{"title":"Inference and Inductive Risk","authors":"L. M. Johnson","doi":"10.1093/med/9780190943646.003.0004","DOIUrl":"https://doi.org/10.1093/med/9780190943646.003.0004","url":null,"abstract":"Several types of inferences are common in the diagnosis and prognosis of brain injuries. These inferences, although necessary, introduce epistemic uncertainty. This chapter details the various inferences and considers the concept of inductive risk, introduced by Richard Rudner in the 1950s, and the problem of inductive risk: given uncertainty, what is the appropriate epistemic standard of evidence for accepting a scientific (or medical) hypothesis? Two principles of inductive risk are proposed to tackle the problem of inductive risk present in disorders of consciousness (and other medical contexts): the First Principle calls on us to index epistemic risk-taking to the level of ethical risk, thus constraining acceptable epistemic risk-taking. The Second Principle tells us to index ethical risk-taking to the level of epistemic risk, thus constraining ethical risk-taking to a level commensurate with epistemic uncertainty.","PeriodicalId":167181,"journal":{"name":"The Ethics of Uncertainty","volume":"259 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116228145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Moral Status and the Consciousness Criterion","authors":"L. M. Johnson","doi":"10.1093/med/9780190943646.003.0007","DOIUrl":"https://doi.org/10.1093/med/9780190943646.003.0007","url":null,"abstract":"The Consciousness Criterion is the claim that moral status requires consciousness, or that being conscious is a necessary condition for being a person. The idea that consciousness imbues an entity with special value, or moral status, is widely accepted in Western cultures. So much so that it is hardly questioned. It should be questioned. This chapter shows that the Consciousness Criterion fails for two reasons: 1) consciousness is not a moral property, and consciousness alone is not sufficient to ground moral properties (like being autonomous, or being a moral agent), and 2) conscious creatures cannot be identified with certainty, so consciousness is not epistemically robust enough to undergird personhood or moral status. Thus consciousness cannot be a necessary condition for being a person. The moral status project of deciding who is and is not a person is rejected as uninformative concerning what is ethically permissible.","PeriodicalId":167181,"journal":{"name":"The Ethics of Uncertainty","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129873551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Consciousness","authors":"L. M. Johnson","doi":"10.1093/med/9780190943646.003.0001","DOIUrl":"https://doi.org/10.1093/med/9780190943646.003.0001","url":null,"abstract":"Consciousness is notoriously difficult to define. Several things are meant by consciousness: sentience, self-awareness, wakefulness, phenomenal consciousness, and more. There are also several consciousness-related ontological, epistemological, and ethical questions, including questions about what consciousness is, what creatures are conscious, how we can know who is conscious, and, importantly, questions about the ethical significance of consciousness. This chapter provides a sketch of several philosophical and scientific theories of consciousness as an introduction to medical, scientific, and philosophical inquiries into consciousness and unconsciousness.","PeriodicalId":167181,"journal":{"name":"The Ethics of Uncertainty","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124520713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Disorders of Consciousness and the Disability Critique","authors":"L. M. Johnson","doi":"10.1093/med/9780190943646.003.0008","DOIUrl":"https://doi.org/10.1093/med/9780190943646.003.0008","url":null,"abstract":"Some members of disability communities and activist organizations have strenuously objected to the withdrawal of life-sustaining treatment from persons in the vegetative state/unresponsive wakefulness syndrome, notably in the case of Terri Schiavo. A history of medical neglect and ableism prompts reasonable fears that the rights of disabled persons are threatened by the withdrawal of treatment from patients who lack the ability to decide for themselves. This chapter considers the disability critique of the right to die. Implicit and explicit bias against disabled persons, and the withdrawal of treatment as a means to prevent disability are examined, alongside concerns about epistemic injustice and questions about who has the epistemic authority to speak for those with disorders of consciousness. What we owe to profoundly impaired persons, including those with disorders of consciousness, is what we owe to others: care, careful consideration of their preferences and interests, and respect for their personhood.","PeriodicalId":167181,"journal":{"name":"The Ethics of Uncertainty","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123962448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Upstream/Downstream","authors":"L. M. Johnson","doi":"10.1093/med/9780190943646.003.0005","DOIUrl":"https://doi.org/10.1093/med/9780190943646.003.0005","url":null,"abstract":"Withdrawal of life-sustaining treatment is the leading factor in deaths after brain injuries: 64 to 92 percent of neurointensive care deaths occur after treatment withdrawal, most within the first 72 hours after injury. There is risk inversion in the way the upstream and downstream ethical risks are weighed for comatose patients. The inversion occurs when more certain risks are undertaken upstream (in neurointensive care) to avoid less certain, more speculative risks downstream. These are ethical risks—the