Research in education and cognitive development suggests that explaining plays a key role in learning and generalization: When learners provide explanations—even to themselves—they learn more effectively and generalize more readily to novel situations. This paper proposes and tests a subsumptive constraints account of this effect. Motivated by philosophical theories of explanation, this account predicts that explaining guides learners to interpret what they are learning in terms of unifying patterns or regularities, which promotes the discovery of broad generalizations. Three experiments provide (...) evidence for the subsumptive constraints account: prompting participants to explain while learning artificial categories promotes the induction of a broad generalization underlying category membership, relative to describing items (Exp. 1), thinking aloud (Exp. 2), or free study (Exp. 3). Although explaining facilitates discovery, Experiment 1 finds that description is more beneficial for learning item details. Experiment 2 additionally suggests that explaining anomalous observations may play a special role in belief revision. The findings provide insight into explanation’s role in discovery and generalization. (shrink)

Without exaggeration, it could be said that we are entering a golden age of neuroscience. Informed by recent developments in neuroimaging that allow us to peer into the working brain at both a structural and functional level, neuroscientists are beginning to untangle mechanisms of recovery after brain injury and grapple with age-old questions about brain and mind and their correlates neural mechanisms and consciousness. Neuroimaging, coupled with new diagnostic categories and assessment scales are helping us develop a new diagnostic nosology (...) about disorders of consciousness which will likely improve prognostication and suggest therapeutic advances. Historically such diagnostic refinement has yield therapeutic advances in medicine and there is no reason to doubt that this will be the case for disorders of consciousness, perhaps bringing relief to a marginalized population now on the periphery of the therapeutic agenda. In spite of this promise, the translation of research findings into the clinical context will be difficult. As we move from descriptive categories about disorders of consciousness, like the vegetative or minimally conscious states, to ones further specified by integrating behavioral and neuroimaging findings, humility not hubris should be the virtue that guides the ethical conduct of research and practice. (shrink)

Autobiographical essays can be an indulgence. Often self-congratulatory and low on self-reflection, they seldom serve a purpose other than to stoke nostalgia. So when given this opportunity to write about my life in medicine and bioethics, I decided I would take stock, and not simply celebrate whatever accomplishments I might have had. Rather, I would use this opportunity to look for themes that linked the decades together. My hope was that the process might assemble the mosaic that has been my (...) life into a discernible pattern that could only be seen from a distance, and from the vantage of historical reflection. Maybe, if I was lucky, past would be prologue, and I would learn something that might help me script the... (shrink)

I would like to share some reflections on how bioethics fosters dialogue between the sciences and humanities by talking a bit about my work as a physician-ethicist collaborating with neuroscientists studying severe brain injury and mechanisms of recovery. If I am successful in this Pilgrim's Progress, I hope I will convince you that the injured brain can teach us much about ourselves. It is not something I was prepared to believe as a medical student, when I was more certain of (...) things than I am now. (shrink)

On January 5, 2019, the Associated Press reported that a woman thought to have been in the vegetative state for over a decade gave birth at a Hacienda HealthCare facility. Until she delivered, the staff at the Phoenix center had not noticed that their patient was pregnant. The patient was also misdiagnosed.Misdiagnosis of patients with disorders of consciousness in institutional settings is more the norm than the exception. Misdiagnosis is also connected to a broad and extremely significant change in the (...) understanding of the vegetative state—a change that the field of bioethics has not yet fully taken into account. In September 2018, the American Academy of Neurology, the American College of Rehabilitation Medicine, and the National Institute on Disability, Independent Living, and Rehabilitation Research issued a comprehensive evidence‐based review on disorders of consciousness and an associated practice guideline on the care of these patients. These landmark publications update the 1994 Multi‐Society Task Force Report on the Vegetative State, which subcategorized the persistent vegetative state as either persistent (once the vegetative state lasted one month) or permanent (once the vegetative state lasted three months after anoxic injury or twelve months after traumatic injury). Noting that 20 percent of patients thought to be permanently unconscious might regain some level of consciousness, the new guideline has eliminated the permanent vegetative state as a diagnostic category, replacing it with the chronic vegetative state. (shrink)

