This is the first modern edition of the works of Lady Mary Shepherd, one of the most important women philosophers of the early modern period. Shepherd has been widely neglected in the history of philosophy, but her work engaged with the dominant philosophers of the time - among them Hume, Berkeley, and Reid. In particular, her 1827 volume Essays on the Perception of an External Universe outlines a theory of causation, perception, and knowledge which Shepherd presents as (...) an alternative to what she sees as the mistaken views of Berkeley and Hume. What she ultimately presents is an original and systematic metaphysics and epistemology. Shepherd's Essays consists of two parts. The first is a theory of perception and knowledge of the external world, which is designed to rebut idealism and skepticism about the external world and show that our ordinary beliefs are based on reason. The second is a collection of essays on topics in metaphysics and epistemology, including the immateriality and eternity of the mind, the relationship between mind and body, the possibility of miracles, the association of ideas, the relationship between physical and mathematical reasoning, and the epistemology of testimony. Antonia LoLordo's edition of Shepherd's Essays includes scholarly notes throughout the text that provide historical and philosophical context and expand on the major concepts of Shepherd's system. Her extensive introduction to Shepherd's life and works surveys some of the major points of Shepherd's system, points out directions for future research, and offers guidance for readers planning to teach her work in their courses. This volume is an invaluable primary resource for scholars, graduate students, and undergraduates interested in metaphysics, epistemology, and early modern philosophy. (shrink)

One necessary condition on any adequate account of perception is clarity regarding whether unconscious perception exists. The issue is complicated, and the debate is growing in both philosophy and science. In this paper we consider the case for unconscious perception, offering three primary achievements. First, we offer a discussion of the underspecified notion of central coordinating agency, a notion that is critical for arguments that purportedly perceptual states are not attributable to the individual, and thus not genuinely perceptual. We develop (...) an explication of what it is for a representational state to be available to central coordinating agency for guidance of behavior. Second, drawing on this explication, we place a more careful understanding of the attributability of a state to the individual in the context of a range of empirical work on vision-for-action, saccades, and skilled typing. The results place pressure on the skeptic about unconscious perception. Third, reflecting upon broader philosophical themes running through debates about unconscious perception, we highlight how our discussion places pressure on the view that perception is a manifest kind, rather than a natural kind. In doing so, we resist the tempting complaint that the debate about unconscious perception is merely verbal. (shrink)

Mary Shepherd's An Essay upon the Relation of Cause and Effect, first published in 1824, was a pioneering work in metaphysics and epistemology. Together with her 1827 Essays on the Perception of an External Universe, they make her one of the most important philosophers of her era. Although widely neglected by the history of philosophy in the decades after her death, her works have recently begun to attract the attention and sustained study they deserve. In the course of her (...) writings, Shepherd offers trenchant and detailed rebuttals of the arguments and conclusions of many prominent predecessors-including George Berkeley, Thomas Reid, Dugald Stewart, Thomas Brown, William Lawrence, and especially David Hume-but she is no merely negative thinker. On the contrary, her critiques are always in the service of her own distinctive and highly original doctrines, which are of striking contemporary interest. Appearing two hundred years after its original publication, this is the first full modern edition of her first book, which presents and defends the theory of causation and scientific knowledge that constitutes the cornerstone of her entire philosophy. The edition includes an extensive introduction and scholarly notes throughout that provide historical and philosophical context while explaining the central ideas of the work. It also includes Shepherd's two essays published in 1828 and all of her known letters-all but one of them published here for the first time-which shed significant additional light on her philosophical ideas. (shrink)

It is natural to think that at root, agents are beings that act. Agents do more than this, however – agents omit to act. Sometimes agents do so intentionally. How should we understand intentional omission? Recent accounts of intentional omission have given causation a central theoretical role. The move is well-motivated. If some form of causalism about intentional omission can successfully exploit similarities between action and omission, it might inherit the broad support causalism about intentional action enjoys. In this paper (...) I consider the prospects for causalism about intentional omission. I examine two recent proposals: one Carolina Sartorio (2009) defends, and one Randolph Clarke (2010a) defends. I argue these versions fail, and for a similar reason. Reflection on the function of intention for agency brings this reason to light, and motivates a novel causalism about intentional omission. On the account I go on to defend necessarily, an agent J intentionally omits to A only if an intention of J’s with relevant content (or the intention’s acquisition) causes in J a disposition not to A. Though the causal work done by intentions to omit differs in some cases from the causal work done by intentions to act, it turns out that causalism about intentional behavior (i.e., about action and omission) is viable. (shrink)

Allison, Lyn; Cannold, Leslie It is great to see such a good turnout for this important occasion and I congratulate the Humanist Society again on this award. It really makes a difference to people's lives: when they get the award, when they know about it, when there is publicity for the person concerned. It is an all-round good thing to do and I congratulate you for it.

