We generally accept that medicine’s conceptual and ethical foundations are grounded in recognition of personhood. With patients in vegetative state, however, we’ve understood that the ethical implications of phenomenal consciousness are distinct from those of personhood. This suggests a need to reconsider medicine’s foundations. What is the role for recognition of consciousness (rather than personhood) in grounding the moral value of medicine and the specific demands of clinical ethics? I suggest that, according to holism, the moral value of (...) medicine is secured when conscious states are recognized in everyday medical science. Moreover, consciousness fully motivates traditional principles of clinical ethics if we understand respect for autonomy as respect for the dominion of an experiencer in the private, inescapable realm of bodily experience. When medicine’s foundations are grounded in recognition of consciousness, we understand how patients fully command respect even when they lack capacity to exercise their bodily dominion through decision-making. (shrink)

In this peer commentary on L. Syd M. Johnson’s “Inference and Inductive Risk in Disorders of Consciousness,” I argue for the necessity of disability education as an integral component of decision-making processes concerning patients with DOC and, mutatis mutandis, all patients with disabilities. The sole qualification Johnson places on such decision-making is that stakeholders are educated about and “understand the uncertainties of diagnosis and prognosis.” Drawing upon research in philosophy of disability, social epistemology, and health psychology, I (...) argue that this educational qualification is insufficient to address systemic ableism and other forms of epistemic bias in quality of life judgments. (shrink)

Recent criticisms of medicine converge on fundamental questions about the aim of medicine. The main task of this paper is to propose an account of the aim of medicine. Discussing and rejecting the initially plausible proposal according to which medicine is pathocentric, the paper presents and defends the Autonomy Thesis, which holds that medicine is not pathocentric, but sanocentric, aiming to promote health with the final aim to enhance autonomy. The paper closes by considering the objection that the Autonomy Thesis (...) is overly permissive and allows many highly controversial procedures as legitimate parts of medicine. (shrink)

Topic modeling—a text‐mining technique often used to uncover thematic structures in large collections of texts—has been increasingly frequently used in the context of the analysis of scholarly output. In this study, we construct a corpus of 19,488 texts published since 1971 in seven leading journals in the field of bioethics and philosophy of medicine, and we use a machine learning algorithm to identify almost 100 topics representing distinct themes of interest in the field. On the basis of intertopic correlations, (...) we group the content‐based topics into eight clusters, thus providing a novel, fine‐grained intellectual map of bioethics and philosophy of medicine. Moreover, we conduct a number of diachronic analyses, examining how the “prominence” of different topics has changed across time. In this way, we are able to observe the distinct patterns in which bioethics and philosophy of medicine have evolved and changed their focus over the past half a century. (shrink)

“Bodily autonomy” has received significant attention in bioethics, medical ethics, and medical law in terms of the general inviolability of a patient’s bodily sovereignty and the rights of patients to make choices (e.g., reproductive choices) that concern their own body. However, the role of the body in terms of how it can or does contribute to a patient’s capacity for, or exercises of their autonomy in clinical decision-making situations has not been explicitly addressed. The approach to autonomy in this paper (...) is aligned with traditional theories that conceive autonomy in terms of an individual’s capacities for, and exercises of rational reflection. However, at the same time, this paper extends these accounts by arguing that autonomy is, in part, embodied. Specifically, by drawing on phenomenological conceptions of the experience of autonomy, we argue that, in principle, the body is a necessary component of the capacity for autonomy. Secondly, through the presentation of two different cases, we highlight ways in which a patient’s body can contribute to the autonomy of treatment choices. Ultimately, we hope to encourage others to explore additional conditions under which a concept of embodied autonomy should be employed in medical decision making, how its underlying principles might be operationalised in clinical situations, and its consequences for approaches to patient autonomy in healthcare practice, policy, and law. (shrink)

First-person reports of Major Depressive Disorder reveal that when an individual becomes depressed a profound change or ‘shift’ to one’s conscious experience occurs. The depressed person reports that something fundamental to their experience has been disturbed or shifted; a change associated with the common but elusive claim that when depressed one finds oneself in a ‘different world’ detached from reality and other people. Existing attempts to utilise these phenomenological observations in a psychiatric context are challenged by the fact that this (...) experiential ‘shift’ characteristic of depression appears mysterious and resists analysis in scientific terms. This paper offers a way out of this predicament. The hypothesis proposed is that when an individual becomes depressed, the individual departs from a state of ordinary wakeful consciousness and enters a distinctive global state of consciousness akin to dreaming and the psychedelic state. After unpacking and motivating this hypothesis in the context of research in consciousness science, I outline two of its important implications for the neurobiology of depression and psychedelic psychiatry. The upshot is a promising and conceptually well-motivated hypothesis about depression which is apt for empirical uptake and development. (shrink)

If one had to identify the biggest change within the philosophical tradition in the twenty-first century, it would certainly be the rapid rise of experimental philosophy to address differences in intuitions about concepts. It is, therefore, surprising that the philosophy of medicine has so far not drawn on the tools of experimental philosophy in the context of a particular conceptual debate that has overshadowed all others in the field: the long-standing dispute between so-called naturalists and normativists about (...) the concepts of health and disease. In this paper, I defend and advocate the use of empirical methods to inform and advance this and other debates within the philosophy of medicine. (shrink)

Respect for autonomy is a central moral principle in bioethics. The concept of autonomy can be construed in various ways. Under the non-ideal conceptualization proposed by Beauchamp and Childress, everyday choices of generally competent persons are autonomous to the extent that they are intentional and are made with understanding and without controlling influences. It is sometimes suggested that authenticity is important to personal autonomy, so that inauthenticity prevents otherwise autonomous persons from making autonomous decisions. Building from Beauchamp and Childress’s theory, (...) this article develops a non-ideal authenticity-based conceptualization of personal autonomy. Factors that indicate inauthentic decision-making are explicated, and the full concept is defended from three expected objections. The theory is then tested on a paradigm case which has concerned theorists and practitioners for some time, namely the possible inauthenticity of anorexia nervosa patients’ decision-making. It is concluded that the theory seems to be fruitful in analyses of the degree of autonomy of patients’ decision-making, and that it succeeds in providing reliable action-guidance in practical contexts. (shrink)

