In 1968, the Harvard criteria equated irreversible coma and apnea with human death and later, the Uniform Determination of Death Act was enacted permitting organ procurement from heart-beating donors. Since then, clinical studies have defined a spectrum of states of impaired consciousness in human beings: coma, akinetic mutism, minimally conscious state, vegetative state and brain death. In this article, we argue against the validity of the Harvard criteria for equating brain death with human death. Brain death does not disrupt somatic (...) integrative unity and coordinated biological functioning of a living organism. Neurological criteria of human death fail to determine the precise moment of an organism’s death when death is established by circulatory criterion in other states of impaired consciousness for organ procurement with non-heart-beating donation protocols. The criterion of circulatory arrest 75 s to 5 min is too short for irreversible cessation of whole brain functions and respiration controlled by the brain stem. Brain -based criteria for determining death with a beating heart exclude relevant anthropologic, psychosocial, cultural, and religious aspects of death and dying in society. Clinical guidelines for determining brain death are not consistently validated by the presence of irreversible brain stem ischemic injury or necrosis on autopsy; therefore, they do not completely exclude reversible loss of integrated neurological functions in donors. The questionable reliability and varying compliance with these guidelines among institutions amplify the risk of determining reversible states of impaired consciousness as irreversible brain death. The scientific uncertainty of defining and determining states of impaired consciousness including brain death have been neither disclosed to the general public nor broadly debated by the medical community or by legal and religious scholars. Heart-beating or non-heart-beating organ procurement from patients with impaired consciousness is de facto a concealed practice of physician-assisted death, and therefore, violates both criminal law and the central tenet of medicine not to do harm to patients. Society must decide if physician-assisted death is permissible and desirable to resolve the conflict about procuring organs from patients with impaired consciousness within the context of the perceived need to enhance the supply of transplantable organs. (shrink)

In early 2017, Nevada amended its Uniform Determination of Death Act, in order to clarify the neurologic criteria for the determination of death. The amendments stipulate that a determination of death is a clinical decision that does not require familial consent and that the appropriate standard for determining neurologic death is the American Academy of Neurology’s guidelines. Once a physician makes such a determination of death, the Nevada amendments require the withdrawal of life-sustaining treatment within twenty-four hours with limited exceptions. (...) Neurologists have generally supported Nevada’s amendments for clarifying the diagnostic standard and limiting the ability of family members to challenge it. However, it is more appropriate to view the Nevada amendments with concern. Even though the primary purpose of the UDDA is to ensure that all functions of a person’s entire brain have ceased, the AAN guidelines do not accurately assess this. In addition, by characterizing the determination of death as solely a clinical decision, the Nevada legislature has improperly ignored the doctrine of informed consent, as well as the beliefs of particular faiths and cultures that reject brain death. Rather than resolving controversies regarding brain death determinations, the Nevada amendments may instead instigate numerous constitutional challenges. (shrink)

BackgroundBioethics and law distinguish between the practices of "physician-assisted death" and "allowing the patient to die."DiscussionAdvances in biotechnology have allowed medical devices to be used as destination therapy that are designed for the permanent support of cardiac function and/or respiration after irreversible loss of these spontaneous vital functions. For permanent support of cardiac function, single ventricle or biventricular mechanical assist devices and total artificial hearts are implanted in the body. Mechanical ventilators extrinsic to the body are used for permanent support (...) of respiration. Clinical studies have shown that destination therapy with ventricular assist devices improves patient survival compared to medical management, but at the cost of a substantial alteration in end-of-life trajectories. The moral and legal assessment of the appropriateness and permissibility of complying with a patient's request to electively discontinue destination therapy in a life-terminating act in non-futile situations has generated controversy. Some argue that complying with this request is ethically justified because patients have the right to request withdrawal of unwanted treatment and be allowed to die of preexisting disease. Other commentators reject the argument that acceding to an elective request for death by discontinuing destination therapy is 'allowing a patient to die' because of serious flaws in interpreting the intention, causation, and moral responsibility of the ensuing death.SummaryDestination therapy with cardiac and/or ventilatory medical devices replaces native physiological functions and successfully treats a preexisting disease. We posit that discontinuing cardiac and/or ventilatory support at the request of a patient or surrogate can be viewed as allowing the patient to die if--and only if--concurrent lethal pathophysiological conditions are present that are unrelated to those functions already supported by medical devices in destination therapy. In all other cases, compliance with a patient's request constitutes physician-assisted death because of the pathophysiology induced by the turning off of these medical devices, as well as the intention, causation, and moral responsibility of the ensuing death. The distinction between allowing the patient to die and physician-assisted death is pivotal to the moral and legal status of elective requests for death by discontinuing destination cardiac and/or ventilatory medical devices in patients who are not imminently dying. This distinction also represents essential information that must be disclosed to patients and surrogates in advance of consent to this type of therapy. (shrink)

Since the introduction of the concept of brain death by the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death in 1968, the validity of this concept has been challenged by medical scientists, as well as by legal, philosophical, and religious scholars. In light of increased criticism of the concept of brain death, Stephen Napier, a staff ethicist at the National Catholic Bioethics Center, set out to prove that the whole-brain death criterion serves as (...) good evidence for death in the Catholic bioethical framework, on the grounds that when whole-brain death has occurred the soul has already departed from the body. Opponents have argued that (1) brain death does not disrupt the somatic integrative unity and coordinated biological functioning of a living organism and (2) clinical tests outlined in the practice guidelines for determining brain death lack sufficient power to exclude persisting function and fail to detect elements of the brain that, although currently functionless, may retain potential for recovery under conditions of optimal medical care. It is therefore possible that heart-beating organ procurement from patients with impaired consciousness is de facto a concealed practice of active euthanasia and physician-assisted death, both of which, either concealed or overt, the Catholic Church opposes. (shrink)

