If Australasian philosophers constitute the kind of group to which a collective identity or broadly shared self-image can plausibly be ascribed, the celebrated history of Australian materialism rightly lies close to its heart. Jack Smart’s chapter in this volume, along with an outstanding series of briefer essays in A Companion to Philosophy in Australia and New Zealand (Forrest 2010; Gold 2010; Koksvik 2010; Lycan 2010; Matthews 2010; Nagasawa 2010; Opie 2010; Stoljar 2010a), effectively describe the naturalistic realism of Australian philosophy (...) of mind. In occasional semi-serious psychogeographic speculation, this long-standing and strongly-felt intellectual attitude has been traced back to the influences of our light, land, or lifestyle (Devitt 1996, x; compare comments by Chalmers and O’Brien in Mitchell, 2006). Australasian work in philosophy of mind and cognition has become more diverse in the last 40 years, but is almost all still marked, in one way or another, by the history of these debates on materialism. (shrink)

In Ecological Thinking, Lorraine Code argues that advocacy “often makes knowledge possible” and without it “certain kinds of knowing are impossible.” By acknowledging the value of subjectivity and testimony in knowledge creation, I argue that ecological thinking serves as an appropriate framework for engagement with individuals who are living with mental illnesses. Contrasted with the dominant Anglo-American epistemologies that involve excessive degrees of mastery and control (with the tendency to silence the voices of Others), I argue that ecological thinking facilitates (...) healthy advocacy practices precisely because of its inclusivity and receptivity towards different perspectives in knowledge creation. (shrink)

Trust is central to the therapeutic relationship, but the epistemic asymmetries between the expert healthcare provider and the patient make the patient, the trustor, vulnerable to the provider, the trustee. The narratives of pain sufferers provide helpful insights into the experience of pain at the juncture of trust, expert knowledge, and the therapeutic relationship. While stories of pain sufferers having their testimonies dismissed are well documented, pain sufferers continue to experience their testimonies as being epistemically downgraded. This kind of epistemic (...) injustice has received limited treatment in bioethics. In this paper, we examine how a climate of distrust in pain management may facilitate what Fricker calls epistemic injustice. We critically interrogate the processes through which pain sufferers are vulnerable to specific kinds of epistemic injustice, such as testimonial injustice. We also examine how healthcare institutions and practices privilege some kinds of evidence and ways of knowing while excluding certain patient testimonies from epistemic consideration. We argue that providers ought to avoid epistemic injustice in pain management by striving toward epistemic humility. Epistemic humility, as a form of epistemic justice, may be the kind disposition required to correct the harmful prejudices that may arise through testimonial exchange in chronic pain management. (shrink)

Next SectionFollowing the influential Gifford and Reith lectures by Onora O’Neill, this paper explores further the paradigm of individual autonomy which has been so dominant in bioethics until recently and concurs that it is an aberrant application and that conceptions of individual autonomy cannot provide a sufficient and convincing starting point for ethics within medical practice. We suggest that revision of the operational definition of patient autonomy is required for the twenty first century. We follow O’Neill in recommending a principled (...) version of patient autonomy, which for us involves the provision of sufficient and understandable information and space for patients, who have the capacity to make a settled choice about medical interventions on themselves, to do so responsibly in a manner considerate to others. We test it against the patient–doctor relationship in which each fully respects the autonomy of the other based on an unspoken covenant and bilateral trust between the doctor and patient. Indeed we consider that the dominance of the individual autonomy paradigm harmed that relationship. Although it seems to eliminate any residue of medical paternalism we suggest that it has tended to replace it with an equally (or possibly even more) unacceptable bioethical paternalism. In addition it may, for example, lead some doctors to consider mistakenly that unthinking acquiescence to a requested intervention against their clinical judgement is honouring “patient autonomy” when it is, in fact, abrogation of their duty as doctors. (shrink)

Electromagnetic field oscillations produced by the brain are increasingly being viewed as causal drivers of consciousness. Recent research has highlighted the importance of the body’s various endogenous rhythms in organizing these brain-generated fields through various types of entrainment. We expand this approach by examining evidence of extracerebral shared oscillations between the brain and other parts of the body, in both humans and animals. We then examine the degree to which these data support one of General Resonance Theory’s principles: the Slowest (...) Shared Resonance principle, which states that the combination of micro- to macro-consciousness in coupled field systems is a function of the slowest common denominator frequency or resonance. This principle may be utilized to develop a spatiotemporal hierarchy of brain-body shared resonance systems. It is predicted that a system’s SSR decreases with distance between the brain and various resonating structures in the body. The various resonance relationships examined, including between the brain and gastric neurons, brain and sensory organs, and brain and spinal cord, generally match the predicted SSR relationships, empirically supporting this principle of GRT. (shrink)

