Abstract:This paper, presented as the 2019 Cambridge Quarterly Neuroethics NetworkCharcot Lecture, traces the nosology of disorders of consciousness in light of 2018 practice guidelines promulgated by the American Academy of Neurology, the American College of Rehabilitation Medicine and the National Institute on Disability, Independent Living and Rehabilitation Research. By exploring the ancient origins of Jennett and Plum’s persistent vegetative state and subsequent refinements in the classification of disorders of consciousness—epitomized by the minimally conscious state, cognitive motor dissociation, and the (...) recently described chronic vegetative state—the author argues that there is a counter-narrative to the one linking these conditions to the right to die. Instead, there is a more nuanced schema distinguishing futility from utility, informed by technical advances now able to identify covert consciousness contemplated by Jennett and Plum. Their prescience foreshadows recent developments in the disorders of consciousness literature yielding a layered legacy with implications for society’s normative and legal obligations to these patients. (shrink)

While neuroethics is generally thought to be a modern addition to the broader field of bioethics, this subdiscipline has existed in clinical practice throughout the course of the 20th century. In this essay, Fins describes an older tradition of clinical neuroethics that featured such physician-humanists as Sir William Osler, Wilder Penfield, and Fred Plum, whose work and legacy exploring disorders of consciousness is highlighted. Their normative work was clinically grounded and focused on the needs of patients, in contrast (...) to modern neuroethics, which is more speculative and distant from the lived reality of the clinic. Using recent developments in the diagnosis and treatment of disorders of consciousness, and the history of the vegetative and minimally conscious states, Fins asks why modern neuroethics has taken this turn and what can be done to restore clinical neuroethics to a more proportionate place in the field. (shrink)

Ford, Norman In 1972 Brian Jennett and Fred Plum recommended the term 'persistent vegetative state' to describe a state of continuing 'wakefulness without awareness', which can follow a variety of severe insults to the brain. Their description of the syndrome has stood the test of time, but PVS continues to be a source of medical, legal, and ethical debate.

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

Fred Feldman is an important philosopher, who has made a substantial contribution to utilitarian moral philosophy. This collection of ten previously published essays plus a new introductory essay reveal the striking originality and unity of his views. Feldman's version of utilitarianism differs from traditional forms in that it evaluates behaviour by appeal to the values of accessible worlds. These worlds are in turn evaluated in terms of the amounts of pleasure they contain, but the conception of pleasure involved is (...) a novel one and the formulation of hedonism improved. In Feldman's view pleasure is not a feeling but a propositional attitude. He also deals with problems of justice that affect standard forms of utilitarianism. The collection is ideally suited for courses on contemporary utilitarian theory. (shrink)

Heart rate variability (HRV), the change in the time intervals between adjacent heartbeats, is an emergent property of interdependent regulatory systems that operate on different time scales to adapt to challenges and achieve optimal performance. This article briefly reviews neural regulation of the heart, and its basic anatomy, the cardiac cycle, and the sinoatrial and atrioventricular pacemakers. The cardiovascular regulation center in the medulla integrates sensory information and input from higher brain centers, and afferent cardiovascular system inputs to adjust heart (...) rate and blood pressure via sympathetic and parasympathetic efferent pathways. This article reviews sympathetic and parasympathetic influences on the heart, and examines the interpretation of HRV and the association between reduced HRV, risk of disease and mortality, and the loss of regulatory capacity. This article also discusses the intrinsic cardiac nervous system and the heart-brain connection, through which afferent information can influence activity in the subcortical and frontocortical areas, and motor cortex. It also considers new perspectives on the putative underlying physiological mechanisms and properties of the ultra-low-frequency (ULF), very-low-frequency (VLF), low-frequency (LF), and high-frequency (HF) bands. Additionally, it reviews the most common time and frequency domain measurements as well as standardized data collection protocols. In its final section, this article integrates Porges' polyvagal theory, Thayer and colleagues' neurovisceral integration model, Lehrer et al.'s resonance frequency model, and the Institute of HeartMath's coherence model. The authors conclude that a coherent heart is not a metronome because its rhythms are characterized by both complexity and stability over longer time scales. Future research should expand understanding of how the heart and its intrinsic nervous system influence the brain. (shrink)

Let α be any countable admissible ordinal greater than ω. There is a transitive set A such that A is admissible, locally countable, On A = α, and A satisfies Σ 1 -separation. In fact, if B is any nonstandard model of $KP + \forall x \subseteq \omega$ (the hyperjump of x exists), the ordinal standard part of B is greater than ω, and every standard ordinal in B is countable in B, then HC B ∩ (standard part of B) (...) satisfies Σ 1 -separation. (shrink)

Drawing on insights from social learning and social cognitive perspectives and research on the multilevel reality of leadership influences, we developed and tested a multilevel model that examines mechanisms and conditions through which ethical leadership deters work unit- and individual-level ostracism. Based on two field studies using multiple measurement points, we found that at the work unit level of analysis, relational climate partially mediates the negative relationship between ethical leadership and work unit-level ostracism whereas state mindfulness partially mediates the cross-level (...) influence of ethical leadership on individual-level ostracism. Contrary to our hypothesis, we found that the relationship between ethical leadership and relational climate was stronger when work units had a more mechanistic structure, and not when it had an organic work unit structure. Finally, we found that relational climate not only moderates the relationship between state mindfulness and individual-level ostracism, but also moderates the indirect influence of ethical leadership on individual-level ostracism through state mindfulness such that the indirect effect is stronger when relational climate is high as opposed to low. These findings highlight the individual- and work unit-level conditions and mechanisms through which ethical leadership relates to decreased ostracism at work, and thus extends theory and research on ethical leadership and ostracism. (shrink)

Third-party punishment (TPP) occurs when the perpetrator of a transgression is punished by an individual who is not the victim of the transgression and, therefore, not directly affected by it. As F...

