Background: Moral case deliberation is increasingly becoming part of various Dutch healthcare organizations. Although some evaluation studies of moral case deliberation have been carried out, research into the results of moral case deliberation within aged care is scarce. Research questions: How did participants evaluate moral case deliberation? What has moral case deliberation brought to them? What has moral case deliberation contributed to care practice? Should moral case deliberation be further implemented and, if so, how? Research design: Quantitative analysis of a (...) questionnaire study among participants of moral case deliberation, both caregivers and team leaders. Qualitative analysis of written answers to open questions, interview study and focus group meetings among caregivers and team leaders. Participants and research context: Caregivers and team leaders in a large organization for aged care in the Netherlands. A total of 61 moral case deliberation sessions, carried out on 16 care locations belonging to the organization, were evaluated and perceived results were assessed. Ethical considerations: Participants gave informed consent and anonymity was guaranteed. In the Netherlands, the law does not prescribe independent ethical review by an Institutional Review Board for this kind of research among healthcare professionals. Findings: Moral case deliberation was evaluated positively by the participants. Content and atmosphere of moral case deliberation received high scores, while organizational issues regarding the moral case deliberation sessions scored lower and merit further attention. Respondents indicated that moral case deliberation has the potential to contribute to care practice as relationships among team members improve, more openness is experienced and more understanding for different perspectives is fostered. If moral case deliberation is to be successfully implemented, top-down approaches should go hand in hand with bottom-up approaches. Conclusion: The relevance of moral case deliberation for care practice received wide acknowledgement from the respondents. It can contribute to the team’s cohesion as mutual understanding for one another’s views is fostered. If implemented well, moral case deliberation has the potential to improve care, according to the respondents. (shrink)

The frequent occurrence of comorbidity has brought about an extensive theoretical debate in psychiatry. Why are the rates of psychiatric comorbidity so high and what are their implications for the ontological and epistemological status of comorbid psychiatric diseases? Current explanations focus either on classification choices or on causal ties between disorders. Based on empirical and philosophical arguments, we propose a conventionalist interpretation of psychiatric comorbidity instead. We argue that a conventionalist approach fits well with research and clinical practice and resolves (...) two problems for psychiatric diseases: experimenter’s regress and arbitrariness. (shrink)

In psychiatry, many scientists desire to move from a classification system based on symptoms toward a system based on biological causes. The idea is that psychiatric diseases should be redefined such that each disease would be associated with specific biological causes. This desire is intelligible because causal disease models often facilitate understanding and identification of new ways to intervene in disease processes. In its attempt to move from syndromal to specific etiological definitions, psychiatry follows the trend of general medicine.Current psychiatric...

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Society has already seen multiple potential futures of neurotechnologies through the multifaceted lens of science fiction. We do not know which of those futures we will come to live, but the strong force in society's evolutionary process will likely continue to be the insight and oversight developed by the bioethics community, pushing and being pushed by the advances of technology, improvements in medical care, and market competitiveness.

Due to its extraordinary predictive power and the great generality of its mathematical structure, quantum theory is able, at least in principle, to describe all the microscopic and macroscopic properties of the physical world, from the subatomic to the cosmological level. Nevertheless, ever since the Copen hagen and Gottingen schools in 1927 gave it the definitive formu lation, now commonly known as the orthodox interpretation, the theory has suffered from very serious logical and epistemologi cal problems. These shortcomings were immediately (...) pointed out by some of the principal founders themselves of quantum theory, to wit, Planck, Einstein, Ehrenfest, Schrodinger, and de Broglie, and by the philosopher Karl Popper, who assumed a position of radical criticism with regard to the standard formulation of the theory. The aim of the participants in the workshop on Open Questions in Quantum Physics, which was held in Bari (Italy), in the Department of Physics of the University, during May 1983 and whose Proceedings are collected in the present volume, accord ingly was to discuss the formal, the physical and the epistemo logical difficulties of quantum theory in the light of recent crucial developments and to propose some possible resolutions of three basic conceptual dilemmas, which are posed respectively ~: (a) the physical developments of the Einstein-Podolsky-Rosen argument and Bell's theorem, i. e. (shrink)