In this paper, I identify two major philosophical crises confronting medicine as a global phenomenon. The first crisis is the epistemological crisis of adopting an epistemic attitude, adequate for improving medical knowledge and practice. The second is the ethical crisis, also known as the “quality-of-care crisis,” arising from the traditional patient-physician dyad. I acknowledge the different proposals put forward in the quest for solutions to these crises. However, I observe that most of these proposals remain inadequate given their over-reliance on (...) the Western biomedical tradition and the medical hegemony that underpins the proposals themselves. Contrary to the approach employed in these proposals, I propose medical pluralism as a viable platform for resolving the philosophic crises in medicine, by critically engaging non-Western medical traditions and thought systems. Ultimately, I make a push for the deliberate inauguration of an African philosophy of medicine and bioethics and other context-specific or indigenous philosophies of medicine and bioethics that will ensure continuous investigations into NMTs and their contribution to global medical issues. (shrink)

The purpose of this chapter is to describe what we see as several important new directions for philosophy of medicine. This recent work (i) takes existing discussions in important and promising new directions, (ii) identifies areas that have not received sufficient and deserved attention to date, and/or (iii) brings together philosophy of medicine with other areas of philosophy (including bioethics, philosophy of psychiatry, and social epistemology). To this end, the next part focuses on what we call (...) the “epistemological turn” in recent work in the philosophy of medicine; the third part addresses new developments in medical research that raise interesting questions for philosophy of medicine; the fourth part is a discussion of philosophical issues within the practice of diagnosis; the fifth part focuses on the recent developments in psychiatric classification and scientific and ethical issues therein, and the final part focuses on the objectivity of medical research. (shrink)

Disorders of consciousness include coma, the vegetative state and the minimally conscious state. Such patients are often regarded as unconscious. This has consequences for end of life decisions for these patients: it is much easier to justify withdrawing life support for unconscious than conscious patients. Recent brain imaging research has however suggested that some patients may in fact be conscious.

The first part of a symposium devoted to Alex Broadbent's essay titled ‘Prediction, Understanding and Medicine’, this article notes the under-development of a variety of issues in the philosophy of medicine that transcend bioethics and the long-standing debates about the nature of health/illness and of evidence-based medicine. It also indicates the importance of drawing on non-Western, and particularly African, traditions in addressing these largely metaphysical and epistemological matters.

In this paper, I open an inquiry that provides a catalyst for the inauguration of African Philosophy of Medicine and Bioethics (APMB) as a full-fledged academic pursuit. I situate this inquiry within the quest of early professional African philosophers for a stirring of the course of contemporary African philosophy along the path of critically retrieving, clarifying, and articulating aspects of traditional African culture and practices in the light of social pluralism and modernization. The case I make for the (...) establishment of this discipline and my effort to delineate its nature, scope, and method hinge on three important realities: (i) The existence of African Traditional Medicine (ATM); (ii) the existence of philosophical puzzles in ATM that require conceptual, metaphysical, epistemological, ethical, and socio-political analyses; and (iii) the need to carry out this analysis in the context of the twenty-first-century reality of medical pluralism and globalization. Solidifying my effort to map out the landscape of this new enterprise, in the concluding part of this paper, I make recommendations on the direction the discipline is to take if it must fulfil its goal of providing a framework for the improvement of medical knowledge and practice in contemporary Africa. (shrink)

In this paper, I argue that the concept of normality in medical research and clinical practice is inextricable from the concept of ambiguity. I make this argument in the context of Edmund Pellegrino's call for a renewed reflection on medicine’s basic concepts and by drawing on work in critical disability studies concerning Deafness and body integrity identity disorder. If medical practitioners and philosophers of medicine wish to improve their understanding of the meaning of medicine as well as its concrete practice, (...) I contend that they should take seriously the import and centrality of ambiguity for biomedicine. (shrink)

In Disturbed Consciousness, philosophers and other scholars examine various psychopathologies in light of specific philosophical theories of consciousness. The contributing authors—some of them discussing or defending their own theoretical work—consider not only how a theory of consciousness can account for a specific psychopathological condition but also how the characteristics of a psychopathology might challenge such a theory. Thus one essay defends the higher-order thought (HOT) theory of consciousness against the charge that it cannot account for somatoparaphrenia (...) (a delusion in which one denies ownership of a limb). Another essay argues that various attempts to explain away such anomalies within subjective theories of consciousness fail. -/- Other essays consider such topics as the application of a model of unified consciousness to cases of brain bisection and dissociative identity disorder; prefrontal and parietal underconnectivity in autism and other psychopathologies; self-deception and the self-model theory of subjectivity; schizophrenia and the vehicle theory of consciousness; and a shift in emphasis away from an internal (or brainbound) approach to psychopathology to an interactive one. Each essay offers a distinctive perspective from the intersection of philosophy, consciousness research, and psychiatry. -/- Contributors Alexandre Billon, Andrew Brook, Paula Droege, Rocco J. Gennaro, Philip Gerrans, William Hirstein, Jakob Hohwy, Uriah Kriegel, Timothy Lane, Thomas Metzinger, Erik Myin, Inez Myin-Germeys, Myrto Mylopoulos, Gerard O’Brien, Jon Opie, J. Kevin O’Regan, Iuliia Pliushch, Robert Van Gulick . (shrink)

Body Integrity Identity Disorder (BIID) is a very rare condition describing those with an intense desire or need to move from a state of ability to relative impairment, typically through the amputation of one or more limbs. In this paper, I draw upon research in critical disability studies and philosophy of disability to critique arguments based upon the principle of nonmaleficence against such surgery. I demonstrate how the action-relative concept of harm in such arguments relies upon suspect notions of (...) biological and statistical normality, and I contend that each fail to provide normative guidance. I then propose a critical theory of harm, one marked by substantive engagement with both empirical and reflective inquiry across the sciences, social sciences, and humanities. I conclude by discussing the implications of this theory and how it might enrich ongoing debates in bioethics, philosophy of disability, and the health humanities. (shrink)

It seems obvious that phenomenally conscious experience is something of great value, and that this value maps onto a range of important ethical issues. For example, claims about the value of life for those in a permanent vegetative state, debates about treatment and study of disorders of consciousness, controversies about end-of-life care for those with advanced dementia, and arguments about the moral status of embryos, fetuses, and non-human animals arguably turn on the moral significance of various facts about (...) consciousness. However, though work has been done on the moral significance of elements of consciousness, such as pain and pleasure, little explicit attention has been devoted to the ethical significance of consciousness. In this book Joshua Shepherd presents a systematic account of the value present within conscious experience. This account emphasizes not only the nature of consciousness, but the importance of items within experience such as affect, valence, and the complex overall shape of particular valuable experiences. Shepherd also relates this account to difficult cases involving non-humans and those with disorders of consciousness, arguing that the value of consciousness influences and partially explains the degree of moral status a being possesses, without fully determining it. The upshot is a deeper understanding of both the moral importance of phenomenal consciousness and its relations to moral status. This book will be of great interest to philosophers and students of ethics, bioethics, philosophy of psychology, philosophy of mind and cognitive science. (shrink)

