The Irish antecedents of the struggle of Archbishop Hughes and his Irish emigrant flock against the Public School Society of the City of New York.

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)

By considering the history of bioethics and international humanitarian law, Joseph J. Fins contends that bioethics as an academic and moral community should stand in solidarity with Ukraine as it defends freedom and civility.

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 is the first article in a two-part series describing subject and family perspectives from the central thalamic deep brain stimulation for the treatment of traumatic brain injury using the Medtronic PC + S first-in-human invasive neurological device trial to achieve cognitive restoration in moderate to severe traumatic brain injury, with subjects who were deemed capable of providing voluntary informed consent. In this article, we report on interviews conducted prior to surgery wherein we asked participants about their experiences recovering from (...) brain injury and their perspectives on study enrollment and participation. We asked how risks and benefits were weighed, what their expectations and fears were, and how decisions were reached about trial participation. We found that informed consent and enrollment decisions are fraught. Subjects and families were often split, with subjects more focused on putative benefits and families concerned about incremental risk. Both subjects and families viewed brain injury as disruptive to personal identity and relationships. As decisions were made about study enrollment, families struggled with recognizing the re-emergent agency of subjects and ceding decision-making authority to subjects who had previously been dependent upon them for protection and guidance. Subjects and family members reported a hope for the relief of cognitive disabilities, improved quality of life, normalization of interpersonal interactions, and a return to work or school as reasons for study participation, along with altruism and a desire to advance science. Despite these aspirations, both subjects and families appreciated the risks of the intervention and did not suffer from a therapeutic misconception. A second essay to be published in the next issue of Cambridge Quarterly of Healthcare Ethics—Clinical Neuroethics will describe interviews conducted after surgery, the effects of cognitive restoration for subjects, families, and challenges presented to the social structures they will call upon to support them through recovery. This subsequent article will be available online prior to its formal publication in October 2023. (shrink)

From mid-March through May 2020, New York City was the world’s epicenter of the COVID-19 pandemic, and its hospitals faced an unparalleled surge of patients who were critically ill with the virus. In addition to putting an enormous strain on medical resources, the pandemic presented many ethical issues to emotionally and physically stressed clinicians and hospital administrators. Analyses of the challenges faced by the ethics consultation services of the two campuses of New York Presbyterian Hospital, and how they assisted their (...) clinician and administrative colleagues, is the subject of the following four articles. (shrink)

As scholars envision a new regulatory or statutory neurorights schema it is important to imagine unintended consequences if reforms are implemented before their implications are fully understood. This paper critically evaluates provisions proposed for a new Chilean Constitution and evaluates this movement against efforts to improve the diagnosis of, and treatment for, individuals with disorders of consciousness within the broader context of disability law, international human rights, and a capabilities approach to health justice as advanced by Amartya Sen and Martha (...) Nussbaum. Framed in this way, any neurorights regime would need to satisfy several criteria. First it would be obliged to balance both positive and negative rights in the furtherance of human capabilities. Second, it would need to be future oriented and informed about the science it sought to regulate and not fall prey to science fiction fantasies that remain ungrounded in reality. Third, it would need to be specific and avoid generalizations that would lead to conceptual confusion and litigation that could delay scientific progress. Finally, it would need to harmonize novel neurorights with long-established norms in international disability and human rights law. A failure to meet these criteria will destine any novel neurorights regime to the periphery. At this juncture Chile’s nascent constitutional venture into neurorights fails to satisfy these criteria. While there yet may be a role for a more capacious and bivalent articulation of neurorights that account for capabilities and precedent, the current Chilean neurorights reforms are vague and premature. As such they should undergo additional scholarly scrutiny and should not be adopted by other jurisdictions. (shrink)

Language, meaning, and ek-sistence, by J. J. Kockelmans.--Heidegger's conception of language in Being and time, by J. Aler.--Poetry and language in Heidegger, by W. Biemel.--Heidegger's topology of being, by O. Pöggeler.--Thinking and poetizing in Heidegger, by H. Birault.--Hermeneutic and personal structure of language, by H. Ott.--Ontological difference, hermeneutics, and language, by J. J. Kockelmans.--The world in another beginning: poetic dwelling and the role of the poet, by W. Marx.--Panel discussion.--Heidegger's language: metalogical forms of thought and grammatical specialties, by E. Schöfer.--M. (...) Heidegger's "ontological difference" and language, by J. Lohmann.--Bibliography (p. 365-368). (shrink)

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)

Many theories of complex cognitive-motor skill learning are built on the notion that basic cognitive processes group actions into easy-to-perform sequences. The present work examines predictions derived from laboratory-based studies of motor chunking and motor preparation using data collected from the real-time strategy video game StarCraft 2. We examined 996,163 action sequences in the telemetry data of 3,317 players across seven levels of skill. As predicted, the latency to the first action is delayed relative to the other actions in the (...) group. Other predictions, inspired by the memory drum theory of Henry and Rogers, received only weak support. (shrink)

