Supported decision making, as outlined by Peterson et al. highlights real-world challenges in the messy context of clinical care. We agree with Peterson et al. that patients...

Complex clinical ethics cases require a blend of compassion, sensitivity, and tenacity in order to navigate the hard work required of stakeholders. Each person comes to the table with rich historie...

As clinical trials end, little is understood about how participants exiting from clinical trials approach decisions related to the removal or post-trial use of investigational brain implants, such as deep brain stimulation (DBS) devices. This empirical bioethics study examines how research participants experience the process of exit from research at the end of clinical trials of implanted neural devices. Using a modified grounded theory study design, we conducted semi-structured, in-depth interviews with 16 former research participants from clinical trials of DBS (...) and responsive neurostimulation (RNS). Open-ended questions elicited motivations for joining the trial, understanding of study procedures at the time of initial informed consent, the process of exiting from research, and decisions about device removal or post-trial device use. Thematic analysis identified categories related to: limited preparedness for the end of research participation, straightforwardness of decisions to explant or keep the device, reconciling with the end of research participation, reconciling post-trial expectations, and achieving a sense of closure after exit from research. A preliminary theoretical model describes contextual factors influencing the process and experience of exit from research. Experiences of clinical trial participants should guide research practices to enhance the ethical design and conduct of clinical trials in DBS and other brain devices. (shrink)

Gilbert and colleagues point out the discrepancy between the limited empirical data illustrating changes in personality following implantation of deep brain stimulating electrodes and the vast number of conceptual neuroethics papers implying that these changes are widespread, deleterious, and clinically significant. Their findings are reminiscent of C. P. Snow’s essay on the divide between the two cultures of the humanities and the sciences. This division in the literature raises significant ethical concerns surrounding unjustified fear of personality changes in the context (...) of DBS and negative perceptions of clinician-scientists engaged in DBS. These concerns have real world implications for funding future innovative, DBS trials aimed to reduce suffering as well as hampering true interdisciplinary scholarship. We argue that the philosophical tradition of pragmatism and the value it places on empirical inquiry, experiential knowledge, and inter-disciplinary scholarship – reflecting diverse ways of knowing – provides a framework to start to address the important questions Gilbert and colleagues raise. In particular, we highlight the importance of expert clinician knowledge in contributing to the neuroethical questions raised by Gilbert and colleagues. Finally, we provide illustrative examples of some of our interdisciplinary empirical research that demonstrate the iterative cycle of inquiry characteristic of pragmatism in which conceptual neuroethics questions have led to empirical studies whose results then raise additional conceptual questions that give rise to new empirical studies in a way that highlights the contributions of the humanities and the sciences. (shrink)

Gilbert and colleagues point out the discrepancy between the limited empirical data illustrating changes in personality following implantation of deep brain stimulating electrodes and the vast number of conceptual neuroethics papers implying that these changes are widespread, deleterious, and clinically significant. Their findings are reminiscent of C. P. Snow’s essay on the divide between the two cultures of the humanities and the sciences. This division in the literature raises significant ethical concerns surrounding unjustified fear of personality changes in the context (...) of DBS and negative perceptions of clinician-scientists engaged in DBS. These concerns have real world implications for funding future innovative, DBS trials aimed to reduce suffering as well as hampering true interdisciplinary scholarship. We argue that the philosophical tradition of pragmatism and the value it places on empirical inquiry, experiential knowledge, and inter-disciplinary scholarship – reflecting diverse ways of knowing – provides a framework to start to address the important questions Gilbert and colleagues raise. In particular, we highlight the importance of expert clinician knowledge in contributing to the neuroethical questions raised by Gilbert and colleagues. Finally, we provide illustrative examples of some of our interdisciplinary empirical research that demonstrate the iterative cycle of inquiry characteristic of pragmatism in which conceptual neuroethics questions have led to empirical studies whose results then raise additional conceptual questions that give rise to new empirical studies in a way that highlights the contributions of the humanities and the sciences. (shrink)

Fox and her colleagues (2007) present an important and foundational study concerning the character of current ethics consultation services (ECSs). Although we have some concerns regarding the gener...

