Circumscribed delusional beliefs can follow brain injury. We suggest that these involve anomalous perceptual experiences created by a deficit to the person's perceptual system, and misinterpretation of these experiences due to biased reasoning. We use the Capgras delusion (the claim that one or more of one's close relatives has been replaced by an exact replica or impostor) to illustrate this argument. Our account maintains that people voicing this delusion suffer an impairment that leads to faces being perceived as drained (...) of their normal affective significance, and an additional reasoning bias that leads them to put greater weight on forming beliefs that are observationally adequate rather than beliefs that are a conservative extension of their existing stock. We show how this position can integrate issues involved in the philosophy and psychology of belief, and examine the scope for mutually beneficial interaction. (shrink)
Until recently, the problem of traumatic brain injury in sports and the problem of performance enhancement via hormone replacement have not been seen as related issues. However, recent evidence suggests that these two problems may actually interact in complex and previously underappreciated ways. A body of recent research has shown that traumatic brain injuries, at all ranges of severity, have a negative effect upon pituitary function, which results in diminished levels of several endogenous hormones, such as growth hormone and (...) gonadotropin. This is a cause for concern for many popular sports that have high rates of concussion, a mild form of TBI. Emerging research suggests that hormone replacement therapy is an effective treatment for TBI-related hormone deficiency. However, many athletic organizations ban or severely limit the use of hormone replacing substances because many athletes seek to use them solely for the purposes of performance enhancement. Nevertheless, in the light of the research linking traumatic brain injury to hypopituitarism, this paper argues that athletic organizations’ policies and attitudes towards hormone replacement therapy should change. We defend two claims. First, because of the connection between TBI and pituitary function, it is likely many more athletes than previously acknowledged suffer from hormone deficiency and thus could benefit from hormone replacement therapy. Second, athletes’ hormone levels should be tested more rigorously and frequently with an emphasis on monitoring TBI and TBI-related issues, rather than simply monitoring policy violations. (shrink)
Psychiatric patients may try (or express a desire) to injure themselves in hospital in order to cope with overwhelming emotional pain. Some health care practitioners and patients propose allowing a controlled amount of self-injury to occur in inpatient facilities, so as to prevent escalation of distress. Is this approach an example of professional assistance with harm? Or, is the approach more likely to minimise harm, by ensuring safer self-injury? In this article, I argue that health care practitioners who (...) use harm-minimisation can be considered to be helping physical injury to occur, although they do not encourage the act. I consider why there are compelling reasons to believe that a patient who self-injures is not maximally autonomous in relation to that choice. However, I then move onto argue that allowing a degree of self-injury may enable engagement with psychotherapy (enhancing autonomy) and behavioural change. In these circumstances, allowing injury (with precautions) may not be harm, all things considered. (shrink)
This paper explicates a conception of injury as right-violation, which allows us to distinguish between setbacks to interests that should, and should not, be the concern of theories of justice. It begins by introducing a hybrid theory of rights, grounded in (a) the mobilisation of our moral equality to (b) protect our most important interests, and shows how violations of rights are the concern of justice, while setbacks where one of the twin grounds of rights is defeated are not. (...) It then looks more closely at the substantive moral components of injury, namely harm—damage to one’s interests—and wrong—disrespect for one’s moral equality. It argues that, on the hybrid conception of rights, harm and wrong are individually necessary and jointly sufficient components of injury, and the disvalue of neither is reducible to the other—in particular, it is a mistake to construe the disrespect identified by wrong as another damaged interest. Finally, it distinguishes between the public and private dimensions of harm and wrong, and makes some preliminary suggestions as to whether the remedy for these different dimensions should lie in criminal, distributive, or corrective justice. (shrink)
To what extent is imagination dependent on embodied experience? In attempting to answer such questions I consider the experiences of those who have to come to terms with altered neurological function, namely those with spinal cord injury at the neck. These people have each lost all sensation and movement below the neck. How might these new ways of living affect their imagination?