Intellectual autonomy has long been identified as an epistemic virtue, one that has been championed influentially by Kant, Hume and Emerson. Manifesting intellectual autonomy, at least, in a virtuous way, does not require that we form our beliefs in cognitive isolation. Rather, as Roberts and Wood note, intellectually virtuous autonomy involves reliance and outsourcing to an appropriate extent, while at the same time maintaining intellectual self-direction. In this essay, I want to investigate the ramifications for intellectual autonomy of a particular (...) kind of epistemic dependence: cognitive enhancement. Cognitive enhancements involve the use of technology and medicine to improve cognitive capacities in healthy individuals, through mechanisms ranging from smart drugs to brain-computer interfaces. With reference to case studies in bioethics, as well as the philosophy of mind and cognitive science, it is shown that epistemic dependence, in this extreme form, poses a prima facie threat to the retention of intellectual autonomy, specifically, by threatening to undermine our intellectual self-direction. My aim will be to show why certain kinds of cognitive enhancements are subject to this objection from self-direction, while others are not. Once this is established, we’ll see that even some extreme kinds of cognitive enhancement might be not merely compatible with, but constitutive of, virtuous intellectual autonomy. (shrink)

Although I agree with Sabine Muller’s conclusion that we should first seek to find alternatives to amputation for patients suffering from Body Integrity Identity Disorder (BIID), I disagree with one of the major premises that she uses to argue for her claim. Muller argues that patients with BIID are likely not autonomous when they request that the limb be amputated. Muller’s argument that BIID suffers are not autonomous is flawed because she conflates philosophical conceptions of autonomy with the conception of (...) autonomy that is operative in the context of medicine. (shrink)

In The Future of Human Nature, Jürgen Habermas raises the question of whether the embryonic genetic diagnosis and genetic modification threatens the foundations of the species ethics that underlies current understandings of morality. While morality, in the normative sense, is based on moral interactions enabling communicative action, justification, and reciprocal respect, the reification involved in the new technologies may preclude individuals to uphold a sense of the undisposability of human life and the inviolability of human beings that is necessary for (...) their own identity as well as for reciprocal relations. Engaging with liberal bioethics and Catholic approaches to bioethics, the article clarifies how Habermas’ position offers a radical critique of liberal autonomy while maintaining its postmetaphysical stance. The essay argues that Habermas’ approach may guide the question of rights of future generations regarding germline gene editing. But it calls for a different turn in the conversation between philosophy and theology, namely one that emphasizes the necessary attention to rights violations and injustices as a common, postmetaphysical starting point for critical theory and critical theology alike. In 2001, Jürgen Habermas published a short book on questions of biomedicine that took many by surprise.[1] To some of his students, the turn to a substantive position invoking the need to comment on a species ethics rather than outlining a public moral framework was seen as the departure from the “path of deontological virtue,”[2] and at the same time a departure from postmetaphysical reason. Habermas’ motivation to address the developments in biomedicine had certainly been sparked by the intense debate in Germany, the European Union, and internationally on human cloning, pre-implantation genetic diagnosis, embryonic stem cell research, and human enhancement. He turned to a strand of critical theory that had been pushed to the background by the younger Frankfurt School in favor of cultural theory and social critique, even though it had been an important element of its initial working programs. The relationship of instrumental reason and critical theory, examined, among others, by Max Horkheimer, Theodor W. Adorno, and Herbert Marcuse and taken up in Habermas’ own Knowledge and Interest and Theory of Communicative Action became ever-more actual with the development of the life sciences, human genome analysis, and genetic engineering of human offspring. Today, some of the fictional scenarios discussed at the end of the last century as “science fiction” have become reality: in 2018, the first “germline gene-edited” children were born in China.[3] Furthermore, the UK’s permission to create so-called “three-parent” children may create a legal and political pathway to hereditary germline interventions summarized under the name of “gene editing.”In this article, I want to explore Habermas’ “substantial” argument in the hope that philosophy and theology become allies in their struggle against an ever-more reifying lifeworld, which may create a “moral void” that would, at least from today’s perspective, be “unbearable”, and for upholding the conditions of human dignity, freedom, and justice. I will contextualize Habermas’ concerns in the broader discourse of bioethics, because only by doing this, his concerns are rescued from some misinterpretations.[1] Jürgen Habermas, The Future of Human Nature.[2] Ibid., 125, fn. 58. 8[3] Up to the present, no scientific publication of the exact procedure exists, but it is known that the scientist, Jiankui He, circumvented the existing national regulatory framework and may have misled the prospective parents about existing alternatives and the unprecedented nature of his conduct. Yuanwu Ma, Lianfeng Zhang, and Chuan Qin, "The First Genetically Gene‐Edited Babies: It's “Irresponsible and Too Early”," Animal Models and Experimental Medicine ; Matthias Braun, Meacham, Darian, "The Trust Game: Crispr for Human Germline Editing Unsettles Scientists and Society," EMBO reports 20, no. 2. (shrink)

The theory of evolution of complex and comprising of human systems and algorithm for its constructing are the synthesis of evolutionary epistemology, philosophical anthropology and concrete scientific empirical basis in modern (transdisciplinary) science. «Trans-disciplinary» in the context is interpreted as a completely new epistemological situation, which is fraught with the initiation of a civilizational crisis. Philosophy and ideology of technogenic civilization is based on the possibility of unambiguous demarcation of public value and descriptive scientific discourses (1), and the object (...) and subject of the cognitive process (2). Both of these attributes are no longer valid. For mass, everyday consciousness and institutional philosophical tradition it is intuitively obvious that having the ability to control the evolutionary process, Homo sapiens came close to the borders of their own biological and cultural identity. The spontaneous coevolutionary process of interaction between the «subject» (rational living organisms) and the «object» (material world), is the teleological trend of the movement towards the complete rationalization of the World as It Is, its merger with the World of Due. The stratification of the global evolutionary process into selective and semantic (teleological) coevolutionary and therefore ontologically inseparable components follows. With the entry of anthropogenic civilization into the stage of the information society, firsty, the post-academic phase of the historical evolution of scientific rationality began, the attributes of which are the specific methodology of scientific knowledge, scientific ethos and ontology. Bioethics as a phenomenon of intellectual culture represents a natural philosophical core of modern post- academic (human-dimensional) science, in which the ethical neutrality of scientific theory principle is inapplicable, and elements of public-axiological and scientific-descriptive discourses are integrated into a single logic construction. As result, hermeneutics precedes epistemology not only methodologically, but also meaningfully, and natural philosophy is regaining the status of the backbone of the theory of evolution – in an explicit form. (shrink)

