Despite its familiarity and widespread acceptance, the concept of “brain death” remains incoherent in theory and confused in practice. Moreover, the only purpose served by the concept is to facilitate the procurement of transplantable organs. By abandoning the concept of brain death and adopting different criteria for organ procurement, we may be able to increase both the supply of transplantable organs and clarity in our understanding of death.

Over the past several decades, medical ethics has gained a solid foothold in medical education and is now a required course in most medical schools. Although the field of medical ethics is by nature eclectic, moral philosophy has played a dominant role in defining both the content of what is taught and the methodology for reasoning about ethical dilemmas. Most educators largely rely on the case‐based method for teaching ethics, grounding the ethical reasoning in an amalgam of theories drawn from (...) moral philosophy, including consequentialism, deontology, and principlism.In this article we hope to make a case for augmenting the focus of education in medical ethics. We propose complementing the traditional approach to medical ethics with a more embedded approach, one that has been described by others as “microethics,” the ethics of everyday clinical practice. (shrink)

Jahi McMath's case has raised challenging uncertainties about one of the most profound existential questions that we can ask: how do we know whether someone is alive or dead? The case is striking in at least two ways. First, how can it be that a person diagnosed as dead by qualified physicians continued to live, at least in a biological sense, more than four years after a death certificate was issued? Second, the diagnosis of brain death has been considered irreversible; (...) in fact, there has never been a case of a person correctly diagnosed as brain‐dead who improved to the point that the person no longer fulfilled the diagnostic criteria. If the neurologist Alan Shewmon is correct that, prior to her cardiac arrest in June 2018, McMath no longer met the criteria for brain death and was actually in a minimally conscious state, this case could have momentous implications for how we think about this diagnosis going forward. In this essay, I will offer a hypothesis that could, perhaps, explain both these aspects of the case. The hypothesis is based on differences in how we distinguish between biological and legal categories. The law tends to prefer to draw bright‐line distinctions between categories, whereas biological categories tend to fall along a spectrum, without sharp distinctions. (shrink)

The Covid-19 pandemic has led to severe shortages of many essential goods and services, from hand sanitizers and N-95 masks to ICU beds and ventilators. Although rationing is not unprecedented, never before has the American public been faced with the prospect of having to ration medical goods and services on this scale.

Hastings Center Report, Volume 51, Issue 5, Page 56-57, September‐October 2021.

_A moving meditation on recent geopolitical crises, viewed through the lens of ancient and modern tragedy__ “Spare, elegant and poignant.... If there is a single contemporary book that should be pressed into the hands of those who decide issues of war and peace, this is it.”—John Gray, _New Statesman_ “It is tragic that Robert D. Kaplan’s luminous _The Tragic Mind_ is so urgently needed.”—George F. Will_ Some books emerge from a lifetime of hard-won knowledge. Robert D. Kaplan has (...) learned, from a career spent reporting on wars, revolutions, and international politics in Europe, the Middle East, and East Asia, that the essence of geopolitics is tragedy. In _The Tragic Mind_, he employs the works of ancient Greek dramatists, Shakespeare, German philosophers, and the modern classics to explore the central subjects of international politics: order, disorder, rebellion, ambition, loyalty to family and state, violence, and the mistakes of power. The great dilemmas of international politics, he argues, are not posed by good versus evil—a clear and easy choice—but by contests of good versus good, where the choices are often searing, incompatible, and fraught with consequences. A deeply learned and deeply felt meditation on the importance of lived experience in conducting international relations, this is a book for everyone who wants a profound understanding of the tragic politics of our time. (shrink)

We seek to change the conversation about brain death by highlighting the distinction between brain death as a biological concept versus brain death as a legal status. The fact that brain death does not cohere with any biologically plausible definition of death has been known for decades. Nevertheless, this fact has not threatened the acceptance of brain death as a legal status that permits individuals to be treated as if they are dead. The similarities between “legally dead” and “legally blind” (...) demonstrate how we may legitimately choose bright-line legal definitions that do not cohere with biological reality. Not only does this distinction bring conceptual coherence to the conversation about brain death, but it has practical implications as well. Once brain death is recognized as a social construction not grounded in biological reality, we create the possibility of changing the social construction in ways that may better serve both organ donors and recipients alike. (shrink)

Robert Rupert argues against the view that human cognitive processes comprise elements beyond the boundary of the organism, developing a systems-based conception in place of this extended view. He also argues for a conciliatory understanding of the relation between the computational approach to cognition and the embedded and embodied views.

