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)

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)

DBS Think Tank IX was held on August 25–27, 2021 in Orlando FL with US based participants largely in person and overseas participants joining by video conferencing technology. The DBS Think Tank was founded in 2012 and provides an open platform where clinicians, engineers and researchers can freely discuss current and emerging deep brain stimulation technologies as well as the logistical and ethical issues facing the field. The consensus among the DBS Think Tank IX speakers was that DBS expanded in (...) its scope and has been applied to multiple brain disorders in an effort to modulate neural circuitry. After collectively sharing our experiences, it was estimated that globally more than 230,000 DBS devices have been implanted for neurological and neuropsychiatric disorders. As such, this year’s meeting was focused on advances in the following areas: neuromodulation in Europe, Asia and Australia; cutting-edge technologies, neuroethics, interventional psychiatry, adaptive DBS, neuromodulation for pain, network neuromodulation for epilepsy and neuromodulation for traumatic brain injury. (shrink)

This paper examines the role of reason in Shepherd's account of acquiring knowledge of the external world via first principles. Reason is important, but does not have a foundational role. Certain principles enable us to draw the required inferences for acquiring knowledge of the external world. These principles are basic, foundational and, more importantly, self‐evident and thus justified in other ways than by demonstration. Justificatory demonstrations of these principles are neither required, nor possible. By drawing on textual and contextual evidence, (...) I will show that Shepherd should have said that we know the first principles of any science, in general, and that “everything which begins to exist must have a cause”, in particular, via intuition, not via reason. Reasoning about such principles can help their self‐evidence shine through in certain cases; their justification, and our being justified in believing them, does not come from this reasoning, however. (shrink)

A deaf lesbian couple who chose to have a deaf child receive a lot of criticismA deaf lesbian couple in the US deliberately tried to create a deaf child. Sharon Duchesneau and Candy McCullough hoped their child, conceived with the help of a sperm donor, would be deaf like the rest of the family. Their daughter, five year old Jehanne, is also deaf and was conceived with the same donor. News of the couple choosing to have a deaf child has (...) only been revealed with the birth of their son Gauvin.1–4To increase their chance of having a deaf baby the women sought a deaf sperm donor from a sperm bank but were told that congenital deafness is “precisely the sort of condition” that disqualifies would-be donors. Rather than dismiss the idea they found their own sperm donor by asking a deaf friend who comes from a family with five generations of deafness.1The women, both professionals in the mental health field, insist that they would still love …. (shrink)

Quantum mechanical measurements on a physical system are represented by observables - Hermitian operators on the state space of the observed system. It is an important question whether all observables may be realized, in principle, as measurements on a physical system. Dirac’s influential text ( [1], page 37) makes the following assertion on the question: The question now presents itself – Can every observable be measured? The answer theoretically is yes. In practice it may be very awkward, or perhaps even (...) beyond the ingenuity of the experimenter, to devise an apparatus which could measure some particular observable, but the theory always allows one to imagine that the measurement can be made. This Letter re-examines the question of whether it is possible, even in principle, to measure every quantum mechanical observable. Unexpectedly, ideas from com-. (shrink)

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)

Special groups [M. Dickmann, F. Miraglia, Special Groups : Boolean-Theoretic Methods in the Theory of Quadratic Forms, Memoirs Amer. Math. Soc., vol. 689, Amer. Math. Soc., Providence, RI, 2000] are a first-order axiomatization of the theory of quadratic forms. In Section 2 we investigate reduced special groups which are a lattice under their natural representation partial order ; we show that this lattice property is preserved under most of the standard constructions on RSGs; in particular finite RSGs and RSGs of (...) finite chain length are lattice ordered. We prove that the lattice property fails for the RSGs of function fields of real algebraic varieties over a uniquely ordered field dense in its real closure, unless their stability index is 1 . We show that Open Problem 1 has a positive answer for the RSG of the field Q . In the final section we explore the meaning of Open Problem 1 for formally real fields, in terms of their orders and real valuations; we introduce the notion of “parameter-rank” of a positive-primitive first-order formula of the language for special groups. (shrink)

