This paper critically engages ethical issues in the allocation of novel, and potentially costly, health care resources to patients with disorders of consciousness. First, we review potential benefits of novel health care resources for patients and their families and outline preliminary considerations to address concerns about cost. We then address two problems regarding the allocation of health care resources to patients with disorders of consciousness: (1) the problem of uncertain moral status; and (2) the problem of accurately measuring the welfare (...) burdens these resources would relieve. We conclude by suggesting that opportunity-based frameworks might complement standard approaches for justifying resources allocation to patients with disorders of consciousness. (shrink)

Following neo-Aristotelians Alasdair MacIntyre and Martha Nussbaum, we claim that humans are story-telling animals who learn from the stories of diverse others. Moral agents use rational emotions, such as compassion which is our focus here, to imaginatively reconstruct others’ thoughts, feelings and goals. In turn, this imaginative reconstruction plays a crucial role in deliberating and discerning how to act. A body of literature has developed in support of the role narrative artworks (i.e. novels and films) can play in allowing us (...) the opportunity to engage imaginatively and sympathetically with diverse characters and scenarios in a safe protected space that is created by the fictional world. By practising what Nussbaum calls a ‘loving attitude’, her version of ethical attention, we can form virtuous habits that lead to phronesis (practical wisdom). In this paper, and taking compassion as an illustrative focus, we examine the ways that students’ moral education might usefully develop from engaging with narrative artworks through Philosophy for Children (P4C), where philosophy is a praxis, conducted in a classroom setting using a Community of Inquiry (CoI). We argue that narrative artworks provide useful stimulus material to engage students, generate student questions, and motivate philosophical dialogue and the formation of good habits which, in turn, supports the argument for philosophy to be taught in schools. (shrink)

ABSTRACTRecent critics have suggested that character education is overly individualised and, as a result, fails to engage adequately with the political. In this paper, I offer an account of character education which takes issue with such criticisms, and seeks to make clear connections between the moral and the political necessary for character formation and expression. Drawing on an Aristotelian understanding of the political, I argue that individuals are intimately connected with their social associations, which in contemporary plural, westernised democracies include (...) the sort of engagement with the political advocated by critics of character education. Through a focus on civic virtue and deliberative engagement, it is argued that an Aristotelian-inspired account of character addresses the precise concerns, including recognising and challenging social injustices and deliberative engagement with difference, which critics suggest are lacking from character education. (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)

In this article, I present an argument that suggests neuroscience should inform judgments of decision-making capacity. First, I review key behavioral and neurocognitive data to demonstrate that neuroscientific tests might be predictive of decision-making capacity, and that these tests might inform clinical judgments of capacity. Second, I argue that, consistent with the principles of autonomy and justice, such data should inform judgements of decision-making capacity. While the neuroscience of decision-making capacity still requires time to mature, there is strong reason to (...) believe that neuroscience might assist clinicians in adjudicating difficult cases in the future. This article focuses on the assessment of capacity in brain injury patients who have profound communication impairments, however, the overarching aim of the article is to highlight the potential use of neuroscience to improve our understanding of the relationship between cognition and decision-making capacity. (shrink)

Discourse between pupils represents a core element of citizenship education in England. However, as it is currently presented within the curriculum, discourse adopts the form of the rather broad terms of 'discussion' and 'debate'. These terms are diffuse, and in themselves offer little pedagogical guidance for teachers implementing the curriculum in schools. Moreover, there has been little academic reflection in England as to how theoretical ideas on civic dialogue may usefully inform approaches to pupil discourse. For this reason, how pupils (...) experience discursive learning activities is likely to depend on how individual schools and teachers understand the terms 'discussion' and 'debate' and the way in which this understanding is translated into pupil learning activities. This article explores how recourse to deliberative democratic theory, and in particular to the principle of contestatory deliberative democracy found within recent republican writing, may be useful in helping educators to consider critically the capacities needed for effective civic discourse as a well as the outcomes of pupils' dialogical engagement. (shrink)