Gilbert and colleagues point out the discrepancy between the limited empirical data illustrating changes in personality following implantation of deep brain stimulating electrodes and the vast number of conceptual neuroethics papers implying that these changes are widespread, deleterious, and clinically significant. Their findings are reminiscent of C. P. Snow’s essay on the divide between the two cultures of the humanities and the sciences. This division in the literature raises significant ethical concerns surrounding unjustified fear of personality changes in the context (...) of DBS and negative perceptions of clinician-scientists engaged in DBS. These concerns have real world implications for funding future innovative, DBS trials aimed to reduce suffering as well as hampering true interdisciplinary scholarship. We argue that the philosophical tradition of pragmatism and the value it places on empirical inquiry, experiential knowledge, and inter-disciplinary scholarship – reflecting diverse ways of knowing – provides a framework to start to address the important questions Gilbert and colleagues raise. In particular, we highlight the importance of expert clinician knowledge in contributing to the neuroethical questions raised by Gilbert and colleagues. Finally, we provide illustrative examples of some of our interdisciplinary empirical research that demonstrate the iterative cycle of inquiry characteristic of pragmatism in which conceptual neuroethics questions have led to empirical studies whose results then raise additional conceptual questions that give rise to new empirical studies in a way that highlights the contributions of the humanities and the sciences. (shrink)

Objective: To examine changes in patients’ desired control of the deep brain stimulator and perception of global life control throughout DBS.Methods: A consecutive cohort of 52 patients with Parkinson’s disease was recruited to participate in a prospective longitudinal study over three assessment points. Semi-structured interviews assessing participants’ desire for stimulation control and perception of global control were conducted at all three points. Qualitative data were coded using content analysis. Visual analog scales were embedded in the interviews to quantify participants’ perceptions (...) of control over time.Results: Participants reported significant increases in their perception of global control over time and significant declines in their desired control of the stimulation. These changes were unrelated to improvements in motor symptoms. Improvements in global control were negatively correlated with a decline in desired stimulation control. Qualitative data indicate that participants have changed, nuanced levels of desired control over their stimulators. Increased global life control following DBS may be attributed to increased control over PD symptoms, increased ability to engage in valued activities, and increased overall self-regulation, while other domains related to global control remained unaffected by DBS.Conclusions: There are few empirical data documenting patients’ desire for stimulation control throughout neuromodulation and how stimulation control is related to other aspects of control despite the growing application of neuromodulation devices to treat a variety of disorders. Our data highlight distinctions in different types of control and have implications for the development of patient-controlled neurostimulation devices. (shrink)

The ethical recruitment of participants with neurological disorders in clinical research requires obtaining initial and ongoing informed consent. The purpose of this study is to characterize barriers faced by research personnel in obtaining informed consent from research participants with neurological disorders and to identify strategies applied by researchers to overcome those barriers. This study was designed as a web-based survey of US researchers with an optional follow-up interview. A subset of participants who completed the survey were selected using a stratified (...) purposeful sampling strategy and invited to participate in an in-depth qualitative interview by phone or video conference. Data were analyzed using a mixed methods approach, including content analysis of survey responses and thematic analysis of interview responses. Over 1 year, 113 survey responses were received from US research personnel directly involved in obtaining informed consent from participants in neurological research. Frequently identified barriers to informed consent included: cognitive and communication impairments (e.g. aphasia), unrealistic expectations of research participants, mistrust of medical research, time constraints, literacy barriers, lack of available social support, and practical or resource-related constraints. Strategies to enhance informed consent included: involving close others to support participant understanding of study-related information, collaborating with more experienced research personnel to facilitate training in obtaining informed consent, encouraging participants to review consent forms in advance of consent discussions, and using printed materials and visual references. Beyond conveying study-related information, researchers included in this study endorsed ethical responsibilities to support deliberation necessary to informed consent in the context of misconceptions about research, unrealistic expectations, limited understanding, mistrust, and/or pressure from close others. Findings highlight the importance of training researchers involved in obtaining informed consent in neurological research to address disease-specific challenges and to support the decision-making processes of potential research participants and their close others. (shrink)

The article Pragmatismand the Importance of Interdisciplinary Teams in Investigating Personality Changes Following DBS.

This collection of essays, offered in honor of the distinguished career of prominent political philosophy professor Clifford Orwin, brings together internationally renowned scholars to provide a wide context and discuss various aspects of the virtue of “humanity” through the history of political philosophy.

