There has been much debate regarding the 'double-effect' of sedatives and analgesics administered at the end-of-life, and the possibility that health professionals using these drugs are performing 'slow euthanasia.' On the one hand analgesics and sedatives can do much to relieve suffering in the terminally ill. On the other hand, they can hasten death. According to a standard view, the administration of analgesics and sedatives amounts to euthanasia when the drugs are given with an intention to hasten (...) death. In this paper we report a small qualitative study based on interviews with 8 Australian general physicians regarding their understanding of intention in the context of questions about voluntary euthanasia, assisted suicide and particularly the use of analgesic and sedative infusions (including the possibility of voluntary or non-voluntary 'slow euthanasia'). We found a striking ambiguity and uncertainty regarding intentions amongst doctors interviewed. Some were explicit in describing a 'grey' area between palliation and euthanasia, or a continuum between the two. Not one of the respondents was consistent in distinguishing between a foreseen death and an intended death. A major theme was that 'slow euthanasia' may be more psychologically acceptable to doctors than active voluntary euthanasia by bolus injection, partly because the former would usually only result in a small loss of 'time' for patients already very close to death, but also because of the desirable ambiguities surrounding causation and intention when an infusion of analgesics and sedatives is used. The empirical and philosophical implications of these findings are discussed. (shrink)

The moral importance of the ‘intention–foresight’ distinction has long been a matter of philosophical controversy, particularly in the context of end-of-life care. Previous empirical research in Australia has suggested that general physicians and surgeons may use analgesic or sedative infusions with ambiguous intentions, their actions sometimes approximating ‘slow euthanasia’. In this paper, we report findings from a qualitative study of 18 Australian palliative care medical specialists, using in-depth interviews to address the use of sedation at the end of life. The (...) majority of subjects were agnostic or atheistic. In contrast to their colleagues in acute medical practice, these Australian palliative care specialists were almost unanimously committed to distinguishing their actions from euthanasia. This commitment appeared to arise principally from the need to maintain a clear professional role, and not obviously from an ideological opposition to euthanasia. While some respondents acknowledged that there are difficult cases that require considered reflection upon one's intention, and where there may be some ‘mental gymnastics,’ the nearly unanimous view was that it is important, even in these difficult cases, to cultivate an intention that focuses exclusively on the relief of symptoms. We present four narratives of ‘terminal’ sedation – cases where sedation was administered in significant doses just before death, and may well have hastened death. Considerable ambiguities of intention were evident in some instances, but the discussion around these clearly exceptional cases illustrates the importance of intention to palliative care specialists in maintaining their professional roles. (shrink)

BackgroundClinical ethics case consultations (CECCs) provide a structured approach in situations of ethical uncertainty or conflicts. There have been increasing calls in recent years to assess the quality of CECCs by means of empirical research. This study provides detailed data of a descriptive quantitative and qualitative evaluation of a CECC service in a department of cardiology and intensive care at a German university hospital.MethodsSemi-structured document analysis of CECCs was conducted in the period of November 1, 2018, to May 31, 2020. (...) All documents were analysed by two researchers independently.ResultsTwenty-four CECCs were requested within the study period, of which most (n = 22; 92%) had been initiated by physicians of the department. The patients were an average of 79 years old (R: 43–96), and 14 (58%) patients were female. The median length of stay prior to request was 12.5 days (R: 1–65 days). The most frequent diagnoses (several diagnoses possible) were cardiology-related (n = 29), followed by sepsis (n = 11) and cancer (n = 6). Twenty patients lacked decisional capacity. The main reason for a CECC request was uncertainty about the balancing of potential benefit and harm related to the medically indicated treatment (n = 18). Further reasons included differing views regarding the best individual treatment option between health professionals and patients (n = 3) or between different team members (n = 3). Consensus between participants could be reached in 18 (75%) consultations. The implementation of a disease specific treatment intervention was recommended in five cases. Palliative care and limitation of further disease specific interventions was recommended in 12 cases.ConclusionsTo the best of our knowledge, this is the first in-depth evaluation of a CECC service set up for an academic department of cardiology and intensive medical care. Patient characteristics and the issues deliberated during CECC provide a starting point for the development and testing of more tailored clinical ethics support services and research on CECC outcomes. (shrink)

