In this paper, we examine the case of psychedelic medicine for Alzheimer’s disease and related dementias (AD/ADRD). These “mind-altering” drugs are not currently offered as treatments to persons with AD/ADRD, though there is growing interest in their use to treat underlying causes and associated psychiatric symptoms. We present a research agenda for examining the ethics of psychedelic medicine and research involving persons living with AD/ADRD, and offer preliminary analyses of six ethical issues: the impact of psychedelics on autonomy and consent; (...) the impact of “ego dissolution” on persons experiencing a pathology of self; how psychedelics might impact caregiving; the potential exploitation of patient desperation; institutional review boards’ orientation to psychedelic research; and methods to mitigate inequity. These ethical issues are magnified for AD/ADRD but bear broader relevance to psychedelic medicine and research in other clinical populations. (shrink)

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)

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)

ABSTRACT:Psychedelic substances have great promise for the treatment of many conditions, and they are the subject of intensive research. As with other medical treatments, both research and clinical use of psychedelics depend on our ability to ensure informed consent by patients and research participants. However, some have argued that informed consent for psychedelic use may be impossible, because psychedelic experiences can be transformative in the sense articulated by L. A. Paul (2014). For Paul, transformative experiences involve either the acquisition of (...) knowledge that cannot be obtained in any other way or changes in the self. Either of these characteristics may appear to undermine informed consent. This article argues, however, that there is limited evidence that psychedelic experiences are transformative in Paul's sense, and that they may not differ in their transformative features from other common medical experiences for which informed consent is clearly possible. Further, even if psychedelic experiences can be transformative, informed consent is still possible. Because psychedelic experiences are importantly different in several respects from other medical experiences, this article closes with recommendations for how these differences should be reflected in informed consent processes. (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)

This article provides an ethical analysis of the U.S. practice guideline update on disorders of consciousness. Our analysis focuses on the guideline’s recommendations regarding the use of investigational neuroimaging methods to assess brain‐injured patients. Complex and multifaceted ethical issues have emerged because these methods alter the clinical understanding of consciousness. We address issues of false hope, patient suffering, and cost. We argue that, in spite of these concerns, there is significant benefit to using neuroimaging to assess brain‐injured patients in most (...) cases. (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.

Over the course of human life, health care decision‐making is often interdependent. In this article, we use “interdependence” to refer to patients’ engagement of nonclinicians—for example, family members or trusted friends—to reach health care decisions. Interdependence, we suggest, is common for patients in all stages of life, from early childhood to late adulthood. This view contrasts with the common bioethical assumption that medical decisions are either wholly independent or dependent and that independence or dependence is tightly coupled with a person's (...) decision‐making capacity. In this article, we array various approaches to decision‐making along a continuum of interdependence. An appreciation of this continuum can empower patients and elucidate ethical challenges that arise when people transition between different kinds of interdependence across the life span. (shrink)

This paper critically examines whether patients with severe brain injury, who can only communicate through assistive neuroimaging technologies, may permissibly participate in medical decisions. We examine this issue in the context of a unique case study from the Brain and Mind Institute at the University of Western Ontario. First, we describe how the standard approach to medical decision making might problematically exclude patients with communication impairments secondary to severe brain injury. Second, we present a modified approach to medical decision making. (...) We argue that this approach might warrant the inclusion of some patients with severe brain injury in low-stakes decisions, or to express preferences. Third, we present a model of supported decision making to address recalcitrant uncertainty. We conclude by suggesting that the modified approach to decision making and supported decision making might allow a patient with severe brain injury to participate in some medical decisions. Our analysis is provisional and has not yet been implemented in practice. Our discussion is intended to generate further debate on approaches to enhancing autonomy in patients with profound motor and cognitive impairments. (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)

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)

: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.

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)

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)

At a time of continued consternation about the nature and organisation of educational studies within universities in the United Kingdom, it is apposite to give further exploration to the precise na...

