Cognitive Disabilities and Disorders, Misc

In this paper, I argue that, contrary to what some critics suggest, political liberalism is not exclusionary with regards to the rights and interests of individuals with cognitive disabilities. I begin by defending four publicly justifiable reasons that are collectively sufficient for the inclusion of members of this group. Briefly, these are the epistemic uncertainty that inevitably exists about individuals’ actual capacities, the political liberal duty to treat parents fairly, the social framework that is required for the fulfilment of parental (...) duties, and the necessity of cultivating certain emotions that are strongly associated with reasonableness. These reasons show why a more inclusive reading of political liberalism is plausible, and how this can be achieved without abandoning or revising the theory’s commitment to public reason, the political conception of the person, and the role of social cooperation. I then turn to the question of what a more inclusive political liberalism would look like. More specifically, I argue that, although it would not require the participation of individuals with cognitive disabilities in the practice of legitimation, it would require their full inclusion in the realm of justice as equal rights-bearers. (shrink)

This paper begins by saying enough about eugenics to explain why disability is central to eugenics (section 2), then elaborates on why cognitive disability has played and continues to play a special role in eugenics and in thinking about moral status (section 3) before identifying three reasons why eugenics remains a live issue in contemporary bioethics (section 4). After a reminder of the connections between Nazi eugenics, medicine, and bioethics (section 5), it returns to take up two more specific clusters (...) of issues at the intersection of eugenics, disability, and bioethics. These concern questions of life, death, and reproductive value (section 6) and the value of standpoint theory and epistemology for understanding some of the tensions between bioethics and disability in light of a shared eugenic past (section 7). (shrink)

Subthreshold Attention-Deficit/Hyperactivity Disorder is defined as a neurobiological condition with some core inattentive or hyperactive/impulsive symptoms of ADHD which do not meet the full diagnosis clinically. Although it has been well documented that deficits in cognitive control, a high-level cognitive construct closely related to attention, are frequently found among children with ADHD, whether subthreshold ADHD is also associated with similar deficits remains unclear. In this study, we examined the attention functions and the cognitive control capacity in children with ADHD, those (...) with subthreshold ADHD, and typically developing peers. The results showed that the ADHD and subthreshold ADHD groups exhibited similar patterns of the impaired executive function of attention and reduced cognitive control capacity, and no significant difference was found between the two groups. These findings suggest that although children with subthreshold ADHD have not met the full criteria of ADHD, they showed reduced efficiency in cognitive control and attention function, similar to children with ADHD. (shrink)

Many intelligent, capable, and successful individuals believe that their success is due to luck and fear that they will someday be exposed as imposters. A puzzling feature of this phenomenon, commonly referred to as imposter syndrome, is that these same individuals treat evidence in ways that maintain their false beliefs and debilitating fears: they ignore and misattribute evidence of their own abilities, while readily accepting evidence in favour of their inadequacy. I propose a novel account of imposter syndrome as an (...) instance of self-deception, whereby biased evidence treatment is driven by the motivational benefit of negative self-appraisal. This account illuminates a number of interconnected philosophical and scientific puzzles related to the explanation, definition, and value of imposter syndrome. (shrink)

Background Genomic research on neurodevelopmental disorders (NDDs), particularly involving minors, combines and amplifies existing research ethics issues for biomedical research. We performed a review of the literature on the ethical issues associated with genomic research involving children affected by NDDs as an aid to researchers to better anticipate and address ethical concerns. Results Qualitative thematic analysis of the included articles revealed themes in three main areas: research design and ethics review, inclusion of research participants, and communication of research results. Ethical (...) issues known to be associated with genomic research in general, such as privacy risks and informed consent/assent, seem especially pressing for NDD participants because of their potentially decreased cognitive abilities, increased vulnerability, and stigma associated with mental health problems. Additionally, there are informational risks: learning genetic information about NDD may have psychological and social impact, not only for the research participant but also for family members. However, there are potential benefits associated with research participation, too: by enrolling in research, the participants may access genetic testing and thus increase their chances of receiving a (genetic) diagnosis for their neurodevelopmental symptoms, prognostic or predictive information about disease progression or the risk of concurrent future disorders. Based on the results of our review, we developed an ethics checklist for genomic research involving children affected by NDDs. Conclusions In setting up and designing genomic research efforts in NDD, researchers should partner with communities of persons with NDDs. Particular attention should be paid to preventing disproportional burdens of research participation of children with NDDs and their siblings, parents and other family members. Researchers should carefully tailor the information and informed consent procedures to avoid therapeutic and diagnostic misconception in NDD research. To better anticipate and address ethical issues in specific NDD studies, we suggest researchers to use the ethics checklist for genomic research involving children affected by NDDs presented in this paper. (shrink)

