I propose a construal of aesthetic value that gives us reason to emphasize some aesthetic practices over others. This construal rests on the existence of a central aesthetic value, namely apprehension-testing intricacy within an appropriate domain. I address three objections: the objection that asks how an aesthetic value based on intricacy can account for the value of minimalism; the objection that asks about the difference between intricacy within a medium and intricacy between media; and the objection that asks about the (...) danger of a regress. I then say that, although this central aesthetic value can in principle allow us to adjudicate between aesthetic practices, we have epistemic limits (about the potential of certain artistic domains to allow for apprehension-testing intricacy) that prevent adjudication in some cases. Even if there is a difference between the vastness of the potential-intricacy-fields somewhere down the line, it is too far for us to see. (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 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 face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role (...) of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM – whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part 1 of this article took up the first two questions. Part 2 took up the second two questions. Part 3 now deals with Questions 5 & 6. Question 5 confronts the issue of utility, whether the manual design of DSM-III and IV favors clinicians or researchers, and what that means for DSM-5. Our final question, Question 6, takes up a concluding issue, whether the acknowledged problems with the earlier DSMs warrants a significant overhaul of DSM-5 and future manuals. As in Parts 1 & 2 of this article, the general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances. (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)

This book analyzes the philosophical foundations of sensorimotor theory and discusses the most recent applications of sensorimotor theory to human computer interaction, child's play, virtual reality, robotics, and linguistics. -/- Why does a circle look curved and not angular? Why doesn't red sound like a bell? Why, as I interact with the world, is there something it is like to be me? These are simple questions to pose but more difficult to answer. An analytic philosopher might respond to the first (...) by merely observing, ``if we ponder the concept `circle' we find that it is the essence of a circle to be round''; but where does this definition come from? Was it set in stone by the gods, the divine arbiters of circle-ness (red-ness and conscious-ness)? It is a measure of the importance of Kevin O'Regan and Alva Noe's 2001 paper `A sensorimotor account of vision and visual consciousness' that it reveals deep scientific and philosophical insight on these foundational issues of perception. -/- Opening with a chapter from Kevin O'Regan, this collection of new essays continues by presenting fifteen additional essays on as many developments achieved in recent years in this field. It provides readers with a critical review of the sensorimotor theory and in so doing introduces them to a radically new approach in cognitive science. (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)

We report key themes arising from a postgraduate workshop organized by the King's Interdisciplinary Discussion Society (KIDS) held in April 2011. KIDS believe that health is a phenomenon that transcends disciplinary boundaries, and therefore issues relating to health care and medical ethics are best addressed with an interdisciplinary approach. The workshop, entitled ‘Everyday Ethics and Primary Healthcare’, included poster presentations and oral presentations from participants from a range of disciplines and occupational backgrounds which highlighted the challenges faced by primary health-care (...) workers. Three common themes emerged: the impersonal and cumbersome work environment that can result from the encroachment of rationalizing tools; the tension between ‘ethical practice as an ongoing sensibility’ and ‘ethical practice as “box-ticking”’; and the contested nature of what constitutes ‘health’. Participants felt that the interdisciplinary perspective was helpful in elucidating the various ethical issues arising in primary health care. (shrink)

Precision medicine is an emerging approach to treatment and disease prevention that relies on linkages between very large datasets of health information that is shared amongst researchers and health professionals. While studies suggest broad support for sharing precision medicine data with researchers at publicly funded institutions, there is reluctance to share health information with private industry for research and development. As the private sector is likely to play an important role in generating public benefits from precision medicine initiatives, it is (...) important to understand what the concerns are and how they might be mitigated. This study reports outcomes of a deliberative method of citizen engagement in Singapore that asked whether sharing precision medicine data with private industry would be permissible, and if so, under what circumstances. Findings from this citizens’ jury suggest sharing with industry would be permissible under certain conditions that are set out in nine recommendations. Implications of the recommendations and their underlying assumptions for policy decision makers are discussed. This study aligns with prior international studies which found conditional acceptance for data sharing with private industry, a public benefit requirement, specific reluctance to share with insurance companies and an emphasis on accountability and transparency to demonstrate trustworthiness. However, our results differ from prior studies in that opt-in consent did not dominate the deliberations as jurors were able to set it aside as an assumed prerequisite for participation in a precision medicine programme. (shrink)

