Neural substrates of fatigue in traumatic brain injury are not well understood despite the considerable burden of fatigue on return to productivity. Fatigue is associated with diminishing performance under conditions of high cognitive demand, sense of effort, or need for motivation, all of which are associated with cognitive control brain network integrity. We hypothesize that the pathophysiology of TBI results in damage to diffuse cognitive control networks, disrupting coordination of moment-to-moment monitoring, prediction, and regulation of behavior. We investigate the cingulo-opercular (...) and frontoparietal networks, which are engaged to sustain attention for task and maintain performance. A total of 61 individuals with mild TBI and 42 orthopedic control subjects participated in functional MRI during performance of a constant effort task requiring altering the amount of effort utilized to manually squeeze a pneumostatic bulb across six 30-s trials. Network-based statistics assessed within-network organization and fluctuation with task manipulations by group. Results demonstrate small group differences in network organization, but considerable group differences in the evolution of task-related modulation of connectivity. The mild TBI group demonstrated elevated CO connectivity throughout the task with little variation in effort level or time on task, while CO connectivity diminished over time in controls. Several interregional CO connections were predictive of fatigue in the TBI group. In contrast, FP connectivity fluctuated with task manipulations and predicted fatigue in the controls, but connectivity fluctuations were delayed in the mild traumatic brain injury group and did not relate to fatigue. Thus, the mTBI group’s hyper-connectivity of the CO irrespective of task demands, along with hypo-connectivity and delayed peak connectivity of the FP, may allow for attainment of task goals, but also contributes to fatigue. Findings are discussed in relation to performance monitoring of prediction error that relies on internal cues from sensorimotor feedback during task performance. Delay or inability to detect and respond to prediction errors in TBI, particularly evident in bilateral insula-temporal CO connectivity, corresponds to day-to-day fatigue and fatigue during task performance. (shrink)

The author responds to a letter by D. Brendan Johnson in the July‐August 2023 issue of the Hastings Center Report concerning his and Joseph Clair's article “Love Your Patient as Yourself: On Reviving the Broken Heart of American Medical Ethics.”.

This article presents a systematic review carried out around the development of technologies that have driven military communication, describing the evolution of communication equipment and protocols used throughout history. This work was carried out from the review of 80 articles related to the field of militarycommunications, from which the fundamentals of the different technologies, equipment and means of communication were extracted. It is concluded that technological progress has improved the speed of response in digital signals, has proposed.

I explain the notion of contributory injustice, a kind of epistemic injustice, and argue that it occurs within psychiatric services, affecting those who hear voices. I argue that individual effort on the part of clinicians to avoid perpetrating this injustice is an insufficient response to the problem; mitigating the injustice will require open and meaningful dialogue between clinicians and service user organisations, as well as individuals. I suggest that clinicians must become familiar with and take seriously concepts and frameworks for (...) understanding mental distress developed in service user communities, such as Hearing Voices Network, and by individual service users. This is especially necessary when these concepts and frameworks explicitly conflict with medical or technical understandings of users’ experiences. I defend this proposal against three objections. (shrink)

In this paper I propose minimal criteria for a successful theory of the mechanisms of motivation, and argue that extant philosophical accounts fail to meet them. Further, I argue that a predictive processing framework gives us the theoretical power to meet these criteria, and thus ought to be preferred over existing theories. The argument proceeds as follows—motivational mental states are generally understood as mental states with the power to initiate, guide, and control action, though few existing theories of motivation explicitly (...) detail how they are meant to explain these functions. I survey two contemporary theories of motivational mental states, due to Wayne Wu and Bence Nanay, and argue that they fail to satisfactorily explain one or more of these functions. Nevertheless, I argue that together, they are capable of giving a strong account of the control function, which competing theories ought to preserve. I then go on to argue that what I call the ‘predictive theory’ of motivational mental states, which makes use of the notion of active inference, is able to explain all three of the key functions and preserves the central insights of Wu and Nanay on control. It thus represents a significant step forward in the contemporary debate. (shrink)

I argue that Schmidtet al, while correctly diagnosing the serious racial inequity in current ventilator rationing procedures, misidentify a corresponding racial inequity issue in alternative ‘unweighted lottery’ procedures. Unweighted lottery procedures do not ‘compound’ (in the relevant sense) prior structural injustices. However, Schmidtet aldo gesture towards a real problem with unweighted lotteries that previous advocates of lottery-based allocation procedures, myself included, have previously overlooked. On the basis that there are independent reasons to prefer lottery-based allocation of scarce lifesaving healthcare resources, (...) I develop this idea, arguing that unweighted lottery procedures fail to satisfy healthcare providers’ duty to prevent unjust population-level health outcomes, and thus that lotteries weighted in favour of Black individuals (and others who experience serious health injustice) are to be preferred. (shrink)