El TDAH constituye un trastorno de gran frecuencia en la niñez. Se caracteriza por patrones persistentes de desatención, hiperactividad-impulsividad. La condición de TDAH se ha asociado con el mecanismo cerebral cognitivo de auto regulación conocido como Funciones Ejecutivas. El presente trabajo de carácter cuantitativo, correlacional y transversal se focalizó en describir y comparar el rendimiento de Funciones Ejecutivas según padres y profesores en una muestra de escolares con y sin diagnóstico de TDAH. La metodología considero la administración de pruebas de (...) diagnóstico de TDAH y de evaluación de FE a través del Inventario Comprensivo de Funciones Ejecutivas. Los resultados indicaron diferencias significativas entre la evaluación de padres y profesores, como también entre las pruebas administradas. Los padres tenderían a evaluar el rendimiento de funciones ejecutivas en términos más flexibles que los docentes. (shrink)

Meeting the needs of individuals who experience vulnerability due to cognitive impairment presents significant challenges to caregivers. Primary caregiver responsibility is often relegated to professionals in hospitals or long-term care facilities, while proxy decision-making responsibility lies with families. The complex relationship among patients, professional caregivers, and families may be further complicated by the relative cognitive capacity of different patients. While some experience diminished cognitive capacity to such an extent that they cannot make any informed voluntary decisions, others may be able (...) to express global preferences and participate more actively in rehabilitative efforts. With reference to Catholic social teaching, I briefly establish the intrinsic dignity of human persons who experience cognitive impairment and then analyze how the web of relationships and responsibilities among patients, professional caregivers, families, and communities ought to be defined. Finally, I consider how these relationships may be optimized to enhance participation in mutually reinforced caregiving and decision making. (shrink)

In this paper we aim to offer a balanced argument to motivate (re)thinking about the mental illness clause within the insanity defence. This is the clause that states that mental illness should have a relevant causal or explanatory role for the presence of the incapacities or limited capacities that are covered by this defence. We offer three main considerations showing the important legal and epistemological roles that the mental illness clause plays in the evaluation of legal responsibility. Although we acknowledge (...) that these advantages could be preserved without having this clause explicitly stated in the law, we resist proposals that deny the importance of mental illness in exculpation. We argue, thus, that any attempt at removing the mental illness clause from legal formulations of the insanity defence should offer alternative ways of keeping in place these advantages. (shrink)

One way to determine whether a mental condition should be considered a disorder is to first give necessary and sufficient conditions for something to be a disorder and then see if it meets these conditions. But this approach has been criticized for begging normative questions. Concerning autism, a neurodiversity movement has arisen with essentially two aims: advocate for the rights and interests of individuals with autism, and de-pathologize autism. We argue that denying autism’s disorder status could undermine autism’s exculpatory role (...) in cases where individuals with autism are charged with a crime. Our argument raises a dilemma for the neurodiversity movement: advocating for the rights and interests of individuals with autism may require viewing autism as a condition that can be inherently disabling. If this is right, autism’s disorder status might be maintained without deriving this result from any general account of disorder. (shrink)

How have and how might philosophers contribute to linking disability and activism in these peri-COVID-19 times, especially in forms of public engagement that go beyond podcasted talks and articles aimed at a public audience? How do we harness philosophical thinking to contribute positively to those living with disability whose vulnerabilities are heightened by this pandemic and the ableism highlighted by collective responses to it?

In her 2006 book The Jumbled Jigsaw, Donna Williams, an autistic author and poet, presents an example of a list of traits associated with autism—one of many such lists commonly found in text books, academic publications, and information leaflets. Her list includes the following: a tendency to stick to well-tried routines and avoid change, a tendency to have a narrow range of interests, a tendency to develop irrational fears and anxieties, a tendency not to develop a sense of danger, a (...) tendency to demonstrate bizarre behaviors and mannerisms, a tendency to copy speech parrot fashion, and isolated areas of ability. "The problem with such a list," Williams explains, "is that the features of each of these areas can be... (shrink)

Recent literature has suggested that generics can harbor and propagate worrying ideologies in a manner which is often not appreciated by speakers. In this article, I argue that the use of generics to convey information about mental illness is unhelpful, whether the knowledge structure conveyed by the generic is 'accurate' or not. Inaccurate generics contribute to insidious forms of social stereotyping and stigma by encouraging us to simplistically generalize characteristics found in very few category members to other members of that (...) kind.Yet, even where the knowledge structure underlying the generic is accurate, generics remain an unhelpful way of talking about mental illness. This is because... (shrink)