This paper makes the case for a wider acceptance of a probabilistic approach to causation in negligence. This acceptance would help to remove much of the incoherence which has come to afflict the English law of personal injury law. This incoherence can also be found in other common law jurisdictions (notably those of the United States, Canada and Australia). Concentrating upon recent UK case law, the argument opposes the contention that ‘naked statistics’ can play no role in establishing causation. (...) The argument is controversial but it can be reduced to three unremarkable grounds: (1) With its acceptance (albeit in certain carefully prescribed circumstances) of liability for a negligently increased risk which has eventuated, the common law has already embraced a probabilistic conception of causation; (2) The English common law already employs a probabilistic (frequentist) approach to identifying coincidences; and (3) With the ‘balance of probabilities’ as the standard of proof in civil cases, the common law has long had a probabilistic (epistemic) concept at its core. Probabilistic approaches (at both the type and token level) are shown to be consistent with laypersons’ understanding of the concepts such as risk, chance, odds and likelihood. Moreover, a wider acceptance of a probabilistic perspective on causation would entail no major challenge to the fundamental aims of tort, viz. deterrence and corrective justice. (shrink)
We formulate an abstract version of the finite injury method in the form of the Baire category theorem. The theorem has the following corollaries: The Friedberg-Muchnik pair of recursively enumerable degrees, the Sacks splitting theorem, the existence of a minimal degree below 0′ and the Shoenfield jump theorem.
Concussion and Mild Traumatic Brain Injury affect millions of people worldwide. mTBI has been called the “signature injury” of the recent conflicts in Iraq and Afghanistan, affecting thousands of active duty service men and women, and veterans. Sport-related concussion represents a significant public health problem, with elite and professional athletes, and millions of youth and amateur athletes worldwide suffering concussions annually. These brain injuries have received scant attention from neuroethicists, and the focus of this special issue is on (...) defining the ethical considerations and developing and elucidating the neuroethical contributions to the discussion about concussion and mTBI. (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)
The aim of this paper was to explore the issue of consent when considering the use of a life saving but not necessarily restorative surgical intervention for severe traumatic brain injury. A previous study has investigated the issue amongst 500 healthcare workers by using a two-part structured interview to assess opinion regarding decompressive craniectomy for three patients with varying injury severity. A visual analogue scale was used to assess the strengths of their opinions both before and after being (...) shown objective outcome data. Opinions were assessed in a number of scenarios, one of which was that the participants themselves were the injured party. The implication, which was clearly stated, was whether they would provide consent for the procedure to be performed. The study demonstrated that participants were relatively risk aversive in regards to survival with severe disability especially when the injury was severe and there was high probability of that outcome occurring. This finding was not however universal and a minority of participants would provide consent even when the possibility of survival with severe disability was very high. The obvious difficulty comes when considering consent in patients who are unable to express their wishes. In order to address this issue we propose a model of consent based on a balance of the various factors that seem to be of material relevance. These include the severity of the injury, the willingness or otherwise to accept survival with severe disability and the willingness to “risk” the possibility of an unacceptable outcome in order to achieve an acceptable outcome. (shrink)
Next SectionExperiencing a spinal cord injury (SCI) and becoming disabled through sport is a major disruptive life event that instigates a multiplicity of difficult and complex issues that the person has to deal with. One of these problems is how to restory a life and construct new body/self relationships and identities over time. To explore this process, we focus on the life stories of a small group of men (n = 14) who have suffered SCI and become disabled through (...) playing rugby football. We illustrate the ways in which certain metaphors, notions of time, and kinds of hope, congregate and coalesce within three specific narrative types and how these operate to shape the individual experiences of these men following SCI. The implications of this dynamic process for the storied body/self and identity construction are highlighted throughout. (shrink)
Rather than focusing on the legal and political questions that surround genocidal rape, in this paper I treat a vital area of inquiry that has received much less attention: the moral significance of genocidal rape. My aim is to augment existing moral accounts of rape in order to address the specific contexts of genocidal rape. I move beyond understanding rape primarily as a violation of an individual's interests or agential abilities. The account I offer builds on these approaches (as well (...) as on a pluralist approach), by arguing that rape, as a moral injury, negatively affects the very human dignity of victims. My account also emphasizes the relational harm that marks genocidal rape. (shrink)
The framing of the risks of experiencing mild traumatic brain injury in American football and ice hockey has an enormous impact in defining the scope of the problem and the remedies that are prioritized. According to the prevailing risk frame, an acceptable level of safety can be maintained in these contact sports through the application of technology, rule changes, and laws. An alternative frame acknowledging that these sports carry significant risks would produce very different ethical, political, and social debates.