Research questions and backgroundThis study explores a highly controversial issue of medical care in Germany: the decision to withhold or withdraw mechanical ventilation in critically ill patients. It analyzes difficulties in making these decisions and the physicians’ uncertainty in understanding the German terminology of Sterbehilfe, which is used in the context of treatment limitation. Used in everyday language, the word Sterbehilfe carries connotations such as helping the patient in the dying process or helping the patient to enter the dying process. (...) Yet, in the legal and ethical discourse Sterbehilfe indicates several concepts: (1) treatment limitation, i.e., withholding or withdrawing life-sustaining treatment (passive Sterbehilfe), (2) the use of medication for symptom control while taking into account the risk of hastening the patient’s death (indirekte Sterbehilfe), and (3) measures to deliberately terminate the patient’s life (aktive Sterbehilfe). The terminology of Sterbehilfe has been criticized for being too complex and misleading, particularly for practical purposes. Materials and methods An exploratory study based on qualitative interviews was conducted with 28 physicians from nine medical intensive care units in tertiary care hospitals in the German federal state of Baden-Wuerttemberg. The method of data collection was a problem-centered, semi-structured interview using two authentic clinical case examples. In order to shed light on the relation between the physicians’ concepts and the ethical and legal frames of reference, we analyzed their way of using the terms passive and aktive Sterbehilfe. Results Generally, the physicians were more hesitant in making decisions to withdraw rather than withhold mechanical ventilation. Almost half of them assumed a categorical prohibition to withdraw any mechanical ventilation and more than one third felt that treatment ought not to be withdrawn at all. Physicians showed specific uncertainty about classifying the withdrawal of mechanical ventilation as passive Sterbehilfe, and had difficulties understanding that terminating ventilation is not basically illegal, but the permissibility of withdrawal depends on the situation. Conclusions The physicians’ knowledge and skills in interpreting clinical ethical dilemmas require specific improvement on the one hand; on the other hand, the terms passive and aktive Sterbehilfe are less clear than desirable and not as easy to use in clinical practice. Fear of making unjustified or illegal decisions may motivate physicians to continue (even futile) treatment. Physicians strongly opt for more open discussion about end-of-life care to allow for discontinuation of futile treatment and to reduce conflict. (shrink)

This book explores some of Kit Fine's outstanding contributions to logic, philosophy of language, philosophy of mathematics, and metaphysics, among others. Contributing authors address in-depth issues about truthmaker semantics, counterfactual conditionals, grounding, vagueness, non-classical consequence relations, and arbitrary objects, offering critical reflections and novel research contributions. Each chapter is accompanied by an extensive commentary, in which Kit Fine offers detailed responses to the ideas and themes raised by the contributors. The book includes a brief autobiography and exhaustive list of his (...) publications to this date. This book is of interest to logicians of all stripes and to analytic philosophers more generally. (shrink)

Talk by members of executive hospital boards influences the organizational positioning of nurses. Talk is a relational leadership practice. Using a qualitative‐interpretive design we organized focus group meetings wherein members of executive hospital boards (7), nurses (14), physicians (7), and managers (6), from 15 Dutch hospitals, discussed the organizational positioning of nursing during COVID crisis. We found that members of executive hospital boards consider the positioning of nursing in crisis a task of nurses themselves and not as a collective, interdependent, (...) and/or specific board responsibility. Furthermore, members of executive hospital boards talk about the nursing profession as (1) more practical than strategic, (2) ambiguous in positioning, and (3) distinctive from the medical profession. Such talk seemingly contrasts with the notion of interdependence that highlights how actors depend on each other in interaction. Interdependence is central to collaboration in hospital crises. In this paper, therefore, we depart from the members of executive hospital boards as leader and “positioner,” and focus on talk—as a discursive leadership practice—to illuminate leadership and governance in hospitals in crisis, as social, interdependent processes. (shrink)

Direct-to-consumer advertising of healthcare products refers to a variety of marketing practices based on a combination of information and promotion strategies directed at consumers through different media such as radio and television broadcasts, newspaper and magazine ads, and, more recently, through the Internet. The principal form of marketing used by the pharmaceutical industry is the distribution of free samples to physicians but DTCA is an increasing part of global promotional spending for prescription drugs. Latest estimates suggest that DTCA now represents (...) an annual $3.2 billion enterprise for the U.S. pharmaceutical industry. Findings from the literature show that these substantial efforts are geared toward the newer pharmaceuticals for chronic conditions with huge market potentials. The lion's share is going to the 20 most prescribed pharmaceuticals. (shrink)

The commentators expressed concerns regarding the relevance and value of non-computational non-symbolic explanations of cognitive performance. But what counts as an “explanation” depends on the pre-theoretical assumptions behind the scenes of empirical science regarding the kinds of variables and relationships that are sought out in the first place, and some of the present disagreements stem from incommensurate assumptions. Traditional cognitive science presumes cognition to be a decomposable system of components interacting according to computational rules to generate cognitive performances (i.e., component-dominant (...) dynamics). We assign primacy to interaction-dominant dynamics among components. Though either choice can be a good guess before the fact, the primacy of interactions is now supported by much recent empirical work in cognitive science. Consequently, in the main, the commentators have failed so far to address the growing evidence corroborating the theory-driven predictions of complexity science. (shrink)