It seems obvious that phenomenally conscious experience is something of great value, and that this value maps onto a range of important ethical issues. For example, claims about the value of life for those in a permanent vegetative state, debates about treatment and study of disorders of consciousness, controversies about end-of-life care for those with advanced dementia, and arguments about the moral status of embryos, fetuses, and non-human animals arguably turn on the moral significance of various facts about consciousness. However, (...) though work has been done on the moral significance of elements of consciousness, such as pain and pleasure, little explicit attention has been devoted to the ethical significance of consciousness. In this book Joshua Shepherd presents a systematic account of the value present within conscious experience. This account emphasizes not only the nature of consciousness, but the importance of items within experience such as affect, valence, and the complex overall shape of particular valuable experiences. Shepherd also relates this account to difficult cases involving non-humans and those with disorders of consciousness, arguing that the value of consciousness influences and partially explains the degree of moral status a being possesses, without fully determining it. The upshot is a deeper understanding of both the moral importance of phenomenal consciousness and its relations to moral status. This book will be of great interest to philosophers and students of ethics, bioethics, philosophy of psychology, philosophy of mind and cognitive science. (shrink)

Like Alice following the white rabbit into a topsy-turvy world where the laws of logic don't apply, subversive thinking unearths the mysteries behind the mundane. Tracking the White Rabbit is a fascinating, original work that invites us to use depth psychology to challenge our deepest assumptions about world politics, theology, social norms, everyday speech, and usual ideas of sex and emotion. Raised in an environment of McCarthyism and rock-and-roll, Jungian analyst Lyn Cowan shows readers-through provocative essays on memory and homosexuality, (...) music and the art of cursing-that we can flip our ingrained attitudes on their heads and achieve a better understanding of our cultural landscape. America has been plagued by a flattening of its psychic life, Cowan argues, exhibited in the escalating need for external stimulation and the distrust of intense emotion. With humor and insight, she confronts the "isms" that entrap our imaginations (capitalism, fundamentalism, feminism, sexism, antisemitism, communism) in order to unearth a more soul-serving culture. Encouraging us to mine the creativity of spontaneous imagination, this psychology brings dramatic new ideas and themes into focus, breaking down barriers and yielding fresh perspectives on some of the more pressing individual dilemmas of our time: abortion, gender, language, homosexuality, and victimization. (shrink)

What are the folk-conceptual connections between free will and consciousness? In this paper I present results which indicate that consciousness plays central roles in folk conceptions of free will. When conscious states cause behavior, people tend to judge that the agent acted freely. And when unconscious states cause behavior, people tend to judge that the agent did not act freely. Further, these studies contribute to recent experimental work on folk philosophical affiliation, which analyzes folk responses to determine whether folk views (...) are consistent with the view that free will and determinism are incompatible (incompatibilism) or with the opposite view (compatibilism). Conscious causation of behavior tends to elicit pro-free will judgments, even when the causation takes place deterministically. Thus, when controlling for consciousness, many folk seem to be compatibilists. However, participants who disagree with the deterministic or cognitive scientific descriptions given of human behavior tend to give incompatibilist responses. (shrink)

This article uses diary data from the most recent Australian Bureau of Statistics Time Use Survey to compare by gender total child care time calculated in the measurements of main activity, main or secondary activity, and total time spent in the company of children. It also offers an innovative gender comparison of relative time spent in the activities that constitute child care, child care as double activity, and time with children in sole charge. These measures give a fuller picture of (...) total time commitment to children and how men and women spend that time than has been available in previous time use analyses. The results indicate that compared to fathering, mothering involves not only more overall time commitment but more multitasking, more physical labor, a more rigid timetable, more time alone with children, and more overall responsibility for managing care. These gender differences in the quantity and nature of care apply even when women work full-time. (shrink)

