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Cardiac surgical interventions for children with trisomy 18 and trisomy 13 remain controversial, despite growing evidence that definitive cardiac repair prolongs survival. Understanding quality of life for survivors and their families therefore becomes crucial. Study objective was to generate a descriptive summary of parental perspectives on quality of life, family impact, functional status, and hopes for children with trisomy 18 and trisomy 13 who have undergone heart surgery.
A concurrent mixed method approach utilising PedsQL™ 4.0 Generic Core Parent Report for Toddlers or the PedsQL™ Infant Scale, PedsQL™ 2.0 Family Impact Module, Functional Status Scale, quality of life visual analogue scale, and narrative responses for 10 children whose families travelled out of state to access cardiac surgery denied to them in their home state due to genetic diagnoses.
Parents rated their child’s quality of life as 80/100, and their own quality of life as 78/100 using validated scales. Functional status was rated 11 by parents and 11.6 by providers (correlation 0.89). On quality of life visual analogue scale, all parents rated their child’s quality of life as “high” with mean response 92.7/100. Parental hopes were informed by realistic perspective on prognosis while striving to ensure their children had access to reaching their full potential. Qualitative analysis revealed a profound sense of the child’s relationality and valued life meaning.
Understanding parental motivations and perceptions on the child’s quality of life has potential to inform care teams in considering cardiac interventions for children with trisomy 18 and trisomy 13.
Various contemporary philosophers, with Richard Swinburne prominent amongst them, have abandoned the traditional philosophical conception of God, according to which He is absolutely simple and eternal (as opposed to sempiternal). These contemporary philosophers conceive of Him as a ‘perfect person’, immaterial, but with human-type virtues in a superhuman degree. I argue that, whilst this development is probably mistaken, nevertheless the traditionalist critics perhaps sometimes exaggerate the differences between these conceptions – except on the crucial issue of God's eternity.
Chapter 10 argued that vague predicates cannot be taken realistically, and in this chapter it is argued that strict identity across certain counterfactuals concerning the identity of physical objects is vague. It follows that there are no such individuals in a realist sense. The view that physical objects are products of our conceptualization and that what exists ‘out there’ are just qualitative events is, in fact, a standard empiricist view. Attempts to avoid this conclusion by, for example, Wiggins and Salmon, are discussed and rejected. So also is the claim that atomic entities avoid the vagueness charge.
In this chapter the distinction between the conceptualist and realist interpretations of predicates is defined and the question of which should be treated in which way is investigated. There are Fs in a purely conceptualist sense if the world is so organized that the concept ‘F’ can be usefully applied to the central cases for which it is devised, but there are no Fs in the realist sense. The realist sense is that, irrespective of what concepts there may or may not be, Fs exist. In the light of this distinction, the application of Kim’s exclusion principle to the non-basic sciences is defended and the inadequacies of modern forms of hylomorphism discussed. Certain currently fashionable philosophical problems can also be solved using this apparatus.
The theories of three philosophers who defend mental substance are considered in this chapter. First is E. J. Lowe, who bases his claim to substance dualism on the fact that persons are substances and that they possess different identity conditions from their bodies, so they must be different substances from their bodies. He admits that this is not a Cartesian dualism and compares his position to P.F. Strawson’s.
Second is Richard Swinburne. The core of his strategy is to appeal to split brain scenarios and argue that it makes no sense to think of a subject as being divided in such cases. We may not be able to work out which part of the brain the subject would follow, but we can certainly conceive that it follows one of them because we can conceive of a subject as surviving the loss of any part of its body.Third is John Foster, who thinks that the choice is between bundle and substance dualism. He rejects the Humean bundle theory on the grounds that it does not allow for the fact that we experience our mental states ‘from the inside’, which requires that there be a subject in addition to the elements in the bundle.
All three of these philosophers dismiss bundle dualism too easily. They claim to have a non-controversial notion of substance and say that, in that sense, the self or mind is a substance, but one common theory of substance is itself a bundle theory. In particular, the bundle theory of the mind makes use of the notion of the co-consciousness relations between the elements in the bundle and none of them discuss whether the nexus of these relations might give a subjective sense of self.
Frank Jackson has abandoned the knowledge argument because he no longer thinks that epiphenomenalism is coherent. The argument does not itself entail epiphenomenalism, but it follows only if you combine the argument with a belief in physical closure, which I believe we should not feel obliged to accept. Jackson tries to answer the argument by appeal to a representational theory of perception. I examine thoroughly all the forms this might take and conclude that none assists the physicalist.
