Grant Gillett

The concept of futility is sometimes regarded as a cloak for medical paternalism in that it rolls together medical and value judgments. Often, despite attempts to disambiguate the concept, that is true and it can be applied in such a way as to marginalize the real interests of a patient. I suggest we replace it with a conceptual toolkit that includes physiological futility, substantial benefit (SB), and the risk of unacceptable badness (RUB) in that these concepts allow us to articulate what is at stake in ethical judgments where outcomes are crucial in determining what should be done

This book uses a neo-Aristotelian framework to examine human subjectivity as an embodied being. It examines the varieties of reductionism that affect philosophical writing about human origins and identity, and explores the nature of rational subjectivity as emergent from our neurobiological constitution. This allows a consideration of the effect of neurological interventions such as psychosurgery, neuroimplantation, and the promise of cyborgs on the image of the human. It then examines multiple personality disorder and its implications for narrative theories of the self, and explores the idea of human spirituality as an essential aspect of embodied human subjectivity.

Libet's experiments, supported by a strict one-to-one identity thesis between brain events and mental events, have prompted the conclusion that physical events precede the mental events to which they correspond. We examine this claim and conclude that it is suspect for several reasons. First, there is a dual assumption that an intention is the kind of thing that causes an action and that can be accurately introspected. Second, there is a real problem with the method of timing the mental events concerned given that Libet himself has found the reports of subjects to be unreliable in this regard. Third, there is a suspect assumption that there are such things as timable and locatable mental and brain events accompanying and causing human behaviour. For all these reasons we reject the claim that physical events are prior to and explain mental events

The human brain is subjective and reflects the life of a being-in-the-world-with-others whose identity reflects that complex engaged reality. Human subjectivity is shaped and in-formed (formed by inner processes) that are adapted to the human life-world and embody meaning and the relatedness of a human being. Questions of identity relate to this complex and dynamic reality to reflect the fact that biology, human ecology, culture, and one's historic-political situation are inscribed in one's neural network and have configured its architecture so that it is a unique and irreplaceable phenomenon. So much is a human individual a relational being whose own understanding and ownership of his or her life is both situated and distinctive that neurophilosophical conceptions of identity and human activity that neglect these features of our being are quite inadequate to ground a robust neuroethics

Freud, working from a background in clinical neurology and against a backdrop of burgeoning theory development in biology and neurophysiology, thought that the layers of the mind mirrored the layers of the brain although he was well aware of the conceptual problems involved in trying to identify the two. His associationist view, based on a neurobiological and evolutionary approach to the mind tends to underestimate the role of consciousness in a holistic conception of the psyche. The role of language and the disciplines and practices which structure the psyche make it a domain in which negotiated solutions to life challenges are produced from the socio-cultural resources of discourse applied to the biological propensities resulting from innate dispositions and learning history. Although the biological and social realms obey fundamentally different rules, their psychological effects are realised in a common medium — the brain — a fact that can be detached from reductive approaches to psychology or psychiatry and can give substance to the idea of the body being inscribed like a surface on which events have left their trace

Abstract The language of consciousness and that of brain function seem vastly different and incommensurable ways of approaching human mental life. If we look at what we mean by consciousness we find that it has a great deal to do with the sensitivity and responsiveness shown by a subject toward things that happen. Philosophically, we can understnd ascriptions of consciousness best by looking at the conditions which make it true for thinkers who share the concept to say that one of them is conscious. This depends on consciousness being manifest. When we also note that manifest, flexible and exploratory responses to one's environment are the basis of concept use, an a priori link between concepts and consciousness is forged. The brain structures subserving such responses are complex but crucially involve the multi?tracked and cross?linked information processing to be found in the neocortex. This function draws on the motivational and orienting activity arising in lower brain systems but orchestrates that into an articulated structure of behaviour control. The conclusion is that human consciousness is an umbrella term for complex and animated mental activity which makes extensive use of many different perceptual systems and also of the social milieu within which human cognition develops