The development of human genetics raises a wide range of important ethical questions for us all. The interpersonal dimension of genetic information in particular means that genetics also poses important challenges to the idea of patient-centredness and autonomy in medicine. How ought practical ethical decisions about the new genetics be made given that we appear, moreover, no longer to be able to appeal to unquestioned traditions and widely shared communitarian values? This paper argues that any coherent ethical approach to these (...) questions must be able both to uphold the moral status of the individual and at the same time recognise the communitarian, interpersonal dimensions both of the world in which we live and of personal autonomy itself. The paper then goes on to propose an approach to the resolution of the ethical questions raised by the use of the new genetics in reproductive choice through the development of a coherent and principled process of public reason and justification oriented towards the support and development of personal autonomy. (shrink)

Autonomy has been the central principle underpinning changes which have affected the practice of medicine in recent years. Medical education is undergoing changes as well, many of which are underpinned, at least implicitly, by increasing concern for autonomy. Some universities have embarked on graduate courses which utilize problem-based learning (PBL) techniques to teach all areas, including medical ethics. I argue that PBL is a desirable method for teaching and learning in medical ethics. It is desirable because the nature of ethical (...) enquiry is highly compatible with the learning processes which characterize PBL. But it is also desirable because it should help keep open the question of what autonomy really is, and how it should operate within the sphere of medical practice and medical education. (shrink)

Pure Type Systems, PTSs, were introduced as a generalization of the type systems of Barendregt's lambda cube and were designed to provide a foundation for actual proof assistants which will verify proofs. Systems of illative combinatory logic or lambda calculus, ICLs, were introduced by Curry and Church as a foundation for logic and mathematics. In an earlier paper we considered two changes to the rules of the PTSs which made these rules more like ICL rules. This led to four kinds (...) of PTSs. Most importantly PTSs are about statements of the form M:A, where M is a term and A a type. In ICLs there are no explicit types and the statements are terms. In this paper we show that for each of the four forms of PTS there is an equivalent form of ICL, sometimes if certain conditions hold. (shrink)

Within the moral/social order maintained and reproduced by biomedical ethics (i.e., the “peaceable community”), suffering is a senseless accident with no value. Insofar as suffering compromises the fundamental pillar of this order, namely, autonomy, it threatens the existence of the “peaceable community”. Consequently, biomedical ethics is only able to offer those who suffer one moral or practical response: that of elimination, embodied most vividly in the increasingly approved practice of assisted-suicide. Another moral/ social order, however, the “peaceable Kingdom” or the (...) “Body of Christ”, provides an alternative understanding of the meaning, purpose, and significance of suffering, through the Roman Catholic sacrament of anointing of the sick. Recognizing the power of sickness and suffering to “dis-inscribe” bodies of their normative self-understandings, the Church responds with a set of liturgical practices which intend to respond to the dynamics of suffering, re-inscribe these bodies, and assist persons in fulfilling the vocation of “participating in Christ's suffering for the salvation of the world”. (shrink)

In ordinary circumstances, human actions have a myriad of unintended and often unforeseen consequences for the lives of other people. Problems of pollution are serious examples, but spillovers and side effects are the rule, not the exception. Who knows what consequences this essay may have? This essay is concerned with the problems of justice created by spillovers. After characterizing such spillovers more precisely and relating the concept to the economist's notion of an externality, I shall then consider the moral conclusions (...) concerning spillovers that issue from a natural rights perspective and from the perspective of welfare economics supplemented with theories of distributive justice. I shall argue that these perspectives go badly awry in taking spillovers to be the exception rather than the rule in human interactions. I. Externalities Economists have discussed spillovers under the heading of “externalities.” To say this is not very helpful, since there is so much disagreement concerning both the definition and significance of externalities. (shrink)

