Patient-reported outcomes are frequently used for medical decision making, at the levels of both individual patient care and healthcare policy. Evidence increasingly shows that PROs may be influenced by patients’ response shifts and dispositions. We identify how response shifts and dispositions may influence medical decisions on both the levels of individual patient care and health policy. We provide examples of these influences and analyse the consequences from the perspectives of ethical principles and theories of just distribution. If influences of response (...) shift and disposition on PROs and consequently medical decision making are not considered, patients may not receive optimal treatment and health insurance packages may include treatments that are not the most effective or cost-effective. We call on healthcare practitioners, researchers, policy makers, health insurers, and other stakeholders to critically reflect on why and how such patient reports are used. (shrink)

People cannot understand intentions behind observed actions by direct simulation, because goal inference is highly context dependent. Context dependency is a major source of computational intractability in traditional information-processing models. An embodied embedded view of cognition may be able to overcome this problem, but then the problem needs recognition and explication within the context of the new, layered cognitive architecture.

This introductory chapter gives an overview of the debate on realism in political theory and sets out two themes that are particularly important for this debate: the role of practice in realist political theory and the nature and place of normativity in realist political theory. These two themes are not only among the most discussed topics in the debate on possibilities to do realist political theory. Answers to the question of what more applied forms of realist political theory might look (...) like will also depend significantly on how realists specify the role of practice in political theory and the meaning of realist normative argumentation. We outline some of the main positions in the field and highlight questions that have been insufficiently addressed. Finally, we give an overview of the arguments of the articles assembled in this collection and how they contribute to the ongoing debates on the two themes. (shrink)

This paper articulates dignity as relational engagement in concrete care situations. Dignity is often understood as an abstract principle that represents inherent worth of all human beings. In actual care practices, this principle has to be substantiated in order to gain meaning and inform care activities. We describe three exemplary substantiations of the principle of dignity in care: as a state or characteristic of a situation; as a way to differentiate between socio-cultural positions; or as personal meaning. We continue our (...) analysis by presenting cases on dignity in care related to us in focus groups with medical professionals. Our empirical ethical lens is in this paper is to analyse, not the meaning of dignity, but the way in which it emerges in practices where it is pursued, within relationships between people, technologies, places, regulations, and the values cherished by or embedded in them. We show that professional caregivers recognize in the dignity of the person they care for their own dignity; giving up on the one implies no less than giving up on the other. This ‘mirrored experience’ of dignity expresses itself in professional’s engagement with the situation. The value of this engagement, we argue, lies not primarily in realizing the particular content of the values at stake. We point to the importance of engagement itself, even if the values engaged with cannot be realized to the full, and even if competing versions of dignity are at stake simultaneously. In this way the caregivers provide us with interesting examples of moral actorship in situations of conflicting values. (shrink)

Despite the power of VR in immersing viewers in an experience, it generally only targets viewers via visual and auditory cues. Human beings use more senses to gather information, so expectedly, the full potential of this medium is currently not yet tapped. This study contributes in answering two research questions: How can conventional VR ads be enriched by also addressing the forgotten sense of smell?; and Does doing so indeed instill more engaging experiences? A 2 × 3 between-subjects study is (...) conducted, whereby an existing branded VR commercial is augmented with “sound” and “scents.” The power of these sensory augmentations is evaluated by inspecting emotional, cognitive and conative dimensions of customer engagement. The results identify product-scent congruence as a deal-maker, albeit product-scent incongruence is not necessarily a deal-breaker. The article concludes with further research avenues and a translation into managerial implications. (shrink)

This article is the introduction to the 7th volume of the Iconicity in Language and Literature Series. First a brief historical outline of the concepts of naturalness and iconicity in linguistic theory is given. Both concepts are then separately dealt with in two sections, in which each concept is elaborated and an overview of seminal readings on naturalness and iconicity is presented. A thorough discussion is also provided of some unresolved issues in the iconicity and naturalness debates. The article rounds (...) off with a summary of the papers collected in the volume. (shrink)

