Grant Gillett

Concepts are basic elements of thought. Piaget has a conception of the nature of concepts as informational or computational operations performed in an inner milieu and enabling the child to understand the world in which it lives and acts. Concepts are, however, not merely logico?mathematical but are also conceptually linked to the mastery of language which itself involves the appropriate use of words in social and interpersonal settings. In the light of Vygotsky's work on the social and interactive nature of children's thinking and the nature of language as an essentially public currency of rule?governed signs, we are led to reconstrue conceptual mastery as the acquisition of an interactive and interpersonal repertoire of tools which introduces the child to the world of those who educate it. In this way we come to see the elements of mind as constitutively involving that activity in which the determinants of meaning constrain and direct the child's linguistic development

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

ABSTRACTThere are a number of arguments that purport to show, in general terms, that there is no difference between killing and letting die. These are used to justify active euthanasia on the basis of the reasons given for allowing patients to die. I argue that the general and abstract arguments fail to take account of the complex and particular situations which are found in the care of those with terminal illness. When in such situations, there are perceptions and intuitions available that do not easily find propositional form but lead most of those whose practice is in the care of the dying to resist active euthanasia. I make a plea for their intuitions to be heeded above the sterile voice of abstract premises and arguments by examining the completeness of the outline form of the pro‐euthanasia argument. In doing so, I make use of Nussbaum's discussion of moral perception and general claims to be found in the literature of moral particularism

It is striking that some arguments in the bioethical literature seem implausible, counterintuitive, and even ridiculous when reported to competent moral agents. When examined, these arguments bear uncanny resemblances to the discourse of patients with debilitating mental disorders. I examine the kinds of irrationality involved, and discuss the fact that such irrationality is worrying in a discipline that purports to serve as a guide for real‐life practical reasoning. I offer some thoughts about correctives that we might use to temper some of the odd opinions that bedevil our subject in the name of ethical analysis. It seems that one ought to be suspicious of neatly rational arguments that produce counterintuitive conclusions, but the alternative seems to be that we explore new constructions of old problems in Bioethics such that our discussion of them does justice to what we regard as of fundamental significance to our lives together as human beings.

This symposium represents the first major foray of the Journal of Bioethical Inquiry into what may well become one of its significant strands of scholarship. The JBI has always encouraged critical and marginal areas of bioethics scholarship and particularly those which make use of contemporary continental philosophy and cultural theory in addition to traditional analytic methods. For that reason this symposium is an expression of a “natural fit” or a “match made in heaven” (or at least the Platonic version of that idea). The authors span times and sites in history and culture, from ancient Greece to present day Brisbane. They draw on a variety of literary genres and figures, ranging from Greek tragedy to an epic Chinese novel; from Jane Austen to William Styron, a major American novelist and essayist; from the modern English science fiction of Kazuo Ishiguro, a Japanese expatriate in London, to the 20th-century English poetry of Philip Larkin. The symposium also engages with some recur

ABSTRACT AIDS raises the moral problem of confidentiality because those in sexual contact with the patient may contract a life‐threatening and incurable disease. Medicine has a tradition in which a patient's condition is regarded as confidential information held by the doctor alone. In this case there is a clear moral inclination to inform those at risk from the disease. In most cases no problem will arise but when it does the moral justification for a violation of confidentiality comes into question. Confidentiality is important because of our respect for certain human values and their importance to our patient. Where that patient acts so as to disregard the welfare of others with whom they are in close relationship, those values are lacking. This lack warrants a departure from our normal canons and provokes a suspension of normal moral privileges. The contention that any transgression, however slight, could be held to justify such a response posits a slope down which we, in fact, have no tendency to slide.

The Snark is an intentional object. I examine the general philosophical characteristics of thoughts of objects from the perspective of Husserl's, hyle, noesis, and noema and show how this meets constraints of opacity, normativity, and possible existence as generated by a sensitive theory of intentionality. Husserl introduces terms which indicate the normative features of intentional content and attempts to forge a direct relationship between the norms he generates and the actual world object which a thought intends. I then attempt to relate Husserl's account to Fregean insights about the sense and reference of a term. Neither Husserl nor Frege suggest plausible routes to a naturalistic account of intentionality and I turn to Wittgenstein to provide a naturalistic reading of the crucial terms involved in the analysis of intentional content. His account is normative in a way required by both Husserl and Frege and yet manages a kind of Aristotelian naturalism which avoids crude biologism

Bioethical debates such as those surrounding the manipulation of human embryos are often based on metaphysical assumptions that lack a foundation in the natural sciences. In this paper we support a gradualist position whereby the embryo progressively takes on the form and associated ethical significance of a human being. We support this position by introducing a concept of biological structure or form to show how the gradualist position has its metaphysical foundations in modern biology. The conceptual basis for form and structure are outlined and their compatibility with and basis in current empirical biology is demonstrated by some recent advances in our understanding of the processes of development from single cell to organism. We then briefly explore the ethical significance of accepting a form or structure based conception of biology for the status of the early embryo.