Organ donation after cardiac or circulatory death (DCD) has been introduced to increase the supply of transplantable organs. In this paper, we argue that the recovery of viable organs useful for transplantation in DCD is not compatible with the dead donor rule and we explain the consequential ethical and legal ramifications. We also outline serious deficiencies in the current consent process for DCD with respect to disclosure of necessary elements for voluntary informed decision making and respect for the donor's autonomy. (...) We compare two alternative proposals for increasing organ donation consent in society: presumed consent and mandated choice. We conclude that proceeding with the recovery of transplantable organs from decedents requires a paradigm change in the ethics of organ donation. The paradigm change to ensure the legitimacy of DCD practice must include: (1) societal agreement on abandonment of the dead donor rule, (2) legislative revisions reflecting abandonment of the dead donor rule, and (3) requirement of mandated choice to facilitate individual participation in organ donation and to ensure that decisions to participate are made in compliance with the societal values of respect for autonomy and self-determination. (shrink)

There is a trend of recruiting faith leaders at mosques to overcome religious barriers to organ donation, and to increase donor registration among Muslims. Commentators have suggested that Muslims are not given enough information about organ donation in religious sermons or lectures delivered at mosques. Corrective actions have been recommended, such as funding campaigns to promote organ donation, and increasing the availability of organ donation information at mosques. These actions are recommended despite published literature expressing safety concerns (i.e., do no (...) harm) in living and end-of-life organ donation. Living donors require life-long medical follow-up and treatment for complications that can appear years later. Scientific and medical controversies persist regarding the international guidelines for death determination in end-of-life donation. The medical criteria of death lack validation and can harm donors if surgical procurement is performed without general anesthesia and before biological death. In the moral code of Islam, the prevention of harm holds precedence over beneficence. Moral precepts described in the Quran encourage Muslims to be beneficent, but also to seek knowledge prior to making practical decisions. However, the Quran also contains passages that demand honesty and truthfulness when providing information to those who are seeking knowledge. Currently, information is limited to that which encourages donor registration. Campaigning for organ donation to congregations in mosques should adhere to the moral code of complete, rather than selective, disclosure of information. We recommend as a minimal standard the disclosure of risks, uncertainties, and controversies associated with the organ donation process. (shrink)

The American Journal of Bioethics, Volume 11, Issue 8, Page 52-54, August 2011.

Advance health care directives and informed consent remain the cornerstones of patients' right to self-determination regarding medical care and preferences at the end-of-life. However, the effectiveness and clinical applicability of advance health care directives to decision-making on the use of life support systems at the end-of-life is questionable. The Uniform Anatomical Gift Act (UAGA) has been revised in 2006 to permit the use of life support systems at or near death for the purpose of maximizing procurement opportunities of organs medically (...) suitable for transplantation. Some states have enacted the Revised UAGA (2006) and a few of those have included amendments while attempting to preserve the uniformity of the revised Act. Other states have introduced the Revised UAGA (2006) for legislation and remaining states are likely to follow soon. (shrink)

Organ donation after cardiac or circulatory death (DCD) has been introduced to increase the supply of transplantable organs. In this paper, we argue that the recovery of viable organs useful for transplantation in DCD is not compatible with the dead donor rule and we explain the consequential ethical and legal ramifications. We also outline serious deficiencies in the current consent process for DCD with respect to disclosure of necessary elements for voluntary informed decision making and respect for the donor's autonomy. (...) We compare two alternative proposals for increasing organ donation consent in society: presumed consent and mandated choice. We conclude that proceeding with the recovery of transplantable organs from decedents requires a paradigm change in the ethics of organ donation. The paradigm change to ensure the legitimacy of DCD practice must include: (1) societal agreement on abandonment of the dead donor rule, (2) legislative revisions reflecting abandonment of the dead donor rule, and (3) requirement of mandated choice to facilitate individual participation in organ donation and to ensure that decisions to participate are made in compliance with the societal values of respect for autonomy and self-determination. (shrink)

The concept of informed consent for medical treatment has been well established as a necessary element in ensuring compliance with patients' right to self determination and respect of individual au...

Organ donation after cessation of circulation and respiration, both controlled and uncontrolled, has been proposed by the Institute of Medicine as a way to increase opportunities for organ procurement. Despite claims to the contrary, both forms of controlled and uncontrolled donation after cardiac death raise significant ethical and legal issues. Identified causes for concern include absence of agreement on criteria for the declaration of death, nonexistence of universal guidelines for duration before stopping resuscitation efforts and techniques, and assumption of presumed (...) intent to donate for the purpose of initiating temporary organ-preservation interventions when no expressed consent to donate is present. From a legal point of view, not having scientifically valid criteria of cessation of circulation and respiration for declaring death could lead to a conclusion that organ procurement itself is the proximate cause of death. Although the revised Uniform Anatomical Gift Act of 2006 provides broad immunity to those involved in organ-procurement activities, courts have yet to provide an opinion on whether persons can be held liable for injuries arising from the determination of death itself. Preserving organs in uncontrolled donation after cardiac death requires the administration of life-support systems such as extracorporeal membrane oxygenation. These life-support systems can lead to return of signs of life that, in turn, have to be deliberately suppressed by the administration of pharmacological agents. Finally, allowing temporary organ-preservation interventions without expressed consent is inherently a violation of the principle of respect for a person's autonomy. Proponents of organ donation from uncontrolled donation after cardiac death, on the other hand, claim that these nonconsensual interventions enhance respect for autonomy by allowing people, through surrogate decision making, to execute their right to donate organs. However, the lack of transparency and the absence of protection of individual autonomy, for the sake of maximizing procurement opportunities, have placed the current organ-donation system of opting-in in great jeopardy. Equally as important, current policies enabling and enhancing organ procurement practices, pose challenges to the constitutional rights of individuals in a pluralistic society as these policies are founded on flawed medical standards for declaring death. (shrink)

