There have been few empirical studies into what non-medical factors influence physicians and nurses when deciding about admission and discharge of ICU patients. Information about the attitudes of healthcare professionals about this process can be used to improve decision-making about resource allocation in intensive care. To provide insight into ethical problems that influence the ICU admission and discharge process, we aimed to identify and explore ethical dilemmas healthcare professionals are faced with.

Patients with a life-threatening illness can be confronted with various types of loneliness, one of which is existential loneliness (EL). Since the experience of EL is extremely disruptive, the issue of EL is relevant for the practice of end-of-life care. Still, the literature on EL has generated little discussion and empirical substantiation and has never been systematically reviewed. In order to systematically review the literature, we (1) identified the existential loneliness literature; (2) established an organising framework for the review; (3) (...) conducted a conceptual analysis of existential loneliness; and (4) discussed its relevance for end-of-life care. We found that the EL concept is profoundly unclear. Distinguishing between three dimensions of EL—as a condition, as an experience, and as a process of inner growth—leads to some conceptual clarification. Analysis of these dimensions on the basis of their respective key notions—everpresent, feeling, defence; death, awareness, difficult communication; and inner growth, giving meaning, authenticity—further clarifies the concept. Although none of the key notions are unambiguous, they may function as a starting point for the development of care strategies on EL at the end of life. (shrink)

In their 2007 paper, Swierstra and Rip identify characteristic tropes and patterns of moral argumentation in the debate about the ethics of new and emerging science and technologies (or “NEST-ethics”). Taking their NEST-ethics structure as a starting point, we considered the debate about tissue engineering (TE), and argue what aspects we think ought to be a part of a rich and high-quality debate of TE. The debate surrounding TE seems to be predominantly a debate among experts. When considering the NEST-ethics (...) arguments that deal directly with technology, we can generally conclude that consequentialist arguments are by far the most prominently featured in discussions of TE. In addition, many papers discuss principles, rights and duties relevant to aspects of TE, both in a positive and in a critical sense. Justice arguments are only sporadically made, some “good life” arguments are used, others less so (such as the explicit articulation of perceived limits, or the technology as a technological fix for a social problem). Missing topics in the discussion, at least from the perspective of NEST-ethics, are second “level” arguments—those referring to techno-moral change connected to tissue engineering. Currently, the discussion about tissue engineering mostly focuses on its so-called “hard impacts”—quantifiable risks and benefits of the technology. Its “soft impacts”—effects that cannot easily be quantified, such as changes to experience, habits and perceptions, should receive more attention. (shrink)

In this article , I first engage in some conceptual clarification of what the words "imagine," "imagining," and "imagination" can mean. Each has a constructive sense, an attitudinal sense, and an imagistic sense. Keeping the senses straight in the course of cognitive theorizing is important for both psychology and philosophy. I then discuss the roles that perceptual memories, beliefs, and genre truth attitudes play in constructive imagination, or the capacity to generate novel representations that go well beyond what's prompted by (...) one's immediate environment. (shrink)

Imaginative representations are crucial to the generation of action--both pretense and plain action. But well-known theories of imagination on offer in the literature [1] fail to describe how perceptually-formatted imaginings (mental images) and motor imaginings function in the generation of action and [2] fail to recognize the important fact that spatially rich imagining can be integrated into one's perceptual manifold. In this paper, I present a theory of imagining that shows how spatially rich imagining functions in the generation of action. (...) I also describe the imaginative structures behind two under-explored forms of action: semi-pretense and pretense layering. In addition, I suggest that my theory of imagining meshes better than the competitors with current work in cognitive and affective neuroscience. (shrink)

This essay argues that there are theoretical benefits to keeping distinct—more pervasively than the literature has done so far—the psychological states of imagining that p versus believing that in-the-story p, when it comes to cognition of fiction and other forms of narrative. Positing both in the minds of a story’s audience helps explain the full range of reactions characteristic of story consumption. This distinction also has interesting conceptual and explanatory dimensions that haven’t been carefully observed, and the two mental state (...) types make distinct contributions to generating emotional responses to stories. Finally, the differences between the mental states illuminate how a given story can be both shared with others and at the same time experienced as personal. (shrink)