En los sectores políticos democráticos liberales, el principio del respeto a la autonomía es ampliamente aceptado —en teoría, si no siempre en la práctica— como un valor moral cardinal que debería guiar tanto la deliberación política, la política pública y las prácticas, como nuestras actitudes respecto a nuestros conciudadanos. En términos simples, respetar la autonomía es respetar los intereses de cada persona de vivir su vida según su propia concepción del bien. En la base del requisito normativo de respetar la (...) autonomía de otro está la presunción de que la autonomía confiere autoridad normativa sobre la propia vida; la autoridad para tomar decisiones de importancia práctica para la propia vida, por razones propias, cualesquiera que sean. Se asume que las personas autónomas tienen la capacidad, el derecho y la responsabilidad de ejercer esta autoridad, incluso si no siempre lo hacen sabiamente. (shrink)

The concept of paternalism is intricately tied to the concept of autonomy. It is commonly assumed that when paternalistic interventions are wrong, they are wrong because they impede individuals’ autonomy. Our aim in this paper is to show that the recent shift towards conceiving of autonomy relationally highlights a separate conceptual space for a nonpaternalistic kind of interpersonal intervention termed maternalism. We argue that maternalism makes a twofold contribution to the debate over the ethics of interpersonal action and decision-making. Descriptively, (...) it captures common experiences that, while not unusual in everyday life, are largely absent from the present discussion. Normatively, it describes a type of intervention with justification conditions distinct from the standard framework of paternalism. We explicate these contributions by describing six key differences between maternalism and paternalism, and conclude by anticipating and responding to potential objections. (shrink)

Finding a scientific, third-person explanation of subjective experience or phenomenal content is commonly called the “hard problem” of consciousness. There has recently been a surge in neuropsychological research on meditation in general and long-term meditators in particular. These experimental subjects are allegedly capable of generating a stable state of consciousness over a prolonged period of time, which makes experimentation with them an interesting paradigm for consciousness research. This perspective article starts out with a historical reconstruction of the “hard problem,” tracing (...) it back to Gottfried Wilhelm Leibniz and Emil du Bois-Reymond in the 18th and 19th century, respectively, and the problem of introspection as already acknowledged by Wilhelm Wundt in the 19th century. It then discusses the prospects of research on long-term meditators from a contemporary perspective and with respect to the neurophenomenological research program already advocated by Francisco J. Varela. (shrink)

Over the past decades, mood enhancement effects of various drugs and neuromodulation technologies have been proclaimed. If one day highly effective methods for significantly altering and elevating one’s mood are available, it is conceivable that the demand for them will be considerable. One urgent concern will then be what role physicians should play in providing such services. The concern can be extended from literature on controversial demands for aesthetic surgery. According to Margaret Little, physicians should be aware that certain aesthetic (...) enhancement requests reflect immoral social norms and ideals. By granting such requests, she argues, doctors render themselves complicit to a collective ‘evil’. In this paper, we wish to question the extent to which physicians, psychiatrists and/or neurosurgeons should play a role as ‘moral gatekeepers’ in dealing with suspect demands and norms underlying potential desires to alter one’s mood or character. We investigate and discuss the nature and limits of physician responsibilities in reference to various hypothetical and intuitively problematic mood enhancement requests. (shrink)

We argue that contemporary psychiatry adopts a defensive strategy vis-à-vis various external sources of pressure. We will identify two of these sources – the plea for individual autonomy and the idea of Managed Care – and explain how they have promoted a strict biomedical conception of disease. The demand for objectivity, however, does not take into account the complexity of mental illness. It ignores that the psychiatrist’s profession is essentially characterized by fragility: fluctuating between scientific reduction and the irreducible complexity (...) of reality. Therefore, the psychiatrist is not in need of hard and fast rules, but of judgment. At the end, we suggest that philosophy could inject some healthy uncertainty within psychiatry in order to restore its fragile identity. Our examples are drawn from the Dutch situation but we are confident that they apply to other countries as well. (shrink)

Autonomy is a concept that holds much appeal to social and legal philosophers. Within a medical context, it is often argued that it should be afforded supremacy over other concepts and interests. When respect for autonomy merely requires non-intervention, an adult’s right to refuse treatment is held at law to be absolute. This apparently simple statement of principle does not hold true in practice. This is in part because an individual must be found to be competent to make a valid (...) refusal of consent to medical treatment, and capacity to decide is not an absolute concept. But further to this, I argue that there are three relevant understandings of autonomy within our society, and each can demand in differing cases that different courses of action be followed. Judges, perhaps inadvertently, have been able to take advantage of the equivocal nature of the concept to come tacitly to decisions that reflect their own moral judgments of patients or decisions made in particular cases. The result is the inconsistent application of principle. I ask whether this is an unforeseen outcome or if it reflects a wilful disregard for equal treatment in favour of silent moral judgments in legal cases. Whatever the cause, I suggest that once this practice is seen to occur, acceptable justification of it in some cases is difficult to find. (shrink)