In the conclusion to this multi-part article I first review the discussions carried out around the six essential questions in psychiatric diagnosis – the position taken by Allen Frances on each question, the commentaries on the respective question along with Frances’ responses to the commentaries, and my own view of the multiple discussions. In this review I emphasize that the core question is the first – what is the nature of psychiatric illness – and that in some manner all further (...) questions follow from the first. Following this review I attempt to move the discussion forward, addressing the first question from the perspectives of natural kind analysis and complexity analysis. This reflection leads toward a view of psychiatric disorders – and future nosologies – as far more complex and uncertain than we have imagined. (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 face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role (...) of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM - whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article will take up the first two questions. With the first question, invited commentators express a range of opinion regarding the nature of psychiatric disorders, loosely divided into a realist position that the diagnostic categories represent real diseases that we can accurately name and know with our perceptual abilities, a middle, nominalist position that psychiatric disorders do exist in the real world but that our diagnostic categories are constructs that may or may not accurately represent the disorders out there, and finally a purely constructivist position that the diagnostic categories are simply constructs with no evidence of psychiatric disorders in the real world. The second question again offers a range of opinion as to how we should define a mental or psychiatric disorder, including the possibility that we should not try to formulate a definition. The general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances. (shrink)

Andrew Webster proposes that science and technology studies align itself more thoroughly with practical policy contexts, actors and issues, so as to become more useful, and thus more a regular actor in such worlds. This commentary raises some questions about this approach. First, I note that manifest influence in science or policy or both should not become-by default, or deliberately-a criterion of intellectual quality for STS research work. I distinguish between reflective historical work, which delineates the contingent ways in (...) which existing policy and technoscientific cultures have become entrenched as such inscribed and perhaps dysfunctional institutional habit; and, work of the kind that Webster's three case studies exemplify, that is, geared to influence policy-decision outcomes. I suggest that many of the important issues facing STS-and "policy"-are not explicit "policy-decision issues" as such, but implicit "policy syndromes" that need naming, diagnosing and open, if enforced, institutional reflection. (shrink)

This short article provides a response to Nowotny and Wynne's commentary on an earlier article by the author that examined the relation between science and technology studies and science policy. The article offers a reply with respect to understanding the domain of science policy; how Nowotny and Wynne seek to broaden the scope and so critical leverage of STS beyond the “policy room”; and the implications this has for the ways in which an STS/non-sts nexus might be configured in the (...) future. (shrink)

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role (...) of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM - whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article took up the first two questions. Part II will take up the second two questions. Question 3 deals with the question as to whether DSM-V should assume a conservative or assertive posture in making changes from DSM-IV. That question in turn breaks down into discussion of diagnoses that depend on, and aim toward, empirical, scientific validation, and diagnoses that are more value-laden and less amenable to scientific validation. Question 4 takes up the role of pragmatic consideration in a psychiatric nosology, whether the purely empirical considerations need to be tempered by considerations of practical consequence. As in Part 1 of this article, the general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances. (shrink)

A comprehensive evidentiary regime that would encompass adaptations, exaptations, spandrels, and constraints requires both a standard to be satisfied and a predesignated default presumption to be maintained before the standard is satisfied. Andrews et al. focus principally on the former component. Some thoughts are here offered on the latter.

In this response to Andrew Benjamin, I examine the manner in which Working With Walter Benjamin interweaves destruction and inauguration to account for the ‘othering’ of the social order. The question of where to locate the normative index of a radically altered social and political world is particularly at issue. While Professor Benjamin argues that the ontological fabric of human relationality bears a ‘counter-measure’ to State sovereignty and capitalism, I insist on the power of concrete historical struggles against oppression (...) to prefigure and orient a transformed world. (shrink)

It is generally unquestioned that human subjects research review boards should assess the ethical acceptability of protocols. It says so right on the tin, after all: they are explicitly called research ethics committees in the UK. But it is precisely those sorts of unchallenged assumptions that should, from time to time, be assessed and critiqued, in case they are in fact unfounded. John Stuart Mill's objection to suppressers of dissent is instructive here: “If the opinion is right, they are deprived (...) of the opportunity of exchanging error for truth: if wrong, they lose, what is almost as great a benefit, the clearer perception and livelier impression of truth, produced by its collision with error”.1 Andrew Moore and Andrew Donnelly's compelling article, “The job of ‘ethics committees’”, is just this sort of challenge to conventional wisdom, a rejection of the notion that review boards should be considering ethical matters at all.2 If true, we should be substantially reforming our research ethics policies. And if false, rebuttals would help strengthen and ground the otherwise unquestioned assumption of the role of ethics committees. As it happens, I will argue that their critiques fall into the second category. While mistaken, they present a valuable opportunity to clarify the role of ethics committees and their relationship to relevant codes. In particular, I will defend a hybrid account where codes have strict primacy, but leave significant room for review boards …. (shrink)