Imagination contributes to human agency in ways that haven't been well understood. I argue here that pathways from imagistic imagining to emotional engagement support three important agential capacities: 1. bodily preparedness for potential events in one's nearby environment; 2. evaluation of potential future action; and 3. empathy-based moral appraisal. Importantly, however, the kind of pathway in question (I-C-E-C: imagining-categorization-emotion-conceptualization) also enables engagement with fiction. So human enchantment with fiction is a consequence of imaginative pathways that make us the kind of (...) agents we are. Finally, I use this approach to address imaginative resistance and the paradox of fiction. [The version archived here is a penultimate draft. Please email me at neilvl@gmail.com to receive a pdf of the final in accordance with fair use.]. (shrink)

The article sets out a framework for analysing the way discourses construct legitimation for social practices in public communication as well as in everyday interaction. Four key categories of legitimation are distinguished: 1) ‘authorization’, legitimation by reference to the authority of tradition, custom and law, and of persons in whom institutional authority is vested; 2) ‘moral evaluation’, legitimation by reference to discourses of value; 3) rationalization, legitimation by reference to the goals and uses of institutionalized social action, and to the (...) social knowledges that endow them with cognitive validity; and 4) mythopoesis, legitimation conveyed through narratives whose outcomes reward legitimate actions and punish non-legitimate actions. Examples are drawn from texts legitimating or de-legitimating compulsory education, including children’s books, brochures for parents, teacher training texts, and media texts. (shrink)

Some examples suggest that religious credences respond to evidence. Other examples suggest they are wildly unresponsive. So the examples taken together suggest there is a puzzle about whether descriptive religious attitudes respond to evidence or not. I argue for a solution to this puzzle according to which religious credences are characteristically not responsive to evidence; that is, they do not tend to be extinguished by contrary evidence. And when they appear to be responsive, it is because the agents with those (...) credences are playing what I call The Evidence Game, which in fundamental ways resembles the games of make-believe described by Walton's theory of make-believe. (shrink)

This intervention study examined the effects of a career crafting training on physicians' perceptions of their job crafting behaviors, career self-management, and employability. A total of 154 physicians working in two hospitals in a large Dutch city were randomly assigned to a waitlist control group or an intervention group. Physicians in the intervention group received an accredited training on career crafting, including a mix of theory, self-reflection, and exercises. Participants developed four career crafting goals during the training, to work on (...) in the subsequent weeks, after which a coaching conversation took place over the phone. Physicians in the control group received no intervention. A pre- and post-test 8 weeks later measured changes in job crafting and career self-management and employability of 103 physicians that completed the pre- and post-test. RM ANOVAs showed that the intervention enhanced perceptions of career self-management and job crafting behavior to decrease hindering job demands. No support was found for the effect of the intervention on other types of job crafting and employability. This study offers novel insights into how career crafting can be enhanced through training, as this is the first empirical study to examine a career crafting intervention. HR managers can use the outcomes to develop tailored career policies and career development practices. (shrink)

In an earlier issue, I argue (2014) that psychology and epistemology should distinguish religious credence from factual belief. These are distinct cognitive attitudes. Levy (2017) rejects this distinction, arguing that both religious and factual “beliefs” are subject to “shifting” on the basis of fluency and “intuitiveness.” Levy’s theory, however, (1) is out of keeping with much research in cognitive science of religion and (2) misrepresents the notion of factual belief employed in my theory. So his claims don’t undermine my distinction. (...) I conclude by suggesting some approaches to empirically testing our views. (shrink)

This paper claims that the standard characterization of the motivational role of belief should be supplemented. Beliefs do not only, jointly with desires, cause and rationalize actions that will satisfy the desires, if the beliefs are true; beliefs are also the practical ground of other cognitive attitudes, like imagining, which means beliefs determine whether and when one acts with those other attitudes as the cognitive inputs into choices and practical reasoning. In addition to arguing for this thesis, I take issue (...) with Velleman's argument that belief and imagining cannot be distinguished on the basis of motivational role. (shrink)

What does it mean to have “strong beliefs”? My thesis is that it can mean two very different things. That is, there are two distinct psychological features to which “strong belief” can refer, and these often come apart. I call the first feature epistemic confidence and the second identity centrality. They are conceptually distinct and, if we take ethnographies of religion seriously, distinct in fact as well. If that’s true, it’s methodologically important for the psychological sciences to have measures that (...) tease them apart. In this paper, I critique some measures that are currently in use and propose some strategies for developing measurement tools that track the distinction in question. (shrink)