Consciousness-based approaches to non-human moral status maintain that consciousness is necessary for (some degree or level of) moral status. While these approaches are intuitive to many, in this paper I argue that the judgment that consciousness is necessary for moral status is not secure enough to guide policy regarding non-humans, that policies responsive to the moral status of non-humans should take seriously the possibility that psychological features independent of consciousness are sufficient for moral status. Further, I illustrate some practical consequences (...) of calling consciousness-based views into question. (shrink)

My topic is the intelligent guidance of action. In this paper I offer an empirically grounded case for four ideas: that [a] cognitive processes of practical reasoning play a key role in the intelligent guidance of action, [b] these processes could not do so without significant enabling work done by both perception and the motor system, [c] the work done by perceptual and motor systems can be characterized as the generation of information specialized for action guidance, which in turn suggests (...) that [d] the cognitive processes of practical reasoning that play a key role in the guidance of intelligent action are not the abstract, syllogistic ones philosophers often treat as the paradigm of practical reasoning. Rather, these cognitive processes are constrained by, and work well with, the specialized concepts outputted by perception and the feedback outputted by sensorimotor processes. (shrink)

The Shape of Agency offers interlinked explanations of the basic building blocks of agency, as well as its exemplary instances. The first part offers accounts of a collection of related phenomena that have long troubled philosophers of action: control over behaviour, non-deviant causation, and intentional action. These accounts build on earlier work in the causalist tradition, and undermine the claims made by many that causalism cannot offer a satisfying account of non-deviant causation, and therefore fails as an account of intentional (...) action. The second part turns to modes of agentive excellence—ways that agents display quality of form—providing a novel account of skill, including an account of the ways that agents display more or less skill. Shepherd discusses the role of knowledge in skill, and concludes that while knowledge is often important, it is inessential. This leads to a discussion of the way that knowledge of action and knowledge of how to act informs action execution. Knowledgeable action includes a unique epistemic underpinning: in knowledgeable action, the agent has authoritative knowledge of what she is doing and how she is doing it when and because she is poised to control her action by way of practical reasoning. (shrink)

Background: Research involving adults lacking mental capacity relies on the involvement of a proxy or surrogate, although this raises a number of ethical concerns. Empirical studies have examined attitudes towards proxy decision-making, proxies’ authority as decision-makers, decision accuracy, and other relevant factors. However, a comprehensive evidence-based account of proxy decision-making is lacking. This systematic review provides a synthesis of the empirical data reporting the ethical issues surrounding decisions made by research proxies, and the development of a conceptual framework of proxy (...) decision-making for research. Methods: A systematic review was conducted according to PRISMA guidelines. Databases including MEDLINE, EMBASE, and CINAHL were searched using a combination of search terms, and empirical data from eligible studies were retrieved. The review followed the framework synthesis approach to refine and develop a conceptual framework. Results: Thirty-four studies were included in the review. Two dimensions of proxy decision-making emerged. The ethical framing criteria of decision-making used by proxies: use of a substituted judgement, use of a best interests approach, combination of substituted judgement and best interests, and ‘something else’, and the active elements of proxy decision-making: ‘knowing the person’, patient-proxy relationship, accuracy of the decision, and balancing risks, benefits and burdens, and attitudes towards proxy decision-making. Interactions between the framing criteria and the elements of decision-making are complex and contextually-situated. Conclusions: The findings from this systematic review challenge the accepted reductionist account of proxy decision-making. Decision-making by research proxies is highly contextualized and multifactorial in nature. The choice of proxy and the relational features of decision-making play a fundamental role: both in providing the proxy’s authority as decision-maker, and guiding the decision-making process. The conceptual framework describes the relationship between the framing criteria used by the proxy, and the active elements of decision-making. Further work to develop, and empirically test the proposed framework is needed. (shrink)

Necessarily, if S lacks the ability to exercise control, S is not an agent. If S is not an agent, S cannot act intentionally, responsibly, or rationally, nor can S possess or exercise free will. In spite of the obvious importance of control, however, no general account of control exists. In this paper I reflect on the nature of control itself. I develop accounts of control ’s exercise and control ’s possession that illuminate what it is for degrees of control (...) —that is, the degree of control an agent possesses or exercises in a given circumstance—to vary. Finally, I demonstrate the usefulness of the account on offer by showing how it generates a solution to a long-standing problem for causalist theories of action, namely, the problem of deviant causation. (shrink)