Background: More and more quantitative information is becoming available about the risks of complications arising from medical treatment. In everyday practice, this raises the question whether each and every risk, however low, should be disclosed to patients. What could be good reasons for doing or not doing so? This will increasingly become a dilemma for practitioners.Objective: To report doctors’ views on whether to disclose or withhold information on low risks of complications.Methods: In a qualitative study design, 37 respondents were included. (...) Focus group interviews were held with 22 respondents and individual in-depth interviews with 15.Results: Doctors have doubts about disclosing or withholding information on complication risk, especially in a risk range of 1 in 200 to 1 in 10 000. Their considerations on whether to disclose or to withhold information depend on a complicated mix of patient and doctor-associated reasons; on medical and personal considerations; and on the kind and purpose of intervention.Discussion: Even though the degree of a risk is important in a doctor’s considerations, the severity of the possible complications and patients’ wishes and competencies have an important role as well. Respondents said that low risks should always be communicated when there are alternatives for the intervention or when the patient may prevent or mitigate the risk. When the appropriateness of disclosing risks is doubtful, doctors should always tell their patients that no intervention is without risk, give them the opportunity to gather all the information they need or want, and enable them to detect a complication at an early stage. (shrink)

Previous studies show that medical students in clinical training face ethical problems that are not often discussed in the literature. In order to make teaching timely and relevant for them, it is important to understand what medical students perceive as ethical problems, as various factors may influence their perception, including cultural differences and working environment. The purpose of this qualitative study was to explore students’ perceptions of what an ethical problem is, during their clinical training in the hospital, and compare (...) the results from two different countries. We observed a total of eighteen ethics group discussions and interviewed fifteen medical students at two medical schools, in Indonesia and the Netherlands. Data were interpreted and analyzed using content analysis. We found that students in both settings encounter problems which are closer to their daily work and responsibilities as medical students and perceive these problems as ethical problems. Indonesian students perceived substandard care and inequity in healthcare as ethical problems, while Dutch students perceived that cases which are not matters of life and death are less worthy to discuss. Our study suggests that there might be a gap between ethical problems that are discussed in class with teachers, and problems that students actually encounter in practice. Teachers should be aware of the everyday situations in clinical training which may be perceived by students as ethically problematic and should acknowledge and discuss these ethical problems with students as part of the learning processes in ethics education. (shrink)

To Aristotle, spoken words are symbols, not of objects in the world, but of our mental experiences related to these objects. Presently there are two major strands of interpretation of Aristotle’s concept of the linguistic sign. First, there is the structuralist account offered by Coseriu (Geschichte der Sprachphilosophie. Von den Anfängen bis Rousseau, 2003 [1969], pp. 65–108) whose interpretation is reminiscent of the Saussurean sign concept. A second interpretation, offered by Lieb (in: Geckeler (Ed.) Logos Semantikos: Studia Linguistica in Honorem (...) Eugenio Coseriu 1921–1981, 1981) and Weidemann (in: Schmitter (Ed.) Geschichte der Sprachtheorie 2. Sprachtheorien der abendländischen Antike, 1991), says that Aristotle’s concept of the linguistic sign is similar to the one presented in Ogden and Richard’s (The meaning of meaning: A study of the influence of language upon thought and of the science of symbolism, 1970 [1923]) semiotic triangle. This paper starts off with an introductory outline of the so-called phýsei-thései discussion which started during presocratic times and culminated in Plato’s Cratylus. Aristotle’s concept of the linguistic sign is to be regarded as a solution to the stalemate position reached in the Cratylus. Next, a discussion is offered of both Coseriu’s and Lieb’s analysis. We submit that Aristotle’s concept of the linguistic sign shows features of both Saussure’s and Ogden and Richards’s sign concept but that it does not exclusively predict one of the two. We argue that Aristotle’s concept of the linguistic sign is based on three different relations which together evince his teleological as well empiricist point of view: one internal (symbolic) relation and two external relations, i.e. a likeness relation and a relation katà synthéken. (shrink)