The use of human tissue raises ethical issues of great concern to health care professionals, biomedical researchers, ethics committees, tissue banks and policy makers because of the heightened importance given to informed consent and patient autonomy. The debate has been intensified by high profile scandals such as the “baby hearts” debacle and revelations about the retention of human brains in neuropathology laboratories worldwide. Respect for patient’s rights seems, however, to impede research and development of clinical knowledge in contemporary health care. The Common clinical endeavour argument and a Presumption for beneficial use argument suggest that the use of tissues for research and teaching in contemporary health care can respect patients and their values in multicultural communities where there are provisions for oversight and for opting not to contribute, both of which should respect the diverse views of different ethnic or cultural groups.

The idea of freedom of the will seems to conflict with the principle of causal efficacy implicit in many theories of mind. The conflict is normally resolved within a compatibilist view whereby the desires and beliefs of the agent, replete with a respectable if yet to be elucidated causal pedigree, are taken to be the basis of individual freedom. The present view is an alternative which erects mental content on a framework of rule following and then argues that rule‐following is conceptually distinct from causally produced activity. The normative aspect of rule‐following defies reduction to descriptive or dispositional terms. According to this view we cannot get beyond the agent as a self‐determining rational individual in formulating a theory of mind and action. The theory is neo‐Kantian in that it identifies rules or conceptions of laws as central in human thought. It, follows Wittgenstein's treatment of rule‐following and generates a plausible (but non‐causal) account of mental explanation and weakness of the will.

Joseph Fins's book Rights Come to Mind: Brain Injury, Ethics, and the Struggle for Consciousness is a considerable addition to the literature on disorders of consciousness and the murky area of minimally conscious states. Fins brings to this fraught area of clinical practice and neuroethical analysis a series of stories and reflections resulting in a pressing and sustained ethical challenge both to clinicians and to health care systems. The challenge is multifaceted, with diagnostic and therapeutic demands to be met by clinicians and a mix of moral, scientific-economic, and political resonances for health care analysts. Everything in the book resonates with my own clinical experience and the often messy and emotionally wrenching business of providing ongoing care for patients with severe brain injuries and disorders, people who frequently resist the categorizations that well-organized health care systems prefer and that can dictate terms of patient management.

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 12.1 (2005) 23-24 [Access article in PDF] Schechtman's Narrative Account of Identity Grant Gillett Keywords personal identity, narrative self, memory I have long been an admirer of Schechtman's sensitive and psychologically realistic account of personal identity. In the present piece, she addresses the issues surrounding personal identity through Locke's view and problems attending that view and the psychological continuity theories descended from it.She examines the claim that the person is more extensive than the conscious mind and includes aspects of nonconscious mental activity. Schechtman argues that one must have a self-conception that includes a trajectory where present experience unfolds meaningfully out of one's past replete with implications for what one does and how one does it. She locates, in current writing on the self, the idea of a perceiver or narrator self who tries to make sense out of herself as a human being with certain thoughts and feelings and is sometimes at a loss to do so. To this potentially very rich starting point we need only add the fact that a person draws on discursive and narrative skills that have been inscribed in her being to do this narrative, editorial, and judicial task and that many of these skills have been imbibed with mother's milk (and father's voice). From this discursively inscribed set of resources and orientations arise guilt, shame, pride, aspiration, vulnerability, and that crucial sense of who one is as a person among others.It follows that here we might also find the source of the discontents that induce a person to apply to a psychiatrist or counselor for help with the narrative work required to fashion a liveable self. If Schechtman is right, the cognitive capacities contributing to memory and "keeping track of oneself"(in a deep and satisfying way) are to be found in part in the nonconscious domain rather than the thin layer of consciousness and propositional attitude psychology that enters the mind of an analytic philosopher or a psychiatrist uninterested in depth.I think she is right and that this paper and her more extensive work on the constitution of self represent a fertile point at which psychiatrists and psychotherapists can begin the task of understanding the nature of identity and the challenges involved in finding one that will serve the unfolding project of understanding and forming the self. I believe that the resources that individuals need for this task are derived from one's rootedness in culture and human relationships where the levels of self that support consciousness can be nurtured according to what Michel Foucault calls the techniques proper to the care of the self. Schechtman has done us a favor in taking the debates surrounding neo-Lockean [End Page 23] views of personal identity and outlining a perspective on identity and memory that can lead us to develop our understanding of the complexity of the human psyche as it roams through the jungle/jumble of discursive life and tries to nourish itself on what it finds there.Grant Gillett is a Professor of Medical Ethics at the University of Otago in Dunedin, New Zealand. He is also a practicing neurosurgeon. His philosophical work is in philosophy of mind and psychiatry, continental philosophy, and bioethics. His most recent books are The Mind and Its Discontents (Oxford University Press) and Bioethics in the Clinic (Johns Hopkins University Press). He works on postmodern and traditional analytic approaches to mind, language, and psychiatry. He can be reached at Dunedin Hospital and Otago Bioethics Centre, University of Otago Medical School, PO Box 913, Dunedin, New Zealand, or via e-mail at [email protected]....