The problem of vagueness throws light on the issues raised in chapter 9 because the logical problems associated with vagueness can be circumvented if one treats non-basic forms of discourse in a conceptualist, as opposed to a strictly realist, manner. In this way one can save classical logic and solve the sorites problem. This involves an account of language according to which it is not a unified formal system.
Brian Loar is credited with devising this strategy. Close attention to the strategy reveals it to be much more obscure than it seems at first sight. Although it pretends to answer the knowledge argument, it actually focuses only on the ‘explanatory gap’ and the ‘conceivability of zombies’’. This enables its protagonists to represent the problem as concerning the relation between two sets of concepts – how one can infer from physical facts to certain mental facts. In fact the problem for the physicalist is to explain how the properties apparently present in qualia can be the same as some ascribed by science to states of the brain. This was the issue that earlier theories, such as Smart’s and Armstrong’s faced up to, but PCS simply tries – unsuccessfully – to evade.
The major theory of consciousness propounded by the earlier generation of physicalists – such as J. J. C. Smart and D. M. Armstrong was that our knowledge of our conscious states was topic neutral – that is, we recognize them only by their relations of similarity and dissimilarity to each other and by the contexts in which they usually occur. I argue in this chapter for two claims. First, that this deployment of topic neutrality seems inevitable for any form of physicalism that allows that sensations (and the like) are occurrent physical states: for we are certainly not aware of them under any of their physical features. Despite this pressure, almost no later physicalists explicitly adopt this strategy, but we see, as the book progresses, they often approach to it indirectly..Second, that the knowledge argument refutes topic neutrality, because if Mary knows all the relevant physical facts, there is nothing left for her to gain when she gets ‘neutral’ knowledge by experience. I then introduce the knowledge argument in some detail and consider the various strategies that might be used against it, and indicate in which of the following chapters these will be discussed.
These three theories all say that there is more to matter than science reveals and that is this extra element that explains matter’s ability to produce consciousness. McGinn has argued that this extra element is something we are constitutionally unable to discover. I argue that if there were such a feature it would have to explain consciousness and have no other effects (otherwise it would be detectable). Thus such a feature might reasonably be assumed to be at least proto-phenomenal, which puts it in the same category as neutral monism.
The main problem facing neutral monism is that it has no plausible account of how something qualitative (as the qualia of neutral monism are said to be) become phenomenal or conscious. The only way to overcome this problem is to go the whole hog and be a panpsychist.
There are a variety of problems with panpsychism, but the two main ones are: (i) Is it really possible to make sense of the kind of consciousness that might belong to a quark? It is doubtful enough whether it makes sense for earthworms. (ii) There is good reason to think that there is cognitive phenomenology as well as sensory phenomenology. It is hard enough to imagine a quark with the sort of very dim feeling that might contribute to our rich perceptual experience, but what would the quark’s contribution to a thought about, for example, the ontological argument consist in?
Lewis and Nemirow both claim that what Mary initially lacks and gains on seeing colour is an ability. Their account of what this ability is – namely the ability to reactivate the original experience – fails to touch the central problem, which is to give an account of what it is like to see a colour: the ability to reactivate a state cannot be an explanation of what that state is. In fact Lewis believes that this – the nature of the quale – is something Mary already knows better than we do on the basis of her scientific knowledge. This claim detaches qualia from what experience is subjectively like in a totally counterintuitive if not actually incoherent manner.
I also discuss Lewis’s attack on phenomenal information and argue that none of his arguments have any force. Stalnaker bases his phenomenal externalism on Lewis’s attack on phenomenal information, and I show how the failure of the latter undermines Stalnaker’s position. I argue that any form of analytic functionalism is a self-destructive theory, because it undermines the very concepts on which it is based. Finally, I criticize Kirk’s attempt to prove that a non-analytic form of functionalism is necessarily true. Kirk’s ground is that the denial of functionalism entails the possibility of epiphenomenalism and epiphenomenalism is incoherent. I argue that it is not incoherent, so its bare possibility is not a reductio.
There is a further argument for substance dualism which rests on the impossibility of vagueness in whether a certain person would have been me if certain things had been different at my conception. The point is that the sort of vagueness in origin, giving rise to mere overlap with no strict fact about identity cannot be applied in the subjective case. This case differs from the problem of identity through time because that rests on the presence of qualitative difference. I might imagine a person with exactly the same history as myself, but minor differences in origin, so there is no empathetic distance between him and me, but the notion of subjective overlap – parallel to the overlap of constitution in the physical cases, is impossible to make sense of. So the self is a genuine individual and unity in the sense in which no physical object is. I also try to see how a simple entity of this sort could also be the complex phenomenon that is a human mind. I appeal to Geach’s account of thought.