Background: Biomedical science is producing an avalanche of data about risk factors, often with a small predictive value, associated with a broad diversity of diseases. Prevention and screening are increasingly moving from public health into the clinic. Therefore, the question of which risk factors to investigate and disclose in the individual patient, becomes ethically increasingly urgent. In line with Wilson and Jungner's public health-related 10 principles for screening, it seems crucial to distinguish important from unimportant health risks.Aim: to explore the (...) ways in which clinicians distinguish important from unimportant health risks.Methods: We interviewed 36 respondents (gastroenterologists and gynaecologists/obstetrics) in 5 focus group interviews and 15 open in-depth interviews on their interpretation of what makes a health risk important.Results: Physicians primarily interpreted importance as the severity of the possible harm, less often its probability. Possibilities of prevention or reassurance strongly influenced their judgment on importance.Discussion: It is not likely that interpreting ‘important’ as ‘severe’ will help in differentiating meaningful from meaningless risk knowledge. A more fundamental change in our ways of dealing with risk may be called for. We discuss existing literature on resilience as an alternative way to deal with risk. Balancing prevention and risk reduction with resilience could be a fruitful direction. (shrink)

Objectives Access to healthcare in most western societies is based on equality. Rapidly rising costs have fuelled debates about differentiation in access to healthcare. We assessed the public's perceptions and attitudes about differentiation in healthcare according to lifestyle behaviour. Methods A vignette study was undertaken in participants in a colorectal cancer screening pilot programme in the Netherlands. Screenees with a negative test result received a questionnaire in which nine hypothetical situations were described: three different healthcare settings (screening, lung cancer, chronic (...) obstructive pulmonary disease) combined with three forms of differentiation each: a difference in premium, waiting list ordering or copayment according to lifestyle. We evaluated the responses using a general hierarchical linear model. Results The percentage of participants in agreement with differentiation varied from 20% to 58% (overall mean of 40%). Significantly more participants were in favour of giving a premium discount to those who do not engage in unhealthy behaviour compared with supporters for higher payments for those who do. More differentiation was supported for non-smoking versus smoking cessation than for participation versus non-participation in screening. We observed in-group favouritism in smokers, but no significant effects of age or disease. There was no support for waiting list ordering based on lifestyle. Conclusions Results of this study show that Dutch citizens eligible for colorectal cancer screening are in favour of some form of financial differentiation in the distribution of healthcare, but that significant differences exist between type of setting and the type of behaviour. Our study can be used in the ongoing discussion about solidarity and behaviour in healthcare. (shrink)

Amsterdam University Press is a leading publisher of academic books, journals and textbooks in the Humanities and Social Sciences. Our aim is to make current research available to scholars, students, innovators, and the general public. AUP stands for scholarly excellence, global presence, and engagement with the international academic community.

Amsterdam University Press is a leading publisher of academic books, journals and textbooks in the Humanities and Social Sciences. Our aim is to make current research available to scholars, students, innovators, and the general public. AUP stands for scholarly excellence, global presence, and engagement with the international academic community.

In reference to the different approaches in philosophy(of medicine) of the nature of (medical) technology,this article introduces the topic of this specialissue of Theoretical Medicine and Bioethics, that is,the way the different forms of medical technologyfunction in everyday medical practice. The authorselaborate on the active role technology plays inshaping our views on disease, illness, and the body,whence in shaping our world.

A large campaign has sought to destigmatize psychiatric disorders by disseminating the view that they are in fact brain disorders. But when psychiatric disorders are associated with neurobiological correlates, laypeople's attitudes toward patients are harsher, and the prognoses seem poorer. Here, we ask whether these misconceptions could result from the essentialist presumption that brain disorders are innate. To this end, we invited laypeople to reason about psychiatric disorders that are diagnosed by either a brain or a behavioral test that were (...) strictly matched for their informative value. Participants viewed disorders as more likely to be innate and immutable when the diagnosis was supported by a brain test as compared to a behavioral test. These results show for the first time that people spontaneously essentialize psychiatric conditions that are linked to the brain, even when the brain probe offers no additional diagnostic or genetic information. This bias suggests that people consider the biological essence of living things as materially embodied. (shrink)

Iris van der Tuin redirects the notion of generational logic in feminism away from its simplistic conception as conflict towards a more nuanced conception of the methodology's useful structures. Experimenting with generational logic as an impetus for a new materialism, this book advances feminist politics for the twenty-first century.

