The relevance of Rawls' principle of justice for research on cognitively impaired patients

An ethical conflict arises when we must performresearch in the interest of future patients,but that this may occasionally injure theinterests of today's patients.In the case of cognitively impaired persons, thequestion arises whether it is compatible withhumane healthcare not only to treat, but alsoto use these patients for research purposes.Some bioethicists and theologians haveformulated a general duty of solidarity, alsopertaining to cognitively impaired persons, as ajustification for research on these persons. Ifone examines this thesis from the theory ofjustice according to John Rawls, it is revealedthat such a duty of solidarity cannotnecessarily be extrapolated from Rawls'conception of justice. This is at least true ofRawls' difference principle, because accordingto the difference principle only those measuresare justifiable which serve the interest of therespective least well off. Those measures whichwould engender additional injury for the leastwell off could not be balanced by any utilityaccording to Rawls.However, John Rawls' difference principleis subordinate to the first principle,which is that each person has an equalright to the most extensive basic libertycompatible with the same liberty for others.These primary goods are determined by thefreedom and integrity of the person.This integrity of decisionally impaired personswould be in danger if one would abstain fromresearch and thus forego the increase inknowledge related to their disease. Thus onecould conclude, at least from Rawls' firstprinciple, that society must take on a duty toguarantee the degrees of freedom forcognitively impaired persons and thus alsosupport the efforts for their healing.     

The use of genetic test information in insurance: The argument from indistinguishability reconsidered

In the bioethical literature, discrimination in insurance on the basis of genetic risk factors detected by genetic testing has been defended and opposed on various ethical grounds. One important argument in favour of the practice is offered by those who believe that it is not possible to distinguish between genetic and non-genetic information, at least not for practical policy purposes such as insurance decision-making. According to the argument from indistinguishability, the use of genetic test information for insurance purposes should be permitted, because genetic test information is no different from non-genetic medical information in any relevant respect, therefore it would be inconsistent to prohibit the former whilst permitting the latter. This paper discusses and defends this argument and suggests a new, more tenable foundation.     

Ministry to the chronic hemodialysis patient

The beginning point of ministry to those persons suffering from renal failure and turning to hemodialysis in order to sustain life is a sensitive understanding of the total dialysis experience. The minister or chaplain who visits a hemodialysis unit only occasionally will be more effective in bringing his skills to the task by understanding the unique dynamics of the physical, emotional and spiritual adjustment of those who depend on this relatively new therapy. The specific elements of this ministry in terms of those closely involved, professional care givers, families, and patients, are discussed with attention to the factors that tend to make ministry to the hemodialysis patient unique.This article is the result of a one-year chaplain residency at the Veterans Administration Hospital in Nashville, Tennessee, in partial fulfillment of clinical requirements for the D. Min. degree in Pastoral Theology and Counseling at the Divinity School, Vanderbilt University, Nashville, Tennessee.     

Subjective experience is probably not limited to humans: the evidence from neurobiology and behavior

In humans, conscious perception and cognition depends upon the thalamocortical (T-C) complex, which supports perception, explicit cognition, memory, language, planning, and strategic control. When parts of the T-C system are damaged or stimulated, corresponding effects are found on conscious contents and state, as assessed by reliable reports. In contrast, large regions like cerebellum and basal ganglia can be damaged without affecting conscious cognition directly. Functional brain recordings also show robust activity differences in cortex between experimentally matched conscious and unconscious events. This basic anatomy and physiology is highly conserved in mammals and perhaps ancestral reptiles. While language is absent in other species, homologies in perception, memory, and motor cortex suggest that consciousness of one kind or another may be biologically fundamental and phylogenetically ancient. In humans we infer subjective experiences from behavioral and brain evidence. This evidence is quite similar in other mammals and perhaps some non-mammalian species. On the weight of the biological evidence, therefore, subjectivity may be conserved in species with human-like brains and behavior.     

Criteria for consciousness in humans and other mammals

The standard behavioral index for human consciousness is the ability to report events with accuracy. While this method is routinely used for scientific and medical applications in humans, it is not easy to generalize to other species. Brain evidence may lend itself more easily to comparative testing. Human consciousness involves widespread, relatively fast low-amplitude interactions in the thalamocortical core of the brain, driven by current tasks and conditions. These features have also been found in other mammals, which suggests that consciousness is a major biological adaptation in mammals. We suggest more than a dozen additional properties of human consciousness that may be used to test comparative predictions. Such homologies are necessarily more remote in non-mammals, which do not share the thalamocortical complex. However, as we learn more we may be able to make "deeper" predictions that apply to some birds, reptiles, large-brained invertebrates, and perhaps other species.