Utopian Moments is an edited volume of essays with an exceptionally wide reach, covering 250 years of the utopian canon, from More's archetype to Le Guin's The Dispossessed. The editors, Miguel A. Ramiro Avilés and J. C. Davis, clearly favor the classics, or what Lyman Tower Sargent, in his contribution, calls "exemplars of the mainstream of utopian writing". All the usual suspects are here—Campanella, Bacon, Harrington, Fourier, Owen, Bellamy, Wells, and others—plus a few "wild cards" thrown in to keep (...) things interesting. True, similar projects have been done before. Claeys's excellent Cambridge Companion to Utopian Literature and Claeys and Sargent's comprehensive Utopian Reader... (shrink)

This article sets forth a view about how epistemic justification figures in the ongoing justification of memory belief, a view that I call moderate justificational preservationism . MJP presupposes a nontraditional notion of memorial justification according to which what makes one's present belief that p prima facie justified is that which provided one with prima facie justification to believe that p originally . The article offers support for MJP by examining a series of cases that involve forgetting, and in doing (...) so, criticizes views of Jennifer Lackey, David Owens, Michael Huemer, and George Pappas. (shrink)

What job should authorities give to review boards? We are grateful to Soren Holm, Rosamond Rhodes, Julian Savulescu and G Owen Schaefer for their thoughtful commentaries on our answer.1–4 Here we add to the discussion. Let us summarise the claims for which we argued.5 Relevant authorities can task boards with review for consistency with duly established code, thereby making code-consistent activities apt for approval and code-inconsistent activities apt for rejection. They can instead task boards with review for ethical acceptability, (...) making ethically acceptable activities apt for approval and ethically unacceptable activities apt for rejection. For every proposal a board might consider, these two different jobs establish different review bases, and their approvals and rejections also sometimes conflict. Some international and national statements require ECR, others instead require CCR, and others again seem either to require both or just to run the two together. Those responsible for these statements should make them clearer and better aligned here. For reasons of practicality, publicity and separation of powers, authorities do better to task boards with CCR and not ECR. These arguments also count against establishing any code with content that in effect collapses CCR into ECR. If our arguments withstand robust scrutiny, authorities should also remove ‘ethics’ and cognate terms from the names of these boards and their review activities and emphasise code expertise not ethics expertise in the required skill sets of boards. Our article noted that ‘ethical considerations informed the genesis of these boards and express their aspirations’. Rhodes similarly notes: ‘the authors and endorsers of research ethics codes, declarations and regulations … articulating the ethical standards for conducting human subject research’ and ‘This framework embeds the ethical parameters of human subject research into the moral missions of institutions’. Schaefer too …. (shrink)

This is the first book to offer the best essays, articles, and speeches on ethics and intelligence that demonstrate the complex moral dilemmas in intelligence collection, analysis, and operations. Some are recently declassified and never before published, and all are written by authors whose backgrounds are as varied as their insights, including Robert M. Gates, former Director of the Central Intelligence Agency; John P. Langan, the Joseph Cardinal Bernardin Professor of Catholic Social Thought at the Kennedy Institute of Ethics, Georgetown (...) University; and Loch K. Johnson, Regents Professor of Political Science at the University of Georgia and recipient of the Owens Award for contributions to the understanding of U.S. intelligence activities. Creating the foundation for the study of ethics and intelligence by filling in the gap between warfare and philosophy, this is a valuable collection of literature for building an ethical code that is not dependent on any specific agency, department, or country. (shrink)

This essay considers the role of the ‘all affected interests’ principle in democratic theory, focusing on debates concerning its form, substance and relationship to the resolution of the democratic boundary problem. It begins by defending an ‘all actually affected’ formulation of the principle against Goodin’s ‘incoherence argument’ critique of this formulation, before addressing issues concerning how to specify the choice set appropriate to the principle. Turning to the substance of the principle, the argument rejects Nozick’s dismissal of its intuitive appeal (...) and considers the two arguments advanced in favour of the principle as a criterion of democratic inclusion: the interlinked interests argument and the tracking power argument. It is shown that neither of these arguments can substantiate a view of the principle as a criterion of democratic inclusion, although both ground a constitutional understanding of the principle as specifying the scope of a duty of justification. It is then proposed that the principle can play an important role in a two-stage resolution of the democratic boundary problem in which it addresses the question of who is entitled to inclusion in the ‘pre-political’ demos that determines whether to constitute a polity. The second stage of this resolution requires an answer to the question of who should constitute the ‘political demos’, that is, the demos of a constituted polity and it is argued that a version of the ‘‘all subjected persons’’ principle can appropriately play this role.Keywords: all affected interests; all subjected persons; democracy; boundary problem; demos problem. (shrink)

