According to international scientific medical consensus, death is a biological, unidirectional, ontological state of an organism, the event that separates the process of dying from the process of disintegration. Death is not merely a social contrivance or a normative concept; it is a scientific reality. Using this paradigm, the international consensus is that, regardless of context, death is operationally defined as “the permanent loss of the capacity for consciousness and all brainstem function. This may result from permanent cessation of circulation (...) or catastrophic brain injury. In the context of death determination, ‘permanent’ refers to loss of function that cannot resume spontaneously and will not be restored through intervention.” The word “permanent” replaces “irreversible” (used in the United States’ 1980 Uniform Declaration of Death Act) in this new definition, arguably invented to allow donation after circulatory determination of death (DCDD) while still complying with the dead donor rule. I will show that this invention fails, for at least four reasons. (shrink)

This paper examines the affective disorders plaguing many young people and the problem of attention-deficit hyperactivity disorder in particular. It aims to define the limits of the critique of British educationalist Sir Ken Robinson in terms of his philosophy of ‘creativity’ through a consideration of the ideas of French philosopher Bernard Stiegler, especially the notions of ‘industrial temporal objects’ and stupidity. It makes the case for adopting elements of each distinct research paradigm as a prolegomena to forging a social critique (...) of capitalist-dominated, market-led educational institutions. The former, it will be seen, identifies some of the problems facing teachers in terms of the use and application of technology, the false divide between arts and the humanities, but falls short of explaining the root of the structural and psychic malaise in neo-liberal regimes regarding classroom breakdown in general. The latter, despite the apocalyptic tone of some his pronouncements provides an update and radicalization of Deleuze’s societies of control thesis in terms of what Stiegler designates ‘uncontrollable societies’. Stiegler, it will be seen, presents a critique of technology that is all the more pressing in an age in which the loss of expectation in the lives of young people can lead to a corresponding fall off or destruction in ‘deep attention’. I want to test the hyperbole of Stiegler’s assertion that young people today suffer from a ‘colossal’ attention deficit disorder of unprecedented scale and magnitude. (shrink)

Objective: Contemporary ethical accounts of the patient-provider relationship emphasise respect for patient autonomy and shared decision making. We sought to examine the relative influence of involvement in decisions, confidence and trust in providers, and treatment with respect and dignity on patients’ evaluations of their hospital care.Design: Cross-sectional survey.Setting: Fifty one hospitals in Massachusetts.Participants: Stratified random sample of adults discharged from a medical, surgical, or maternity hospitalisation between January and March, 1998. Twelve thousand six hundred and eighty survey recipients responded.Main outcome (...) measure: Respondent would definitely be willing to recommend the hospital to family and friends.Results: In a logistic regression analysis, treatment with respect and dignity 3.4, 99% confidence interval 2.8 to 4.2) and confidence and trust in providers were more strongly associated with willingness to recommend than having enough involvement in decisions . Courtesy and availability of staff , continuity and transition , attention to physical comfort , and coordination of care were also significantly associated with willingness to recommend.Conclusions: Confidence and trust in providers and treatment with respect and dignity are more closely associated with patients’ overall evaluations of their hospitals than adequate involvement in decisions. These findings challenge a narrow emphasis on patient autonomy and shared decision making, while arguing for increased attention to trust and respect in ethical models of health care. (shrink)

Many believe that the ethical problems of donation after cardiocirculatory death (DCD) have been "worked out" and that it is unclear why DCD should be resisted. In this paper we will argue that DCD donors may not yet be dead, and therefore that organ donation during DCD may violate the dead donor rule. We first present a description of the process of DCD and the standard ethical rationale for the practice. We then present our concerns with DCD, including the following: (...) irreversibility of absent circulation has not occurred and the many attempts to claim it has have all failed; conflicts of interest at all steps in the DCD process, including the decision to withdraw life support before DCD, are simply unavoidable; potentially harmful premortem interventions to preserve organ utility are not justifiable, even with the help of the principle of double effect; claims that DCD conforms with the intent of the law and current accepted medical standards are misleading and inaccurate; and consensus statements by respected medical groups do not change these arguments due to their low quality including being plagued by conflict of interest. Moreover, some arguments in favor of DCD, while likely true, are "straw-man arguments," such as the great benefit of organ donation. The truth is that honesty and trustworthiness require that we face these problems instead of avoiding them. We believe that DCD is not ethically allowable because it abandons the dead donor rule, has unavoidable conflicts of interests, and implements premortem interventions which can hasten death. These important points have not been, but need to be fully disclosed to the public and incorporated into fully informed consent. These are tall orders, and require open public debate. Until this debate occurs, we call for a moratorium on the practice of DCD. (shrink)