Bad philosophy is responsible for the climate and nature crises, and other global problems too that threaten our future. That sounds mad, but it is true. A philosophy of science, or of theatre or life is a view about what are, or ought to be, the aims and methods of science, theatre or life. It is in this entirely legitimate sense of “philosophy” that bad philosophy is responsible for the crises we face. First, and in a (...) blatantly obvious way, those institutions, organizations, corporations, businesses, endeavours, and activities of humanity that cause the crises and global problems we face, do so because of the aims they pursue (profit perhaps, or power, or heat and light for homes), and the methods adopted in pursuit of those aims – the philosophy in other words, built into the institution, organization, business, human activities, or whatever it may be. It is the philosophy of these institutions, organizations and activities that we need to change to put a stop to, or at least lessen the severity of, the crises we face, the global problems that confront us, above all the climate and nature crises. One institution has an especially crucial role in this respect: our universities. They are dominated in a multitude of ways by a particularly disastrous philosophy, a philosophy of inquiry which may be called knowledge-inquiry. This holds that the basic aim of the university is to acquire and apply knowledge. First, knowledge is to be acquired; once acquired, it can be applied to help solve social problems. But this philosophy of knowledge-inquiry is an intellectual disaster. As a result, universities are, in devastating and almost entirely unrecognized ways, humanitarian disasters too. Judged from the standpoint of helping to promote human welfare, the university shaped by the philosophy of knowledge-inquiry violates THREE of the four most elementary rules of rational problem solving conceivable in a wholesale, structural fashion, and it is this gross, wholesale, structural irrationality of the university, unnoticed by all but a few scientists and scholars, that is in part responsible for the creation of our grave global problems, and our current incapacity to learn how to solve them. The pursuit of knowledge, conducted in universities, within the framework of knowledge-inquiry over the decades and centuries, has produced much of great benefit to humanity. It has made the modern world possible. It has led to modern power production, modern industry and armaments, modern agriculture, modern hygiene and medicine, modern travel and communications, and the internet. But these very successes have also created many of our most serious current global problems: the climate crisis; the destruction of natural habitats, the catastrophic loss of wild life, and impending mass extinction of species (the nature crisis); the lethal character of modern war; the impact on the natural world of the rapid growth of the human population; the menace posed by nuclear weapons; pollution of earth, sea and air; threats to democracy caused in part by the internet and social media. All these grave global problems have been made possible by modern science and technology, pursued largely in universities within the framework of knowledge-inquiry. Nevertheless, it is not science and technology as such that are the problem, but science pursued in a way that is dissociated from a more fundamental task of the university to help humanity resolve conflicts and problems of living in increasingly cooperatively rational ways, so that progress may be made to a better world. Science and technology, pursued within the framework of knowledge-inquiry, create for some of us the power to act, but not the power to act wisely – not the power to learn how to resolve conflicts and problems of living in increasingly cooperatively rational ways. For that, we need our institutions of learning, above all our universities, to take as their primary task to help humanity learn how to do it. In order to do that, the philosophy of inquiry put into practice by universities needs to be dramatically transformed. We urgently need to bring about a revolution in the overall aims and methods of academic inquiry – a revolution in the philosophy of the university, all around the world, wherever possible, so that the basic aim becomes to seek and promote wisdom, construed to be the capacity, active endeavour, and perhaps desire, to realize what is of value in life, for oneself and others, wisdom in this sense including knowledge, understanding and technological know-how, but much else besides, methods being dramatically modified too so as to help achieve the new academic aim. The basic task of the university would be, not to solve problems of knowledge, but rather to help people in the social world beyond the university to resolve conflicts and problems of living so that what is of value in life may be realized by everyone, insofar as that is possible. The pursuit of knowledge would be vital, but not intellectually fundamental. The intellectual and institutional revolution we so urgently need in our universities would affect every discipline and aspect of the university; it would dramatically affect both research and education, and the whole way the university is related to the rest of the social world. The revolution, from knowledge-inquiry to wisdom-inquiry would dramatically enhance the intellectual integrity and rationality of natural science, social inquiry, the humanities and technology, the character of these disciplines and the relationships they have with one another. University education throughout the university would be dramatically improved. And academic inquiry as a whole would do what, on the whole, it fails to do at present: it would help humanity resolve conflicts and problems of living in increasingly cooperatively rational and, as a result, increasingly successful ways, progress at last being made to a genuinely good, civilized world – a world in which there is peace, justice, liberal democracy, individual freedom, education, reasonable equality, sustainable prosperity and worthwhile opportunities in life, all of these for everyone, insofar as this is possible. Why, it may be asked, has academic philosophy not noticed that we urgently need to transform the current bad philosophy of inquiry of knowledge-inquiry into the far more intellectually rigorous and humanly valuable philosophy of wisdom-inquiry, so that we can begin to do what so far we have failed to do so lamentably: learn how to avoid impending disasters, and even make progress to a better world, something that seems at present almost unthinkable given the horrors of war, poverty, political enslavement of the 20th century, and the horrors of this century so far too? The answer is that academic philosophy is in a particularly pitiful state, as philosophers themselves, are just beginning to realize and lament. That is why academic philosophers are blind to the intellectual and humanitarian disaster of the bad philosophy that dominates universities today, and inconceivable to them to them that they might have, as a disciplinary task, to ensure academic inquiry implements a good philosophy of inquiry, and advocate and argue for change if it does not. Once upon a time, in Europe at least, philosophy was an intellectual power in the world. In the 17th century it created modern science which massively increased and improved our knowledge and understanding of the world, which in turn led to the Enlightenment, the industrial revolution, and the modern world. Philosophy was once so intellectually powerful and influential that it changed the course of history. But philosophy also made in the past three disastrous intellectual blunders: the post-Cartesian blunder, the post-Newtonian blunder, and the Enlightenment blunder. Never acknowledged and corrected by subsequent philosophy right down to the present, these unrecognized intellectual blunders rendered academic philosophy the esoteric, pathetic, and powerless discipline it is today, so that throughout the last century and, so far, throughout this one, academic philosophy has remained blind to the intellectual disaster of knowledge-inquiry, and thus failed entirely to take up its proper disciplinary task of warning fellow academics of the structural irrationality of the philosophy that prevails in the university, and of proposing what steps need to be taken to put things right. Instead of performing such an urgently needed philosophical task, so-called analytic philosophy was reduced to analysing the meaning of words. Since then, there has been hardly any discernible improvement, even if analysis of concepts no longer dominates the scene. Bad academic philosophy is indeed responsible for intellectual and humanitarian failures of the university. What the three past intellectual blunders of philosophy are, why their persistence so dramatically reduces academic philosophy to a triviality, and why, furthermore, this results in the failure of scientists and scholars to see what is so blatantly bad about the philosophy prevailing in universities around the world – the failure to see what so urgently needs to be done to put right what has been wrong for so long: all this is made clear in this book. A new kind of philosophy emerges during the course of the argument, critical fundamentalism, which has as its task to keep alive imaginative and critical – that is rational – thinking about our fundamental problem: How can our human world, the world we experience and live in – the world of living things, people, consciousness, free will, meaning and value – how can all of this exist and best flourish embedded as it is in the physical universe? That problem encompasses all others of life, science and thought. Critical fundamentalism tries to improve answers to aspects of this problem; but it also seeks to encourage everyone to think about the problem, from time to time, and think about how it interacts, in both directions, with more urgent particular and specialized problems of life and thought. Critical fundamentalism sets out to help improve bad philosophy wherever it is to be found: in social, political, commercial, legal, financial, and international life; and especially in academia, in institutions of learning, so that they become devoted to enhancing the capacity of people to learn how to achieve what is of genuine value in this brief life of a few decades if we are fortunate. Critical fundamentalism does everything it can to bring about the revolution in our universities we so urgently need. If taken up by mainstream philosophy, it might really have an impact, and begin to transform universities for the better, in both intellectual and humanitarian terms, and thus, enable humanity to learn how, after the grim failures and horrors of the last century and this one, to make progress to a better world. -/- . (shrink)

