BackgroundSevere brain injury is a leading cause of death and disability. Diagnosis and prognostication are difficult, and errors occur often. Novel neuroimaging methods can improve diagnostic and prognostic accuracy, especially in patients with prolonged disorders of consciousness (PDoC). Yet it is currently unknown how family caregivers understand this information, raising ethical concerns that disclosure of neuroimaging results could result in therapeutic misconception or false hope.MethodsTo examine these ethical concerns, we conducted semi-structured interviews with caregivers of patients with PDoC who were (...) enrolled in a concurrent neuroimaging research program designed to detect covert consciousness following severe brain injury. Caregivers held surrogate decision-making status for a patient. Interviews were conducted at two time points for each caregiver. The first interview occurred before the disclosure of neuroimaging results. The second occurred after disclosure. Descriptive analysis was applied to the data of four interview topics: (1) expectations for neuroimaging; (2) reactions to evidence of preserved cognition; (3) reactions to null results; and (4) understanding of the results and study.ResultsTwelve caregivers participated in the study; two caregivers shared surrogate decision-making status for one patient with PDoC. Twenty-one interviews were completed; one caregiver declined to participate in the post-disclosure interview. Three patients with PDoC associated with the study displayed evidence of covert consciousness. Overall, caregivers understood the neuroimaging research and results. Caregivers who received results of covert consciousness were generally pleased. However, there was some variation in expectations and reactions to these data and null results.ConclusionThis study, for the first time, reveals caregiver expectations for and reactions to neuroimaging evidence of covert consciousness in patients with PDoC. Caregivers understood the neuroimaging research and results, casting doubt on speculative ethical concerns regarding therapeutic misconception and false hope. However, disclosure of neuroimaging result could be improved. Pre-disclosure consultations might assist professionals in shaping caregiver expectations. Standardization of disclosure might also improve comprehension of the results. (shrink)

Patient outcome after serious brain injury is highly variable. Following a period of coma, some patients recover while others progress into a vegetative state (unresponsive wakefulness syndrome) or minimally conscious state. In both cases, assessment is difficult and misdiagnosis may be as high as 43%. Recent advances in neuroimaging suggest a solution. Both functional magnetic resonance imaging and electroencephalography have been used to detect residual cognitive function in vegetative and minimally conscious patients. Neuroimaging may improve diagnosis and prognostication. These techniques (...) are beginning to be applied to comatose patients soon after injury. Evidence of preserved cognitive function may predict recovery, and this information would help families and health providers. Complex ethical issues arise due to the vulnerability of patients and families, difficulties interpreting negative results, restriction of communication to “yes” or “no” answers, and cost. We seek to investigate ethical issues in the use of neuroimaging in behaviorally nonresponsive patients who have suffered serious brain injury. The objectives of this research are to: (1) create an approach to capacity assessment using neuroimaging; (2) develop an ethics of welfare framework to guide considerations of quality of life; (3) explore the impact of neuroimaging on families; and, (4) analyze the ethics of the use of neuroimaging in comatose patients. (shrink)

After severe brain injury, one of the key challenges for medical doctors is to determine the patient’s prognosis. Who will do well? Who will not do well? Physicians need to know this, and families need to do this too, to address choices regarding the continuation of life supporting therapies. However, current prognostication methods are insufficient to provide a reliable prognosis. -/- Functional Magnetic Resonance Imaging (MRI) holds considerable promise for improving the accuracy of prognosis in acute brain injury patients. Nonetheless, (...) research on functional MRI in the intensive care unit context is ethically challenging. These studies raise several ethical issues that have not been addressed so far. In this article, Prof. Charles Weijer and his co-workers provide a framework for researchers and ethics committees to design and review these studies in an ethically sound way. (shrink)

This book interrogates the nature and state of African American citizenship through the prism of Social Contract Theory. Challenging the United States’ commitment to African American citizenship, this book explores the idea of Social Nullification, the decision to reject, revoke and re-define the social contract with a state and society. Charles F. Peterson surveys the history of Social Contract Theory, examines Nullification as political and legal theory, argues public policy as a measure of the state’s commitment to the (...) contractarian relationship and frames the writings and activism of Martin R. Delany, Ida B. Wells-Barnett and the African American Reparations Movement as examples of Social Nullification and challenges to the terms of Black life in America. (shrink)