The legalisation of euthanasia creates a certain tension when it is compared with those traditional medical principles that seem to embody respect for the sanctity of life. It also creates a real need for us to explore what we mean by harm in relation to dying patients. When we consider that we must train physicians so that they not only understand ethical issues but also show the virtues in their clinical practice, it becomes important for us to strive to train them in virtue rather than mere knowledge. We can only do this by conveying a real sense of the needs of the patient and an ability to relate to patients as people not problems. Such attitudes take shape in a training programme in which practical situations are explored and discussed and the limits of scientific medical responses to those challenges are exposed. Keywords: bioethics education, euthanasia, moral judgment, training, virtue CiteULike Connotea Del.icio.us What's this?

Cara sui (care of the self) is a guiding thread in Foucault's later writings on ethics. Following Foucault in that inquiry, we are urged beyond our fairly superficial conceptions of consequences, harms, benefits, and the rights of persons, and led to examine ourselves and try to articulate the sense of life that animates ethical reasoning. The result is a nuanced understanding with links to virtue ethics and post-modern approaches to ethics and subjectivity. The approach I have articulated draws on the phenomenology of Levinas and Heidegger, the Virtue ethics of Baier, and the post-structuralist writing of Michel Foucault. The subject is seen as negotiable, embodied, provisional and able to be transformed in a way that denies essentialism about human beings, their moral status, and the idea of the good. The human being emerges as responsible because, properly, responsive to the context of discourse in which morality becomes articulated. When we import this style of thinking into bioethics we find that it reaches beyond issues of policy or right conduct and allows us to use the biomedical sciences and the clinical world to revise and interrogate our understanding of ourselves and the theoretical foundations of health care ethics.

Informed consent is the practical expression of the doctrine of autonomy. But the very idea of autonomy and conscious free choice is undercut by the view that human beings react as their unconscious brain centres dictate, depending on factors that may or may not be under rational control and reflection. This worry is, however, based on a faulty model of human autonomy and consciousness and needs close neurophilosophical scrutiny. A critique of the ethics implied by the model takes us towards a 'care of the self' view of autonomy and the subject's attunement to the truth as the crux of reasoning rather than the inner mental/neural state views of autonomy and human choice on offer at present.

The psychopathic personality disorder historically has been thought to include an insensitivity to morality. Some have thought that the psychopath's insensitivity indicates that he does not understand morality, but the relationship between the psychopath's defects and moral understanding has been unclear. We attempt to clarify this relationship, first by arguing that moral understanding is incomplete without concern for morality, and second, by showing that the psychopath demonstrates defects in frontal lobe activity which indicate impaired attention and adaptation to environmental conditions which are relevant to the formation of complex intentions. We argue that these frontal lobe defects can help to explain both the psychopath's apparent insensitivity to morality and his characteristic imprudence.

Free will seems to be part of the romantic echo of a world view which predates scientific psychology and, in particular, cognitive neuroscience. Findings in cognitive neuroscience seem to indicate that some form of physicalist determinism about human behavior is correct. However, when we look more closely we find that physical determinism based on the view that brain events cause mental events is problematic and that the data which are taken to support that view, do nothing of the kind. In fact that view meets some substantial objections which turn on the role of the contents of our thoughts and experiences in explaining our behavior. When we look at mental or psychological content we find it is governed by rules and not just causal laws. Rule-following is an activity which invokes the role of the thinker as rational agent and this is not a causal type of explanation. The fact that the thinker as agent is important means that when we invoke the way that a subject thinks about the world, we conceive of that subject as located in a socio–cultural context. This in turn requires that we recognize an explanatory circle according to which neither brain science nor social science can claim priority in explaining human behavior and it follows that, for the purposes of psychological explanation and the understanding of the brain as an organ subserving a system of representation, we are bound to regard human beings as reasoning beings who exert some control over their own behavior and not just as physical systems. This defeats the causal determinist position