Although medicolegal challenges to the use of neurologic criteria to declare death in the USA have been well-described, the management of court cases in the United Kingdom about objections to the use of neurologic criteria to declare death has not been explored in the bioethics or medical literature. This article (1) reviews conceptual, medical and legal differences between death by neurologic criteria (DNC) in the United Kingdom and the rest of the world to contextualize medicolegal challenges to DNC; (2) summarizes (...) highly publicized legal cases related to DNC in the United Kingdom, including the nuanced 2022 case of Archie Battersbee, who was transiently considered dead by neurologic criteria, but ultimately determined to be in a vegetative state/unresponsive-wakeful state; and (3) provides an overview of ethical issues raised by medicolegal challenges to DNC in the United Kingdom and a comparison to the management of these challenges in the USA. (shrink)

The intent of the Uniform Determination of Death Act (UDDA) was to facilitate a consistent legal standard for death and align the law with medical practice throughout the United States subsequent t...

Although death by neurologic criteria is legally recognized throughout the United States, state laws and clinical practice vary concerning three key issues: the medical standards used to determine death by neurologic criteria, management of family objections before determination of death by neurologic criteria, and management of religious objections to declaration of death by neurologic criteria. The American Academy of Neurology and other medical stakeholder organizations involved in the determination of death by neurologic criteria have undertaken concerted action to address variation (...) in clinical practice in order to ensure the integrity of brain death determination. To complement this effort, state policymakers must revise legislation on the use of neurologic criteria to declare death. We review the legal history and current laws regarding neurologic criteria to declare death and offer proposed revisions to the Uniform Determination of Death Act and the rationale for these recommendations. (shrink)

In 1968, the definition of death in the United States was expanded to include not just death by cardiopulmonary criteria, but also death by neurologic criteria. We explore the way the definition has been modified by the medical and legal communities over the past 50 years and address the medical, legal and ethical controversies associated with the definition at present, with a particular highlight on the Supreme Court of Nevada Case of Aden Hailu.

Recently, there have been a number of lawsuits in the United States in which families objected to performance of apnoea testing for determination of brain death. The courts reached conflicting determinations in these cases. We discuss the medicolegal complications associated with apnoea testing that are highlighted by these cases and our position that the decision to perform apnoea testing should be made by clinicians, not families, judges, or juries.

We describe two unusual cases of cardiopulmonary death in mechanically ventilated patients in the neurological intensive care unit. After cardiac arrest, both patients were pulseless for a protracted period. Upon extubation, both developed agonal movements (gasping respiration) resembling life. We discuss these cases and the literature on the ethical and medical controversies associated with determining time of cardiopulmonary death. We conclude that there is rarely a single moment when all of a patient’s physiological functions stop working at once. This can (...) pose a challenge for determining the exact moment of death. (shrink)

Tissue plasminogen activator (tPA) is administered to patients with suspected ischemic stroke to improve blood flow to the brain In rare cases, patients present with complaints of stroke symptoms that appear to be non-organic due to malingering, factitious disorder, or conversion disorder (psychogenic stroke mimics). Deciding whether or not to administer tPA to these patients can be challenging. The risk of hemorrhage after administration of tPA is low, but not zero. The ethical principles of beneficence and nonmaleficence need to be (...) weighed carefully in these situations. We present two cases of patients with suspected psychogenic stroke mimics to illustrate the ethical challenges faced in identifying and managing psychogenic stroke mimics. Further research is needed to demonstrate effective treatment strategies for patients with acute stroke symptoms of psychogenic etiology. (shrink)

Volume 20, Issue 6, June 2020, Page 20-22.