The museum of the colonial moment fused the expansion of knowledge and global contact of North Atlantic powers with the aggressive nationalist pride of their hegemonic positions, building national, cultural, and racial identity through framing. How does Black Panther use the museum scene to illustrate a fear of Black museums and the problems of existence observed through the philosophies of Black existentialism and Africana phenomenology? Killmonger's questioning of Wakanda reveals the truth and effect of Wakanda's isolationist history. Yet, Wakanda is (...) nevertheless shown as a representation of African history, not just in the tribal nature of Wakanda's social structure or in the clothing and physical adornments and jewelry, but also in the rituals and spirituality. (shrink)

Abstract:The ethical principle of autonomy requires physicians to respect patient autonomy when present, and to protect the patient who lacks autonomy. Fulfilling this ethical obligation when a patient has a communication impairment presents considerable challenges. Standard methods for evaluating decision-making capacity require a semistructured interview. Some patients with communication impairments are unable to engage in a semistructured interview and are at risk of the wrongful loss of autonomy. In this article, we present a general strategy for assessing decision-making capacity in (...) patients with communication impairments. We derive this strategy by reflecting on a particular case. The strategy involves three steps: (1) determining the reliability of communication, (2) widening the bandwidth of communication, and (3) using compensatory measures of decision-making capacity. We argue that this strategy may be useful for assessing decision-making capacity and preserving autonomy in some patients with communication impairments. (shrink)

Introductions and Histories: How, When, and Where of Race in Philosophy Africana Philosophy has successfully argued itself to be an important area of philosophical discourse. Fundamental to this effort is Africana Philosophy's work to bring race, race thinking, and racism to the fore of philosophical examination. In the wake of Africana Philosophy's influence, discussions of race, race thinking, and racism are becoming central to regular philosophical discourse. The production of introductory works on race and philosophy and works examining the place (...) of race and race thinking in the history of European canonical philosophy points to philosophy's growing self awareness of race as foundational to what philosophy as a body of knowledge is and its self awareness of how race and race thinking informed the development of the field. These types of texts contribute to the normalization of race as a subfield of philosophy. Specifically, this essay will analyze four contemporary texts that exemplify this trend and what they contribute to mainstream philosophy's evolution as a site that understands race and race's role as a part of human experience and a necessary part of the larger philosophical project. (shrink)

Willem II van Haecht?s panel of the Cabinet of Cornelis van der Geest (1628), introduces the viewer to the theme of the Five Senses by including five prominently displayed paintings, each corresponding to one of the senses, in the foreground. The paper offers a new reading of the panel, suggesting that this image may be read as an allegory of the Five Senses, proposing this theme as a key to the rhetorical performance the collector, van der Geest, is shown undertaking, (...) and connecting the senses to the picture?s punning motto: Vive l?Esprit. (shrink)

The most recent attempt to explain Aristotle's use of in Poetics 13 is that of T. C. W. Stinton , 221–54). Stinton insists that must not be restricted to any one definition, but should be understood to include a ‘range of applications’ embracing both moral error and ‘ignorance of fact’.

In this essay I seek to critically evaluate some forms of holism and organicism in biological thought, as a more deflationary echo to Gilbert and Sarkar's reflection on the need for an 'umbrella' concept to convey the new vitality of holistic concepts in biology (Gilbert and Sarkar 2000). Given that some recent discussions in theoretical biology call for an organism concept (from Moreno and Mossio’s work on organization to Kirschner et al.’s research paper in Cell, 2000, building on chemistry to (...) articulate what they called “molecular vitalism,” studying the “vitalistic” properties of molecular, cellular, and organismal function, and Pepper and Herron’s suggestion in their 2008 paper that organisms define a category that evolutionary biology cannot do without), the question, what concept of organicism are they calling for? To what extent are such claims philosophically committed to a non-naturalistic concept of organism as organizing centre, as a foundational rather than heuristic concept – or possibly a “biochauvinism,” to use Di Paolo’s term (Di Paolo 2009)? My aim in this paper is to conceptually clarify the forms of holism and organicism that are involved in these cases (and I acknowledge that the study of early 20th-century holisms [Peterson 2010] indicates that not all of them were in fact ‘organicist’ or ‘biologistic’). I suggest that contemporary holists are still potentially beholden to a certain kind of vitalism or “biochauvinism”; but that when they reduce their claims to mere heuristics, conversely, they risk losing sight of a certain kind of organizational “thickness”, a “vital materiality” (Wheeler 2010) which is characteristic of biological systems (Bechtel 2007). And I ask if it is possible to articulate a concept of biological holism or organicism which is neither an empirical ‘biochauvinism’ nor a metaphysical ‘vitalism’? (shrink)

