The dead donor rule: how much does the public care...and how much should we care?

In this brief commentary, we reflect on the recent study by Siminoff, Burant, and Youngner of public attitudes toward "brain death" and organ donation, focusing on the implications of their findings for the rules governing from whom organs can be obtained. Although the data suggest that many seem to view "brain death" as "as good as death" rather than "dead" (calling the dead donor rule into question), we find that the study most clearly demonstrates that understanding an individual's definition of death is neither a straightforward task nor a good predictor of views about donation. Reflecting on the implications for ongoing debates over the dead donor rule, we suggest that perhaps it is not a change in policy that is warranted, but rather a change in the priorities that have garnered such intense focus on this issue within the field of bioethics.     

Is Lying Bound to Commitment? Empirically Investigating Deceptive Presuppositions,Implicatures, and Actions

Lying is an important moral phenomenon that most people are affected by on a daily basis—be it in personal relationships, in political debates, or in the form of fake news. Nevertheless, surprisingly little is known about what actually constitutes a lie. According to the traditional definition of lying, a person lies if they explicitly express something they believe to be false. Consequently, it is often assumed that people cannot lie by more indirectly communicating believed-false claims, for instance by merely conversationally implicating them. In this paper, we subject this claim to an empirical test. In a preregistered study of 300 participants, we investigate how people judge cases of implicit deceptions that would usually be excluded by the traditional definition of lying (i.e., conversational implicatures, presuppositions, and nonverbal actions). Our results show that people do in fact consider it possible to lie by indirect means, suggesting that people have a broader concept of lying than is usually assumed. Moreover, our findings indicate that lie judgments are closely tied to the extent to which agents are perceived as having committed themselves to the believed-false claims they have communicated. We discuss the implications of our results for the traditional definition of lying and propose a new commitment-based definition of lying that can account for the findings of our experiment.     

The psychoanalytic theories of wish‐fulfilment and meaning

Psychoanalysis regards many previously inexplicable phenomena as wish‐fulfilments, which have meaning inasmuch as they express the person's wishes or affects. This might appear to make such psychoanalytic explanations rather like ordinary explanations of conduct and to enlarge the area of intentional and possibly that of responsible behavior. But a critique of these psychoanalytic accounts will show that they are very unlike accounts in terms of ordinary notions of fulfilling or expressing wishes and that the psychoanalytic concept of wish‐fulfilment differs sufficiently from the ordinary one for it to be difficult to determine how to test psychoanalytic hypotheses concerning wish‐fulfilment by merely considering the way in which we assess claims utilizing the ordinary notion. In fact, such a critique will show that for a certain type of claim regarding wish‐fulfilments, psychoanalysts have not indicated ways of confirming or disconfirming such claims — in the sense that they have not shown how to find any evidence which would support these claims to a higher degree than contrary or contradictory claims. After offering the first part of this critique, which is a comparison of psychoanalytic and ordinary notions of fulfilling and expressing wishes, some considerations concerning a second part of the critique are presented regarding the connection between the construct of psychic energy and that of wish‐fulfilment.     

Abandon the dead donor rule or change the definition of death?

Research by Siminoff and colleagues reveals that many lay people in Ohio classify legally living persons in irreversible coma or persistent vegetative state (PVS) as dead that additional respondents, although classifying such patients as living, would be willing to procure organs from them. This paper analyzes possible implications of these findings for public policy. A majority would procure organs from those in irreversible coma or in PVS. Two strategies for legitimizing such procurement are suggested. One strategy would be to make exceptions to the dead donor rule permitting procurement from those in PVS or at least those who are in irreversible coma while continuing to classify them as living. Another strategy would be to further amend the definition of death to classify one or both groups as deceased, thus permitting procurement without violation of the dead donor rule. Permitting exceptions to the dead donor rule would require substantial changes in law--such as authorizing procuring surgeons to end the lives of patients by means of organ procurement--and would weaken societal prohibitions on killing. The paper suggests that it would be easier and less controversial to further amend the definition of death to classify those in irreversible coma and PVS as dead. Incorporation of a conscience clause to permit those whose religious or philosophical convictions support whole-brain or cardiac-based death pronouncement would avoid violating their beliefs while causing no more than minimal social problems. The paper questions whether those who would support an exception to the dead donor rule in these cases and those who would support a further amendment to the definition of death could reach agreement to adopt a public policy permitting organ procurement of those in irreversible coma or PVS when proper consent is obtained.     

