According to a standard account of patient decision-making capacity, patients can provide ethically valid consent or refusal only if they are able to understand and appreciate their medical c...

The dominant approach to assessing decision-making capacity in medicine focuses on determining the extent to which individuals possess certain core cognitive abilities. Critics have argued that this model delivers the wrong verdict in certain cases where patient values that are the product of mental disorder or disordered affective states undermine decision-making without undermining cognition. I argue for a re-conceptualization of what it is to possess the capacity to make medical treatment decisions. It is, I argue, the ability to (...) track one’s own personal interests at least as well as most people can. Using this idea, I demonstrate that it is possible to craft a solution for the problem cases—one that neither alters existing criteria in dangerous ways (e.g. does not open the door to various kinds of abuse) nor violates the spirit of widely accepted ethical constraints on decision-making assessment. (shrink)

The majority of studies on absorptive capacity (AC) underscore the importance of absorbing technological knowledge from other firms to create economic value. However, to preserve moral legitimacy and create social value, firms must also discern and adapt to (shifts in) societal values. A comparative case study of eight firms in the food industry reveals how organizations prioritize and operationalize the societal value health in product innovation while navigating inter- and intravalue conflicts. The value-sensitive framework induced in this article extends (...) AC by explaining how technically savvy, economic value–creating firms diverge in their receptivity, articulation, and reflexivity of societal values. (shrink)

This is the 2011 Aquinas Lecture delivered by John McDowell on February 27, 2011 at Marquette University. A central theme in much of Professor McDowell's work is the harmful effect, in modern philosophy and in the modern reception of pre-modern philosophy, of a conception of nature that reflects an understanding, in itself perfectly correct, of the proper goals of the natural sciences. He has argued that we can free ourselves from the characteristic sorts of philosophical anxiety by recalling the possibility (...) of a less restrictive conception of what it takes for something to be natural. (shrink)

Theories of consciousness divide over whether perceptual consciousness is rich or sparse in specific representational content and whether it requires cognitive access. These two issues are often treated in tandem because of a shared assumption that the representational capacity of cognitive access is fairly limited. Recent research on working memory challenges this shared assumption. This paper argues that abandoning the assumption undermines post-cue-based “overflow” arguments, according to which perceptual conscious is rich and does not require cognitive access. Abandoning it (...) also dissociates the rich/sparse debate from the access question. The paper then explores attempts to reformulate overflow theses in ways that don’t require the assumption of limited capacity. Finally, it discusses the problem of relating seemingly non-probabilistic perceptual consciousness to the probabilistic representations posited by the models that challenge conceptions of cognitive access as capacity-limited. (shrink)

Humankind is facing many existential global problems that require international and transgenerational efforts to be solved. Preparing our next generation with sufficient knowledge and skills to deal with such problems is imperative. Fortunately, the digital environment provides foundational conditions for children’s and adolescents’ exploration and self-learning, which might help them cultivate the necessary knowledge and skills for future survival. We conducted the Bayesian Mindsponge Framework (BMF) analytics on a dataset of 2069 students from 54 Vietnamese elementary, secondary, and high schools (...) to test this presumption. The results showed that students with higher digital literacy are more curious and have better knowledge regarding global issues (i.e., climate change, disease, overpopulation, aging, etc.). Students’ curiosity also mediates the relationship between digital literacy and global issues knowledge. Based on these findings, we argue that digital explorative space is essential for digital natives’ education for survival, individually (i.e., for future employment requirements) and socially (i.e., for making informed decisions and creating innovations that can be helpful to society). Children’s and adolescents’ exposure to digital explorative space should be promoted to improve their digital literacy rather than prohibition. During the exploration, emotional intelligence is critical in mitigating existential risks, or threats, to digital natives to navigate and overcome chaotic processes occurring in unchartered waters in the virtual world. (shrink)