To a first approximation, ‘bodily skill’ refers to the capacity to successfully utilize the body in the world to achieve goals. But the body is complex, and bodily skill manifests in many different ways. Further, work on bodily skill spans the philosophy of mind, action, and cognitive science, as well as the sciences of motor control and perception. This chapter aims to provide an overview of recent themes and key ideas. First, we review work on the nature of skill as (...) such. Second, we discuss ways theorists have discussed the implementation of skill in the human body, and a theoretical difficulty associated with explanations of implementation. Third, we discuss the importance of the idea of a hierarchical representational architecture for understanding skill’s implementation, and various ways this architecture can be made more sophisticated. Fourth, we discuss work that attempts to understand skill execution on-the-fly, and in particular, work that attempts to understand the connection between intentions and motor representations, and the connection between implicit sensorimotor adaptation and explicit planning and executive control. Fifth, we discuss work on the models that assist fine-grained skill execution, as well as the idea that even at rapid, fine-grained motoric levels, one finds intelligent systems and mechanisms supporting skill. Finally, we consider the place of bodily awareness in an account of bodily skill. (shrink)

Rodney Syme, retired medical doctor, urologist and advocate for medically assisted dying for 20 years, has helped scores of people die peacefully - people whose suffering has become unbearable to them. He takes on governments, the law and the medical profession. Most recently he won his challenge of an order by the Medical Board of Australia to prohibit him from doing anything that has the primary purpose of ending a person's life. The case in question was a 71-year-old man dying (...) of tongue and lung cancer whose life, the man said, was as miserable as hell. The Medical Board argued that the assistance in dying was a departure from accepted standards and presented a significant risk to that person. (shrink)

Older single women in Australia are increasingly experiencing homelessness. Age and gender seem inherently related to single older women’s housing crises, but no attempt has been made to account for the causes of their homelessness through an intersectional lens. This article develops a complex and contingent causal explanation of the structures and mechanisms implicated in growing homelessness for this group. We demonstrate an original use of critical realist-informed intersectional analysis which is characterized by stratified social ontology and emergence. We theoretically (...) reframe existing literature to demonstrate how the intersectional causal powers of gender and age (‘gender*age’) discrimination and conventional life course experiences intersect to generate financial precarity for older women. Our causal model explains how economic insecurity, structural and individual contexts, and crisis events interact, challenging older women’s housing security and precipitating first-time homelessness later in life. (shrink)

(2002). The Making of American Audiences: From Stage to Television, 1750–1990. Ethics, Place & Environment: Vol. 5, No. 3, pp. 285-287.

Journal of Mass Media Ethics, Volume 27, Issue 1, Page 60-62, January-March.

The women's sensation novel of the 1860s and the New Woman fiction of the 1890s were two major examples of a perceived feminine invasion of fiction which caused a critical furore in their day. Both genres, with their shocking, `fast' heroines, fired the popular imagination by putting female sexuality on the literary agenda and undermining the `proper feminine' ideal to which nineteenth-century women and fictional heroines were supposed to aspire. By exploring in impressive depth and breadth the material and discursive (...) conditions in which these novels were produced, The `Improper' Feminine draws attention to key gendered interrelationships within the literary and wider cultures of the mid-Victorian and fin-de-diècle periods. (shrink)

Older single women in Australia are increasingly experiencing homelessness. Age and gender seem inherently related to single older women’s housing crises, but no attempt has been made to account for the causes of their homelessness through an intersectional lens. This article develops a complex and contingent causal explanation of the structures and mechanisms implicated in growing homelessness for this group. We demonstrate an original use of critical realist-informed intersectional analysis which is characterized by stratified social ontology and emergence. We theoretically (...) reframe existing literature to demonstrate how the intersectional causal powers of gender and age (‘gender*age’) discrimination and conventional life course experiences intersect to generate financial precarity for older women. Our causal model explains how economic insecurity, structural and individual contexts, and crisis events interact, challenging older women’s housing security and precipitating first-time homelessness later in life. (shrink)

The scientific discovery of a range of genetic mutations has meant that people with a strong family history of cancer can find out whether they are at risk of developing cancer well before they have any symptoms. Genetic testing has opened up the possibility for otherwise healthy mutation carriers to access prophylactic treatments in order to minimise their risk. These include surgery to remove at-risk body parts, treatment with cancer drugs, medical surveillance strategies, self-surveillance and change in lifestyle. Clinical experience (...) to date has shown considerable resistance to the uptake of medical preventative measures despite their promise of risk reduction. This paper provides a summary review of the available literature on the medical, psychological, counselling and social aspects of genetic testing and the use of risk-reducing treatments by people who have been diagnosed with a genetic predisposition to cancer. It acknowledges what has been learned from these approaches but points to the similarity of the philosophical underpinnings of most of the research. It concludes by tentatively making some suggestions, informed by the literature, about new directions for guiding our understanding the genetically at risk and the factors that influence their decision-making. (shrink)