Over 115 000 people are waiting for life-saving organ transplants, of whom a small fraction will receive transplants and many others will die while waiting. Existing efforts to expand the number of available organs, including increasing the number of registered donors and procuring organs in uncontrolled environments, are crucial but unlikely to address the shortage in the near future and will not improve donor/recipient compatibility or organ quality. If successful, organ bioengineering can solve the shortage and improve functional outcomes. Studying (...) manufactured organs in animal models has produced valuable data, but is not sufficient to understand viability in humans. Before risking manufactured organ experimentation in living humans, study of bioengineered organs in recently deceased humans would facilitate evaluation of the function of engineered tissues and the complex interactions between the host and the transplanted tissue. Although such studies do not pose risk to human subjects, they pose unique ethical challenges concerning the previous wishes of the deceased, rights of surviving family members, effective operation and fair distribution of medical services, and public transparency. This article investigates the ethical, legal and social considerations in performing engineered organ research on the recently deceased. (shrink)

Ariane Lewis offers a comprehensive and expert review of ethical issues raised by brain death in the United Kingdom and how they compare to management of those issues in the United States (Lewis 20...

Arian Lewis provides a comprehensive overview of how the United Kingdom’s medicolegal context manages challenges to determining death by neurologic criteria (DNC) and suggests that a well-crafted s...

Ariane Lewis provided an insightful review of several controversial cases of death by neurologic criteria (“brain death”) in the UK, focusing on Archie Battersbee, a boy whose tragic illness provok...

Ariane Lewis reviewed medicolegal challenges to Death by Neurologic Criteria (DNC) in the United Kingdom in order to identify and discuss the ethical issues raised (Lewis 2024). Here I briefly clar...

In her interesting paper on cross-jurisdictional legal approaches to brain death, Ariane Lewis considers whether informed consent is required for DNC testing in the UK, and proposes that it is not...

We were delighted to be asked by the editors of the American Journal of Bioethics to provide this editorial in response to Dr. Ariane Lewis’s paper “An Overview of Ethical Issues Raised by Medicole...

A question, long discussed by legal scholars, has recently provoked a considerable amount of philosophical attention: ‘Is it ever appropriate to base a legal verdict on statistical evidence alone?’ Many philosophers who have considered this question reject legal reliance on bare statistics, even when the odds of error are extremely low. This paper develops a puzzle for the dominant theories concerning why we should eschew bare statistics. Namely, there seem to be compelling scenarios in which there are multiple sources of (...) incriminating statistical evidence. As we conjoin together different types of statistical evidence, it becomes increasingly incredible to suppose that a positive verdict would be impermissible. I suggest that none of the dominant views in the literature can easily accommodate such cases, and close by offering a diagnosis of my own. (shrink)

This paper defends the heretical view that, at least in some cases, we ought to assign legal liability based on purely statistical evidence. The argument draws on prominent civil law litigation concerning pharmaceutical negligence and asbestos-poisoning. The overall aim is to illustrate moral pitfalls that result from supposing that it is never appropriate to rely on bare statistics when settling a legal dispute.