The ‘romance of teams’: Toward an understanding of its psychological underpinnings and implications

Although advocates of teamwork suggest that teams enhance performance, empirical evidence does not consistently, or robustly, support these claims. Still, a belief in the effectiveness of teams—among managers, employees, and the general lay population—seems very strong. What accounts for this ‘romance of teams’? In this paper, we offer a psychological answer to this question. We review evidence regarding the actual effectiveness of teams, in order to show that teams are not as effective as many believe them to be, and we argue that the romance of teams stems from the psychological benefits of group‐based activity. Specifically, we propose that team members experience both social‐emotional, and competence‐related, benefits, and we review an eclectic mix of research in support of this claim. We argue that these psychological benefits of teams lead people to assume that teams are ‘high performance’, thus, causing the romance of teams. Finally, we discuss potential implications of the romance for organizations, researchers, and employees.     

Bodily Thought and the Corpse Problem

Abstract: A key consideration in favour of animalism—the thesis that persons like you and me are identical to the animals we walk around with—is that it avoids a too many thinkers problem that arises for non‐animalist positions. The problem is that it seems that any person‐constituting animal would itself be able to think, but if wherever there is a thinking person there is a thinking animal distinct from it then there are at least two thinkers wherever there is a thinking person. Most find this result unacceptable, and some think it provides an excellent reason for accepting animalism. It has been argued, however, that animalists face an analogous problem of too many thinkers, the so‐called corpse problem, as they must accept both 1) that we are distinct from our bodies, as our bodies can and we cannot persist through death as corpses and 2) that our bodies can think. I argue that the best reasons animalists have for accepting the two claims that generate the distinctness part of the problem double up as reasons to reject the claim that our bodies can think, and vice versa. I argue further that Lockeans cannot similarly get around their problem of too many thinkers.     

The dead donor rule: should we stretch it, bend it, or abandon it?

The dead donor rule--that persons must be dead before their organs are taken--is a central part of the moral framework underlying organ procurement. Efforts to increase the pool of transplantable organs have been forced either to redefine death (e.g., anencephaly) or take advantage of ambiguities in the current definition of death (e.g., the Pittsburgh protocol). Society's growing acceptance of circumstances in which health care professionals can hasten a patient's death also may weaken the symbolic importance of the dead donor rule. We consider the implications of these efforts to continually revise the line between life and death and ask whether it would be preferable to abandon the dead donor rule and rely entirely on informed consent as a safeguard against abuse.     

The Concept of Death: A Religio-philosophical Analysis

In an age in which vast progress has been made in organ transplant technology, it is imperative to determine the point at which a human being is considered dead, for transplantation cannot occur until after death. Traditional religious views imply that a human being is dead upon the departure of the soul from the body. Taking the biological death of the body as a conclusive sign of the soul's departure is not an option. Biological death refers to decomposition, and this cannot equate to the death of the person as such, for this would make the concept and practice of transplantation absurd, for transplantable parts of a biologically dead—i.e. decomposing—body could not be used. On the other hand, if parts of the human body are themselves still biologically alive, could it not be said that taking such parts would amount to murder?

Two conclusions follow from this predicament. First, death as a ‘normative’ concept stands in sharp distinction from a purely biological concept. Second, a normative concept of death is entangled with a normative concept of personhood. That is to say, from the moment that a human being is not considered a person as such, parts of the body could be removed for transplantation or, indeed, for any other justified medical purpose. In this regard, various theories of the person are put forward. Which of these theories is compatible with a workable concept of death? In this paper two principal theories of the person will be discussed and it will be argued that a brain-based theory of death is conducive to a normative concept of death, thus allowing for organ transplantation.     

The death of Philosophy: a response to Stephen Hawking

Abstract

In his 2010 work, The Grand Design, Stephen Hawking, argues that ‘… philosophy is dead’ (2010: 5). While not a Philosopher, Hawking provides strong argument for his thesis, principally that philosophers have not taken science sufficiently seriously and so Philosophy is no longer relevant to knowledge claims. In this paper, Hawking’s claim is appraised and critiqued, becoming a meta-philosophical discussion. It is argued that Philosophy is dead, in some sense, due to particular philosophers having embarked on an intellectual path no longer in keeping with the ancient definition of Philosophy. Philosophy as the seeking of wisdom necessarily includes the consideration of findings of other intellectual pursuits, including physical and natural science. While Philosophy has justifiably evolved through its long history, is it unrecognisable in the terms by which it historically defined itself? Seeking consistency, Hawking is critiqued for appearing to practise ‘dead’ Philosophy. Indeed, Hawking’s appeal to multiverse theory and his core discussion of the metaphysical problem of being are philosophical. The question of the death of Philosophy has contemporary relevance for the discipline which is particularly under threat for its survival in the academy, oftentimes assumed to be irrelevant.     

