Behavioural variant frontotemporal dementia (bvFTD) is a subtype of frontotemporal dementia characterized by changes in personality, social behaviour, and cognition. Although neural abnormalities cause bvFTD patients to struggle with inhibiting problematic behaviour, they are generally considered fully autonomous individuals. Subsequently, bvFTD patients demonstrate understanding of right and wrong but are unable to act in accordance with moral norms. To investigate the ethical, legal, and social issues associated with bvFTD, we conducted a scoping review of academic literature with inclusion & exclusion (...) criteria and codes derived from our prior work. Among our final sample of fifty-six articles, four mentioned bvFTD patient-offenders as unfit to stand trial by insanity, and sixteen mentioned the use of dementia evidence in a court of law to better understand the autonomy of bvFTD patients. Additional emergent issues that were discovered include: training police officers to handle situations involving bvFTD patients and educating healthcare providers on how to help caregivers navigate bvFTD. The current literature highlights the inadequacy of traditional applications of medico-legal categories such as autonomy, capacity and competence, in informing cognitive capacity assessments in clinical and legal settings and deserves consideration by neuroethicists. (shrink)

Since at least the 1960s, deontic logicians and ethicists have worried about whether there can be normative systems that allow conflicting obligations. Surprisingly, however, little direct attention has been paid to questions about how we may reason with conflicting obligations. In this paper, I present a problem for making sense of reasoning with conflicting obligations and argue that no deontic logic can solve this problem. I then develop an account of reasoning based on the popular idea in ethics that reasons (...) explain obligations and show that it solves this problem. (shrink)

The dead donor rule, which requires that organ donors not be killed by the process of organ procurement, is thought to protect vulnerable patients from exploitation and from being harmed through organ procurement. In current practice, the majority of transplantable organs are retrieved from patients who are declared dead by neurological criteria, or "brain-dead." Because brain death is considered to be sufficient for death, it is thought that brain-dead donors are neither harmed nor wronged by organ removal.In this essay I (...) argue that this is not the case. Brain-dead donors can be, and many are, harmed and wronged by... (shrink)

The didactic proposal of the post-constructivist (Grossi, 2005), takes into account the relationship between the subject, reality, others and the Other interior and considers the learning potential of all students. Its theoretical foundation is, among other things, the principle that learning is a social phenomenon, and that the spatial organization of the class, in groups of adults, promotes the teaching-learning process. Post-constructivism is a didactic proposition that allows us to respond to the purpose of teaching all students. This article on (...) group work in post-constructivism aims to analyze the change in posture of teachers, and the professional development that follows, and which demonstrates a break with the traditional form of education. The trick of the identified researcher is then to take up in a teacher training, through the aulic groups in the Geempa class and the weekly study group, the scientific approach of post-constructivism. (shrink)

In an earlier study by Nair,1 undergraduate national servicemen were interviewed regarding their perceptions on their conscript experience and nation-building. The present study examines the congruent perceptions of military commanders in the context of social psychological theory and research. Twenty senior military commanders were selected to represent a cross-section of formations and appointments in the army. They were individually interviewed with particular reference to their recall of policies, procedures and practices in conscript service that might have a bearing on (...) nation- building. Verbatim transcriptions of each interview were scrutinized and responses coded and tallied. There was clear identification of the unifying effect of common barracks and training regimes across economic, ethnic and religious differences. The findings provide converging evidence for the presence of the psychological effects of superordinate goals,2 the minimal group paradigm, 3 and the contact hypothesis,4 serving to build a cohesive nation. There were also recurrent and converging attributions of the military experience resulting in national servicemen with the qualities of discipline, responsibility, team spiritedness and physical fitness. It was perceived that these acquired positive qualities were carried over to civilian life and characterized the Singapore workforce. (shrink)