This article argues that environmental ethics can deemphasize environmental problem-solving in preference for a more exemplarist mode. This mode will renarrate what we admire in those we have long admired, in order to make them resonate with contemporary ethical needs. First, I outline a method problem that arose for me in ethnographic fieldwork, a problem that I call, far too reductively, “solution thinking.” Second, I relate that method problem to movements against “quandary ethics” in ethical theory more broadly. Third, I (...) discuss some interpretive work I am engaged in about Henry David Thoreau and how it bears on the methodological issues my fieldwork raised. I argue that some of the most important icons of right relation to environment, especially Francis of Assisi and Thoreau, should be envisioned as far more politically invested than they usually are. They demonstrate to scholars of religious ethics that an exemplarist ethic focused on character need not neglect politics. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Notes and Fragments PLATONIC ELEMENTS IN KAFKA'S "INVESTIGATIONS OF A DOG" by Lewis W. Leadbeater Few critics of Kafka, and certainly few German critics of Kafka, have been willing to allow for much of any classical influence on his works. There are exceptions, but for the most part these commentators can bring themselves to admit only the fact Kafka endured with distaste his lengthy involvement with the classical (...) languages and literature and that, if in any way, he was influenced only in terms of syntax or style.1 Yet it is certain that Kafka read classical literature with interest and that he was well acquainted with classical epic, tragedy, philosophy, and mythology. The wandering Odysseus, the sea god Poseidon, tortured Prometheus —all these and other classical figures are to be found in his works. Indeed, a recent interpretation of The Trial involves a discussion of it in comparison with the trial of Socrates.2 The fact is that Kafka knew Plato's Apology and counted as one of his prized possessions a copy of Plato's Phaedrus. He and Brod read Plato together in high school.3 Are we really to assume, then, that, given Kafka's philosophical bent, he saw no relationship between Plato and the later philosophers, like Kierkegaard for instance, with whom he was quite taken, and that given his fertile mind and penchant for metaphor, Kafka reflects only Platonic syntax?4 Quite the contrary; we must, I think, cede his classicism to Kafka, and in the discussion which follows I should like to point out that in one of the short stories, "Investigations of a Dog," parable and metaphor blend as well as they do because of Platonic influence, and especially that of the Apology and the Phaedrus. Kafka's animals pervade his works in both metaphor and simile. Gregor Samsa awakes one morning to find himself transformed into a gigantic beetle; Joseph K dies, at the end of his trial, like a dog, and it is a questioning canine which investigates the meaning of dog104 Lewis W. Leadbeater105 ness in "Forschungen eines Hundes." Generally the animalistic metaphor involves removal, alienation, and isolation— a loss of kinship with humanity to be sure, but more important a loss of communication, an inability to communicate, and hence an emphasis on all-encompassing, frustrating silence. The natural result for these people turned animal is an involvement in a process of severe introspection frequently linked with the pursuit of some idea or ideal which will provide a hitherto unknown, transcendent nourishment for a famished, alienated soul. Such is certainly the case with Gregor Samsa and quite possibly the case with Joseph K; it is in fact such pursuits which lie at the heart of the researches of our investigating Dog. Though any attempt to pinpoint the source of Kafka's penchant for animalistic metaphors is quite certainly futile, one might well posit as paradigmatic the alienation plays of Aristophanes involving animals, and certainly the notion of a psychological link between man and beast is present in Plato's Phaedrus, a dialogue in which the soul metaphor itself involves horses, and one in which there is considerable discussion of the interchangeability of the souls of men and beasts.5 As noted above such interchangeability or transformation occurs regularly in Kafka; within the ugly form of beetle lay the psyche of Gregor Samsa. Perhaps within the not-so-ugly canine form of our investigating hound lies the soul of Socrates. Consider for a moment the character of our Dog in light of Plato's Socrates as he appears in the Apology. To begin with, the Dog, as he tells us, is a solitary creature, withdrawn and involved solely in his "investigations" (p. 278).6 In addition, he fully realizes that he is different from the rest of his species (p. 279) and that indeed at times he feels rejected by his kind, realizing as he does that his investigations run counter to the traditional values of his species, a species by which he had hoped at one time to be accepted with great honor (p. 308). What he has capitulated to is "questions" which, furthermore, have quite removed him from normal... (shrink)

Researchers face perennial difficulties in studying live jury deliberation. As a result, the academic community struggles to reach a consensus on key matters of legal reform concerning jury trials. The hurdles faced by empirical jury researchers are often legal or institutional. This note argues that the legal and institutional barriers preventing live deliberation research should be removed and discusses two forms that live deliberation research could take.

Ever since its first documented live birth in 2014, the use of uterine transplantation (UTx) for the treatment of absolute uterine factor infertility (UFI) has seen major clinical advances, which include the use of alternative surgical approaches, different donor states, and diverse patient populations. In addition to the thorough research programs that developed the technique, this accomplishment has occurred in large part following a number of ethical frameworks, such as the Montreal Criteria and the Indianapolis Consensus, which paved the way (...) to transition from experimental animal trials to human ones. To date, over 60 uterine transplants have been performed in the world, and at least 18 births have been thus far confirmed. While the procedure remains experimental, the vast knowledge and procedural experience amassed over the last 20 years of rigorous research have hinted at the next step of discovery. In particular, advancing social circumstances have prompted the question regarding the use of this technology in transgender individuals. Though the potential use of uterine transplants in the transgender population has been hypothesized, no in‐depth ethical framework has been developed towards this purpose. Herein, we explore the ethical issues revolving around the use of this technology in this patient population and provide key insights that may advance this cause. (shrink)

Relatively compact biography of the seventeenth-century French philosopher is determined to reverse the slander of scandal in vogue among Descartes' recent biographers and to modify the view of his intellectual development.