We examined two potential correlates of hypnotic suggestibility: dissociation and cognitive inhibition. Dissociation is the foundation of two of the major theories of hypnosis and other theories commonly postulate that hypnotic responding is a result of attentional abilities . Participants were administered the Waterloo-Stanford Group Scale of Hypnotic Susceptibility, Form C. Under the guise of an unrelated study, 180 of these participants also completed: a version of the Dissociative Experiences Scale that is normally distributed in non-clinical populations; a latent inhibition (...) task, a spatial negative priming task, and a memory task designed to measure negative priming. The data ruled out even moderate correlations between hypnotic suggestibility and all the measures of dissociation and cognitive inhibition overall, though they also indicated gender differences. The results are a challenge for existing theories of hypnosis. (shrink)

The hypnosis technique is currently used in the medical field and influences directly the patient's state of relaxation, perception of the body and its visual imagination. There is evidence to suggest that hypnosis state may help patients to better achieve the task of motor imagination, which is central in rehabilitation protocols after a stroke. However, the hypnosis technique could also alter the activity in motor cortex. To the best of our knowledge, the impact of hypnosis on the EEG signal during (...) a movement or an imagined movement is poorly investigated. In particular, how event-related desynchronization (ERD) and event-related synchronization (ERS) patterns would be modulated for different motor tasks may provide a better understanding of the potential benefits of hypnosis for stroke rehabilitation. To investigate this purpose, we recorded EEG signals from 23 healthy volunteers who performed real movements and motor imageries in closed eye condition. Our results suggest that the state of hypnosis changes the sensorimotor beta rhythm during the ERD phase but maintains the ERS phase in the mu and beta frequency band suggesting a different activation of the motor cortex in the hypnotized state. (shrink)

This paper examines research on three hypnotic phenomena: suggested amnesia, suggested analgesia, and “trance logic.” For each case a social-psychological interpretation of hypnotic behavior as a voluntary response strategy is compared with the traditional special-process view that “good” hypnotic subjects have lost conscious control over suggestion-induced behavior. I conclude that it is inaccurate to describe hypnotically amnesic subjects as unable to recall the material they have been instructed to forget. Although amnesics present themselves as unable to remember, they in fact (...) retain control over retrieval processes and accommodate their recall (or lack of it) to the social demands of the test situation. Hypnotic suggestions of analgesia do not produce a dissociation of pain from phenomenal awareness. Nonhypnotic suggestions of analgesia and distractor tasks that deflect attention from the'noxious stimuli are as effective as hypnotic suggestions in producing reductions in reported pain. Moreover, when appropriately motivated, subjects low in hypnotic suggestibility report pain reductions as large as those reported by highly suggestible hypnotically analgesic subjects. Finally, the data fail to support the view that a tolerance for logical incongruity (i.e., trance logic) uniquely characterizes hypnotic responding. So-called trance-logic-governed responding appears to reflect the attempts of “good” subjects to meet implicit demands to report accurately what they experience. (shrink)

Altered state theories of hypnosis posit that a qualitatively distinct state of mental processing, which emerges in those with high hypnotic susceptibility following a hypnotic induction, enables the generation of anomalous experiences in response to specific hypnotic suggestions. If so then such a state should be observable as a discrete pattern of changes to functional connectivity (shared information) between brain regions following a hypnotic induction in high but not low hypnotically susceptible participants. Twenty-eight channel EEG was recorded from 12 high (...) susceptible (highs) and 11 low susceptible (lows) participants with their eyes closed prior to and following a standard hypnotic induction. The EEG was used to provide a measure of functional connectivity using both coherence (COH) and the imaginary component of coherence (iCOH), which is insensitive to the effects of volume conduction. COH and iCOH were calculated between all electrode pairs for the frequency bands: delta (0.1–3.9Hz), theta (4–7.9Hz) alpha (8–12.9Hz), beta1 (13–19.9Hz), beta2 (20–29.9Hz) and gamma (30–45Hz). The results showed that there was an increase in theta iCOH from the pre-hypnosis to hypnosis condition in highs but not lows with a large proportion of significant links being focused on a central-parietal hub. There was also a decrease in beta1 iCOH from the pre-hypnosis to hypnosis condition with a focus on a fronto-central and an occipital hub that was greater in high compared to low susceptibles. There were no significant differences for COH or for spectral band amplitude in any frequency band. The results are interpreted as indicating that the hypnotic induction elicited a qualitative change in the organization of specific control systems within the brain for high as compared to low susceptible participants. This change in the functional organization of neural networks is a plausible indicator of the much theorized “hypnotic-state”. (shrink)

