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)

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)

Once a neural implant has shown some efficacy during initial research trials, it begins to enter the world of clinical application. This culminates when the implant becomes approved for a particular indication. However, the ethical challenges continue as the technology is adopted as a standard of practice. Patient eligibility criteria, as documented by inclusion and exclusion criteria with any new treatment, are not always clearly quantified and defined. These vagaries can result in considerable debate regarding who should or should not (...) proceed with surgery. There is often considerable room for clinical judgment that can result in extension of the treatment to a wider range of patients. The ethical questions that arise in clinical decisionmaking differ significantly from those inherent in engineering design and research development. (shrink)

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

Wexler and Specker Sullivan (2023) note that, “unbridled speculation can imperil the credibility of neuroethics, generate unrealistic expectations amongst different stakeholders, take up time that...

What happens at the end of a clinical trial for an investigational neural implant? It may be surprising to learn how difficult it is to answer this question. While new trials are initiated with increasing regularity, relatively little consensus exists on how best to conduct them, and even less on how to ethically end them. The landscape of recent neural implant trials demonstrates wide variability of what happens to research participants after an neural implant trial ends. Some former research participants (...) continue to receive support for their devices (e.g., battery and component replacements, software updates, etc.). Others, when safe, have their neural implants removed through surgical explantation. Still others continue to live with a deactivated neural implant embedded in their body. In the United States, there are no uniform requirements to provide services, of any kind, after an neural implant study ends, and other nations are similarly facing this challenge. The existence of a post-trial gap in an expanding neural implant research ecosystem invites obvious questions: What is owed to neural implant research participants post-trial, and why has providing it been so difficult to accomplish in practice? To take a step forward on this difficult issue, we assembled one group of stakeholders – researchers funded for neuroethics grants by the National Institutes of Health – to explore possible starting points on one topic: ethical guidance for post-trial care of research participants in neural implant trials. Based on shared concerns discussed in the expert workshop the current paper is a call to action. It reports the key areas of convergence from the meeting and highlights important next steps towards developing much needed guidance. (shrink)

Objective: To examine changes in patients’ desired control of the deep brain stimulator and perception of global life control throughout DBS.Methods: A consecutive cohort of 52 patients with Parkinson’s disease was recruited to participate in a prospective longitudinal study over three assessment points. Semi-structured interviews assessing participants’ desire for stimulation control and perception of global control were conducted at all three points. Qualitative data were coded using content analysis. Visual analog scales were embedded in the interviews to quantify participants’ perceptions (...) of control over time.Results: Participants reported significant increases in their perception of global control over time and significant declines in their desired control of the stimulation. These changes were unrelated to improvements in motor symptoms. Improvements in global control were negatively correlated with a decline in desired stimulation control. Qualitative data indicate that participants have changed, nuanced levels of desired control over their stimulators. Increased global life control following DBS may be attributed to increased control over PD symptoms, increased ability to engage in valued activities, and increased overall self-regulation, while other domains related to global control remained unaffected by DBS.Conclusions: There are few empirical data documenting patients’ desire for stimulation control throughout neuromodulation and how stimulation control is related to other aspects of control despite the growing application of neuromodulation devices to treat a variety of disorders. Our data highlight distinctions in different types of control and have implications for the development of patient-controlled neurostimulation devices. (shrink)

This is one of the seminal articles of the pragmatist tradition where C.S. Peirce sets out his doctrine of doubt and belief --and their relationship to inquiry and clarity of our concepts. Originally published in the Popular Science Monthly; and widely available in reprints and collections of Peirce's writings.

“Probably Peirce’s best-known works are the first two articles in a series of six that originally were collectively entitled Illustrations of the Logic of Science and published in Popular Science Monthly from November 1877 through August 1878. The first is entitled ‘The Fixation of Belief’ and the second is entitled ‘How to Make Our Ideas Clear.’ In the first of these papers Peirce defended, in a manner consistent with not accepting naive realism, the superiority of the scientific method over other (...) methods of overcoming doubt and ‘fixing belief.’” — Robert Burch, “Charles Sanders Peirce,” entry in the Stanford Encyclopedia of Philosophy (2021 revision) -/- “Pragmatist epistemologies often explore how we can carry out inquiries in a self-controlled and fruitful way. (Where much analytic epistemology centres around the concept of knowledge, considered as an idealised end-point of human thought, pragmatist epistemology centres around the concept of inquiry, considered as the process of knowledge-seeking and how we can improve it.) So pragmatists often provide rich accounts of the capacities or virtues that we must possess in order to inquire well, and the rules or guiding principles that we should adopt. A canonical account is Peirce’s classic early paper ‘The Fixation of Belief‘. Here Peirce states that inquiry is a struggle to replace doubt with “settled belief“, and that the only method of inquiry that can make sense of the fact that at least some of us are disturbed by inconsistent beliefs, and will subsequently reflect upon which methods of fixing belief are correct is the Method of Science, which draws on the Pragmatic Maxim described above. This contrasts with three other methods of fixing belief: i) refusing to consider evidence contrary to one’s favored beliefs (the Method of Tenacity), ii) accepting an institution’s dictates (the Method of Authority), iii) developing the most rationally coherent or elegant-seeming belief-set (the A Priori Method).“ — Catherine Legg, “Pragmatism,” entry in the Stanford Encyclopedia of Philosophy (2021 revision). (shrink)

C. S. Lewis sets out to disentangle this knotty issue but wisely adds that in the end no intellectual solution can dispense with the necessity for patience and ...

