The fundamental determinant of death in donation after circulatory determination of death is the cessation of brain circulation and function. We therefore propose the term donation after brain circulation determination of death [DBCDD]. In DBCDD, death is determined when the cessation of circulatory function is permanent but before it is irreversible, consistent with medical standards of death determination outside the context of organ donation. Safeguards to prevent error include that: 1] the possibility of auto-resuscitation has elapsed; 2] no brain circulation (...) may resume after the determination of death; 3] complete circulatory cessation is verified; and 4] the cessation of brain function is permanent and complete. Death should be determined by the confirmation of the cessation of systemic circulation; the use of brain death tests is invalid and unnecessary. Because this concept differs from current standards, consensus should be sought among stakeholders. The patient or surrogate should provide informed consent for organ donation by understanding the basis of the declaration of death. In cases of circulatory cessation, such as occurs in DBCDD, death can be defined as the permanent cessation of brain functions, determined by the permanent cessation of brain circulation. (shrink)

Abstract:Disturbing cases continue to be published of patients declared brain dead who later were found to have a few intact brain functions. We address the reasons for the mismatch between the whole-brain criterion and brain death tests, and suggest solutions. Many of the cases result from diagnostic errors in brain death determination. Others probably result from a tiny amount of residual blood flow to the brain despite intracranial circulatory arrest. Strategies to lessen the mismatch include improving brain death determination training (...) for physicians, mandating a test showing complete intracranial circulatory arrest, or revising the whole-brain criterion. (shrink)

The Uniform Determination of Death Act (UDDA) provides that “an individual who has sustained either (1) irreversible cessation of circulatory and respiratory functions or (2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead.” We show that the UDDA contains two conflicting interpretations of the phrase “cessation of functions.” By one interpretation, what matters for the determination of death is the cessation of spontaneous functions only, regardless of their generation by artificial means. By the (...) other, what matters is the cessation of both spontaneous and artificially supported functions. Because each UDDA criterion uses a different interpretation, the law is conceptually inconsistent. A single consistent interpretation would lead to the conclusion that conscious individuals whose respiratory and circulatory functions are artificially supported are actually dead, or that individuals whose brain is entirely and irreversibly destroyed may be alive. We explore solutions to mitigate the inconsistency. (shrink)

The dead donor rule (DDR) originally stated that organ donors must not be killed by and for organ donation. Scholars later added the requirement that vital organs should not be procured before death. Some now argue that the DDR is breached in donation after circulatory determination of death (DCDD) programs. DCDD programs do not breach the original version of the DDR because vital organs are procured only after circulation has ceased permanently as a consequence of withdrawal of life-sustaining therapy. We (...) hold that the original rendition of the DDR banning killing by and for organ donation is the fundamental norm that should be maintained in transplantation ethics. We propose separating the DDR from two other fundamental normative rules: the duties to prevent harm and to obtain informed consent. (shrink)

We thank Nielsen Busch and Mjaaland for their article on the dead donor rule (Nielsen Busch and Mjaaland 2023). We would like to take this opportunity to go beyond the dead donor rule in order to r...

In the context of deceased organ donation, donors are routinely tested for HIV, to check for suitability for organ donation. This article examines whether a donor’s HIV status should be disclosed to the donor’s next of kin.On the one hand, confidentiality requires that sensitive information not be disclosed, and a duty to respect confidentiality may persist after death. On the other hand, breaching confidentiality may benefit third parties at risk of having been infected by the organ donor, as it may (...) permit them to be tested for HIV and seek treatment in case of positive results.We conclude that the duty to warn third parties surpasses the duty to respect confidentiality. However, in order to minimize risks linked to the breach of confidentiality, information should be restrained to only concerned third parties, that is, those susceptible to having been infected by the donor. (shrink)

In this paper, we discuss the largely neglected topic of semantics in medicine and the associated ethical issues. We analyse several key medical terms from the informed perspective of the healthcare professional, the lay perspective of the patient and the patient’s family, and the descriptive perspective of what the term actually signifies objectively. The choice of a particular medical term may deliver different meanings when viewed from these differing perspectives. Consequently, several ethical issues may arise. Technical terms that are not (...) commonly understood by lay people may be used by physicians, consciously or not, and may obscure the understanding of the situation by lay people. The choice of particular medical terms may be accidental use of jargon, an attempt to ease the communication of psychologically difficult information, or an attempt to justify a preferred course of action and/or to manipulate the decision-making process. (shrink)

In response to Anne L. Dalle Ave and David M. Shaw, we agree with their general argument but emphasize a moral risk of HIV disclosure in deceased donation cases: the risk of relational rupture. Because of the importance that close relationships have to our sense of self and our life plans, this kind of rupture can have long-ranging implications for surviving loved ones. Moreover, the now-deceased individual cannot participate in any relational mending. Our analysis reveals the hefty moral (...) costs that disclosure can bring, which should influence what information is given to wouldbe donors and how organ procurement coordinators approach these conversations. (shrink)

Laura Specker Sullivan (2022) makes a fairly compelling case for the value of the perspectives of Buddhist practitioners in neuroethics. In this study, Tibetan Buddhist monks have been asked, among other things, whether consciousness, in brain-injured patients in a minimally conscious state, entails a duty to preserve life. In our view, some of the participants’ responses could be used to inform the bioethical debate on death determination.

