The phenomenological effects of deep brain stimulation (DBS) on the self of the patient remains poorly understood and under described in the literature, despite growing evidence that a significant number of patients experience postoperative neuropsychiatric changes. To address this lack of phenomenological evidence, we conducted in-depth, semistructured interviews with 17 patients with Parkinson's disease who had undergone DBS. Exploring the subjective character specific to patients' experience of being implanted gives empirical and conceptual understanding of the potential phenomenon of DBS-induced self-estrangement. (...) Our study concluded that (1) the more patients preoperatively felt alienated by their illness, the more they experienced postoperative self-estrangement, and (2) the notion of self-estrangement seems to exist in association with certain common qualitative characters, namely, loss of control, which reflects a deteriorative estrangement, and distorted perception of capacities, which reveals a restorative estrangement. These findings indicate that subjective self-reports help us to understand some aspects of the potential phenomenon of DBS-induced self-estrangement. (shrink)

Relativism has been, in its various guises, both one of the most popular and most reviled philosophical doctrines of our time. Defenders see it as a harbinger of tolerance and the only ethical and epistemic stance worthy of the open-minded and tolerant. Detractors dismiss it for its alleged incoherence and uncritical intellectual permissiveness. Debates about relativism permeate the whole spectrum of philosophical sub-disciplines. From ethics to epistemology, science to religion, political theory to ontology, theories of meaning and even logic, philosophy (...) has felt the need to respond to this heady and seemingly subversive idea. Discussions of relativism often also invoke considerations relevant to the very nature and methodology of philosophy and to the division between the so-called “analytic and continental” camps in philosophy. And yet, despite a long history of debate going back to Plato and an increasingly large body of writing, it is still difficult to come to an agreed definition of what, at its core, relativism is, and what philosophical import it has. This entry attempts to provide a broad account of the many ways in which “relativism” has been defined, explained, defended and criticized. (shrink)

Gilbert et al. argue that the neuroethics literature discussing the putative effects of Deep Brain Stimulation on personality largely ignores the scientific evidence and presents distorted claims that personality change is induced by the DBS stimulation. This study contributes to the first-hand primary research on the topic exploring DBS clinicians’ views on post-DBS personality change among their patients and its underlying cause. Semi-structured interviews were conducted with sixteen clinicians from various disciplines working in Australian DBS practice for movement disorders and/or (...) psychiatric conditions. Thematic analysis of the interviews revealed five primary themes: 1) types, frequency and duration of personality change, 2) causes of personality change, 3) impact on patient and family, 4) communication, comprehension and awareness, and 5) management. Clinicians described a variety of personality changes in Parkinson’s disease following DBS including irritability, impulsivity and impaired decision-making. The frequency of personality change seen in patients varied amongst clinicians, but changes were overwhelmingly transient. Clinicians considered both DBS stimulation and additional factors as inducing personality change. For DBS patients with major depressive disorder, a restoration of pre-morbid personality was associated with alleviation of illness. Considerations for future research of personality change following DBS include selecting suitable tools for quantitative examination and developing a common language between the scientific and ethics communities. Clinical implications including recommendations for the informed consent process for patients and families and clinicians’ management of personality change are discussed. (shrink)

Gilbert et al. argue that the neuroethics literature discussing the putative effects of Deep Brain Stimulation on personality largely ignores the scientific evidence and presents distorted claims that personality change is induced by the DBS stimulation. This study contributes to the first-hand primary research on the topic exploring DBS clinicians’ views on post-DBS personality change among their patients and its underlying cause. Semi-structured interviews were conducted with sixteen clinicians from various disciplines working in Australian DBS practice for movement disorders and/or (...) psychiatric conditions. Thematic analysis of the interviews revealed five primary themes: 1) types, frequency and duration of personality change, 2) causes of personality change, 3) impact on patient and family, 4) communication, comprehension and awareness, and 5) management. Clinicians described a variety of personality changes in Parkinson’s disease following DBS including irritability, impulsivity and impaired decision-making. The frequency of personality change seen in patients varied amongst clinicians, but changes were overwhelmingly transient. Clinicians considered both DBS stimulation and additional factors as inducing personality change. For DBS patients with major depressive disorder, a restoration of pre-morbid personality was associated with alleviation of illness. Considerations for future research of personality change following DBS include selecting suitable tools for quantitative examination and developing a common language between the scientific and ethics communities. Clinical implications including recommendations for the informed consent process for patients and families and clinicians’ management of personality change are discussed. (shrink)