While artificial intelligence has the potential to process vast amounts of data, generate new insights, and unlock greater productivity, its widespread adoption may entail unforeseen consequences. We identify conditions under which AI, by reducing the cost of access to certain modes of knowledge, can paradoxically harm public understanding. While large language models are trained on vast amounts of diverse data, they naturally generate output towards the ‘center’ of the distribution. This is generally useful, but widespread reliance on recursive AI systems (...) could lead to a process we define as “knowledge collapse”, and argue this could harm innovation and the richness of human understanding and culture. However, unlike AI models that cannot choose what data they are trained on, humans may strategically seek out diverse forms of knowledge if they perceive them to be worthwhile. To investigate this, we provide a simple model in which a community of learners or innovators choose to use traditional methods or to rely on a discounted AI-assisted process and identify conditions under which knowledge collapse occurs. In our default model, a 20% discount on AI-generated content generates public beliefs 2.3 times further from the truth than when there is no discount. An empirical approach to measuring the distribution of LLM outputs is provided in theoretical terms and illustrated through a specific example comparing the diversity of outputs across different models and prompting styles. Finally, we consider further research directions to counteract harmful outcomes. (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 (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)

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)

Is character education flawed as an approach to values education? A 2013 article answered that question in the negative and defused ten common objections against character education as ‘myths’. The aim of the present article is to revisit those objections and consider the evidence that has accumulated since 2013. After a brief historical and conceptual rehearsal, the core section of the article is taken up with reminders of the original arguments rebutting each myth, complemented with additional updated, and more extensive, (...) considerations that were not available at the time. The original article contained a section on ‘three well-founded misgivings’. We argue that none of those misgivings is as relevant in today’s climate as they were in 2013. However, we acknowledge that those misgivings have been superseded by new challenges that test the theoretical flexibility and empirical credibility of character education. To ensure that those interested in human flourishing can continue to dispel myths about character education and address the most pressing challenges in the field, we close with some reflections on the future of character education and where we see its next ideal academic destinations to be. (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)

In recent years, third-party forgiveness has received renewed attention, much of it negative. While a few have undertaken important attempts to defend or expound accounts of third-party forgiveness, many suspect that it is incoherent, vicious, or both. If true, this would be bad news for Christians, for Christians rely on notions of third-party forgiveness for their accounts of salvation and pastoral authority. I think there is reason to think that some notions of third-party forgiveness can overcome the critics’ worries. In (...) what follows, I argue that third-party forgiveness is more common, coherent, salutary, and diverse in species than many critics suppose. After considering key objections to third-party forgiveness, I offer a constructive account of it that makes sense of these objections while also defending the underlying concept and act. What emerges from this defense is a newfound appreciation for the diverse species of third-party forgiveness. Still, some of these species are more intelligible and safeguarded from declension than others, and I conclude by examining the limits of third-party forgiveness by considering its most contentious species. (shrink)

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)

First—before you define the dilemma, parse out principles, or vocalize about virtues—consider what caused this case.The COVID-19 pandemic has challenged us all, but particularly caregivers and the...

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...

Despite the vital part played by teachers in education and schooling, the role, work and status of teachers, including their preparation and continuing professional development, remain in a conditi...

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)

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.

In an age of growing academic specialisation, one, moreover, in which experts and expertise are habitually derided in a ‘post-truth’ era, the notion of the ‘public intellectual’ has come to be wide...

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)

Ethics and the Good Teacher brings together reviews of existing literature and analysis of empirical data from three research projects conducted by the Jubilee Centre for Character and Virtues - The Good Teacher, Schools of Virtue and Teacher Education - to explore the ethical dimensions of the teaching profession. The book is premised on the idea that what constitutes a "good" teacher involves more than technical skills and subject knowledge. Understood as a professional activity, teaching involves an important ethical dimension, (...) a fact that has come under increased scrutiny - and some would argue increased threat - over recent years as education and schooling have become shaped by market logic and accountability. Addressing the influence of personal and professional character on teachers and teaching, and containing clear implications for policy, practice and research, the book will be of great interest to teachers and other professionals working in education settings, as well as those working in educational policy. It will also appeal to academics, undergraduate students and postgraduate students researching the teaching profession and ethics/morality in education more generally. (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)

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)

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)