According to the traditional Western concept of freedom, the ability to exercise free will depends on the availability of options and the possibility to consciously decide which one to choose. Since neuroscientific research increasingly shows the limits of what we in fact consciously control, it seems that our belief in free will and hence in personal autonomy is in trouble. -/- A closer look at the phenomenology of Obsessive-Compulsive Disorder (OCD) gives us reason to doubt the traditional concept of freedom (...) in terms of conscious control. Patients suffering from OCD experience themselves as unfree. The question is whether their lack of freedom is due to a lack of will power. Do they have too little conscious control over their thoughts and actions? Or could it be the opposite: are they exerting too much conscious control over their thoughts and actions? -/- In this chapter, we will argue that OCD patients testify to the general condition that exercising an increased conscious control over actions can in fact diminish the sense of agency rather than increase the experience of freedom. The experiences of these patients show that the traditional conception of freedom in terms of ‘free will’ has major shortcomings. There is an alternative, however, to be found in the work of Hannah Arendt. She advocates a conception of freedom as freedom in action. Combined with phenomenological insights on action, Arendt’s account of freedom helps us to get a more adequate understanding of the role of deliberation in the experience of freedom. We argue that the experience of freedom depends on the right balance between deliberate control and unreflective actions. (shrink)

This metatheoretical paper investigates mind wandering from the perspective of philosophy of mind. It has two central claims. The first is that, on a conceptual level, mind wandering can be fruitfully described as a specific form of mental autonomy loss. The second is that, given empirical constraints, most of what we call “conscious thought” is better analyzed as a subpersonal process that more often than not lacks crucial properties traditionally taken to be the hallmark of personal-level cognition - such (...) as mental agency, explicit, consciously experienced goal-directedness, or availability for veto control. I claim that for roughly two thirds of our conscious life-time we do not possess mental autonomy (M-autonomy) in this sense. Empirical data from research on mind wandering and nocturnal dreaming clearly show that phenomenally represented cognitive processing is mostly an automatic, non-agentive process and that personal-level cognition is an exception rather than the rule. This raises an interesting new version of the mind-body problem: How is subpersonal cognition causally related to personal-level thought? More fine-grained phenomenological descriptions for what we called “conscious thought” in the past are needed, as well as a functional decomposition of umbrella terms like “mind wandering” into different target phenomena and a better understanding of the frequent dynamic transitions between spontaneous, task-unrelated thought and meta-awareness. In an attempt to lay some very first conceptual foundations for the now burgeoning field of research on mind wandering, the third section proposes two new criteria for individuating single episodes of mind-wandering, namely, the “self-representational blink” (SRB) and a sudden shift in the phenomenological “unit of identification” (UI). I close by specifying a list of potentially innovative research goals that could serve to establish a stronger connection between mind wandering research and philosophy of mind. (shrink)

The term "human dignity" is the source of considerable confusion in contemporary bioethics. It has been used by Kantians to refer to autonomy, by others to refer to the sanctity of life, and by still others to refer—albeit obliquely—to an important but infrequently discussed set of human goods. In the first part of this article, I seek to disambiguate the notion of human dignity. The second part is a defense of the philosophical utility of such a notion; I argue that (...) there is nothing implausible about appealing to a deontological "principle of dignity" to solve bioethical problems, especially those concerning the development of new biotechnologies. There may, however, be problems associated with any attempt to use dignity as a basis for public policy. This sort of worry is explained and briefly addressed in the final section. (shrink)

Medicine is increasingly subject to various forms of criticism. This paper focuses on dominant forms of criticism and offers a better account of their normative character. It is argued that together, these forms of criticism are comprehensive, raising questions about both medical science and medical practice. Furthermore, it is shown that these forms of criticism mainly rely on standards of evaluation that are assumed to be internal to medicine and converge on a broader question about the aim of medicine. Further (...) work making medicine’s internal norms explicit and determining the aim of medicine would not only help to clarify to what extent the criticism is justified, but also assist an informed deliberation about the future of medicine. To illustrate some of the general difficulties associated with such a task, the paper concludes by critically engaging Edmund Pellegrino’s account of the aim of medicine as well as the Hastings Center’s consensus report. (shrink)