Volume 20, Issue 6, June 2020, Page 42-44.

In this experimental piece of writing I want to think about the pedagogy of contact and the plight of the hikikomori or social recluse in Japan. I am interested in exploring how the hikikomori practices a kind of contactlessness or what I will call a deadly ipseity of desire. What does it mean to resist contact, to be without contact, to be without desire? What does it mean to risk contact, to risk being tactile with the other, to risk affirming (...) one’s desires? I want to generate a discussion about what has happened to desire, to its promise and possibility and why it is so difficult to anticipate or forecast what is to come. For me the BwO of hikikomori is the ruin of desire, the collapse of desire, a disaster of desire. I am pursuing a line of thought which highlights the loss of the possibility of processual schizophrenic breakthrough and in its place the becoming-autistic of the self, the perilous breakdown of the self. (shrink)

A recent commentary defends 1) the concept of 'brain arrest' to explain what brain death is, and 2) the concept that death occurs at 2–5 minutes after absent circulation. I suggest that both these claims are flawed. Brain arrest is said to threaten life, and lead to death by causing a secondary respiratory then cardiac arrest. It is further claimed that ventilation only interrupts this way that brain arrest leads to death. These statements imply that brain arrest is not death (...) itself. Brain death is a devastating state that leads to death when intensive care, which replaces some of the brain's vital functions such as breathing, is withdrawn and circulation stops resulting in irreversible loss of integration of the organism. Circulatory death is said to occur at 2–5 minutes after absent circulation because, in the context of DCD, the intent is to not attempt reversal of the absent circulation. No defense of this weak construal of irreversible loss of circulation is given. This means that paents in identical physiologic states are dead (in the DCD context) or alive (in the resuscitation context); the current state of death (at 2–5 minutes) is contingent on a future event (whether there will be resuscitation) suggesting backward causation; and the commonly used meaning of irreversible as 'not capable of being reversed' is abandoned. The literature supporting the claim that autoresuscitation does not occur in the context of no cardiopulmonary resuscitation is shown to be very limited. Several cases of autoresuscitation are summarized, suggesting that the claim that these cases are not applicable to the current debate may be premature. I suggest that brain dead and DCD donors are not dead; whether organs can be harvested before death from these patients whose prognosis is death should be debated urgently. (shrink)

Ariane Lewis reviewed medicolegal challenges to Death by Neurologic Criteria (DNC) in the United Kingdom in order to identify and discuss the ethical issues raised (Lewis 2024). Here I briefly clar...

Brain death is accepted in most countries as death. The rationales to explain why brain death is death are surprisingly problematic. The standard rationale that in brain death there has been loss of integrative unity of the organism has been shown to be false, and a better rationale has not been clearly articulated. Recent expert defences of the brain death concept are examined in this paper, and are suggested to be inadequate. I argue that, ironically, these defences demonstrate the lack (...) of a defensible rationale for why brain death should be accepted as death itself. If brain death is death, a conceptual rationale for brain death being equivalent to death should be clarified, and this should be done urgently. (shrink)

We are living in and beyond two massive changes in the world, both of which must be addressed by education, the caretaker of memory. First is the geological era of the Anthropocene—a crisis...