This book is a collection of secondary essays on America's most important philosophic thinkers—statesmen, judges, writers, educators, and activists—from the colonial period to the present. Each essay is a comprehensive introduction to the thought of a noted American on the fundamental meaning of the American regime.

Recovering Reason: Essays in Honor of Thomas L. Pangle is a collection of essays composed by students and friends of Thomas L. Pangle to honor his seminal work and outstanding guidance in the study of political philosophy. These essays examine both Socrates' and modern political philosophers' attempts to answer the question of the right life for human beings, as those attempts are introduced and elaborated in the work of thinkers from Homer and Thucydides to Nietzsche and Charles Taylor.

This collection of essays, offered in honor of the distinguished career of prominent political philosophy professor Clifford Orwin, brings together internationally renowned scholars to provide a wide context and discuss various aspects of the virtue of “humanity” through the history of political philosophy.

Background: There is little research into medical students’ or doctors’ attitudes to abortion, yet knowing this is important, as policy makers should be aware of the views held by professionals directly involved in abortion provision and changing views may have practical implications for the provision of abortion in the future. Methods: We surveyed 300 medical students about their views on abortion, their beliefs about the status of the fetus and the rights of the mother, their attitude towards UK law and (...) their willingness to be involved in abortion provision as qualified doctors. Results: 62% of medical students were pro-choice, 33% pro-life and 7% undecided. Students’ views correlated with gender, year of study and holding a religious belief. Their beliefs about abortion, the status of the fetus and the rights of women significantly correlated with their attitudes towards the UK law and their willingness to be involved in abortion provision. Students’ willingness to be involved in abortion provision was related to their views on abortion, the extent of participation required, the circumstances of the pregnancy and the stage of pregnancy. Conclusions: The percentage of pro-choice students was lower than that found in research on general practitioners’ attitudes to abortion. It is unclear whether this is because students become more pro-choice as they progress through their medical career or because there is genuinely a change in attitudes to abortion. (shrink)

Professor Kai Nielsen is one of the most forceful proponents of the view that theological assertions have no factual reference because they are compatible with any empirical state of affairs; no evidence, it is alleged, is allowed to count as falsification of such assertions, and therefore they spuriously purport to be what they are not. In this he follows the well-known essay by Professor Antony Flew in which the same argument was advanced, and Nielsen's own most recent contribution on the (...) subject in Religious Studies should be read against the background of his earlier controversy with Professors John Hick and George Mavrodes in The Canadian Journal of Theology. In this latest article he broadens the canvas to question the significance of applying language and concepts appropriate to the realm of empirical observation to anything that is held to transcend it; and this is the substance of Part II of his paper, in which he engages in debate with Professor Ian Crombie, treading well-worn ground that has been the subject of innumerable philosophical discussions. The rest of the paper, however, is a restatement of his earlier contention, and it is with this more limited issue that I shall be concerned in what follows. For I believe that Nielsen is wrong in two quite fundamental respects: he is mistaken in supposing that theological assertions are compatible with any empirical state of affairs: he bases his critique of theological assertions on a far too uncritical appraisal of the principles of verification and falsification in the case of ordinary factual statements. If I am right, the larger questions raised in Part II will still remain open, but it is high time that the ‘verification-falsification argument’ should be shown to be unfounded. (shrink)

There have been a number of attempts to apply mechanism-related concepts to the notion of extended cognition. Such accounts appeal to the idea that extended cognitive routines are realized by mechanisms that transcend some salient border or boundary. The present paper describes some of the challenges confronting the effort to develop a mechanistic account of extended cognition. In particular, it describes five problems that must be resolved if we are to make sense of the idea that extended cognition can be (...) understood via an appeal to extended mechanisms. These problems are intended to guide the philosophical effort to develop a mechanistic account of extended cognition. (shrink)