Traditionalists affirm that in self-deception I intend to deceive myself; but, on the standard account of interpersonal deception, according to which deceiver intend to make their target believe a falsehood, traditionalism generates paradoxes, arising from the fact that I will surely know that I want to make myself believe a falsehood. In this thesis, I argue that these well-known paradoxes need not arise under my manipulativist account of deception. In particular, I defend traditionalism about self-deception by showing that what causes (...) paradoxes is not the idea that self-deception is an intrapersonal analogue of interpersonal deception but rather our incorrect conceptions of deception, interpersonal deception, and lying. I show, by way of counterexamples, that the essence of deception is not ending up epistemically worse off but rather being intentionally manipulated into forming or retaining a certain truth-evaluable mental state. Vitally, contra the standard view, the deceiver need not hold that the mental state he intends to produce in the deceived involves a falsehood; in fact, the targeted effect may involve a proposition believed by the deceiver to be true or about whose truth the deceiver suspends belief. Any phenomenon rightly called self-deception, I argue, involves an action in which the person intentionally manipulates (by way of a trick) her own way of forming or retaining some truth-evaluable mental state of her own (belief or a belief-like thought). Thus, on the manipulativist view, a self-deceiver may non-paradoxically intend to deceive himself: the relevant intention is to affect a particular truth-evaluable thought by way of non-deviantly manipulating his agential use of his own cognitive capacities. While all cases of self-deception involve intentional manipulation of the self by the self, how this manipulative trick works out varies in different kinds of cases. In some cases, the self-deceptive manipulative trick is not intentional under that description, a description that captures the so-called deflationary view. Although the manipulativist account allows for numerous different strategies of self-deception, and is consistent with both traditionalism and deflationism, it cannot, by itself, vindicate the idea of lying to oneself. On the standard conception, lying to myself is practically impossible (if the mind is not partitioned) and this is because the very forming the intention to lie to myself – as including the intention to make myself believe my own lie – seems very unlikely. Arguably, people will not φ if they think that φ-ing is impossible. I argue that some kinds of behaviour typically understood as self-deception are actually cases in which the person is lying to herself without the intention to deceive herself; rather, she avoids legitimising an unfavourable state of affairs by openly affirming its contrary. It may also be the case, however, that some lies to oneself are aimed at deceiving – this is because, as I argue, liars need not assert what they believe is false; hence, by lying to myself, I may intend to increase my confidence in the belief I already hold. Finally, the motive for self-deception is always a matter of preserving the person’s endorsed idealised picture of reality. This account allows me to explain all possible cases of self-deception. In the last chapter, I apply my theory to some paradigmatic cases first outlined in my introduction. (shrink)

About 75% of subjects diagnosed with schizophrenia experience auditory-verbal hallucination and report "hearing voices" that are not actually present. One notable feature of AVH is that it seems involuntary and not directly in the subject's control. With regard to content, these represented voices make utterances, typically commands and evaluations, and either are directed to the patient or speak about her in the third person. Voices may echo the subject's thoughts or comment on the subject's behavior and, in some cases, the (...) voices seem to carry on conversations or even argue. Subjects often experience the voices as having pitch, timbre, and intensity, and as having a... (shrink)

This article proposes a formal model that integrates cognitive and psychodynamic psychotherapeutic models of psychopathy to show how two major psychopathic traits called lacks remorse and self-aggrandizing can be understood as a form of abnormal Bayesian inference about the self. This model draws on the predictive coding (i.e., active inference) framework, a neurobiologically plausible explanatory framework for message passing in the brain that is formalized in terms of hierarchical Bayesian inference. In summary, this model proposes that these two cardinal psychopathic (...) traits reflect entrenched maladaptive Bayesian inferences about the self, which defend against the experience of deep-seated, self-related negative emotions, specifically shame and worthlessness. Support for the model in extant research on the neurobiology of psychopathy and quantitative simulations are provided. Finally, we offer a preliminary overview of a novel treatment for psychopathy that rests on our Bayesian formulation. (shrink)

Argues for a form of humanism on which we have reason to care about human beings that we do not have to care about other animals and human beings have rights against us other animals lack. Humanism respects the equal worth of those born with severe congenital cognitive disabilities. I address the charge of 'speciesism' and explain how being human is an ethically relevant fact.