How the Dead Live

This paper maintains (following Yougrau 1987; 2000 and Hinchliff 1996) that the dead and other former existents count as examples of non-existent objects. If the dead number among the things there are, a further question arises: what is it to be dead—how should the state of being dead be characterised? It is argued that this state should be characterised negatively: the dead are not persons, philosophers etc. They lack any of the (intrinsic) qualities they had while they lived. The only facts involving the dead are facts about the relations they stand in—including the relations they bear to the qualities they formerly instantiated, and the intentional relations they stand in to us. Given an appropriate conception of qualities the dead can be said to be quality-less objects: bare particulars. The ‘Bare Particular Theory’ of individuals, it is argued, is coherent if and only if it concedes that the bare particulars it allows for don’t exist. The account of the dead and other former existents as bare particulars does justice to the misfortune of death, and points the way to a general theory of nonexistent objects.     

Explaining in conversation: Towards an argument model

We examine the proposition that, in ordinary conversation, people are concerned to argue — to justify their claims and to counter potential and actual counter claims. We test out the proposition by analysing explanations in one particular conversation. We attend to the validity claims of what the speakers say, and to the authority with which they say it. Viewed in that light, we find that the majority of what might look like causal attributions turn out to look like argumentative claim-backings. We then go on to flesh out the quasi-pragmatic rules which might help to decide formally whether any given utterance is be er understood as an argument or a causal explanation. These rules revolve around the speaker's apparent intention and the projected relationship between the clauses in what she or he says. All of this takes us a fair way from attribution theory's model of explanation as the reporting of a cause, and we end up with an argumentative model of ordinary explanation.     

Enactivism,other minds,and mental disorders

Although enactive approaches to cognition vary in terms of their character and scope, all endorse several core claims. The first is that cognition is tied to action. The second is that cognition is composed of more than just in-the-head processes; cognitive activities are (at least partially) externalized via features of our embodiment and in our ecological dealings with the people and things around us. I appeal to these two enactive claims to consider a view called “direct social perception” (DSP): the idea that we can sometimes perceive features of other minds directly in the character of their embodiment and environmental interactions. I argue that if DSP is true, we can probably also perceive certain features of mental disorders as well. I draw upon the developmental psychologist Daniel Stern’s notion of “forms of vitality”—largely overlooked in these debates—to develop this idea, and I use autism as a case study. I argue further that an enactive approach to DSP can clarify some ways we play a regulative role in shaping the temporal and phenomenal character of the disorder in question, and it may therefore have practical significance for both the clinical and therapeutic encounter.

     

The significance of death for the living

Heidegger's conception of death as an attitude toward life, overlooked in current literature on death and dying, offers potential for deepening our understanding of the care of non-critically ill patients. By breaking away from the notion of death as an event distinct from life and viewing it as an anticipated possibility at every moment of life, Heidegger provides insight into our attempts to evade death through our fundamental attitudes and value commitments, which in turn determine our behavior and actions. When combined with a method of application — the Nietzschean principle of reversal — these insights permit the understanding of diverse types of human mentality confronted with significant situations. Among the most important applications of these conceptions is to persons in need of medical care, and the resultant types, which are sampled as hypothetical cases, carry important implications for the sensitive care and psychosocial management of non-terminally ill patients.     

Base‐rates of Negative Traits: Instructions for Use in Criminal Trials

Decision‐makers in institutional and non‐institutional contexts are sometimes confronted with the issue of whether to use generalisations expressing the statistical incidence of a negative trait in a disadvantaged and discriminated‐against social group in order to draw an inference concerning a member of that group. If a criminal court were confronted with such a question, what answer should it give? First, the article argues that, our qualms notwithstanding, morality does not demand that these generalisations be disregarded. In doing so, the article addresses the relationship between factual accuracy and the demands of morality in criminal trials. Second, the article considers the implications of this conclusion for the legal question as to whether the evidence at issue should be excluded, in particular, on grounds of unfairness — pursuant to section 78(1) of the Police and Criminal Evidence Act 1984.     

Defining death

ABSTRACT Modern technology has made it uncertain as to when exactly death occurs, and this has put us in a quandary over when we can initiate behaviour traditionally deemed apt if and only if a patient is dead. In the light of this, there is general agreement that death should be redefined, but wide disagreement remains about how. I argue, against this, that it is a mistake to redefine death in any way: (1) redefining death will not help to settle the question of when traditional death-behaviour becomes appropriate, (2) any attempt to redefine death is attended with significant disutilities and no compensating utilities, and (3) the practical problems generated by the indeterminacy can be better handled in other ways.     