This article presents a radical claim: American medical ethics is broken, and it needs love to be healed. Due to a unique set of cultural and economic pressures, American medical ethics has adopted a mechanistic mode of ethical reasoning epitomized by the doctrine of principlism. This mode of reasoning divorces clinicians from both their patients and themselves. This results in clinicians who can ace ethics questions on multiple‐choice tests but who fail either to recognize a patient's humanity or to navigate (...) the ethical quandaries into which they are frequently thrown. Drawing on personal experience as well as the philosophical work of Augustine of Hippo, Simone Weil, and Iris Murdoch, we propose a novel ethical approach grounded in a conception of neighbor love, specifically, the virtue of love understood as attention to a sufferer's humanity. We conclude with five practical recommendations for reimagining medical ethics education oriented around the virtue of love. (shrink)

How accurate is Kevin Carson’s characterization of “freed” markets? Carson, a left-libertarian “free market anti-capitalist,” portrays free markets as so radically different from actually-existing markets that they are almost unrecognizable. In The Homebrew Industrial Revolution: A Low Overhead Manifesto, he provides an alternative history of industrialization that argues that large-scale industrial organization and production are largely creatures of state intervention and that truly free markets would be characterized mainly by small-scale production for local markets. This paper evaluates Carson’s narrative in (...) order to determine whether his vision of the freed market is credible. I find that Carson fails to provide sufficient evidence to demonstrate that, but for government intervention, national markets would only exist for a few goods. Furthermore, many of the features he believes freed markets would possess are based on fallacious views of competition, knowledge, capital, and entrepreneurship. (shrink)

Programs, policies, and technologies — particularly those concerned with health equity — are often designed with justice envisioned as the end goal. These policies or interventions, however, frequently fail to recognize how the beneficiaries have historically embodied the cumulative effects of marginalization, which undermines the effectiveness of the intended justice. These well-meaning attempts at justice are bounded by greater socio-historical constraints. Bounded justice suggests that it is impossible to attend to fairness, entitlement, and equity when the basic social and physical (...) infrastructures underlying them have been eroded by racism and other historically entrenched isms. Using the case of Brazil’s National Health Policy for the Black Population, this paper proposes that bounded justice can contribute to justice discourses by serving as a concept, a proffering to a multi-disciplinary conceptual framework, and a potential analytic for those interested in the design of policy, technology, and programmatic interventions towards health equity. (shrink)

Competition among scientists for funding, positions and prestige, among other things, is often seen as a salutary driving force in U.S. science. Its effects on scientists, their work and their relationships are seldom considered. Focus-group discussions with 51 mid- and early-career scientists, on which this study is based, reveal a dark side of competition in science. According to these scientists, competition contributes to strategic game-playing in science, a decline in free and open sharing of information and methods, sabotage of others’ (...) ability to use one’s work, interference with peer-review processes, deformation of relationships, and careless or questionable research conduct. When competition is pervasive, such effects may jeopardize the progress, efficiency and integrity of science. (shrink)

This essay explores the relationship between the modern era’s impulse toward control and the practices of family planning and disability-selective abortion. Drawing from experiences as a pediatric palliative care physician working within a busy fetal care program, as well as the social theory of sociologist Hartmut Rosa, the author argues that there is an unresolved cultural and professional conflict within perinatal medicine between maximizing control of the future and maximizing a culture of anti-ableism.

Shane Glackin's 2019 Philosophical Quarterly article aims to offer a framework for understanding the philosophical debate about the nature of disease and utilise this framework to reply to several standard objections to normativist theories of disease. Specifically, Glackin claims his model avoids three central challenges to normativism, which we term the ‘Flippancy Problem’, ‘Repugnancy Problem’, and the ‘Explanatory Problem’. Although we find Glackin's framework helpful in clarifying the terrain of the debate, we argue these three challenges continue to afflict his (...) preferred construal of the normativist/social constructivist position. (shrink)

The nature of scientific societies’ relationships with their members limits their ability to promote research integrity. They must therefore leverage their strengths as professional organizations to integrate ethical considerations into their ongoing support of their academic disciplines. This paper suggests five strategies for doing so.

