Deep brain stimulation — a novel surgical procedure — is emerging as a treatment of last resort for people diagnosed with neuropsychiatric disorders such as severe obsessive-compulsive disorder. The US Food and Drug Administration granted a so-called humanitarian device exemption to allow patients to access this intervention, thereby removing the requirement for a clinical trial of the appropriate size and statistical power. Bypassing the rigors of such trials puts patients at risk, limits opportunities for scientific discovery, and gives device manufacturers (...) unique marketing opportunities. We argue that Congress and federal regulators should revisit the humanitarian device exemption to ensure that it is not used to sidestep careful research that can offer valuable data with appropriate patient safeguards. (shrink)

When the COVID-19 surge hit New York City hospitals, the Division of Medical Ethics at Weill Cornell Medical College, and our affiliated ethics consultation services, faced waves of ethical issues sweeping forward with intensity and urgency. In this article, we describe our experience over an eight-week period (16 March through 10 May 2020), and describe three types of services: clinical ethics consultation (CEC); service practice communications/interventions (SPCI); and organizational ethics advisement (OEA). We tell this narrative through the prism of time, (...) describing the evolution of ethical issues and trends as the pandemic unfolded. We delineate three phases: anticipation and preparation, crisis management, and reflection and adjustment. The first phase focused predominantly on ways to address impending resource shortages and to plan for remote ethics consultation, and CECs focused on code status discussions with surrogates. The second phase was characterized by the dramatic convergence of a rapid increase in the number of critically ill patients, a growing scarcity of resources, and the reassignment/ redeployment of staff outside their specialty areas. The third phase was characterized by the recognition that while the worst of the crisis was waning, its medium- and long-term consequences continued to pose immense challenges. We note that there were times during the crisis that serving in the role of clinical ethics consultant created a sense of dis-ease as novel as the coronavirus itself. In retrospect we learned that our activities far exceeded the familiar terrain of clinical ethics consultation and extended into other spheres of organizational life in novel ways that were unanticipated before this pandemic. To that end, we defined and categorized a middle level of ethics consultation, which we have termed service practice communication intervention (SPCI). This is an underappreciated dimension of the work that ethics consult services are capable of in times of crisis. We believe that the pandemic has revealed the many enduring ways that ethics consultation services can more robustly contribute to the ethical life of their institutions moving forward. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Minding Brain Injury, Consciousness, and Ethics: Discourse and DeliberationsJoseph J. Fins (bio) and James Giordano (bio)The annual John Collins Harvey Lecture at the Georgetown University’s Pellegrino Center for Clinical Bioethics is a forum for addressing contemporary topics at the intersection of medicine and bioethics. This year, in marking the decadal anniversary of the launch of the Brain Research through Advancing Innovative Neurotechnology (BRAIN) Initiative, the Harvey Lecture provided (...) an interactive discussion with renowned clinician, researcher, scholar, and author, Joseph J. Fins, MD—who is the E. William Davis, Jr., MD Professor of Medical Ethics, Chief of the Division of Medical Ethics, and a Professor of Medicine at Weill Cornell Medical College—conducted by James Giordano, PhD, MPhil—who is a Professor of Neurology and Biochemistry, and Chief of the Pellegrino Center’s Neuroethics Studies Program at the Georgetown University Medical Center. The discourse focused upon the topic of covert consciousness, and the ways in which current and developing brain science technologies, together with revised practices of medicine, in general, may afford new opportunities in patient care, but may also give rise to issues, questions, challenges, and opportunities for neuroethics.Prof. James GIORDANO:Prof. Fins, your most recent book, Rights Come to Mind: Brain Injury, Ethics, and the Struggle for Consciousness (Fins 2015), addresses your ongoing work to employ current and emerging neurological approaches to reveal conscious functions in patients with profound brain injury and disease. To be sure, the destination—if you will—is to talk about covert consciousness. But in commencing this discussion, I’d like to propose a route, which traces your professional journey to this point in your career, and how it led you on your search to reveal consciousness in those patients who lack expressive capability. You went into palliative care first, and that brought you to where you are today. [End Page 227]Prof. Joseph J. FINS:First, let me thank you and the Pellegrino Center for the honor of giving the John Harvey Collins Lecture in such an interactive manner. The forefront of neurological care—and the neuroethical issues and methods focal to such practice—wasn’t what I initially intended to do professionally, but I think that therein is a good lesson for young people’s career aspirations. Simply put, one doesn’t always know where they’ll end up at the beginning of the journey, and as Kierkegaard said, life is lived forward, but is understood backwards (Kierkegaard 1843).In the nineties and the early 2000s, I was trying to help improve the quality of care of people at the end of life, and I wrote a book, entitled The Palliative Ethic of Care: Clinical Wisdom at Life’s End (Fins 2006), in which I addressed notions of phronesis—practical wisdom—in integrating theory and practice toward improving how people die. I became interested in the Quinlan case (Quinlan 1976), and the right to die, and around the same time, I ran into a colleague of mine at Cornell: Dr. Nicholas D. Schiff. Dr. Schiff is a neurologist, who was a protégé of Fred Plum, who was the originator of the concept of the vegetative state with Bryan Jennett, back in 1972. Fred was both of our teachers here at Cornell. Niko (Dr. Schiff) was interested in patients with disorders of consciousness, and was beginning to envision doing work—that ultimately, we did—using deep brain stimulation (DBS) to try to treat patients in the minimally conscious state, a category that was subsequently codified in 2002.I realized that a whole population of people—with these disorders of consciousness—had been somewhat marginalized, and their neglect essentially devolves back to the considerations of the right to die. The right to die was established in the Quinlan case because Judge Hughes—the presiding chief judge of the New Jersey Supreme Court—talked about Ms. Quinlan’s loss of a cognitive, sapient state as being the moral warrant for her right to die, given the fact that it was viewed as a futile situation. I recognized, over the ensuing years—from my background in palliative and end-of-life care—[1] that we had over-generalized notions of futility... (shrink)