Business ethics researchers and practitioners are interested in understanding the temporal mechanisms of various managerial activities, processes, and policies. In this direction, I borrow notions of time from Virginia Woolf’s _Mrs. Dalloway_ to examine how social time intersperses with the paid and (unpaid) care work of female employees during the pandemic. I explore how discussions of social time in connection to care work appear in newspaper discourses of “shecession”, i.e. the large-scale job/income losses experienced by women during the COVID-19 pandemic. (...) Since shecession is a byproduct of the pandemic times, exploring the role of time in it is crucial. In fact, my findings show that the macro social time of the pandemic affects working women with care responsibilities who are situated at the intersection of multiple vulnerable social categories by simultaneously being a penalizer and a lost opportunity. Similarly, I also find that the micro social times of working women embed, stratify, and synchronize differently during the pandemic when compared to normal times. Working women with care responsibilities are thus adversely affected by both micro and macro social time changes. My findings, therefore, could be instrumental in developing and implementing inclusive policies and processes in business organizations and labor markets. In so doing, my study also indicates how a consideration of social time enriches the application of care ethics in work contexts. Ultimately, this article is also about developing caring organizations, societies, and families which care for the caregivers (working women), since receiving care is a precondition of giving care. (shrink)

Though there have been productive interactions between moral philosophers and deontic logicians, there has also been a tradition of neglecting the insights that the fields can offer one another. The most sustained interactions between moral philosophers and deontic logicians have notbeen systematic but instead have been scattered across a number of distinct and often unrelated topics. This chapter primarily focuses on three topics. First, we discuss the “actualism/possibilism” debate which, very roughly, concerns the relevance of what one will do at (...) some future time to what one ought to do at present (§2). This topic is also used to introduce various modal deontic logics. Second we discuss the particularism debate which, very roughly, concerns whether there can be any systematic general theory of what we ought to do (§3). This topic is also used to introduce various non-modal deontic logics. Third, we discuss collective action problems which concern the connection between the obligations of individuals and the behavior and obligations of groups of individuals (§4).This topic is also used to discuss formal systems that allow us to study the relationship between individuals and groups. The chapter also contains a general discussion of the relation between ethical theory and deontic logic (§1) and a brief consideration of other miscellaneous topics (§5). (shrink)

Physicians participate in several kinds of activities in their professional lives. Clinical care is the core function of the physician. Medical education is overwhelmingly oriented toward this func...

Frank Miller and I recently argued that the common assertion that ‘brain dead’ patients merely appear to be alive, though in reality are dead, is false.1 This assertion relies on an inaccurate and overly simplistic understanding of the role of medical technology in the physiology of a ‘brain dead’ patient. In response, Symons and Chua endorsed our conclusions regarding the vital status of the ventilated ‘brain dead’ patient, and then pursued the question: what does this imply if we are to (...) preserve the dead donor rule?2 To their credit, Symons and Chua unflinchingly acknowledge that if we seek to maintain the dead donor rule then we must restrict not expand the donor pool because ‘brain dead’ individuals are still living. This would mean fewer organs, and hence more deaths of those on the waiting list. This is the price of holding to the conviction that doctors must never kill patients in order to procure organs for transplantation. Of course, that has always been the price: the dead donor rule is principally a deontic prohibition, not a consequentialist rule designed to maximise good outcomes. Symons’s and Chua’s view is a valid position in the debate on death and the ethics of vital organ procurement, and …. (shrink)

This paper is an enquiry into some commonalities between fiction and atheism. It suggests that ‘disbelief’ may be a state of mind shared by both and asks how a meaningful semantics might be derived from the mental stance of disbelief. Albert Camus’ The Plague, published in 1947 post the trauma of two successive world wars, is a key ‘existentialist’ text that focuses on this dilemma. Not only is this work of fiction especially relevant to our current times of natural, political, (...) economic and psychological distress gone ‘viral’, it is also one in which a blunt question is posed to the atheist hero of the novel, Doctor Rieux, in Oran, a small French Algerian town fighting a terrible pandemic: ‘Do you believe in God, doctor?’. Rieux’s answer is telling: ‘No, but what does that really mean? I’m fumbling in the dark, struggling to make something out.’ It is this human ‘struggle’ to discern the contours of the invisible ‘in the dark’ that could animate the thought worlds of fiction as well as of atheism. The paper seeks to draw out some of these putative similarities through the lens of ‘ordinary language philosophy’ and J.L, Austin and John Searle’s classification of basic speech-acts. It also considers the evolutionary, affective and cross-cultural appeal of the parallel narratives of science and religion. Oran’s most remarkable aspect, Camus insists, is its ‘ordinariness’; yet, it is here that the ‘extraordinariness’ of the plague strikes. Quotidian local circumstances thus paradoxically set in motion the sorts of ‘universal’ inquiries into ‘what it means to be human’ that, my paper argues, alike motivate the fiction of atheism and the atheism of fiction. (shrink)