The promotion of rights, autonomy and choice reacts against paternalism, an early twentieth-century response to intellectual disability that suppressed individual personhood through a combination of resource limitations and poor administration. These liberal individualist concepts reflect the contemporary zeitgeist of Anglophone nations, although the strength and certainty with which these concepts are expressed in ID policy when compared with policy for other vulnerable groups suggests that they also serve a secondary function. It has been argued that excessive certainty in ID evidences (...) a feared drop... (shrink)

A patient’s decision-making capacity or competence is among the prerequisites for valid consent to medical treatment, and is regarded as the gatekeeping element in ensuring respect for patients’ self-determination. The issue is especially relevant in the case of vulnerable persons, such as patients who are cognitively or mentally impaired, and where medical decisions carry far-reaching consequences. As a grounding principle, DMC is a priori assumed, and challenged only when substantial doubts arise owing to observed or assumed deficiencies of the capacities (...) commonly considered relevant for competent decision making ; in this sense, the onus is on... (shrink)

We are grateful to Paul S. Appelbaum and Wayne Martin for their thoughtful remarks on our paper. Among the various aspects that we might address and refute in return, we have decided to focus on just two issues that we believe have potential to advance the debate. According to Appelbaum, the “assessment of an intuitive process is being predicated on a patient having the ability to reflect on determinants of which he may be completely unaware.” In this passage, he points (...) to an apparently “self-evident paradox.” Also, Martin is skeptical about the assessment of intuitive reasoning ability. We agree that relying entirely on unarticulated gut feelings is problematic in terms of... (shrink)

As a starting point, Clegg, Murphy, and Almack contend that frameworks of policy fail both to engage with ethical theory and to fit with the complex realities of how services are delivered. Both of these points are well-supported both in their engagement with literature and in the research presented. Their Deleuzoguattarian analysis and Deleuzean ethical alternatives provide fresh and challenging insights. The key question in this rejoinder is whether their critique goes too far, or not far enough. To begin, however, (...) it is worth making a comment on terminology. Clegg et al. begin with a passing comment to the effect that ‘intellectual disability’ was ‘formerly learning disability in the UK and... (shrink)

In the UK and beyond, Down's syndrome screening has become a universal programme in prenatal care. But why does screening persist, particularly in light of research that highlights pregnant women's ambivalent and problematic experiences with it? Drawing on an ethnography of Down's syndrome screening in two UK clinics, Thomas explores how and why we are so invested in this practice and what effects this has on those involved. Informed by theoretical approaches that privilege the mundane and micro practices, discourses, materials, (...) and rituals of everyday life, Down's Syndrome Screening and Reproductive Politics describes the banal world of the clinic and, in particular, the professionals contained within it who are responsible for delivering this programme. In so doing, it illustrates how Down's syndrome screening is 'downgraded' and subsequently stabilised as a 'routine' part of a pregnancy. Further, the book captures how this routinisation is deepened by a systematic, but subtle, framing of Down's syndrome as a negative pregnancy outcome. By unpacking the complex relationships between professionals, parents, technology, policy, and clinical practice, Thomas identifies how and why screening is successfully routinised and how it is embroiled in both new and familiar debates surrounding pregnancy, ethics, choice, diagnosis, care, disability, and parenthood. The book will appeal to academics, students, and professionals interested in medical sociology, medical anthropology, science and technology studies, bioethics, genetics, and/or disability studies. (shrink)

The perceived meaning of life significantly affects the quality of human life. It is of particular significance in borderline situations. One of such situations is the birth of an intellectually disabled child. The article presents the results of the study concerning the perceived meaning of life in the case of parents who bring up a child with limited intellectual abilities. The study included 87 mothers and 65 fathers bringing up an intellectually disabled child. In the studied cases, parents perceived their (...) life as highly meaningful. The results indicated that the perceived meaning of life in the case of parents of intellectually disabled children was related with: suffering experienced by the parents as a result of a limited intellectual ability of their daughter/son, the manner of performing their parental role and the sense of parental identity. (shrink)

What are the duties of carers and health professionals to people with mental incapacity? How ought we to think about the ethical and legal issues? What can any of us do to improve and safeguard the lives of those cared for? This book seeks to examine in detail and find ethically robust answers to such questions. Among the topics discussed are withholding treatment, tube-feeding patients with dementia, the 'persistent vegetative state', medical research, and sterilisation of intellectually disabled adults. Contributors come (...) from a wide range of disciplines, including psychiatry, nursing, philosophy, theology and law. The book includes an account by Wendy Hiscox of non-voluntary euthanasia in the Netherlands and Belgium, and a chapter by John Finnis exploring some aspects of Britain's Mental Capacity Act 2005. (shrink)

In this article we discuss the validity of previous preferences and advance directives in cases of severe mental illness.