This entry addresses the question of group minds, by focusing specifically on empirical arguments for group cognition and group cognitive states. Two kinds of positive argument are presented and critically evaluated: the argument from individually unintended effects and the argument from functional similarity. A general argument against group cognition – which appeals to Occam’s razor – is also discussed. In the end, much turns on the identification of a mark of the cognitive; proposed marks are briefly surveyed in the final (...) section. (shrink)

The concept of brain death has become deeply ingrained in our health care system. It serves as the justification for the removal of vital organs like the heart and liver from patients who still have circulation and respiration while these organs maintain viability. On close examination, however, the concept is seen as incoherent and counterintuitive to our understandings of death. In order to abandon the concept of brain death and yet retain our practices in organ transplantation, we need to either (...) change the definition of death or no longer maintain a commitment to the dead donor rule, which is an implicit prohibition against removing vital organs from individuals before they are declared dead. After exploring these two options, the author argues that while new definitions of death are problematic, alternatives to the dead donor rule are both ethically justifiable and potentially palatable to the public. Even so, the author concludes that neither of these approaches is likely to be adopted and that resolution will most probably come when technological advances in immunology simply make the concept of brain death obsolete. (shrink)

Recent debates over adults' theory of mind use have been fueled by surprising failures of perspective-taking in communication, suggesting that perspective-taking may be relatively effortful. Yet adults routinely engage in effortful processes when needed. How, then, should speakers and listeners allocate their resources to achieve successful communication? We begin with the observation that the shared goal of communication induces a natural division of labor: The resources one agent chooses to allocate toward perspective-taking should depend on their expectations about the other's (...) allocation. We formalize this idea in a resource-rational model augmenting recent probabilistic weighting accounts with a mechanism for (costly) control over the degree of perspective-taking. In a series of simulations, we first derive an intermediate degree of perspective weighting as an optimal trade-off between expected costs and benefits of perspective-taking. We then present two behavioral experiments testing novel predictions of our model. In Experiment 1, we manipulated the presence or absence of occlusions in a director–matcher task. We found that speakers spontaneously modulated the informativeness of their descriptions to account for “known unknowns” in their partner's private view, reflecting a higher degree of speaker perspective-taking than previously acknowledged. In Experiment 2, we then compared the scripted utterances used by confederates in prior work with those produced in interactions with unscripted directors. We found that confederates were systematically less informative than listeners would initially expect given the presence of occlusions, but listeners used violations to adaptively make fewer errors over time. Taken together, our work suggests that people are not simply “mindblind”; they use contextually appropriate expectations to navigate the division of labor with their partner. We discuss how a resource-rational framework may provide a more deeply explanatory foundation for understanding flexible perspective-taking under processing constraints. (shrink)

Savulescu and colleagues have provided interesting insights into how the UK public view the ‘best interests’ of children like Charlie Gard. But is best interests the right standard for evaluating these types of cases? In the USA, both clinical decisions and legal judgments tend to follow the ‘harm principle’, which holds that parental choices for their children should prevail unless their decisions subject the child to avoidable harm. The case of Charlie Gard, and others like it, show how the USA (...) and the UK have strikingly different approaches for making decisions about the treatment of severely disabled children. (shrink)

The concept of brain death was recently described as being “at once well settled and persistently unresolved.” Every day, in the United States and around the world, physicians diagnose patients as brain dead, and then proceed to transplant organs from these patients into others in need. Yet as well settled as this practice has become, brain death continues to be the focus of controversy, with two journals in bioethics dedicating major sections to the topic within the last two years.By way (...) of background, the Uniform Determination of Death Act states that “[a]n individual who has sustained either: irreversible cessation of circulatory and respiratory functions, or irreversible cessation of all functions of the entire brain, including the brain stem, is dead. A determination of death must be made in accordance with accepted medical standards.” In other words, death can be defined by either cardiorespiratory or neurological criteria, with “brain death” representing the loss of all brain function. This standard, or closely related variants, has become the accepted approach throughout the United States and in many parts of the world. (shrink)