Some patients who have been diagnosed as “dead by neurologic criteria” continue to exhibit certain brain functions, most commonly, neuroendocrine functions. This preservation of neurologic function after the diagnosis of “brain death” or “brainstem death” is an ongoing source of controversy and concern in the medical, bioethics, and legal literatures. Most obviously, if some brain function persists, then it is not the case that all functions of the entire brain have ceased and hence, declaring such a patient to be “dead” (...) would be a false positive, in any nation with so-called “whole brain death” laws. Furthermore, and perhaps more concerning, the preservation of any brain function necessarily entails the preservation of some amount of brain perfusion, thereby raising the concern as to whether additional areas of neural tissue may remain viable, including areas in the brainstem. These and other considerations cast significant doubt on the reliability of diagnosing either “brain death” or “brainstem death.”. (shrink)

The concept of death and its relationship to organ transplantation continue to be sources of debate and confusion among academics, clinicians, and the public. Recently, an international group of scholars and clinicians, in collaboration with the World Health Organization, met in the first phase of an effort to develop international guidelines for determination of death. The goal of this first phase was to focus on the biology of death and the dying process while bracketing legal, ethical, cultural, and religious perspectives. (...) The next phase of the project will include a broader group of stakeholders in the development of clinical practice guidelines and will use expert consensus on biomedical criteria for death from the first phase as scientific input into normative deliberation about appropriate policies and practices. Surely, science alone cannot resolve the normative and philosophical questions intertwined in debates about moral status, legal and moral rights, the ethics of killing, and personhood and the nature of the self; however, scientific input is necessary for informed moral deliberation. An objective and unbiased investigation of the biology of death is independent of, and should be undertaken prior to, an analysis of the normative questions engendered by debate about determination of death. This strategy is explicitly endorsed by the International Guidelines for Determination of Death and reflects the prevailing view of these issues in the mainstream medical literature. However, this mainstream literature, exemplified by the IGDD group's recent report, does not exhibit any of the characteristics usually associated with a scientifically rigorous investigation, such as making empirically testable and falsifiable claims, a commitment to evidence and logic over authoritative assertion, or a willingness to revise hypotheses and theories in light of new evidence. Indeed, the core claims and methodologies of the mainstream medical literature on death, both of which are represented by the IGDD report, are not merely scientifically unjustified; they are not science at all. This situation creates a problem for the integrity of science and the academy, and it unjustly obscures and prevents legitimate democratic and moral deliberation about issues that, at bottom, are normative, not scientific. (shrink)

Engineering is a practice that must function in an environment of incomplete and uncertain knowledge. This environment has become even more difficult in an increasingly complex world. Engineering ethics has to be framed and taught in a way that addresses these realities. This paper proposes a combination of the philosophy of pragmatism and the ethic of care as a possible framework for the practice of engineering ethics that can provide flexibility and openness to address engineering ethics problems more realistically within (...) the ethos and culture of engineering. Embedding values into practice, pragmatism and care provide a broad, reflective, and corrective framework for engineering ethics that can accommodate the realities in which engineering operates. It is shown that these two approaches are more consonant with design methodologies and have a natural fit with design thinking, so they mesh well with what engineers do and with the complexities of their work today. As humans more and more try to alter the socio-techno-natural world, e.g., the earth’s climate, the combination of pragmatism and care will allow enhanced ethical behavior. Alterations to complex adaptive systems will produce highly uncertain results that require engineers to have a mindset that allows them to act with humility in the face of significant uncertainty and potential catastrophic failures. (shrink)

One family of maximizing act consequentialist theories are actualist direct theories. Indeed, historically there are at least three different forms of actualist direct consequentialism (due to Bentham, Moore, and contemporary consequentialists). This paper is about the logical differences between these three actualist direct theories and the differences between actualist direct theories and their competitors. Three main points emerge. First, the sharpest separation between actualist direct theories and their competitors concerns the so-called inheritance principle. Second, there are a myriad of other (...) logical differences among actualist direct theories. Third, one theory (Moore's theory) stands out among actualist direct theories because it entails a variety of logical principles. This fact may count in favor of that theory. (shrink)