"Evidence of a flight from reason is as old as human record-keeping: the fact of it certainly goes back an even longer way. Flight from science specifically, among the forms of rational inquiry, goes back as far as science itself... But rejection of reason is now a pattern to be found in most branches of scholarship and in all the learned professions."--from the introduction In the widely acclaimed Higher Superstition: The Academic Left and Its Quarrels with Science, Paul R. (...) Gross and Norman Levitt offered a spirited response to the "science bashers," raising serious questions about the growing criticism of scientific practice from humanists and social scientists on the academic left. Now, in The Flight from Science and Reason, Gross and Levitt are joined by Martin W. Lewis to bring together a diverse and distinguished group of scholars, scientists, and experts to engage these questions from a wide variety of perspectives. The authors take on critics of science whose views range from moderate to extreme, from social constructivists to deconstructionists, from creationists and feminists to Afro-centrists. They discuss the rise of "alternative medicine" and radical environmentalism (here skewered as "ecosentimentalism"). They explain why the "uncertainty principle" does not work as a metaphor for ambiguity, and why "chaos theory" cannot be invoked without an understanding of mathematics. Throughout, they grapple with the paradox inherent in arguing with opponents who contend that reason itself, and thus logic, is suspect. Distributed for the New York Academy of Sciences. (shrink)

Using astrology as a case study, this paper attempts to establish a criterion for demarcating science from pseudoscience. Numerous reasons for considering astrology to be a pseudoscience are evaluated and rejected; verifiability and falsifiability are briefly discussed. A theory is said to be pseudoscientific if and only if (1) it has been less progressive than alternative theories over a long period of time, and faces many unsolved problems, but (2) the community of practitioners makes little attempt to develop the theory (...) towards solutions of the problems, shows no concern for attempts to evaluate the theory in relation to others, and is selective in considering confirmations and disconfirmations. This criterion has the interesting consequence that a theory can be scientific at one time but pseudoscientific at another. (shrink)

Mandevillian intelligence is a specific form of collective intelligence in which individual cognitive vices are seen to play a positive functional role in yielding collective forms of cognitive success. The present paper introduces the concept of mandevillian intelligence and reviews a number of strands of empirical research that help to shed light on the phenomenon. The paper also attempts to highlight the value of the concept of mandevillian intelligence from a philosophical, scientific and engineering perspective. Inasmuch as we accept the (...) notion of mandevillian intelligence, then it seems that the cognitive and epistemic value of a specific social or technological intervention will vary according to whether our attention is focused at the individual or collective level of analysis. This has a number of important implications for how we think about the design and evaluation of collective cognitive systems. For example, the notion of mandevillian intelligence forces us to take seriously the idea that the exploitation of individual cognitive shortcomings could, in some situations, provide a productive route to collective forms of cognitive and epistemic success. (shrink)

To all appearances, the basic building blocks of reality tend to keep existing unless something intervenes to destroy them. In other words, basic things seem to have existential inertia. But why might this be? This paper considers a number of arguments for and against existential inertia. It discusses arguments inspired by Aquinas, Descartes, and Spinoza, as well as considerations deriving from Occam’s Razor, entropy, and certain views about the nature of time and change.

This article explores the notion of the Web-extended mind, which is the idea that the technological and informational elements of the Web can sometimes serve as part of the mechanistic substrate that realizes human mental states and processes. It is argued that while current forms of the Web may not be particularly suited to the realization of Web-extended minds, new forms of user interaction technology as well as new approaches to information representation do provide promising new opportunities for Web-based forms (...) of cognitive extension. In addition, it is suggested that extended cognitive systems often rely on the emergence of social practices and conventions that shape how a technology is used. Web-extended minds may thus depend on forms of socio-technical co-evolution in which social forces and factors play just as important a role as do the processes of technology design and development. (shrink)

Since Plato, most philosophers have drawn a sharp line between reason and emotion, assuming that emotions interfere with rationality and have nothing to contribute to good reasoning. In his dialogue the Phaedrus, Plato compared the rational part of the soul to a charioteer who must control his steeds, which correspond to the emotional parts of the soul (Plato 1961, p. 499). Today, scientists are often taken as the paragons of rationality, and scientific thought is generally assumed to be independent of (...) emotional thinking. (shrink)