End-of-life organ donation is controversial in Islam. The controversy stems from: scientifically flawed medical criteria of death determination; invasive perimortem procedures for preserving transplantable organs; and incomplete disclosure of information to consenting donors and families. Data from a survey of Muslims residing in Western countries have shown that the interpretation of religious scriptures and advice of faith leaders were major barriers to willingness for organ donation. Transplant advocates have proposed corrective interventions: reinterpreting religious scriptures, reeducating faith leaders, and utilizing media (...) campaigns to overcome religious barriers in Muslim communities. This proposal disregards the intensifying scientific, legal, and ethical controversies in Western societies about the medical criteria of death determination in donors. It would also violate the dignity and inviolability of human life which are pertinent values incorporated in the Islamic moral code. Reinterpreting religious scriptures to serve the utilitarian objectives of a controversial end-of-life practice, perceived to be socially desirable, transgresses the Islamic moral code. It may also have deleterious practical consequences, as donors can suffer harm before death. The negative normative consequences of utilitarian secular moral reasoning reset the Islamic moral code upholding the sanctity and dignity of human life. (shrink)

The Royal College of Physicians of London published the 2013 national clinical guidelines on prolonged disorders of consciousness in vegetative and minimally conscious states. The guidelines acknowledge the rapidly advancing neuroscientific research and evolving therapeutic modalities in PDOC. However, the guidelines state that end-of-life decisions should be made for patients who do not improve with neurorehabilitation within a finite period, and they recommend withdrawal of clinically assisted nutrition and hydration . This withdrawal is deemed necessary because patients in PDOC can (...) survive for years with continuation of CANH, even when a ceiling on medical care has been imposed, i.e., withholding new treatment such as cardiopulmonary resuscitation for acute life-threatening illness. The end-of-life care pathway is centered on a staged escalation of medications, including sedatives, opioids, barbiturates, and general anesthesia, concurrent with withdrawal of CANH. Agitation and distress may last from several days to weeks because of the slow dying process from starvation and dehydration. The potential problems of this end-of-life care pathway are similar to those of the Liverpool Care Pathway. After an independent review in 2013, the Department of Health discontinued the Liverpool Care pathway in England. The guidelines assert that clinicians, supported by court decisions, have become the final authority in nonconsensual withdrawal of CANH on the basis of “best interests” rationale. We posit that these guidelines lack high-quality evidence supporting: 1) treatment futility of CANH, 2) reliability of distress assessment from starvation and dehydration, 3) efficacy of pharmacologic control of this distress, and 4) proximate causation of death. Finally, we express concerns about the utilitarian-based assessment of what constitutes a person’s best interests. We are disturbed by the level and the role of medical authoritarianism institutionalized by these national guidelines when deciding on the worthiness of life in PDOC. We conclude that these guidelines are not only harmful to patients and families, but they represent the means of nonconsensual euthanasia. The latter would constitute a gross violation of the public’s trust in the integrity of the medical profession. (shrink)

Background Requirements for organ donation after cardiac or imminent death have been introduced to address the transplantable organs shortage in the United States. Organ procurement organizations (OPOs) increasingly use the Internet for organ donation consent. Methods An analysis of OPO Web sites available to the public for enrollment and consent for organ donation. The Web sites and consent forms were examined for the minimal information recommended by the United States Department of Health and Human Services for informed consent. Content scores (...) were calculated as percentages of data elements in four information categories: donor knowledge, donor consent reinforcement, donation promotion, and informed consent. Results There were 60 Web sites for organ donation enrollment serving the 52 states. The median percent (10 percentile-90 percentile) content scores of the Web sites for donor knowledge, donor consent reinforcement, and donation promotion were 33% (20–47), 79% (57–86), and 75% (50–100), respectively. The informed consent score was 0% (0–33). The content scores for donor knowledge and informed consent were significantly lower than donor consent reinforcement and donation promotion for all Web sites (P < .05). The content scores for the four categories were similar among the 11 regions of the United Network for Organ Sharing. Conclusion The Web sites and consent forms for public enrollment in organ donation do not fulfill the necessary requirements for informed consent. The Web sites predominantly provide positive reinforcement and promotional information rather than the transparent disclosure of organ donation process. Independent regulatory oversight is essential to ensure that Internet enrollment for organ donation complies with legal and ethical standards for informed consent. (shrink)

Background Bioethics and law distinguish between the practices of "physician-assisted death" and "allowing the patient to die." Discussion Advances in biotechnology have allowed medical devices to be used as destination therapy that are designed for the permanent support of cardiac function and/or respiration after irreversible loss of these spontaneous vital functions. For permanent support of cardiac function, single ventricle or biventricular mechanical assist devices and total artificial hearts are implanted in the body. Mechanical ventilators extrinsic to the body are used (...) for permanent support of respiration. Clinical studies have shown that destination therapy with ventricular assist devices improves patient survival compared to medical management, but at the cost of a substantial alteration in end-of-life trajectories. The moral and legal assessment of the appropriateness and permissibility of complying with a patient's request to electively discontinue destination therapy in a life-terminating act in non-futile situations has generated controversy. Some argue that complying with this request is ethically justified because patients have the right to request withdrawal of unwanted treatment and be allowed to die of preexisting disease. Other commentators reject the argument that acceding to an elective request for death by discontinuing destination therapy is 'allowing a patient to die' because of serious flaws in interpreting the intention, causation, and moral responsibility of the ensuing death. Summary Destination therapy with cardiac and/or ventilatory medical devices replaces native physiological functions and successfully treats a preexisting disease. We posit that discontinuing cardiac and/or ventilatory support at the request of a patient or surrogate can be viewed as allowing the patient to die if--and only if--concurrent lethal pathophysiological conditions are present that are unrelated to those functions already supported by medical devices in destination therapy. In all other cases, compliance with a patient's request constitutes physician-assisted death because of the pathophysiology induced by the turning off of these medical devices, as well as the intention, causation, and moral responsibility of the ensuing death. The distinction between allowing the patient to die and physician-assisted death is pivotal to the moral and legal status of elective requests for death by discontinuing destination cardiac and/or ventilatory medical devices in patients who are not imminently dying. This distinction also represents essential information that must be disclosed to patients and surrogates in advance of consent to this type of therapy. (shrink)