Eric C. Ip has recently argued that seriously anorexic service users ought to be assumed to be legally incapacitous to refuse life‐saving artificial nutrition unless they can demonstrate otherwise, reversing the ordinary legal presumption in place to protect patients’ liberty and values. In this response, I argue against this proposal on two grounds. Firstly, the proposal is wrongfully discriminatory; it would expose service users to serious harm, and wrong them in numerous ways, on the basis of their diagnosis alone, without (...) significantly benefitting them in any way relative to the status quo. Secondly, he is unable to show that a large majority of such service users actually are incapacitous to refuse life‐saving artificial nutrition. This means that his proposal would likely involve declaring a large number of actually capacitous patients to be incapacitous, without even the requirement of a formal assessment, and burdening them with the responsibility of proving their clinical team wrong if they wish to avoid deprivation of liberty and/or compelled treatment. Given this, his proposal is indefensible. (shrink)

In this paper I aim to show why pediatric suffering must be understood as a judgment or evaluation, rather than a mental state. To accomplish this task, first I analyze the various ways that the label of suffering is used in pediatric practice. Out of this analysis emerge what I call the twin poles of pediatric suffering. At one pole sits the belief that infants and children with severe cognitive impairment cannot suffer because they are nonverbal or lack subjective life (...) experience. At the other pole exists the idea that once child suffering reaches some threshold it is ethical to eliminate the sufferer. Concerningly, at both poles, any particular child vanishes from view. Second, in an attempt to identify a theory of suffering inclusive of children, I examine two prominent so-called experiential accounts of suffering. I find them both wanting on account of their absurd entailments and their flawed assumptions regarding the subjective experiences of people who cannot communicate expressively. Finally, I extend arguments found in Alastair MacIntyre’s Dependent Rational Animals to argue that child suffering can be understood only as a set of absences—absences of conditions such as love, warmth, and freedom from pain. An evaluation of these absences reveals the exquisite dependency of children. It also discloses why pediatric suffering is necessarily a social and political event. Unlike adults, children will never be either the authors or the mitigators of their own suffering. Rather, children must rely wholly on others in order to resist suffering, grow, and flourish. (shrink)

This article explains the problems with Alan Shewmon’s critique of brain death as a valid sign of human death, beginning with a critical examination of his analogy between brain death and severe spinal cord injury. The article then goes on to assess his broader argument against the necessity of the brain for adult human organismal integration, arguing that he fails to translate correctly from biological to metaphysical claims. Finally, on the basis of a deeper metaphysical analysis, I offer a revised (...) rationale for the validity of the neurological criterion of human death. (shrink)

Realists about practical reasons agree that judgments regarding reasons are beliefs. They disagree, however, over the question of how such beliefs motivate rational action. Some adopt a Humean conception of motivation, according to which beliefs about reasons must combine with independently existing desires in order to motivate rational action; others adopt an anti-Humean view, according to which beliefs can motivate rational action in their own right, either directly or by giving rise to a new desire that in turn motivates the (...) action. I argue that the realist who adopts a Humean model for explaining rational action will have a difficult time giving a plausible account of the role that desire plays in this explanation. I explore four interpretations of this role and argue that none allows a Humean theory to explain rational action as convincingly as an anti-Humean theory does. The first two models, in different ways, make acting on a reason impossible. The third allows this possibility, but only by positing a reason-sensitive desire that itself demands an explanation. The fourth avoids this explanatory challenge only by retreating to an empty form of the Humean view. In contrast, an anti-Humean theory can provide an intuitively plausible explanation of rational action. I conclude that the realist about reasons should adopt an anti-Humean theory to explain rational action. (shrink)

Globalization generates new structures of human interdependence and vulnerability while also posing challenges for models of democracy rooted in territorially bounded states. The diverse phenomena of globalization have stimulated two relatively new branches of political theory: theoretical accounts of the possibilities of democracy beyond the state; and comparative political theory, which aims at bringing non-Western political thought into conversation with the Western traditions that remain dominant in the political theory academy. This article links these two theoretical responses to globalization by (...) showing how comparative political theory can contribute to the emergence of new global “publics” around the common fates that globalization forges across borders. Building on the pragmatist foundations of deliberative democratic theory, it makes a democratic case for comparative political theory as an architecture of translation that helps deliberative publics grow across boundaries of culture. (shrink)

