Rationales for organ donation: Charity or duty?

Media appeals encouraging people to sign organ donor cards suggest that donating one's own organs after death or donating the organs of a deceased family member is an act of charity, i.e., something which it would be meritorious for people to do but not wrong to avoid. This paper argues to the contrary that posthumous organ donation is a moral duty, a duty of the type that rests at the base of recently enacted state “Good Samaritan” laws which require a witness to an emergency situation to render aid to the victim(s) when this can be done at minimal cost/risk to the potential rescuer.     

Clarifying the paradigm for the ethics of donation and transplantation: Was 'dead' really so clear before organ donation?

Recent commentaries by Verheijde et al, Evans and Potts suggesting that donation after cardiac death practices routinely violate the dead donor rule are based on flawed presumptions. Cell biology, cardiopulmonary resuscitation, critical care life support technologies, donation and transplantation continue to inform concepts of life and death. The impact of oxygen deprivation to cells, organs and the brain is discussed in relation to death as a biological transition. In the face of advancing organ support and replacement technologies, the reversibility of cardiac arrest is now purely related to the context in which it occurs, in association to the availability and application of support systems to maintain oxygenated circulation. The 'complete and irreversible' lexicon commonly used in death discussions and legal statutes are ambiguous, indefinable and should be replaced by accurate terms. Criticism of controlled DCD on the basis of violating the dead donor rule, where autoresuscitation has not been described beyond 2 minutes, in which life support is withdrawn and CPR is not provided, is not valid. However, any post mortem intervention that re-establishes brain blood flow should be prohibited. In comparison to traditional practice, organ donation has forced the clarification of the diagnostic criteria for death and improved the rigour of the determinations.     

What is an organ? Heidegger and the phenomenology of organ transplantation

This paper investigates the question of what an organ is from a phenomenological perspective. Proceeding from the phenomenology of being-in-the-world developed by Heidegger in Being and Time and subsequent works, it compares the being of the organ with the being of the tool. It attempts to display similarities and differences between the embodied nature of the organs and the way tools of the world are handled. It explicates the way tools belong to the totalities of things of the world that are ready to use and the way organs belong to the totality of a bodily being able to be in this very world. In so doing, the paper argues that while the organ is in some respects similar to a bodily tool, this tool is nonetheless different from the tools of the world in being tied to the organism as a whole, which offers the founding ground of the being of the person. However, from a phenomenological point of view, the line between organs and tools cannot simply be drawn by determining what is inside and outside the physiological borders of the organism. We have, from the beginning of history, integrated technological devices (tools) in our being-in-the-world in ways that make them parts of ourselves rather than parts of the world (more organ- than tool-like), and also, more recently, have started to make our organs more tool-like by visualising, moving, manipulating, and controlling them through medical technology. In this paper, Heidegger’s analysis of organ, tool, and world-making is confronted with this development brought about by contemporary medical technology. It is argued that this development has, to a large extent, changed the phenomenology of the organ in making our bodies more similar to machines with parts that have certain functions and that can be exchanged. This development harbours the threat of instrumentalising our bodily being but also the possibility of curing or alleviating suffering brought about by diseases which disturb and destroy the normal functioning of our organs.     

The "spare parts person"? Conceptions of the human body and their implications for public attitudes towards organ donation and organ sale

Background  

The increasing debate on financial incentives for organ donation raises concerns about a "commodification of the human body". Philosophical-ethical stances on this development depend on assumptions concerning the body and how people think about it. In our qualitative empirical study we analyze public attitudes towards organ donation in their specific relation to conceptions of the human body in four European countries (Cyprus, Germany, the Netherlands and Sweden). This approach aims at a more context-sensitive picture of what "commodification of the body" can mean in concrete clinical decisions concerning organ donation.     

The ethics of donation and transplantation: are definitions of death being distorted for organ transplantation?

A recent commentary defends 1) the concept of 'brain arrest' to explain what brain death is, and 2) the concept that death occurs at 2–5 minutes after absent circulation. I suggest that both these claims are flawed. Brain arrest is said to threaten life, and lead to death by causing a secondary respiratory then cardiac arrest. It is further claimed that ventilation only interrupts this way that brain arrest leads to death. These statements imply that brain arrest is not death itself. Brain death is a devastating state that leads to death when intensive care, which replaces some of the brain's vital functions such as breathing, is withdrawn and circulation stops resulting in irreversible loss of integration of the organism. Circulatory death is said to occur at 2–5 minutes after absent circulation because, in the context of DCD, the intent is to not attempt reversal of the absent circulation. No defense of this weak construal of irreversible loss of circulation is given. This means that paents in identical physiologic states are dead (in the DCD context) or alive (in the resuscitation context); the current state of death (at 2–5 minutes) is contingent on a future event (whether there will be resuscitation) suggesting backward causation; and the commonly used meaning of irreversible as 'not capable of being reversed' is abandoned. The literature supporting the claim that autoresuscitation does not occur in the context of no cardiopulmonary resuscitation is shown to be very limited. Several cases of autoresuscitation are summarized, suggesting that the claim that these cases are not applicable to the current debate may be premature. I suggest that brain dead and DCD donors are not dead; whether organs can be harvested before death from these patients whose prognosis is death should be debated urgently.     