You can use the power that roams your nocturnal mind to improve your daily life. Learn what dream work is and how it has been practiced from ancient times to the present, for healing, for self-development, and as a means of contacting the creative inner self. Dream-work techniques, like remembering and recording, incubation, gestalt, guided visualization, working with symbols, and a host of others, will help you reach your goals. Understand what each dream symbol means to you, in essence piecing (...) together an unconscious story of your experiences. (shrink)

This paper draws on data from the most recent Australian Bureau of Statistics (ABS) Time Use Survey (TUS) (over 4,000 randomly selected households) to tease out the dimensions of the ‘second shift’. Predictions that as women entered the paid workforce men would contribute more to household labour have largely failed to eventuate. This underpins the view that women are working a second shift because they are shouldering a dual burden of paid and unpaid work. However, time use research seems to (...) show that when both paid and unpaid work is counted, male and female workloads are in total very similar. This has led to suggestions that a literal second shift is a myth; that it exists in the sense that women do more domestic work than men, but not in the sense that they work longer hours in total. Using a more accurate and telling measure of workload than previous research (paid and unpaid labour including multitasked activities), this paper explores the second shift and how it relates to family configuration, ethnicity and indicators of class and socioeconomic standing. It finds a clear disparity between the total workloads of mothers and fathers, much of which consists of simultaneous (secondary) activity, and some demographic differences in female (but not male) total workloads. It concludes that the view that the second shift is a myth is only sustainable by averaging social groups very broadly and by excluding multitasking from the measurement of total work activity. (shrink)

In this interesting paper, Lavazza and Massimini draw attention to a subset of the ethical issues surrounding the development and potential uses of cerebral organoids. This subset concerns the possibility that cerebral organoids may one day develop phenomenal consciousness, and thereby qualify as conscious subjects—that there may one day be something it is like to be an advanced cerebral organoid. This possibility may feel outlandish. But as Lavazza and Massimini demonstrate, the science of organoids is moving fast, and I agree (...) that the ethical issues now deserve careful scrutiny. The ethical issues are not entirely separate from epistemological issues concerning how certain we could ever be (a) that an organoid is conscious or (b) that regarding any conscious state or process, an organoid is capable of tokening that state or undergoing that process. Lavazza and Massimini’s approach is theory-based—they claim that ‘we need a general theory of consciousness that attempts to explain what experience is and what type of physical systems can have it’. I am not convinced, however, that a theory of consciousness is what we need. Nor am I convinced that detecting the presence of consciousness is the most important moral issue. Let me say a word regarding theories of consciousness first. In general, to the extent that pervasive disagreement characterises expert discussion of some phenomenon P, one should modify one’s credence downward regarding any theory of the nature of P. In my view, this is the case regarding expert discussion of consciousness. Although most philosophers are confident that consciousness is an entirely physical phenomenon, a …. (shrink)

In this paper it is argued that physicians’ restrictive attitudes in offering abortions during 1946–1965 in Sweden were due to their private values. The values, however, were rarely presented openly. Instead physicians’ values influenced their assessment of the facts presented—that is, the women's’ trustworthiness. In this manner the physicians were able to conceal their private values and impede the women from getting what they wanted and needed. The practice was concealed from both patients and physicians and never publicly discussed. It (...) is also argued that a similar tacit practice could currently be applied by palliative care physicians. Such practice might allow palliative care physicians to be restrictive when offering sedation therapy without appearing paternalistic or declaring conscientious objections. However, the practice runs counter to patients’ right to participate in making decisions. The women seeking abortion began to oppose the situation and eventually a new abortion law was introduced 1975. Patients at the end of life will never be able to protest against palliative care physicians’ restrictive attitudes. This is a vulnerable and weak group, unable to lodge complaints after the treatment. In order to respect patients’ autonomy, even suffering patients at the end of their lives, it is suggested that physicians should openly declare their values when it comes to providing treatments that might shorten life. Such transparency might facilitate more genuine shared decision-making and accordingly less suboptimal end-of-life care. (shrink)