Gilbert et al. argue that the neuroethics literature discussing the putative effects of Deep Brain Stimulation on personality largely ignores the scientific evidence and presents distorted claims that personality change is induced by the DBS stimulation. This study contributes to the first-hand primary research on the topic exploring DBS clinicians’ views on post-DBS personality change among their patients and its underlying cause. Semi-structured interviews were conducted with sixteen clinicians from various disciplines working in Australian DBS practice for movement disorders and/or (...) psychiatric conditions. Thematic analysis of the interviews revealed five primary themes: 1) types, frequency and duration of personality change, 2) causes of personality change, 3) impact on patient and family, 4) communication, comprehension and awareness, and 5) management. Clinicians described a variety of personality changes in Parkinson’s disease following DBS including irritability, impulsivity and impaired decision-making. The frequency of personality change seen in patients varied amongst clinicians, but changes were overwhelmingly transient. Clinicians considered both DBS stimulation and additional factors as inducing personality change. For DBS patients with major depressive disorder, a restoration of pre-morbid personality was associated with alleviation of illness. Considerations for future research of personality change following DBS include selecting suitable tools for quantitative examination and developing a common language between the scientific and ethics communities. Clinical implications including recommendations for the informed consent process for patients and families and clinicians’ management of personality change are discussed. (shrink)

Deep brain stimulation of the subthalamic nucleus for the treatment of Parkinson’s disease can lead to the development of neuropsychiatric symptoms. These can include harmful changes in mood and behaviour that alienate family members and raise ethical questions about personal responsibility for actions committed under stimulation-dependent mental states. Qualitative interviews were conducted with twenty participants following subthalamic DBS at a movement disorders centre, in order to explore the meaning and significance of stimulation-related neuropsychiatric symptoms amongst a purposive sample of persons (...) with PD and their spousal caregivers. Interview transcripts underwent inductive thematic analysis. Clinical and experiential aspects of post-DBS neuropsychiatric symptoms were identified. Caregivers were highly burdened by these symptoms and both patients and caregivers felt unprepared for their consequences, despite having received information prior to DBS, desiring greater family and peer engagement prior to neurosurgery. Participants held conflicting opinions as to whether emergent symptoms were attributable to neurostimulation. Many felt that they reflected aspects of the person’s “real” or “younger” personality. Those participants who perceived a close relationship between stimulation changes and changes in mental state were more likely to view these symptoms as inauthentic and uncontrollable. Unexpected and troublesome neuropsychiatric symptoms occurred despite a pre-operative education programme that was delivered to all participants. This suggests that such symptoms are difficult to predict and manage even if best practice guidelines are followed by experienced centres. Further research aimed at predicting these complications may improve the capacity of clinicians to tailor the consent process. (shrink)

It appears to have been established that it is not possible for us to harm distant future generations by failing to adopt long-range welfare policies which would conserve resources or limit pollution. By exploring a number of possible worlds, the present article shows, first, that the argument appears to be at least as telling against Aristotelian, rights-based and Rawlsian approaches as it seems to be against utilitarianism, but second, and most importantly, that it only holds if we fail to view (...) moral agents as individuals. The article also concludes that the argument has profoundly counter-intuitive implications. (shrink)

Epistemology and Relativism Epistemology is, roughly, the philosophical theory of knowledge, its nature and scope. What is the status of epistemological claims? Relativists regard the status of epistemological claims as, in some way, relative— that is to say, that the truths which epistemological claims aspire to are … Continue reading Epistemology and Relativism →.

A familiar point in the literature on the epistemology of disagreement is that in the face of disagreement with a recognised epistemic peer the epistemically virtuous agent should adopt a stance of intellectual humility. That is, the virtuous agent should take a conciliatory stance and reduce her commitment to the proposition under dispute. In this paper, we ask the question of how such intellectual humility would manifest itself in a corresponding peer disagreement regarding knowledge-how. We argue that while it is (...) relatively straightforward to recast this debate in terms of a reductive intellectualist account of knowledge-how, whereby knowledge-how just is a matter of having a particular propositional attitude, the issue becomes more complex once we turn to anti-intellectualist positions. On these views, after all, such a disagreement won’t be just a matter of disagreeing about the truth of a proposition. Accordingly, to the extent that some kind of conciliation is plausibly required of the virtuous agent in the face of a recognised peer disagreement, this conciliation will not consist simply in belief revision. We propose a novel way to address this problem. We claim that what is required of the epistemically virtuous agent when confronted with peer disagreement regarding knowing how to φ is that thereafter she should be disposed to employ her way of φ-ing across a narrower range of practical circumstances than beforehand. Moreover, just as an agent needs to call on her intellectual virtues in order to determine the extent of conciliation required in an ordinary case of epistemic peer disagreement, so the intellectual virtues will play an important role in determining this shift in dispositions to φ that occurs as regards epistemic peer disagreement about knowledge-how. (shrink)