Harvesting the living?: separating "brain death" and organ transplantation

The chronic shortage of transplantable organs has reached critical proportions. In the wake of this crisis, some bioethicists have argued that there is sufficient public support to expand organ recovery through use of neocortical criteria of death or even pre-mortem organ retrieval. I present a typology of ways in which data gathered from the public can be misread or selectively used by bioethicists in service of an ideological or policy agenda, resulting in bad policy and bad ethics. Such risks should lead us to look at alternatives for increasing organ supplies short of expanding or abandoning the dead donor rule. The chronic problem of organ scarcity should prompt bioethicists to engage in constructive dialogue about the relation of the social sciences and bioethics, to examine the social malleability of the definition of death, and to revisit the question of the priority of organ transplants in the overall package of healthcare benefits provided to most, but not all, citizens.     

Teasing: for superiority or solidarity?

Humor among friends is typically regarded as a means of strengthening friendships. However, there may be a side of humor that is used to compete rather than bond (R. D. Alexander, 1986; C. R. Gruner, 1997). In the present studies, the participants were asked to imagine that they were sitting with a group of mixed-sex peers. One of the group (a same-sex friend) made a comment about the participant. Different groups of participants were told that the remark did or did not involve teasing. While the participants imagined they were the target of the remark, they rated their emotional reactions as well as their perceived relationship with the teaser and the character traits attributed to the teaser. The outcomes from analyses of variance of perceived competitiveness, emotional responses, and expected social outcomes largely supported superiority perspectives of humor.     

How wide is the widening scope of psychoanalysis and how solid is its structural model? Some concerns and observations

The author advances the thesis that in the past 35 years there has been a relatively silent but nonetheless significant movement within the mainstream of American psychoanalysis toward a more "modest" position. This movement has been stimulated from different sources, sometimes with diverse goals and different programs. One determinant was the reaction to the post-World War II euphoria in regard to psychoanalysis and its possible therapeutic powers. Another element has been the ongoing consolidation of our knowledge and understanding of the ego-psychological, structural-model approach to analytic theory and technique, an approach which emphasizes both intrapsychic conflict and compromise formations. A consequence of this more modest position has been a greater appreciation of the limitations of psychoanalysis as well as the significance of those limitations. This more realistic appraisal of psychoanalysis may not have encouraged the widening scope of the indications for analysis, but the enhanced understanding of its limitations offers the promise of more effective psychoanalytic work in areas that have not been considered ideal for the so-called "traditional" analysis. It is suggested that more sophisticated approaches in the analysis of resistance and character, of "conflict" (in distinction to "diagnoses"), together with a more applicable understanding of the psychoanalytic process, can all contribute to a deepening, if not necessarily widening, of our psychoanalytic endeavors.     

What is chaos and how is it relevant for philosophy of mind?

This paper argues, in agreement with Neuringer, Beggs and others, that if we wish to scientifically characterise human choice, we have to work with a probabilistic or chaos-derived model. This has a number of implications for philosophy of mind. Firstly, it is in theory possible to describe human behaviour with some form of law-like equation; it is just a matter of figuring out what equation best captures the states of our central nervous system. Secondly, it means that our choices are not random but are chaotic: deterministic, but just hard to predict due to internal complexity. According to the current research, our actions are most likely caused by ‘precipitated avalanches’ of neural activity, which are difficult to predict due to chaos.     

Where is the Fundamental Disagreement Between Naive Realism and Intentionalism?

This paper aims to reveal the source of the dispute between naive realism and intentionalism. To accomplish this task, it examines Adam Pautz’s challenge to naive realism, according to which a naive intuition about visual phenomenology, which is the only workable case for naive realism, is problematic. It argues that naive realists can address the challenge from Pautz by rejecting his assumption that naive realists and intentionalists agree on the nominal definition of visual phenomenology. The paper then argues that the reason naive realists want to preserve the naive intuition is its irresistibility rather than its reliability. Given this, it concludes that the disagreement between naive realism and intentionalism is rooted in what philosophical projects they tackle. Naive realists are engaged in the philosophical project of delineating a coherent view of the actual world in which the irresistible naive intuition can be true; the intentionalist philosophical project differs from it.     

Psycho-educational group treatment for the severely and persistently mentally ill: how much leader training is necessary?

