AimsThis study evaluates a protocol for early, routine ethics consultation for patients on extracorporeal membrane oxygenation to support decision-making in the context of clinical uncertainty with the aim of mitigating ethical conflict and moral distress.MethodsWe conducted a single-site qualitative analysis of EC documentation for all patients receiving ECMO support from 15 August 2018 to 15 May 2019. Detailed analysis of 20 ethically complex cases with protracted ethics involvement identifies four key ethical domains: limits of prognostication, bridge to nowhere, burden of (...) treatment and system-level concerns. There are three subthemes: relevant contextual factors, the role of EC and observed outcomes. Content analysis of transcripts from interviews with 20 members of the multidisciplinary ECMO team yields supplemental data on providers’ perceptions of the impact of the early intervention protocol.ResultsLimited outcome data for ECMO, unclear indications for withdrawal, adverse effects of treatment and an obligation to attend to programme metrics present significant ethical challenges in the care of this patient population. Upstream EC mitigates ethical conflict by setting clear expectations about ECMO as a time limited trial, promoting consistent messaging among multiple services and supporting surrogate decision-makers. When ECMO becomes a ‘bridge to nowhere’, EC facilitates decision-making that respects patient values yet successfully sets limits on non-beneficial use of this novel therapy.ConclusionData from this study support the conclusion that ECMO poses unique ethical challenges that necessitate a standardised protocol for early, routine EC—at least while this medical technology is in its nascent stages. (shrink)

The hopes and fears expressed in the debate on human enhancement are not always based on a realistic assessment of the expected possibilities. Discussions about extreme scenarios may at times obscure the ethical and policy issues that are relevant today. This paper aims to contribute to an adequate and ethically sound societal response to actual current developments. After a brief outline of the ethical debate concerning neuro-enhancement, it describes the current state of the art in psychopharmacological science and current uses (...) of psychopharmacological enhancement, as well as the prospects for the near future. It then identifies ethical issues regarding psychopharmacological enhancements that require attention from policymakers, both on the professional and on the governmental level. These concern enhancement research, the gradual expansion of medical categories, off-label prescription and responsibility of doctors, and accessibility of enhancers on the Internet. It is concluded that further discussion on the advantages and drawbacks of enhancers on a collective social level is still needed. (shrink)

This article discusses the role of moment-to-moment affect dynamics in mental disorder and aims to integrate recent literature on this topic in the context of complex dynamical system theory. First, we will review the relevance of temporal and contextual aspects of affect dynamics in relation to psychopathology. Related to this, we will discuss recent insights resulting from a network view on affect dynamics in psychopathology. Next, we explore how we can reconcile literature findings from a perspective of complex dynamical system (...) theory. Finally, future directions with regard to personalized assessment of risk and diagnostic use are discussed. (shrink)

We demonstrate that the key components of cognitive architectures (declarative and procedural memory) and their key capabilities (learning, memory retrieval, probability judgment, and utility estimation) can be implemented as algebraic operations on vectors and tensors in a high‐dimensional space using a distributional semantics model. High‐dimensional vector spaces underlie the success of modern machine learning techniques based on deep learning. However, while neural networks have an impressive ability to process data to find patterns, they do not typically model high‐level cognition, and (...) it is often unclear how they work. Symbolic cognitive architectures can capture the complexities of high‐level cognition and provide human‐readable, explainable models, but scale poorly to naturalistic, non‐symbolic, or big data. Vector‐symbolic architectures, where symbols are represented as vectors, bridge the gap between the two approaches. We posit that cognitive architectures, if implemented in a vector‐space model, represent a useful, explanatory model of the internal representations of otherwise opaque neural architectures. Our proposed model, Holographic Declarative Memory (HDM), is a vector‐space model based on distributional semantics. HDM accounts for primacy and recency effects in free recall, the fan effect in recognition, probability judgments, and human performance on an iterated decision task. HDM provides a flexible, scalable alternative to symbolic cognitive architectures at a level of description that bridges symbolic, quantum, and neural models of cognition. (shrink)