upstream risk is that withdrawing life-sustaining treatment soon after a brain injury will result in death, and a lost opportunity to survive and live a good and flourishing life. The downstream risk is that the patient will survive, but in a condition that is unacceptable to them. The upstream/downstream problem is a wicked problem, where each solution can create new problems. Whether the risks can, and should, be reinverted is the question.","PeriodicalId":167181,"journal":{"name":"The Ethics of Uncertainty","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132346090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Unconsciousness","authors":"L. M. Johnson","doi":"10.1093/med/9780190943646.003.0002","DOIUrl":"https://doi.org/10.1093/med/9780190943646.003.0002","url":null,"abstract":"Neuroscientific knowledge about disorders of consciousness has rapidly developed in recent decades, expanding the diagnostic categories. This chapter describes the disorders and what is known about them and traces their medical and ethical history, examining how old and dogmatic certainties have given way to new and urgent uncertainties. Bioethical and philosophical discourses have not adequately kept pace with what is known and unknown about these disorders. It is argued that there is a need to reconsider outdated ethical conclusions and to revise the taxonomy of these orders, both to excise stigmatizing terms like vegetative, to more accurately reflect the changing and mercurial clinical picture, and to knock down the monoliths of conscious and unconscious.","PeriodicalId":167181,"journal":{"name":"The Ethics of Uncertainty","volume":"62 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124879723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Responding to Uncertainty","authors":"L. M. Johnson","doi":"10.1093/med/9780190943646.003.0009","DOIUrl":"https://doi.org/10.1093/med/9780190943646.003.0009","url":null,"abstract":"There are numerous contexts, beyond disorders of consciousness, where there is a need for decisive action in the presence of unavoidable epistemic uncertainty. The ethics of uncertainty can help. This chapter examines three complex decisional contexts with intersecting, interacting epistemic and ethical uncertainty. The first is pain. Pain, like consciousness, is a subjectively phenomenal experience, the quality and quantity of which are hard to put into words. Pain sufferers encounter testimonial injustice because of the subjectivity, invisibility, and objective uncertainty of pain. The second context is vaccine research and development, and the emergency approval of COVID-19 vaccines under conditions of time pressure and uncertainty. The third context is research with conscious nonhuman animals. There are known, certain risks of harm to the animals, but the benefits of the research are epistemically uncertain. Judging the permissibility of such research requires considering inductive risks, and the principles of inductive risk.","PeriodicalId":167181,"journal":{"name":"The Ethics of Uncertainty","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129511984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Uncertainty","authors":"L. M. Johnson","doi":"10.1093/med/9780190943646.003.0003","DOIUrl":"https://doi.org/10.1093/med/9780190943646.003.0003","url":null,"abstract":"The relatively brief history of disorders of consciousness has seen two epistemic eras—the first was marked by certainty, both ethical and epistemic, about the vegetative state. The second era has been notable for its epistemic and ethical uncertainty. This chapter looks at the 21st century neuroscientific revolution in disorders of consciousness and its ongoing reverberations. Uncertainty about these disorders continues to increase. There are ontological and epistemic doubts about behavioral diagnosis, which looks for the contents of consciousness, or local states of consciousness, while trying to capture the global states of consciousness that are of most diagnostic and ethical interest. The scientific and medical uncertainty, and the high rate of misdiagnosis, complicate ethical decision-making for patients with these disorders.","PeriodicalId":167181,"journal":{"name":"The Ethics of Uncertainty","volume":"78 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130895320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The Ethics of Uncertainty","authors":"L. M. Johnson","doi":"10.1093/med/9780190943646.003.0006","DOIUrl":"https://doi.org/10.1093/med/9780190943646.003.0006","url":null,"abstract":"The ethics of uncertainty is an approach to ethical decision-making under conditions of uncertainty. Two legal cases involving patients in the minimally conscious state—Robert Wendland, and a U.K. patient known as M—illustrate the difficulty and complexity of making decisions when so much is unknown about the experiences and minds of these patients. The ethics of uncertainty refocuses ethical enquiry concerning patients with disorders of consciousness, placing less emphasis on their contested personhood and more on inductive risk, on respect for autonomy, and on justice, especially epistemic justice, and the duties of privileged epistemic agents like physicians and medical staff. It encourages an expansive All Things Considered approach to ethical decision-making where the goal is not to arrive at clean, consistent, abstract, ideal decisions for an ideal world, but to enable decision makers facing complexity and uncertainty to fulfill their duties as moral and epistemic agents.","PeriodicalId":167181,"journal":{"name":"The Ethics of Uncertainty","volume":"181 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116544498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
求助内容：
应助结果提醒方式：