In this essay, I outline fundamental anthropological and moral principles related to human sexuality and gender identity and then apply these principles to analyze and evaluate the views of several authors who attempt to carve out a “middle way” between liberal and traditionalist approaches to these issues. In doing so, I engage especially with the claim that gender dysphoria, rather than being a psychological issue, is a type of biological intersex condition in which one’s “brain sex” is out of line (...) with one’s genital and chromosomal sex. I argue that understanding the human person as a unity of body and soul and recognizing human sexuality as ordered toward the human good of marriage understood as inseparably unitive and procreative reveals the flaws in this position and helps to show why hormonal or surgical gender reassignment therapy is not a medically or ethically appropriate response to gender dysphoria. I also offer an alternative characterization of gender dysphoria and suggestions for responding with true compassion to those who suffer from it. (shrink)

Reflective essay focusing on a discussion of friendship with a group of fourth grade students. Includes a brief discussion of a learning game that focuses on the problems of listening to others.

In this response essay, I borrow a page from Jack Halberstam to explore the ties that bind—ligates, as in re-ligio—the two sibling fields of sociology and religious studies.

A central goal of the scientific endeavor is to explain phenomena. Scientists often attempt to explain a phenomenon by way of representing it in some manner—such as with mathematical equations, models, or theory—which allows for an explanation of the phenomenon under investigation. However, in developing scientific representations, scientists typically deploy simplifications and idealizations. As a result, scientific representations provide only partial, and often distorted, accounts of the phenomenon in question. Philosophers of science have analyzed the nature and function of how (...) scientists construct representations, deploy idealizations, and provide explanations. As such, our aim in this special issue is to bring these three pillars of research into closer contact with the contributions to it focusing on three main themes. -/- The first set of papers, Alan Baker (2021) and Marc Lange (2021), address mathematical explanations in science. Baker (2021), a proponent of mathematical Platonism, examines its capacity to evade the critique that the so-called Enhanced Indispensability Argument is circular. Lange (2021) examines distinctively mathematical explanations, arguing that neither Platonism nor representationalism are successful paths, and instead argues in favor of Aristotelian realism. A second theme emerging from the papers in this special issue is the impact that various conceptualizations of idealization have on our abilities to offer scientific explanations, to pro- duce an analysis of what explanations are or should be, and to understand scientific representation. Peter Tan (2021) suggests amending inferentialist accounts of scientific representation to account for inconsistent idealizations. Michael Strevens (2021) advocates a view wherein the introduction of idealizations into a model is legitimate so long as it pertains to non-difference-making factors, arguing for a logical reading of the notion of difference-making. Natalia Carrillo and Tarja Knuuttila (2022) offer an alternative account to the idealization-as-distortion view, emphasizing instead the holistic nature of idealization. -/- Finally, contributions by Carrillo and Knuuttila (2022), Terzian (2021), Valente (2021), and Rodriguez (2021) illustrate how issues regarding idealization, representation, and explanation are applied to specific contexts and across various sciences. Carrillo and Knuuttila (2022) examine conceptions of idealization in the context of models of the nerve impulse. Giulia Terzian (2021) extends the discussion of idealizations to the context of generative linguistics. Giovanni Valente (2021) examines how idealizations and evaluations of accurate representation impact capacities to explain phenomena in the context of statistical thermodynamics. Quentin Rodriguez (2021) examines the role of idealizations and analogies in various strategies to explain critical phenomena. -/- In what follows, we offer a brief overview of important philosophical issues connected to representation, idealization, and explanation in science. We then provide short summaries of the eight papers in this special issue. (shrink)

Explores the challenges facing democracies in the twenty-first century In Democratic Failure, Melissa Schwartzberg and Daniel Viehoff bring together a distinguished group of interdisciplinary scholars in political science, law, and philosophy to explore the key questions and challenges facing democracies, both in the past and present, around the world. In ten timely essays, contributors examine the fascinating, centuries-old question of whether or not democracy can ever fulfill the promise of its ideals. Together, they explore lessons from the history of (...) democracy, various failures of democratic representation, and more. Ultimately, this latest installment of the NOMOS series provides thought-provoking insights into how we conceptualize, measure, and address democratic erosion in our present-day world. (shrink)

As is clear in the 2008 report of the President's Council on Bioethics, the brain death debate is plagued by ambiguity in the use of such key terms as ‘integration’ and ‘wholeness’. Addressing this problem, I offer a plausible ontological account of organismal unity drawing on the work of Hoffman and Rosenkrantz, and then apply that account to the case of brain death, concluding that a brain dead body lacks the unity proper to a human organism, and has therefore undergone (...) a substantial change. I also show how my view can explain hard cases better than one in which biological integration is taken to imply ontological wholeness or unity. (shrink)