In this article, we use the theory of Information Ethics to argue that deceased people have a prima facie moral right to privacy in the context of health data research, and that this should be reflected in regulation and guidelines. After death, people are no longer biological subjects but continue to exist as informational entities which can still be harmed/damaged. We find that while the instrumental value of recognising post-mortem privacy lies in the preservation of the social contract for health (...) research, its intrinsic value is grounded in respect for the dignity of the post-mortem informational entity. However, existing guidance on post-mortem data protection is available only in the context of genetic studies. In comparing the characteristics of genetic data and other health-related data, we identify two features of DNA often given as arguments for this genetic exceptionalism: relationality and embodiment. We use these concepts to show that at the appropriate Level of Abstraction, there is no morally relevant distinction between posthumous genetic and other health data. Thus, genetic data should not automatically receive special moral status after death. Instead we make a plea for ‘contextual exceptionalism’. Our analysis concludes by reflecting on a real-world case and providing suggestions for contextual factors that researchers and oversight bodies should take into account when designing and evaluating research projects with health data from deceased subjects. (shrink)

The ethics of hope has often been understood as a conflict between duties: do not lie versus do not destroy hope. However, such a way of framing the ethics of hope may easily place healthcare professionals at the side of realism and patients at the side of hope. That leaves unexamined relational dimensions of hope. The objective of this study was to describe a relational ethics of hope based on the perspectives of palliative care patients, their family members and their (...) healthcare professionals. A qualitative longitudinal method based on narrative theories was used. Semi-structured interviews on hope were conducted with twenty-nine palliative care patients, nineteen friends or family members, and fifty-two healthcare professionals, which were recorded and transcribed. Data on hope were thematically analyzed. The researchers wrote memos and did member checking with participants. When participants spoke about hope, they referred to power and empowerment, like the powerful bonding of hope between patients and physicians. They also associated hope with the loss of hope and suffering. Several participating healthcare professionals tried to balance both sides, which involved acknowledgment of hope and suffering. Hope and power were reflected in the ethical concept of empowerment, whereas suffering and the loss of hope were reflected in the ethical concept of compassion. Empowerment and compassion can be balanced in solicitude. In conclusion, a relational ethics of hope requires solicitude, in which healthcare professionals are able to weigh empowerment and compassion within particular relationships. (shrink)

Humans can recollect past events in details and/or know that an object, person, or place has been encountered before. During the last two decades, there has been intense debate about how recollection and familiarity are organized in the brain. Here, we propose an integrative memory model which describes the distributed and interactive neurocognitive architecture of representations and operations underlying recollection and familiarity. In this architecture, the subjective experience of recollection and familiarity arises from the interaction between core systems and an (...) attribution system. By integrating principles from current theoretical views about memory functioning, we provide a testable framework to refine the prediction of deficient versus preserved mechanisms in memory-impaired populations. The case of Alzheimer's disease is considered as an example because it entails progressive lesions starting with limited damage to core systems before invading step-by-step most parts of the model-related network. We suggest a chronological scheme of cognitive impairments along the course of AD, where the inaugurating deficit would relate early neurodegeneration of the perirhinal/anterolateral entorhinal cortex to impaired familiarity for items that need to be discriminated as viewpoint-invariant conjunctive entities. The integrative memory model can guide future neuropsychological and neuroimaging studies aiming to understand how such a network allows humans to remember past events, to project into the future, and possibly also to share experiences. (shrink)

