We discuss experimental support for the existence of a corollary discharge signal of attention movement control and its formulation in terms of the corollary discharge of attention model of attention movement . The data is from fMRI, MEG and EEG activity observed about 200 ms after stimulus onset in various attention paradigms and in which the activity is mainly sited in parietal and extra-striate visual areas. Moreover the data arises from neural activity observed before report of (...) a subject’s experience occurs. The overall experimental support for the existence of a copy of the attention movement control signal generates, it is suggested, a viable route to explore the relation between this signal and human consciousness, as concluded in the paper. (shrink)

Abstract: How it is that one's own thoughts can seem to be someone else's? After noting some common missteps of other approaches to this puzzle, I develop a novel cognitive solution, drawing on and critiquing theories that understand inserted thoughts and auditory verbal hallucinations in schizophrenia as stemming from mismatches between predicted and actual sensory feedback. Considerable attention is paid to forging links between the first-person phenomenology of thought insertion and the posits (e.g. efference copy, corollary discharge) of (...) current cognitive theories. I show how deficits in the subconscious mechanisms regulating inner speech may lead to a 'fractured phenomenology' responsible for schizophrenic patients' reports of inserted thoughts and auditory verbal hallucinations. Supporting work on virtual environments is discussed, and lessons concerning the fixity of delusional belief are drawn. (shrink)

Is vision informationally encapsulated from cognition or is it cognitively penetrated? I shall argue that intentions penetrate vision in the experience of visual spatial constancy: the world appears to be spatially stable despite our frequent eye movements. I explicate the nature of this experience and critically examine and extend current neurobiological accounts of spatial constancy, emphasizing the central role of motor signals in computing such constancy. I then provide a stringent condition for failure of informational encapsulation that emphasizes a computational (...) condition for cognitive penetration: cognition must serve as an informational resource for visual computation. This requires proposals regarding semantic information transfer, a crucial issue in any model of informational encapsulation. I then argue that intention provides an informational resource for computation of visual spatial constancy. Hence, intention penetrates vision. (shrink)

Current thinking suggests that dissociation could be a significant comorbid diagnosis in a proportion of schizophrenic patients with a history of trauma. This potentially may explain the term “schizophrenia” in its original definition by Bleuler, as influenced by his clinical experience and personal view. Additionally, recent findings suggest a partial overlap between dissociative symptoms and the positive symptoms of schizophrenia, which could be explained by inhibitory deficits. In this context, the process of dissociation could serve as an important conceptual framework (...) for understanding schizophrenia, which is supported by current neuroimaging studies and research of corollary discharges. These data indicate that the original conception of “split mind” may be relevant in an updated context. Finally, recent data suggest that the phenomenal aspects of dissociation and conscious disintegration could be related to underlying disruptions of connectivity patterns and neural integration. (shrink)

The relation between mind and matter is considered in terms of recent ideas from both phenomenology and brain science. Phenomenology is used to give clues to help bridge the brain-mind gap by providing constraints on any underlying neural architecture suggested from brain science. A tentative reduction of mind to matter is suggested and used to explain various features of phenomenological experience and of ownership of conscious experience. The crucial mechanism is the extended duration of the corollary discharge of (...) attention movement, with its gating of activity for related content. Aspects of experience considered in terms of the model are the discontinuous nature of consciousness, immunity to error through misidentification, and the state of 'pure' consciousness as experienced through meditation. Corollary discharge of attention movement is proposed as the key idea bringing together basic features of meditation, consciousness and neuroscience, and helping to bridge the gap between mind and matter. (shrink)

There has recently been emphasis put on providing two-factor accounts of monothematic delusions. Such accounts would explain (1) whether a delusional hypothesis (e.g. someone else is inserting thoughts into my mind) can be understood as a prima facie reasonable response to an experience and (2) why such a delusional hypothesis is believed and maintained given its implausibility and evidence against it. I argue that if we are to avoid obfuscating the cognitive mechanisms involved in monothematic delusion formation we should split (...) the first factor (1 above) into two factors: how abnormal experience can give rise to a delusional ‘proto-hypothesis’ and how a ‘proto-hypothesis’ in consort with normal experiences and background information, can be developed into a delusional hypothesis. In particular I will argue that a schizophrenic is faced with the unusual requirement of having to identify an introspectively accessible thought as one's own, and that this requirement of identification is the central experiential abnormality of thought insertion, auditory verbal hallucination, and alien control (i.e. passivity symptoms). Additionally, I will consider non-experiential factors which are required for the formation of a delusional hypothesis. (shrink)

Transcranial magnetic stimulation, EEG, and behavioral studies by our group implicate spurious activation of speech perception neurocircuitry in the genesis of auditory hallucinations in schizophrenia. The neurobiological basis of these abnormalities remains uncertain, however. We review our ongoing studies, which suggest that altered cortical coupling underlies speech processing in schizophrenia and is expressed via disrupted gamma resonances and impaired corollary discharge function of self-generated verbal thought.