Clinical decisions are expected to be based on factual evidence and official values derived from healthcare law and soft laws such as regulations and guidelines. But sometimes personal values instead influence clinical decisions. One way in which personal values may influence medical decision-making is by their affecting factual claims or assumptions made by healthcare providers. Such influence, which we call ‘value-impregnation,’ may be concealed to all concerned stakeholders. We suggest as a hypothesis that healthcare providers’ decision making is sometimes affected (...) by value-impregnated factual claims or assumptions. If such claims influence e.g. doctor–patient encounters, this will likely have a negative impact on the provision of correct information to patients and on patients’ influence on decision making regarding their own care. In this paper, we explore the idea that value-impregnated factual claims influence healthcare decisions through a series of medical examples. We suggest that more research is needed to further examine whether healthcare staff’s personal values influence clinical decision-making. (shrink)

Common-sense folk psychology and mainstream philosophy of action agree about decisions: these are under an agent's direct control, and are thus intentional actions for which agents can be held responsible. I begin this paper by presenting a problem for this view. In short, since the content of the motivational attitudes that drive deliberation and decision remains open-ended until the moment of decision, it is unclear how agents can be thought to exercise control over what they decide at the moment of (...) deciding. I note that this problem might motivate a non-actional view of deciding?a view that decisions are not actions, but are instead passive events of intention acquisition. For without an understanding of how an agent might exercise control over what is decided at the moment of deciding, we lack a good reason for maintaining commitment to an actional view of deciding. However, I then offer the required account of how agents exercise control over decisions at the moment of deciding. Crucial to this account is an understanding of the relation of practical deliberation to deciding, an understanding of skilled deliberative activity, and the role of attention in the mental action of deciding. (shrink)

Background Physician-assisted suicide is a controversial issue and has sometimes raised emotion-laden reactions. Against this backdrop, we have analyzed how Swedish physicians are reasoning about physician-assisted suicide if it were to be legalized. Methods and participants We conducted a cross-sectional study and analyzed 819 randomly selected physicians’ responses from general practitioners, geriatricians, internists, oncologists, psychiatrists, surgeons, and all palliativists. Apart from the main questions about their attitude toward physician-assisted suicide, we also asked what would happen with the respondents’ own trust (...) in healthcare if physician-assisted suicide were legalized. Response options were that trust would decrease, not be influenced, or would increase. Results We identified a strong statistical association between on the one hand those whose own trust would increase and who were pro physician-assisted suicide, and on the other hand those who were against physician-assisted suicide and whose own trust would decrease [relative risk: 16.7 (95% confidence interval: 10.2–27.2)]. Among those whose own trust would not be influenced (n = 456), 60% were pro pysician-assisted suicide, 16% were against, and 24% were undecided. Of those whose trust would increase or not be influenced, a large majority supported autonomy-based arguments, whereas those whose trust would decrease supported non-maleficence-based arguments. Conclusion Analyzing the answers after having divided respondents into those whose own trust in healthcare would decrease or increase and not be influenced brings about interesting results such as how the three groups prioritize arguments for and against physician-assisted suicide. This way of analyzing the data seems to be a promising strategy when identifying value-impregnated factual claims. (shrink)

The rise of experimental philosophy has placed metaphilosophical questions, particularly those concerning concepts, at the center of philosophical attention. X-phi offers empirically rigorous methods for identifying conceptual content, but what exactly it contributes towards evaluating conceptual content remains unclear. We show how x-phi complements Rudolf Carnap’s underappreciated methodology for concept determination, explication. This clarifies and extends x-phi’s positive philosophical import, and also exhibits explication’s broad appeal. But there is a potential problem: Carnap’s account of explication was limited to empirical and (...) logical concepts, but many concepts of interest to philosophers are essentially normative. With formal epistemology as a case study, we show how x-phi assisted explication can apply to normative domains. (shrink)

