neuroethics

UK Supreme Court Decision Means Patients No Longer Forced to Live

By Mackenzie Graham

On July 30, The UK’s Supreme Court ruled that there is no requirement to obtain court approval before withdrawing clinically assisted nutrition and hydration (CANH), when there is agreement between physicians and the family that this is in the best interests of the patient.

In the judgement, Lady Black writes:

“If the provisions of the MCA [Mental Capacity Act] 2005 are followed and the relevant guidance observed, and if there is agreement upon what is in the best interests of the patient, the patient may be treated in accordance with that agreement without application to the court.”

Until now, requests to withdraw CANH needed to be heard by the Court of Protection to determine if withdrawing treatment was in the patient’s best interest. In addition to being emotionally difficult for families, this is a time-consuming and expensive process, and often results in the patient dying before a judgement is rendered.

I think this decision has much to be said in its favour. First, it means that when there is agreement that continued treatment is no longer in the best interests of a patient with a prolonged disorder of consciousness, these patients are no longer being ‘forced to live’ until the Court affirms that being allowed to die is in their best interests. In many cases, court decisions take months, meaning that a patient is forced to be kept alive, against their best interests and the wishes of their family. Making the decision to withdraw care from a loved one is highly distressing, and this is likely further compounded by the burden and distraction of court proceedings.

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Pain for Ethicists: What is the Affective Dimension of Pain?

This is my first post in a series highlighting current pain science that is relevant to philosophers writing about well-being and ethics.  My work on this topic has been supported by the W. Maurice Young Centre for Applied Ethics, the Oxford Uehiro Centre for Practical Ethics, and the Wellcome Centre for Ethics and Humanities, as well as a generous grant from Effective Altruism Grants

There have been numerous published cases in the scientific literature of patients who, for various reasons, report feeling pain but not finding the pain unpleasant. As Daniel Dennett noted in his seminal paper “Why You Can’t Make A Computer That Feels Pain,” these reports seem to be at odds with some of our most basic intuitions about pain, in particular the conjunction of our intuitions that ‘‘a pain is something we mind’’ and ‘‘we know when we are having a pain.’’ Dennett was discussing the effects of morphine, but similar dissociations have been reported in patients who undergo cingulotomies to treat terminal cancer pain and in extremely rare cases called “pain asymbolia” involving damage to the insula cortex. Continue reading

Addiction, Desire, and The Polluted Environment – Richard Holton’s 2nd Uehiro Lecture

By Jonathan Pugh

 

In the second of his three Uehiro lectures on the theme of ‘illness and the social self’, Richard Holton turned to the moral questions raised by addiction. In the first half of the lecture, he outlined an account of addictive behaviour according to which addictive substances disrupt the link between wanting and liking. In the second half of the lecture, he discusses the implications of this account for the moral significance of preferences, and for how we might structure environments to avoid triggering addictive desires.

 

You can find a recording of the lecture here

 

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Video Series: Tom Douglas Defends the Chemical Castration of Sex Offenders

The Minister of Justice in the UK wants to dramatically increase the use of chemical castration in sex offenders to reduce their risk of reoffending.Dr Tom Douglas (University of Oxford) argues that offering chemical castration to sex offenders might be a better option than current practices to prevent sex offenders from reoffending (e.g. incarceration), and responds to concerns about coercion and interfering in sex offenders’ mental states (e.g. by changing their desires).

Neuroblame?

Written by Stephen Rainey

Brain-machine interfaces (BMIs), or brain-computer interfaces (BCIs), are technologies controlled directly by the brain. They are increasingly well known in terms of therapeutic contexts. We have probably all seen the remarkable advances in prosthetic limbs that can be controlled directly by the brain. Brain-controlled legs, arms, and hands allow natural-like mobility to be restored where limbs had been lost. Neuroprosthetic devices connected directly to the brain allow communication to be restored in cases where linguistic ability is impaired or missing.

It is often said that such devices are controlled ‘by thoughts’. This isn’t strictly true, as it is the brain that the devices read, not the mind. In a sense, unnatural patterns of neural activity must be realised to trigger and control devices. Producing the patterns is a learned behaviour – the brain is put to use by the device owner in order to operate it. This distinction between thought-reading and brain-reading might have important consequences for some conceivable scenarios. To think these through, we’ll indulge in a little bit of ‘science fiction prototyping’.