The question of how the brain can construct a stable representation of the external world despite eye movements is a very old one. If there have been some wrong statements of problems (such as the inverted retinal image), other statements are less naive and have led to analytic solutions possibly adopted by the brain to counteract the spurious effects of eye movements. Following the MacKay (1973) objections to the analytic view of perceptual stability, Bridgeman et al. claim that the idea (...) that signals canceling the effects of saccadic eye movements are needed is also a misconception, as is the claim that stability and position encoding are two distinct problems. It must be remembered, however, that what made the theory of “cancellation” formulated by von Holst and Mittelstaedt (1950) so appealing was the clinical observation of perceptual instability following ocular paralysis. Following the concept of corollary discharge, the theory of efference copy had the advantage of simultaneously solving three problems: the stability of the visual world during the saccade, the same visual stability across saccades, and the visual constancy problem of allowing the subject to know where an object in space is. (shrink)

In 2003, Peratt demonstrated that rock art images worldwide bear a remarkable similarity to high-energy plasma discharge formations. In later papers, Peratt located the plasma discharge column in which all of these would have occurred at the Earth’s South Pole. This article accepts the relation between the rock art images and the plasma formations, but concludes that the geometry of the reconstruction is incompatible with the global occurrence of the rock art images. As a corollary, the finer (...) details of the reconstructed column must also be called into question. In particular, the reconstruction of the top cusp, the two upper plasmoids, and the filamentary sheath in a single column at the South Pole cannot be reliably deduced from the data as presented by Peratt. All evidence points to a worldwide distribution of the phenomena. (shrink)

Preterm discharge effects: Relationship between the maternal experience and newborn's psychobiological regulation The purpose of this study is to investigate how the past experiences of mothers and their potentially traumatic events during pregnancy may have influenced the processes of psychobiological self-regulation and cognitive development in a child born preterm. Eighty children who had a gestational age of < 32 weeks were examined at the 9th month of the corrected age. The mothers and children were divided in two groups: multipara (...) mothers and their children and the primipara mothers and their children. These children were examined on the basis of sleep disorders, nutritional problems and mental development. Perinatal data from clinical observations and data from standardized developmental tests were used to describe the differences. The children of primipara mothers who had unexpected preterm delivery presented major incidences of sleep disorders while the children of primipara mothers, who programmed preterm delivery, presented a major incidences of nutrition problems. The predictability of preterm delivery has a major influence on the capacity of newborns for self-regulation in the case of primipara mothers. (shrink)

Discharging a homeless patient from hospital raises ethical issues which are compounded when the patient is from outside the United Kingdom. This article begins with an extended case study of a 30-year-old homeless man from Lithuania describing his complex medical and social needs. It is best practice for all homeless patients to have their housing needs planned for prior to discharge, but this is made more difficult by the United Kingdom’s ‘hostile environment’ policy which creates a subclass of homeless (...) people who are not eligible for support. This means healthcare professionals discharge patients back to homelessness, even when this is likely to adversely affect their health and dignity both directly and indirectly through impairing access to care for chronic conditions. Policies in health and social care which compel professionals to treat some patients with second-class care undermine the ethics of healthcare professions. (shrink)

The ethical obligation to provide a reasonably safe discharge option from the inpatient setting is often confounded by the context of homelessness. Living without the security of stable housing is a known determinant of poor health, often complicating the safety of discharge and causing unnecessary readmission. But clinicians do not have significant control over unjust distributions of resources or inadequate societal investment in social services. While physicians may stretch inpatient stays beyond acute care need in the interest of (...) their patients who are experiencing homelessness, they must also consider the implications of using an inpatient hospital bed for someone without the attendant level of medical need. Caring for patients in an inpatient setting when they no longer require acute care means fewer beds for acute care patients. And when a patient who is experiencing homelessness declines a medically safer option such as a skilled nursing facility, then clinicians may be faced with the sole option of discharge to the street, which raises troubling questions of nonmaleficence and social justice. Here we investigate the different forms of injustice that play out when patients are discharged to the street, and offer a map of the interwoven ethical responsibilities of clinicians, hospitals, and skilled nursing facilities. (shrink)

