Many with schizophrenia find social interactions a profound and terrifying threat to their sense of self. To better understand this we draw upon dialogical models of the self that suggest that those with schizophrenia have difficulty sustaining dialogues among diverse aspects of self. Because interpersonal exchanges solicit and evoke movement among diverse aspects of self, many with schizophrenia may consequently find those exchanges overwhelming, resulting in despair, the sensation of fusion with another, and/or self-dissolution. In short, compromised dialogical capacities may (...) be a contributing factor to social dysfunction in schizophrenia. (shrink)

Michael Tye’s considered position on visual experience combines representationalism with externalism about color, so when considering spectrum inversion, he needs a principled reason to claim that a person with inverted color vision is seeing things incorrectly. Tye’s responses to the problem of the inverted spectrum ( 2000 , in: Consciousness, color, and content, The MIT Press, Cambridge, MA and 2002a , in: Chalmers (ed.) Philosophy of mind: classical and contemporary readings, Oxford University Press, Oxford) rely on a teleological approach to (...) the evolution of vision to secure the grounds upon which people with normal color vision can be justly called ‘right’ and those with inverted color vision can be called ‘wrong’. I demonstrate that since the inverted spectrum thought experiment requires that both sorts of vision be behaviorally indistinguishable, no biologically acceptable concept of teleology will allow Tye to draw the distinction he needs. (shrink)

In response to new research into the phenomena of inattentional blindness and change- blindness, several philosophers and vision researchers have proposed a novel form of scepticism: they contend that we do not have the conscious experience that we think we have. I will show that this claim is not supported by the evidence usually cited in support of it, and I expose what I believe to be the underlying error motivating this position: the belief that consciousness is either focal (what (...) occupies the focus of attention) or non- existent. Once we appreciate the phenomenology of the periphery of attention, we see that we have the resources to place the problematic phenomena in our peripheral. (shrink)

I contend that Alva Noë’s Enactive Approach to Perception fails to give an adequate account of the periphery of attention. Noë claims that our peripheral experience is not produced by the brain’s representation of peripheral items, but rather by our mastery of sensorimotor skills and contingencies. I offer a two-pronged assault on this account of the periphery of attention. The first challenge comes from Mack and Rock’s work on inattentional blindness, and provides robust empirical evidence for the semantic processing (and (...) hence representation) of some wholly unattended stimuli. The second challenge draws on LaBerge’s theory of attention to provide a substantial advantage to peripheral representations, saving time whenever we shift the focus of our attention to something which had been in the periphery, allowing us to respond to that thing more quickly than would be possible if Noë’s account of perception were correct. (shrink)

As neural implants transition from engineering design and testing into human subjects research, careful consideration must be paid to the ethical elements in developing research protocols. Although these ethical aspects may be framed by the design choices of the engineering, a number of challenging choices arise. In spite of many ethical considerations for neural implant technologies being shared with generic research ethics questions, there are subsets needing special attention. Even in considerations requiring increased attention, substantial overlap can be found with (...) research ethics questions for general medical implants and for psychiatric pharmaceuticals. The special attention to specific ethical questions in neural implants exists because of the value placed on preserving cognition and control as well as our continued memory of significant past research abuses in neurosurgery. This paper focuses on three issues of particular saliency to neural implant testing: inclusion/exclusion of subjects with psychiatric conditions, consent withdrawal of research subjects, and enhancement as a goal. (shrink)

William Rapaport, in “How Helen Keller used syntactic semantics to escape from a Chinese Room,” (Rapaport 2006), argues that Helen Keller was in a sort of Chinese Room, and that her subsequent development of natural language fluency illustrates the flaws in Searle’s famous Chinese Room Argument and provides a method for developing computers that have genuine semantics (and intentionality). I contend that his argument fails. In setting the problem, Rapaport uses his own preferred definitions of semantics and syntax, but he (...) does not translate Searle’s Chinese Room argument into that idiom before attacking it. Once the Chinese Room is translated into Rapaport’s idiom (in a manner that preserves the distinction between meaningful representations and uninterpreted symbols), I demonstrate how Rapaport’s argument fails to defeat the CRA. This failure brings a crucial element of the Chinese Room Argument to the fore: the person in the Chinese Room is prevented from connecting the Chinese symbols to his/her own meaningful experiences and memories. This issue must be addressed before any victory over the CRA is announced. (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)

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)

This reader, a companion to The Open University's four-volume Art of the Twentieth Century series, offers a variety of writings by art historians and art theorists. The writings were originally published as freestanding essays or chapters in books, and they reflect the diversity of art historical interpretations and theoretical approaches to twentieth-century art. Accessible to the general reader, this book may be read independently or to supplement the materials explored in the four course texts. The volume includes a general introduction (...) as well as a brief introduction to each piece, outlining its origin and relevance. (shrink)