In what follows I distinguish «postmodern animism» from my preferred term «postmedia animism», which I propose is a better term to express a minor, virtual, contrarian art and media. In the time of planetary trauma, ecological devastation and collapse, this term will serve as a heuristic concept to trace the passage from pandemic, panic, catastrophe and crisis to the series pandemonium, delirium and the carnivalesque. My gambit is to invoke a rebellious and affirmative Yōkai imaginary (妖怪, ghost, phantom, strange apparition) (...) in order to contest passive forms of «transcendental narcissism» or «transcendental miserabilism».This we shall designate s an aesthetics of existence. In particular, I will analyse the relationship between natural disasters and politics within the Japanese imagination through reference to Namazu-e (鯰絵, woodblock prints depicting catfish), and their political effects in the aftermath of the earthquake of October 1855 (安政江戸地震, Ansei Edo Jishin) in the Edo period of Japanese history (FIG 1). My intention is to show that this historic art form, which grew out of trauma, demonstrates a fabulatory, dissensual and political aesthetics of resistance and creativity. It is an imaginary which appears conspicuously absent in our contemporary moment. (shrink)

French philosopher Bernard Stiegler’s teacher, the great Jacques Derrida, when speaking of the nature of the life of Aristotle, questioned the need for biography and anecdote. Philosophy excludes b...

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...

: Medical research is widely thought to have a fundamentally therapeutic orientation, in spite of the fact that clinical research is thought to be ethically distinct from medical care. We need an entirely new conception of clinical research ethics—one that looks to science instead of the doctor-patient relationship.

The concept of self-gaslighting has recently become prevalent in popular discourse but has yet to be subjected to detailed philosophical analysis. In this paper, I examine one context in which self-gaslighting is often discussed: situations in which someone has experienced trauma. I argue that the phenomenon currently described as self-gaslighting fails to display core features of manipulative gaslighting and that therefore we should seek other conceptual resources for understanding such cases. I suggest that self-gaslighting, at least in some paradigmatic cases, (...) amounts to either extremely successful interpersonal gaslighting or to internalized oppression. Utilizing these concepts instead of self-gaslighting avoids conceptual difficulties and also has a significant practical payoff. By moving away from the language of self-gaslighting we can move away from feelings of self-blame that so often accompany trauma. (shrink)

Brain death has been accepted worldwide medically and legally as the biological state of death of the organism. Nevertheless, the literature has described persistent problems with this acceptance ever since brain death was described. Many of these problems are not widely known or properly understood by much of the medical community. Here we aim to clarify these issues, based on the two intractable problems in the brain death debates. First, the metaphysical problem: there is no reason that withstands critical scrutiny (...) to believe that BD is the state of biological death of the human organism. Second, the epistemic problem: there is no way currently to diagnose the state of BD, the irreversible loss of all brain functions, using clinical tests and ancillary tests, given potential confounders to testing. We discuss these problems and their main objections and conclude that these problems are intractable in that there has been no acceptable solution offered other than bare assertions of an ‘operational definition’ of death. We present possible ways to move forward that accept both the metaphysical problem - that BD is not biological death of the human organism - and the epistemic problem - that as currently diagnosed, BD is a devastating neurological state where recovery of sentience is very unlikely, but not a confirmed state of irreversible loss of all [critical] brain functions. We argue that the best solution is to abandon the dead donor rule, thus allowing vital organ donation from patients currently diagnosed as BD, assuming appropriate changes are made to the consent process and to laws about killing. (shrink)

By tracing the genealogy of Lawrence Ferlinghetti's outlandish notion of the fourth person singular and its appropriation in The Logic of Sense, several keys concepts in Deleuze's thought such as the nonpersonal and pre-individual subjectivity can be rendered clearer to the understanding. While there is poetic licence in the use of the term by Ferlinghetti, the fourth person singular is heuristic for exploring the notion of free indirect speech and, more speculatively, the ideas of impersonal death and suicide. The fourth (...) person singular is thus a trope that sheds light on the ideas of humour, irony, lightness and becoming ‘without a verb’ in Deleuze's thought. Under close scrutiny is what Ferlinghetti designates as the ‘cool’ eyes of the fourth person singular. We shall work to differentiate these from so-called mad, Dada-esque ‘unblinking’ eyes. We shall ask how the poet in ‘obscenely seeing’ the impossible possibility of life can envision – perspicaciously – the immanent sense of death-in-life. From what standpoint does the poet gain access to the real? To consider this fully it is necessary to follow the Deleuzian interpretation of singularities as true transcendental events so as to clarify what gives life a ‘non-personal power, above individuals’. (shrink)

