One in three university students experiences mental health problems during their study. A similar percentage leaves higher education without obtaining the degree for which they enrolled. Research suggests that both mental health problems and academic underperformance could be caused by students lacking control and purpose while they are adjusting to tertiary education. Currently, universities are not designed to cater to all the personal needs and mental health problems of large numbers of students at the start of their studies. Within the (...) literature aimed at preventing mental health problems among students (e.g., anxiety or depression), digital forms of therapy recently have been suggested as potentially scalable solutions to address these problems. Integrative psychological artificial intelligence (AI) in the form of a chatbot, for example, shows great potential as an evidence-based solution. At the same time, within the literature aimed at improving academic success, the online life-crafting intervention in which students write about values and passions, goals, and goal-attainment plans has shown to improve the academic performance and retention rates of students. Because the life-crafting intervention is delivered through the curriculum and doesn’t bear the stigma that is associated with therapy, it can reach larger populations of students. But life-crafting lacks the means for follow-up or the interactiveness that online AI-guided therapy can offer. In this paper, we propose to integrate the current literature on chatbot interventions aimed at the mental health of students with research about a life-crafting intervention that uses an inclusive curriculum-wide approach. When a chatbot asks students to prioritize both academic as well as social and health-related goals and provides personalized follow-up coaching, this can prevent -often interrelated- academic and mental health problems. Right on-time delivery, and personalized follow-up questions enhance the effects of both -originally separated- intervention types. Research on this new combination of interventions should use design principles that increase user-friendliness and monitor the technology acceptance of its participants. (shrink)

The goal of this paper is to understand how common aversions to critical thinking, and, in particular, critical thinking related to deliberation about ethics, is arguably akin to math anxiety (MA). However, unlike ethical-critical thinking anxiety (ECTA), MA has a body of literature and neuroscientific findings supporting it and correlating thoughts about math with neurobiology of pain and fear activation. The crux of the paper lies in the answer to the following question: how is ECTA like and unlike MA? Is (...) there a history—educational and otherwise—similar to MA—that leads to ECTA? In this paper, I argue that there are myriad factors contributing to ECTA but that, ultimately, the result is likely the same: a neurobiology of fear/pain response that inhibits ethical thought and judgment, largely given its dependence on critical thinking. My thesis statement, therefore, is that critical thinking engenders the angst engendered by MA and for similar reasons, and I surmise that current models of teaching applied clinical ethics to health care practitioners would benefit from approaches framing the lack of ethical thinking in our field of health and human services as an ego-defense mechanism or neurobiological constraint. This leads to the question of how workshops aimed at teaching ethics take into account the realities of avoidance, promote critical thinking, and avoid the pitfalls of ECTA. (shrink)

Periodic attacks of uncertain origin, where the clinical presentationresembles epilepsy but there is no evidence of a somatic disease, arecalled Pseudo-Epilepsy or Pseudo-Epileptic Attack Disorder (PEAD). PEADmay be called a `non-disease', i.e. a disorder on the fringes ofestablished disease patterns, because it lacks a rationalpathophysiological explanation. The first aim of this article is tocriticize the idea, common in medical science, that diseases are realentities which exist separately from the patient, waiting to bediscovered by the doctor. We argue that doctor and (...) patient construct adisease, and that the construction of the disease PEAD includes manynormative evaluations. The second aim is to provide insight into thesuffering of patients with PEAD. We focus on three aspects of thepatient, identity, autonomy and responsibility. We present somecharacteristic descriptions of (pseudo-)epileptic attacks by FjodorDostoevsky, Gustave Flaubert and Thomas Mann. We argue that diagnosingPEAD reduces a meaningful life event into an insignificant, thoughintriguing, medical phenomenon, and that the patient will not benefitfrom being diagnosed as having PEAD. (shrink)