The theoretical challenge posed by this paper is to find a conceptualisation of value for entrepreneurship theory grounded in Indigenous knowledge from a Māori perspective capable of guiding entrepreneurs operating for sustainability and wellbeing. We review Western and Māori theories of value, values, and valuation. We argue that Indigenous concepts of value centre on collective wellbeing as opposed to self-interest, and have spiritual and material elements. The paper proposes a tentative Māori theory of value we call manahau, which combines mana (...) (power, authority, and dignity) and hau (vitality of people, places, and objects). We define manahau as an axiological agent Māori entrepreneurs employ to synergistically negotiate cultural and commercial imperatives to achieve multidimensional wellbeing, human potential, and relational balance. We discuss research which illustrates manifestations of manahau in the Māori cultural ethics of utu (reciprocity) in Māori entrepreneurship and tauutuutu (reciprocity and balance) in Māori agribusiness. We argue that an Indigenous Māori theory of value has implications for entrepreneurship theory and practice. (shrink)

Developing cells acquire mature fates in part by selective (i.e. qualitatively different) expression of a few cell‐specific genes. However, all cells share the same basic repertoire of molecular and subcellular building blocks. Therefore, cells must also specialize according to quantitative differences in cell‐specific distributions of those common molecular resources. Here we propose the novel hypothesis that evolutionarily‐conserved transcription factors called scaling factors (SFs) regulate quantitative differences among mature cell types. SFs: (1) are induced during late stages of cell maturation; (2) (...) are dedicated to specific subcellular domains; and, thus, (3) allow cells to emphasize specific subcellular features. We identify candidate SFs and discuss one in detail: MIST1 (BHLHA15, vertebrates)/DIMM (CG8667, Drosophila); professional secretory cells use this SF to scale up regulated secretion. Because cells use SFs to develop their mature properties and also to adapt them to ever‐changing environmental conditions, SF aberrations likely contribute to diseases of adult onset. (shrink)

Corporate environmental performance has become a key focus of business leaders, policy makers, and scholars alike. Today, scholarship on environmental practice increasingly highlights how various aspects of corporate governance can influence environmental performance. However, the prior literature is inconclusive as to whether ownership by insiders (officers and directors) will have positive or negative environmental effects and whether insider voting control or equity control is more salient to environmental outcomes. This article leverages a unique empirical data set of dual-class firms, where (...) insiders have voting rights disproportionate to their equity rights, to shed light on this question. We find that, on average, dual-class firms underperform their single-class peers on environmental measures and that the discrepancy comes from dual-class firms where insiders have more voting control, relative to their equity stake. While small increases in voting control are associated with improved environmental performance, too much (relative to insiders’ equity stake) worsens firms’ environmental performance. Insider equity control alone has no impact on environmental outcomes. Our findings have important implications for agency theory and environmental scholarship by identifying contingencies on the impact of voting and equity-based incentives. This research casts doubt on the idea that providing insiders with significant voting control will aid environmental performance. (shrink)

Clinical ethicists encounter the most emotionally eviscerating medical cases possible. They struggle to facilitate resolutions founded on good reasoning embedded in compassionate care. This book fills the considerable gap between current texts and the continuing educational needs of those actually facing complex ethics consultations in hospital settings. 28 richly detailed cases explore the ethical reasoning, professional issues, and the emotional aspects of these impossibly difficult consultations. The cases are grouped together by theme to aid teaching, discussion and professional growth. The (...) cases inform any reader who has a keen interest in the choices made in real-life medical dilemmas as well as the emotional cost to those who work to improve the situations. On a more advanced level, this book should be read by ethics committee members who participate in ethics consultations, individual ethics consultants, clinicians who seek education about complex clinical ethics cases, and bioethics students. (shrink)

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...