To Aristotle, spoken words are symbols, not of objects in the world, but of our mental experiences related to these objects. Presently there are two major strands of interpretation of Aristotle’s concept of the linguistic sign. First, there is the structuralist account offered by Coseriu (Geschichte der Sprachphilosophie. Von den Anfängen bis Rousseau, 2003 [1969], pp. 65–108) whose interpretation is reminiscent of the Saussurean sign concept. A second interpretation, offered by Lieb (in: Geckeler (Ed.) Logos Semantikos: Studia Linguistica in Honorem (...) Eugenio Coseriu 1921–1981, 1981) and Weidemann (in: Schmitter (Ed.) Geschichte der Sprachtheorie 2. Sprachtheorien der abendländischen Antike, 1991), says that Aristotle’s concept of the linguistic sign is similar to the one presented in Ogden and Richard’s (The meaning of meaning: A study of the influence of language upon thought and of the science of symbolism, 1970 [1923]) semiotic triangle. This paper starts off with an introductory outline of the so-called phýsei-thései discussion which started during presocratic times and culminated in Plato’s Cratylus. Aristotle’s concept of the linguistic sign is to be regarded as a solution to the stalemate position reached in the Cratylus. Next, a discussion is offered of both Coseriu’s and Lieb’s analysis. We submit that Aristotle’s concept of the linguistic sign shows features of both Saussure’s and Ogden and Richards’s sign concept but that it does not exclusively predict one of the two. We argue that Aristotle’s concept of the linguistic sign is based on three different relations which together evince his teleological as well empiricist point of view: one internal (symbolic) relation and two external relations, i.e. a likeness relation and a relation katà synthéken. (shrink)

Imagine yourself sitting on your front porch, sipping your morning coffee and admiring the scene before you. You see trees, houses, people, automobiles; you see a cat running across the road, and a bee buzzing among the flowers. You see that the flowers are yellow, and blowing in the wind. You see that the people are moving about, many of them on bicycles. You see that the houses are painted different colors, mostly earth tones, and most are one-story but a (...) few are two-story. It is a beautiful morning. Thus the world interfaces with your mind through your senses. There is a strong intuition that we are not disconnected from the world. We and the other things we see around us are part of a continuous whole, and we have direct access to them through vision, touch, etc. However, the philosophical tradition tries to drive a wedge between us and the world by insisting that the information we get from perception is the result of inference from indirect evidence that is about how things look and feel to us. The philosophical problem of perception is then to explain what justifies these inferences. We will focus on visual perception. Figure one presents a crude diagram of the cognitive system of an agent capable of forming beliefs on the basis of visual perception. Cognition begins with the stimulation of the rods and cones on the retina. From that physical input, some kind of visual processing produces an introspectible visual image. In response to the production of the visual image, the cognizer forms beliefs about his or her surroundings. Some beliefs the perceptual beliefs are formed as direct responses to the visual input, and other beliefs are inferred from the perceptual beliefs. The perceptual beliefs are, at the very least, caused or causally influenced by having the image. This is signified by the dashed arrow marked with a large question mark. We will refer to this as the mystery link. Figure one makes it apparent that in order to fully understand how knowledge is based on perception, we need three different theories.. (shrink)

In this chapter, I propose to use the layered structure of a Russian Doll Model initially used by Frans de Waal and some of the most recent and influential empirical studies to interpret ceyin zhi xin. At the core of ceyin zhi xin, I argue, lies the Perceptive-Affective-Motive Triplet that includes perceptive, affective and motivational aspects. The Russian Doll Model helps to illustrate the structure of ceyin zhi xin as containing both the multifaceted triplet as its inner layer and higher (...) cognitive activities—such as long-term memory, taking perspectives other than one’s own, semantic processing and imagination—as its outer layers. These outer layer faculties make the normative and cultural development of ceyin zhi xin possible. The higher cognitive capacities are in close contact and constantly interacting with the triplet. I argue that this model is the best interpretative model for ceyin zhi xin because of its rich support from empirical studies, its emphasis on the interactions of the different aspects of ceyin zhi xin, as well as how it explains the normative and cultural potential of ceyin zhi xin. (shrink)

The present research examined whether Asian-American (AA) versus European-American (EA) women differed in experiential, expressive, or autonomic physiological responding to a laboratory anger provocation and assessed the mediating role of values about emotional control. Results indicate that AA participants reported and behaviourally displayed less anger than EA participants, while there were no group differences in physiological responses. Observed differences in emotional responses were partially mediated by emotion control values, suggesting a potential mechanism for effects of cultural background on anger responding.