Meno's Paradox,the Slave‐Boy Interrogation,and the Unity of Platonic Recollection

Plato invokes the Theory of Recollection to explain both ordinary and philosophical learning. In a new reading of Meno's Paradox and the Slave‐Boy Interrogation, I explain why these two levels are linked in a single theory of learning. Since, for Plato, philosophical inquiry starts in ordinary discourse, the possibility of success in inquiry is tied to the character of the ordinary comprehension we bring to it. Through the claim that all learning is recollection, Plato traces the knowledge achievable through inquiry back to our pretheoretical comprehension, showing not just that knowledge is in us, but that it is inchoate in the grasp of a property—akin to a concept—that enables us to speak and think about it ordinarily. Plato acknowledges in the Meno that a second step of argument, and a second application of Recollection, is needed to explain how knowledge comes to be inchoate in our ordinary grasp of a property. Though this second argument is provided most fully in the Phaedo, the evidence of the Meno is sufficient to outline Recollection as a two‐stage theory of learning, beginning in ordinary speech and thought and extending, through philosophical reflection, to knowledge.     

The Status of our Ordinary Three Dimensions in a Quantum Universe 1

There are now several, realist versions of quantum mechanics on offer. On their most straightforward, ontological interpretation, these theories require the existence of an object, the wavefunction, which inhabits an extremely high‐dimensional space known as configuration space. This raises the question of how the ordinary three‐dimensional space of our acquaintance fits into the ontology of quantum mechanics. Recently, two strategies to address this question have emerged. First, Tim Maudlin, Valia Allori, and her collaborators argue that what I have just called the ‘most straightforward’ interpretation of quantum mechanics is not the correct one. Rather, the correct interpretation of realist quantum mechanics has it describing the world as containing objects that inhabit the ordinary three‐dimensional space of our manifest image. By contrast, David Albert and Barry Loewer maintain the straightforward, wavefunction ontology of quantum mechanics, but attempt to show how ordinary, three‐dimensional space may in a sense be contained within the high‐dimensional configuration space the wavefunction inhabits. This paper critically examines these attempts to locate the ordinary, three‐dimensional space of our manifest image “within” the ontology of quantum mechanics. I argue that we can recover most of our manifest image, even if we cannot recover our familiar three‐dimensional space.     

When are you dead enough to be a donor? Can any feasible protocol for the determination of death on circulatory criteria respect the dead donor rule?

The basic question concerning the compatibility of donation after circulatory death (DCD) protocols with the dead donor rule is whether such protocols can guarantee that the loss of relevant biological functions is truly irreversible. Which functions are the relevant ones? I argue that the answer to this question can be derived neither from a proper understanding of the meaning of the term “death” nor from a proper understanding of the nature of death as a biological phenomenon. The concept of death can be made fully determinate only by stipulation. I propose to focus on the irreversible loss of the capacity for consciousness and the capacity for spontaneous breathing. Having accepted that proposal, the meaning of “irreversibility” need not be twisted in order to claim that DCD protocols can guarantee that the loss of these functions is irreversible. And this guarantee does not mean that reversing that loss is either conceptually impossible or known to be impossible with absolute certainty.

     

The Automaton Self: Defensive organisation,psychodynamics and treatment approaches

Abstract

This paper is not primarily concerned with the content of theory and what we then, in the light of this and of our own experience, say to our clients. Rather, it is concerned with the nature of this knowledge that we are using and that the client in turn uses and experiences in the counselling.

How, or the way in which, we know, defines our knowledge as much as the actual content of that knowledge. The paper delineates two fundamental ways of knowing. One is our ordinary practical and rational way of understanding reality and is usually about achieving some goal – this is what I am calling the product side of counselling: the other is concerned with our more immediate first-hand experiential knowing of ourselves and our world.

The paper opens with a definition of these two kinds of knowledge, product and process, and presents some clinical material to show how these different ways of knowing can have a real effect on the counselling. It then moves on to the question of why counselling trainings are becoming increasingly concerned with product knowledge, and ends with a discussion of how Freud himself was constantly using both ways of knowing as if they were the same, without understanding the implications of this for therapeutic practice.     

Legal rulings on suicide in India and implications for the right to die

In this paper I am concerned to address the question of voluntary or self‐willed death from two distinct positions—a particular community's socio‐religious practice (viz. Jaina sallekhanā) and as the matter stands in law (penal code, constitution, judicial wisdom, etc.) in India—in the light of the recent move by a bench of its apex court striking down the penal code section proscribing suicide. I also wish to draw out some implications of these deliberations for the beneficence of medical practice and related bio‐ethical ramifications in the Indian context.