This paper is a conceptual essay rooted in two basic observations. First, felt dignity—the subjective sense people have of their own autonomy and self-worth—ultimately emerges from, and is thus most evident in the connective space between people. Second, stories are everyday works of art that afford unique insight into the subtle complexities of the socio-emotional realities of work. Building on these observations, we describe how personal stories about episodes of interpersonal connections and disconnections at work—moments in which we feel mutual (...) appreciation and empowerment or a sense of separation and distancing from another—can help us better understand the felt experience of dignity at work. In attending to such personal stories as art, we become more attuned to their felt, aesthetic qualities, which then helps us develop a more holistic and visceral appreciation of how actors experience, make sense of, and claim felt dignity. In support of our ideas, we present a few illustrative story excerpts and briefly consider how a select few aesthetic qualities—the way the stories’ elements are configured, the stories’ acuity or sharpness, and their rawness—enhance the felt impact of the stories and help to remind us of their and the storytellers’ intrinsic value. (shrink)

This experiment compared the effects of exposure to masked phobic stimuli at a very brief stimulus-onset asynchrony on spider-phobic and non-phobic individuals. Participants were identified through a widely used questionnaire and a Behavioral Avoidance Test with a live, caged tarantula to establish baseline levels of avoidance. One week later, they were individually administered one of two continuous series of masked images: spiders or flowers. Preliminary masking experiments showed that independent samples of participants from the same populations failed to recognize these (...) stimuli. Participants in the main experiment reported ratings of subjective distress immediately before and after the exposure manipulation. Then they engaged in the BAT once again. Very brief exposure to images of spiders reduced phobic participants’ avoidance of the tarantula. No effects were evidenced on subjective distress, or on non-phobic participants. Theoretical implications for the non-conscious basis of fear are discussed. (shrink)

The vulnerability of patients receiving significantly innovative neurosurgical procedures, either as research or as non-standard therapy, presents particularly potent challenges for those attempting to substantially advance clinical Neurosurgical practice in the most ethically and efficacious manner. This beginning formulation has built into it several important notions about research participation, balancing values, and clinical advancement in the context of neurological illness. For the time being, allow vulnerability to act as a placeholder for circumstances or states of being wherein the established checks (...) and balances of power and interest are no longer sufficient in promoting the just treatment of persons. Further, the phrase to substantially advance Neurosurgical practice encompasses radical innovation as well as significant research into new procedures. Finally, few of these explorations involve true randomized placebo controlled trials, but rather they enroll patients rightfully hoping for some benefit by means of undergoing the procedure.When a neurosurgeon asks me, as an ethicist, to meet with a patient who has medically refractory disease and no good standard therapy options remaining, he is asking for help concerning whether to offer, as a last chance, an unproven therapy as either innovation or research. (shrink)

Seven specific challenges in patient vulnerability related to neurosurgical advancement highlight needed augmentations for standards in innovation and research that do not unduly inhibit access to potential therapies while assuring just treatment of patients.

Beginning in September of 1924, Alfred North Whitehead presented a regular course of 85 lectures which concluded in May of 1925. These represent the first ever philosophy lectures he gave and capture him working out the philosophical implications of the remarkable turns physics had taken in his lifetime. This volume finally recreates these lectures by transcribing notes by W.P. Bell, W.E. Hocking and Louise Heath taken at the time - many of which have only recently been discovered and including hundreds (...) of sketches of Whitehead's blackboard diagrams. This is a unique insight into the evolution of Whitehead's thought during the months when he was drafting his seminal work, Science and the Modern World. (shrink)

We examine the possible states of subsystems of a system of bits or qubits. In the classical case (bits), this means the possible marginal distributions of a probability distribution on a finite number of binary variables; we give necessary and sufficient conditions for a set of probability distributions on all proper subsets of the variables to be the marginals of a single distribution on the full set. In the quantum case (qubits), we consider mixed states of subsets of a set (...) of qubits; in the case of three qubits we find quantum Bell inequalities—necessary conditions for a set of two-qubit states to be the reduced states of a mixed state of three qubits. We conjecture that these conditions are also sufficient. (shrink)

BackgroundFear of cancer recurrence is an important cause of suffering for cancer survivors, and both empirical evidence and theoretical models suggest that prognostic uncertainty plays a causal role in its development. However, the relationship between prognostic uncertainty and FCR is incompletely understood.ObjectiveTo explore the relationship between prognostic uncertainty and FCR among patients with ovarian cancer.DesignA qualitative study was conducted utilizing individual in-depth interviews with a convenience sample of patients with epithelial ovarian cancer who had completed first-line treatment with surgery and/or (...) chemotherapy. Semi-structured interviews explored participants’ understanding of their prognosis; experiences, preferences, and attitudes regarding prognostic information; and strategies for coping with prognostic uncertainty. Inductive qualitative analysis and line-by-line software-assisted coding of interview transcripts was conducted to identify key themes and generate theoretical insights on the relationship between prognostic uncertainty and FCR.ResultsThe study sample consisted of 21 participants, nearly all of whom reported experiencing significant FCR, which they traced to an awareness of the possibility of a bad outcome. Some participants valued and pursued prognostic information as a means of coping with this awareness, suggesting that prognostic uncertainty causes FCR. However, most participants acknowledged fundamental limits to both the certainty and value of prognostic information, and engaged in various strategies aimed not at reducing but constructing and maintaining prognostic uncertainty as a means of sustaining hope in the possibility of a good outcome. Participants’ comments suggested that prognostic uncertainty, fear, and hope are connected by complex, bi-directional causal pathways mediated by processes that allow patients to cope with, construct, and maintain their uncertainty. A provisional dual-process theoretical model was developed to capture these pathways.ConclusionAmong patients with OC, prognostic uncertainty is both a cause and an effect of FCR—a fear-inducing stimulus and a hope-sustaining response constructed and maintained through various strategies. More work is needed to elucidate the relationships between prognostic uncertainty, fear, and hope, to validate and refine our theoretical model, and to develop interventions to help patients with OC and other serious illnesses to achieve an optimal balance between these states. (shrink)