These are the proceedings of the Workshop on Quantum Logic held in Erice (Sicily), December 2 - 9, 1979, at the Ettore Hajorana Centre for Scientific Culture. A conference of this sort was originally proposed by Giuliano Toraldo di Francia, who suggested the idea to Antonino Zichichi, and thus laid the foundation for the Workshop. To both of them we express our appreciation and thanks, also on behalf of the other participants, for having made this conference possible. There were approximately (...) fifty participants; their names and institutions are listed in the text. Quantum logic, which has now a history of some forty or more years, has seen remarkable growth during the sixties and seventies. The papers in the present volume presuppose, by and large, some acquaintance with the elements of the subject. These may be found in the well-known books by J.H. Jauch (Foundations of Quantum Hechanics; Reading, 1968), V.S. Varadarajan (Geometry of Quantum Theory: Princeton, 1968), and C. Piron (Foundations of Quantum Theory; New York, 1976). The initial program for the conference listed about twenty-five invited papers. But in the context of a very active and qualified attendance, other contributions were offered. This volume contains all of them. The program listed six main topics: I. Classification or different areas of quantum logic, and open problems. II. Comparison and unification of different approaches to quantum theories; problems of interpretation. III. Formal quantum logic; axiomatics. IV. Hodal interpretations of quantum logic. v vi FOREWORD V. Quantum set theory. (shrink)

A brain-computer interface technology that can decode the neural signals associated with attempted but unarticulated speech could offer a future efficient means of communication for people with severe motor impairments. Recent demonstrations have validated this approach. Here we assume that it will be possible in future to decode imagined (i.e., attempted but unarticulated) speech in people with severe motor impairments, and we consider the characteristics that could maximize the social utility of a BCI for communication. As a social interaction, communication (...) involves the needs and goals of both speaker and listener, particularly in contexts that have significant potential consequences. We explore three high-consequence legal situations in which neurally-decoded speech could have implications:Testimony, where decoded speech is used as evidence;Consent and Capacity, where it may be used as a means of agency and participation such as consent to medical treatment; andHarm, where such communications may be networked or may cause harm to others. We then illustrate how design choices might impact the social and legal acceptability of these technologies. (shrink)

This paper investigates connectionism's potential to solve the frame problem. The frame problem arises in the context of modelling the human ability to see the relevant consequences of events in a situation. It has been claimed to be unsolvable for classical cognitive science, but easily manageable for connectionism. We will focus on a representational approach to the frame problem which advocates the use of intrinsic representations. We argue that although connectionism's distributed representations may look promising from this perspective, doubts can (...) be raised about the potential of distributed representations to allow large amounts of complexly structured information to be adequately encoded and processed. It is questionable whether connectionist models that are claimed to effectively represent structured information can be scaled up to a realistic extent. We conclude that the frame problem provides a difficulty to connectionism that is no less serious than the obstacle it constitutes for classical cognitive science. (shrink)

Enfleshed: Ecologies of Entities and Beings brings together practitioners, thinkers, and artists from across Eurasia to collectively explore multispecies ecologies. The volume reflects anthrodecentric and embodied approaches to collaboration and knowledge production -- processes that are always interwoven with a multitude of entities and actors. In this book, the contributions flow like a river across the Eurasian continent, branching out into all directions. The contributors engage in an exploration of experimental epistemic alliances, which operate as a way to learn and (...) make new dialogic relations. The conflicts generated by ecological disaster, war, the global economy, identity politics, and the power structures of knowledge production and science here intertwine with shamanisms, rituals, magic, speculation, politics, and poetics. How do we imagine an active and implicated role of the human as one being among other beings? What might this entail, and what might this generate?"--Page 4 of cover. (shrink)

Recent accounts on the global workspace theory suggest that consciousness involves transient formations of functional connections in thalamo-cortico-cortical networks. The level of connectivity in these networks is argued to determine the state of consciousness. Emotions are suggested to play a role in shaping consciousness, but their involvement in the global workspace theory remains elusive. In the present study, the role of emotion in the neural workspace theory of consciousness was scrutinized by investigating, whether unconscious and conscious display of emotional compared (...) to neutral facial expressions would differentially modulate EEG coherence. EEG coherence was measured by means of computing an average EEG coherence value between the frontal, parietal, and midline scalp sites. Objective awareness checks evidenced that conscious identification of the masked facial expressions was precluded. Analyses revealed reductions in EEG coherence in the lower frequency range for the masked as compared to unmasked neutral facial expressions. Crucially, a decline in EEG coherence was not observed for the emotional facial expressions. In other words, the level of EEG coherence did apparently vary as a function of awareness, but not when emotion was involved. The current finding suggests that EEG coherence is modulated by unconscious emotional processes, which extends common views on the global workspace architecture of consciousness. (shrink)