Substantially revised to include a wealth of new material, the second edition of this highly acclaimed work provides a concise, coherent introduction that brings structure to an increasingly fragmented and amorphous discipline. Paul R. McHugh and Phillip R. Slavney offer an approach that emphasizes psychiatry's unifying concepts while accommodating its diversity. Recognizing that there may never be a single, all-encompassing theory, the book distills psychiatric practice into four explanatory methods: diseases, dimensions of personality, goal-directed behaviors, and life stories. These (...) perspectives, argue the authors, underlie the principles and practice of all psychiatry. With an understanding of these fundamental methods, readers will be equipped to organize and evaluate psychiatric information and to develop a confident approach to practice and research. Praise for the original edition: "This brilliant book illuminates psychiatry more clearly than any other work I know.... This is the best (and the shortest) single volume on psychiatry that anyone could read."-- New England Journal of Medicine "Every psychiatry department, regardless of ideology, should build a course around this... work. Open-mindedness might become fashionable."-- Journal of Clinical Psychiatry "An elegantly reasoned and eloquently written book that enriches our understanding of clinical events.... [It provides] an opportunity to open our eyes to new possibilities."-- Hospital and Community Psychiatry. (shrink)

Social machines are a prominent focus of attention for those who work in the field of Web and Internet science. Although a number of online systems have been described as social machines, there is, as yet, little consensus as to the precise meaning of the term “social machine.” This presents a problem for the scientific study of social machines, especially when it comes to the provision of a theoretical framework that directs, informs, and explicates the scientific and engineering activities of (...) the social machine community. The present paper outlines an approach to understanding social machines that draws on recent work in the philosophy of science, especially work in so-called mechanical philosophy. This is what might be called a mechanistic view of social machines. According to this view, social machines are systems whose phenomena are explained via an appeal to socio-technical mechanisms. We show how this account is able to accommodate a number of existing attempts to define the social machine concept, thereby yielding an important opportunity for theoretical integration. (shrink)

This chapter reviews the aspects of Mencius that did and did not interest Han-dynasty writers. With the help of digital concordances, it is easy to discover that many of the passages considered crucial today were rarely, if ever, cited in the Han. These include the parable of the infant about to fall into a well (2A.6), the debate with a Mohist named Yi Zhi 夷之 (3A.5), and the concept of liangzhi 良知 (7A.15), which, since Wang Yangming 王陽明 (1472–1528), has been (...) considered a cornerstone of Mencian ethics. The chapter discusses other key passages that are never mentioned in Han sources. Absence of evidence is not evidence of absence, and thus one cannot simply infer that these passages were unknown in the Han dynasty, but it remains significant that they were not regarded as essential to understanding Mencius’s philosophy. The conclusion will explore the differences between Mencius’s reception in the Han dynasty and his Neo-Confucianized reception today. (shrink)

Chapter 49 of the Han Feizi, entitled 'Wudu', includes one of the earliest discussions in Chinese history of the concepts of gong and si: Han Fei takes si to mean 'acting in one's own interest'. Gong is simply what opposes si. 'Acting in one's own interest' is not inherently reprehensible in Han Fei's view; but a ruler must remember why ministers propose their policies: they are concerned only with enriching themselves, and look upon the ruler as nothing more than a (...) resource to be exploited in their quest for material aggrandizement. The interests of the ministers and the ruler are diametrically opposed. Ministers hope for a comfortable career; a ruler must weed out the posers in his search for those rare and invaluable adjuvants who are genuinely capable of administering the state. In short, if si is the self-interest of the minister, gong is the self-interest of the ruler. (shrink)

Biodiversity studies comprise the systematic examination of the full array of different kinds of organisms together with the technology by which the diversity can be maintained and used for the benefit of humanity. Current basic research at the species level focuses on the process of species formation, the standing levels of species numbers in various higher taxonomic categories, and the phenomena of hyperdiversity and extinction proneness. The major practical concern is the massive extinction rate now caused by human activity, which (...) threatens losses in the esthetic quality of the world, in economic opportunity, and in vital ecosystem services. (shrink)

As gene editing technologies such as CRISPR have become increasingly prominent, so have media portrayals of them. With this in mind, the present study builds on theoretical accounts of framing effects, cultivation effects, and genre-specific viewing effects to examine how different forms of media use predict attitudes toward applications of gene editing. Specifically, the study tests how news use, overall television viewing, and science fiction viewing are related to such attitudes. The analyses draw on original data from two surveys of (...) the U.S. public, one conducted in 2020 and the other in 2021. The results from both surveys indicate that news use and overall television viewing predict support for uses of gene editing, whereas science fiction viewing is not significantly related to opinion. The findings suggest that media frames and images may carry implications for the trajectory of public opinion about gene editing technologies and, ultimately, the social context for their development and adoption. (shrink)