate account.

Irvin Rock's hypothesis that certain stages of perceptual processing resemble problem solving in cognition is contrasted to some recent work in computer vision (Marr, Ullman) which tries to reduce intelligence in perception to computational organization. The focal example is subjective contours which Marr thought could be handled by computational modules without descending control, and which Rock thinks are the outcome of intelligent processing.

Narrative inquiry in a nursing practicum One approach to creating research‐based nursing education is to think and write narratively about the daily life of a BScN program student and her teacher in diverse settings and over time. Gail, as a nurse‐teacher, and Faith, as a nursing student and now Public Health Nurse, reconstruct their teaching–learning experiences in an integrated practicum in maternal–child health services as a narrative inquiry. After presenting this reconstruction of experience at a conference on maternal scholarship, (...) further inquiry into their experiences shows how narrative inquiry matters to construction of nursing praxis and to life‐long learning as a nurse. Teaching–learning relationships are seen as a template for a student's connections to people experiencing nursing care and to other clinicians. Construction of stories to live by that take into account becoming a nurse, constructing knowledge and enacting caring–healing nursing practices is illuminated through narrative inquiry. (shrink)

Two very different insights motivate characterizing the brain as a computer. One depends on mathematical theory that defines computability in a highly abstract sense. Here the foundational idea is that of a Turing machine. Not an actual machine, the Turing machine is really a conceptual way of making the point that any well-defined function could be executed, step by step, according to simple 'if-you-are-in-state-P-and-have-input-Q-then-do-R' rules, given enough time (maybe infinite time) [see COMPUTATION]. Insofar as the brain is a device whose (...) input and output can be characterized in terms of some mathematical function -- however complicated -- then in that very abstract sense, it can be mimicked by a Turning machine. Given what is known so far brains do seem to depend on cause-effect operations, and hence brains appear to be, in some formal sense, equivalent to a Turing machine [see CHURCH-TURING THESIS]. On its own, however, this reveals nothing at all of how the mind-brain actually works. The second insight depends on looking at the brain as a biological device that processes information from the environment to build complex representations that enable the brain to make predictions and select advantageous behaviors. Where necessary to avoid ambiguity, we will refer to the first notion of computation as algorithmic computation, and the second as information processing computation. (shrink)

The explanation of a child's discriminate responses to his environment turns on ascribing to the child a perceptual discrimination which counts certain things as more similar to one another than to some other thing. As Quine forcefully puts it:If an individual is to learn at all, differences in degree of similarity must be implicit in his learning pattern. Otherwise any response, if reinforced, would be conditioned equally and indiscriminately to any and every future episode, all these being equally similar.Now for (...) those determined to cleave to behaviourist canons, the problem is to use ‘perceptual similarity’ in explaining the subject's discriminating responses in a way which does not imply the existence of mental states and entities. What this really means is that the behaviourist must reconstruct the notion of ‘perceptual similarity', purifying it of its mentalistic dimension. So long as physicalism is a reasonable position, and while we are awaiting and abetting the neurophysiological millennium, the behaviourist's project is of significant moment. Now in Word and Object Quine does not seriously attempt to provide behavioural criteria for a subject's perceiving similarities, and he provisionally permits himself the mentalistic idiom he avows finally to eschew. (shrink)

Many questions concerning the nature of the mind have remained intractable since their first systematic discussion by the ancient Greeks. What is the nature of knowledge, and how is it possible to represent the world? What are consciousness and free will? What is the self and how is it that some organisms are more intelligent than others? Since it is now overwhelmingly evident that these are phenomena of the physical brain, it is not surprising that an established empirical and theoretical (...) foundation in this domain has eluded us for so long. For in order to understand what we are and how we work, we must understand the brain and how it works. Yet the brain is exceedingly difficult to study, and research on any significant scale is critically dependent on advanced technology. (shrink)

This collection was prepared in the belief that the most useful and revealing of anyone's writings are often those shorter essays penned in conflict with...

The value of any kind of data is greatly enhanced when it exists in a form that allows it to be integrated with other data. One approach to integration is through the annotation of multiple bodies of data using common controlled vocabularies or ‘ontologies’. Unfortunately, the very success of this approach has led to a proliferation of ontologies which itself creates obstacles to integration. The Open Biomedical Ontologies (OBO) consortium has set in train a strategy to overcome this problem. Existing (...) OBO ontologies, including the Gene Ontology, are undergoing a process of coordinated reform and new ontologies being created on the basis of an evolving set of shared principles governing ontology development. The result is an expanding family of ontologies designed to be interoperable, logically well-formed, and to incorporate accurate representations of biological reality. We describe the OBO Foundry initiative, and provide guidelines for those who might wish to become involved. (shrink)

The development of the Functional Genomics Investigation Ontology (FuGO) is a collaborative, international effort that will provide a resource for annotating functional genomics investigations, including the study design, protocols and instrumentation used, the data generated and the types of analysis performed on the data. FuGO will contain both terms that are universal to all functional genomics investigations and those that are domain specific. In this way, the ontology will serve as the “semantic glue” to provide a common understanding of data (...) from across these disparate data sources. In addition, FuGO will reference out to existing mature ontologies to avoid the need to duplicate these resources, and will do so in such a way as to enable their ease of use in annotation. This project is in the early stages of development; the paper will describe efforts to initiate the project, the scope and organization of the project, the work accomplished to date, and the challenges encountered, as well as future plans. (shrink)