Addiction is increasingly described as a “chronic and relapsing brain disease”. The potential impact of the brain disease model on the treatment of addiction or addicted individuals’ treatment behaviour remains uncertain. We conducted a qualitative study to examine: (i) the extent to which leading Australian addiction neuroscientists and clinicians accept the brain disease view of addiction; and (ii) their views on the likely impacts of this view on addicted individuals’ beliefs and behaviour. Thirty-one Australian addiction neuroscientists and clinicians (10 females (...) and 21 males; 16 with clinical experience and 15 with no clinical experience) took part in 1 h semi-structured interviews. Most addiction neuroscientists and clinicians did not uncritically support the use of brain disease model of addiction. Most were cautious about the potential for adverse impacts on individuals’ recovery and motivation to enter treatment. While some recognised the possibility that the brain disease model of addiction may provide a rationale for addicted persons to seek treatment and motivate behaviour change, Australian addiction neuroscientist and clinicians do not assume that messages about “diseased brains” will always lead to increased treatment-seeking and reduced drug use. Research is needed on how neuroscience research could be used in ways that optimise positive outcomes for addicted persons. (shrink)

Digital mental health can be understood as the in situ quantification of an individual’s data from personal devices to measure human behavior in both health and disease (Huckvale, Venkatesh and Chr...

Within contemporary philosophy of mind, it is taken for granted that externalist accounts of meaning and mental content are, in principle, orthogonal to the matter of whether cognition itself is bound within the biological brain or whether it can constitutively include parts of the world. Accordingly, Clark and Chalmers (Analysis 58(1):7–19, 1998) distinguish these varieties of externalism as ‘passive’ and ‘active’ respectively. The aim here is to suggest that we should resist the received way of thinking about these dividing lines. (...) With reference to Brandom’s (1994, 2000, Inquiry 47:236–253, 2008) broad semantic inferentialism, we show that a theory of meaning can be at the same time a variety of active externalism. While we grant that supporters of other varieties of content externalism (e.g., Putnam 1975 and Burge (Philosophical Review 95:3–45, 1986) can deny active externalism, this is not an option for semantic inferentialists: On this latter view, the role of the environment (both in its social and natural form) is not ‘passive’ in the sense assumed by the alternative approaches to content externalism. (shrink)

Ascertaining the optimum global population raises not just substantive moral problems but also philosophical ones, too. In particular, serious problems arise for utilitarianism. For example, should one attempt to bring about the greatest total happiness or the highest level of average happiness? This article argues that neither approach on its own provides a satisfactory answer, and nor do rights-based or Rawlsian approaches, either. Instead, what is required is a multidimensional approach to moral questions—one which recognises the plurality of our values. (...) Such an approach can be formalised by employing multidimensional indifference-curves. Moreover, whereas classical utilitarianism might be thought to enjoin us to bring about a larger global population, a multidimensional approach clearly suggests a significant reduction in human numbers. (shrink)

Lewis’ neurodevelopmental model provides a plausible alternative to the brain disease model of addiction that is a dominant perspective in the USA. We disagree with Lewis’ claim that the BDMA is unchallenged within the addiction field but we agree that it provides unduly pessimistic prospects of recovery. We question the strength of evidence for the BDMA provided by animal models and human neuroimaging studies. We endorse Lewis’ framing of addiction as a developmental process underpinned by reversible forms of neuroplasticity. His (...) view is consistent with epidemiological evidence of addicted individuals ‘maturing out’ and recovering from addiction. We do however hold some reservations about Lewis’ model. We do not think that his analysis of the neurobiological evidence is clearly different from that of the BDMA or that his neurodevelopmental model provides a more rigorous interpretation of the evidence than the BDMA. We believe that our understanding of the neurobiology of drug use is too immature to warrant the major role given to it in the BDMA. Our social research finds very mixed support for the BDMA among addicted people and health professionals in Australia. Lewis’ account of addiction requires similar empirical evaluation of its real-world implications. (shrink)