Brain dead organ donors are the principal source of transplantable organs. However, it is controversial whether brain death is the same as biological death. Therefore, it is unclear whether organ removal in brain death is consistent with the ‘dead donor rule’, which states that organ removal must not cause death. Our aim was to evaluate the public9s opinion about organ removal if explicitly described as causing the death of a donor in irreversible apneic coma. We conducted a cross-sectional internet survey (...) of the American public (n=1096). Questionnaire domains included opinions about a hypothetical scenario of organ removal described as causing the death of a patient in irreversible coma, and items measuring willingness to donate organs after death. Some 71% of the sample agreed that it should be legal for patients to donate organs in the scenario described and 67% agreed that they would want to donate organs in a similar situation. Of the 85% of the sample who agreed that they were willing to donate organs after death, 76% agreed that they would donate in the scenario of irreversible coma with organ removal causing death. There appears to be public support for organ donation in a scenario explicitly described as violating the dead donor rule. Further, most but not all people who would agree to donate when organ removal is described as occurring after death would also agree to donate when organ removal is described as causing death in irreversible coma. (shrink)

The established view regarding ‘brain death’ in medicine and medical ethics is that patients determined to be dead by neurological criteria are dead in terms of a biological conception of death, not a philosophical conception of personhood, a social construction or a legal fiction. Although such individuals show apparent signs of being alive, in reality they are dead, though this reality is masked by the intervention of medical technology. In this article, we argue that an appeal to the distinction between (...) appearance and reality fails in defending the view that the ‘brain dead’ are dead. Specifically, this view relies on an inaccurate and overly simplistic account of the role of medical technology in the physiology of a ‘brain dead’ patient. We conclude by offering an explanation of why the conventional view on ‘brain death’, though mistaken, continues to be endorsed in light of its connection to organ transplantation and the dead donor rule. (shrink)

The controversy over brain death and the dead donor rule continues unabated, with some of the same key points and positions starting to see repetition in the literature. One might wonder whether some of the participants are talking past each other, not all debating the same issue, even though they are using the same words (e.g., “death”). One reason for this is the complexity of the debate: It’s not merely about the nature of human life and death. Interwoven into this (...) debate are deep philosophical issues on realism, the normative/descriptive distinction, the relation of thought and language to the world, the mind–body problem, personhood, moral status, and the ethics of killing. There are also social and legal .. (shrink)

We thank the authors of commentaries for their thoughtful discussion of our target article. Here we briefly summarize the points made in the target article (Nair-Collins and Joffe 2023). Then we em...

ABSTRACT:Organismal superposition holds that the same individual both is and is not an organism, as a consequence of organismal pluralism. When coupled with the assumption that death is the cessation of an organism, this entails that there is no unique answer as to whether brain death is biological death. This essay argues that concerns about organismal pluralism and superposition do not undermine a theory of biological death, nor entail any metaphysical indeterminacy about the biological vital status of a brain-dead individual.

The book discusses citizenship in the contemporary world; as a concept, as an ideal, as a policy and as a goal to be achieved from the perspective of different academic disciplines.

Reasons can interact in a variety of ways to determine what we ought to do or believe. And there can be cases where two reasons to do an act or have a belief are individually worse than a reason to not do that act or have that belief, but the reasons together are better than the reason to not do that act or have that belief. So the reasons together―which we can call the accrual of those reasons—can have a strength (...) that is an increasing function of the strengths of the individual reasons. In this paper, we will look at how reasons determine what we ought to do and believe in cases where the accrual of reasons is relevant. Our focus will not primarily be on questions about the nature of individual reasons and their weight. Instead, we will at the outset rely on our pretheoretical grip on what reasons there are and how weighty they are individually and ask the more formal or structural question of how to determine the strength of their accrual based on these facts. In looking at these issues, my goal will not be anything as ambitious as developing a full theory of the accrual of reasons. Rather, my goal will be more modest: I will introducing some of the challenges for providing an adequate model and argue that a promising approach to resolving these challenges involves making use of the familiar distinction in moral philosophy between derivative and non-derivative normative notions. (shrink)

Legally defining “death” in terms of brain death unacceptably obscures a value judgment that not all reasonable people would accept. This is disingenuous, and it results in serious moral flaws in the medical practices surrounding organ donation. Public policy that relies on the whole-brain concept of death is therefore morally flawed and in need of revision.