The intensification of cross-sector collaboration phenomena has occurred in multiple fields of action. Organizations in the private, public, and social sectors are working together to tackle society’s most wicked problems. Some success has resulted in a generalized belief that cross-sector collaborations represent the new paradigm to manage complex problems. Yet, important knowledge gaps remain about how cross-sector alliances generate value for society, particularly to its beneficiaries. This paper answers the question: How cross-sector collaborations lead to systemic change? It uses a (...) qualitative embedded case study design. I use two general cases of alliance-based interventions in the developing country Colombia. Embedded cases within each general case identify evidence of collective action capacity of the beneficiaries. Findings identify and explain alliances’ contributions to beneficiaries’ capacity building: brokering trust and creating spaces where beneficiaries develop an emergent collective action capacity. Alliances also enable beneficiaries to enact that capacity by building bridges, circulating capitals, and buffering relationships to protect people’s initiatives. Alliances and empowered collectives of beneficiaries produce systemic change using five mechanisms: brokering trust, creating spaces, building bridges, circulating capitals, and buffering relationships. Beneficiaries increased capacity for collective action is an outcome that becomes an alliance input, leading overtime to further benefits involving systemic change. (shrink)

"How can human beings, who are liable to error, possess knowledge, since the grounds on which we believe do not rule out that we are wrong? Andrea Kern argues that we can disarm this skeptical doubt by conceiving knowledge as an act of a rational capacity. In this book, she develops a metaphysics of the mind as existing through knowledge of itself."--Provided by publisher.

Objectives To determine the role played by law in medical specialists9 decision-making about withholding and withdrawing life-sustaining treatment from adults who lack capacity, and the extent to which legal knowledge affects whether law is followed. Design Cross-sectional postal survey of medical specialists. Setting The two largest Australian states by population. Participants 649 medical specialists from seven specialties most likely to be involved in end-of-life decision-making in the acute setting. Main outcome measures Compliance with law and the impact of legal (...) knowledge on compliance. Results 649 medical specialists (of 2104 potential participants) completed the survey (response rate 31%). Responses to a hypothetical scenario found a potential low rate of legal compliance, 32% (95% CI 28% to 36%). Knowledge of the law and legal compliance were associated: within compliers, 86% (95% CI 83% to 91%) had specific knowledge of the relevant aspect of the law, compared with 60% (95% CI 55% to 65%) within non-compliers. However, the reasons medical specialists gave for making decisions did not vary according to legal knowledge. Conclusions Medical specialists prioritise patient-related clinical factors over law when confronted with a scenario where legal compliance is inconsistent with what they believe is clinically indicated. Although legally knowledgeable specialists were more likely to comply with the law, compliance in the scenario was not motivated by an intention to follow law. Ethical considerations (which are different from, but often align with, law) are suggested as a more important influence in clinical decision-making. More education and training of doctors is needed to demonstrate the role, relevance and utility of law in end-of-life care. (shrink)

This article advances two views on the role of evaluative judgment in clinical assessments of decision-making capacity. The first is that it is rationally impossible for such assessments to exclude judgments of the values a patient uses to motivate their decision-making. Predictably, and second, attempting to exclude such judgments sometimes yields outcomes that contain intractable dilemmas that harm patients. These arguments count against the prevailing model of assessment in common law countries—the four abilities model—which is often incorrectly advertised as (...) being value-neutral in respect of patient decision-making both by its proponents and in statute. A straightforward evaluative model of capacity assessment which wears its values on its sleeves and is biased against what are called ‘serious prudential mistakes’ avoids these rational and practical problems. (shrink)

Volume 24, Issue 8, August 2024, Page 103-106.

Previous studies have suggested that the Zhongyong thinking style is associated with psychological features. However, little is known about the direct association between Zhongyong thinking and resilience and the underlying mechanisms of this relationship in Chinese culture. The present study aimed to investigate the association between Zhongyong thinking and undergraduates’ resilience and to assess whether cognitive reappraisal and positive effects mediated this association. A sample of undergraduates was recruited for this study and the participants completed the Zhongyong Thinking Style Scale, (...) the Emotion Regulation Questionnaire, the Positive Affect and Negative Affect Scale, and the Resilience-11. Results indicated that the Zhongyong thinking style was positively and significantly associated with resilience. Undergraduates’ resilience was affected by Zhongyong thinking partly through 3 different pathways: the mediating role of cognitive reappraisal, the mediating role of positive effect, and the mediating chain role of both cognitive reappraisal and positive effect. These findings might provide a deeper understanding of the protective factors for resilience among Chinese undergraduates. (shrink)