Although clinical ethics consultation is a high-stakes endeavor with an increasing prominence in health care systems, progress in developing standards for quality is challenging. In this article, we describe the results of a pilot project utilizing portfolios as an evaluation tool. We found that this approach is feasible and resulted in a reasonably wide distribution of scores among the 23 submitted portfolios that we evaluated. We discuss limitations and implications of these results, and suggest that this is a significant step (...) on the pathway to an eventual certification process for clinical ethics consultants. (shrink)

The COVID-19 Pandemic a stress test for clinical medicine and medical ethics, with a confluence over questions of the proportionality of resuscitation. Drawing upon his experience as a clinical ethicist during the surge in New York City during the Spring of 2020, the author considers how attitudes regarding resuscitation have evolved since the inception of do-not-resuscitate orders decades ago. Sharing a personal narrative about a DNR quandry he encountered as a medical intern, the author considers the balance of patient rights (...) versus clinical discretion, warning about the risk of resurgent physician paternalism dressed up in the guise of a public health crisis. (shrink)

Let’s face it, the humanities are in trouble. Last year, in The Chronicle of Higher Education, Thomas H. Benton warned prospective graduate students to avoid doctoral studies in the humanities. His rationale: a job market down 40%, the improbability of tenure, the more certain prospect of life as an adjunct, and eventual outright exile from one’s chosen field. Benton, the pen name of William Pannapacker, an associate professor of English at Hope College in Holland, Michigan, pulled no punches. His piece (...) was entitled, “Graduate School in the Humanities: Just Don’t Go.”. (shrink)

Patient narratives from two investigational deep brain stimulation trials for traumatic brain injury and obsessive‐compulsive disorder reveal that injury and illness rob individuals of personal identity and that neuromodulation can restore it. The early success of these interventions makes a compelling case for continued post‐trial access to these technologies. Given the centrality of personal identity to respect for persons, a failure to provide continued access can be understood to represent a metaphorical identity theft. Such a loss recapitulates the pain of (...) an individual's initial injury or illness and becomes especially tragic because it could be prevented by robust policy. A failure to fulfill this normative obligation constitutes a breach of disability law, which would view post‐trial access as a means to achieve social reintegration through this neurotechnological accommodation. (shrink)

Pickering & Garrod's interactive alignment account corresponds directly with the account Skinner gave in his book Verbal Behavior. This correspondence becomes evident when “properties of verbal stimuli” substitutes for “channels of alignment.” Skinner 's account appears to have the dual advantages of requiring fewer basic terms and integrating the field of verbal behavior with the whole field of human behavior.

Jacques Rancière: An Introduction offers the first comprehensive introduction to the thought of one of today's most important and influential theorists. Joseph Tanke situates Rancière's distinctive approach against the backdrop of Continental philosophy and extends his insights into current discussions of art and politics. Tanke explains how Rancière's ideas allow us to understand art as having a deeper social role than is customarily assigned to it, as well as how political opposition can be revitalized. The book presents Rancière's body (...) of work as a coherent whole, tracing key notions such as the distribution of the sensible, the aesthetics of politics, and the supposition of equality from his earliest writings through to his most recent interventions. Tanke concludes with a series of critical questions for Rancière's work, indicating how contemporary thought might proceed after its encounter with him. The book provides readers new to Rancière with a clear overview of his enormous intellectual output. Engaging with many un-translated and unpublished sources, the book will also be of interest to Rancière's long-time readers. (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)