Background Doctors sometimes encounter parents who object to prescribed treatment for their children, and request suboptimal substitutes be administered instead. Previous studies have focused on parental refusal of treatment and when this should be permitted, but the ethics of requests for suboptimal treatment has not been explored. Methods The paper consists of two parts: an empirical analysis and an ethical analysis. We performed an online survey with a sample of the general public to assess respondents’ thresholds for acceptable harm and (...) expense resulting from parental choice, and the role that religion played in their judgement. We also identified and applied existing ethical frameworks to the case described in the survey to compare theoretical and empirical results. Results Two hundred and forty-two Mechanical Turk workers took our survey and there were 178 valid responses. Respondents’ agreement to provide treatment decreased as the risk or cost of the requested substitute increased. More than 50% of participants were prepared to provide treatment that would involve a small absolute increased risk of death for the child and a cost increase of US$<500, respectively. Religiously motivated requests were significantly more likely to be allowed. Existing ethical frameworks largely yielded ambiguous results for the case. There were clear inconsistencies between the theoretical and empirical results. Conclusion Drawing on both survey results and ethical analysis, we propose a potential model and thresholds for deciding about the permissibility of suboptimal treatment requests. (shrink)

How do multiple reasons combine to support a conclusion about what to do or believe? This question raises two challenges: How can we represent the strength of a reason? How do the strengths of multiple reasons combine? Analogous challenges about confirmation have been answered using probabilistic tools. Can reductive and nonreductive theories of reasons use these tools to answer their challenges? Yes, or more exactly: reductive theories can answer both challenges. Nonreductive theories, with the help of a result in confirmation (...) theory, can answer one, and there are grounds for optimism that they can answer the other. (shrink)

A “universalist” policy on brain death holds that brain death is death, and neurologic criteria for death determination are rightly applied to all, without exemptions or opt outs. This essay argues that advocates of a universalist brain death policy defend the same sort of coercive control of end-of-life decision-making as “pro-life” advocates seek to achieve for reproductive decision-making, and both are grounded in an illiberal political philosophy. Those who recognize the serious flaws of this kind of public policy with respect (...) to abortion must apply the same logic to brain death. (shrink)

A traditional picture is that cases of deontic constraints--- cases where an act is wrong (or one that there is most reason to not do) even though performing that act will prevent more acts of the same morally (or practically) relevant type from being performed---form a kind of fault line in ethical theory separating (agent-neutral) consequentialist theories from other ethical theories. But certain results in the recent literature, such as those due to Graham Oddie and Peter Milne in "Act and (...) Value", do not sit well this traditional wisdom. My aim in this paper is to argue that both the traditional wisdom and Oddie and Milne are mistaken. I begin by looking more closely at the traditional wisdom and why it fails (§1). Then I develop my account of this fault line in ethical theory and its importance (§2). Finally I show that a diagnosis of where Oddie and Milne go wrong follows as a corollary of this new account (§3). An important upshot will be that discussions of cases of deontic constraints would do best to focus on the account of the nature and importance of the cases identified in this paper rather than continuing to work with the mistaken traditional picture. (shrink)

One of the popular albeit controversial ideas in the last century of moral philosophy is that what we ought to do is explained by our reasons. And one of the central features of reasons that accounts for their popularity among normative theorists is that they can conflict. But I argue that the fact that reasons conflict actually also poses two closely related problems for this popular idea in moral philosophy. The first problem is a generalization of a problem in deontic (...) logic concerning the existence of conflicting obligations. The second problem arises from a tension between the fact that reasons can conflict and a model of how reasons explain ‘ought’s that has been widely accepted. Having presented each of these problems, I develop a unified solution to them that is informed by results in both ethics and deontic logic. An important implication of this solution is that we must distinguish between derivative and nonderivative reasons and revise our conception how it is that reasons explain ‘ought’s. (shrink)