'Thought insertion' in schizophrenia involves somehow experiencing one's own thoughts as someone else's. Some philosophers try to make sense of this by distinguishing between ownership and agency: one still experiences oneself as the owner of an inserted thought but attributes it to another agency. In this paper, we propose that thought insertion involves experiencing thought contents as alien, rather than episodes of thinking. To make our case, we compare thought insertion to certain experiences of 'verbal hallucination' and show that they (...) amount to different descriptions of the same phenomenon: a quasi-perceptual experience of thought content. We add that the agency/ownership distinction is unhelpful here. What requires explanation is not why a person experiences a type of intentional state without the usual sense of agency, but why she experiences herself as the agent of one type of intentional state rather than another. We conclude by sketching an account of how this might happen. (shrink)

Marjorie Grene has argued in a number of contexts that any attempt to reduce the explanation of human actions to “mechanistic” explanations is doomed to failure in advance because it is absurd. “This argument examines the status of the reductivist thesis in its own terms and reduces it to absurdity …” ; “the attempt to reduce human purposive, or ‘intentional,‘ action to physiology and ultimately to physics and chemistry is an absurdity rather than simply a confusion”. I wish to show (...) that this argument is fallacious because it involves a petitio principii; and if Plato can be credited with introducing the same argument in the Theaetetus, as she suggests, so much the worse for Plato. (shrink)

It is sometimes suggested that expressivism in meta-ethics is to be criticized on grounds which do not themselves concern meta-ethics in particular, but which rather concern philosophy of language more generally. Frank Jackson and Philip Pettit (1998; see also Jackson and Pettit 1999, and Jackson 2001) have recently advanced a novel version of such an argument. They begin by noting that expressivism in its central form makes two claims—that ethical sentences are not truth evaluable, and that to assert an ethical (...) sentence is to express one’s desires or feelings rather than to report a fact. They then argue that, given some plausible premises in the philosophy of language emanating mainly from Locke, the two central claims of expressivism are contradictory: when combined with the plausible premises, they say, the second claim refutes the first. The purpose of this paper is to formulate Jackson and Pettit’s Lockean argument, and to suggest that it fails. (shrink)

Today's modern car is an assemblage of mechanical and digital components, of metal panels that comprise its structure and silicon chips that run its functions. Communication and information studies scholars have interrogated the problematic aspects of the programs that run those functions, revealing serious issues surrounding privacy and security, worker surveillance, and racial, gendered, and class-based bias. This article contributes to that work by taking a step back and asking about the issues inherent not in the software running on these (...) chips, but on the microchips themselves. Using the lens of “chipification”—the process by which a device is rendered capable of reading and processing data through the embedding of microchips—this article explores how the integration of microchips also involves processes that are often borne from, replicate, or create troubling power dynamics of their own. It takes light-duty passenger vehicles as a case study into how chipification is radically reshaping such processes as resource allocation, labor flows, and cultural practices around car manufacture, use, repair, and modification. By naming the process of chipification, this article allows researchers to identify and analyze the ways that integrating data processing capabilities into everyday devices is not a frictionless practice, but rather one that implicates a variety of power dynamics within these massive industries. (shrink)

In the past decades, an enormous amount of precious information has been collected about molecular and genetic characteristics of cancer. This knowledge is mainly based on a reductionistic approach, meanwhile cancer is widely recognized to be a ‘system biology disease’. The behavior of complex physiological processes cannot be understood simply by knowing how the parts work in isolation. There is not solely a matter how to integrate all available knowledge in such a way that we can still deal with complexity, (...) but we must be aware that a deeply transformation of the currently accepted oncologic paradigm is urgently needed. We have to think in terms of biological networks: understanding of complex functions may in fact be impossible without taking into consideration influences outside of the genome. Systems Biology involves connecting experimental unsupervised multivariate data to mathematical and computational approach than can simulate biologic systems for hypothesis testing or that can account for what it is not known from high-throughput data sets. Metabolomics could establish the requested link between genotype and phenotype, providing informations that ensure an integrated understanding of pathogenic mechanisms and metabolic phenotypes and provide a screening tool for new targeted drug. (shrink)

