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Effaced Enigmata

When Ethics Precedes Neuroscience

Published online by Cambridge University Press:  22 September 2017

GRANT GILLETT
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Abstract:

Severe head injury or brain injury presents clinical neuroscientists with a unique challenge. Based on an objective assessment of cognitive and neurological function, it is sometimes hard to recognize our patients as members of our moral community (actually or potentially) but we treat them as if that were is the case, and, therefore, as if they need rescuing. Thus their existences as enigmata—beings who may or may not reveal themselves to us through social and personal function realized in conversations and relationships—are in doubt. However, the objective mode of assessing individuals and their mental functions needs to be bracketed here, as we reconnect with them and offer them our help in the restorative journey that they need to take. The journey has many tortuous paths comprising it, not the least of which is the existential question of whether the damaged human being with whom we are engaged actually can be restored to a meaningful life. A negative answer to that question can bring the whole process to an abrupt end. Neuroscience cannot answer some of these questions, as they are ethical. Is this a life worth living and are our commitments going to go the distance that must be traversed here. Therefore, this is an area where ethics take priority over neuroscience, and it is on our ethical response that everything else hinges. Understanding the light this throws on the nature of a human being takes us to the heart of the value of every human being and the nexus of mutuality that is the moral community.

Keywords

neuroscienceethicsmoral communityhead injurybrain injurycognitive functionneurological function
Type
Articles
Information
Cambridge Quarterly of Healthcare Ethics , Volume 26 , Special Issue 4: Clinical Neuroethics , October 2017 , pp. 616 - 627
Copyright
Copyright © Cambridge University Press 2017 

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References

Notes

1. King, JR, Jacobo, D, Faugeras, F, Rohaut, B, El Karoui, I, Cohen, L, et al. Information sharing in the brain indexes consciousness in noncommunicative patients. Current Biology 2013;23:1914–19.CrossRefGoogle ScholarPubMed

2. Gillett, G. Culture, the crack’d mirror, and the neuroethics of disease. Cambridge Quarterly of Healthcare Ethics 2016;25:634–46 .CrossRefGoogle Scholar

3. Peperzak, A, Critchley, S, Bernasconi, R, eds. Levinas, E. Basic Philosophical Writings . Bloomington: Indiana University Press; 1996.Google Scholar

4. Strawson, P. Freedom and Resentment and Other Essays. London: Methuen; 1974.Google Scholar

5. Hughlings Jackson, J. Remarks on the evolution and dissolution of the nervous system. British Journal of Psychiatry 1887;33:25–48.CrossRefGoogle Scholar

6. Butler, J. Giving an account of oneself. Diacritics 2001;31(4):23.CrossRefGoogle Scholar

7. See note 5, Hughlings Jackson 1887, at 34.

8. Lindemann–Nelson, H. What child is this? Hastings Center Report 2002;32(6):29–38.CrossRefGoogle Scholar

9. Van Staden, CW, Fulford, KWM. The indaba in African values-based practice: Respecting diversity of values without ethical relativism or individual liberalism. In: Van Staden CW, Daler J., Fulford, KWM, eds. Oxford Handbook of Psychiatric Ethics, Vol. I, Oxford: University Press; 2015:295–318.Google Scholar

10. Heidegger, M (Stambaugh J, trans.). Being and Time. New York: SUNY Press; 1996 (orig. publication 1953).Google Scholar

11. Gillett, G, Amos, C. The discourse of clinical ethics and the maladies of the soul. In: Oxford Handbook of Psychiatric Ethics. Vol. I, Oxford: University Press; 2015: 336–53.Google Scholar

12. Pickering, N. The Metaphor of Mental Illness. Oxford: University Press; 2006.Google Scholar

13. McDowell, J. Mind, Value and Reality. Cambridge, MA: Harvard University Press; 1998 Google Scholar; Pinker, S. The cognitive niche: coevolution of intelligence, sociality and language Proceedings of the National Academy of Sciences 2010;107(s2):8993–9.CrossRefGoogle Scholar

14. Nussbaum, M. Love’s Knowledge. Oxford: University Press; 1990.Google Scholar

15. Tomasello, M. The Natural History of Human Thinking. Cambridge, MA: Harvard University Press; 2014 CrossRefGoogle Scholar

16. Gillett, G. Sanctity of life, a sense of life, and good endings. QUT Law and Justice Journal 2006;6(2):243–52.Google Scholar