Introductory and advanced textbooks in bioethics focus almost entirely on issues that disproportionately affect disabled people and that centrally deal with becoming or being disabled. However, such textbooks typically omit critical philosophical reflection on disability, lack engagement with decades of empirical and theoretical scholarship spanning the social sciences and humanities in the multidisciplinary field of disability studies, and avoid serious consideration of the history of disability activism in shaping social, legal, political, and medical understandings of disability over the last fifty (...) years. For example, longstanding discussions on topics such as euthanasia, physician aid-in-dying, pre-implantation genetic diagnosis, prenatal testing, selective abortion, enhancement, patient autonomy, beneficence, non-maleficence, and health care rationing all tend to be premised on shared and implicit assumptions regarding disability, especially in relation to quality of life, yet with too little recognition of the way that “disability” is itself a topic of substantial research and scholarly disagreement across multiple fields. This is not merely a concern for academic and medical education; as an applied field tied to one of the largest economic sectors of most industrialized nations, bioethics has a direct impact on healthcare education, practice, policy, and, thereby, the health outcomes of existing and future populations. It is in light of these pressing issues that the Disability Bioethics Reader is the first reader to introduce students to core bioethical issues and concepts through the lens of critical disability studies and philosophy of disability. The Disability Bioethics Reader will include over thirty-five chapters covering key areas such as: critical histories and state-of-the-field analyses of modern medicine, bioethics, disability studies, and philosophy of medicine; methods in bioethics; concerns at the edge- and end-of-life; enhancement; disability, quality of life, and well-being; prenatal testing and abortion; invisible disabilities; chronic illness; healthcare justice; genetics and genomics; intellectual disability and neurodiversity; ethics and diagnosis; and epistemic injustice in healthcare. (shrink)

Impairment of self-control is often said to be a defining feature of addiction. Yet many addicts display what appears to be a considerable amount of control over their drug-oriented actions. Not only are their actions clearly intentional and frequently carried out in a conscious and deliberate manner, there is evidence that many addicts are responsive to a wide range of ordinary incentives and counter-incentives. Moreover, addicts have a wide variety of reasons for using drugs, reasons which often seem to go (...) a long way towards explaining their drug-oriented behavior. Many use drugs, for example, to cope with stressful or traumatic experiences. In this article I argue that some standard philosophical explanations of addicts’ impairment of self-control are inadequate, and propose an alternative. (shrink)

Rather than eliminate the terms "mental health and illness" because of the grave moral consequences of psychiatric labeling, conservative definitions are proposed and defended. Mental health is rational autonomy, and mental illness is the sustained loss of such. Key terms are explained, advantages are explored, and alternative concepts are criticized. The value and descriptive components of all such definitions are consciously acknowledged. Where rational autonomy is intact, mental hospitals and psychotherapists should not think of themselves as treating an illness. Instead, (...) they are functioning as applied axiologists, moral educators, spiritual mentors, etc. They deal with what Szasz has called "personal, social, and ethical problems in living." But mental illness is real. (shrink)

In this Introduction, I situate the underlying project “Autonomy and Mental Disorder” with reference to current debates on autonomy in moral and political philosophy, and the philosophy of action. I then offer an overview of the individual contributions. More specifically, I begin by identifying three points of convergence in the debates at issue, stating that autonomy is: 1) a fundamentally liberal concept; 2) an agency concept and; 3) incompatible with (severe) mental disorder. Next, I explore, in the context (...) of decisional capacity assessments, the difficulties to reconcile 1) and 2) with 3) which they at the same time seem to imply. Having clarified the centrality of a cogent notion of mental disorder for addressing these difficulties, I comment on three promising lines of inquiry about the nature and scope of autonomy that emerge from the following chapters. (shrink)

[186 pages] Just as the six branches of a snow crystal converge in regular proportions toward their common center, the six contributions to this book point toward a future philosophy of cosmic life. In this sense, this edited volume represents a multidisciplinary and transcultural polylogue of distinguished authors from three continents, which aims to establish highly innovative perspectives and open new frontiers of developing philosophical reflections and scientific foundations for the emergence of a common cosmic consciousness, for an (...) integral ecology, and for a cooperative planetary civilization of humanity. John B. Cobb, Jr. uses a process-philosophical foundation to describe life as living events expressing novelty and the cosmos as a process of self-enriching and self-evolving “Life Itself.” Chandra Wickramasinghe unfolds his scientific and philosophical perspective on cosmic life in twelve successive steps, offering a wide range of arguments and insights that support an up-to-date theory of panspermia. Attila Grandpierre presents the "Cosmic Life Principle" and the comprehensive science based upon it that is inextricably linked to the healthy and cooperative civilization, to the biological laws of nature, to the laws of logic, to the uplifting of the well-being of people and ecological communities. Chunyou Yan introduces the approach of his holographic philosophy, according to which the universe must be understood as a vast living entity, every aspect of which represents life. Bei Peng shows that the proportions of energy meridians in traditional Chinese medicine correspond to musical intervals, and on this basis she demonstrates the analogy of the human body to macrocosmic phenomena. David Bartosch offers an examination of three important systematic foundations for a poly-contextural, transcultural philosophy of cosmic life with roots in Greek, Chinese, South and West Asian, and European traditions of thought. (shrink)

The goal of this programmatic paper is to highlight a close connection between the core problem in the philosophy of medicine, i.e. the concept of health, and the core problem of the philosophy of mind, i.e. the concept of consciousness. I show when we look at these phenomena together, taking the evolutionary perspective of modern state-based behavioural and life-history theory used as the teleonomic tool to Darwinize the agent- and subject-side of organisms, we will be in a (...) better position to make sense of them both as natural phenomena. (shrink)

The paper reports results of the very first survey-based study on the prevalence, frequency and nature of ethical or other non-medical difficulties faced by Polish physicians in their everyday clinical practice. The study involved 521 physicians of various medical specialties, practicing mainly in inpatient healthcare. The study showed that the majority of Polish physicians encounter ethical and other non-medical difficulties in making clinical decisions. However, they confront such difficulties less frequently than their foreign peers. Moreover, Polish doctors indicate different circumstances (...) as a source of the experienced problems. The difficulties most often reported relate to (i) patients (or their proxies) requests for medically non-indicated interventions; (ii) problems with communication with patients (or their proxies) due to the patients’ negative attitude, unwillingness to cooperate, or aggression; and (iii) various difficulties with obtaining informed consent. Polish physicians report difficulties associated with disagreements among care givers or scarcity of resources less frequently than doctors from other countries. The study’s findings provide support for the thesis that a significant portion of Polish physicians still follow a traditional, paternalistic, and hierarchical model of healthcare practice. Instead of promoting patient’s empowerment, engagement, and rights, they often consider these ideas as a threat to physicians’ professional authority and autonomy. The study leads to the conclusion that due to insufficient training in medical ethics, communication skills, and medical law, many Polish physicians lack the knowledge and competence necessary to adequately respond to challenges posed by modern healthcare practice. (shrink)