Approaches to clinical ethics dilemmas that rely on basic principles or rules are difficult to apply because of vagueness and conflict among basic values. In response, casuistry rejects the use of basic values, and specification produces a large set of specified rules that are presumably easily applicable. Balancing is a method employed to weigh the relative importance of different and conflicting values in application. We argue against casuistry and specification, claiming that balancing is superior partly because it most clearly exhibits (...) the reasoning behind moral decision-making. Hence, balancing may be most effective in teaching bioethics to medical professionals. (shrink)

Researchers designing a clinical trial may be aware of disputed evidence of serious risks from previous studies. These researchers must decide whether and how to describe these risks in their model informed consent document. They have an ethical obligation to provide fully informed consent, but does this obligation include notice of controversial evidence? With ACCORD as an example, we describe a framework and criteria that make clear the conditions requiring inclusion of important controversial risks. The ACCORD model consent document did (...) not include notice of prior trials with excess death. We develop and explain a new standard labeled risk in equipoise. We argue that our approach provides an optimal level of integrity to protect the informational needs of the reasonable volunteers who agree to participate in clinical trials. We suggest language to be used in a model consent document and the informed consent discussion when such controversial evidence exists. (shrink)

Neil Levy offers the most prominent moral principles that are specifically and exclusively designed to apply to neuroethics. His two closely related principles, labeled as versions of the ethical parity principle , are intended to resolve moral concerns about neurological modification and enhancement [1]. Though EPP is appealing and potentially illuminating, we reject the first version and substantially modify the second. Since his first principle, called EPP , is dependent on the contention that the mind literally extends into external props (...) such as paper notebooks and electronic devices, we begin with an examination of the extended mind hypothesis and its use in Levy’s EPP . We argue against reliance on EMH as support for EPP . We turn to his second principle, EPP , which is not dependent on EMH but is tied to the acceptable claim that the mind is embedded in, because dependent on, external props. As a result of our critique of EPP , we develop a modified version of EPP , which we argue is more acceptable than Levy’s principle. Finally, we evaluate the applicability of our version of EPP. (shrink)

In “Potential Subjects’ Responses to an Ethics Questionnaire in a Phase I Study of Deep-Brain Stimulation in Early Parkinson’s Disease,” Finder, Bliton, Gill, Davis, Konrad, and Charles undertake informed consent research on what they describe as a Phase I trial of deep brain stimulation (DBS) for Parkinson’s disease. We argue that the authors should have more carefully characterized the nature of the DBS study at the start of their clinical study.

Lukas J. Meier et al. offer the promise of a pathway for resolving clinical bioethical problems using an artificial intelligence interface. The ultimate goal, we assume, is...

Benchmarks against which healthcare ethics consultation (HCEC) services can assess their performance are needed. As first-generation benchmarks continue to be developed, it is the obligation of the field to continually evaluate how these measures reflect the performance of any single HCEC service. This will be possible only with widespread reporting of standardized data points. In their article in this issue of The Journal of Clinical Ethics, Glover and colleagues provide a valuable preliminary approach for assessing appropriate consult volumes for a (...) HCEC service. The limitations of their study read as a call to action for the field of clinical ethics to expand and standardize data reporting so that more robust metrics can be developed. In response to this call by Glover and colleagues, the Cleveland Clinic HCEC service provides consult data from 2015 through 2019 for one of its medical centers, and offers an additional volumebased metric, consult-to-ICU-to-bed ratio (CiBR), that may add nuance to any normative assessment of HCEC service consult volume. Given that volume-based metrics are the native language of the clinical environment, efforts to improve such metrics in the field through transparency and standardization are warranted. However, the expositive power of volume-based metrics is limited; additional domains related to quality and outcomes are needed. (shrink)

Volume 19, Issue 11, November 2019, Page 78-80.

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...

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