17. Sontag, S. Illness as Metaphor. New York: Vintage; 1979.Google Scholar

18. See note 3, Peperzak et al. 1996.

19. See note 3, Peperzak et al. 1996, at 3.

20. Kant, I (White Beck L, trans.). Foundation of the Metaphysics of Morals. New York; Bobbs Merrill; 1959.Google Scholar

21. Merleau-Ponty, M. Signs. Evanston, IL: Northwestern University Press; 1964, at 54.Google Scholar

22. Foucault, Michel. See Rabinow, P, ed. The Foucault Reader. London: Penguin; 1984, at 83.Google Scholar

23. Fins, J. Rights Come to Mind: Brain Injury, Ethics, and the Struggle for Consciousness. Cambridge: Cambridge University Press; 2015 CrossRefGoogle ScholarPubMed; Giacono, J. Disorders of consciousness: Differential diagnosis and neuropathological features. Seminars in Neurology 1997;17(2):105–11.CrossRefGoogle Scholar Gillett, G. Minimally conscious states, deep brain stimulation and what is worse than futility. Journal of Bioethical Inquiry 2011;8(2):145–50.CrossRefGoogle Scholar

24. Sartre, JP (Barnes H, trans.). Being and Nothingness. London: Methuen & Co.; 1958 Google Scholar

25. Husserl, E (Kersten F, trans.). Ideas Pertaining to a Pure Phenomenology and to a Phenomenological Philosophy. The Hague: Martinus Nijhoff1; 1982 (orig. publication 1913).CrossRefGoogle Scholar

26. Merleau-Ponty, M (Smith C, trans.). The Phenomenology of Perception. London: Routledge; 1962, at 139.Google Scholar

27. See note 26, Merleau-Ponty 1962, at 97.

28. Gillett, G, Seniuk, P. Neuroscience, psychiatric disorder and the intentional arc. In: Stanghellini, G, Broome, M, Fernandez, A, Poli, PF, Raballo, A, Rosfort, R, eds. Oxford Handbook of Phenomeology and Psychiatry. Oxford: Oxford University Press; forthcoming.Google Scholar

29. Chemero, A. Radical Embodied Cognitive Science. Cambridge, MA: MIT Press; 2009, at 185.Google Scholar

30. See note 26, Merleau-Ponty 1962, at 140.

31. Kant I (Bernard JH, trans.). Critique of Judgment New York: Hafner; 1953 (orig. publication 1793).

32. Dehaene, S. Consciousness and the Brain. New York: Penguin; 2014.Google Scholar

33. See note 32, Dehaene 2014, at 153

34. See note 32, Dehaene 2014, at 156.

35. See note 32, Dehaene 2014, at 158.

36. See note 32, Dehaene 2014, at 166.

37. Locke, J (Nidditch P, ed.). An Essay Concerning Human Understanding. Oxford: Clarendon; 1975 (orig. publication 1689);Google Scholar Gillett, G. Subjectivity and Being Somebody: Human Identity and Neuroethics (St. Andrews Series on Philosophy and Public Affairs). Exeter: Imprint Academic; 2008.Google Scholar

38. See note 31, Kant 218–9.

39. Engel, GL. The clinical application of the biopsychosocial model. American Journal of Psychiatry 1980:137(5):536.Google ScholarPubMed

40. Gillett, G. Mind and caring about ethics in brain injury [review of Fins, Rights Come to Mind (See note 23)]. The Hastings Center Report 46(3):44–45.Google Scholar

41. Gillett, G. Sense and moral sensibility in vegetative states. AJOB Neuroscience 2015;6(2):42–53.Google Scholar

42. Wittgenstein, L (Anscombe GEM, von Wright GH, eds.). On Certainty. New York: Harper; 1969.Google Scholar

43. See note 26, Merleau-Ponty 1962, at vii.

44. See note 26, Merleau-Ponty 1962, at xviii, xxi.

45. Wittgenstein, L. (Anscombe GEM, trans., Anscombe GEM, von Wright GM, eds.) Zettel. Oxford: Basil Blackwell; 1967.Google Scholar

46. Wittgenstein, L (Anscombe GEM, trans.). Philosophical Investigations. Oxford: Blackwells; 1953, at para. 420.Google Scholar

47. See note 24, Sartre 1958, at 257.

48. See note 24, Sartre 1958, at 259.

49. Van Fraassen, B. Scientific Representation: Paradoxes of Perspective. Oxford: Oxford University Press; 2008, at 30–1.CrossRefGoogle Scholar

50. See note 26, Merleau-Ponty 1962, 97.