AimsThis study evaluates a protocol for early, routine ethics consultation for patients on extracorporeal membrane oxygenation to support decision-making in the context of clinical uncertainty with the aim of mitigating ethical conflict and moral distress.MethodsWe conducted a single-site qualitative analysis of EC documentation for all patients receiving ECMO support from 15 August 2018 to 15 May 2019. Detailed analysis of 20 ethically complex cases with protracted ethics involvement identifies four key ethical domains: limits of prognostication, bridge to nowhere, burden of (...) treatment and system-level concerns. There are three subthemes: relevant contextual factors, the role of EC and observed outcomes. Content analysis of transcripts from interviews with 20 members of the multidisciplinary ECMO team yields supplemental data on providers’ perceptions of the impact of the early intervention protocol.ResultsLimited outcome data for ECMO, unclear indications for withdrawal, adverse effects of treatment and an obligation to attend to programme metrics present significant ethical challenges in the care of this patient population. Upstream EC mitigates ethical conflict by setting clear expectations about ECMO as a time limited trial, promoting consistent messaging among multiple services and supporting surrogate decision-makers. When ECMO becomes a ‘bridge to nowhere’, EC facilitates decision-making that respects patient values yet successfully sets limits on non-beneficial use of this novel therapy.ConclusionData from this study support the conclusion that ECMO poses unique ethical challenges that necessitate a standardised protocol for early, routine EC—at least while this medical technology is in its nascent stages. (shrink)

Oxford Scholarly Classics is a new series that makes available again great academic works from the archives of Oxford University Press. Reissued in uniform series design, the reissues will enable libraries, scholars, and students to gain fresh access to some of the finest scholarship of the last century.

The hopes and fears expressed in the debate on human enhancement are not always based on a realistic assessment of the expected possibilities. Discussions about extreme scenarios may at times obscure the ethical and policy issues that are relevant today. This paper aims to contribute to an adequate and ethically sound societal response to actual current developments. After a brief outline of the ethical debate concerning neuro-enhancement, it describes the current state of the art in psychopharmacological science and current uses (...) of psychopharmacological enhancement, as well as the prospects for the near future. It then identifies ethical issues regarding psychopharmacological enhancements that require attention from policymakers, both on the professional and on the governmental level. These concern enhancement research, the gradual expansion of medical categories, off-label prescription and responsibility of doctors, and accessibility of enhancers on the Internet. It is concluded that further discussion on the advantages and drawbacks of enhancers on a collective social level is still needed. (shrink)

'Thought insertion' in schizophrenia involves somehow experiencing one's own thoughts as someone else's. Some philosophers try to make sense of this by distinguishing between ownership and agency: one still experiences oneself as the owner of an inserted thought but attributes it to another agency. In this paper, we propose that thought insertion involves experiencing thought contents as alien, rather than episodes of thinking. To make our case, we compare thought insertion to certain experiences of 'verbal hallucination' and show that they (...) amount to different descriptions of the same phenomenon: a quasi-perceptual experience of thought content. We add that the agency/ownership distinction is unhelpful here. What requires explanation is not why a person experiences a type of intentional state without the usual sense of agency, but why she experiences herself as the agent of one type of intentional state rather than another. We conclude by sketching an account of how this might happen. (shrink)

Today's modern car is an assemblage of mechanical and digital components, of metal panels that comprise its structure and silicon chips that run its functions. Communication and information studies scholars have interrogated the problematic aspects of the programs that run those functions, revealing serious issues surrounding privacy and security, worker surveillance, and racial, gendered, and class-based bias. This article contributes to that work by taking a step back and asking about the issues inherent not in the software running on these (...) chips, but on the microchips themselves. Using the lens of “chipification”—the process by which a device is rendered capable of reading and processing data through the embedding of microchips—this article explores how the integration of microchips also involves processes that are often borne from, replicate, or create troubling power dynamics of their own. It takes light-duty passenger vehicles as a case study into how chipification is radically reshaping such processes as resource allocation, labor flows, and cultural practices around car manufacture, use, repair, and modification. By naming the process of chipification, this article allows researchers to identify and analyze the ways that integrating data processing capabilities into everyday devices is not a frictionless practice, but rather one that implicates a variety of power dynamics within these massive industries. (shrink)

It is sometimes suggested that expressivism in meta-ethics is to be criticized on grounds which do not themselves concern meta-ethics in particular, but which rather concern philosophy of language more generally. Frank Jackson and Philip Pettit (1998; see also Jackson and Pettit 1999, and Jackson 2001) have recently advanced a novel version of such an argument. They begin by noting that expressivism in its central form makes two claims—that ethical sentences are not truth evaluable, and that to assert an ethical (...) sentence is to express one’s desires or feelings rather than to report a fact. They then argue that, given some plausible premises in the philosophy of language emanating mainly from Locke, the two central claims of expressivism are contradictory: when combined with the plausible premises, they say, the second claim refutes the first. The purpose of this paper is to formulate Jackson and Pettit’s Lockean argument, and to suggest that it fails. (shrink)