The utilitarian construct of two alternative criteria of human death increases the supply of transplantable organs at the end of life. Neither the neurological criterion (heart-beating donation) nor the circulatory criterion (non-heart-beating donation) is grounded in scientific evidence but based on philosophical reasoning. A utilitarian death definition can have unintended consequences for dying Muslim patients: (1) the expedited process of determining death for retrieval of transplantable organs can lead to diagnostic errors, (2) the equivalence of brain death with human death (...) may be incorrect, and (3) end-of-life religious values and traditional rituals may be sacrificed. Therefore, it is imperative to reevaluate the two different types and criteria of death introduced by the Resolution (Fatwa) of the Council of Islamic Jurisprudence on Resuscitation Apparatus in 1986. Although we recognize that this Fatwa was based on best scientific evidence available at that time, more recent evidence shows that it rests on outdated knowledge and understanding of the phenomenon of human death. We recommend redefining death in Islam to reaffirm the singularity of this biological phenomenon as revealed in the Quran 14 centuries ago. (shrink)

The left ventricular assist device was originally designed to be surgically implanted as a bridge to transplantation for patients with chronic end-stage heart failure. On the basis of the REMATCH trial, the US Food and Drug Administration and the US Centers for Medicare & Medicaid Services approved permanent implantation of the left ventricular assist device as a destination therapy in Medicare beneficiaries who are not candidates for heart transplantation. The use of the left ventricular assist device as a destination therapy (...) raises certain ethical challenges. Left ventricular assist devices can prolong the survival of average recipients compared with optimal medical management of chronic end-stage heart failure. However, the overall quality of life can be adversely affected in some recipients because of serious infections, neurologic complications, and device malfunction. Left ventricular assist devices alter end-of-life trajectories. The caregivers of recipients may experience significant burden (e.g., poor physical health, depression, anxiety, and posttraumatic stress disorder) from destination therapy with left ventricular assist devices. There are also social and financial ramifications for recipients and their families. We advocate early utilization of a palliative care approach and outline prerequisite conditions so that consenting for the use of a left ventricular assist device as a destination therapy is a well informed process. These conditions include: (1) direct participation of a multidisciplinary care team, including palliative care specialists, (2) a concise plan of care for anticipated device-related complications, (3) careful surveillance and counseling for caregiver burden, (4) advance-care planning for anticipated end-of-life trajectories and timing of device deactivation, and (5) a plan to address the long-term financial burden on patients, families, and caregivers. Short-term mechanical circulatory devices (e.g. percutaneous cardiopulmonary bypass, percutaneous ventricular assist devices, etc.) can be initiated in emergency situations as a bridge to permanent implantation of ventricular assist devices in chronic end-stage heart failure. In the absence of first-person (patient) consent, presumed consent or surrogate consent should be used cautiously for the initiation of short-term mechanical circulatory devices in emergency situations as a bridge to permanent implantation of left ventricular assist devices. Future clinical studies of destination therapy with left ventricular assist devices should include measures of recipients' quality of end-of-life care and caregivers' burden. (shrink)

In assisted dying, the end-of-life trajectory is shortened to relieve unbearable suffering. Unbearable suffering is defined broadly enough to include cognitive (early dementia), psychosocial or existential distress. It can include old-age afflictions that are neither life-threatening nor fatal in the “vulnerable elderly”. The voluntary refusal of food and fluids (VRFF) combined with continuous deep sedation (CDS) for assisted dying is legal. Scientific understanding of awareness of internal and external nociceptive stimuli under CDS is rudimentary. CDS may blunt the wakefulness component (...) of human consciousness without eradicating internal affective awareness of thirst and hunger. Patients may suffer because of the slow dying process following dehydration and starvation. The difficulty to adequately control distress, without bringing the dying process to a rapid conclusion by lethal pharmacological interventions, can cause feelings of guilt among hospice and medical staff. Furthermore, the double-effect principle is not applicable in these situations because the primary objective of VRFF is to hasten death. Legal and societal debate should focus on sharpening the boundaries between assisted dying and palliative care. This separation is necessary to: 1) uphold trust in the patient-phyician relationship, and 2) preserve integrity and ethics of the medical profession. (shrink)

Islam and End-of-Life Practices in Organ Donation for Transplantation: New Questions and Serious Sociocultural Consequences Content Type Journal Article Pages 175-205 DOI 10.1007/s10730-009-9095-8 Authors Mohamed Y. Rady, Mayo Clinic Hospital in Phoenix 5777 East Mayo Boulevard Phoenix Arizona USA 85054 Joseph L. Verheijde, Mayo Clinic College of Medicine 5777 East Mayo Boulevard Phoenix Arizona USA 85054 Muna S. Ali, Arizona State University Phoenix Arizona USA Journal HEC Forum Online ISSN 1572-8498 Print ISSN 0956-2737 Journal Volume Volume 21 Journal (...) Issue Volume 21, Number 2. (shrink)

Recently, several articles in the scholarly literature on medical ethics proclaim the need for “responsible scholarship” in the debate over the proper criteria for death, in which “responsible scholarship” is defined in terms of support for current neurological criteria for death. In a recent article, James M. DuBois is concerned that academic critiques of current death criteria create unnecessary doubt about the moral acceptability of organ donation, which may affect the public’s willingness to donate. Thus he calls for a closing (...) of the debate on current death criteria and for journal editors to publish only critiques that “substantially engage and advance the debate.” We argue that such positions as DuBois’ are a threat to responsible scholarship in medical ethics, especially scholarship that opposes popular stances, because it erodes academic freedom and the necessity of debate on an issue that is literally a matter of life and death, no matter what side a person defends. (shrink)

The American Journal of Bioethics, Volume 12, Issue 2, Page 40-42, February 2012.

Volume 20, Issue 6, June 2020, Page 22-24.