According to the theoretical framework relating hypnosis to attention, baseline attentional functioning in highly hypnotizable individuals should be more efficient than in low hypnotizable individuals. However, previous studies did not find differences in Stroop-like tasks in which the measure indicative of the Stroop interference effect was based on response latencies. This study was designed to determine whether subjects with different levels of hypnotic susceptibility show differences in baseline attentional functioning. To assess this hypothesis, high, medium, and low hypnotizable subjects performed (...) a Stroop task designed to evaluate accuracy performance, before being subjected to hypnotic induction. Results showed that the Stroop interference effect was smaller in high hypnotizable subjects than in low hypnotizable subjects, whereas it was not different between high, and medium hypnotizable subjects. This outcome supports the notion that baseline attentional functioning is related to hypnotic susceptibility. (shrink)

As understood by neodissociation and sociocognitive theorists, hypnotic responses are instances of self-deception. Neodissociation theory matches the strict definition of Sackeim and Gur (1978) and sociocognitive theory matches Mele's looser definition. Recent data indicate that many hypnotized individuals deceive themselves into holding conflicting beliefs without dissociating, but others convince themselves that the suggested state of affairs is true without simultaneously holding a contrary belief.

The metaverse concept constructs a virtual world parallel to the real world. The social economic dynamics model establishes a systematic model for social economic dynamics simulation that integrates macroeconomy and microeconomy based on modeling mechanism of the new theory of value by analogy with Newtonian mechanics and the modeling approach of Agent-based computational economics. This article describes the SED model’s modeling mechanisms, modeling rules, and behavior equations. At the same time, this article introduces the methods, testing standards, and some typical (...) cases about using the SED model to generate the economic digital twin systems. By doing so, we hope to demonstrate that the method of computer simulation experiment based on the SED model is a scientific empirical method, which has more advantages than the existing empirical research methods in economics. The SED model, which can be fully used to form an economic engine and construct a virtual economic system by digital twin method, can be integrated with the extant physical engine in the metaverse concept to build a virtual world consisting of physics, economy, culture, and politics that is close to and coexists with reality. (shrink)

It is difficult to place jazz within a philosophy of music dominated by the concepts and practices of classical music. One key puzzle concerns the nature and role, if any, of musical works in jazz. I briefly describe the debate between those who deny that there are musical works in jazz (Kania) and those who affirm that there are such (Dodd and others). I argue that musical works are performed in jazz but that jazz performance of works is very different (...) from performance of classical music works. The first step toward resolving the puzzle is to embrace the descriptive concept of a musical work and reject inappropriate normative concepts of a musical work. In particular, I argue against the accounts of musical works by Kania and Goehr, each of which implies a no-works thesis for jazz performance. I contrast the norms governing work performance in classical music with the practices governing performances of works in jazz, which I call realization or staging. Finally, I propose a model of jazz appreciation that incorporates a role for jazz works and that differs from the appreciation of classical music. (shrink)

In recent decades, the focus in autism research progressively expanded. It presently offers extensive material on sensorimotor disturbances as well as on perceptive-cognitive preferences of people with autism. The present article proposes not only a critical interpretation of the common theoretical framework in autism research but also focuses on certain experiences common to some people with autism and which can be appropriately understood by phenomenology. What I will call “hypnotic experiences” in autism are moments in which some individuals withdraw into (...) intense sensorial and perceptive experiences. Following their examples, I use the term “hypnosis” primarily to describe a trance state in which the individuals become highly alert to and awake for an experience of a totally new kind. Through a close analysis of autobiographical writings from people with autism I defend the idea that the particularity of hypnotic experiences in autism consists in a certain qualitative shift within experience itself: what changes, in the hypnotic moments, is the way a person with autism relates to his/her own bodily experiences. If this qualitative shift is indeed difficult to account for within a reifying and intellectualist research perspective, phenomenology offers a large conceptual framework for understanding it. Phenomenology, and precisely, phenomenological psychopathology, will thus emerge as a major device in accounting for such “hypnotic experiences”. The argument mainly draws on the twofold structure of experience which is traditionally used in phenomenological research: it claims that in hypnotic experience people with autism are inclined to focus on non-reified “sensings”, “perceivings” and “movings”, and thus leave aside the object itself and any intentional reification of it. Finally, I will claim that this restriction to mere non-reified sensings might lead to a completely new conception of self and world. In the hypnotic experiences of autism, neither the subject nor the object come to a full-blown and independent existence. A thorough phenomenological analysis of hypnotic experience in autism therefore also has to face the question of a corresponding ontology of these experiences. (shrink)