Obtaining informed consent from patients is a moral and legal duty and, thus, a key legitimation for medical treatment. The pivotal prerequisite for valid informed consent is decision-making capacity of the patient. Related to the question of whether and when consent should be morally and legally valid, there has been a long-lasting philosophical debate about freedom of will and the connection of freedom and responsibility. The scholarly discussion on decision-making capacity and its clinical evaluation does not sufficiently take (...) into account this fundamental debate. It is contended that the notion of free will must be reflected when evaluating decision-making capacity. Namely, it should be included as a part of the appreciation-criterion for decision-making capacity. The argumentation is mainly drawn on the compatibilism of Harry Frankfurt. A solution is proposed which at the same time takes the notion of free will seriously and enriches the traditional understanding of decision-making capacity, strengthening its justificatory force while remaining clinically applicable. (shrink)

Smajdor’s Reification and Assent in Research Involving Those Who lack Capacity claims, among other things, that ‘adults who cannot give informed consent may nevertheless have the ability to assent and dissent, and that these capacities are morally important in the context of research’.1 More pointedly, she suggests we can rely upon Gillick competence, or that ‘it is worth thinking about why the same trajectory [as children] has not been evident in the context of [adults with impairments of capacity (...) to give informed consent (AWIC)]’.1 I argue that her likening assent in AWIC to assent in children is problematic for at least two related reasons. First, direct comparisons between AWIC and children run the risk of perpetuating or reinforcing infantilising stereotypes against people with disabilities. Second, I argue that people with disabilities are vulnerable in ways that most children are not, and thus, are dissimilar in a morally relevant manner. The infantilising of people with disabilities is quite widely documented and thought to be deeply problematic.2 Not only are people with disabilities often thought to be infantile in regard to particular …. (shrink)

This essay develops an interpretation of Kant’s conception of the faculty of reason as the capacity for what he calls "comprehension" (Begreifen). In doing so, it first discusses Kant's characterizations of reason in relation to what he describes as the two highest grades of cognition—insight and comprehension. Then it discusses how the resulting conception of reason relates to more familiar characterizations as the faculty for inference and the faculty of principles. In doing so, it focuses on how the idea (...) of reason as aiming at comprehension expresses the modesty about reason that is essential to Kant’s critical philosophy. It concludes by showing how this grounds an elegant account of the unity of theoretical and practical reason—one that does justice both to the "primacy" that Kant assigns to practical reason and the fact that this "primacy" is grounded in a more basic unity. (shrink)

The unpredictability of maternal sensory signals in caregiving behavior has been recently found to be linked with infant neurodevelopment. The research area is new, and very little is yet known, how maternal anxiety and depressive symptoms and specific parental characteristics relate to the unpredictable maternal care. The aims of the current study were to explore how pre- and postnatal maternal anxiety and depressive symptoms and self-regulation capacity associate with the unpredictability of maternal sensory signals. The study population consisted of (...) 177 mother-infant dyads. The unpredictability of the maternal sensory signals was explored from the video-recorded mother-infant free play situation when the infant was 8 months of age. Pre- and postnatal anxiety and depressive symptoms were measured by questionnaires prenatally at gwks 14, 24, 34, and 3 and 6 months postpartum. Maternal self-regulation capacity, a trait considered to be stable in adulthood, was assessed using adult temperament questionnaire when the infant was 12 months of age. We found that elevated prenatal maternal anxiety symptoms associated with higher unpredictability in the maternal care while depressive symptoms were unrelated to the unpredictability of maternal care. Moreover, the association was moderated by maternal self-regulation capacity, as higher anxiety symptoms during pre-and postnatal period were associated more unpredictability among the mothers with low self-regulation capacity. The combination of higher amount of maternal anxiety symptoms and lower self-regulation capacity seems to constitute specific risk for the unpredictable maternal care. (shrink)

Stevan Harnad and I seem to be thinking about many of the same issues. Sometimes we agree, sometimes we don't; but I always find his reasoning refreshing, his positions sensible, and the problems with which he's concerned to be of central importance to cognitive science. His "Grounding Symbols in the Analog World with Neural Nets" (= GS) is no exception. And GS not only exemplifies Harnad's virtues, it also provides a springboard for diving into Harnad- Bringsjord terrain.