We respond to Morgan and Feeley’s critique on our article “Mass Media in Organ Donation: Managing Conflicting Messages and Interests.” We noted that Morgan and Feeley agree with the position that the primary aims of media campaigns are: “to educate the general public about organ donation process” and “help individuals make informed decisions” about organ donation. For those reasons, the educational messages in media campaigns should not be restricted to “information from pilot work or focus groups” but should include evidence-based (...) facts resulting from a comprehensive literature research. We consider the controversial aspects about organ donation to be relevant, if not necessary, educational materials that must be disclosed in media campaigns to comply with the legal and moral requirements of informed consent. With that perspective in mind, we address the validity of Morgan and Feeley’s claim that media campaigns have no need for informing the public about the controversial nature of death determination in organ donation. Scientific evidence has proven that the criteria for death determination are inconsistent with the Uniform Determination of Death Act and therefore potentially harmful to donors. The decision by campaign designers to use the statutory definition of death without disclosing the current controversies surrounding that definition does not contribute to improved informed decision making. We argue that if Morgan and Feeley accept the important role of media campaigns to enhance informed decision making, then critical controversies should be disclosed. In support of that premise, we will outline: (1) the wide-spread scientific challenges to brain death as a concept of death; (2) the influence of the donor registry and team-huddling on the medical care of potential donors; (3) the use of authorization rather than informed consent for donor registration; (4) the contemporary religious controversy; and (5) the effects of training desk clerks as organ requestors at the Department of Motor Vehicles offices. We conclude that organ donation is a medical procedure subject to all the ethical obligations that the medical profession must uphold including that of transparency and truthfulness. (shrink)

The American Journal of Bioethics, Volume 11, Issue 6, Page 60-62, June 2011.

The American Journal of Bioethics, Volume 12, Issue 6, Page 17-20, June 2012.

Mass media campaigns are widely and successfully used to change health decisions and behaviors for better or for worse in society. In the United States, media campaigns have been launched at local offices of the states’ department of motor vehicles to promote citizens’ willingness to organ donation and donor registration. We analyze interventional studies of multimedia communication campaigns to encourage organ-donor registration at local offices of states’ department of motor vehicles. The media campaigns include the use of multifaceted communication tools (...) and provide training to desk clerks in the use of scripted messages for the purpose of optimizing enrollment in organ-donor registries. Scripted messages are communicated to customers through mass audiovisual entertainment media, print materials and interpersonal interaction at the offices of departments of motor vehicles. These campaigns give rise to three serious concerns: (1) bias in communicating information with scripted messages without verification of the scientific accuracy of information, (2) the provision of misinformation to future donors that may result in them suffering unintended consequences from consenting to medical procedures before death (e.g, organ preservation and suitability for transplantation), and (3) the unmanaged conflict of interests for organizations charged with implementing these campaigns, (i.e, dual advocacy for transplant recipients and donors). We conclude the following: (1) media campaigns about healthcare should communicate accurate information to the general public and disclose factual materials with the least amount of bias; (2) conflicting interests in media campaigns should be managed with full public transparency; (3) media campaigns should disclose the practical implications of procurement as well as acknowledge the medical, legal, and religious controversies of determining death in organ donation; (4) organ-donor registration must satisfy the criteria of informed consent; (5) media campaigns should serve as a means of public education about organ donation and should not be a form of propaganda. (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)

Background A biobank is a structure which collects and manages biological samples and their associated data. The collected samples will then be made available for various uses. The sharing of those samples raised ethical questions which have been answered through specific rules. Thus, a Biobank functioning under tight ethical rules would be immensely valuable from a scientific and an economic view point. In 2009, Côte d’Ivoire established a biobank, which has been chosen to house the regional biobank of Economic Community (...) of West African States countries in 2018. To ensure optimal and efficient use of this biobank, the scientific community must be aware of its existence and its role. It was therefore necessary to evaluate the knowledge of laboratories staff on the role and activities of a biobank. Methods This descriptive study was done by questioning staff from laboratories working on human’s health, animals or plants. The laboratories were located in southern Côte d’Ivoire. Results A total of 205 people completed the questionnaire. Of these 205 people, 34.63% were biologists, 7.32% engineers, 48.78% technicians and 9.27% PhD students. The average length of work experience was 10.11 ± 7.83 years. In this study, 43.41% of the participants had never heard of biobanking. Only 48.78% of participants had a good understanding of the role of a biobank. Technicians and PhD students were less educated on the notion of biobank. Conclusion The level of knowledge of laboratory staff about biobanking needs to be improved. Training on the role, activities and interests of the biobank is important. (shrink)

Ben Saunders claims that actual consent is not necessary for organ donation due to ‘normative consent’, a concept he borrows from David Estlund. Combining normative consent with Peter Singer's ‘greater moral evil principle’, Saunders argues that it is immoral for an individual to refuse consent to donate his or her organs. If a presumed consent policy were thus adopted, it would be morally legitimate to remove organs from individuals whose wishes concerning donation are not known. This paper disputes Saunders' arguments. (...) First, if death caused by the absence of organ transplant is the operational premise, then, there is nothing of comparable moral precedence under which a person is not obligated to donate. Saunders' use of Singer's principle produces a duty to donate in almost all circumstances. However, this premise is based on a flawed interpretation of cause and effect between organ availability and death. Second, given growing moral and scientific agreement that the organ donors in heart-beating and non-heart-beating procurement protocols are not dead when their organs are surgically removed, it is not at all clear that people have a duty to consent to their lives being taken for their organs. Third, Saunders' claim that there can be good reasons for refusing consent clashes with his claim that there is a moral obligation for everyone to donate their organs. Saunders' argument is more consistent with a conclusion of ‘mandatory consent’. Finally, it is argued that Saunders' policy, if put into place, would be totalitarian in scope and would therefore be inconsistent with the freedom required for a democratic society. (shrink)