Consciousness in experimental subjects is typically inferred from reports and other forms of voluntary behaviour. A wealth of everyday experience confirms that healthy subjects do not ordinarily behave in these ways unless they are conscious. Investigation of consciousness in vegetative state patients has been based on the search for neural evidence that such broad functional capacities are preserved in some vegetative state patients. We call this the standard approach. To date, the results of the standard approach have suggested (...) that some vegetative state patients might indeed be conscious, although they fall short of being demonstrative. The fact that some vegetative state patients show evidence of consciousness according to the standard approach is remarkable, for the standard approach to consciousness is rather conservative, and leaves open the pressing question of how to ascertain whether patients who fail such tests are conscious or not. We argue for a cluster-based ‘natural kind’ methodology that is adequate to that task, both as a replacement for the approach that currently informs research into the presence or absence of consciousness in vegetative state patients and as a methodology for the science of consciousness more generally. 1. Introduction2. The Vegetative State3. The Standard Approach4. The Natural Kind Methodology5. Is Consciousness a Special Case? 5.1 Is consciousness a natural kind?5.2 A special obstacle?6. Conclusion. (shrink)

It has a long history for the exploration of the origin and essence of human consciousness with different definitions and explanations in various fields such as philosophy, medicine, sociology, biology, and psychology. However, all of them had not been recognized so far. The main reason is that the complexity of consciousness leads to the inability of various fields to understand its essence fully, reasonably, and comprehensively, and there are still significant differences for it, and which have become (...) an eternal mystery. So, it is necessary to delve deeper into it. Here we show that this article concludes that the origin of consciousness comes from natural matter, the essence of consciousness is material information, the ability of consciousness is the degree to which the complexity and orderliness of material information are utilized, and consciousness has the attributes of congenital, materiality, systematicness, complexity, dynamics, difference, and selfness according to the analysis, summary and induction of knowledge from various disciplines. (shrink)

In this paper, I explore the nature of medical interventions like neuromodulation on the complex human experience of love. Love is built upon two fundamental natures, viz: the biological and the psychosocial. As a result of this distinction, scientists, and bioethicists have been exploring the possible ways this complex human experience can be biologically tampered with to produce some supposed higher-order ends like well-being and human flourishing. At the forefront in this quest are Earp, Sandberg and Savulescu whose research works (...) over ten years has focused on the good that could stem from the medicalization of love. I acknowledge the various criticisms that have been made against this stance. However, most of these criticisms have been directed towards the mere side effects and sociocultural disservices that could result from the process of using drugs to influence human romantic relationships and in the end, critiques endorse the medicalization of love on the basis that its benefits outweigh the disadvantages. Consequently, I advance two strands of arguments against “medically-assisted love,” the ontological and the socio-ethical arguments. The former presupposes that beyond the possible side effects of medicalizing love there is something inherently mistaken about this effort and there is something intrinsically different about love that distinguishes it from its medically-engineered alternative. In the latter argument, I claim that drug interventions in romantic love contravene the very nature of medicine. Overall, I believe that critiques were still able to endorse medicalizing love despite their objections because they were only looking at one direction, the physical/cultural complications. (shrink)

Evidence-Based Medicine has little consideration for mechanisms and philosophers of science and medicine have recently made pleas to increase the place of mechanisms in the medical evidence hierarchy. However, in this debate the notions of mechanisms seem to be limited to 'mechanistic processes' and 'complex-systems mechanisms,' understood as 'componential causal systems'. I believe that this will not do full justice to how mechanisms are used in biological, psychological and social sciences and, consequently, in a more biopsychosocial approach to medicine. Here, (...) I propose, following (Kuorikoski, 2009), to pay more attention to 'abstract forms of interaction' mechanisms. The present work scrutinized review articles on depression and medically unexplained pain, which are considered to be of multifactorial pathogenesis, for their use of mechanisms. In review articles on these disorders there seemed to be a range of uses between more 'abstract forms of interaction' and 'componential causal system' mechanisms. I therefore propose to expand the notions of mechanisms considered in medicine to include that of more 'abstract forms of interaction' to better explain and manage biopsychosocial disorders. (shrink)

What is it like to be a bat? What is it like to be sick? These two questions are much closer to one another than has hitherto been acknowledged. Indeed, both raise a number of related, albeit very complex, philosophical problems. In recent years, the phenomenology of health and disease has become a major topic in bioethics and the philosophy of medicine, owing much to the work of Havi Carel (2007, 2011, 2018). Surprisingly little attention, however, has been given (...) to the phenomenology of animal health and suffering. This omission shall be remedied here, laying the groundwork for the phenomenological evaluation of animal health and suffering. (shrink)

Autonomy in bioethics is coming under sustained criticism from a variety of perspectives. The criticisms, which target personal or individual autonomy, are largely justified. Moral conceptions of autonomy, such as Kant’s, on the other hand, cannot simply be applied in bioethical situations without moralizing care provision and recipience. The discussion concludes with a proposal for re-thinking autonomy by focusing on what different agents count as reasons for choosing one rather than another course of action, thus recognising their involvement in the (...) decision process. (shrink)

Advocates of the Person-Centered Healthcare (PCH) approach say that PCH is a response to a failure of caring for patients as persons. Nevertheless, there are many human subjects falling to fulfill the requirements of a traditional philosophical definition of personhood. Hence, if we take, PCH seriously, a greater clarification of the key terminology of PCH is urgently needed. It seems necessary, for instance, that the concept of the person should be extended in order to include those individuals with insipient or (...) immature levels of consciousness, as well as those who are severely and permanently mentally handicapped. In this article, we will depart from some well-known philosophical concepts of what it means to be a person and try to offer a broader and more inclusive meaning. We suggest that persons are human beings with a socially recognized biography, which implies to recognize as persons individuals with necessities, but also with narratives about their interests and claims, expressed sometimes by other people related to them. This is particularly the case of individuals that suffer from severe disorders of consciousness. For those, is not only care that matters; respect matters too. Caregivers should therefore not only sympathetically care for the well-being of these people; they should also be concerned to respect their interests and claims by interpreting them empathetically, in the light of their biographical story. Our conclusion is that, in order to be coherent, PCH must consider individuals with severe disorders of consciousness as persons and we think that our revised concept of personhood fits with this requirement. (shrink)

Dominant views about the nature of health and disease in bioethics and the philosophy of medicine have presumed the existence of a fixed, stable, individual organism as the bearer of health and disease states, and as such, the appropriate target of medical therapy and ethical concern. However, recent developments in microbial biology, neuroscience, the philosophy of cognitive science, and social and personality psychology (Ickes...