At first glance a Russian anarchist’s revolutionary address to the youth of his day made in the late 19th century and the address to youth made by a contemporary French philosopher may appear to have little in common as their context and era are ostensibly very different. How would Petr Kropotkin’s address be understood in our time? Are Kropotkin’s concerns the same as those raised by Bernard Stiegler? Could Kropotkin speak of universal concerns, a sense of elevation and sublimation not (...) governed, undermined or circumvented by digital relations, calculation or algorithmic determination? I find a mutual concern with the coming into maturity of youth, but, I am concerned that as we are passing through an epochal and revolutionary transformation driven by digital and cognitive capitalism and in our toxic and crisis-ridden milieu, Kropotkin’s rhetoric would inevitably fall on deaf ears? Is his rhetoric on revolution anachronistic? How would his rhetoric be crafted for a youth seemingly indifferent to the plight of fellow brethren? Is it conceivable that the humanist-inflected prospects of youth so vaunted by Kropotkin have now been devastated by the inhuman and nihilistic tendencies of the so-called miscreant, ‘blank generation’ as described by Stiegler? True, while it is difficult to calibrate the vision of youth affirmed in Kropotkin with the fear of youth in Stiegler, and, despite differences in episteme, tradition and political orientation, both thinkers I think are concerned with the trials and tribulations of youth and both hold out the prospect of the not-yet of youth, of the coming into being of the maturity of youth, of Aufklärung. It is this shared focus I wish to examine further. (shrink)

My intention is to consider Bernard Stiegler’s concept of ‘journeys of knowledge’. Open Humanities Press, 2020) and to explore how one might rethink the knowledge-creating potentialities of information itself. This has become all the more apparent in the time of lockdowns, physical distancing during the pandemic but the primary purpose of the paper is to look at the distinction between knowledge/information and the role of the teacher in using technology pharmacologically to safeguard the savoirs and to stem the proletarianization of (...) knowledge or stupidity as such. The point is that the pandemic is bringing home the question of the role of the teacher, the role of the school and the necessity of the co-production and co-creation of knowledge. It seems essential to understand the concept of ‘journeys of knowledge’ in the time of the pandemic as students are left at home without a journey to voyage upon. As such, there is a lack of futurally-bound collective protentions, an absence of any vision projection into the future. What is there in the concept of ‘journeys of knowledge’ that demonstrates how to use the Internet in bifurcatory ways, to produce what Stiegler calls negentropic knowledge or new forms of knowledge, or what I want to designate as experiments with truth-telling. What does it mean to produce negentropic knowledge without the teacher to guide, curate and care? With the above in mind, and by writing out of the wound of thinking, it is by rethinking the concept of curation in a different way that it is hoped one can contribute to educational research to produce unheard-of bifurcations of knowledge, to invoke Deleuze’s sense of the incomprehensible and Stiegler’s sense of the impossible, the improbable and the incalculable in educational concerns, to pave a path out of the aporia of the present—a present which is without decision and epoch. (shrink)

In thinking the passage from the “all-human cerebrum” to what one might call the contemporary “all-too-human” cerebrum in neo-liberal societies and beyond to the “all-too-transhuman” cerebrum in the cybernetic society, in contrasting Wells’s idea of a new world order with the dystopia of the disordering un-world, in considering the prospects of a “world brain” faced with the realities of the “global mnemotechnical system”, in highlighting the differences between the global and authoritarian instrument of “control” in Wells and the descriptions of (...) the control society by Deleuze, and finally, in critiquing the “unifying of the general intelligence services of the world” in Wells and the capturing of the “general intellect”, this paper maps the contemporary prospects of the “world brain” against the backdrop of the worldweariness of the present. (shrink)