The Jeffreys–Lindley paradox displays how the use of a \ value ) in a frequentist hypothesis test can lead to an inference that is radically different from that of a Bayesian hypothesis test in the form advocated by Harold Jeffreys in the 1930s and common today. The setting is the test of a well-specified null hypothesis versus a composite alternative. The \ value, as well as the ratio of the likelihood under the null hypothesis to the maximized likelihood under the (...) alternative, can strongly disfavor the null hypothesis, while the Bayesian posterior probability for the null hypothesis can be arbitrarily large. The academic statistics literature contains many impassioned comments on this paradox, yet there is no consensus either on its relevance to scientific communication or on its correct resolution. The paradox is quite relevant to frontier research in high energy physics. This paper is an attempt to explain the situation to both physicists and statisticians, in the hope that further progress can be made. (shrink)

Johan Brännmark's article “Patients as Rights Holders,” in this issue of the Hastings Center Report, squarely identifies some important problems with the way we in clinical practice conceive of our obligations to our patients. As a solution, he helpfully suggests augmenting our focus on autonomy and informed consent with a broader menu of considerations drawn from the literature on human rights. Respect for autonomy is, of course, one of the hallowed principles of bioethics. In our traditional understanding, our patients deserve (...) our respect because they are capable of autonomous choice, and the way we demonstrate our respect is by seeking their informed consent for our care. This model is so deeply ingrained that many of us have difficulty imagining that there could be any other way of thinking about it. But this model has two very serious drawbacks, problems that speak to much of what is wrong with health care today. (shrink)

The language we use over the course of conversation changes as we establish common ground and learn what our partner finds meaningful. Here we draw upon recent advances in natural language processing to provide a finer‐grained characterization of the dynamics of this learning process. We release an open corpus (>15,000 utterances) of extended dyadic interactions in a classic repeated reference game task where pairs of participants had to coordinate on how to refer to initially difficult‐to‐describe tangram stimuli. We find that (...) different pairs discover a wide variety of idiosyncratic but efficient and stable solutions to the problem of reference. Furthermore, these conventions are shaped by the communicative context: words that are more discriminative in the initial context (i.e., that are used for one target more than others) are more likely to persist through the final repetition. Finally, we find systematic structure in how a speaker's referring expressions become more efficient over time: Syntactic units drop out in clusters following positive feedback from the listener, eventually leaving short labels containing open‐class parts of speech. These findings provide a higher resolution look at the quantitative dynamics of ad hoc convention formation and support further development of computational models of learning in communication. (shrink)

This paper engages critically with anti-representationalist arguments pressed by prominent enactivists and their allies. The arguments in question are meant to show that the “as-such” and “job-description” problems constitute insurmountable challenges to causal-informational theories of mental content. In response to these challenges, a positive account of what makes a physical or computational structure a mental representation is proposed; the positive account is inspired partly by Dretske’s views about content and partly by the role of mental representations in contemporary cognitive scientific (...) modeling. (shrink)

Stolorow and his collaborators' post-Cartesian psychoanalytic perspective – intersubjective-systems theory – is a phenomenological contextualism that illuminates worlds of emotional experience as they take form within relational contexts. After outlining the evolution and basic ideas of this framework, Stolorow shows both how post-Cartesian psychoanalysis finds enrichment and philosophical support in Heidegger's analysis of human existence, and how Heidegger's existential philosophy, in turn, can be enriched and expanded by an encounter with post-Cartesian psychoanalysis. In doing so, he creates an important psychological (...) bridge between post-Cartesian psychoanalysis and existential philosophy in the phenomenology of emotional trauma. (shrink)

Summary of claims: (1) One of the most important relationships between the ontical and the ontological in Heidegger’s thought is the central, ontologically revelatory role that he gives to moods. (2) Heidegger uses the word “mood” as a term of art to refer to the whole range of disclosive affectivity. (3) Because of the role that Heidegger grants to mood as a primordial way of disclosing Being-in-the-world, and because it is impossible to think mood without also thinking the lived body, (...) Heidegger has placed the latter at the center of Dasein’s disclosedness. (4) Heidegger’s account of mood thus entails and highlights, rather than neglects, the ontological significance of the body. (shrink)