More than any other legal philosopher in the Anglo-American jurisprudence of the 1970s and 1980s Joseph Raz defined with analytical clarity the parameters for a theory of the limits of laws and legal systems. This work was foundational not only for those wishing to defend such theory but also for others (like myself) who took a systematic approach to challenging it. In laying out the conditions for a limited understanding of laws and legal systems, the early works of Raz (...) also reveal the conditions that must be met for its critique. By reference to Raz, the first paragraph of my PhD dissertation, submitted in July 1991, declared a challenge to the notion of both a limited legal system and the boundedness of individual legal rules and principles. In this sense, it contains clear echoes of the thesis of the limits of law as expounded by Raz. In my critique of the limits of law, I did not follow the Anglo-American tradition, but rather postmodern, notably deconstructive, thought. My aim was to argue for the intrinsically plural and—at that stage _de_-limited—nature of laws and legal systems. It was a further 25 years before I argued more forcefully in favour of an _un_limited aspect to law. Nonetheless a recurring obsession with the question of the limits of law and its relationship to the different notions of legal plurality has defined essentially all my work in legal philosophy. In this paper, I will trace the connections to these early works of Raz and their resonance in my subsequent works. A critical questioning of the limits of law in my view remains essential to a generative view of law appropriate to the 21st century—that is a view of law that is intrinsically open to modern imperatives of decolonisation, anti-hierarchical social relationships, and care for our living planet. This article is a lightly referenced and slightly expanded version of a keynote lecture delivered online as part of the workshop ‘Plural Visions of Law—the Legacy of Joseph Raz’ hosted by York University, 11 May 2023. (shrink)

Camil Petrescu (1894-1957) was a Romanian novelist, dramatist, poet and philosopher. His PhD thesis in philosophy was entitled The Aesthetic Method of Theater, and wasinfluenced by Joseph Gregor, Julius Bab, Gordon Craig, Constantin Stanislavski, Adolphe Appia, and William Butler Yeats.. His thesis was published in 1937. In Romanian literature, he was the initiator of the modern novel, with the volume The Last Night of Love, the First Night of War (1930). As a philosopher he was influned by and continued (...) to studyPlato, Descartes, Kant, Hegel, James, Bergson and Husserl. Petrescu is the first Romanian philosopher to write a micro-monograph about Husserl (1938). His main philosophical work, entitled The Doctrine of Substance (deposited in 1942 to the Library of Vatican), was published in 1988 (The Doctrine of Substance, volumes I-II). In this paper, I present a placement of the Romanian philosopher in his time and in the relationshe has with his contemporaries, some of them of world-class (Mircea Eliade, Eugen Ionesco, Emil Cioran, inclusiv Constantin Noica). (shrink)