It has been argued that there is an irreconcilable difference between those advocating animal liberation or animal rights, on the one hand, and those preferring a wider environmental ethic, which includes concern for non-sentient life-forms and species preservation, on the other. In contrast, I argue that it is possible to provide foundations for both seemingly environmentalist positions by exploring some of the potential of a 'collective-projectivist' reading of Hume – one that seems more consistent with Hume's texts than other readings. (...) In short, this article seeks to advance our understanding of some of the possibilities within Humean moral theory, while simultaneously providing new foundations for both animal welfare and a wider environmental ethic. (shrink)

The article defends the forms of civil disobedience currently practised by environmental protesters. It reviews the justifications of civil disobedience by Dworkin, Rawls and Singer, and finds them more or less wanting. A new and more extensive justification is provided on the basis of our duties to prevent harm befalling future generations.

There is growing evidence that dopamine replacement therapy (DRT) used to treat Parkinson’s Disease can cause compulsive behaviours and impulse control disorders (ICDs), such as pathological gambling, compulsive buying and hypersexuality. Like more familiar drug-based forms of addiction, these iatrogenic disorders can cause significant harm and distress for sufferers and their families. In some cases, people treated with DRT have lost their homes and businesses, or have been prosecuted for criminal sexual behaviours. In this article we first examine the evidence (...) that these disorders are caused by DRT. If it is accepted that DRT cause compulsive or addictive behaviours in a significant minority of individuals, then the following ethical and clinical questions arise: Under what circumstances is it ethical to prescribe a medication that may induce harmful compulsive behaviours? Are individuals treated with DRT morally responsible and hence culpable for harmful or criminal behaviour related to their medication? We conclude with some observations of the relevance of DRT-induced ICDs for our understanding of addiction and identify some promising directions for future research and ethical analysis. (shrink)

Deep brain stimulation (DBS) has been proposed as a potential treatment of drug addiction on the basis of its effects on drug self-administration in animals and on addictive behaviours in some humans treated with DBS for other psychiatric or neurological conditions. DBS is seen as a more reversible intervention than ablative neurosurgery but it is nonetheless a treatment that carries significant risks. A review of preclinical and clinical evidence for the use of DBS to treat addiction suggests that more animal (...) research is required to establish the safety and efficacy of the technology and to identify optimal treatment parameters before investigating its use in addicted persons. Severely addicted persons who try and fail to achieve abstinence may, however, be desperate enough to undergo such an invasive treatment if they believe that it will cure their addiction. History shows that the desperation for a cure of addiction can lead to the use of risky medical procedures before they have been rigorously tested. In the event that DBS is used in the treatment of addiction, we provide minimum ethical requirements for clinical trials of its use in the treatment of addiction. These include: restrictions of trials to severely intractable cases of addiction; independent oversight to ensure that patients have the capacity to consent and give that consent on the basis of a realistic appreciation of the potential benefits and risks of DBS; and rigorous assessments of the effectiveness and safety of this treatment compared to the best available treatments for addiction. (shrink)

Brian Earp and colleagues argue that the major harms associated with the use of illicit drugs largely arise from, or are at least exacerbated by, the fact that their use attracts criminal pe...

Using this case, Lavazza and Reichlin (2018) explored the ethical dilemmas associated with decision making in people with Alzheimer’s disease (AD), specifically when their new preferences conflict...

Alan Carter; XIII*—Moral Theory and Global Population, Proceedings of the Aristotelian Society, Volume 99, Issue 1, 1 June 1999, Pages 289–314, https://doi.org/.

The authors comments on several articles on addiction. Research suggests that addicted individuals have substantial impairments in cognitive control of behavior. The authors maintain that a proper study of addiction must include a neurobiological model of addiction to draw the attention of bioethicists and addiction neurobiologists. They also state that more addiction neuroscientists like S. E. Hyman are needed as they understand the limits of their research. Accession Number: 24077921; Authors: Carter, Adrian 1; Email Address: [email protected] Hall, Wayne 1; Affiliations: (...) 1: The University of Queensland, Brisbane, Australia; Subject: EDITORIALS; Subject: ADDICTIONS; Subject: BEHAVIOR; Subject: HYMAN, S. E.; Subject: NEUROBIOLOGISTS; Subject: NEUROSCIENTISTS; Number of Pages: 3p. (shrink)