In three experiments we explored developmental changes in probabilistic reasoning, taking into account the effects of cognitive capacity, thinking styles, and instructions. Normative responding increased with grade levels and cognitive capacity in all experiments, and it showed a negative relationship with superstitious thinking. The effect of instructions (in Experiments 2 and 3) was moderated by level of education and cognitive capacity. Specifically, only higher-grade students with higher cognitive capacity benefited from instructions to reason on the basis (...) of logic. The implications of these findings for research on the development of probabilistic reasoning are also discussed. (shrink)

Selective mutism is an anxiety disorder in which an individual is unable to speak in certain social situations though may speak normally in other settings (Hua & Major, 2016 ). Selective mutism in adults is rare, though people with this condition might have other methods of communicating their needs outside of verbal communication. Healthcare professionals rely on a patient’s ability to communicate to establish if they have decision-making capacity. This commentary responds to a case of a young adult patient (...) with selective mutism and social anxieties that significantly limited his ability to communicate with anyone in the healthcare team. This required a creative, patient-centered approach to engage in meaningful communication. (shrink)

Any ethical inquiry into addiction research is faced with the preliminary challenge that the term “addiction” is itself a matter of scientific and ethical controversy. Accordingly, the chapter begins with a brief history of the term “addiction.” The chapter then turns to ethical issues surrounding consent and decision-making capacity viewed from the perspective of the current opioid epidemic. One concern is the neglect of the cyclical nature of addiction and the implications of this for the validity of current psychometric (...) instruments used to evaluate decision-making capacity in addiction. Another is the apparent discrepancy—possibly an ethical double standard—in the manner in which society and addiction researchers view the mental capacity and vulnerability of individuals who suffer from severe addiction. On the whole, the main ethical concern of the chapter is the puzzling lack of clinical research on decision-making capacity in research on addiction. (shrink)

This book explores how we can measure consciousness. It clarifies what consciousness is, how it can be generated from a physical system, and how it can be measured. It also shows how conscious states can be expressed mathematically and how precise predictions can be made using data from neurophysiological studies.

The aim of this chapter is to explain Aristotle’s definition of the vegetative part of the soul in the De anima from a methodological point of view. I discuss Aristotle’s conception of the soul and his conception of “parts of the soul” before I turn to his definition of the vegetative part of the soul in De anima II 4. I argue that the definition of the vegetative capacity is deliberately abstract so as to cover its various activities under (...) one common heading. I also argue that the De anima deliberately avoids a positive and determinate description of the activity of the soul that is properly responsible for the vegetative functions, and that Aristotle offers such a positive and determinate description in his works dedicated to the actions and affections “common to body and soul”. (shrink)

Pre-college philosophy has proliferated greatly over the last few decades, including in the form of ‘philosophy across the curriculum’. However, there has been very little sustained examination of the nature of philosophy as a subject relative to other standard pre-college subjects and the kinds of expertise an effective philosophy teacher at this level should possess. At face value, the minimal academic preparation expected for competence in secondary philosophy instruction, compared to the high standards for teaching other subjects, raises questions and (...) concerns. In this paper I make some provisional observations about the subject of philosophy and how it is taught from p4c through to the post-secondary level. I begin by examining the concept of ‘philosophy across the curriculum’ and offer a working analysis of the main features of philosophy's form and content that enable us to determine its relevance to, and difference from, other subjects. Next, I examine and critique what I term the ‘populist’ conception of philosophy, which correlates to lower expectations of teacher training, and use my own experience of teaching philosophy across the curriculum to shed doubt on the viability of this approach. In the third section I consider what I term the ‘autonomous’ conception of philosophy, which correlates to more stringent expectations of teacher capacity, and explain why it is preferable to the populist conception with some qualifications. I conclude by reflecting on how philosophy compares to other subjects that are advanced cross-curricularly and argue for more training of high school philosophy teachers. (shrink)