This essay addresses the question: What is the probative value of including neuroscience data in court cases where the defendant might have had a traumatic brain injury? That is, this essay attempts to articulate how well we can connect scientific data and clinical test results to the demands of the Daubert standard in the United States’ court system, and, given the fact that neuroimaging is already being used in our courts, what, if anything, we should do about this fact. (...) Ultimately, I am not sure that there are completely satisfactory answers to this query at this particular time in our legal history. I briefly rehearse the recent use of brain research in our legal system, summarize how neuroscience data regarding TBI and its relation to poor behavioral outcomes are currently used in the courtroom, review challenges with using these data, and highlight fundamental tensions between how the legal system views the causes of behavior and how medicine, neuroscience, and psychology do. Until these tensions are resolved, it is unclear the place neuroscience data should have in courts. (shrink)
Many people who believe that abortion may often be justiﬁed by appeal to the pregnant woman’s interests also believe that a woman’s inﬂiction of signiﬁcant but nonlethal injury on her fetus can seldom be justiﬁed by appeal to her interests. Yet the second of these beliefs can seem to cast doubt on the ﬁrst. For the view that the inﬂiction of prenatal injury is seriously morally objectionable may seem to presuppose a view about the status of the fetus (...) that challenges the permissibility of abortion. The fear of being interpreted as implicitly endorsing such a view has thus led some defenders of abortion to be reluctant for tactical reasons to condemn the inﬂiction of prenatal injury. In this they are encouraged by those who exploit the issue of prenatal injury in their campaign against abortion. When, for example, the House and Senate in 2004 passed legislation recognizing two victims of an assault against a pregnant woman, many viewed this as a tactic in a larger strategy to restrict access to abortion. This tactic is potentially effective. For people may ﬁnd it compelling to infer that, if injuring a fetus is seriously objectionable, abortion must be even more objectionable, since killing is normally more seriously objectionable than merely injuring. (shrink)
Assessment of decision-making capacity can be difficult in acquired brain injury particularly with the syndrome of organic personality disorder. Clinical neuroscience may help but there are challenges translating its constructs to the decision-making abilities considered relevant by law and ethics. An in-depth interview study of DMC in OPD was undertaken. Six patients were purposefully sampled and rich interview data were acquired for scrutiny using interpretative phenomenological analysis. Interview data revealed that awareness of deficit and thinking about psychological states can (...) be present. However, the awareness of deficit may not be “online” and effectively integrated into decision-making. Without this online awareness of deficit the ability to appreciate or use and weigh information in the process of deciding some matters appeared absent. We argue that the decision-making abilities discussed are: necessary for DMC, threatened by ABI, and assessable at interview. Some advice for practically incorporating these abilities within assessments of DMC in patients with OPD is outlined. (shrink)
We show that the existence of a recursively enumerable set whose Turing degree is neither low nor complete cannot be proven from the basic axioms of first order arithmetic (P -) together with Σ 2 -collection (BΣ 2 ). In contrast, a high (hence, not low) incomplete recursively enumerable set can be assembled by a standard application of the infinite injury priority method. Similarly, for each n, the existence of an incomplete recursively enumerable set that is neither low n (...) nor high n - 1 , while true, cannot be established in P - + BΣ n + 1 . Consequently, no bounded fragment of first order arithmetic establishes the facts that the high n and low n jump hierarchies are proper on the recursively enumerable degrees. (shrink)