In the past decades, an enormous amount of precious information has been collected about molecular and genetic characteristics of cancer. This knowledge is mainly based on a reductionistic approach, meanwhile cancer is widely recognized to be a ‘system biology disease’. The behavior of complex physiological processes cannot be understood simply by knowing how the parts work in isolation. There is not solely a matter how to integrate all available knowledge in such a way that we can still deal with complexity, (...) but we must be aware that a deeply transformation of the currently accepted oncologic paradigm is urgently needed. We have to think in terms of biological networks: understanding of complex functions may in fact be impossible without taking into consideration influences outside of the genome. Systems Biology involves connecting experimental unsupervised multivariate data to mathematical and computational approach than can simulate biologic systems for hypothesis testing or that can account for what it is not known from high-throughput data sets. Metabolomics could establish the requested link between genotype and phenotype, providing informations that ensure an integrated understanding of pathogenic mechanisms and metabolic phenotypes and provide a screening tool for new targeted drug. (shrink)

Ghazālī’s The Incoherence of the Philosophers is an unusual philosophical work for a number of reasons, not the least of which is the author’s explicit disavowalof any of the conclusions contained within it. The present essay examines some of the hermeneutical challenges that face readers of the work and offers anexegetical account of the much-neglected Third Discussion, which examines a key point of Neoplatonic metaphysics. The paper argues that Ghazālī’s maintaining of the incompatibility of metaphysical creationism and Neoplatonic emanationism should (...) not be viewed as simply a rhetorical or dialectical argument, but rather is best understood, to use Ghazālī’s words, as a philosophical “proof.” Essential to this proof in the solution to the argument of the Third Discussion is an implicit theory of metaphorical predication that can be pieced together from several of Ghazālī’s remarks as well as a reductio ad absurdum argument about the very possibility of ethical discourse. (shrink)

This article explores yet another paradox – aside from the privacy paradox – related to the datafication of media: citizens trust least the media they use most It investigates the role that daily life plays in shaping the trust that citizens place in datafied media. The study reveals five sets of heuristics guiding the trust assessments of citizens: characteristics of media organisations, old media standards, context of use and purpose, experiences of datafication and understandings of datafication. The article discusses the (...) use of these heuristics and the value that everyday life holds in assessing trust in datafied media. It concludes that, guided by a partial ‘structure of perception’ and enticed into trusting datafied media in the context of their daily lives, citizens may be highly concerned by the datafication of media but use them nevertheless. (shrink)

Critical educational research offers the researcher a position and an ethos of comfort. Even the declared recognition of the relativity of principles, norms or criteria so characteristic of much critical research does not prevent it from looking immediately for a way out of this uncomfortable situation i.e. to keep to the idea that comfort is needed and desirable. However, we suggest that this uncomfortable condition is constitutive for critical educational research and may be even for education as such. Therefore the (...) article can be considered as a genealogical analysis of this comfortable critical research, in which we show how the birth of the milieu of the modern school goes together with the instauration of two forms of a comfortable research ‘ethos’: a research ethos rooted in a pastoral milieu and a research ethos rooted in a bureaucratic milieu. In the last section of the article we indicate that another ‘experimental’ ethos of research is possible, including the acceptance of discomfort. This is the ethos of a critical researcher as an inhabitant of a coming research community and as being exposed to the present. (shrink)

Background In 2002, Belgium set a legal framework for euthanasia, whereby granting and performing euthanasia is entrusted entirely to physicians, and—as advised by Belgian Medical Deontology—in the context of a trusted patient–physician relationship. Euthanasia is, however, rarely practiced, so the average physician will not attain routine in this matter. Aim To explore how general practitioners in Flanders (Belgium) deal with euthanasia. This was performed via qualitative analysis of semistructured interviews with 52 general practitioners (GPs). Results Although GPs can understand a (...) patient's request for euthanasia, their own willingness to perform it is limited, based on their assumption that legal euthanasia equates to an injection that ends life abruptly. Their willingness to perform euthanasia is affected by the demanding nature of a patient's request, by their views on what circumstances render euthanasia legitimate and by their own ability to inject a lethal dose. Several GPs prefer increasing opioid dosages and palliative sedation to a lethal injection, which they consider to fall outside the scope of euthanasia legislation. Conclusions Four attitudes can be identified: (1) willing to perform euthanasia; (2) only willing to perform as a last resort; (3) feeling incapable of performing; (4) refusing on principle. The situation where GPs have to consider the request and—if they grant it—to perform the act may result in arbitrary access to euthanasia for the patient. The possibility of installing transparent referral and support strategies for the GPs should be further examined. Further discussion is needed in the medical profession about the exact content of the euthanasia law. (shrink)

This paper argues that consciousness can, and often does, extend beyond the confines of the skull and skin. Conscious acts can extend to the extent they are intentional. Intentionality is revealing activity, and revealing activity often straddles processes occurring both inside and outside the subject’s body. What makes a conscious act extended is identical with what makes it intentional.