The aim of this paper is to consider the ways in which civic republican theory can provide a meaningful and useful account of social justice, one that is which holds resonance for educational debates. Recognising the need for educationalists interested in civic republicanism to pay greater attention to ideas of justice—and in particular social justice as it concerns relationships between citizens —it is argued that a form of civic republicanism committed to freedom as non-domination is capable of providing a substantive (...) model for analysing social justice within educational arenas. After positioning the contribution offered here within existing educational literature on civic republicanism, salient elements of social justice as freedom as non-domination are identified. On this basis, debates concerning the existence and potential expansion of state grammar schools in England are considered in relation to the account of republican social justice as non-domination. It is argued that from this republican position grammar schools represent an arbitrary domination of the interests of those less well off by those with greater material and cultural capital and in doing so lead to advantages for some at the expense of others. Though the focus of the paper is on grammar schools in England, it is suggested that republican justice may be a useful frame for considering similar educational cases in England and elsewhere. (shrink)

Non-consensual organ procurement from prisoners in China raises serious questions regarding the ethics of Chinese transplant research. In their article, published in this issue of JME, Higgins and colleagues address these questions through the lens of publication ethics. They argue that, ‘while there are potentially compelling justifications for use [of unethical research] under some circumstances, these justifications fail when unethical practices are ongoing’.1 Consequently, they recommend non-publication of Chinese transplant research and call for a mass retraction of the articles identified (...) in their review.2 To support their argument, Higgins and colleagues appeal to internationally recognised guidelines from the WHO3 and the World Medical Association, which assert that ‘executed prisoners must not be considered as organ and/or tissue donors’ due to the inability to acquire valid consent.4 Failing to declare an immediate publishing moratorium for transplant research involving prisoners in China, they argue, ‘undermines efforts to stop transplant-related human rights abuses, taints the evidence base, and renders those who publish and use the research complicit in the continuing harm’.5 We agree with Higgins and colleagues that non-consensual organ procurement from prisoners in China is a crime against humanity. Ongoing human rights violations in Chinese prisons are well documented and universally condemned. We also agree that the subsequent use of data acquired from unethical research is morally complex. Nonetheless, Higgins and colleagues’ arguments leave us with three …. (shrink)

In this article, I present an argument that suggests neuroscience should inform judgments of decision-making capacity. First, I review key behavioral and neurocognitive data to demonstrate that neuroscientific tests might be predictive of decision-making capacity, and that these tests might inform clinical judgments of capacity. Second, I argue that, consistent with the principles of autonomy and justice, such data should inform judgements of decision-making capacity. While the neuroscience of decision-making capacity still requires time to mature, there is strong reason to (...) believe that neuroscience might assist clinicians in adjudicating difficult cases in the future. This article focuses on the assessment of capacity in brain injury patients who have profound communication impairments, however, the overarching aim of the article is to highlight the potential use of neuroscience to improve our understanding of the relationship between cognition and decision-making capacity. (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 commentary critically examines a recent qualitative study, published in this issue of Neuroethics, on the attitudes of family caregivers toward evidence of covert consciousness in brain-injured patients.

:In this paper, the author argues that Joseph Fins’ mosaic decisionmaking model for brain-injured patients is untenable. He supports this claim by identifying three problems with mosaic decisionmaking. First, that it is unclear whether a mosaic is a conceptually adequate metaphor for a decisionmaking process that is intended to promote patient autonomy. Second, that the proposed legal framework for mosaic decisionmaking is inappropriate. Third, that it is unclear how we ought to select patients for participation in mosaic decisionmaking.

In this paper we are interested in the connections between Philosophy for Children and character education. In sketching these connections we suggest some areas where the relationship is potentially fruitful, particularly in light of research which suggests that in practice schools and teachers often adopt and mix different approaches to values education. We outline some implications of drawing connections between the two fields for moral education. The arguments made in this article are done so in the hope of encouraging further (...) critical reflection on the potential relationship between Philosophy for Children and character education. (shrink)

Cosmopolitanism has become an influential theory in both political and, increasingly, educational discourse. In simple terms cosmopolitanism can be understood as a response to the globalised and diverse world in which we live. Diverse in nature, cosmopolitan ideas come in many forms. The focus here is on what have been termed 'strong' ethical forms of cosmopolitanism; that is, positions which conceptualise moral bonds and obligations as resulting from a shared, common humanity. The view that pupils should be taught that all (...) human beings are equal and, crucially, that this entails a responsibility to take action when human equity is challenged or transgressed, is finding increasing expression within educational literature. The suggestion explored here is that strong forms of ethical cosmopolitanism are limited in ways which seriously restrict their educational worth. In the final section, it is argued that forms of cultural and political cosmopolitanism (which are part of the lived experiences of intra- and supra-national citizenship) are best responded to by developing the requisite virtues in pupils to engage with diverse and dialogic communities. (shrink)