La « philosophie chrétienne » a-t-elle encore un avenir, ou connaît-elle aujourd’hui sa fin ? Le présent article cherche à répondre de manière nuancée à cette question, après avoir évoqué la naissance du problème et le contexte culturel, rappelé l’essentiel de la fameuse querelle des années 1930, et examiné plusieurs tentatives ultérieures d’articuler la rencontre de la philosophie autonome et de l’expérience chrétienne.

In lieu of an abstract, here is a brief excerpt of the content:BOOK REVIEWS 263 articles, and supplementing his anthology of Wright (Liberal Arts Press). The biographical chapter presents Wright as an attractive character among devoted friends and also as a solitary, original scientist. Wright's primary achievement was to apply utilitarian principles to Darwinian natural selection theory. Since Darwin himself made no such attempt, nor did John Stuart Mill, and since Darwin showed an evident interest in Wright's attempt, this represents (...) a major contribution to evolutionary theory. On the negative side, too, Wright was incisive in his criticisms of Spencer, Mivart, Hamilton, Mansel, and Lewes. The pragmatic strains in Wright's philosophical method were incidental to his primary interest in showing that sciences are metaphysically "neutral." But his influence on Peirce and James was direct and strong, both on their cosmological and methodological doctrines. He deserves to be mentioned as the prime mover in this trinity of early pragmatism and naturalism, but since his own writings were relatively few and scattered, his historical importance rests largely on the use which Peirce and James made of his ideas and the development which they gave to his philosophy. HER~VRTW. SCHNEIDER Claremont, California Propos sur Jules Lequier: Philosophe de la libert~--R~flexions sur sa vie et sur sa pens~e. Par s Callot. (Paris: l~ditions Marcel Rivi~re et Cie, 1962. Pp. 142 [1]. Biblioth6que Philosophique.) L'oeuvre de Jules Lequier est importante. Nos philosophes am~ricains Charles Hartshorne et William L. Reese en ont fait un grand ~loge dans leur Philosophers Speak of God (pp. ix, 17, 109, 118, 227-230). Dans ce nouveau livre I~mile Callot nous donne des rfiflexions, des considerations, vraiment des Propos sur Jules Lequier en occasion du centenaire de la mort de Lequier (1862). La vie de Lequier est incontestablement dramatique. N~ en 1814 en Br6tagne off il passa son enfance, Lequier subit l'influence de son pays natal, de sa m~re dont il ~tait le ills unique, et d'une 6ducation profond~ment catholique. I1 entra ~t l'l~cole Polytechnique et il en sortit peu apr~s. Mais il y connut Renouvier et c'est grace ~ Renouvier que la pens~e de Lequier nous est connue. Renouvier intercala dans ses livres des fragments de Lequier et en publia des bonnes pages sous ce titre La recherche d'une premiOre v~rit& A l'~ge