Ghazālī’s The Incoherence of the Philosophers is an unusual philosophical work for a number of reasons, not the least of which is the author’s explicit disavowalof any of the conclusions contained within it. The present essay examines some of the hermeneutical challenges that face readers of the work and offers anexegetical account of the much-neglected Third Discussion, which examines a key point of Neoplatonic metaphysics. The paper argues that Ghazālī’s maintaining of the incompatibility of metaphysical creationism and Neoplatonic emanationism should (...) not be viewed as simply a rhetorical or dialectical argument, but rather is best understood, to use Ghazālī’s words, as a philosophical “proof.” Essential to this proof in the solution to the argument of the Third Discussion is an implicit theory of metaphorical predication that can be pieced together from several of Ghazālī’s remarks as well as a reductio ad absurdum argument about the very possibility of ethical discourse. (shrink)

This article explores yet another paradox – aside from the privacy paradox – related to the datafication of media: citizens trust least the media they use most It investigates the role that daily life plays in shaping the trust that citizens place in datafied media. The study reveals five sets of heuristics guiding the trust assessments of citizens: characteristics of media organisations, old media standards, context of use and purpose, experiences of datafication and understandings of datafication. The article discusses the (...) use of these heuristics and the value that everyday life holds in assessing trust in datafied media. It concludes that, guided by a partial ‘structure of perception’ and enticed into trusting datafied media in the context of their daily lives, citizens may be highly concerned by the datafication of media but use them nevertheless. (shrink)

Critical educational research offers the researcher a position and an ethos of comfort. Even the declared recognition of the relativity of principles, norms or criteria so characteristic of much critical research does not prevent it from looking immediately for a way out of this uncomfortable situation i.e. to keep to the idea that comfort is needed and desirable. However, we suggest that this uncomfortable condition is constitutive for critical educational research and may be even for education as such. Therefore the (...) article can be considered as a genealogical analysis of this comfortable critical research, in which we show how the birth of the milieu of the modern school goes together with the instauration of two forms of a comfortable research ‘ethos’: a research ethos rooted in a pastoral milieu and a research ethos rooted in a bureaucratic milieu. In the last section of the article we indicate that another ‘experimental’ ethos of research is possible, including the acceptance of discomfort. This is the ethos of a critical researcher as an inhabitant of a coming research community and as being exposed to the present. (shrink)

Background In 2002, Belgium set a legal framework for euthanasia, whereby granting and performing euthanasia is entrusted entirely to physicians, and—as advised by Belgian Medical Deontology—in the context of a trusted patient–physician relationship. Euthanasia is, however, rarely practiced, so the average physician will not attain routine in this matter. Aim To explore how general practitioners in Flanders (Belgium) deal with euthanasia. This was performed via qualitative analysis of semistructured interviews with 52 general practitioners (GPs). Results Although GPs can understand a (...) patient's request for euthanasia, their own willingness to perform it is limited, based on their assumption that legal euthanasia equates to an injection that ends life abruptly. Their willingness to perform euthanasia is affected by the demanding nature of a patient's request, by their views on what circumstances render euthanasia legitimate and by their own ability to inject a lethal dose. Several GPs prefer increasing opioid dosages and palliative sedation to a lethal injection, which they consider to fall outside the scope of euthanasia legislation. Conclusions Four attitudes can be identified: (1) willing to perform euthanasia; (2) only willing to perform as a last resort; (3) feeling incapable of performing; (4) refusing on principle. The situation where GPs have to consider the request and—if they grant it—to perform the act may result in arbitrary access to euthanasia for the patient. The possibility of installing transparent referral and support strategies for the GPs should be further examined. Further discussion is needed in the medical profession about the exact content of the euthanasia law. (shrink)

The paper consists of a reflexive exercise in which Herbert Simon 's views concerning science are applied to his own research. It argues that what connected his ventures into so many different disciplinary domains was a search for complex, hierarchical systems. In the process, the paper establishes a close connection between Simon 's insights and his focus on simulation. Instead of simulating Simon on a computer, though, it simulates Simon on paper. This exercise is then contrasted with Simon 's own (...) attempts to simulate science. This comparison leads to a reflexive evaluation of Simon 's simulations. (shrink)