There has been a process of moral extensionism within environmental ethics from anthropocentrism, through zoocentrism, to ecocentrism. This article maps key elements of that process, and concludes that each of these ethical positions fails as a fully adequate, environmentalist ethic, and does so because of an implicit assumption that is common within normative theory. This notwithstanding, each position may well contribute a value. The problem that then arises is how to trade off those values against each other when they conflict. (...) The solution here proposed is to employ multidimensional isovalue-contours along with a multidimensional practicability-frontier. This would result in a rich, value-pluralist environmentalist ethic that enjoined different outcomes to those enjoined by purely anthropocentric, zoocentric or ecocentric ethics. (shrink)

Developments in the field of neuroscience, according to its proponents, offer the prospect of an enhanced understanding and treatment of addicted persons. Consequently, its advocates consider that improving public understanding of addiction neuroscience is a desirable aim. Those critical of neuroscientific approaches, however, charge that it is a totalising, reductive perspective–one that ignores other known causes in favour of neurobiological explanations. Sociologist Nikolas Rose has argued that neuroscience, and its associated technologies, are coming to dominate cultural models to the extent (...) that 'we' increasingly understand ourselves as 'neurochemical selves'. Drawing on 55 qualitative interviews conducted with members of the Australian public residing in the Greater Brisbane area, we challenge both the 'expectational discourses' of neuroscientists and the criticisms of its detractors. Members of the public accepted multiple perspectives on the causes of addiction, including some elements of neurobiological explanations. Their discussions of addiction drew upon a broad range of philosophical, sociological, anthropological, psychological and neurobiological vocabularies, suggesting that they synthesised newer technical understandings, such as that offered by neuroscience, with older ones. Holding conceptual models that acknowledge the complexity of addiction aetiology into which new information is incorporated suggests that the impact of neuroscientific discourse in directing the public's beliefs about addiction is likely to be more limited than proponents or opponents of neuroscience expect. (shrink)

Response to Ernest Partridge's paper 'The Future - For Better or Worse' in this issue of Environmental Values.

By distinguishing between contributory values and overall value, and by arguing that contributory values are variable values insofar as they contribute diminishing marginal overall value, this article helps to establish the superiority of a certain kind of maximizing, value-pluralist axiology over both sufficientarianism and prioritarianism, as well as over all varieties of value-monism, including utilitarianism and pure egalitarianism.

Earl (2019) argues that the current uniform restriction of innovative practice limits clinicians’ ability to provide optimal treatment and stunts progress in medicine. We agree that it is important...

Why are some patients with Parkinson's disease unhappy about the outcome of deep brain stimulation (DBS)? Meccaci and Haselager (2014) attempt to answer this question by analyzing the seminal case...

ABSTRACT In this article I examine the concept ‘self‐exploitation’ and its use in criticising workers' co‐operatives. I argue that the concept is incoherent and that the kind of exploitation which members of workers' co‐ops actually face is ‘market‐exploitation’. Moreover, some of the criticisms of workers' co‐ops which are made by those who employ the confused concept ‘self‐exploitation’ are shown to be inapposite when ‘market‐exploitation’ is recognised to be the real problem. I conclude with a discussion of the reasons for the (...) acceptance of the misguided concept ‘self‐exploitation’ by a number on the Left in Britain today. (shrink)

This volume analyzes authoritarian, reformist, Marxist and anarchist approaches to the environmental problem, exposing the relationships between environmental crises, economic structures and the role of the state.

This article considers two different, yet related, theoretical approaches that could be employed to ground the anarchist critique of Marxist-Leninist revolutionary practice, and thus of the state in general: the State-Primacy Theory and the Quadruplex Theory. The State-Primacy Theory appears to be consistent with several of Bakunin's claims about the state. However, the Quadruplex Theory might, in fact, turn out to be no less consistent with Bakunin's claims than the State-Primacy Theory. In addition, the Quadruplex Theory seems no less capable (...) of supporting the anarchist critique of Marxism-Leninism than the State-Primacy Theory. The article concludes by considering two possible refinements that might be made to the Quadruplex Theory. (shrink)

The 30th anniversary of the first DBS surgery of the subthalamic nucleus (STN) for Parkinson’s disease was celebrated in Grenoble this June. Since this initial surgery, the application of DBS has e...