Patients’ admission to modern substance use disorder treatment comes with the attendant risk of being discharged from treatment— a widespread practice. This article describes the three mainstream theories of addiction that operate as a reference point for clinicians in reasoning about a decision to discharge a patient from treatment. The extant literature is reviewed to highlight the pathways that patients follow after administrative discharge. Little scientific research has been done to investigate claims and hypotheses about the therapeutic function of AD, (...) which points to the need for empirical ethics to inform clinical addictions practice. (shrink)

In this paper I revive two important formal approaches to the interpretation of natural language, that of Montague and that of Karttunen and Peters. Armed with insights from dynamic semantics (Heim, Krifka) the two turn out to stand up against age-old criticisms in an orthodox fashion. The plan is mainly methodological, as I only want to illustrate the technical feasibility of the revived proposals. Even so, there are illuminating and welcome empirical consequences on the subject of scope islands (as discussed (...) by Abusch and Kratzer, among many others), as well as unintended theoretical implications in the contextualist debate (Grice, Recanati, Simons, Stanley, and many others again). (shrink)

What is the right thing to do? -- "You have nothing to fear if you've done nothing wrong" -- Between culpable and blameless -- Are all mistakes equal? -- Report, disclose, protect, learn -- A just culture in your organization -- The criminalization of human error -- Is criminalization bad for safety? -- Without prosecutors, there would be no crime -- Three questions for your just culture -- Why do we blame?

This paper explores the ambiguous notion of bodily integrity, focusing on male and female circumcision. In the empirical part of the study we describe and analyse the various meanings that are given to the notion of bodily integrity by people in their daily lives. In the philosophical part we distinguish (1) between a person-oriented and a body-oriented approach and (2) between four levels of interpretation, i.e. bodily integrity conceived of as a biological wholeness, an experiential wholeness, an intact wholeness, and (...) as an inviolable wholeness. We argue that bodily integrity is a prima facie principle in its own right, closely connected with, but still fundamentally different from, the principle of personal autonomy, that is, autonomy over the body. (shrink)

Recent advances in molecular genetics, plant physiology, and biochemistry have opened up the new biotechnology of herbicide resistant crops (HRCs). Herbicide resistant crops have been characterized as the solution for many environmental problems associated with modern crop production, being described as powerful tools for farmers that may increase production options. We are concerned that these releases are occurring in the absence of forethought about their impact on agroecosystems, the broader landscape, and the rural and urban economies and cultures. Many of (...) the benefits and risks associated with HRCs are not apparent to either the public, farmers, policy makers, or the scientific community. HRC technology raises moral issues in three areas: our duties toward the natural environment; our political and economic responsibilities to each other; and our communal character as one generation among many. We also need a rational basis on which to make evaluations of this new biotechnology. The technical aspects of their release require a logical guide to the ecological, environmental, and biological effects the release might have in sustainable agroecosystems. The initial step should include an assessment of the intrinsic qualities of the crop, the herbicide, and the resistance mechanisms. The second step should include an assessment of effects associated with population ecology, population genetics, environmental degradation, consumer health, and farm economic viability due to the resistant crop-herbicide pair. Herbicides have been used in crop production for nearly a half a century. There has been a tremendous increase in the use of these chemicals in that time. Society has seen the use of these chemicals not only help to feed many people, but also to bring costs not anticipated before the introduction of the chemicals. We need to draw on that long history of use and learn the lessons it can provide us as we approach the introduction and commercialization of the next generation of weed control technology, herbicide resistant crops. We also need to reflect on the lessons we missed during that half century because we spend more time imagining the possible benefits that would come from the technology than scrutinizing the possible harm. (shrink)

It is a commonly held position in the literature on distributive justice that choices individuals make from an equalized background may lead to inequalities of outcome. This raises the question of how to assign consequences to particular types of behaviour. Theories of justice based on the concept of moral responsibility offer considerable guidance as to how society should be structured, but they rarely address the question of what the consequences of making a particular choice should be. To fill this lacuna, (...) these theories must rely on a theory of consequences. I argue that the most plausible theories of consequences are substantive rather than procedural in nature. Such theories of consequences are inherently based on the concept of desert. By evaluating individuals' choices society may determine the appropriate consequences of choices for which they are responsible. (shrink)

