Grant Gillett

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

The two commentators have examined and illuminated different aspects of the analysis of delusions that we have offered. Their discussions both raise points that clarify that analysis in helpful ways. Richard Bentall (2014) makes the telling point that distinguishing the mental phenomena that count as delusions is not always straightforward and that, at the margins, there is a perennial problem with patterns of thought that seem to fall outside the realm of shared meanings that most of us derive from our experiences. The problem is evident in certain marginal conditions that come to psychiatric attention, like conversion reactions, body dysmorphic disorder, anorexia, and the many obsessions or strained ..

The idea that there is an inherent incentive in moral judgment or, in Classical terms, that there is an essential relationship between virtue and well‐being is sharply criticized in contemporary moral theory. The associated theses that there is a way of living which is objectively good for human beings and that living that way is part of understanding moral truth are equally problematic. The Aristotelian argument proceeded via the premise that a human being was a rational social being. The present reworking of that thesis builds on the internal connection between rationality and concept use. Moral judgment is linked to the grasp of moral concepts and thereby to an appreciation of how it is with other persons. The judgment that another person instances a morally relevant ascription is grounded on an empathic grasp of how it is with that person and thus tied to the thought that one ought to act in such and such a way or. in other words, to a disposition to act. Because the empathically grasped content of moral concepts is related to a number of mental ascriptions and reactive attitudes, the grasp of that content is interwoven deeply in the structure of human mental life and any attempt systematically to devalue or undermine it is threatening to one's mental integrity as a rational social being. Thus there is a deep link between moral sense or the disposition to act morally and an adequately grounded conception of human well‐being.

Walter Freeman, the self styled neurosurgeon, became famous (or infamous) for psychosurgery. The operation of frontal leucotomy swept through the world (with Freeman himself performing something like 18,000 cases) but it has tainted the whole idea of psychosurgery down to the present era. Modes of psychosurgery such as Deep Brain Stimulation and other highly selective neurosurgical procedures for neurological and psychiatric conditions are in ever-increasing use in current practice. The new, more exciting techniques are based in a widely held philosophical position on the relationship between the mind, brain and soul, which is the key to ethical debates in this area. Psychosurgery has always posed questions of responsibility, personality, character, identity, spirit, relationship, integrity, and human flourishing and they do not go away when we enter the brave new world of neuroethics and Deep Brain Stimulation

In European philosophical psychology, the work of Jacques Lacan has exerted a great deal of influence but it has received little attention from analytic philosophers. He is famous for the view that the unconscious is a repository of influences arising from language and the meanings it captures, but the presentation of his ideas is sometimes perplexing and impenetrable and its conceptual links with analytic philosophers like Frege and Wittgenstein are not easily discerned. In fact, there are a number of such links and they are worth pursuing for those interested in language, mind, and the unconscious. If we explore Lacan's claim about the link between signification and the tuchè (the encounter with the real) we find that the mental content of the subject is essentially tied to the external world both causally and linguistically. The means of tying the two together arise in the context of human interactions and therefore are charged with personal and emotive content as well as the semantic content with which we are normally concerned in philosophy of language. When we pursue the implications of his view it becomes plausible both that the unconscious is structured like a language and that language borrows much of its meaning and significance to a subject from the interpersonal medium through which it has been inscribed on that subject. His approach is therefore illuminating both for linguistics (especially psycholinguistics) and for the psychology of the unconscious.

We view a human being as a mental and spiritual entity and also as having a physical nature. The essence of a person is revealed in our thinking about personal identity, quality of life, and personal responsibility. These conceptions do not fare well in a Cartesian or dualist picture of the person as there are deep problems with the idea that the mind is an inner realm. I argue that it is only as we see the thoughts, actions, and interactions of persons as necessarily involving physical entities in the world whose nature is not completely captured in scientific descriptions that we can understand our existence as mental and spiritual beings.

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

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 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 problematic features of the cognitive function of patients with brain damage are often taken to indicate that such persons have split or dual consciousness. An intentional or cognitive theory of consciousness which focuses on the structure and contents of conscious experience makes this thesis look quite unattractive. Consciousness is active and directed toward objects and in the human case it shows an internally reflective structure based on the abilities required to grasp and use concepts. On this view, consciousness is a way of referring to the active, integrative, conceptualizing activity of a human thinker in a world of other objects and persons. When we look at consciousness this way and re-examine, in the light of that analysis, the performance of split brain patients, one sees such persons as individuals afflicted with internal difficulties in their information processing capacities but neither as split consciousnesses nor as split minds