The purpose of our study was to measure the relationship between performance on various attentional tasks and hypnotic susceptibility. Healthy volunteers participated in a study, where they had to perform several tasks measuring various attention components in a waking state: sustained attention, selective or focused attention, divided attention and executive attention in task switching. Hypnotic susceptibility was measured in a separate setting by the Waterloo-Stanford Groups Scale of Hypnotic Susceptibility, Form C .We found no significant correlation between any of the (...) attentional measures and hypnotic susceptibility. Highly hypnotizables did not prove to be superior to or worse than the other individuals in any of the tests.These results do not support the neuropsychophysiological model of hypnosis, as they show no consistent relationship between hypnotic susceptibility and waking attentional performance. (shrink)

Hypnotic responding might be due to attenuated frontal lobe functioning after the hypnotic induction. Little is known about whether personality traits linked with frontal functioning are associated with responsiveness to hypnotic suggestions. We assessed whether hypnotic suggestibility is related to the traits of self-control and impulsivity in 154 participants who completed the Brief Self-Control Scale, the Self-Regulation Scale, the Barratt Impulsiveness Scale , and the Harvard Group Scale of Hypnotic Susceptibility . BIS-11 non-planning impulsivity correlated positively with HGSHS:A . Furthermore, (...) in the best model emerging from a stepwise multiple regression, both non-planning impulsivity and self-control positively predicted hypnotic suggestibility, and there was an interaction of BIS-11 motor impulsivity with gender. For men only, motor impulsivity tended to predict hypnotic suggestibility. Hypnotic suggestibility is associated with personality traits linked with frontal functioning, and hypnotic responding in men and women might differ. (shrink)

Continuous deep sedation (CDS) has the effect of making the patient unconscious until death, and that it has this effect is clearly an undesirable aspect of CDS. However, some authors have recently maintained that many physicians do not intend this effect when practicing CDS. According to these authors, CDS is differentiated into two types; in what is called “gradual” CDS (or CDS as a result of proportionate palliative sedation), physicians start with low doses of sedatives and increase them only (...) gradually, whereas in “rapid” CDS (or palliative sedation to unconsciousness), physicians rapidly administer a heavy dose that clearly induces unconsciousness from the beginning. The claim is that the physicians intend permanent unconsciousness only if they rapidly administer a heavy dose, but they do not intend it when the unconsciousness is the result of a gradual increase of sedatives. This paper attempts to refute these claims based on a close examination of the protocol of gradual CDS. If my argument is valid, the doctrine of double effect would not be useful in justifying most, if not all, cases of CDS. (shrink)

To examine the influence of hypnotic suggestibility testing as a source of individual differences in hypnotic responsiveness, we compared behavioral and subjective responses on three scales of hypnotic suggestibility: The Harvard Group Scale of Hypnotic Susceptibility, Form A . Harvard Group Scale of Hypnotic Susceptibility. Berlin: Consulting Psychologists Press); the Carleton University Responsiveness to Suggestion Scale . The Carleton University Responsiveness to Suggestion Scale: Normative data and psychometric properties. Psychological Reports, 53, 523–535); and the Group Scale of Hypnotic Ability . (...) The Group Scale of Hypnotic Ability and response booklet. Australian Journal of Clinical and Experimental Hypnosis, 27, 20–31). Behavioral and subjective responses to the CURSS were significantly different than those on the HGSHS: A and GSHA. More participants were classified as “low suggestible” on the CURSS and they reported subjective experiences more similar to everyday mentation. Attitudes and expectancies of participants who received the GSHA were less predictive of responding, but rates of responding and subjective experiences were similar on the GSHA and the HGSHS: A. Discussion focuses on implications for the use of group hypnotic suggestibility scales. (shrink)