Should we use the same standard of proof to adjudicate guilt for murder and petty theft? Why not tailor the standard of proof to the crime? These relatively neglected questions cut to the heart of central issues in the philosophy of law. This paper scrutinises whether we ought to use the same standard for all criminal cases, in contrast with a flexible approach that uses different standards for different crimes. I reject consequentialist arguments for a radically flexible standard of proof, (...) instead defending a modestly flexible approach on non-consequentialist grounds. The system I defend is one on which we should impose a higher standard of proof for crimes that attract more severe punishments. This proposal, although apparently revisionary, accords with a plausible theory concerning the epistemology of legal judgments and the role they play in society. (shrink)

Much attention has been devoted in recent years to the personal idealism of Martin Luther King, Jr. Among the major contributors to the scholarship in this area is Rufus Burrow, Jr., who places King firmly in the tradition of personal idealism, or personalism, while also uncovering the intellectual unease that made King both a deep and creative thinker and a committed and effective social activist.1 Clearly, Burrow's own sense of his role as a personalist informs his approach to the life (...) and thought of King. Although philosophical personalism figures prominently in Burrow's treatment of King in his writings, ethical and social personalism provides the primary theoretical framework for both Burrow's exploration of .. (shrink)

Cathleen Kaveny's Prophecy Without Contempt seeks to reorient the conversation among religious ethicists and political theorists about religion in public life. Rather than focus on religious speech in general, Kaveny distinguishes deliberation and indictment as forms of discourse, and she subjects indictment to ethical evaluation. She aims to constrain the public exercise of inordinate indictment, while encouraging prophetic indictment that meets the demands of justice. While the book is a much-needed corrective, Kaveny's focus on the powerful rhetoric of prophetic indictment (...) omits the harms that can come to the body politic from unjust silence. Such silence deserves more moral attention. (shrink)

La préface des Principes oppose les quatre premiers degrés d'une sagesse empirique, fondée sur les notions communes, l'expérience sensible et la fréquentation d'autrui dans la conversation ou la lecture (IX, B, 5), à la morale la plus achevée qu'il situe ainsi au sommet du système : " Toute la philosophie est comme un arbre, dont les racines sont la métaphysique, le tronc est la physique et les branches qui sortent de ce tronc sont toutes les autres sciences, qui se réduisent (...) à trois principales, à savoir la médecine, la mécanique et la morale ; j'entends la plus haute et la plus parfaite morale, qui présupposant une entière connaissance des autres sciences, est le dernier degré de la sagesse. ". (shrink)

Hermann Grassmann's Ausdehnungslehre of 1844 and his Lehrbuch der Arithmetik of 1861 are landmark works in mathematics; the former not only developed new mathematical fields but also both contributed to the setting of modern standards of rigor. Their very modernity, however, may obscure features of Grassmann's view of the foundations of mathematics that were not adopted since. Grassmann gave a key role to the learning of mathematics that affected his method of presentation, including his emphasis on making initial assumptions explicit. (...) In order to better understand this less well-known aspect of his work it will help to examine why some commentators have overlooked his theme of unifying logic, pedagogy and foundations, while others have recognised it. (shrink)

This chapter contains section titled: Sample Coordination Problems Analysis of Coordination Problems Solving Coordination Problems Convention Sample Conventions.

This chapter contains section titled: Sample Signals Analysis of Signaling Verbal Signaling Conventional Meaning of Signals Meaning nn of Signals.

This chapter contains section titled: Agreement Social Contracts Norms Rules Conformative Behavior Imitation.

This chapter contains section titled: Possible Languages Grammars Semantics in a Possible Language Conventions of Truthfulness Semantics in a Population.

This chapter contains section titled: Common Knowledge Knowledge of Conventions Alternatives to Conventions Degrees of Convention Consequences of Conventions.