continent. 2.1 (2012): 56–58 Nechvatal, Joseph, Immersion Into Noise , Open Humanities Press, 2011, 267 pp, $23.99 (pbk), ISBN 1-60785-241-1. As someone who’s knowledge of “art” mostly began with the domestic (Western) and Japanese punk and noise scenes of the late 80’s and early 90’s, practices and theories of noise fall rather close to my heart. It is peeking into the esoteric enclaves of weird music and noise that helped me understand what I think I might like art to (...) be: A way of learning about the world through perturbation—exploration by incitement and speculation of possible conditions. What I have always loved about artistic investigations influenced by noisy aesthetics or sensibilities is that they can be simultaneously transcendent and absurd, amusing and revelatory, singular and pluralistic, mindless and intensely penetrating. The provocative friction that noise brings to bear on aesthetic experience, artistic practice, and “the” Art World acts as a kind of impulse response, proposing new energies while revealing underlying structure; noise signals are a simultaneous synthesis and analysis of spaces, subjects and relations. About two weeks prior to Christmas 2011, Joseph Nechvatal was generous enough to spend some time with me at 39 Quai des Grands Augustins, Paris . We each had one glass of red wine, briefly discussed common acquaintances, shared points of interest, and his published writings. We also, I recall, disagreed lightheartedly about how much contemporary relevance the ideas of telematic-artist Roy Ascott have for today’s art-and-technology practitioner (Joseph > Jamie). After the encounter, I read through a PDF version of Immersion Into Noise Joseph was kind enough to send me ( the HTML version is here ). A number of points of entry into cultures of “noise” are available these days. There are the acoustic-spatial approaches of thinkers like Douglas Kahn, Brandon LaBelle and Salome Voegelin; the techno-cultural musicologies of Jonathan Sterne and David Toop; the political writings of Jacques Attali, former adviser to President François Mitterrand, in his Noise: The Political Economy of Music (spoiler alert: It’s not really about music). Enter the new writings of one Joseph Nechvatal, with his invitation of an Immersion Into Noise . Nechvatal has been active for over 20 years in on- and off-line discussions of art, technology, virtuality, as well as his own set of art-theoretical departures and terminologies. A practicing artist, and instructor at the School of Visual Arts in New York City, Immersion Into Noise , is Nechvatal’s third published volume. His writings, broadly, address a concern with the possibilities of a synthesis between the biological and the virtual, and the contemporary artistic resonances that these possibilities suggest. Nechvatal’s project is to try to name contemporary currents of artistic practice within our technologized culture. He comes at this through art history, post-modern philosophy, anthropology and consciousness studies. Portions of Immersion Into Noise have appeared in his PhD dissertation, as well as online art publications like Zing Magazine . An open-access publication, and part of the impressive and heartening activities of the Open Humanities Press, Nechvatal’s book is a somewhat unexpected addition to the Critical Climate Change series edited by Tom Cohen of SUNY University and Claire Colebrook of Penn State. Other titles in the series have address themes of post-globalism and cultures of threat. Joseph Nachvetal’s title is the first to focus entirely on art history, art practice and aesthetics. It is awkward to too easily fit Nechvatal’s writings in with the aforementioned burgeoning canon of cultural and artistic practice in, and writings on, noise (Russolo, Schaeffer, Cage and Yves Klein through to Kahn, LaBelle, Voegelin, et. al). Immersion Into Noise is not primarily an examination of sound-noise or phenomenologies of sound, and the relativist, non-objectivist possibilities arising therefrom in social, public, and exhibition art practices. Although Nechvatal makes mention of sonic practice and experience (his own encounter in 1968 with the technological complex was set in motion at a Jimi Hendrix concert at the Chicago Coliseum), he does so only by way of introducing a broader concept of “art-noise.” The noise-scape can envelope various kinds of involvement in all kinds of art, by artists, audiences, and distributed amalgams of all of these. Midway through the book, we are offered characteristics of an “immersive noise vision theory.” This theory, leading to an even more syncretic thinking about the art experience, is sketched out through further reference to the author’s personal observation, as well as his art-historical research and notes. Personal examples take on the reflex of a kind of art-noise-travel-writing, as Nechvatal visits Ryoji Ikeda’s Datamatics [ver 2.0] installation at the Centre Pompidou, Paris), hears Cecil Taylor at Alice Tully Hall in New York, spends time with the cave paintings of Lascaux, France, and explores the Wagner-inspired Venus Grotto of Linderhof, Bavaria, to name a few. These site-events, to varying degrees, are renderings of noise-art’s potential to “place us back into a ritual position by dragging art down into the felt 360° noise-perspective of the enthusiastic and participatory.” (p.103) The arc of the ideas proposed here position immersiveness, saturation and “scopic all-over tension” as most productively foundational to noise art, or art-noise. An itinerary from the most ancient of artistic expressions (cave drawings) to the most digital of presentations is charted (Ikeda’s minimal/maximal bitwise works for synchronized audio and visual projection). The harsh sonic onslaught of Masami Akita (a.k.a. Merzbow), is, under this analysis, not so far from colossal denseness of the churches of the High Baroque (Nechvatal visits the Rosario Chapel in Santo Domingo Church, Puebla, Mexico). And there is much more here, eaten up by noise: A rethinking of the work of Duchamp, Jackson Pollock, Nicolas Schöffler (whom Nechvatal names the true “the Father of Cybernetic Art”) and the Happenings of Alan Kaprow, all as art-noise in their own right. Each of these artists and moments demonstrate techniques of destabilization, immersiveness, frame-breaking and “all-over fullness and fervor.” Here is writing on art and art history that is as ambitious as it is promising: “wildly visionary,” Nechvatal states as in conclusion. Self-admittedly far-reaching to the point of verging on totalization, we are asked to consider that the moments, spaces, arts and artists Nechvatal appreciates in the book all derive from an increasingly prevalent “noise consciousness.” Along the way we gain an appreciation of noise as a productive and proactive tension in art, rather than an unwanted signal or unwelcome intrusion. Most promising here for me are Nechvatal’s revealing descriptions of the potential for noise to make manifest the material-perceptual framework of individual and collective art experience. How might we allow what we have been repeatedly taught is our contemporary condition of “information overload” to transform itself into a calm, warm, sympathetic kind of inundation. Treatment of experience in this way, dissolves boundaries between the bodily, informational, material and technical complexes that make up our world, and is the promise of a radical, if momentary, Immersion Into Noise. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Feminist Studies 44, no. 2. © 2018 by Feminist Studies, Inc. 333 Michelle V. Rowley, Elora Halim Chowdhury, and Isis Nusair Refusing to Account: Toward a Pedagogy of Tectonic Instability The increasing commoditization of knowledge and corporatization of the academy have led to a drastic restructuring of higher education, and in particular, of public institutions of learning. There is a striking similarity to the strategies enacted across institutions, each (...) governed by modes of efficiency and profitability. These moves have included a preference for larger classes, curriculum decisions that are governed by seats rather than pedagogical possibilities, an expansion of online offerings, tuition increases, and ramped-up bureaucratization, with the latter being accompanied by fewer faculty hires, a greater dependence on contingent faculty, and a swell in the ranks of senior administrative staff. This restructuring has held very specific consequences for women ’s studies programs. While larger classes are not inherently at odds with a student-centered feminist pedagogy, they do require adjustments in order to achieve similar results with our students, and they do exact greater physical and emotional labor from us as instructors. These restructuring strategies have also positioned the field in a Catch22 in that a number of issues that we have lobbied to have valued within the academy have now come into the university’s line of vision only to be redeployed as part of the university’s public relations branding agenda. There are numerous examples if we would but look: campuses that are spotted with banners portraying faculty and students of color —a visual map to the institution’s “embrace of diversity”; committees 334 Michelle V. Rowley, Elora Halim Chowdhury, and Isis Nusair that are convened to review the institution’s sexual harassment policy while simultaneously refusing the involvement of women’s studies academics in the process, for whom these are scholarly and intellectual areas of study; the introduction of multicultural general education curricula, where the study of “difference” amounts to a banal presence of one or more categories of “otherness” in syllabi. This list is not exhaustive but the similarity that threads through is the commodification and the PR-ization of issues that sit at the heart of the field of women’s studies. Such cooptation notwithstanding, in this economic climate of profit maximization, small, interdisciplinary programs and departments such as women’s studies, ethnic studies, and LGBT studies have become woefully vulnerable to mergers, downsizing, and elimination.1 Our own program, now defunct, attests to this growing reality.2 So what then is the story to be told for a program that no longer exists? As alumna of Clark University’s now defunct women’s studies doctoral program, we consider the ways in which Clark, under the guidance of Cynthia Enloe, worked to move the field toward a more transnational bent. While we begin with an engagement with Clark’s specific institutional vulnerabilities, we use Clark’s commitment to a transnational praxis as our comparative point of departure to note the ways in which the importance and acuity of a transnational feminist critique have seeped away from the field. At various points in the article, we discuss how our individual trajectories emerged out of a transnational feminist sensibility. We interrogate the ways that the dominant logics of the field continue to be complicit with the very inequities and modes of representation critiqued within transnational feminist discourses. We point to the role that our scholarly pursuits play in an ongoing effort to hold the field accountable to a transnational feminist critique. Finally, 1. See Miranda Joseph, Debt to Society: Accounting for Life under Capitalism (Minneapolis, MN: University of Minnesota Press, 2014); and Chandra Talpade Mohanty, “Privatized Citizens, Corporate Academies, and Feminist Projects,” in Feminism without Borders: Decolonizing Theory, Practicing Solidarity (Durham, NC: Duke University Press, 2003). 2. The doctoral program at Clark began in 1992 and closed in 2008, graduating twenty-six PhDs and training many more who have gone on to make significant contributions at NGOs among other locations. For example, Parissara Liewkeat and Barbara Schulman have held positions with the International Labor Organization and Amnesty International, respectively. Michelle V. Rowley, Elora Halim Chowdhury, and Isis Nusair 335 we look back at our own training... (shrink)