have recently provided a compelling demonstration of enhanced attentional control under post-hypnotic suggestion. Using the classic color-word interference paradigm, in which the task is to ignore a word and to name the color in which it is printed (e.g., RED in green, say ''green''), they gave a post-hypnotic instruction to participants that they would be unable to read. This eliminated Stroop interference in high suggestibility participants but did not alter interference in low suggestibility participants. replicated this pattern and further demonstrated (...) that it is not due to a visual strategy (such as blurring or looking at a different location). As a historical footnote, we describe a ''case study'' from 18 years ago in which we observed the same result using a hypnotic instruction to a single highly suggestible individual that he could not read. The elimination of Stroop interference has important implications for both the study of attention and the study of hypnosis. (shrink)

The ‘default mode’ network refers to cortical areas that are active in the absence of goal-directed activity. In previous studies, decreased activity in the ‘default mode’ has always been associated with increased activation in task-relevant areas. We show that the induction of hypnosis can reduce anterior default mode activity during rest without increasing activity in other cortical regions. We assessed brain activation patterns of high and low suggestible people while resting in the fMRI scanner and while engaged in visual tasks, (...) in and out of hypnosis. High suggestible participants in hypnosis showed decreased brain activity in the anterior parts of the default mode circuit. In low suggestible people, hypnotic induction produced no detectable changes in these regions, but instead deactivated areas involved in alertness. The findings indicate that hypnotic induction creates a distinctive and unique pattern of brain activation in highly suggestible subjects. (shrink)

The readiness potential (RP) is one of the most controversial topics in neuroscience and philosophy due to its perceived relevance to the role of conscious willing in action. Libet and colleagues reported that RP onset precedes both volitional movement and conscious awareness of willing that movement, suggesting that the experience of conscious will may not cause volitional movement (Libet, Gleason, Wright, & Pearl, 1983). Rather, they suggested that the RP indexes unconscious processes that may actually cause both volitional movement and (...) the accompanying conscious feeling of will (Libet et al., 1983; pg. 640). Here, we demonstrate that volitional movement can occur without an accompanying feeling of will. We additionally show that the neural processes indexed by RPs are insufficient to cause the experience of conscious willing. Specifically, RPs still occur when subjects make self-timed, endogenously-initiated movements due to a post-hypnotic suggestion, without a conscious feeling of having willed those movements. (shrink)

The present study investigated how the magnitude the word blindness suggestion effect on Stroop interference depended on hypnotic suggestibility when given as an imaginative suggestion and under conditions in which hypnosis was not mentioned. Hypnotic suggestibility is shown to be a significant predictor of the magnitude of the imaginative word blindness suggestion effect under these conditions. This is therefore the first study to show a linear relationship between the imaginative word blindness suggestion effect and hypnotic suggestibility across the whole hypnotizability (...) spectrum. The results replicate previous findings showing that highs respond to the word blindness suggestion to a greater extent than lows but extend previous work by showing that the advantage for those higher on the hypnotizability spectrum occurs even in a non-hypnotic context. Negative attitudes about hypnosis may not explain the failure to observe similar effects of the word blindness suggestion in less hypnotizable individuals. (shrink)

Forming implementation intentions has been consistently shown to be a powerful self-regulatory strategy. As the self-regulation of thoughts is important for the experience of involuntariness in the hypnotic context, investigating the effectiveness of implementation intentions on the suppression of thoughts was the focus of the present study. Participants were randomly assigned to one of four conditions . Results showed that participants who received information included in the “Carleton Skill Training Program” and in addition formed implementation intentions improved their hypnotic responsiveness (...) as compared to all of the other three groups on measures of objective responding and involuntary responding. Thus, in line with the nonstate or cognitive social–psychological view of hypnosis stating that an individual’s hypnotic suggestibility is not dispositional but modifiable, our results suggest that hypnotic responsiveness can be heightened by furnishing hypnotic instructions with ad hoc implementation intentions. (shrink)