A repackaged edition of the revered author's classic work that examines the four types of human love: affection, friendship, erotic love, and the love of God—part of the C. S. Lewis Signature Classics series. C.S. Lewis—the great British writer, scholar, lay theologian, broadcaster, Christian apologist, and bestselling author of Mere Christianity, The Screwtape Letters, The Great Divorce, The Chronicles of Narnia, and many other beloved classics—contemplates the essence of love and how it works in our daily lives in one of (...) his most famous works of nonfiction. Lewis examines four varieties of human love: affection, the most basic form; friendship, the rarest and perhaps most insightful; Eros, passionate love; charity, the greatest and least selfish. Throughout this compassionate and reasoned study, he encourages readers to open themselves to all forms of love—the key to understanding that brings us closer to God. (shrink)

Are there dispositions which not only do not manifest, but which could not manifest? We argue that there are dispositions to Ф in circumstances C where C is impossible, and some where Ф is impossible. Furthermore, postulating these dispositions does useful theoretical work. This paper describes a number of cases of dispositions had by objects even though those dispositions are not possibly manifest, and argues for the importance of these dispositions.

Philosophers readily talk about merely verbal disputes, usually without much or any explicit reflection on what these are, and a good deal of methodological significance is attached to discovering whether a dispute is merely verbal or not. Currently, metaphilosophical advances are being made towards a clearer understanding of what exactly it takes for something to be a merely verbal dispute. This paper engages with this growing literature, pointing out some problems with existing approaches, and develops a new proposal which builds (...) on their strengths. (shrink)

This paper takes the form of a critical discussion of Crispin Wright’s notion of entitlement of cognitive project. I examine various strategies for defending the claim that entitlement can make acceptance of a proposition epistemically rational, including one which appeals to epistemic consequentialism. Ultimately, I argue, none of these strategies is successful, but the attempt to isolate points of disagreement with Wright issues in some positive proposals as to how an epistemic consequentialist should characterize epistemic rationality.

Under what circumstances if ever ought we to grant that Artificial Intelligences (AI) are persons? The question of whether AI could have the high degree of moral status that is attributed to human persons has received little attention. What little work there is employs western conceptions of personhood, while non-western approaches are neglected. In this article, I discuss African conceptions of personhood and their implications for the possibility of AI persons. I focus on an African account of personhood that is (...) prima facie inimical to the idea that AI could ever be ‘persons’ in the sense typically attributed to humans. I argue that despite its apparent anthropocentrism, this African account could admit AI as persons. (shrink)

On the occasion of the 50th anniversary of C. S. Lewis’s death, a special annotated edition of his Christian classic, The Screwtape Letters, with notes and excerpts from his other works that help illuminate this diabolical masterpiece. Since its publication in 1942, The Screwtape Letters has sold millions of copies worldwide and is recognized as a milestone in the history of popular theology. A masterpiece of satire, it offers a sly and ironic portrayal of human life and foibles from the (...) vantage point of Screwtape, a highly placed assistant to “Our Father Below.” At once wildly comic, deadly serious, and strikingly original, The Screwtape Letters comprises the correspondence of the worldly-wise devil Screwtape and his nephew Wormwood, a novice demon in charge of securing the damnation of an ordinary young man. For the first time, The Screwtape Letters will be presented in full-text accompanied by helpful annotations in a striking two-color format. These annotations will give fans a deeper, more nuanced understanding of the popular book, providing background information, explanations of terms, historical significance, and excerpts from Lewis’s other works that more fully explain the ideas in this volume. For both expert Lewis fans and casual readers, The Screwtape Letters: Annotated Edition will be a beautiful and insightful guide to a beloved classic. (shrink)

Persons think. Bodies, time-slices of persons, and brains might also think. They have the necessary neural equipment. Thus, there seems to be more than one thinker in your chair. Critics assert that this is too many thinkers and that we should reject ontologies that allow more than one thinker in your chair. I argue that cases of multiple thinkers are innocuous and that there is not too much thinking. Rather, the thinking shared between, for example, persons and their bodies is (...) exactly what we should expect at the intersection of part sharing and the supervenience of the mental on the physical. I end by responding to the overcrowding objection, the personhood objection, the personal-pronoun reference problem and the epistemic objection. (shrink)

C. S. Lewis takes us on a profound journey through both heaven and hell in this engaging allegorical tale. Using his extraordinary descriptive powers, Lewis introduces us to supernatural beings who will change the way we think about good and evil.