In this article, we describe a project in which philosophy, in combination with methods drawn from mental modeling, was used to structure dialogue among stakeholders in a region-scale climate adaptation process. The case study we discuss synthesizes the Toolbox dialogue method, a philosophically grounded approach to enhancing communication and collaboration in complex research and practice, with a mental modeling approach rooted in risk analysis, assessment, and communication to structure conversations among non-academic stakeholders who have a common interest in planning for (...) a sustainable future. We begin by describing the background of this project, including details about climate resiliency efforts in West Michigan and the Toolbox dialogue method, which was extended in this project from academic research into community organization involving the West Michigan Climate Resiliency Framework Initiative. This extension involved application of several methods, which are the focus of the Methods section. We then present and discuss preliminary results that suggest the potential for philosophical dialogue to enhance mutual understanding in complex community initiatives that focus on sustainable responses to climate change. Overall, the article supplies a detailed, instructive example of how philosophy can support policy-relevant decision-making processes at the community level. (shrink)

Hospitalized patients lacking the mental capacity to consent to treatment may demand to be discharged from the hospital against medical advice. Forced custody of these patients, including the use of restraints, may be required if the plan is to proceed with treatment. This raises ethical concerns with regard to depriving people of their liberty. The determination of the wishes and values of the patient and her best interests may sometimes vary, depending on the assessor or the clinical team entrusted (...) to perform the evaluation. We therefore propose the following triad for clinicians when determining the best interests for this group of patients to ensure ethical and legal soundness as well as in providing consistency in approach. Firstly, the treatment should serve as a rescue response. Secondly, any restraint deployed must be proportionate with a foreseeable end. Her liberty and autonomy interests should be enhanced by the treatment. Thirdly, the patient’s family must be supportive. This paper analyzes the use of the triad approach on two clinical cases, both assessed as lacking in mental capacity to decide on treatment and insisting to be discharged. Using this approach, we could justify how the contrasting outcomes, one in which the voluntary discharge was acquiesced versus the other, which was not acquiesced, were reached. We also examine the compatibility of the triad approach with the obligations under the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD). (shrink)

This book examines how Shanghai aims to improve public service provision by accelerating the use of artificial intelligence (AI) in the public sector. After clarifying the technical and social factors that shape the use of AI in this area, the book delves into the AI policy environment and AI ecosystem of Shanghai to gauge the city’s capacity to implement public sector AI applications. Then it examines how this capacity translates into real-world policy initiatives through the investigation of case (...) studies. It highlights the analytical, operational and political capabilities that determine the strengths and limitations of such initiatives in deploying AI in the public sector, and it assesses their impacts on public service provision in Shanghai. By using the findings on Shanghai to gain a deeper understanding of key topics in public sector AI research, this book also contributes new knowledge about the use of AI to improve the provision of public services. (shrink)

Volume 24, Issue 8, August 2024, Page 121-123.

This paper examines the influence on product innovation of factors based on a company’s transformation and exploitation of knowledge gathered from its intra-organizational relationships. Specifically, this paper analyses the influence of intra-organizational social capital on realized absorptive capacity. Moreover, it analyses the mediating role of RACAP on the relationship between internal SC and product innovation. Based on a sample of companies from the Spanish biotechnological and pharmaceutical industries, two hypotheses were tested using a structural equations model and the partial (...) least squares technique. The results support both hypotheses, suggesting that the development of strong and tightly knit links based on a common understanding and trust among company members lead the firm to develop dynamic capabilities for transforming and exploiting knowledge acquired externally, which fosters innovation based on new product development. Research limitations, implications and future research are also discussed by the authors of the paper. (shrink)

Decisional capacity evaluations (DCEs) occur in clinical settings where it is unclear whether a consumer of medical services has the capacity to make an informed decision about the relevant medical options. DCEs are localized interventions, not the global loss of competence, that assign a surrogate decision maker to make the decision on behalf of the medical consumer. We maintain that one important necessary condition for a DCE to be morally justified, in cases of medical necessity, is that the (...) health care consumer under evaluation is incapable of expressing a preference for a certain outcome. (shrink)

Most organizations and/or their sub-units like ethics programs want to acquire the knowledge, skills and other resources needed to achieve their goals efficiently and effectively. Thus, they want to acquire or develop needed capacity. But there are pre-conditions to building capacity that are often overlooked or forgotten, but which nevertheless, must be in place before capacity can be developed. This essay identifies these pre-conditions and discusses why they are necessary before attempts are made to enhance the (...) class='Hi'>capacity of any ethics program. The essay closes by offering a series of questions that ethics program leaders/and or members can asked themselves to assess whether or not these pre-conditions exist. (shrink)