In all fields of clinical medicine, there is an increasing awareness that outcome must be assessed in terms of quality of life and cost effectiveness, rather than merely length of survival. This is especially the case when considering decompressive craniectomy for severe traumatic brain injury. The procedure itself is technically straightforward and involves temporarily removing a large section of the skull vault in order to provide extra space into which the injured brain can expand. A number of studies have (...) demonstrated many patients going on to make a good long-term functional recovery, however, this is not always the case and a significant number survive but are left with severe neurocognitive impairment. Unfortunately, many of these patients are young adults who were previously fit and well and are, therefore, likely to spend many years in a condition that they may feel to be unacceptable, and this raises a number of ethical issues regarding consent and resource allocation. In an attempt to address these issues, we have used the analytical framework proposed by Jonsen, that requires systematic consideration of medical indications, patient preferences, quality of life and contextual features. (shrink)
Geron recently announced that it had begun enrolling patients in the world's first-in-human clinical trial involving cells derived from human embryonic stem cells (hESCs). This trial raises important questions regarding the future of hESC-based therapies, especially in spinal cord injury (SCI) patients. We address some safety and efficacy concerns with this research, as well as the ethics of fair subject selection. We consider other populations that might be better for this research: chronic complete SCI patients for a safety trial, (...) subacute incomplete SCI patients for an efficacy trial, and perhaps primary progressive multiple sclerosis (MS) patients for a combined safety and efficacy trial. (shrink)
In ethical theory, different concepts of autonomy can be distinguished. In this article we explore how these concepts of autonomy are combined in theory in the citizenship paradigm, and how this turns out in the practice of care for people with acquired brain injury. The stories of a professional caregiver and a client with acquired brain injury show that the combination of various concepts of autonomy in practice leads to tensions between caregivers and clients. These dynamics are discussed (...) from a care ethics perspective, stressing the importance of relationships and interdependence, as well as paying attention to various, sometimes conflicting, perspectives in a deliberative dialogue. (shrink)
Informed by the critical humanisms of Hannah Arendt, Frantz Fanon, and Paul Gilroy, the authors argue for an orientation to teaching and learning that troubles the continuing effects of dehumanizing race logic. Reflecting on Paul Haggis's Oscar award winning film Crash from 2004, they suggest that the metaphor of racial 'crashing' captures what happens when we act out from experiences of racial injury instead of being touched by it. They propose a psychoanalytic pedagogy of emotions as a method for (...) reading representation beyond the limits of detached rational critique. Learning from the affect of racial injury as it is made manifest in representation, they suggest, is an important ethical starting point for generating new insights into what it might mean to live within and beyond contemporary legacies of racial hatred. (shrink)
Our essay will address both the right-to-die movement in America and the emerging culture of neglect in the treatment of a class of patients with disorders of consciousness with which the right-to-die movement is entwined. We trace the etiology of these two themes through changes in our scientific understanding of brain injury and recovery against a growing societal acculturation to dominion over one's self at life's end.
This study examined more than 2,500 war images from U.S. television news, newspapers, news magazines, and online news sites during the first five weeks of the U.S.-led invasion of Iraq in 2003 and found that only 10% showed injury or death. The paper analyzes which media platforms were most willing to show casualties and offers insights on when journalists should use gruesome war images or keep them secret.
Working in the language of first-order arithmetic we consider models of the base theory P - . Suppose M is a model of P - and let M satisfy induction for σ 1 -formulas. First it is shown that the Friedberg-Muchnik finite injury argument can be performed inside M, and then, using a blocking method for the requirements, we prove that the Sacks splitting construction can be done in M. So, the "amount" of induction needed to perform the known (...) finite injury priority arguments is Σ 1 -induction. (shrink)
: The effects of head injury, even mild traumatic brain injury, are wide-ranging and profound. Persons with adult-onset head injury offer feminist philosophers important perspectives for philosophical methodology and philosophical research concerning personal identity, mind-body theories, and ethics. The needs of persons with head injury require the expansion of typical teaching strategies, and such adaptations appear beneficial to both disabled and non-disabled students.