Charles Taylor has recently provided an in-depth exploration of secularity, with a central characteristic being the understanding that religious commitment is optional. This essay extends this analysis, considering the possibility that American society may be entering a second stage of secularity, one in which the possibility of religious commitment ceases to be an option at all for many. The possible implications of such a development are considered for the theology-and-science dialogue.

This book presents the first systematic typological analysis of applicatives across African, American Indian, and East Asian languages. It is also the first to address their functions in discourse, the derivation of their semantic and syntactic properties, and how and why they have changed over time.Applicative constructions are typically described as transitivizing because they allow an intransitive base verb to have a direct object. The term originates from the seventeenth-century missionary grammars of Uto-Aztecan languages. Constructions designated as prepositional, benefactive, and (...) instrumental may refer to the same or similar phenomena. Applicative constructions have been deployed in the development of a range of syntactic theories which have then often been used to explain their functions, usually within the context of Bantu languages. Dr Peterson provides a wealth of cross-linguistic information on discourse-functional, diachronic, and typological aspects of applicative constructions. He documents their unexpected synchronic variety and the diversity of diachronic sources about them. He argues that many standard assumptions about applicatives are unfounded, and provides a clear guide for future language-specific and cross-linguistic research and analysis. (shrink)

Joseph Heath defends competitive markets and conceptualizes business ethics with reference to Pareto efficiency, which he takes to be the “implicit morality of the market.” His justification for markets is that they generate Pareto efficient outcomes, meaning that markets optimally satisfy consumer preferences. And, for Heath, business ethics is the set of normative constraints—regulation and beyond-compliance norms—needed to preserve that outcome. The present paper accepts Heath’s claim that the economic justification for markets is ethical, in that satisfying consumer preferences is (...) a good. But, contra Heath, the ethical consideration at work is a consequentialist one; and acknowledging this consequentialism exposes limitations of Heath’s “market failures” approach to business ethics. We suggest two limitations, and we expect many will accept our argument that Heath’s conception of business ethics is too narrow. The present paper outlines two broader implications. First, acknowledging that the justification for markets is ethical eliminates the apparent—and false—conflict between purportedly amoral economic activity on one hand and ethical considerations on the other; instead, business ethics is a matter of weighing the consequentialist ethical benefit of economic activity and markets against other moral arguments/other ethical considerations. Second, Heath restricts business ethics to the constraints needed to protect the market’s ability to efficiently satisfy consumer preferences, constraints he calls “efficiency imperatives”; this restriction supports the widespread tendency to think that all social problems are economic; and, a business ethics so-conceived diminishes the perceived importance of noneconomic values—this attitude is dangerous. (shrink)

Joseph Heath states that our paper “misinterpret[s]” and so misrepresents his account. The present Commentary corrects the record. Our paper (Cohen and Peterson 2019) outlined Heath’s account on his own terms; it explained that Heath distances himself from consequentialism. But then we argued that Heath is mistaken and so offered a repaired version of the market failures approach. Our central concern, in the original paper and in this short Commentary, is showing that the economic argument for markets is at (...) the same time ethical, and then being more precise about the ethical consideration that does the work. (shrink)

This paper describes one style of functional analysis commonly used in the neurosciences called task-bound functional analysis. The concept of function invoked by this style of analysis is distinctive in virtue of the dependence relations it bears to transient environmental properties. It is argued that task-bound functional analysis cannot explain the presence of structural properties in nervous systems. An alternative concept of neural function is introduced that draws on the theoretical neuroscience literature, and an argument is given to show that (...) this alternative concept of may help to overcome the explanatory limitations of task-bound functional analysis. (shrink)

The COVID-19 pandemic has been devastating for people living with dementia (PLWD) and their caregivers. While prior research has documented these effects, it has not delved into their specific causes or how they are modified by contextual variation in caregiving circumstances.