University of Colorado, Boulder If there are laws of psychology, they would seem to hold only ceteris paribus (c.p., hereafter), i.e., other things being equal. If a person wants that q and believes that doing a is the most efficient way to make it the case that q, then she will attempt to do a—but not, however, if she believes that a carries with it consequences much more hated than q is liked, or she believes she is incapable of doing (...) a, or she gets distracted from her goal that q, or she suddenly has a severe brain hemorrhage, or.... No one can say precisely where the list ends, but the idea is supposed to be clear enough: normally the law holds, but there are many cases, exceptions, one might say, in which the law does not; the difficulty of characterizing these exceptions invites the qualification ‘c.p.’ as a catch-all. (shrink)

Herodotus gives a lengthy description of the important council of the Greek allies which took place at Samos after Mycale in 479, but Thucydides fails to mention it. This is likely not because of succinctness in his treatment of the period. Throughout the Pentecontaetia, Thucydides presents the events which led to the Peloponnesian War in a somewhat indirect and passive way in order to attribute its causality to historical forces of deeper import. His desire to accentuate the role of Athenian (...) growth and Spartan fear of that growth in making the war inevitable commended the omission of events which by their nature might focus attention instead on the deliberate policy choices of the protagonists. Thucydides’ decision to omit other key events during the Pentecontaetia may stem from the same motivation. (shrink)

As a member of the committee that authored the Multiorganization Policy Statement under discussion, I fully endorse the response of Bosslet and my colleagues to the provocative article by Schneiderman, Jecker, and Jonson. In addition, I would like to offer some thoughts about how the different positions reflected here may be at least partially reconciled by considering the different contexts in which the word and the concept of futility may be invoked. The main thrust of the classic paper by Schneiderman, (...) Jecker, and Jonsen, which is that medicine should not offer or perform treatments that are futile, still resonates with many clinicians, including myself. I... (shrink)

It seems intuitive to the believer that God intended through instruction in the Law to define morality, intended to lead humankind to “the right and the good.” Further, God's love for humankind, exemplified by the incarnation, atonement and teachings of Jesus, and empowered by the Holy Spirit, should lead to a better world. Indeed, the Christian worldview is a coherent and valid way to look at bioethical issues in public policy and at the bedside. Yet, as this paper explores, in (...) a pluralistic society such as the United States, it is neither possible nor desirable for Christians to try to force their views on others. Still, it is obligatory for Christians to stand up and articulate their views in the public square. We should try to persuade others using either prudential or moral arguments. While we must be willing to live with “the will of the people,” at the same time, we must not be intimidated into accepting the position that our voice is not valid because it has a religious basis. (shrink)

Trauma and Human Existence effectively interweaves two themes central to emotional trauma--the first pertains to the contextuality of emotional life in general, and of the experience of emotional trauma in particular, and the second pertains to the recognition that the possibility of emotional trauma is built into the basic constitution of human existence. This volume traces how both themes interconnect, largely as they crystallize in the author’s personal experience of traumatic loss. As discussed in the book's final chapter, whether or (...) not this constitutive possibility will be brought lastingly into the foreground of our experiential world depends on the relational contexts in which we live. (shrink)

This paper evaluates the Natural-Kinds Argument for cognitive extension, which purports to show that the kinds presupposed by our best cognitive science have instances external to human organism. Various interpretations of the argument are articulated and evaluated, using the overarching categories of memory and cognition as test cases. Particular emphasis is placed on criteria for the scientific legitimacy of generic kinds, that is, kinds characterized in very broad terms rather than in terms of their fine-grained causal roles. Given the current (...) state of cognitive science, I conclude that we have no reason to think memory or cognition are generic natural kinds that can ground an argument for cognitive extension. (shrink)

Controversies about the diagnosis and meaning of brain death have existed as long as the concept itself. Here we review the historical development of brain death, and then evaluate the various attempts to justify the claim that patients who are diagnosed as brain dead can be considered dead for all legal and social purposes, and especially with regard to procuring their vital organs for transplantation. While we agree with most commentators that death should be defined as the loss of integration (...) of the functioning of the organism as a whole, we conclude that patients diagnosed as brain dead have not, in fact, lost this integrated functioning. We close with reflections on the implications of this conclusion generally and particularly with regard to organ transplantation, and briefly make reference to alternative approaches to justifying the procurement of transplantable organs that do not depend upon a flawed approach to the diagnosis of death. (shrink)