de 37 ans Lequier eut un acc6s de dfimence. Puis il eut un amour exaltfi pour une jeune fille qui le refusa en mariage. Lequier mourut, noy~, ~t l'~ge de 48 ans. De sa fin il nous est impossible de savoir si elle a 6t~ un suicide ou un accident, mais Lequier garda toujours con- 264 HISTORY OF PHILOSOPHY science de son g6nie: "Je crois avoir trouv6 un myst~re merveilleux de simplicitY, de profondeur et de t~n6bres: quelque chose h quoi nul ne pense." Lequier est un philosophe de la libert& Tout philosophe part de l'id& de v~rit~, cela est n&essaire, mais la prudence exige qu'on la mette sans cesse en cause. Comme Vinet (1797-1847) a dit, "La v6rit~, sans la recherche de la verit6, n'est que la moiti~ de la v~rit& On ne salt bien que ce qu'on n'a pas su toujours; on ne croit bien qu'apr& avoir dour6; on n'est vainqueur qu'apr6s avoir &6 vaincu. Et c'est pourquoi, en cette mati~re, notre premier effort doit avoir pour objet de mettre l'homme en demeure de choisir." Lequier avait eu tr& fort le sentiment du d&erminisme universel. Mais, au moment oth la croyance ~ la n&essit6 semblait devoir triompher dans son esprit, il la rejetta brusquement "par une r&olte de l'&re entier." Selon Lequier, la premiere et fondamentale d6marche de l'esprit est une affirmation de la libert~ par la libert6 m~me. La libert~ ne cr& pas la v6rit6, mais la croyance en la libert6 est une premi6re v6rit6. Sans cette croyance, on ne peut rien chercher et rien d&ouvrir. Mais l'homme, auteur de ses actes par la libertY, ne l'est pas de sa libert& Le Dieu de la Bible est un &re infini qui rien ne peut &happer. Ainsi le probl6me entier de la pr6destination se pose ici de nouveau. Et Lequier d&ouvre une solution originale: Si Dieu... (shrink)

Let ${\mathbb{B}}$ and ${\mathbb{C}}$ be Boolean algebras and ${e: \mathbb{B}\rightarrow \mathbb{C}}$ an embedding. We examine the hierarchy of ideals on ${\mathbb{C}}$ for which ${ \bar{e}: \mathbb{B}\rightarrow \mathbb{C} / \fancyscript{I}}$ is a regular (i.e. complete) embedding. As an application we deal with the interrelationship between ${\fancyscript{P}(\omega)/{{\rm fin}}}$ in the ground model and in its extension. If M is an extension of V containing a new subset of ω, then in M there is an almost disjoint refinement of the family ([ω]ω) V (...) . Moreover, there is, in M, exactly one ideal ${\fancyscript{I}}$ on ω such that ${(\fancyscript{P}(\omega)/{{\rm fin}})^V}$ is a dense subalgebra of ${(\fancyscript{P}(\omega)/\fancyscript{I})^M}$ if and only if M does not contain an independent (splitting) real. We show that for a generic extension V[G], the canonical embedding $$\fancyscript{P}^V(\omega){/}{\rm fin}\hookrightarrow \fancyscript{P}(\omega){/}(U(Os)(\mathbb{B}))^G$$ is a regular one, where ${U(Os)(\mathbb{B})}$ is the Urysohn closure of the zero-convergence structure on ${\mathbb{B}}$. (shrink)