This article proffers a critical reading of multiliteracy pedagogy and a materialism of the multimodal and machinic. A critical stance is taken against the mesmerising modes of representation that run rampant across our ocular territories. The article assesses the dangers of fetishizing technologies. To this end, Multiple Literacies Theory (MLT) is read through a Guattarian theoretical prism to emphasise four chief points: (1) the role of the unconscious, (2) the role of affect (affectus in the Spinozian sense; contrary to feeling (...) which immobilises, affect moves us), (3) the apparent becoming cyborg of the human race and (4) the desire to desire repression. The author contends that while qualitative multiplicities play a central role for MLT, it is neither inconsistent nor contradictory to consider the role of the machinic in greater detail. It is argued that more research must be directed into the cartographic, ethological and noological mechanisms at work in plastic universes of reference (new technologies and the arts) which transform the virtual and transfigure the dynamic of affect. (shrink)

Medical ethics assumes a clear boundary between clinical research and clinical medicine: one produces knowledge for the benefit of future patients, while the other provides optimal care to individuals right now. It also assumes that the two cannot be integrated without sacrificing the needs of the current patient to those of future patients. But integration could allow us to provide better care to everyone, now and in the future.

Devoted to the late Paul Virilio (1932–2018) and in the advent of debates surrounding the Anthropocene and in light of corresponding changes to conceptions of scale and image, this paper attempts to extrapolate a Virilian pedagogy of the image. It is Virilio’s work which remains timely and singularly fecund in this area and it is for this reason that it may help to shape a new pedagogy of scale and image. This may allow us to better grasp the decentring of (...) human conceptions of time and space as we come to better understand the vastness of cosmological space and time. To demonstrate this, his work is read in tandem with Félix Guattari’s work on ecosophy and Bernard Stiegler’s work on negentropy to show how Virilio’s critique of the diminishment of perspective diverges from their respective approaches to forge an arresting pedagogy of the image vis-à-vis geographical and ecological conceptions of Earthly spatial and temporal scale. The perceived poverty of Earthly perspective is read in the light of a scalar perspectivism which understands the enormity of the universe and humanity’s microscopic place within it. As Virilio is concerned with the changes in scale which manifest with the onset of globalization, the question arises as to how an applied dromology (that is the philosophy of speed) may work alongside both Guattari’s schizoanalytic and ecosophical research and Stiegler's pharmacology of the image in a way that mounts a robust and unique critique of the mental pollution of the image as such. Here the pedagogical implications are significant as the diminishment of world perspective for Virilio – a consequence of the singular global time of capital – devastates our understanding of the cosmos. This understanding of the poverty of scale and perspective is contrasted with a multiscalar approach to the world, which is itself searching for a philosophical and pedagogical response to the reduction of the world to nothing. (shrink)

Doug McGill published several articles about the massacre of 425 members of the Anuak tribe by the Ethiopian military in 2003 and 2004 on his Web site, The McGill Report. The mainstream news media ignored it. McGill's narrative demonstrates the impact of his reporting on the Anuak community worldwide, its impact on several beneficiary groups in the United States, and the lack of interest by the mainstream news media that failed to fulfill journalism's primary purpose. Two responses (...) follow McGill's narrative. Jeremy Iggers examines the social and economic realities that make it difficult for journalists to fulfill their primary purpose. He suggests that partnerships between journalists and engaged citizens may provide a new model for journalism. Andrew Cline examines the rhetorical and ethical nature of the journalistic transaction between journalist and audience. Who counts as a journalist arises from the experiences of an audience that uses a journalist's work as a civically important text. (shrink)

This paper sets out to analyze how causation works by focusing on biology, as represented by epidemiology and by scientific information on how the body works (“physiology”). It starts by exploring the specificity of evolved physiological systems, in which evolutionary, developmental and proximal causes all fit together, and the concept of function is meaningful; in contrast, this structure does not apply in epidemiology (or outside biology). Using these two contrasting branches of biology, I examine the role both of mechanism and (...) of difference making in causation. I find that causation necessarily involves both mechanism and difference making, and that they play complementary roles. Both are seen as ontologically necessary, even if the evidence is not always available for both. Influential monist accounts that focus on one of these, at the expense of ignoring the other, are found to be inadequate on these and on other grounds. Recent attempts to combine them are reviewed, notably that of Russo and Williamson (Int Stud Philos Sci 21:157–170, 2007), and it is argued that their epistemic view requires there to be a source of the different types of evidence that a rational agent would consider, and that this source must be ontic. I then analyze how causal relationships work in evolved physiological systems and in those studied by epidemiology, with a particular focus on how mechanism interacts with input. Finally, I consider this concept of causation from the perspective of everyday language, and of its possible generalisability outside biology. (shrink)