IntroductionAlthough the topic of consciousness is both mysterious and controversial, psychedelic drugs are popularly believed to provide unique insights into the nature of consciousness despite a lack of empirical evidence.MethodsThis study addresses the question of whether psychedelics change the attribution of consciousness to a range of living and non-living entities. A survey was conducted in 1,606 respondents who endorsed a belief changing psychedelic experience.ResultsParticipants rated their attributions of consciousness to a range of living and non-living entities before and after their (...) psychedelic experience. Superstitious beliefs and belief in freewill were also assessed. From before the experience to after, there were large increases in attribution of consciousness to various entities including non-human primates, quadrupeds, insects, fungi, plants, inanimate natural objects, and inanimate manmade objects. Higher ratings of mystical experience were associated with greater increases in the attribution of consciousness. Moreover, the increased attributions of consciousness did not decrease in those who completed the survey years after the psychedelic experience. In contrast to attributions of consciousness, beliefs in freewill and superstitions did not change. Notably, all findings were similar when restricted to individuals reporting on their first psychedelic experience.DiscussionThis study demonstrates that, among people who reported belief-changing psychedelic experiences, attribution of consciousness to various entities increases. Future prospective psychedelic drug administration studies that control for expectancies are needed. (shrink)

Kim Atkins argues that Thomas Nagel’s argument regarding a bat’s phenomenal experience is important for understanding the value placed on patient autonomy in medical ethics. In this paper I demonstrate that Atkins’s argument (a) is based on her misinterpretations of Nagel’s argument, and (b) can be established without appealing to such a controversial assumption as that which she makes.

The recent ruling from England on the case of M is one of very few worldwide to consider whether life-sustaining treatment, in the form of clinically assisted nutrition and hydration, should continue to be provided to a patient in a minimally conscious state. Formally concerned with the English law pertaining to precedent autonomy (specifically advance decision-making) and the best interests of the incapacitated patient, the judgment issued in M's case implicitly engages with three different accounts of the value of human (...) life, which respectively emphasise its self-determined, intrinsic and instrumental value. The judge appeared to be most persuaded by the intrinsic value of life and he concluded that treatment ought to continue. Assessing whether his approach or conclusion were ethically appropriate involves significant substantive and evidential questions regarding where the burden of proof should lie and what standard of proof should be required when decisions are to be made about the fates of patients inhabiting ‘twilight worlds’. (shrink)

Abortion has been legal in the United States since the Supreme Court's landmark 1973 ruling in Jane Roe, et al. v. Henry Wade, District Attorney of Dallas County. Over the past forty years, however, access to abortion has diminished as states have devised creative ways to regulate and restrict the abortion procedure. In the first half of 2011, state legislators introduced a record number of antiabortion bills. In 19 states alone, 80 laws ranging from mandatory counseling and waiting periods to (...) gestational laws and bans on insurance coverage were passed, a legislative testimony to the incremental successes of the antiabortion campaign. Since 2011, the rapid increase in restrictive... (shrink)

Trust is central to the therapeutic relationship, but the epistemic asymmetries between the expert healthcare provider and the patient make the patient, the trustor, vulnerable to the provider, the trustee. The narratives of pain sufferers provide helpful insights into the experience of pain at the juncture of trust, expert knowledge, and the therapeutic relationship. While stories of pain sufferers having their testimonies dismissed are well documented, pain sufferers continue to experience their testimonies as being epistemically downgraded. This kind of epistemic (...) injustice has received limited treatment in bioethics. In this paper, we examine how a climate of distrust in pain management may facilitate what Fricker calls epistemic injustice. We critically interrogate the processes through which pain sufferers are vulnerable to specific kinds of epistemic injustice, such as testimonial injustice. We also examine how healthcare institutions and practices privilege some kinds of evidence and ways of knowing while excluding certain patient testimonies from epistemic consideration. We argue that providers ought to avoid epistemic injustice in pain management by striving toward epistemic humility. Epistemic humility, as a form of epistemic justice, may be the kind disposition required to correct the harmful prejudices that may arise through testimonial exchange in chronic pain management. (shrink)

Discovering obligations that are ascribed to them by others is potentially an important element in the development of the moral imagination of engineers. Moral imagination cannot reasonably be developed by contemplating oneself and one’s task alone: there must be some element of discovering the expectations of people one could put at risk. In practice it may be impossible to meet ascribed obligations if they are completely general and allow no exceptions — for example if they demand an unlimited duty to (...) avoid harm. But they can still serve to modify engineers’ prior ethics, for example by limiting a purely utilitarian approach to deciding who should bear risk and how much risk they should bear. Ascribed obligations can also give engineers insight into the public reaction to risks that arise from engineered systems, and the consequent expectations that the public have about how much protection is desirable and where the responsibility for this protection lies. This article analyses the case for taking ascribed obligations seriously, and reviews some of the obligations that have been ascribed in the aftermath of recent engineering failures. It also proposes ways in which ascribed obligations could be used in engineers’ moral development. (shrink)