Are a statue and the lump of clay that constitutes it one object or two? Many philosophers have answered ‘two’ because the lump seems to have properties, such as the property of being able to survive flattening, that the statue lacks. This answer faces a serious problem : it seems that nothing grounds the difference in properties between colocated objects. The statue and lump are in the same environment and inherit properties from the same composing parts. But it seems that (...) differences in properties should be grounded. For this reason, philosophers including Mark Heller, Dean Zimmerman, Theodore Sider, Trenton Merricks, and Eric Olson have rejected the answer ‘two’. -/- I offer a solution to the grounding problem, in order to revive the traditional account. I argue that extrinsic relations contribute to the supervenience base of many kinds or sorts, and these extrinsic relations ground differences between colocated objects, such as statues and lumps of clay, human beings and lumps of tissue, and planets and masses of matter. The same collection of parts can stand in more than one extrinsic relation, with each relation grounding the composition of a distinct kind of object. In cases in which this happens, the properties of each object differ from the properties of other objects that share the same parts. (shrink)

C. S. Lewis sets out to persuade his audience of the importance and relevance of universal values such as courage and honor in contemporary society.

I argue that mind-independence realism should be characterised in terms of what I call 'essential', rather than 'modal', independence from our mental lives. I explore the connections between the two kinds of independence, and argue that characterizations in terms of essence respect more intuitions about what realism is, harmonize better with standard characterizations of anti-realism, and avert the threat of subversion from Blackburn's quasi-realist.

In recent work Timothy Williamson argues that the epistemology of metaphysical modality is a special case of the epistemology of counterfactuals. I argue that Williamson has not provided an adequate argument for this controversial claim, and that it is not obvious how what he says should be supplemented in order to derive such an argument. But I suggest that an important moral of his discussion survives this point. The moral is that experience could play an epistemic role which is more (...) epistemically significant than a mere 'enabling' role but not equivalent to an evidential role. (shrink)

The purpose of this paper is to clarify what metaontological realism, as discussed in contemporary metaontological literature, amounts to. Although metaontological debates are of relatively long standing, the terms ‘realism’ and ‘anti‐realism’ have only recently come to be regularly applied to metaontological positions. The new usage is not fully stable. This paper aims to: (1) distinguish three key claims associated with the term ‘realism’ in metaontology, and give some initial reasons why it is important to be very clear about the (...) differences between these claims; (2) argue that the three ‘realist’ claims are independent of one other; and (3) argue that the label ‘ontological realism’ is best attached to just one of the three claims, namely the claim that the facts of ontology are objective. (shrink)

forthcoming in R. Cameron, B. Hale and A. Hoffmann (ed.s), The Logic, Epistemology and Metaphysics of Modality, Oxford University Press. Presents a concept-grounding account of modal knowledge.

We discuss explanation of an earlier event by a later event, and argue that prima facie cases of backwards event explanation are ubiquitous. Some examples: (1) I am tidying my flat because my brother is coming to visit tomorrow. (2) The scarlet pimpernels are closing because it is about to rain. (3) The volcano is smoking because it is going to erupt soon. We then look at various ways people might attempt to explain away these prima facie cases by arguing (...) that in each case the 'real' explanation is something else. We argue that none of the explaining-away strategies are successful, and so any plausible account of explanation should either make room for backwards explanation, or have a good story to tell about why it doesn't have to. (shrink)

forthcoming in Philosophy Compass. This is a paper which aims both to survey the field and do some work at its cutting edge.

Craig casts doubt upon the project of trying to give the traditional sort of necessary and sufficient conditions for A knows that p. He interprets the inadequacy of existing analyses of knowledge as evidence that our concept of knowledge is complex and diffuse, and concludes that we should aim to understand it by thinking about the rôle the concept plays in our lives, rather than by trying to find necessary and sufficient conditions for the truth of knowledge ascriptions.There is surely (...) something right about Craig's view: we are unlikely to succeed in any attempt to analyse away the intricacies in our concept of knowledge. We cannot realistically hope to uncover a set of necessary and sufficient conditions for A knows that p which are in all cases either clearly satisfied or clearly not satisfied. Nor, I suspect, is it possible to offer necessary and sufficient conditions for knowledge which are widely accepted as being more securely understood than knowledge itself. (shrink)

This chapter attempts to put structure on some of the different philosophical uses of ‘intuition’. It argues that ‘intuition’-hood is associated with four bundles of symptoms: a commonsensicality bundle; an a prioricity and immediacy bundle, and a metaphilosophical bundle. Tentatively suggesting that the word ‘intuition’ as used by philosophers is best regarded as ambiguous, the chapter offers a much simpler view concerning the meaning of ‘intuition’ in philosophy. With some of the attacks on ‘intuition’ as an epistemic source explored, the (...) chapter concludes that one significant kind of philosophical ‘intuition’, related to a prioricity and conceptual truth, can be defended against a range of typical epistemological challenges. (shrink)