Psycho-educational groups (PEGs) have been shown to be a particularly effective form of treatment for patients classified under the rubric of severely and persistently mentally ill (SPMI). However, recent surveys suggest that certain professionals, such as nurses and clinical psychologists, called on to conduct these groups may have limited to no training. This study tested three methods (self-instructional, workshop, and workshop plus clinical supervision) designed to provide on-the-job training to practicing clinicians. Specifically, training was based on two manuals; one that operationalized the basic knowledge and skills needed to run an effective PEG and the second being a commonly used PEG program for symptom management targeted at SPMI patients. Eight nurses from four adult units at a state psychiatric hospital initially received self-instructional or workshop training and then conducted a 12-session symptom management PEG composed of four to five SPMI patients (e.g., schizophrenia, schizoaffective or major depression disorders). In a second wave of additional training, nurses received workshop training or clinical supervision and then conducted a second PEG. Differences between training methods were assessed by nurse- and patient-completed measures that tapped the knowledge and skills emphasized in the symptom management and PEG (nurses only) manuals. Results indicated limited support for the superiority of the workshop method on the nurse measures alone. Implications for training working professionals in group treatments and assessing outcomes with chronic SPMI patients are discussed.     

Water clubs in residential care: is it the water or the club that enhances health and well-being?

Recent research suggests that establishing water clubs in care homes can counteract the dangers of dehydration and enhance residents' health and well-being. This study provided an experimental test of this idea, and also explored the possibility that it is the social interaction that clubs provide which delivers health-related benefits. Consistent with this hypothesis, the study found no evidence that, on its own, increased focus on water consumption enhanced residents' health or well-being. However, residents who took part in water clubs showed improved levels of perceived social support, and those who participated in water and control clubs showed beneficial outcomes in terms of the number of General Practitioner calls they required. Consistent with a social identity approach to health and well-being, a mediation analysis also indicated that clubs achieve these positive outcomes by providing social support that helps to build a shared sense of social identity among residents.     

Between reality and imagination: when is spatial updating automatic?

Spatial updating has been shown to occur automatically and operate on both real and imagined environments. In three experiments, we compared spatial updating in real and imagined environments and examined when automatic spatial updating occurs. Participants learned the locations of real objects in a room and imagined being in their kitchens. They turned to face either the kitchen or the room targets and pointed to the targets before and after turning. Although objects in the real environment were automatically updated when the participants turned in the imagined environment, targets in the imagined environment were not automatically updated when the participants turned in the real environment. However, explicit spatial updating of imagined environments was as efficient as that of real environments. Automatic updating of the real objects required perceptual experience of these targets, either visually or by touch, and did not occur when the targets were described verbally. Implications for spatial cognition research are discussed.     

Beyond the medical model? Disability,formal justice,and the exception for the "profoundly impaired"

The formal justice model proposed by Anita Silvers in Disability, Discrimination, and Difference emphasizes the social model of disability and the need for full equality of opportunity, and it suggests that a distributive model of justice that gives special benefits to individuals with disabilities is self-defeating. Yet in that work, Silvers allows an exception for the "profoundly impaired." In this paper, I show how the formal justice theory falls short when it comes to defining and dealing with "profoundly impaired" individuals and explore the ways in which making the exception raises serious theoretical concerns for the grounding of the formal justice model.     

Executive function and children's understanding of false belief: how specific is the relation?

The present study examined developmental relations among understanding false belief, understanding “false” photographs, performance on the Dimensional Change Card Sort (DCCS), and performance on a picture–sentence verification task in 69 3–5-year-old children. Results showed that performance on the DCCS predicted performance on false belief questions even after controlling for children's age and verbal ability. However, neither performance on the picture–sentence verification task, nor performance on the “false” photograph task predicted false belief understanding. Implications of these findings are discussed in the context of suggestions that understanding false belief reflects a general understanding of representation, propositional negation, and the ability to use higher order rules.     

Cross-modal working memory binding and word recognition skills: how specific is the link?

Recent research has suggested that the creation of temporary bound representations of information from different sources within working memory uniquely relates to word recognition abilities in school-age children. However, it is unclear to what extent this link is attributable specifically to the binding ability for cross-modal information. This study examined the performance of Grade 3 (8–9 years old) children on binding tasks requiring either temporary association formation of two visual items (i.e., within-modal binding) or pairs of visually presented abstract shapes and auditorily presented nonwords (i.e., cross-modal binding). Children’s word recognition skills were related to performance on the cross-modal binding task but not on the within-modal binding task. Further regression models showed that cross-modal binding memory was a significant predictor of word recognition when memory for its constituent elements, general abilities, and crucially, within-modal binding memory were taken into account. These findings may suggest a specific link between the ability to bind information across modalities within working memory and word recognition skills.