In this paper, I claim that extant empirical data do not support a radically embodied understanding of the mind but, instead, suggest (along with a variety of other results) a massively representational view. According to this massively representational view, the brain is rife with representations that possess overlapping and redundant content, and many of these represent other mental representations or derive their content from them. Moreover, many behavioral phenomena associated with attention and consciousness are best explained by the coordinated activity (...) of units with redundant content. I finish by arguing that this massively representational picture challenges the reliability of a priori theorizing about consciousness. (shrink)

Causal theories of mental content (CTs) ground certain aspects of a concept's meaning in the causal relations a concept bears to what it represents. Section 1 explains the problems CTs are meant to solve and introduces terminology commonly used to discuss these problems. Section 2 specifies criteria that any acceptable CT must satisfy. Sections 3, 4, and 5 critically survey various CTs, including those proposed by Fred Dretske, Jerry Fodor, Ruth Garrett Millikan, David Papineau, Dennis Stampe, Dan Ryder, and the (...) author himself. The final section considers general objections to the causal approach. (shrink)

The recent literature on mental causation has not been kind to nonreductive, materialist functionalism (‘functionalism’, hereafter, except where that term is otherwise qualified). The exclusion problem2 has done much of the damage, but the epiphenomenalist threat has taken other forms. Functionalism also faces what I will call the ‘problem of metaphysically necessary effects’ (Block, 1990, pp. 157-60, Antony and Levine, 1997, pp. 91-92, Pereboom, 2002, p. 515, Millikan, 1999, p. 47, Jackson, 1998, pp. 660-61). Functionalist mental properties are individuated partly (...) by their relation to the very effects those properties’ instantiations are thought to cause. Consequently, functionalist causal generalizations would seem to have the following problematical structure: The state of being, among other things, a cause of e (under such-andsuch conditions) causes e (under those conditions).3 The connection asserted lacks the contingency one would expect of a causal generalization. Mental states of the kind in question are, by metaphysical necessity, causes of e; any state that does not cause e is thereby a different kind of state. Yet, a mental state’s being the sort of state it is must play some causal role if functionalism is to account for mental causation.4 In what follows, I first articulate more fully the problem of metaphysically necessary effects. I then criticize three functionalist attempts to solve the problem directly. Given the failure of functionalist efforts to meet the problem head-on, I consider less direct strategies: these involve formulating functionalism or its causal claims in such a way that they appear not to generate the problem of metaphysically necessary effects. I argue against these indirect solutions, in each case concluding either that the problem still arises or that avoiding it requires the adoption of an unorthodox form of functionalism (itself a surprising result). In the final.. (shrink)

It is sometimes said that Heidegger neglected the ontological significance of the lived body until the Zollikon Seminars, where he elaborates on the bodily aspect of Being-in-the-world as a “bodying forth.” Against such a contention, in this article I argue that, because of the central role that Heidegger grants to mood as a primordial way of disclosing Being-in-the-world, and because it is impossible to think mood without also thinking the lived body, Heidegger has actually placed the latter at the very (...) center of Dasein’s disclosedness. Heidegger’s account of mood thus entails and highlights, rather than neglects, the ontological significance of the body. (shrink)

In this article I chronicle the emergence of two interrelated themes that crystallized in my investigations of emotional trauma during the more than 16 years that followed my own experience of traumatic loss. One pertains to the context-embeddedness of emotional trauma and the other to the claim that the possibility of emotional trauma is built into our existential constitution. I find a reconciliation and synthesis of these two themes—trauma’s contextuality and its existentiality—in the recognition of the bonds of deep emotional (...) attunement we can form with one another in virtue of our common finitude. (shrink)

A careful reading of the Gorgias along with related dialogues, such as the Apology, the Theaetetus, and other texts, shows that agonism is indispensable to the critique of prevailing opinions, to the transformation of the interlocutor through shame-inducing elenchos, and to philosophy as an ongoing, lifelong ‘training’ (askêsis) of oneself in relation to others. In this way, following Plato’s texts in understanding philosophy as agôn involves rethinking philosophy as an engaged contestation of one’s peers and the received opinions that are (...) part of our relatedness to one another, as well as rethinking agôn as involving not just verbal combativeness, but also—in line with its root-meaning—as a matter of being gathered together in community through discourse (logos). (shrink)