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PubMed1998

My developing understanding of Roger Wolcott Sperry's philosophy.

Reviewed are some of the dramatic experimental results and penetrating analyses characterizing the career of Roger Sperry. These require that we seriously consider his opinions regarding matters not yet testable, especially regarding the brain/mind relationships. His opinions include first, that a worthwhile understanding of brain function requires a biological explanation of consciousness; second, that mental properties described by him as "overall pattern effects in brain dynamics" can govern neuronal traffic at the cellular level by virtue of "mental forces'; and third, that further development of this outlook can provide a scientific basis for moral values. Discussion here is restricted to the first two of these points, urging that most criticisms of them arise largely from semantic confusions inherited from our past. Particular emphasis is placed on distinguishing mind from soul, thus totally separating the brain-onto-mind mapping problem from the nexus problem inherited from Descartes. Taken here is a physicalist position regarding mind, together with agnosticism regarding the nonmaterial.

Central Nervous System↗
PubMed2005

Clinical pragmatism and the care of brain damaged patients: toward a palliative neuroethics for disorders of consciousness.

Unraveling the mysteries of consciousness, lost and regained, and perhaps even intervening so as to prompt recovery are advances for which neither the clinical nor the lay community are prepared. These advances will shake existing expectations about severe brain damage and will find an unprepared clinical context, perhaps even one inhospitable to what should clearly be viewed as important advances. This could be the outcome of this line of inquiry, if this exceptionally imaginative research can continue at all. This work faces a restrictive research environment that has the potential to imperil it. Added to the complexity of the scientific challenges that must be overcome is the societal context in which these investigations must occur. Research on human consciousness goes to the heart of our humanity and asks us to grapple with fundamental questions about the self. Added to this is the regulatory complexity of research on subjects who may be unable to provide their own consent because of impaired decision-making capacity, itself a function of altered or impaired consciousness. These factors can lead to a restrictive view of research that can favor risk aversion over discovery. In this paper, I attempt to explain systematically some of these challenges. I suggest that some of the resistance might be tempered if we view the needs of patients with severe brain injury through the prism of palliative care and adopt that field's ethos and methods when caring for and conducting research on individuals with severe brain damage and disorders of consciousness. To make this argument I draw upon the American pragmatic tradition and utilize clinical pragmatism, a method of moral problem-solving that my colleagues and I have developed to address ethical challenges in clinical care and research.

Brain Damage, Chronic↗
PubMed2001

Human gene patents: core issues in a multi-layered debate.

After ten years of debate Directive 98/44/EG on the legal protection of biotechnological inventions was adopted in 1998. This directive takes decisions on some controversial bioethical and legal issues and offers the European biotech industries more space to develop their inventions, but leaves a number of philosophical and moral issues unresolved. This paper distinguishes between different layers in the debate and maps its modes of argumentation. Major philosophical, ethical and conceptual issues are located. It is argued that further analysis of these issues can help resolve further ethical and legal difficulties as regards patenting of human DNA. As the allegedly special status of genetic material remains unclear, the status of (human) DNA and its relation to the human body and personal identity should be further explored.

Bioethics↗
PubMed1998

Cognitive impairment and its relationship to psychopathic tendencies in children with emotional and behavioral difficulties.

This study investigated whether performance on the card playing task (Newman, Patterson, & Kosson, 1987) and the moral/conventional distinction measure predict level of childhood conduct problems as indexed by the Psychopathy Screening Device (Frick & Hare, in press). The card-playing task indexes the child's sensitivity to changes in reinforcement rate. The moral/conventional distinction measure indexes the child's sensitivity to the difference between moral transgressions which result in harm to another from conventional transgressions which more usually result in social disorder. The Psychopathy Screening Device indexes a behavioral syndrome that consists of two dimensions: affective disturbance and impulsive and conduct problems. Thirty-nine children with emotional and behavioral difficulties were presented with both measures. Performance on both measures did predict extent of behavioral disturbance. Moreover, there was a significant association between performance on the card playing tasks and the moral/conventional distinction. The results are interpreted within the response set modulation and violence inhibition mechanism models and by reference to recent work at the anatomical level.

Adolescent↗
PubMedDate not supplied

Deadly addiction: India and Pakistan on the nuclear brink.

The effects of nuclear weapons on Hiroshima and Nagasaki and the political and moral context surrounding their use are discussed. The rationale for development of the Indian and Pakistani nuclear weapons programmes are summarised and critically examined in comparison to the costs of the programmes and the social needs, which could have been addressed. Alternative routes to provide peace and security are proposed, both for India, Pakistan, and other nuclear-weapon states, with particular emphasis on the role of physicians and other health workers.

Civil Defense↗
PubMed1989

Heider's foreseeability level of responsibility attribution: does it come after intentionality?