The modern theory of computability is based on the works of Church, Markov and Turing who, starting from quite different models of computation, arrived at the same class of computable functions. The purpose of this paper is the show how the main results of the Church-Markov-Turing theory of computable functions may quickly be derived and understood without recourse to the largely irrelevant theories of recursive functions, Markov algorithms, or Turing machines. We do this by ignoring the problem of what constitutes (...) a computable function and concentrating on the central feature of the Church-Markov-Turing theory: that the set of computable partial functions can be effectively enumerated. In this manner we are led directly to the heart of the theory of computability without having to fuss about what a computable function is.The spirit of this approach is similar to that of [RGRS]. A major difference is that we operate in the context of constructive mathematics in the sense of Bishop [BSH1], so all functions are computable by definition, and the phrase “you can find” implies “by a finite calculation.” In particular ifPis some property, then the statement “for eachmthere isnsuch thatP” means that we can construct a functionθsuch thatP)for allm. Church's thesis has a different flavor in an environment like this where the notion of a computable function is primitive.One point of such a treatment of Church's thesis is to make available to Bishopstyle constructivists the Markovian counterexamples of Russian constructivism and recursive function theory. The lack of serious candidates for computable functions other than recursive functions makes it quite implausible that a Bishopstyle constructivist could refute Church's thesis, or any consequence of Church's thesis. Hence counterexamples such as Specker's bounded increasing sequence of rational numbers that is eventually bounded away from any given real number [SPEC] may be used, as Brouwerian counterexamples are, as evidence of the unprovability of certain assertions. (shrink)

We consider notions of boundedness of subsets of the natural numbers ℕ that occur when doing mathematics in the context of intuitionistic logic. We obtain a new characterization of the notion of a pseudobounded subset and we formulate the closely related notion of a detachably finite subset. We establish metric equivalents for a subset of ℕ to be detachably finite and to satisfy the ascending chain condition. Following Ishihara, we spell out the relationship between detachable finiteness and sequential continuity. Most (...) of the results do not require countable choice. (shrink)

Ferreira outlines Bradley’s account of judgment and perception, and then, towards the end of his essay, indicates the sort of reason that Bradley takes to be an argument in favour of his views. I want to look at that argument, but will first summarize Ferreira’s account of Bradley’s views. This account seems to me to make a very important point about the role of feeling in Bradley’s philosophy, specifically that feeling in Bradley’s ontology/epistemology has a very different status and role (...) from that of the feeling=sensation of the empiricists. The latter is indeed “mere” feeling, from Bradley’s point of view, but that feeling which plays a central role in his own philosophy is anything but mere. (shrink)

It is incorrect to construe Hume as a Pyrrhonian sceptic. Or so I have argued elsewhere. To the contrary, Hume in fact offers a detailed defence of the thesis that the norms of scientific inference, that is, the “rules by which to judge of causes and effects”, arereasonablerules to follow in forming our beliefs. Conforming to these rules in its formation of causal beliefs is astrategythe understanding employs in order to satisfy the end of curiosity (T271). Science is reasonable because, (...) so far as we can, within our fallible limits, discover, it is the strategy of belief formation that is the best means of achieving our end of truth, insofar as the latter is, within our fallible limits, attainable. (shrink)

The purpose of this essay is to defend the deductive-nomological model of explanation against a number of criticisms that have been made of it. It has traditionally been thought that scientific explanations were causal and that scientific explanations involved deduction from laws. In recent years, however, this three-fold identity has been challenged: there are, it is argued, causal explanations that are not scientific, scientific explanations that are not deductive, deductions from laws that are neither causal explanations nor scientific explanations, and (...) causal explanations that involve no deductions from laws. The aim of the present essay is to defend the traditional identities, and to show that the more recent attempts at invalidating them fail in their object. More specifically, this essay argues that a Humean version of the deductive-nomological model of explanation can be defended as the correct account of scientific explanation of individual facts and processes, and as the correct account of causal explanations of individual facts and processes. The deductive-nomological model holds that to explain an event E, say that a is G, one must find some initial conditions C, say that a is F, and a law or theory T such that T and C jointly entail E, and both are essential to the deduction. (shrink)

This paper attempts to answer Joseph B. McAllister’s critique o f the epistemology of F. S. C. Northrop. Toward this end an exposition of the essence of Northrop’s theory of knowledge is presented and a simple comparison with McAllister’s similar effort reveals the latter’s deficiencies. I also reveal how McAllister’s criticism of Northrop’s “supposed” realism depends on equating realism in general with one kind, direct realism. If this is so, then Northrop is neither a skeptic nor a moral or legal (...) relativist. (shrink)

This essay argues that Rand's conception of truth marshals all the strengths of the four theories of truth detailed by philosopher Nicholas Rescher: correspondence, coherence, intuitionistic, and pragmatic.

Seddon echoes comments he made in his original Spring 2003 Journal of Ayn Rand Studiesreview of GregNyquist's book, Ayn Rand Contra Human Nature. He argues that Nyquist's reply still does not grasp fully the Objectivist view of logic and the role of induction.