The following suggestions for the interpretation of Parmenides and Melissus can be grouped for convenience about one problem. This is the problem whether, as Aristotle thought and as most commentators still assume, Parmenides wrote his poem in the broad tradition of Ionian and Italian cosmology. The details of Aristotle's interpretation have been challenged over and again, but those who agree with his general assumptions take comfort from some or all of the following major arguments. First, the cosmogony which formed the (...) last part of Parmenides' poem is expressly claimed by the goddess who expounds it to have some measure of truth or reliability in its own right, and indeed the very greatest measure possible for such an attempt. Second, the earlier arguments of the goddess prepare the ground for such a cosmogony in two ways. For in the first place these arguments themselves start from assumptions derived from earlier cosmologists, and are concerned merely to work out the implications of this traditional material. And, in the second place, they end by establishing the existence of a spherical universe: the framework of the physical world can be secured by logic even if the subsequent introduction of sensible qualities or ‘powers’ into this world marks some decline in logical rigour. (shrink)

In this essay we provide (1) an argument for why ethics should be naturalized, (2) an analysis of why it is not yet naturalized, (3) a defense of ethical naturalism against two fallacies—Hume’s and Moore’s—that ethical naturalism allegedly commits, and (4) a proposal that normative ethics is best conceived as part of human ecology committed to pluralistic relativism. We explain why naturalizing ethics both entails relativism and also constrains it, and why nihilism about value is not an especially worrisome for (...) ethical naturalists. The substantive view we put forth constitutes the essence of Duke Naturalism. (shrink)

Kant’s doctrine of the Fact of Reason is one of the most perplexing aspects of his moral philosophy. The aim of this paper is to defend Kant’s doctrine from the common charge of dogmatism. My defense turns on a previously unexplored analogy to the notion of ‘matters of fact’ popularized by members of the Royal Society in the seventeenth century. In their work, ‘facts’ were beyond doubt, often referring to experimental effects one could witness first hand. While Kant uses the (...) German equivalent in different contexts, I argue that the scientific analogy opens up a new framework for interpreting his strategy of justification in the Critique of Practical Reason. In the final section, I address a few possible objections to my reading, one of which I anticipate coming from Dieter Henrich and Ian Proops, who have argued that Kant’s Fact of Reason is best understood under a legal analogy. (shrink)

ABSTRACTMiranda Fricker has characterized epistemic injustice as “a kind of injustice in which someone is wronged specifically in her capacity as a knower” (2007, Epistemic injustice: Power & the e...

INTRODUCTION There may be times when what is most needed is, not so much a new discovery or a new idea as a different 'slant'; I mean a comparatively slight ...

Ontological monists hold that there is only one way of being, while ontological pluralists hold that there are many; for example, concrete objects like tables and chairs exist in a different way from abstract objects like numbers and sets. Correspondingly, the monist will want the familiar existential quantifier as a primitive logical constant, whereas the pluralist will want distinct ones, such as for abstract and concrete existence. In this paper, we consider how the debate between the monist and pluralist relates (...) to the standard test for logicality. We deploy this test and show that it favors the monist. (shrink)

Recent literature on epistemic innocence develops the idea that a defective cognitive process may nevertheless merit special consideration insofar as it confers an epistemic benefit that would not otherwise be available. For example, confabulation may be epistemically innocent when it makes a subject more likely to form future true beliefs or helps her maintain a coherent self-concept. I consider the role of confabulation in typical cases of interpersonal gaslighting, and argue that confabulation will not be epistemically innocent in such cases (...) even if it does preserve a coherent self-concept or belief-set for the subject. Analyzing the role of confabulation in gaslighting illustrates its role in on-going interpersonal relationships, and augments already growing evidence that confabulation may be quite widespread. The role of confabulation in gaslighting shows that whether confabulation confers epistemic benefits will depend greatly on the interpersonal context in which it is deployed, while whether a coherent self-concept is epistemically beneficial will depend to a great extent on the content of that self-concept. This shows that the notion of an epistemically harmful or beneficial feature of a cognitive process can and should be further clarified, and that doing so has both theoretical and practical advantages in understanding epistemic innocence itself. (shrink)