Our experiences with the external world are possible mainly through vision, hearing, taste, touch, and smell providing us a sense of reality. How the brain is able to seamlessly integrate stimuli from our external and internal world into our sense of reality has yet to be adequately explained in the literature. We have previously proposed a three-dimensional unified model of consciousness that partly explains the dynamic mechanism. Here we further expand our model and include illustrations to provide a better (...) conception of the ill-defined space within the self, providing insight into a unified mind-body concept. In this article, we propose that our senses “super-impose” on an existing dynamic space within us after a slight, imperceptible delay. The existing space includes the entire intrapersonal space and can also be called the “the body’s internal 3D default space”. We provide examples from meditation experiences to help explain how the sense of ‘self’ can be experienced through meditation practice associated with underlying physiological processes that take place through cardio-respiratory synchronization and coherence that is developed among areas of the brain. Meditation practice can help keep the body in a parasympathetic dominant state during meditation, allowing an experience of inner ‘self’. Understanding this physical and functional space could help unlock the mysteries of the function of memory and cognition, allowing clinicians to better recognize and treat disorders of the mind by recommending proven techniques to reduce stress as an adjunct to medication treatment. (shrink)

Experimental philosophy of consciousness aims to investigate and explain our thinking about phenomenally conscious states. Based on empirical studies, researchers have argued (a) that we lack a folk concept of consciousness, (b) that we do not think entities like Microsoft feel regret, (c) that unfelt pains are widely accepted, and (d) that people do not attribute phenomenally conscious states to duplicated hamsters. In this article, I review these and other intriguing claims about people’s understanding of phenomenal (...) class='Hi'>consciousness. In doing so, I also show why experimental philosophy of consciousness is challenging, although perhaps not quite as daunting as studying phenomenal consciousness itself. (shrink)

In recent decades, the intertwining ideas of self-determination and well-being have received tremendous support in bioethics. Discussions regarding self-determination, or autonomy, often focus on two dimensions—the capacity of the patient and the freedom from external coercion. The practice of obtaining informed consent, for example, has become a standard procedure in therapeutic and research medicine. On the surface, it appears that patients now have more opportunities to exercise their self-determination than ever. Nonetheless, discussions of patient autonomy in the bioethics literature, which (...) focus on individual patients making particular decisions, neglect the social structure within which health-care decisions are made. Looking through the lens of disability and informed by the feminist conception of relational autonomy, this essay argues that the issue of autonomy is much more complex than the individualist model suggests. The social system and the ableist ideology impose various forms of pressure or oppressive power that can affect people’s ability to choose according to their value system. Even if such powers are not directly coercive, they influence potential parents’ decisions indirectly—they structure their alternatives in such a way that certain options are never considered as viable and other decisions must be made. This paper argues that, instead of only focusing on the individual act of decision-making, we need to pay attention to the social structure that frames people’s decision. (shrink)

ABSTRACT -/- In this dissertation I make a case for how mental health care, specifically disordered eating, is in need of an adjunctive field of discourse, that being theories on philosophy of consciousness, cosmology, and the new epistemology of science based on physics. Without psychological inquiry and education on new theories about consciousness and new perspectives on the nature of reality, mental health treatment is incomplete and outdated. I bring these topics to the eating disorder field in (...) three ways: by choosing the scientific and philosophical discourse to be added into treatment; by translating the complex and abstract topics into psychologically relevant, lay public coursework; and, finally, through the creation of actual processes that help bring the material into direct experience. The science and philosophy discourse topics that will transform disordered eating are presented through lecture, inquiry for consideration, and discussion options. Consciousness, cosmology, and the new epistemology of science based on physics is simplified with examples of how it can be implemented within individual sessions, group sessions, or workshops for disordered eating treatment and with application to other mental health problems. The psychological application of the material is further enhanced through my description of a variety of experiential processes, from writing assignments and guided visualizations to storytelling, rituals, encounters in nature, and embodiment activities. I have created the lectures, inquiry, and experiential processes within a dynamic body of work, named the Emergence Courses, that have been introduced to professionals treating disordered eating and to clients for use. (shrink)

Consent governs innumerable everyday social interactions, including sex, medical exams, the use of property, and economic transactions. Yet little is known about how ordinary people reason about the validity of consent. Across the domains of sex, medicine, and police entry, Study 1 showed that when agents lack autonomous decision-making capacities, participants are less likely to view their consent as valid; however, failing to exercise this capacity and deciding in a nonautonomous way did not reduce consent judgments. Study 2 found that (...) specific and concrete incapacities reduced judgments of valid consent, but failing to exercise these specific capacities did not, even when the consenter makes an irrational and inauthentic decision. Finally, Study 3 showed that the effect of autonomy on judgments of valid consent carries important downstream consequences for moral reasoning about the rights and obligations of third parties, even when the consented-to action is morally wrong. Overall, these findings suggest that laypeople embrace a normative, domain-general concept of valid consent that depends consistently on the possession of autonomous capacities, but not on the exercise of these capacities. Autonomous decisions and autonomous capacities thus play divergent roles in moral reasoning about consent interactions: while the former appears relevant for assessing the wrongfulness of consented-to acts, the latter plays a role in whether consent is regarded as authoritative and therefore as transforming moral rights. (shrink)

Disorders of consciousness (DoC)—that is, unresponsive wakefulness syndrome/vegetative state and minimally conscious state—are debilitating conditions for which no reliable markers of consciousness recovery have yet been identified. Evidence points to the GABAergic system being altered in DoC, making it a potential target as such a marker.

When many people think of bioethics, they think of gripping issues in clinical medicine such as end-of-life decision-making, controversies in biomedical research such as that over work with stem cells, or issues in allocating scarce health-care resources such as organs or money. The term “bioethics” may evoke images of moral controversies being discussed on news programs and talk shows. But this “controversy of the day” focus often treats ethical issues in medicine superficially, for it addresses them as if they could (...) be examined and discussed in isolation from the context in which they are situated. Such a focus on the latest controversies fails to take into account that medicine is a social institution and that the controversies in bioethics often reflect deeper social and moral issues that transcend the boundaries of medicine and ethics. If one moves beyond the issue-of-the-day approach to bioethics, one can see that the field must address these deeper issues. (shrink)