Transcranial magnetic stimulation (TMS) is a method capable of transiently modulating neural excitability. Depending on the stimulation parameters information processing in the brain can be either enhanced or disrupted. This way the contribution of different brain areas involved in mental processes can be studied, allowing a functional decomposition of cognitive behavior both in the temporal and spatial domain, hence providing a functional resolution of brain/mind processes. The aim of the present paper is to argue that TMS with its ability to (...) draw causal inferences on function and its neural representations is a valuable neurophysiological tool for investigating the causal basis of neuronal functions and can provide substantive insight into the modern interdisciplinary and (anti)reductionist neurophilosophical debates concerning the relationships between brain functions and mental abilities. Thus, TMS can serve as a heuristic method for resolving causal issues in an arena where only correlative tools have traditionally been available. (shrink)

The book is an “introductory” reconstruction of Davidson on interpretation —a claim to be taken with a grain of salt. Writing introductory books has become an idol of the tribe. This is a concise book and reflects much study. It has many virtues along with some flaws. Ramberg assembles themes and puzzles from Davidson into a more or less coherent viewpoint. A special virtue is the innovative treatment of incommensurability and of the relation of Davidson’s work to hermeneutic themes. The (...) weakness comes in a certain unevenness. While generally convincing and well written, the book has low points which may leave the reader confused or unconvinced. Davidson is the hero in this book, and our hero is sometimes over idealized. (shrink)

From an epistemological viewpoint, the Forms constitute the objects of true knowledge. From an ontological point of view, they are the principles that underlie the order of the universe.

Probability kinematics is the theory of how subjective probabilities change with time, in response to certain constraints . Rules are classified by the imposed constraints for which the rules prescribe a procedure for updating one's opinion. The first is simple conditionalization , and the second Jeffrey conditionalization . It is demonstrated by a symmetry argument that these rules are the unique admissible rules for those constraints, and moreover, that any probability kinematic rule must be equivalent to a conditionalization preceded by (...) a determination of the values x i to be given to the members of such a partition. Next two rival rules which can go beyond such conditionalization are described. INFOMIN and MTP . Their properties are investigated and compared. (shrink)

OBJECTIVES: Cognitive and sensory difficulties frequently jeopardize informed consent of frail elderly patients This study is the first to test whether preliminary research experience could enhance geriatric patients' capacity to consent. DESIGN/SETTING: A step-wise consent procedure was introduced in a study on fluid balance in geriatric patients. Eligible patients providing verbal consent participated in a try-out of a week, during which bioelectrical impedance and weight measurements were performed daily. Afterwards, written informed consent was requested. Comprehension, risk and inconvenience scores (ranges: (...) 0-10) were obtained before and after the try-out by asking ten questions about the study's essentials and by asking for a risk and inconvenience assessment on a ten-points rating scale. SUBJECTS AND RESULTS: Seventy of the 78 eligible subjects started the try-out and 53 (68%) provided written consent. The comprehension score increased from 5.0 (+/- 2.3) to 7.0 (+/- 1.9) following the try-out (P < 0.001). The number of subjects capable of weighing risks and inconveniences increased from 32 to 48 (P < 0.001). CONCLUSIONS: Research experience improved the capacity to consent, still enabling an acceptable participation rate. Therefore, experienced consent seems a promising tool to optimize informed consent in frail elderly subjects. (shrink)

Kit Fine’s contribution to logic is vast and diverse; the chapters in this book deal with a significant part of it. In this introductory chapter, we clarify and contextualize the main themes of Fine’s work that are centre stage in this book, after which we give a summary of each chapter.

Demonstrates the fertility of the phenomenological tradition of philosophy for intergenerational justice and climate ethics.--In the face of the current environmental crisis, relations with future people—overlapping generations and more distant ones—have moved to the top of political and scholarly agendas. The anthology proposed here seeks to demonstrate the enormous fertility of philosophical phenomenology in accounting for relations among different generations. This is due to phenomenology’s rich reflections on the role of time in the constitution of the social-historical world and its (...) relation to the environment. The volume will boast 11 chapters from different authors across the spectrum of phenomenological currents and subfields, from Husserl and Heidegger to Jonas, Merleau-Ponty and Levinas. A connecting thread will be the relations among mortality, natality, and generativity in connecting as well as separating generations. Authors will reflect on the social-ontological and normative significance of these connections, paying particular attention to political and environmental obligations to people living in the future. (shrink)

In this issue of topiCS, we present the best papers from the ICCM meeting. These best papers represent advances in the state of the art in cognitive modeling. Since ICCM was for the first time also held jointly with the Society for Mathematical Psychology, we use this preface to also reflect on the similarities and differences between mathematical psychology and cognitive modeling.