We have examined healthcare staff attitudes of toward a blogging cancer patient who publishes critical posts about her treatment and their possible effect on patient-staff relationships and treatment decisions. We used two versions of a questionnaire containing a vignette based on a modified real case involving a 39-year-old cancer patient who complained on her blog about how she was encountered and the treatment she received. Initially she was not offered a new, and expensive treatment, which might have influenced her perception (...) of further encounters. In one version of the vignette, the team decides to put extra effort into both encounters and offers the expensive new cancer treatment. In the other version, the team decides to follow the clinic’s routine to the letter. Subsequently, blog postings became either positive or negative in tone. We also divided participants into value-neutral and value-influenced groups by asking how their trust in healthcare would be affected if the team’s suggestion were followed. A total of 56 % of the respondents faced with a team decision to ‘do something-extra’ in encounters would act in accordance with this ambition. Concerning treatment, 32 % would follow the team’s decision to offer a new and expensive treatment. A large majority of those who received the “follow-routine” version agreed to do so in encountering [94 % ]. Similar proportions were found regarding treatment [86 % ]. A total of 83 % of the value-neutral participants who received the “do-something-extra” version stated that they would act as the team suggested regarding encounters, while 57 % would do so in regard to treatment. Among the value-influenced participants who received the “do-something-extra” version, 45 % stated that they would make an extra effort to accommodate the patient and her needs, while the proportion for treatment was 22 %. Among those who had received the “follow-routine” version, a large majority agreed, and no difference was indicated between the value-neutral and the value-influenced participants. The present study indicates that healthcare staff is indeed influenced by reading a patient’s critical blog entries, largely regarding encounters, but also concerning treatment is concerned. Value-neutral healthcare personnel seem to exhibit a pragmatic attitude and be more inclined to heed and respond to a patient whose criticism may well be warranted. The study also indicates that healthcare staff is partly positive or negative to future blogging patients depending on how the issue has been framed. For future research we suggest as a bold hypothesis that the phrase “clinical routine” might conceal power aspects masquerading as adopted ethical principles. (shrink)

The extensive involvement of nonconscious processes in human behaviour has led some to suggest that consciousness is much less important for the control of action than we might think. In this article I push against this trend, developing an understanding of conscious control that is sensitive to our best models of overt action control. Further, I assess the cogency of various zombie challenges—challenges that seek to demote the importance of conscious control for human agency. I argue that though nonconscious contributions (...) to action control are evidently robust, these challenges are overblown. (shrink)

This essay presents an overview of the TRC— its establishment, procedures, and operating principles — and examines the way in which the commission emphasizes forgiveness rather than retribution for past wrongs.

A scientific paradigm typically embraces research norms and values, such as truth-seeking, critical thinking, disinterestedness, and good scientific practice. These values should prevent a paradigm from introducing defective assumptions. But sometimes, scientists who are also physicians develop clinical norms that are in conflict with the scientific enterprise. As an example of such a conflict, we have analyzed the genesis and development of the shaken baby syndrome paradigm. The point of departure of the analysis is a recently conducted systematic literature review, (...) which concluded that there is very low scientific evidence for the basic assumption held by Child Protection Teams: when certain signs are present the infant has been violently shaken. We suggest that such teams have developed more value-based than scientific-based criteria when classifying SBS cases. Further, we suggest that the teams are victims of “groupthink,” aggravating the difficulties in considering critics’ questioning the criteria established by the teams. (shrink)

People who are unable to make decisions about participating in research rely on proxies to make a decision based on their wishes and preferences. However, patients rarely discuss their preferences about research and proxies find it challenging to determine what their wishes would be. While the process of informed consent has traditionally been the focus of research to improve consent decisions, the more conceptually complex area of what constitutes ‘good’ proxy decision-making for research has remained unexplored. Interventions are needed to (...) improve and support proxy decision-making for research but are hampered by a lack of understanding about what constitutes decision quality in this context. A global increase in conditions associated with cognitive impairment such as dementia has led to an urgent need for more research into these conditions. The COVID-19 pandemic and subsequent necessity to conduct research with large numbers of critically ill patients has made this need even more pressing. Much of the empirical research centres on the desire to improve decision accuracy, despite growing evidence that authenticity is more reflective of the aim of proxy decisions and concerns about the methodological flaws in authenticity-focused studies. Such studies also fail to take account of the impact of decision-making on proxies, or the considerable body of research on improving the quality of healthcare decisions. This paper reports a concept synthesis of the literature that was conducted to develop the first conceptualisation of ‘good’ proxy decisions about research participation. Elements of decision quality were identified across three stages of decision-making: proxy preparedness for decision-making which includes knowledge and understanding, and values clarification and preference elicitation; the role of uncertainty, decisional conflict, satisfaction and regret in the decision-making process; and preference linked outcomes and their effect. This conceptualisation provides an essential first step towards the future development of interventions to enhance the quality of proxy decision-making and ensure proxy decisions represent patients’ values and preferences. (shrink)