Walter Glannon

In a provocative 1991 paper, Alvin Moss and Mark Siegler argued that it may be fair to give individuals with alcohol-related end-stage liver disease lower priority for a liver transplant than those who develop end-stage liver disease from other factors. Like other organs, there is a substantial gap between the available livers for transplantation and the number of people who need liver transplants. Yet, unlike those with end-stage renal disease, who can survive for some time on dialysis before receiving a kidney transplant, those with liver failure will die without a liver transplant

In 1999, a case was described on national television in which a woman had enlisted onto an international bone marrow registry with the altruistic desire to offer her bone marrow to some unidentified individual in need of a transplant. The potential donor then was notified that she was a compatible match with someone dying from leukemia and gladly donated her marrow, which cured the recipient of the disease. Years later, though, the recipient developed end-stage renal disease, a consequence of the high-dose chemotherapy she received earlier to destroy her stem cells and prepare her for the bone marrow transplant. Finding a suitable donor for a kidney transplant proved extremely difficult. Desperate, she requested that the donor registry personnel help her locate the individual who earlier was determined to be a compatible donor and asked this now-identifiable individual to consider donating one of her two normally functioning kidneys for a kidney transplant

In a recent article in this journal, we argued that living organ donation from a parent to a child should be described as a beneficent rather than an altruistic act. Emotional relationships can generate an obligation of beneficence to help those with whom we have these relationships. This may involve an obligation for a parent to donate an organ to a child, even though it entails some risk to the parent. The parent's donation is not altruistic because altruistic acts are not obligatory but optional, and they are motivated solely or primarily by other-regarding concerns. In contrast, donor parents' other-regarding concerns are inseparable from their own self-regarding concerns. An individual who donates to a stranger is acting altruistically. She may choose to help others to whom she is not emotionally related for a variety of reasons—sympathy, compassion, generosity, or a desire to give something back to humanity. But she does not have an obligation to do so. Although she may benefit as a consequence of donating, this is not her reason for donating. Instead, her action is motivated by a concern for the recipient's own sake. This is what makes the donation altruistic, and it can be justified without any expectation of benefit to the donor. However, although the potential competent donor decides whether the donation is in her best interests, physicians have the right to refuse to perform a transplant if the risks to the donor are too great or the potential benefits to the recipient are too small

Brain implants, such as Deep Brain Stimulation (DBS), which are designed to improve motor, mood and behavioural pathology, present unique challenges to our understanding of identity, agency and free will. This is because these devices can have visible effects on persons' physical and psychological properties yet are essentially undetectable when operating correctly. They can supplement and compensate for one's inherent abilities and faculties when they are compromised by neuropsychiatric disorders. Further, unlike talk therapy or pharmacological treatments, patients need not ‘do’ anything for the treatment to take effect. If one accepts, as we argue here, that brain implants are unique among implantable types of devices, then this can have significant implications for what it means to persist as the same person and be the source of one's thoughts and actions. By examining two of the most common indications for DBS in current use, namely in the motor (Parkinson's Disease) and psychiatric (Major Depression) domains, we further argue that although DBS, as it is currently applied, does not necessarily represent a unique threat to personal identity and agency per se, it introduces an unprecedented ‘third party’ into the debate on these concepts. In this way, DBS can be used as a tool to begin probing, both conceptually and empirically, some of philosophy's most perennial metaphysical questions

