The Physican Manager's Handbook: Essential Business Skills for Succeeding in Health Care Book

The cover says to me the doors to the mind. The cover has as its main image three doors side-by-side.

This is a book about neuroethics, a subfield of bioethics. It looks at how the brain figures into ethical decisions in four ways. The first part of the book looks at given what we know of the brain, what ethical decisions should we make in regards to the beginning and ending of life, such as when should we give moral status to a fetus and how does the aging brain figure into how we treat people with various forms of dementia. The second part looks at whether we should seek to improve the brain through genes, training, or drugs. In the third part we are given a picture of how the brain, free will, and the law should relate. Finally, in part four it explores the brain in relation to beliefs and how ethics is produced.

Here are my comments on parts of the text. Kindle locations are shown in brackets [].

[303] "We can show in clever studies that the brain of a six-week-old baby is conscious of complex concepts." This indicates that language may not be needed to think, which gives weight to the idea that we do not think in language that I currently favor. It would also seem to show that maybe animals are capable of some concept formation; although, I admit this is more speculative.

[310] "The moment life began for any individual is a simple issue'conception. But this is looking at the issue in hindsight, and unfair, in that we are looking at a person and assessing when his or her life began." I consider my life began at my birth'end of story, or is that beginning.

[515] "The specter of designer babies is unsettling on one level, but old hat on another. Evolutionary biologists and psychologists have been studying mate selection for years. People seek the smartest, most beautiful mate possible. We like blonds, or we don't; we like tall and lanky or heavyset, or smart, or cheerful, or dark and mysterious, or anything else. By realizing what our preferences are, and sorting through everyone we meet with these criteria before deciding with whom we will conceive a child with, we already engage in serious genetic screening." I do not think everyone is that picky. And, plenty of children are conceived in a fit of passion. Most people marry and thus have children because they fall in love in various situations. They do not go through a checklist of criteria. Some selection may take place in the sense of what we are attracted to, but it is most often a crap shoot. If these studies are based on animal mating studies where close observation is going on, how much validity does this give to mate selection in humans. Also, if psychologist are relying on questionnaires, how accurate are these self reports, and do they really transfer to actual mate selection in reality. While Gazzaniga often gives references in his endnotes, there are none for these studies. Maybe, there are none

[732] Wrapping up his chapter on genetic engineering of the brain, he writes: "I am confident that we will always understand what is ultimately good for the species and what is not." Is this not just hubris or delusion? People are killing each other all over the planet. We cannot even take care of the poor and unfortunate. And, the latest news has me question if we are so wise; how come we cannot even come up with sane gun control laws in the United States?

[@732] This whole chapter leads me to ask, what about those that cannot afford these genetic brain enhancements, will they not be allowed to have children? I mean is he aware that a significant portion of the people on this planet live in poverty, including one sixth of the children in the United States.

[1097] Speaking of cognitive enhancement drugs he includes the comment, "just as most people don't alter their mood with Prozac . . ." This sounds condescending toward people that must take anti-depressant to live a more mentally healthy life, unless he is referring to those that would take it to boost an already good mood, which I do not even know if this is possible.

[1120] "We now understand that changes in our brain are both necessary and sufficient for changes in our mind." All I can say is absolutely. There is no separate mind stuff. Thus, the mind is the brain. This last statement my not be the view of Gazzaniga.

[1133] "When we become consciously aware of making a decision, the brain has already made it happen." Again, yes. This is similar to my notion that are thoughts come first, then the language to describe them is produce so that we are aware of some of our thoughts. But, these studies are done in a laboratory under highly restricted conditions. This does not necessarily mean that all are decision might be made before we are aware of them. But, this cannot be ruled out.

[1139] After stating that brains are deterministic, he writes: "Personal responsibility is a public concept. It exists in groups, not in an individual. If you were the only person on earth, there would be no concept of personal responsibility. Responsibility is a concept you have about other people's actions and they about yours. Brains are determined; people (more than one human being) follow rules when they live together, and out of that interaction arises the concept of freedom of action." I do not buy this explanation. First, the major reason that there would be no responsibility is that there would be no one to be responsible to, so in a way it is so, but only because it is a social concept. But, even if it is so, the social sphere is just as deterministic as the individual one. If it were not, there would be social chaos (not the theoretical type, which is still deterministic and may actually apply), just like in what is thought of as the physical world (everything is physical).

[1146] "Those aspects [the social] of our personhood are'oddly'not in our brains. They exist only in the relationships that exist when our automatic brains interact with other automatic brains." (his italics) This is different than other explanations of social responsibility that I have come across. As I said above, it is still deterministic. [Deterministic + Deterministic ≠ Nondeterministic]

[1173] In a famous experimental study of the awareness of decision he relates: "The time between the onset of the readiness potential and the moment of conscious decision-making was about 300 milliseconds. If the readiness potential of the brain begins before we are aware of making the decision to move our hand, it would appear that our brains know our decisions before we become consciousness of them." And, that is if the potential represents the making of the decision. Regardless, decisions are deterministic, and it is likely that decision and consciousness thereof, are separate brain events.

[1266] In keeping with the above: "Our freedom is found in the interaction of the social world." I do not see how this is necessarily so. As I said previously, the social world is determined too.

[1273] "No pixel in a brain scan will ever be able to show culpability or nonculpability." What about during the actual commission of the crime? Also, what about scanning memories, which, who knows, may be something that we will be able to do in the future? Not that I especially think it is probable in the least, but you cannot rule it out.

[1553] ". . . it is hard to keep a long, complex logic and a derived set of principles in mind when trying to formulate a new thought." Maybe it is the difficulty of translation of thought into language.

[1726] Discussing split-brain patient experiments, he writes: "Therefore his left brain (which processes language and deals with constructing verbal information, but never saw the picture of the snowy house) offered an explanation: he must have chosen the shovel because it could be used to clean out the chicken coop [the picture shown to the right part of the brain]." This I think adds support to my thinking that we do not actually think in language. At least it is in the right brain of these split-brain individuals in these experiments.

[1964] "Of course, this hint at a basis for beliefs does not mean that those who possess religious beliefs are undergoing seizure activity." Maybe, brain freeze.

[1978] "Others whose life's stories contain evidence of epileptic seizures include Moses . . ." First, Moses almost certainly did not exist. Second, you would need actual physical evidence rather than just literary evidence to make this claim.

[2098] "Moral emotions'those that motivate behavior'are driven mostly by the brain stem and limbic axis . . ." Might not this be where free will arises. I see this as evidence that free will is an emotion.

I was somewhat disappointed with the book. From the title I thought it was going to talk about how the brain produced ethics. It does in part four, but the first three were on how what we may know about the brain affects ethical decisions and what might be ethical avenues of brain enhancements (e.g. genetics and drugs) These parts were good, but I felt overall the book gave no deep understanding of how the brain makes ethical decisions or guides moral behavior.

This book would be good for anyone concerned with neuroethics, which tries to determine what are good moral responses to issues that involve the brain. As I said above, if you want any more but a few clues to how the brain produces ethics, and are not satisfied with the majority of what the book does cover, you may want to think twice about reading it.

[Note - I am not sure of a four star rating.