The notion of the common good has been cited as a key constituent of citizenship education in England, within which the development of a concern for the common good represents a key disposition. The term has, however, received little critical attention to date within the discourse of the subject, either in terms of its theoretical basis or its educational function and form. For this reason to develop the common good represents an ill?defined aim of the citizenship education in schools. This (...) article seeks to redress this by critically engaging with different formulations of the common good within recent civic republican political theory. More specifically, it attempts to delineate between notions of the common good that are essentially moral and notions that emphasise political understandings of the term, and which, in so doing, minimise the moral. On the basis of this exploration a number of issues are raised for citizenship education in England and it is suggested that to fail to view the common good as a moral enterprise is inherently problematic. (shrink)

Around the world, the landscape of Higher Education is increasingly shaped by discourses of employability, rankings, and student satisfaction. Under these conditions, the role of universities in preparing students for all facets of life, and to contribute to the public good, is reshaped in significant ways: ways which are often negative and pessimistic. This book raises important and pressing questions about the nature and role of universities as formative educational institutions, drawing together contributors from both Western and non-Western perspectives. While (...) the editors and contributors critique the current situation, the chapters evince a more humane and compassionate framing of the work of and in universities, based on positive and valued relationships and notions of the good. Drawing together a wide range of theoretical and conceptual frameworks to illuminate the issues discussed, this volume changes the debate to one of hopefulness and inspiration about the role of higher education for the public good: ultimately looking towards a potentially exciting and rewarding future through which humanity and the planet can flourish. (shrink)

Supported decision making is a model of decision making in which an adult with impaired capacity enters freely into an agreement with a closely trusted person or persons (the “s...

Severe brain injury is a leading cause of death and disability. Following severe brain injury diagnosis is difficult and errors frequently occur. Recent findings in clinical neuroscience may offer a solution. Neuroimaging has been used to detect preserved cognitive function and awareness in some patients clinically diagnosed as being in a vegetative state. Remarkably, neuroimaging has also been used to communicate with some vegetative patients through a series of yes/no questions. Some have speculated that, one day, this method may allow (...) severely brain-injured patients to make medical decisions. Yet, skepticism is rife, due in part to the inherent difficulty of assessing decision-making capacity through neuroimaging communication. In this thesis, I provide the first systematic analysis of this problem. I present and defend a strategy for assessing decision-making capacity in brain-injured patients who can only communicate through neuroimaging. (shrink)

Those with at least in passing interest in Philosophy for Children will be aware of the work of Philip Cam. Cam’s corpus of texts have provided educators with countless insights, activities and resources for developing philosophical investigations and thinking with young people. Philosophy park: A beginner’s guide to great philosophers and their ideas is a significant addition to this body of work. Tackling the complex ideas of leading philosophers in the Western tradition, Cam has achieved something that is often rather (...) rare—the ability to convey complex ideas in an accessible and engaging way. The main tool employed is the use of stories, each of which draws out a central idea within the thought of the philosopher or school of philosophers at hand. (shrink)

This article argues that supported decision making is ideal for people with dynamic cognitive and functional impairments that place them at the margins of autonomy. First, we argue that guardianship and similar surrogate decision-making frameworks may be inappropriate for people with dynamic impairments. Second, we provide a conceptual foundation for supported decision making for individuals with dynamic impairments, which integrates the social model of disability with relational accounts of autonomy. Third, we propose a three-step model that specifies the necessary conditions (...) of supported decision making: identifying domains for support; identifying kinds of supports; and reaching a mutually acceptable and formal agreement. Finally, we identify a series of challenges for supported decision making, provide preliminary responses, and highlight avenues for future bioethics research. (shrink)

In his early work on the problem of coordination, Hans Reichenbach introduced axioms of coordination to describe the relationship between theory and observation. His insistence that these axioms are determinable a priori, however, causes him to ignore the normative dimensions of scientific inquiry and, in turn, generates a misleading interpretation of the theory-observation relationship. In response, I propose an alternative approach that describes this relationship through the framework of scientific practices. My argument will draw on two examples that have not (...) been explored by the philosophical literature in the context of coordination problems: the clinical definition of death and Stanley Prusiner’s prion hypothesis. (shrink)

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. 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: expectations for neuroimaging; reactions to evidence of preserved cognition; reactions to null results; and 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)