Mrs. Smith's eyes filled with tears as she said, “I feel like I've done something wrong. Are they punishing me because I've been refusing therapy and won't go to a nursing home?” She acknowledged that she hadn't always listened to her doctors but said that she knew better now and wanted to go home and see if she could make it work. Many staff members at our rehabilitation hospital had explained their safety concerns to her, and some had enlisted her (...) adult daughter, with whom she lived, to convince her too. The rehabilitation team had called on the ethics consultation service, of which I am a part, to help figure out whether Mrs. Smith had the capacity to make an informed refusal of discharge recommendations. (shrink)

Simplicius surveys ideas about place and time from the preceding thousand years of Greek philosophy. Translation of text with commentary and notes.

In this article we wonder how a person can discharge the political responsibility for supporting and benefiting from unjust social structures. Firstly, we introduce the concept of structural injustice and defend it against three possible objections: ‘explanatory nationalism’, a diachronic interpretation of the benefits of industry-led growth, being part of a social structure does not automatically mean being responsible for its negative consequences. Then, we hold that both Iris Marion Young’s ‘social connection model’ and Robin Zheng’s ‘role-ideal model’ provide (...) clear indications on how to unload responsibility for supporting/participating in unjust social structures, but fail to explain how to get rid of responsibility for unjust enrichment. We maintain that both models should be complemented with a global redistributive scheme that allows to disgorge the benefits that are unfairly obtained in the global economic system, besides undertaking collective transformative actions and assuming ideal-role responsibilities. (shrink)

A growing number of discharges at acute-care hospitals involve patients who are undocumented and lack legal status. Because such patients are ineligible for public assistance, long-term care facilities will routinely deny them admission. These discharges become complex discharges because of such financial barriers. If local family support is unavailable, discharging such patients to a safe and suitable location becomes increasingly difficult. These complex discharges implicate a number of ethical principles. We describe such complex discharge cases, apply various ethical frameworks, (...) and call for potential policy solutions to address this growing ethical concern. (shrink)

During a clinical ethics fellow’s first week of independent supervised service, two unhoused patients on the same floor were resisting the medical team’s recommendations to discharge. In the team’s view, both were medically stable and no longer required hospitalization in an acute setting. The medical team suspected malingering for both. The social worker and case manager had employed their usual means of gentle persuasion and eliminating psychosocial barriers to no avail. Rather than call the police, the attending physician, social (...) worker, and case manager decided to call ethics. These cases lead the fledgling fellow to consider the appropriate role for ethicists in difficult discharge cases. The article analyzes each case, evaluates their similarities and differences in the context of suspected malingering, and comments on ethical issues surrounding cases of suspected malingering. Finally, I reflect on the value and importance of developing and maintaining epistemic and professional independence. (shrink)

Pratt, Zion, and Loff (2012) correctly point out that most international clinical research (ICR) is not intended to address the vast inequities in access to health care between developed and develo...

Collaboration among nurses and other healthcare professionals is needed for effective hospital discharge planning. However, interprofessional interactions and practices related to discharge vary within and across hospitals. These interactions are influenced by the ways in which healthcare professionals’ roles are being shaped by hospital discharge priorities. This study explored the experience of bedside nurses’ interprofessional collaboration in relation to discharge in a general medicine unit. An ethnographic approach was employed to obtain an in‐depth insight into the (...) perceptions and practices of nurses and other healthcare professionals regarding collaborative practices around discharge. Sixty‐five hours of observations was undertaken, and 23 interviews were conducted with nurses and other healthcare professionals. According to our results, bedside nurses had limited engagement in interprofessional collaboration and discharge planning. This was apparent by bedside nurses’ absence from morning rounds, one‐way flow of information from rounds to the bedside nurses following rounds, and limited opportunities for interaction with other healthcare professionals and decision‐making during the day. The disconnection, disempowerment and devaluing of bedside nurses in patient discharge planning has implications for quality of care and nursing work. Study findings are positioned within previous work on nurse–physician interactions and the current context of nursing care. (shrink)