Gay marriages (as such) are not as yet allowed anywhere but the demand for them is increasing. Most countries take a liberal attitude towards marriage: few obstacles are put in its way. But objections to gay marriages continue to be raised. These objections are refuted and the case for gay marriage is assessed through the prism of various forms of liberalism. The normative argument for allowing gay marriage is shown to be both strong and consistent with many of the values (...) upheld by the opponents of such unions. (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)

In lieu of an abstract, here is a brief excerpt of the content:Participation and Immersion in Walton and CalvinoM. Carleton SimpsonThe novel begins in a railway station, a locomotive huffs, steam from a piston covers the opening of the chapter, a cloud of smoke hides part of the first paragraph... The pages of the book are clouded like the windows of an old train, the cloud of smoke rests on the sentences.1Part of Kendall Walton's theory of psychological participation, explicated in (...) Mimesis as Make-Believe, is that representations that display or draw attention to their fictionality discourage participation; part of our enjoyment of representational art is our psychological participation with the representation. The activity of participating comprises the game world, while the material representation comprises the work world. We play games of make-believe with representations, much as children play games with toys or other props. For Walton, the fullest psychological participation arises from the fullest immersion in the game world. Immersion means ignoring or being unaware of the materiality of the work world, attending only to the fictional reality of the work world. It is to "look past" the painted surface, or to become engrossed in the novel's narrative.To the extent that we consider the material of the work, we are distracted from participating in the game prescribed by the work: we do either the one or the other. So, Walton claims "One obvious way in which works sometimes discourage participation is by prominently declaring or displaying their fictionality, betraying their own pretense" (p. 275).2 For example, "The conspicuous brush strokes of Van Gogh's Starry Night call attention to themselves and to their record of the process by which paint was applied to the canvas, possibly intruding on the viewer's participation in his game... One can ignore the brush [End Page 321] strokes enough to lose oneself in the fictional world" (p. 277). In response to prodding by Patrick Maynard, Walton tempers this position: "Prominent brush strokes, as in many of Vincent van Gogh's paintings, can have an inhibiting effect, especially if the observer isn't used to such. Then they not only constitute a plain indication that what one is seeing is a mere painted canvas, but force this fact on the viewer's attention" (italics added).3Ernst Gombrich endorsed this position in Art and Illusion, attributing it to Kenneth Clark.4 Gombrich tells of Clark attempting to see both the brush strokes and the representation, and his failure to "observe what went on when the brush strokes and dabs of pigment on the canvas transformed themselves into a vision of transfigured reality as he stepped back" (p. 6). Walton intends his theory of psychological participation to be widely applicable to the representational arts; he argues that what holds for visual representations holds also for verbal representations. When reading a novel our ability to participate in the story is diminished to the extent the novel draws attention to its fictionality. We either immerse ourselves in the fictional world of the novel or attend to the historical production or materiality of the novel.Attending is contained in Walton's notion of appreciation. Appreciation without participation results when some representations "positively discourage participation, especially the psychological participation that would constitute the experience of being caught up in the story" (p. 274). Works like these employ a variety of strategies, "deliberately 'distancing' the appreciator from the fictional world... For if one does not imagine a proposition, it is unlikely to be fictional that one knows or believes it; and if one imagines it with minimal vivacity, one is unlikely to have the experience of fictionally being concerned or upset or relieved or frightened or overjoyed by the fact that it is true" (p. 274). Just as children imagine themselves to be participants in games of make-believe, more mature imaginings require us to imagine we are participants, not simply observers. Reflexive imagining is central to Walton's theory, and is a point he extensively develops.I argue against this disjunction of activities. My thesis is that participation need not arise from immersion at the expense of awareness. I am also critical of Walton's distinction between appreciation and participation—they are... (shrink)

Open peer commentary on the article “Never Mind the Gap: Neurophenomenology, Radical Enactivism, and the Hard Problem of Consciousness” by Michael D. Kirchhoff & Daniel D. Hutto. Upshot: I strongly agree with Kirchhoff and Hutto that consciousness and embodied action are one and the same, but I disagree when they say this identity cannot be fully explained and must simply be posited. Here I attempt to sketch the outlines of just such an explanation.