Translating ethical theories into clinical practice presents a perennial challenge to educators. While many suggestions have been put forth to bridge the theory-practice gap, none have sufficiently remedied the problem. We believe the ascendance of hospital medicine, as a dominant new force in medical education and patient care, presents a unique opportunity that could redefine the way clinical ethics is taught. The field of hospital medicine in the United States is comprised of more than 50,000 hospitalists—specialists in inpatient medicine—representing the (...) fastest growing subspecialty in the history of medicine, and its members have emerged as a dominant new force around which medical education and patient care pivot. This evolution in medical education presents a unique opportunity for the clinical ethics community. Through their proximity to patients and trainees, hospitalists have the potential to teach medical ethics in real time on the wards, but most hospitalists have not received formal training in clinical ethics. We believe it is time to strengthen the ties between hospital medicine and medical ethics, and in this article we outline how clinical ethicists might collaborate with hospitalists to identify routine issues that do not rise to the level of an “ethics consult,” but nonetheless require an intellectual grounding in normative reasoning. We use a clinical vignette to explore how this approach might enhance and broaden the scope of medical education that occurs in the inpatient setting: A patient with an intra-abdominal abscess is admitted to the academic hospitalist teaching service for drainage of the fluid, hemodynamic support, and antimicrobial therapy. During the initial encounter with the hospitalist and his team of medical students and residents, the patient reports night sweats and asks if this symptom could be due to the abscess. How should the hospitalist approach this question? (shrink)

Book reviewed in this article: How We Die. By Sherwin B. Nuland. New York: Alfred A. Knopf.

In Wittgenstein on Meaning, Colin McGinn argues that the skeptical argument that Kripke distills from Wittgenstein's rule-following considerations generates at most what might be called meaning skepticism (the non-factuality view of meaning), and not concept skepticism (the non-factuality view of concepts). If correct, this would mean the skeptical reasoning is far less significant than Kripke thinks. Others have seemed to agree with McGinn. I argue that McGinn is wrong here--that, in fact, Kripke's skeptical reasoning has a straightforward extension to concepts. (...) Whether the reasoning succeeds, however, is another matter, which I do not address here. (shrink)

When addressing cultural and religious differences in the clinical setting we need to be realists. Despite our public homage to pluralism and good intentions, it is just not possible to overcome all the differences that might exist and achieve perfect understanding of others. Try as we may, we will never be able to see perfectly the world through another's eyes. Instead of reaching for such perfection, we should instead reach for an approximation of shared understanding that will promote discourse and (...) civility when peoples of different races, genders, cultures, religions, and sexual preferences interact in the clinic. (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)

The application of neuroimaging technology to the study of the injured brain has transformed how neuroscientists understand disorders of consciousness, such as the vegetative and minimally conscious states, and deepened our understanding of mechanisms of recovery. This scientific progress, and its potential clinical translation, provides an opportunity for ethical reflection. It was against this scientific backdrop that we convened a conference of leading investigators in neuroimaging, disorders of consciousness and neuroethics. Our goal was to develop an ethical frame to move (...) these investigative techniques into mature clinical tools. This paper presents the recommendations and analysis of a Working Meeting on Ethics, Neuroimaging and Limited States of Consciousness held at Stanford University during June 2007. It represents an interdisciplinary approach to the challenges posed by the emerging use of neuroimaging technologies to describe and characterize disorders of consciousness. (shrink)

In this article we will draw on experiences from our own research on deep brain stimulation of the central thalamus in the minimally conscious state. We describe ethical challenges faced in clinical research involving medical devices and offer several cautionary notes about its funding and the interplay of market forces and scientific inquiry and suggest some reforms.

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)

When the COVID-19 surge hit New York City hospitals, the Division of Medical Ethics at Weill Cornell Medical College, and our affiliated ethics consultation services, faced waves of ethical issues sweeping forward with intensity and urgency. In this article, we describe our experience over an eight-week period (16 March through 10 May 2020), and describe three types of services: clinical ethics consultation (CEC); service practice communications/interventions (SPCI); and organizational ethics advisement (OEA). We tell this narrative through the prism of time, (...) describing the evolution of ethical issues and trends as the pandemic unfolded. We delineate three phases: anticipation and preparation, crisis management, and reflection and adjustment. The first phase focused predominantly on ways to address impending resource shortages and to plan for remote ethics consultation, and CECs focused on code status discussions with surrogates. The second phase was characterized by the dramatic convergence of a rapid increase in the number of critically ill patients, a growing scarcity of resources, and the reassignment/ redeployment of staff outside their specialty areas. The third phase was characterized by the recognition that while the worst of the crisis was waning, its medium- and long-term consequences continued to pose immense challenges. We note that there were times during the crisis that serving in the role of clinical ethics consultant created a sense of dis-ease as novel as the coronavirus itself. In retrospect we learned that our activities far exceeded the familiar terrain of clinical ethics consultation and extended into other spheres of organizational life in novel ways that were unanticipated before this pandemic. To that end, we defined and categorized a middle level of ethics consultation, which we have termed service practice communication intervention (SPCI). This is an underappreciated dimension of the work that ethics consult services are capable of in times of crisis. We believe that the pandemic has revealed the many enduring ways that ethics consultation services can more robustly contribute to the ethical life of their institutions moving forward. (shrink)