This paper suggests that the contemporary feminist debate on relational autonomy is best understood as an attempt at ameliorative inquiry—the concept of autonomy is defined in order to secure political and theoretical advantages. Most theorists adopt some sort of constructionist, or relational, account precisely because of the political and theoretical advantages relational accounts are meant to offer. But there are also significant drawbacks to this approach. I argue that there are reasons to be skeptical of ameliorative inquiries into the concept (...) of autonomy: first, the goals of inquiry have not been made explicit and may not be shared; second, because ameliorative inquiries are guided by unclear and unshared goals, the debate will continue to pull feminists in conflicting directions; and finally, the normative and aspirational nature of ameliorative inquiry unacceptably threatens the exclusion of some women from the category of autonomous agents. (shrink)

Classic statements of research ethics advise against permitting physician-investigators to obtain consent for research participation from patients with whom they have preexisting treatment relationships. Reluctance about “dual-role” consent reflects the view that distinct normative commitments govern physician–patient and investigator–participant relationships, and that blurring the research–care boundary could lead to ethical transgressions. However, several features of contemporary research demand reconsideration of the ethics of dual-role consent. Here, we examine three arguments advanced against dual-role consent: that it creates role conflict for the (...) physician-investigator; that it can compromise the voluntariness of the patient-participant’s consent; and that it promotes therapeutic misconceptions. Although these concerns have merit in some circumstances, they are not dispositive in all cases. Rather, their force—and the ethical acceptability of dual-role consent—varies with features of the particular study. As research participation more closely approximates usual care, it becomes increasingly acceptable, or even preferable, for physicians to seek consent for research from their own patients. It is time for a more nuanced approach to dual-role consent. (shrink)

Here several utopian/dystopian thought experiments are proffered to explore the contemporary sheer dread in thinking otherwise than the contemporary unworld as it is.1 With reference to the 2017 BBC drama Hard Sun and the cosmological horror of a world without a sun, what is demonstrated is the contemporary incapacity of thought to think beyond the utopos of the unworld as it is. Hard Sun, an essentially failed science-fiction TV series, is contrasted with the satirical optimism of Gabriel Tarde’s Underground Man, (...) published in 1905, in which a postapocalypse sunless utopia, and with it utopic forms of telluric life, is envisaged under the Earth. Shaping and guiding these considerations are the different... (shrink)

Here, I wish to pursue an analysis of the potential link between the thinkers Félix Guattari and Bernard Stiegler as I see in both thinkers a profound rumination of the question of therapeutic care and curation at the institutional level. My concern is with the institutional object and its deadly repetitions. By and through agitating the coefficient of transversality, my argument is that this might problematize the dyadic and sometimes dysfunctional transindividual relationships between doctor and patient, teacher and pupil. My (...) concern is with the passage from the machinic objet petit ‘a’ in Lacan to Winnicott’s transitional object (objet petit ‘b’), and then beyond their functions to the institutional object itself which Guattari idiosyncratically calls the objet petit ‘c’. The rationale behind this move is to consider how the mediating third object needs to be recast in light of the poisonous and addictive nature of transitional objects such as smartphone technology. My point is that we must rethink the pharmacological possibility of the incorporation of the transitional object at the institutional level, which is to say, to understand the relationship between institutional objects such as the therapeutic club and the transitional object (digital technologies) in order to appreciate critically the toxic effects of the latter. Yet we also must understand the pharmacological or therapeutic aspects of the transitional object in itself, which is to say to understand its precise curative usage at the institutional level. (shrink)