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.

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)

This is the second paper in a two-part series describing subject and family perspectives from the CENTURY-S (CENtral Thalamic Deep Brain Stimulation for the Treatment of Traumatic Brain InjURY-Safety) first-in-human invasive neurological device trial to achieve cognitive restoration in moderate to severe traumatic brain injury (msTBI). To participate, subjects were independently assessed to formally establish decision-making capacity to provide voluntary informed consent. Here, we report on post-operative interviews conducted after a successful trial of thalamic stimulation. All five msTBI subjects met (...) a pre-selected primary endpoint of at least a 10% improvement in completion time on Trail-Making-Test Part B, a marker of executive function. We describe narrative responses of subjects and family members, refracted against that success. Interviews following surgery and the stimulation trial revealed the challenge of adaptation to improvements in cognitive function and emotional regulation as well as altered (and restored) relationships and family dynamics. These improvements exposed barriers to social reintegration made relevant by recoveries once thought inconceivable. The study’s success sparked concerns about post-trial access to implanted devices, financing of device maintenance, battery replacement, and on-going care. Most subjects and families identified the need for supportive counseling to adapt to the new trajectory of their lives. (shrink)

Joseph J. Kockelmans provides a clear and systematic treatment of the central themes and topics of Heidegger's later writings, focusing on the all-important question of the relationship of truth and Being. If we are to understand Heidegger's thought, Kockelmans explains, we must conceive it as a path or way, rather than as a finished system. Adopting this approach himself, Kockelmans leads us with scholarly care through the wide range of issues that Heidegger wrote about between roughly 1935 and 1965. (...) After a discussion of Heidegger's own effort to learn to think, subsequent chapters present Heidegger's views on such matters as the meaning of Being; the ontological difference; heaven and earth; gods and mortals; and language, art, science, technology, ethics, and politics. In conclusion, Kockelmans reflects on the task of thinking in an age when classical philosophy has reached its logical end. (shrink)

: This paper presents a method of moral problem solving in clinical practice that is inspired by the philosophy of John Dewey. This method, called "clinical pragmatism," integrates clinical and ethical decision making. Clinical pragmatism focuses on the interpersonal processes of assessment and consensus formation as well as the ethical analysis of relevant moral considerations. The steps in this method are delineated and then illustrated through a detailed case study. The implications of clinical pragmatism for the use of principles in (...) moral problem solving are discussed. (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)

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)

Husserl's Original View on Phenomenological Psychology* JOSEPH J.KOCKELMANS Some forty years ago Edmund Husserl spoke publicly for the first time of a ...

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)

This essay critiques the fiercely utilitarian allocation scheme of Cameron et al. Children have no hope of recovery if their lives are cut short based on administrative protocols that misrepresent the nature of their conditions. Unilateral futility judgements - especially those based on a false predicate - are discriminatory. When considering the best interests of children, we should see possibility in disability and not advance ill-informed utilitarianism.

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)

As improvements in neuroscience have enabled a better understanding of disorders of consciousness as well as methods to treat them, a hurdle that has become all too prevalent is the denial of coverage for treatment and rehabilitation services. In 2011, a settlement emerged from a Vermont District Court case, Jimmo v. Sebelius, which was brought to stop the use of an “improvement standard” that required tangible progress over an identifiable period of time for Medicare coverage of services. While the use (...) of this standard can have deleterious effects on those with many chronic conditions, it is especially burdensome for those in the minimally conscious state, where improvements are unpredictable and often not manifested through repeatable overt behaviors. Though the focus of this paper is on the challenges of brain injury and the minimally conscious state, which an estimated 100,000 to 200,000 individuals suffer from in the United States, the post-Jimmo arguments presented can and should have a broad impact as envisioned by the plaintiffs who brought the case on behalf of multiple advocacy groups representing patients with a range of chronic care conditions. (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)

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...

An effort is made in this essay to show the intrinsic hermeneutic nature of the natural sciences by means of a critical reflection on data taken from the history of classical mechanics and astronomy. The events which eventually would lead to the origin of Newton's mechanics are critically analyzed, with the aim of showing that and in what sense the natural sciences are essentially interpretive enterprises.

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)

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)

The Palgrave Handbook of Philosophy and Money surveys the role of money in the history of ideas. Volume 1: Ancient and Medieval Thought explores the worldviews of societies in the process of monetization. The volume is divided into sections on early Civilizations, classical Greece, the Roman era, and Medieval and Renaissance thought.

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)

This book argues that the philosophical significance of Kant’s aesthetics lies not in its explicit account of beauty but in its implicit account of intentionality. Kant’s account is distinct in that feeling, affect, or mood must be operative within the way the mind receives the world. Moreover, these modes of receptivity fall within the normative domain so that we can hold each other responsible for how we are "struck" by an object or scene. Joseph Tinguely composes a series of (...) investigations into the philosophically rich but regrettably neglected topics at the intersection of Kant’s aesthetics and epistemology, such as how we orient ourselves in the world, whether tonality is a property of the subject or object, and what we hope to accomplish when we quarrel about taste. Taken together, these investigations offer a robust and defensible picture of mind, which not only resolves tensions in a Kantian account of intentionality but also offers a timely intervention into contemporary debates about the "aesthetic" nature of the way the mind is in touch with the world. Kant and the Reorientation of Aesthetics will appeal to scholars and students of Kant, as well as those working at the intersection of aesthetics and philosophy of mind. (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)

The paper presents Henry More’s doctrine of the Spirit of Nature. Through a thorough analysis of both his earlier and later work, it shows in which regards he draws from traditional Neo-Platonic notions of a soul of the world and in which regards he transforms it in order to fi t it into the framework of early modern natural philosophy. The guideline is an attempt to map possible parallels between the functions of imagination on a microcosmic scale and the Spirit (...) of Nature on a macrocosmic one. Although this parallel cannot be pushed through to its ultimate consequences within More’s system, it nevertheless proves to be fruitful. Both the Spirit of Nature and the imagination are for More something ambivalent, both noble and gross, on the edge between body and soul. As such, however, they are remnants of More’s early gradualism that are in confl ict with the psycho-physical dualism he endorsed in his later work. (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)