BackgroundIn most Anglophone nations, policy and law increasingly foster an autonomy-based model, raising issues for large numbers of people who fail to fit the paradigm, and indicating problems in translating practical and theoretical understandings of ‘good death’ to policy. Three exemplar populations are frail older people, people with dementia and people with severe traumatic brain injury. We hypothesise that these groups face some over-lapping challenges in securing good end-of-life care linked to their limited agency. To better understand these challenges, (...) we conducted a scoping review and thematic synthesis.MethodsTo capture a range of literature, we followed established scoping review methods. We then used thematic synthesis to describe the broad themes emerging from this literature.ResultsInitial searches generated 22,375 references, and screening yielded 49, highly heterogeneous, studies that met inclusion criteria, encompassing 12 countries and a variety of settings. The thematic synthesis identified three themes: the first concerned the processes of end-of-life decision-making, highlighting the ambiguity of the dominant shared decision-making process, wherein decisions are determined by families or doctors, sometimes explicitly marginalising the antecedent decisions of patients. Despite this marginalisation, however, the patient does play a role both as a social presence and as an active agent, by whose actions the decisions of those with authority are influenced. The second theme examined the tension between predominant notions of a good death as ‘natural’ and the drive to medicalise death through the lens of the experiences and actions of those faced with the actuality of death. The final theme considered the concept of antecedent end-of-life decision-making, its influence on policy and decision-making, and some caveats that arise from the studies.ConclusionsTogether these three themes indicate a number of directions for future research, which are likely to be applicable to other conditions that result in reduced agency. Above all, this review emphasises the need for new concepts and fresh approaches to end of life decision-making that address the needs of the growing population of frail older people, people with dementia and those with severe traumatic brain injury. (shrink)
Recent research suggests that spiritual experiences are related to increased physiological activity of the frontal and temporal lobes and decreased activity of the right parietal lobe. The current study determined if similar relationships exist between self-reported spirituality and neuropsychological abilities associated with those cerebral structures for persons with traumatic brain injury (TBI). Participants included 26 adults with TBI referred for neuropsychological assessment. Measures included the Core Index of Spirituality (INSPIRIT); neuropsychological indices of cerebral structures: temporal lobes (Wechsler Memory Scale-III), (...) right parietal lobe (Judgment of Line Orientation), and frontal lobes (Trail Making Test, Controlled Oral Word Association Test). As hypothesized, spirituality was significantly negatively correlated with a measure of right parietal lobe functioning and positively correlated (nonsignificantly) with measures of left temporal lobe functioning. Contrary to hypotheses, correlations between spirituality and measures of frontal lobe functioning were zero or negative (and nonsignificant). The data support a neuropsychological model that proposes that spiritual experiences are related to decreased activity of the right parietal lobe, which may be associated with decreased awareness of the self (transcendence) and increased activity of the left temporal lobe, which may be associated with the experience of specific religious archetypes (religious figures and symbols). (shrink)
The tendency for judges to respond positively to negligence claims advanced by those who have rendered assistance to accident victims has recently come into collision with the judicial impulse to limit the range of circumstances in which recovery can be made for psychiatric injury. The upshot of this collision is identified as a reduction in the range of circumstances in which those rendering assistance to accident victims can recover for psychiatric harm. This development is criticized on the ground that (...) it has compromised pursuit of what is identified as one of the law's subsidiary purposes: namely, the promotion (in a narrow range of circumstances) of strongly altruistic activity. The ground for making this criticism is found in a body of doctrine that supports the claim that the law is informed by a commitment to the altruism principle. This principle is contrasted with the narrower rescue principle and is identified as supporting not only the claims of rescuers but also those of persons who render assistance in the aftermath of particularly harrowing accidents. While the House of Lords» decision is identified as exhibiting insensitivity to the altruism principle, it is none the less concluded that the position staked out by their Lordships is defensible. Support for this conclusion is found in the ideal of distributive justice, which provided one of the grounds for the House's decision in White. Further, the relationship between the ideal of corrective justice and the ideal of distributive justice is identified as a source of significant tension in the law of negligence. (shrink)