I raise three puzzles concerning self-deception: (i) a conceptual paradox, (ii) a dilemma about how to understand human cognitive evolution, and (iii) a tension between the fact of self-deception and Davidson’s interpretive view. I advance solutions to the first two and lay a groundwork for addressing the third. The capacity for self-deception, I argue, is a spandrel, in Gould’s and Lewontin’s sense, of other mental traits, i.e., a structural byproduct. The irony is that the mental traits of which self-deception is (...) a spandrel/byproduct are themselves rational. (shrink)

This essay discusses Peter Langland-Hassan's approach to "explaining imagination" as it plays out in his recent book of that title. Langland-Hassan offers a theory of “attitude imagining” that avoids positing what he calls a “sui generis cognitive attitude.” This theory attempts to explain things like pretend play, hypothetical reasoning, and cognition of fiction; to explain them using only (what he calls) more “basic” mental states like beliefs and desires; and thus to explain them without positing a distinct cognitive attitude of (...) imagining, as many theorists do (including me). In other words, “attitude imagining,” for Langland-Hassan, is whatever explains those things (except for a distinct cognitive attitude of imagining itself). Despite the theoretical interest of this approach, I argue it is ontologically pennywise and pound foolish: for a slight savings in ontological complexity it dramatically reduces explanatory power. (shrink)

Axel Honneth draws a distinction between three types of recognition: (1) love, (2) respect and (3) social esteem. In his The Struggle for Recognition, the recognition of cultural particularity is situated in the third sphere. It will here be argued that the logic of recognition of cultural identity also demands a non-evaluative recognition, namely a respect for difference. Difference-respect is formal because it is a recognition of the value of a particular culture not "for society" or "as such", but for (...) the social group involved. Yet, although it is formal, difference-respect cannot be reduced to respect for personal autonomy and its preconditions, as Honneth wrongly suggests in Redistribution or Recognition? It is argued here that difference-respect is oriented towards another dimension of the person, namely social attachments. This kind of respect entails a separate register of formal recognition with a corresponding concept of personal identity and a parallel category of social disrespect. What morally justifies difference-respect from a recognition-theoretic approach is the practical relation-to-self that thus becomes possible, namely self-respect as a sense of belonging. The formal conception of the good life that Honneth articulates should include the insight that this sense of belonging is as much a necessary condition for the good life as is personal autonomy. (shrink)

Recent analysis of genome sequences has identified individuals that are healthy despite carrying severe disease‐associated mutations. A possible explanation is that these individuals carry a second genomic perturbation that can compensate for the detrimental effects of the disease allele, a phenomenon referred to as suppression. In model organisms, suppression interactions are generally divided into two classes: genomic suppressors which are secondary mutations in the genome that bypass a mutant phenotype, and dosage suppression interactions in which overexpression of a suppressor gene (...) rescues a mutant phenotype. Here, we describe the general properties of genomic and dosage suppression, with an emphasis on the budding yeast. We propose that suppression interactions between genetic variants are likely relevant for determining the penetrance of human traits. Consequently, an understanding of suppression mechanisms may guide the discovery of protective variants in healthy individuals that carry disease alleles, which could direct the rational design of new therapeutics. (shrink)

ion is arguably one of the most important methods in modern science in analysing and understanding complex phenomena. In his book The Philosophy of Information, Floridi (The philosophy of information. Oxford University Press, Oxford, 2011) presents the method of levels of abstraction as the main method of the Philosophy of Information. His discussion of abstraction as a method seems inspired by the formal methods and frameworks of computer science, in which abstraction is operationalised extensively in programming languages and design methodologies. (...) Is it really clear what we should understand by levels of abstraction? How should they be specified? We will argue that levels of abstraction should be augmented with annotations, in order to express semantic information for them and reconcile the method of level of abstraction (LoA’s) with other approaches. We discuss the extended method when applied e.g. to the analysis of abstract machines. This will lead to an example in which the number of LoA’s is unbounded. (shrink)