A conceptual analysis of Heider's level 3 foreseeability rule for the attribution of responsibility suggests that it is more difficult than levels 2 (commission) and 4 (intentionality) because it requires forms of reasoning ascribed to Piaget's formal operational thought. Thus, the rule should be acquired in early adolescence, or later. Previous studies showing foreseeability attributions in younger children have been confounded by the fact that their stimulus materials required an inference of intentionality. The present study, of 5-15-year-olds, avoided this confound by using an "omniscient narrator" technique to control the children's inferences of intent. The results suggest that children first employ Heider's commission rule, then his intentionality rule, and finally adopt the foreseeability rule at about 11 years. The study did not assess whether or not foreseeability attribution is a "stage" in the sense of Piaget's formal operational thought.

Adolescent↗
PubMed2000

On the intersection of casuistry and particularism.

A comparison of casuistry with the strain of particularism developed by John McDowell and David Wiggins suggest that casuistry is susceptible to two very different mistakes. First, as sometimes developed, casuistry tends toward an implausible rigidity and systematization of moral knowledge. Particularism offers a corrective to this error. Second, however, casuistry tends sometimes to present moral knowledge as insufficiently systematized: It often appears to hold that moral deliberation is merely a kind of perception. Such a perceptual model of deliberation cannot offer a convincing account of the possibility of moral progress. This second problem is one to which particularism is itself prone. To redress it, other aspects of casuistry must be exploited: Casuistry contains an account of presumptive generalizations that explains how moral deliberation might be structured by rules while also depending at critical junctures on perception.

Bioethics↗
PubMed2004

Alternative gene therapy strategies for the repair of craniofacial bone defects.

Craniofacial anomalies, bone defects and cartilage lesions pose a difficult and challenging problem for both the doctor and for patients and their families. Conventional therapies focus on orthopaedic surgery, grafting with autogenous bone, allogenic bone grafts, or distraction osteogenesis. However, the efficacy of these techniques is limited by high cost, donor morbidity, scarcity of tissue resources, and alterations in volume [Marx & Morales, 1988]. On the basis of recent insights into the development, growth, and adaptation of bone, together with the significant advances in recombinant DNA technology, gene therapy is increasingly becoming recognised as an alternative technique for augmenting and promoting bone regeneration in vivo. It can be applied in craniofacial skeletal tissues by transferring genes encoding for specific growth factors such as BMPs in osteoblasts, chondrocytes or progenitor cells for the purpose of enhancing protein production [Scaduto & Lieberman, 1999]. It can be performed by either direct administration of gene delivery vectors, or by transplantation of genetically modified cells. This review will focus on recent advances in molecular mechanisms of bone formation, and development in various viral and non-viral vectors for direct in vivo therapeutic gene transfer and genetically engineered cells ex vivo therapy.

Adenoviridae↗
PubMed1998

When worlds collide: elder caregiving poses new challenges for balancing work and life.

Nearly one in four U.S. households (an estimated 22.4 million) are caring for elderly family members or friends; as the nation's population ages, more and more workers will take on elder caregiving responsibilities. As this trend continues, employers will face increasing concerns about lost productivity and many employees will struggle to balance the demands of work and caregiving responsibilities. To help resolve the situation, many employers may look to a comprehensive work/life program, which incorporates an intensive focus on elder-care issues, to help boost morale, improve employee productivity and job performance, and reduce stress and absenteeism associated with caregiving.

Absenteeism↗
PubMed1998

Rewarding with dignity.

Job satisfaction affects employee morale, which in turn affects employee productivity. Therefore, managers need to learn about contributing factors and use the factors within their power to improve job satisfaction. Extrinsic rewards, such as a high salary and good work benefits, are important, but studies show that how a job makes an employee feel is the greatest determinant of job satisfaction. Managers can influence the emotional effect of work on an employee through, among other strategies, recognizing the employee's efforts, providing opportunities for the employee to participate in decision making, and allowing the employee to grow professionally.

Humans↗
PubMed1999

Developing nursing practice as part of the collaborative TB control programme, Tomsk, Siberia.

SETTING: Review of nursing practice, identification of training needs and implementation of training for nurses working in the Tomsk Oblast' Tuberculosis Services (TOTBS), Russia. OBJECTIVE: Preparation of TOTBS nurses for the implementation of a WHO-style TB control programme in January 1997. METHODS: Nursing services and training needs were assessed through observation visits to a number of institutions providing care for TB patients, semi-structured interviews, and discussions at staff meetings. Training sessions focused on the WHO DOTS strategy, patient education and default tracing. An evaluation visit focused on nurses' attitudes and levels of treatment completion. RESULTS: Out of a total of 165 TB cases notified in Tomsk Oblast' between January and March 1997, 53 were started on DOTS on an ambulatory basis. Five patients who defaulted returned to treatment within five days (range 2-5) and no patients were lost to follow up. Improved compliance was attributed to better patient education offered by nurses and a reliable supply of medication. Quarterly reports continue to show satisfactory levels of treatment completion. CONCLUSIONS: Obstacles to the development of nursing practice included resistance to change and low morale due to enormous workloads, no pay and staff shortages. Motivation improved through the setting of achievable targets.

Communicable Disease Control↗