Studies have shown that students may feel emotional discomfort when they are asked to identify ethical problems which they have encountered during their training. Teachers in medical ethics, however, more often focus on the cognitive and rational ethical aspects and not much on students’ emotions. The purpose of this qualitative study was to explore students’ feelings and emotions when dealing with ethical problems during their clinical training and explore differences between two countries: Indonesia and the Netherlands. We observed a total (...) of eighteen ethics group discussions and interviewed fifteen medical students at two medical schools. Data were interpreted and analyzed using content analysis. We categorized students’ negative emotions based on their objects of reflection and came up with three categories: emotions concerning their own performance, emotions when witnessing unethical behaviors, and emotions related to barriers and limitations of their working environment. Our study suggests that addressing emotional responses in a culturally sensitive way is important to develop students’ self-awareness. Teachers should be able to guide students to reflect on and be critical of their own thoughts and emotions, to understand their own moral values, especially when confronted with other individuals. (shrink)

The recognition that human minds/brains are finite systems with limited resources for computation has led some researchers to advance the Tractable Cognition thesis: Human cognitive capacities are constrained by computational tractability. This thesis, if true, serves cognitive psychology by constraining the space of computational‐level theories of cognition. To utilize this constraint, a precise and workable definition of “computational tractability” is needed. Following computer science tradition, many cognitive scientists and psychologists define computational tractability as polynomial‐time computability, leading to the P‐Cognition thesis. (...) This article explains how and why the P‐Cognition thesis may be overly restrictive, risking the exclusion of veridical computational‐level theories from scientific investigation. An argument is made to replace the P‐Cognition thesis by the FPT‐Cognition thesis as an alternative formalization of the Tractable Cognition thesis (here, FPT stands for fixed‐parameter tractable). Possible objections to the Tractable Cognition thesis, and its proposed formalization, are discussed, and existing misconceptions are clarified. (shrink)

Productivity—the hallmark of linguistic competence—is typically attributed to algebraic rules that support broad generalizations. Past research on spoken language has documented such generalizations in both adults and infants. But whether algebraic rules form part of the linguistic competence of signers remains unknown. To address this question, here we gauge the generalization afforded by American Sign Language (ASL). As a case study, we examine reduplication (X→XX)—a rule that, inter alia, generates ASL nouns from verbs. If signers encode this rule, then they (...) should freely extend it to novel syllables, including ones with features that are unattested in ASL. And since reduplicated disyllables are preferred in ASL, such rule should favor novel reduplicated signs. Novel reduplicated signs should thus be preferred to nonreduplicative controls (in rating), and consequently, such stimuli should also be harder to classify as nonsigns (in the lexical decision task). The results of four experiments support this prediction. These findings suggest that the phonological knowledge of signers includes powerful algebraic rules. The convergence between these conclusions and previous evidence for phonological rules in spoken language suggests that the architecture of the phonological mind is partly amodal. (shrink)

This article contributes to contemporary philosophy of technology by carrying out a diffractive reading of Ernst Cassirer’s “Form und Technik” (1930) and Gilbert Simondon’s Du mode d’existence des objets techniques (1958). Both thinkers, who are here brought together for the first time, stood on the brink of the defining bifurcations of twentieth-century philosophy. However, in their endeavor to come to grips with the “being” of technology, Cassirer and Simondon, each in their own way, were prompted to develop an ontology of (...) emergence that gives ontological priority to “technicity,” that is, to technology considered in its efficacy or operative functioning. By reading Cassirer’s and Simondon’s insights through one another, we aim to further develop this ontology of emergence, and, simultaneously, to demonstrate the relevance of these thinkers for present-day theorizing. As we hope to show, the insistence on the ontological force of technological apparatuses transverses received philosophical and ontological divides and revitalizes the notions of “nature” and “the human,” which are now understood as coevolving with technology. (shrink)

[MAGA thought process: We must punish evil China for sending this horrible virus that is just the common cold and we don’t need masks but Trump was a hero for wearing one that one time and God bles...

Traduçáo do artigo Il tema del “ pecato originale ” nella teoria della conoscenza di Cusano.