In this article, I discuss cases in which moral grievances, particularly assertions that a moral injury has taken place, are systematically obstructed by received linguistic and epistemic practices. I suggest a social epistemological model for theorizing such cases of moral epistemic injustice. Towards this end, I offer a reconstruction of Lyotard’s concept of the differend, comparing it with Miranda Fricker’s concept of epistemic injustice, and considering it in light of some criticisms posed by Axel Honneth. Through this reconstruction and (...) a series of examples, I demonstrate that a basic formal structure recurs in cases of discursively repressed moral injury, namely, a particular kind of dilemma. I argue that appreciating this dilemma pushes us in the direction of a form of non-ideal ethical theory and I conclude by elaborating a conception of moral reflective judgement that begins from particular experiences of moral injury and moves towards the creation of new moral universals. (shrink)
This article describes the Vaccine/Injury Project Corpus, a collection of legal decisions awarding or denying compensation for health injuries allegedly due to vaccinations, together with models of the logical structure of the reasoning of the factfinders in those cases. This unique corpus provides useful data for formal and informal logic theory, for natural-language research in linguistics, and for artificial intelligence research. More importantly, the article discusses lessons learned from developing protocols for manually extracting the logical structure and generating the (...) logic models. It identifies sub-tasks in the extraction process, discusses challenges to automation, and provides insights into possible solutions for automation. In particular, the framework and strategies developed here, together with the corpus data, should allow “top–down” and contextual approaches to automation, which can supplement “bottom-up” linguistic approaches. Illustrations throughout the article use examples drawn from the Corpus. (shrink)
The principle of non-injury toward all living beings (ahimsā) in India was originally a rule restraining human interaction with the natural environment. I compare two discourses on the relationship between humans and the natural environment in ancient India: the discourse of the priestly sacrificial cult and the discourse of the renunciants. In the sacrificial cult, all living beings were conceptualized as food. The renunciants opposed this conception and favored the ethics of non-injury toward all beings (plants, animals, etc.), (...) which meant that no living being should be food for another. The first represented an ethics modeled on the power that the eater has over the eaten while the second attempted to overturn this food chain ethics. The ethics of non-injury ascribed ultimate value to every individual living being. As a critique of the individualistic ethics of noninjury, a holistic ethics was developed that prescribed the unselfish performance of one’s duties for the sake of the functioning of the natural system. Vegetarianismbecame a popular adaptation of the ethics of non-injury. These dramatic changes in ethics in ancient India are suggestive for the possibility of dramatic changes in environmental ethics today. (shrink)
The point of this article is to test how well Josiah Royce’s philosophy of community can be utilized to conceptualize moral injury and recovery.1 The term “moral injury” is of recent coinage, articulated by those working with combat veterans and their challenges returning to civilian life, particularly veterans returned from Vietnam and from America’s recent presence in the Middle East. The basic idea is that, in combat, soldiers harm their own moral capacities by committing or participating in acts (...) that they understand to be morally repugnant. The consequences of such harm include difficulty with participating well or fully in civilian life, even to the point of committing violence against loved ones. Despite the... (shrink)
The rules governing recovery for negligently inflicted psychiatric injury are among the most criticized of all of tort law. However, one area which, to date, has escaped with a minimum of judicial or academic scrutiny concerns the very threshold requirement for these actions: proof of a ‘recognized psychiatric illness’. This article critiques that longstanding requirement of English law from two perspectives. First, it is argued that the international classifications of psychiatric disorders (ICD-10 and DSM-IV) are being misapplied and misconstrued (...) in the English medico-legal context and that the role (and limitations) of these classifications are worthy of far greater judicial examination and critical scrutiny than has typically been the case to date. Secondly, it is contended that the insistence upon a recognized psychiatric illness, as a threshold requirement, is giving rise to inconsistencies and distortions in the law and that the requirement is neither legally nor medically supportable in the modern era. Instead, it is argued that the stage has been reached whereby something lesser than a recognized psychiatric illness should be sufficient to trigger a compensable injury in law. The article concludes by suggesting various legal avenues by which to feasibly and robustly ‘ring-fence’ the number of potential claims in negligence, should the reform-oriented approach of this article be adopted. (shrink)