In this paper we examine C. I. Lewis's view on the roleof coherence – what he calls ''congruence'' – in thejustification of beliefs based on memory ortestimony. Lewis has two main theses on the subject. His negativethesis states that coherence of independent items ofevidence has no impact on the probability of a conclusionunless each item has some credibility of its own. Thepositive thesis says, roughly speaking, that coherenceof independently obtained items of evidence – such asconverging memories or testimonies – raises (...) the probabilityof a conclusion to the extent sufficient for epistemicjustification, or, to use Lewis's expression, ''rationaland practical reliance''.It turns out that, while thenegative thesis is essentially correct, astrong positive connection between congruence andprobability – a connection of the kind Lewis ultimatelyneeds in his validation of memory – is contingent on thePrinciple of Indifference. In the final section we assess therepercussions of the latter fact for Lewis's theory in particularand for coherence justification in general. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:BOOK REVIEWS 263 articles, and supplementing his anthology of Wright (Liberal Arts Press). The biographical chapter presents Wright as an attractive character among devoted friends and also as a solitary, original scientist. Wright's primary achievement was to apply utilitarian principles to Darwinian natural selection theory. Since Darwin himself made no such attempt, nor did John Stuart Mill, and since Darwin showed an evident interest in Wright's attempt, this represents (...) a major contribution to evolutionary theory. On the negative side, too, Wright was incisive in his criticisms of Spencer, Mivart, Hamilton, Mansel, and Lewes. The pragmatic strains in Wright's philosophical method were incidental to his primary interest in showing that sciences are metaphysically "neutral." But his influence on Peirce and James was direct and strong, both on their cosmological and methodological doctrines. He deserves to be mentioned as the prime mover in this trinity of early pragmatism and naturalism, but since his own writings were relatively few and scattered, his historical importance rests largely on the use which Peirce and James made of his ideas and the development which they gave to his philosophy. HER~VRTW. SCHNEIDER Claremont, California Propos sur Jules Lequier: Philosophe de la libert~--R~flexions sur sa vie et sur sa pens~e. Par s Callot. (Paris: l~ditions Marcel Rivi~re et Cie, 1962. Pp. 142 [1]. Biblioth6que Philosophique.) L'oeuvre de Jules Lequier est importante. Nos philosophes am~ricains Charles Hartshorne et William L. Reese en ont fait un grand ~loge dans leur Philosophers Speak of God (pp. ix, 17, 109, 118, 227-230). Dans ce nouveau livre I~mile Callot nous donne des rfiflexions, des considerations, vraiment des Propos sur Jules Lequier en occasion du centenaire de la mort de Lequier (1862). La vie de Lequier est incontestablement dramatique. N~ en 1814 en Br6tagne off il passa son enfance, Lequier subit l'influence de son pays natal, de sa m~re dont il ~tait le ills unique, et d'une 6ducation profond~ment catholique. I1 entra ~t l'l~cole Polytechnique et il en sortit peu apr~s. Mais il y connut Renouvier et c'est grace ~ Renouvier que la pens~e de Lequier nous est connue. Renouvier intercala dans ses livres des fragments de Lequier et en publia des bonnes pages sous ce titre La recherche d'une premiOre v~rit& A l'~ge de 37 ans Lequier eut un acc6s de dfimence. Puis il eut un amour exaltfi pour une jeune fille qui le refusa en mariage. Lequier mourut, noy~, ~t l'~ge de 48 ans. De sa fin il nous est impossible de savoir si elle a 6t~ un suicide ou un accident, mais Lequier garda toujours con- 264 HISTORY OF PHILOSOPHY science de son g6nie: "Je crois avoir trouv6 un myst~re merveilleux de simplicitY, de profondeur et de t~n6bres: quelque chose h quoi nul ne pense." Lequier est un philosophe de la libert& Tout philosophe part de l'id& de v~rit~, cela est n&essaire, mais la prudence exige qu'on la mette sans cesse en cause. Comme Vinet (1797-1847) a dit, "La v6rit~, sans la recherche de la verit6, n'est que la moiti~ de la v~rit& On ne salt bien que ce qu'on n'a pas su toujours; on ne croit bien qu'apr& avoir dour6; on n'est vainqueur qu'apr6s avoir &6 vaincu. Et c'est pourquoi, en cette mati~re, notre premier effort doit avoir pour objet de mettre l'homme en demeure de choisir." Lequier avait eu tr& fort le sentiment du d&erminisme universel. Mais, au moment oth la croyance ~ la n&essit6 semblait devoir triompher dans son esprit, il la rejetta brusquement "par une r&olte de l'&re entier." Selon Lequier, la premiere et fondamentale d6marche de l'esprit est une affirmation de la libert~ par la libert6 m~me. La libert~ ne cr& pas la v6rit6, mais la croyance en la libert6 est une premi6re v6rit6. Sans cette croyance, on ne peut rien chercher et rien d&ouvrir. Mais l'homme, auteur de ses actes par la libertY, ne l'est pas de sa libert& Le Dieu de la Bible est un &re infini qui rien ne peut &happer. Ainsi le probl6me entier de la pr6destination se pose ici de nouveau. Et Lequier d&ouvre une solution originale: Si Dieu... (shrink)