The self-notion is an essential constituent of any self-belief or self-knowledge. But what is the self-notion? In this paper, I tie together several themes from the philosophy of John Perry to explain how he answers this question. The self-notion is not just any notion that happens to be about the person in whose mind that notion appears, because it's possible to have ways of thinking about oneself that one doesn't realize are about oneself. Characterizing the self-notion properly (and hence self-belief (...) and self-knowledge) requires understanding the role of that notion in tracking agent-relative information and motivating normally self-effecting ways of acting. [Note: the file here is an uncorrected proof. Please see the final book, now called _Identity, Language, and Mind_, for citation purposes.]. (shrink)

_ Source: _Volume 35, Issue 1, pp 158 - 167 This paper deals with the influence of De veritate on Van Limborch’s Amica collatio cum erudito Judaeo, which is often considered as an early example of interfaith dialogue in a tolerant atmosphere. The first section introduces the Remonstrant theologian Van Limborch, with special attention to his relation to Grotius. The second section focuses on the Collatio. Van Limborch’s discussion partner Orobio de Castro is introduced. The way in which the dialogue (...) develops is sketched: it starts in a reasonable mode, but towards the end Van Limborch’s tone can hardly be called ‘friendly’ anymore. He cannot accept that a reasonable man does not see the superiority of Jesus, and tries to convert his discussion partner. The third section summarizes the influence of Grotius on the Collatio. Van Limborch learned from him not to argue about dogmatic constructions, but to start from the Bible and its unquestionable revelations. He follows the logic of De veritate, Book II and III, arguing that the truth about Jesus can only be proven from the New Testament, which contains reliable testimonies to him and his miracles. He follows the tenor of Book v as well, arguing that the Jews should look upon the miracles of Jesus as sufficiently attested and greater than those of Moses, and therefore should convert themselves. On closer analysis the Collatio can hardly be considered as an example of interfaith tolerance, neither can Grotius’ De veritate. (shrink)

In spite of the seminal work A Philosophical Basis of Medical Practice, the debate on the task and goals of philosophy of medicine still continues. From an European perspective it is argued that the main topics dealt with by Pellegrino and Thomasma are still particularly relevant to medical practice as a healing practice, while expressing the need for a philosophy of medicine. Medical practice is a discursive practice which is highly influenced by other discursive practices like science, law and economics. (...) Philosophical analysis of those influences is needed to discern their effect on the goals of medicine and on the ways in which the self-image of man may be changed. The nature of medical practice and discourse itself makes it necessary to include different philosophical disciplines, like philosophy of science, of law, ethics, and epistemology. Possible scenario's of euthanasia and the human genome project in the USA and Europe are used to exemplify how philosopy of medicine can contribute to a realistic understanding of the problems which are related to the goals of medicine and health care. (shrink)

The moral justification of Will Kymlicka's theory of minority rights is unconvincing. According to Kymlicka, cultural embeddedness is a necessary condition for personal autonomy (which is, in turn, the precondition for the good life) and for that reason liberals should be concerned about culture. I will criticize this instrumentalism of social attachments and the moral monism behind it. On the basis of a modification of Axel Honneth's theory of recognition, I will reject the false opposition between the instrumental value and (...) the intrinsic value of culture. Honneth makes a distinction between three types of recognition: (1) love; (2) respect; and (3) social esteem. Recognition of cultural difference is situated in the third sphere. But the logic of a recognition of cultural difference also demands a non-evaluative recognition, a respect for difference. Difference-respect cannot be reduced to the recognition of personal autonomy or to the recognition of a culture ‘as such’. Difference-respect is concerned with a formal recognition of difference, namely the recognition of a culture's intrinsic value for the other. By recognizing the moral importance both of personal autonomy and of social attachments, we do not have to surrender to the reductive bent in modern moral philosophy. 1 Key Words: Axel Honneth • identity • instrumentalism • intrinsic value of culture • moral justification • multiculturalism • recognition • value pluralism • Will Kymlicka. (shrink)

This paper claims that the standard characterization of the motivational role of belief should be supplemented. Beliefs do not only, jointly with desires, cause and rationalize actions that will satisfy the desires, if the beliefs are true; beliefs are also the practical ground of other cognitive attitudes, like imagining, which means beliefs determine whether and when one acts with those other attitudes as the cognitive inputs into choices and practical reasoning. In addition to arguing for this thesis, I take issue (...) with Velleman's argument that belief and imagining cannot be distinguished on the basis of motivational role. (shrink)