This anthology of selections from the works of noted philosophers affords the student an immediate contact with the unique historical background of the philosophy of science. The selections, many of which have not been readily accessible, follow the development of the philosophy of science from 1786 to 1927. Each selection is preceded by a brief introduction by the editor designed to familiarize the reader with a particular philosopher and provide insights into his work. Joseph J. Kockelmans divides the selections (...) into several sections. Part 1, from 17861850, includes chapters by Immanuel Kant, on the metaphysical foundations of natural science, John Frederick William Herschel, on experience and the analysis of phenomena, William Whewell, on the nature and conditions of inductive science, and John Stuart Mill, on induction and the law of universal causation; part 2, from 18701899, includes chapters by Hermann Von Helmholtz, on the origin and significance of geometrical axioms, William Stanley Jevons, on the philosophy of inductive inference, John Bernard Stallo, on the kinetic theory of gasses and the conditions of the validity of scientific hypotheses, Ernst Mach, on the economical nature of physical inquiry, Karl Pearson, on perceptual and conceptual space, Emile Boutroux, on mechanical laws, Heinrich Hertz, on the appropriateness, correctness, and permissibility of scientific theories, and Ludwig Boltzmann, on the fundamental principles and basic equations of mechanics. The third part, covering the first decade of the twentieth century, includes chapters by Henri Jules Poincare, on science and reality, Charles Peirce, on Induction, Pierre Marie Duhem, on the laws of physics, William Ostwald, on energetism and mechanics, Emile Meyerson, on identity of thought and nature as the final goal of science, Ernst Cassirer, on functional concepts of natural science; part 4, from 19101927, includes chapters by Charles Dunbar Broad, on phenomenalism, Alfred North Whitehead, on time, space, and material, Bertrand Russell, on the world of physics and the world of sense, Norman Robert Cambbell, on the meaning of science, Moritz Schlick, on basic issues of the philosophy of natural science, and Percy Williams Bridgman, on the concepts of space, time, and causality. Philosophy of Science provides a concise single volume text to the discipline and enables students to understand and evaluate the various trends in our contemporary philosophy of science. Joseph J. Kockelmans is professor emeritus of philosophy at the Pennsylvania State Univers. (shrink)

In the United States, the rise in income inequality and downward intergenerational social mobility since the 1970s represent twin problems facing community and economic development today. This paper proposes a Structure of Labor theory to apply at the local and regional level to address these development challenges. The objective is to provide a simple local approach to development that maximizes upward economic mobility and enables individuals and communities to achieve their development goals in the 21st century development landscape of the (...) United States. The proposed theory fuses free-enterprise principles with state-planned dirigiste efforts to maximize the best of both theoretical perspectives. After reviewing pertinent literature and articulating the Structure of Labor theory, the latter sections of the paper explicate its implications for community and economic development practice. (shrink)

If ever I summon before me my highest ideals of men and medicine, I find them sprung from the spirit of Osler. —Wilder Penfield, M.D. Neuroethics is a recently coined term that is shaping our cultu...

"This fine work's ample documentation should gladden the scholarly reader while its accessible prose & well-organized presentation will make it useful for ...

Der folgende Artikel ist im Jahr 2003 unter dem Titel „Clinical Pragmatism: A Method of Moral Problem Solving“ in dem Sammelband „Pragmatic bioethics“ erschienen, welcher sich mit der Bedeutung der pragmatistischen Philosophie für die Praxis befasst. In dem vom Internisten und Bioethiker Joseph J. Fins, dem Thoraxchirurgen Matthew D. Bacchetta und dem Philosophen und Medizinethiker Franklin G. Miller verfassten Beitrag wird der pragmatistische Ansatz in der klinischen Ethik anhand eines Fallbeispiels gleichzeitig beschrieben, begründet und demonstriert. Obgleich die Denkrichtung der (...) pragmatistischen Philosophie sowohl wissenschaftstheoretisch wie praktisch hoch bedeutsam ist – ohne diese ist weder die heutige sozialwissenschaftliche Forschung noch die angewandte, insbesondere die klinische Ethik denkbar –, werden pragmatistische Ansätze im deutschsprachigen Raum bis heute eher rudimentär rezipiert. (shrink)

While we share many of the views on emotion research put forth in Kagan’s article “Once More into the Breach,” our commentary focuses on two points of disagreement. First, we argue for the importance of a priori principles. In particular, emotions cannot be understood without reference to final and formal cause, and the related principles of equifinality and equipotentiality. Secondly, although we agree the term “basic emotions” is misleading, we maintain that the emotions traditionally called “basic” should still be seen (...) as a distinct set of emotions by virtue of their being constitutive for other, derived emotions. In conclusion we argue for moving beyond the strict empiricist approach proposed by Kagan and many thinkers before him. (shrink)

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)