The following definition of “objective” is proposed: A statement S is objective if and only if in S all parameters that are relevant to its truth value are made explicit. The objectivity of predicates and relations can be defined in a similar manner. This simple conception of objectivity-which could be called “explicitness conception of objectivity”-can be found in Hermann Weyl and plays a central part in the natural sciences. There are grades of objectivity depending on the ‘quality’ and the number (...) of parameters our predicates are relativized to A relativistic Ockham principle has to be recognized: Relativization parameters are not to be multiplied beyond necessity. The explicitness conception of objectivity is accessible to mathematical specifications, is the core of the idea of invariance, has a lot of philosophical applications and leads to precise notions of ‘subjectivity’ and a precise formulation of the problem of the limits of objectivity. (shrink)

We demonstrate that the key components of cognitive architectures (declarative and procedural memory) and their key capabilities (learning, memory retrieval, probability judgment, and utility estimation) can be implemented as algebraic operations on vectors and tensors in a high‐dimensional space using a distributional semantics model. High‐dimensional vector spaces underlie the success of modern machine learning techniques based on deep learning. However, while neural networks have an impressive ability to process data to find patterns, they do not typically model high‐level cognition, and (...) it is often unclear how they work. Symbolic cognitive architectures can capture the complexities of high‐level cognition and provide human‐readable, explainable models, but scale poorly to naturalistic, non‐symbolic, or big data. Vector‐symbolic architectures, where symbols are represented as vectors, bridge the gap between the two approaches. We posit that cognitive architectures, if implemented in a vector‐space model, represent a useful, explanatory model of the internal representations of otherwise opaque neural architectures. Our proposed model, Holographic Declarative Memory (HDM), is a vector‐space model based on distributional semantics. HDM accounts for primacy and recency effects in free recall, the fan effect in recognition, probability judgments, and human performance on an iterated decision task. HDM provides a flexible, scalable alternative to symbolic cognitive architectures at a level of description that bridges symbolic, quantum, and neural models of cognition. (shrink)

The same research proposal was submitted to 24 district health authority (DHA) research ethics committees in different parts of the country. The objective was to obtain permission for a multi-centre research project. The study of neonatal care in different types of unit (regional, subregional and district), required that four health authorities were approached in each of six widely separated health regions in England. Data were collected and compared concerning aspects of processing, including application forms, information required, timing and decision-making. The (...) key finding was that ethics committees received and processed the applications variably, reflecting individual factors and local problems. To improve consensus and facilitate multicentre studies, standard forms and instructions are suggested and the establishment of a national committee or advisory group advocated. (shrink)

The traditional “realist” conception of physics, according to which human concepts, laws and theories can grasp the essence of a reality in our absence , seems incompatible with quantum formalism and it most fruitful interpretation. The proof rests on the violation by quantum mechanical formalism of some fundamental principles of the classical ontology. We discuss if the conception behind Einstein’s idea of a reality in our absence, could be still maintained and at which price. We conclude that quantum mechanical formalism (...) is not formulated on those terms, leaving for a separated paper the discussion about the terms in which it could be formulated and the onto-epistemological implications it might have. (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)

Literary accounts of traumatic events can be more informative and insightful than personal testimonials. In particular, reference to works of literature can give us a more vivid sense of what it is like to receive a devastating diagnosis. In turn this can lead us to question some common assumptions about the nature of autonomy, particularly for patients in these circumstances. The literature of concentration camp and labour camp experiences can help us understand what it is like to have one's life-plans (...) altered utterly and unexpectedly. Contrary to common views of autonomy which have difficulty in characterising autonomous action when long-standing assumptions are suddenly lost, these examples show that autonomy is possible in these circumstances. We need a theory of autonomy which can deal with traumatic events and is useful in the clinical context. (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)

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)

In the first Critique Kant introduced the analytic/synthetic distinction and illustrated it with theoretical propositions. As his main aim in that work was to justify synthetic a priori propositions, Kant was able to bring his central questions into relief and discuss the methodology of their solution by contrasting synthetic propositions, such as: “Every event has a cause” with analytic propositions, such as: “Every effect has a cause.” Consequently, few commentators have any difficulty in stating as propositions the propositions Kant is (...) justifying in the first Critique or in pointing out the difficulty of justifying such propositions. (shrink)