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Guest Post: Mind the accountability gap: On the ethics of shared autonomy between humans and intelligent medical devices

Guest Post by Philipp Kellmeyer

Imagine you had epilepsy and, despite taking a daily cocktail of several anti-epileptic drugs, still suffered several seizures per week, some minor, some resulting in bruises and other injuries. The source of your epileptic seizures lies in a brain region that is important for language. Therefore, your neurologist told you, epilepsy surgery – removing brain tissue that has been identified as the source of seizures in continuous monitoring with intracranial electroencephalography (iEEG) – is not viable in your case because it would lead to permanent damage to your language ability.

There is however, says your neurologist, an innovative clinical trial under way that might reduce the frequency and severity of your seizures. In this trial, a new device is implanted in your head that contains an electrode array for recording your brain activity directly from the brain surface and for applying small electric shocks to interrupt an impending seizure.

The electrode array connects wirelessly to a small computer that analyses the information from the electrodes to assess your seizure risk at any given moment in order to decide when to administer an electric shock. The neurologist informs you that trials with similar devices have achieved a reduction in the frequency of severe seizures in 50% of patients so that there would be a good chance that you benefit from taking part in the trial.

Now, imagine you decided to participate in the trial and it turns out that the device comes with two options: In one setting, you get no feedback on your current seizure risk by the device and the decision when to administer an electric shock to prevent an impending seizure is taken solely by the device.

This keeps you completely out of the loop in terms of being able to modify your behaviour according to your seizure risk and – in a sense – relegates some autonomy of decision-making to the intelligent medical device inside your head.

In the other setting, the system comes with a “traffic light” that signals your current risk level for a seizure, with green indicating a low, yellow a medium, and red a high probability of a seizure. In case of an evolving seizure, the device may additionally warn you with an alarm tone. In this scenario, you are kept in the loop and you retain your capacity to modify your behavior accordingly, for example to step from a ladder or stop riding a bike when you are “in the red.”

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A Second Response to Professor Neil Levy’s Leverhulme Lectures.

Written by Richard Ngo , an undergraduate student in Computer Science and Philosophy at the University of Oxford.

Neil Levy’s Leverhulme Lectures start from the admirable position of integrating psychological results and philosophical arguments, with the goal of answering two questions:

(1) are we (those of us with egalitarian explicit beliefs but conflicting implicit attitudes) racist?

(2) when those implicit attitudes cause actions which seem appropriately to be characterised as racist (sexist, homophobic…), are we morally responsible for these actions? Continue reading

Loebel Lecture 3 of 3: What is the upshot?

Lecture 3 Audio [MP3] | YouTube link [MP4] 
Grove Auditorium, Magdalen College, Longwall Street, Oxford
5 November 2015, 6-8pm Continue reading

Loebel Lectures and Workshop, Michaelmas Term 2015, Lecture 1 of 3: Neurobiological materialism collides with the experience of being human

The 2015 Loebel Lectures in Psychiatry and Philosophy were delivered by Professor Steven E. Hyman, director of the Stanley Center for Psychiatric Research at the Broad Institute of MIT and Harvard as well as Harvard University Distinguished Service Professor of Stem Cell and Regenerative Biology. Both the lecture series and the one-day workshop proved popular and were well-attended. Continue reading

Guest Post: Should the army abandon their zero-tolerance policy on substance use?

Written by Anke Snoek

Macquarie University

In the UK around 500 soldiers each year get fired because they fail drug-testing. The substances they use are mainly recreational drugs like cannabis, XTC, and cocaine. Some call this a waste of resources, since new soldiers have to be recruited and trained, and call for a revision of the zero tolerance policy on substance use in the army.

This policy stems from the Vietnam war. During the First and Second World War, it was almost considered cruel to deny soldiers alcohol. The use of alcohol was seen as a necessary coping mechanism for soldiers facing the horrors of the battlefield. The public opinion on substance use by soldiers changed radically during the Vietnam War. Influenced by the anti-war movement, the newspapers then were dominated by stories of how stoned soldiers fired at their own people, and how the Vietnamese sold opioids to the soldiers to make them less capable of doing their jobs. Although Robins (1974) provided evidence that the soldiers used the opioids in a relatively safe way, and that they were enhancing rather than impairing the soldiers’ capacities, the public opinion on unregulated drug use in the army was irrevocably changed. Continue reading

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