The malaise of todays "Cultural Studies" is perhaps best summarized by Picasso (paraphrased) "success can lead to copying from oneself, and copying from oneself, and that is worse than copying from others". This book is both a response and an independent configuration of the dominant, current trend: that is "cultural studies" known as the Birmingham/U.S. School (B/USS). Contemporary Cultural Studies leapfrogs the Birmingham/U.S. School of future self-clarification. The fundamental conceptual, mythological and philosophical problematics have been worked over the last 40-plus (...) years in the United States in advance of the current self-clarificaion exercises. Surprisingly, the genesis of U.S. Contemporary Cultural Studies is in Continental philosophy, not unlike the genesis of the Birmingham/U.S. School. This book discusses some procedural questions and practical features relevant to theory and research practice in social science and humanities from the standpoint of phenomenology. (shrink)

In Edmund Husserl's Phenomenology, Joseph J. Kockelmans provides the reader with a biographical sketch and an overview of the salient features of Husserl's thought. Kockelmans focuses on the essay for the Encyclopedia Britannica of 1928, Husserl's most Important effort to articulate the aims of phenomenology for a more general audience. Included are Husserl's text -- in the original German and in English translation on facing pages -- a synopsis, and an extensive commentary that relates Husserl's work as a whole (...) to the essay for the Encyclopedia. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Why Rancière Now?Joseph J. Tanke (bio)I. IntroductionAs philosophy's representative at an art college, a question is put to me by my colleagues, students, and other art-world types frequently enough that it is worth considering systematically: Why Rancière now? The query is in large part prompted by a recent issue of Artforum devoted to the work of the French philosopher Jacques Rancière, the publication of which caps a seemingly (...) overnight ascendance within discussions of art and politics. The very temporality of the question indicates that the discovery of Rancière by art professionals is a relatively recent development. Why is this taking place now? To begin to answer this question, we must first understand something about the current relationship between theoretical discourse and artistic practice.That Rancière is only now beginning to be discussed within the art world is indeed surprising, given the long-standing reliance upon theoretical approaches and the fact that Baudrillard, Derrida, and Deleuze now function as standard reference points. While it would be incorrect to say that Rancière was an unknown quantity in the Anglophone world until recently, the sense of revelation suggested by the query "Why now?" must be understood in terms of the ongoing exchange between European theory and contemporary art. This is a conversation that, independent of one's perspective as to whether it has had positive or negative consequences, cannot be denied. With this relationship between Continental philosophy, art making, and critical discourses, one is justified in asking, Why is Rancière only now coming to be read with any seriousness in art circles? The point is sharpened when we note that Rancière's work, unlike that of some of the more [End Page 1] celebrated names, is more readily suited for an interface with critical art discourse, concerned as it is with aesthetic issues and the analysis of contemporary art.One might be tempted to find lurking behind our question a certain amount of suspicion about further incursions by theory and detect a sense of exasperation at having yet another French name to pronounce. Those of us who find this interaction between art and theory edifying, however, should not simply shrug off this question and attribute it to an aversion to philosophy, or to a backlash against the excess of the past two decades. Understanding the context in which the question is posed allows us to expand it. And, while not all would agree, I think it is safe to say that there is a tacit consensus that fruitful arrangements between art and philosophy can be forged. With this situation in mind, we might, therefore, transform our question into something like the following: What might Rancière contribute to the work of the nonphilosopher, placed, for good or ill, within a dispositif wherein art and European theory discourse about many of the same phenomena, but in different idioms? The advantage of this formulation, of course, is that it allows us to avoid many of the facile responses to our initial question, variations on a theme suggesting that Rancière is simply one of the few members of that esteemed generation of thinkers still living and that the turning to his work is indicative of a generalized anxiety about the future of theoretical developments. We might also, in thus expanding our question, sketch an answer directed at those working at the edges of their respective disciplines: philosophers, artists, critics, historians—in short, all those interested in questions of contemporary culture. In accordance with what Rancière describes as the fortuitous breakdown of specializations, my efforts in this essay are intended as a contribution to an interdisciplinary conversation that is grappling with the intellectual issues raised by works of art, their reception, and the historical discourses that are created around them.II. To Avoid Two Discourses of MourningThe temporality of our question, why now?, is hinted at by Rancière at various points throughout his own work and pertains to what might be characterized as the default theoretical position of art, that of "mourning." For Rancière, this mourning takes two major forms: spectacle and the impossible. The former finds its genesis... (shrink)