In contemporary discussion of the philosophy of religion, or for that matter of any branch of philosophy, the names of Whitehead and Wittgenstein are not often linked. Whitehead's later work is, for the most part, treated as a rather specialized interest, an attractively under-cultivated field for the enterprising thesis-writer perhaps, but well away from the main centres of current philosophical activity. And what he has to say about specifically religious or theological issues 1 becomes simply one ramification of an ingenious (...) but somewhat eccentric system. Nonetheless, there is at least this much justification for considering it in relation to the much more influential and widely discussed views of Wittgenstein. Whitehead has some original things to say about God, Wittgenstein some original reasons for thinking that Whitehead's brand of originality is here radically misplaced. And the possibility or otherwise of such theological originality is an issue of very considerable importance for the philosophy of religion. (shrink)

What is a natural kind? As we shall see, the concept of a natural kind has a long history. Many of the interesting doctrines can be detected in Aristotle, were revived by Locke and Leibniz, and have again become fashionable in recent years. Equally there has been agreement about certain paradigm examples: the kinds oak, stickleback and gold are natural kinds, and the kinds table, nation and banknote are not. Sadly agreement does not extend much further. It is impossible to (...) discover a single consistent doctrine in the literature, and different discussions focus on different doctrines without writers or readers being aware of the fact. In this paper I shall attempt to find a defensible distinction between natural and non-natural kinds. (shrink)

. Ill BERGSONS THEORY OF ART . . .141 THE PHILOSOPHY OF INTENSIVE MANIFOLDS I I CINDERS ..... 215 APPENDICES A. REFLECTIONS ON VIOLENCE . . 249 B. PLAN FOR A ...

Laland and colleagues have sought to challenge the proximate–ultimate distinction claiming that it imposes a unidirectional model of causation, is limited in its capacity to account for complex biological phenomena, and hinders progress in biology. In this article the core of their argument is critically analyzed. It is claimed that contrary to their claims Laland et al. rely upon the proximate–ultimate distinction to make their points and that their alternative conception of reciprocal causation refers to phenomena that were already accounted (...) for by standard theory. (shrink)

Commentary on Tarkasaṅgraha of Annambhaṭṭa, active 17th century, treatise on the fundamentals of Nyaya philosophy.