Since the early 1980s, James Bernat’s scholarship has accompanied and shaped most scientific and policy developments on death determination. In 1981, he, Charles Culver, and Bernard Gert provided a...

In this comment, we propose a short exploration of the differences among the declaration of death, the determination of death, and the concept of death, and how they relate to the ethics and practi...

Continued confinement of those most vulnerable to COVID-19—e.g., the elderly, those with chronic diseases and other risk factors—is presented as an uncontroversial measure when planning exit strategies from lockdown measures. Policies for deconfinement assume that these persons will remain confined even when others will not. This, however, could last quite a long time, and for some this could mean that they will remain in confinement for the rest of their lives.In a policy brief on ethical, legal, and social issues of (...) transition strategies, the Swiss national COVID-19 science task force stated that:Specific interventions should target the risks associated with isolation... (shrink)

Puisqu’elles sont considérées comme des produits du monde occidental et de son modèle libéral, les églises évangéliques en Russie sont soumises à un contrôle accru des autorités gouvernementales. L’engagement politique des membres de ces églises est de ce fait souvent subi ou forcé, et il s’inscrit dans une critique à peine voilée de la société russe dans son ensemble. Cela se traduit par le recours de la part des évangéliques à des réseaux socioprofessionnels qui se développent en dehors des réseaux (...) habituels et surtout, tournés vers l’extérieur. Les individus les plus en rupture optent souvent pour l’émigration vers les pays occidentaux. (shrink)

Three periods in the development of Whitehead's thought are generally recognized : ()-: The period of the writing of Universal Algebra, ...

Enduring disparities in choice of college major constitute one of the most significant forms of gender inequality among undergraduate students. The existing literature generally equates major choice with career choice and overlooks possible variation across student populations. This is a significant limitation because gender differences in major choice among liberal arts students, who attend college less for specific career training and more for broader learning objectives, are just as great as among those choosing pre-professional majors. This study addresses this gap (...) by examining how privileged men and women at an elite, liberal arts university select their fields of study. Drawing on in-depth interviews, findings contradict the prevailing assumption of a unitary model of major choice as career choice by revealing a plurality of gendered meanings around choosing a field of study. Majors may play an important part in the construction of an intellectual identity as much as a means of career preparation. How students approach the choice relates to both gender and social background. For privileged students, traditional gendered associations with bodies of knowledge hold salience in their decision making as well as expectations of reproducing future elite family roles. This research also illuminates how gendered processes of choosing fields of study take place in relationship to particular institutional contexts. (shrink)

Since its early American inception, the Ph.D. has been the hallmark of American higher education. Yet it has not been above controversy. Recent discussions of its purpose vis-a-vis teaching and professional endeavors have continued a long tradition of examining graduate education. This bibliography offers an entree to the Ph.D. phenomenon. Of interest to administrators, educators, and scholars, the volume covers the history, research, and evolution of the Ph.D. An introductory essay offers an historical overview of the degree and sets the (...) degree within the context of contemporary research. The entries, organized into four sections, cover the controversies, critical studies, and purpose of the Ph.D. degree for science and technology, social science, and the humanities disciplines. (shrink)

This paper addresses the significance of the general class of diffeomorphisms in the theory of general relativity as opposed to the Poincaré group in a special relativistic theory. Using Anderson's concept of an absolute object for a theory, with suitable revisions, it is shown that the general group of local diffeomorphisms is associated with the theory of general relativity as its local dynamical symmetry group, while the Poincaré group is associated with a special relativistic theory as both its global dynamical (...) symmetry group and its geometrical symmetry group. It is argued that the two groups are of equal significance as symmetry groups of their associated theories. (shrink)

Numerous researchers have investigated accounting students’ levels of moral reasoning, ethical choice and judgment employing the Defining Issues Test and using its P score as an indicator of moral reasoning. Not surprisingly, a number of DIT studies report conflicting results. Moreover, despite widespread use of the DIT, there is concern that it may not adequately measure all facets of ethical judgment :1–26, 2010). Thus, we endeavor to provide insight not only into the contradictory results but also about the applicability of (...) the DIT for studying accounting students. To do so, we collect published and unpublished DIT studies employing accounting students as subjects and use meta-analysis to aggregate findings across these studies to quantify their results, examining commonly employed variables. We show significant relationships between P scores and some variables but not others. Further, our findings demonstrate that the DIT provides added insights when exploring questions of ethical choice, and ethics instruction, particularly when the instruction is embedded in an accounting course. Finally, we find that the level of DIT P scores reported in the studies relates to whether the study was published. We discuss the implications of our findings for future research. (shrink)