In lieu of an abstract, here is a brief excerpt of the content:Walter Glannon WHAT LITERARY THEORY MISSES IN WITTGENSTEIN Wittgenstein's stock is rising in literary criticism. The market value of expressions such as "language games" and "form oflife" is increasing in that they seem to lend themselves to the notion of interpretive communities endorsed by diose of reader-response persuasion.1 Wittgenstein's style is also apparently at a premium, in light of a recent attempt by a proponent of deconstruction to relate the philosopher's writing to that movement's use of rhetorical strategies in dealing with texts.2 There are affinities between Wittgenstein's repudiation (in the Investigations and the Remarks on the Foundations of Mathematics) of the metaphysical realism in the Tractatus and die arguments from reader-response critics against the notion of unmediated facts, as well as the rejection of the metaphysics of presence by deconstructionists. All diree oppose the idea that truth and falsity are conferred on our statements about the world by properties independent of diese statements. Insofar as these two critical schools are concerned primarily with language, they share Wittgenstein's aspiration to "bring words back from their metaphysical to their everyday use" (PI, I, § 116), for we can arrest the tendency to postulate objective, unmediated facts by "looking into the workings of our language" (PI, I, § 109). Moreover, Wittgenstein avoids psychology which involves the mental faculties. Presumably, this puts him at one with die concerted effort of many critics to rid texts of die author and with it the problem of intentionality. At first blush, then, the relation between Wittgenstein and literary criticism appears to be an attractive one. Yet Wittgenstein's antirealism does not militate against his passion for truth, that is, his intense desire to achieve complete understanding in the areas ofphilosophy that vexed him most.3 Nor does it debar him from thinking about the inexpressible realm 263 264Philosophy and Literature of the mystical, since, despite his concern for language, Wittgenstein never ceased being attracted to "things that cannot be put into words" (TLP, 6.522). This is not at all congenial to die purpose ofliterary theory, which admits ofno such shadowy domain beyond words and our linguistic practices. Indeed, I shall illustrate that Wittgenstein's resdess search for truth, spiritual concerns, and the dialectical structure of his works for the most part put him radically at odds with a critical enterprise whose aversion to truth and penchant for rhetorical analysis and conventions blinds it to both his view of literature and his aim in doing philosophy. I Since die advent of the New Criticism, literary theory has in great measure addressed itself to die discourse ramer than the story in texts. With the focus on literature as a rhetorical construct, more traditional humanistic interpretations have been excised. A more recent development of this shift to the discursive side of diings has been the effort to blur the distinction between literature and philosophy.4 With neidier discipline having a privileged status, both have been reduced to a textual discourse with no lines ofdemarcation, a reduction diat is at variance with Wittgenstein on two counts. First, he compartmentalized literature and philosophy as having distinct purposes: the literary works that interested him were stories ofmoral import; philosophy was to be practiced for the sake of clarity in thought. To the extent diat such clarity, if attainable, pointed toward an ethical dimension that lay beyond the bounds of language, literature and philosophy for him did have a common goal; but the paths leading to it were distinct. Second, and more importantly, Wittgenstein had no concern for the discourse of the literature diat he read. Rather, it was the moral import of the stories that attracted him. Most noteworthy on this score were the writings of Tolstoy, who had a profound influence on Wittgenstein's view oflife, and Dostoevsky.5 Wittgenstein often recommended Tolstoy's Twenty-three Tales to his friends, and while a schoolmaster in Lower Austria from 1920 to 1926, he constantly read The Brothers Karamazov, doing so aloud on one occasion in die presence of the village priest. He was especially impressed with Dostoevsky's character the Elder Zossima, "who could see into people's hearts and direct diem" (Rhees...

In defending what he calls ‘full-blooded Epicureanism’, James Stacey Taylor argues that the dead cannot be harmed or wronged.1 This has implications for a range of bioethical issues pertaining to death, including posthumous organ procurement. Taylor claims that respecting the autonomy of persons requires that their desires regarding the treatment of their postmortem bodies be given due consideration while these persons are alive. It is not obvious what this means in practical terms, though Taylor says that respect for autonomy requires that these wishes be recorded with the intention that they be followed. Yet if respect for autonomy only applies to the wishes of premortem persons, and if there are no posthumous harms or wrongs, then it is not clear why it would matter morally whether one's wishes about what to do with one's organs were fulfilled or thwarted after one's death.Most of us have an interest in what happens to our bodies not just during our lives but also after our deaths. Personal sovereignty and autonomy give persons a right to control what happens to their bodies, and since the body …

Neuroimaging showing brain abnormalities is increasingly being introduced in criminal court proceedings to argue that a defendant could not control his behavior and should not be held responsible for it. But imaging has questionable probative value because it does not directly capture brain function or a defendant’s mental states at the time of a criminal act. Advanced techniques could transform imaging from a coarse-grained measure of correlations between brain states and behavior to a fine-grained measure of causal connections between them. Even if this occurs, bias and other attitudes may unduly influence jurors’ interpretation of the data. Moreover, judges’ decisions about whether neuroimaging data is legally relevant and admissible are normative decisions based on more than empirical evidence. Advanced neuroimaging will better inform assessments of criminal responsibility but will not supplant or explain away the psychological and normative foundation of the criminal law

All psychiatric disorders have a neurobiological basis. This has led to a better understanding of these disorders and a reduction in the social stigma associated with them. But the claim that mental states can be explained entirely in neurobiological terms may give us de-stigmatization at the cost of de-personalization. A holistic view of the mind as distributed among the brain, body and environment provides the best model to guide interventions that will have the most salutary ef ects on the brain and the mind

Many drugs have therapeutic off-label uses for which they were not originally designed. Some drugs designed to treat neuropsychiatric and other disorders may enhance certain normal cognitive and affective functions. Because the long-term effects of cognitive and affective enhancement are not known and may be harmful, a precautionary principle limiting its use seems warranted. As an expression of autonomy, though, competent individuals should be permitted to take cognition- and mood-enhancing agents. But they need to be aware of the risks in chronic use of these agents and to take responsibility for their effects. A reasonable middle ground between these positions is to warn those who choose to enhance that doing so entails risks.