Over the last few decades, multiple studies have examined the understanding of participants in clinical research. They show variable and often poor understanding of key elements of disclosure, such as expected risks and the experimental nature of treatments. Did the participants in these studies give valid consent? According to the standard view of informed consent they did not. The standard view holds that the recipient of consent has a duty to disclose certain information to the profferer of consent because valid (...) consent requires that information to be understood. The contents of the understanding and disclosure requirements are therefore conceptually linked. In this paper, we argue that the standard view is mistaken. The disclosure and understanding requirements have distinct grounds tied to two different ways in which a token of consent can be rendered invalid. Analysis of these grounds allows us to derive the contents of the two requirements. It also implies that it is sometimes permissible to enroll willing participants who have not understood everything that they ought to be told about their clinical trials. (shrink)

The essence of who we are depends on our brains. They enable us to think, to feel joy and sorrow, communicate through speech, reflect on the moments of our lives, and to anticipate, plan for, and worry about our imagined futures. Although some of our abilities are comparatively new, key features of our behavior have deep roots that can be traced to the beginning of life. By following the story of behavior, step-by-step, over its roughly four-billion-year trajectory, we come to (...) understand both how similar we are to all organisms that have ever lived, and how different we are from even our closest animal relatives. We care about our differences because they are ours. But differences do not make us superior; they simply make us different. (shrink)

This book critically assesses arguments for the existence of the God of classical theism, develops an innovative account of objects’ persistence, and defends new arguments against classical theism. The authors engage the following classical theistic proofs: Aquinas’s First Way, Aquinas’s De Ente argument, and Feser’s Aristotelian, Neo-Platonic, Augustinian, Thomistic, and Rationalist proofs. The authors also provide the first systematic treatment of the ‘existential inertia thesis’. By connecting the thesis to relativity theory and recent developments in the philosophy of physics, and (...) by developing a variety of novel existential-inertia-friendly explanations of persistence, they mount a formidable new case against classical theistic proofs. Finally, they defend new arguments against classical theism based on abstract objects and changing divine knowledge. The text appeals to students, researchers, and others interested in classical theistic proofs, the existence and nature of God, and the ultimate explanations of persistence, change, and contingency. (shrink)

The history of philosophy is a history of moral circle expansion. This history correlates with a history of expansionism about consciousness. Recently, expansionism about consciousness has exploded: to invertebrates, to plants, to logic gates, and to fundamental entities. The last of these expansions stems from a surge of interest in panpsychism. In an exploratory spirit, this paper considers some largely uncharted territory: the ethical implications of panpsychism. Our conclusion is that while panpsychism probably does significantly expand our moral circle, it's (...) also probably short on anything of practical significance. (shrink)

The modal ontological argument (MOA) proceeds from God’s possible existence to God’s actual existence. A prominent objection to the MOA is that it suffers from a symmetry problem: an exactly parallel modal ontological argument can be given for God's non-existence. Several attempts have been made to break the symmetry between the arguments. This draft is a mostly comprehensive survey of those attempts. -/- The draft was initially written as a supplement to the 2024 Summer edition of the SEP entry on (...) Ontological Arguments. However, the draft is not included in the SEP entry. (shrink)

It is sometimes argued that medical professionals should protect a future child's rights by prohibiting disabled parents from using technology to deliberately have a disabled child because disability is taken as an inevitable, severe threat to a child's otherwise “open” future. I will first argue that the open future that allegedly protects a child's future autonomy is precluded by the very conditions needed to develop that future autonomy. Any child's future will be narrowed as they are socialized in a way (...) that gives them the capacity for autonomous choice. However, oppressive master narratives can diminish a future child's autonomy by distorting their narrative identity and constricting their agency. In fact, the open future argument does just this by advancing one of the most damaging master narratives about disability: that disability inevitably and severely restricts a person's autonomy and closes their future. (shrink)

It is commonly believed that parents have special duties toward their children—weightier duties than they owe other children. How these duties are acquired, however, is not well understood. This is problematic when claims about parental responsibilities are challenged; for example, when people deny that they are morally responsible for their biological offspring. In this paper I present a theory of the origins of parental responsibilities that can resolve such cases of disputed moral parenthood.

Over the past half century, our best scientific understanding of the immune system has been transformed. The immune system has turned out to be extremely sophisticated, densely connected to the central nervous system and cognitive capacities, deeply involved in the production of behavior, and responsive to different kinds of psychosocial event. Such results have rendered the immune system part of the subject-matter of psychology and cognitive science. I argue that such results, alongside the history of psychoneuroimmunology, give us good reason (...) to be skeptical about the characterization of cognitive science and psychology as studying the mind and the mental. (shrink)

Socrates’ official answer to Meno’s question about the value of knowledge, near the end of Plato’s Meno, is that knowledge is stable. I argue that both the answer and the question have been widely misunderstood. The question has been taken to be why knowing at a time is better than true belief at that time, and Socrates’ answer has been taken to point to the greater persistence of knowledge over time. I argue instead that, given the broader context of the (...) question and answer in the Meno, together with what Plato has to say about stability elsewhere, Meno’s question is better understood as a more difficult question – and Socrates’ answer as a good solution to it. This also involves arguing that Socrates’ analogy to the statues of Daedalus is not intended as the simple illustration of Socrates’ official answer for which commentators have taken it. (shrink)