This book offers a philosophical analysis of what it is to be a human being in all her aspects. It analyses what is meant by the self and the I and how this feeling of a self or an I is connected to the brain. It studies specific cases of brain disorders, based on the idea that in order to understand the common, one has to study the specific. The book shows how the self is thought of as a three-fold (...) emergent self, comprising a relationship between an objective neural segment, a subjective neural segment and a subjective transcendent segment. It explains that the self in the world tackles philosophical problems such as the problem of free will, the problem of evil, the problem of human uniqueness and empathy. It demonstrates how the problem of time also has its place here. For many people, the world includes ultimate reality; hence the book provides an analysis and evaluation of different relationships between human beings and Ultimate Reality (God). The book presents an answer to the philosophical problem of how one could understand divine action in the world. (shrink)

Perceived behavioral integrity involves the employee’s perception of the alignment of the manager’s words and deeds. This meta-analysis examined the relationship between perceived behavioral integrity of managers and the employee attitudes of job satisfaction, organizational commitment, satisfaction with the leader and affect toward the organization. Results indicate a strong positive relationship overall (average r = 0.48, p<0.01). With only 12 studies included, exploration of moderators was limited, but preliminary analysis suggested that the gender of the employees and the number of (...) levels between the employee and the manager are potential moderators of the relationship. In the current sample of studies, country where the research was conducted did not seem to have any moderating effects. In addition to suggesting further investigation of potential moderators, we call for research that examines the relationship between behavioral integrity and outcomes that include individual behavior and organizational performance. (shrink)

The “classic” is a vexed term in the work of William Carlos Williams. He uses the category to describe both the stale classicism of T. S. Eliot and Ezra Pound and, conversely, the authentic, “aberrant” classic of James Joyce and surrealism. Analyzing unpublished archival manuscripts alongside the posthumously published collection of essays, The Embodiment of Knowledge, I approach the classic through Williams's theories of pedagogy. Williams parodies and rejects academic modes of reading that cling to the “malignant rigidities” of the (...) past. Yet Paterson and The Embodiment also theorize the reader's interpretive power to disrupt any homogenizing conformity latent in the literary tradition. This dissonant hermeneutics can recuperate the classics and represents a form of resistance to a binary logic of past versus present, or European versus American literature. (shrink)

While Russian leaders are clearly dissatisfied with the United States and the European Union, they are not inherently opposed to a liberal world order. The question of Russia's desire to change a liberal international order hangs on the type of liberalism embedded in that order. Despite some calls from within for it to create a new, post-liberal order premised on conservative nationalism and geopolitics, Russia is unlikely to fare well in such a world.

Inequality isn’t just for the young anymore. People over age sixty-five face large and growing inequalities in health, wealth, work, and family. The widening gap between better- and worse-off older Americans has begun to undermine legal institutions that once worked to correct inequality, including Social Security, Medicare, private pensions, and family law. In this Article, I briefly document the inequalities that have transformed old age in the last fifty years and then analyze three common justifications for reform: budget solvency, inequality, (...) and progressivity. I show that each of these falls short of the kind of principled justification that will be needed to justify cutting benefits, raising taxes, or both. (shrink)

International Studies in the Philosophy of Science, Volume 25, Issue 3, Page 303-305, September 2011.

This article addresses the tension between conceptualizations of the objective body, which are central to biomedicine, and conceptualizations of the expressive body. Within a metaphysics which can be an adequate grounding for the practice of alternative medicine, I argue, the natural body must be fully conceptualized as both object and as expressive. I draw on phenomenology and on actor-network theory to outline a new model of `biosocial nature' which is inherently figurative and which is constructed by a network of human (...) and non-human actors. I then look at two remedies within the homeopathic materia medica, arguing that their capacity to treat ill health by acting as nodes with a network of `imagined connections' is more explicable within a biosocial than within a modernist metaphysics. (shrink)

This is the twenty-sixth volume in the Library of Living Philosophers, a series founded by Paul A. Schilpp in 1939 and edited by him until 1981, when the editorship was taken over by Lewis E. Hahn. This volume follows the design of previous volumes. As Schilpp conceived this series, every volume would have the following elements: an intellectual autobiography of the philosopher, a series of expository and critical articles written by exponents and opponents of the philosopher's thought, replies to these (...) critics and commentators by the philosopher, and as nearly complete a bibliography of the published work of the philosopher as possible. (shrink)