Evaluating readiness for discharge from the intensive care unit (ICU) is a critical aspect of patient care. Whereas evidence-based criteria for ICU admission have been established, practical criteria for discharge from the ICU are lacking. Often discharge guidelines simply state that a patient no longer meets ICU admission criteria. Such discharge criteria can be interpreted differently by different healthcare providers, leaving a clinical void where misunderstandings of patients’ readiness can conflict with perceptions of what readiness means (...) for patients, families, and healthcare providers. In considering ICU discharge readiness, the use and application of ethical principles may be helpful in mitigating such conflicts and achieving desired patient outcomes. Ethical principles propose different ways of understanding what readiness might mean and how clinicians might weigh these principles in their decision-making process. This article examines the concept of discharge readiness through the lens of the most widely cited ethical principles (autonomy [respect for persons], nonmaleficence/beneficence, and justice) and provides a discussion of their application in the critical care environment. Ongoing bioethics discourse and empirical research are needed to identify factors that help determine discharge readiness within critical care environments that will ultimately promote safe and effective ICU discharges for patients and their families. (shrink)

In February 2016 a twelve-month-old asylum seeker, who came to be know as Baby Asha, was transferred from Nauru and hospitalized in Brisbane. This case came to public attention after Doctors refused to discharge Asha as she would have been returned to detention on Nauru. What in other circumstances would have been considered routine clinical care, quickly turned into an act of civil disobedience. This paper will discuss the ethical aspects of this case, along with its implications for clinicians (...) and the broader healthcare community. (shrink)

‘Terminal discharges’ are carried out in Singapore for patients who wish to die at home. However, if due diligence is not exercised, parallels may be drawn with euthanasia. We present a theoretical discussion beginning with the definition of terminal discharges and the reasons why they are carried out in Singapore. By considering the intention behind terminal discharges and utilising a multidisciplinary team to deliberate on the clinical, social and ethical intricacies with a patient- and context-specific approach, euthanasia is avoided. It (...) is hoped that this will provide a platform for professionals in palliative medicine to negotiate challenging issues when arranging a terminal discharge, so as to avoid the pitfall of committing euthanasia in a country such as Singapore where euthanasia is illegal. It is hoped that a set of guidelines for terminal discharges may someday be realised to assist professionals in Singapore and around the world. (shrink)

As fundamental researchers in the neuroethology of efference copy, we were stimulated by Grush's bold and original synthesis. In the following critique, we draw attention to ways in which it might be tested in the future, we point out an avoidable conceptual error concerning emulation that Grush seems to share with other workers in the field, and we raise questions about the neural correlates of Grush's schemata that might be probed by neurophysiologists.

Discharge planning for vulnerable infants and children is a collaborative, inter-disciplinary, decision-making activity that is grounded in the ethical complexities of clinical practice. Although it is a psychosocial intervention that frequently causes moral distress for professionals and has the potential to inflict harm on children and their families, the process has received little attention from ethicists. An ongoing study of the transition of technology-dependent children from hospital to home suggests that the ethical issues embedded in the discharge-planning process (...) may be concealed by dominant cultural values, institutional policies, clinical standards, historical precedents, and legal regulations. (shrink)

In response to a competitive environment, hospital administrators are pressuring physicians to discharge Medicare patients “sicker and quicker” and to transfer indigent patients from their emergency rooms. This paper compares health administrators' ethics to public expectations regarding financially motivated hospital transfers and discharges. Health administrators use balancing strategies: code morality, survivalism, mission dependency, and tithing. Public expectations, exemplified in P.L. 99–272, P.L. 99–509, and recent case law, are based on norms of potential for patient harm and patient occupancy. These (...) norms are morally preferable to those of health administrators; they reinforce the value of identified lives and the reliability of the health care system. (shrink)

How do we respond to the patient who no longer needs inpatient care but refuses to leave the hospital? Complex hospital discharges commonly involve consideration of legal, financial, clinical, and practical issues. Yet, the ethical and contextual issues embedded in complex inpatient discharges are of concern and have not received adequate attention by medical ethicists. The aim of this work is to encourage clinicians and administrators to incorporate a justice rubric when approaching inpatient discharge dilemmas. This paper presents justice (...) as the ethical principle most neglected in situations involving complex discharges and suggests that a justice focused lens allows clinicians and administrators to move beyond notions of patient autonomy in crafting morally responsible hospital discharge decisions that reflect efficient stewardship of an appropriate share of medically indicated services. This issue deserves additional attention from medical ethicists in the future. (shrink)