If one wishes to give individuals what they deserve, one must find some way of appraising those characteristics that render them deserving. In modern democratic societies, it seems attractive to base this appraisal on an aggregation of the valuations individuals hold of the desert bases under consideration. Some have argued that the market can provide such an appraisal. However, I argue that the market does not provide a satisfactory democratic appraisal that is relevant for desert, as it allows for the (...) existence of net consumer surplus. Nevertheless, I submit that a procedure that does not leave any net consumer surplus would succeed where the market fails. Taking the average valuation of the individuals in society for a given desert base would meet this requirement. Hence, I claim that such a procedure can provide the satisfactory democratic appraisal that the market cannot, and can be used to give individuals what they deserve. (shrink)

The compelling case that Anderson makes for neural reuse and against modularity as organizing principle of the brain is further supported by evidence from developmental disorders. However, to provide a full evolutionary-developmental theory of neural reuse that encompasses both typical and atypical development, Anderson's (MRH) could be further constrained by considering brain development across ontogeny.

For a few decades, patients with Parkinson's disease have been treated with intracerebral transplantations of fetal mesencephalic tissue. The results of open trials have been variable. Double blind, placebo-controlled studies have recently been started in order to further investigate the efficacy of this new medical technique. In this paper we challenge the need for sham surgery in neurotransplantation research on PD patients. Considerations regarding the research subjects' informed consent, therapeutic misconception, the integrity of the human body, and the assessment of (...) risks and benefits argue against sham surgery for patients with PD. Moreover, there is an alternative, less harmful mode of research that can provide the same or comparable scientific evidence. A plea is made for intrapatient research based on quantitative measurements of the patient's pre- and post-operative condition combined with similar research on a reference group of patients who have received the standard treatment. (shrink)

In this article some of the presuppositions that underly the current ideas about decision making capacity, autonomy and independence are critically examined. The focus is on chronic disorders, especially on chronic physical disorders. First, it is argued that the concepts of decision making competence and autonomy, as they are usually applied to the problem of legal (in)competence in the mentally ill, need to be modified and adapted to the situation of the chronically (physically) ill. Second, it is argued that autonomy (...) and dependence must not be considered as two mutually exclusive categories. It is suggested that decision making may take on the form of a more or less conscious decision not to be involved in making all kinds of explicit and deliberate decisions. Elaborating on Agich's distinction between ideal and actual autonomy, the concept of Socratic autonomy is introduced. (shrink)

Residents who do not internalize professional values may not be a good fit for their specialty and compromise the quality of their patient care. Research aimed at recognizing residents’ shortcomings in professionalism may help to prevent future shortcomings towards patients. The aim of this study was to increase insight into residents’ shortcomings in medical professionalism in light of professional values relevant within residency training. We analyzed all law cases from the Dutch national conciliation board from 2011 to 2020 on the (...) unprofessional behaviors described. During the period investigated, 61 dismissed residents challenged their dismissal. In 39 of 61 cases (64%), the program director named unprofessional behavior(s) as (one of the) reasons for dismissal. The most prevalent deficit of residents deemed unprofessional was poor self-awareness (80%); less prevalent deficits were: shortness of engagement and dishonest and disrespectful behavior (31% or less). We describe perceived unprofessional behavior in residency, which was not about exceptional or abominable behaviors. For the most part, these behaviors concerned the accumulation of remediation-resistant day-to-day underperformance, discrediting trust and professional reliability. This finding encourages dedicated longitudinal assessment of professionalism and fuels the ethical debate about required professional values in hospital care. (shrink)

This paper focuses on the causation of diseases, particularly on the idea of a “genetic cause” taking Alzheimer’s Disease (AD) as an example. We (1) provide some historical information and a synopsis of the current knowledge on the etiology and pathogenesis of AD, (2) analyse some conceptual problems related to the notion of “genetic disease” (3) elaborate on the alleged (genetic) cause of AD, and (4) place the discussion on the cause of AD in a broader philosophical context, paying attention (...) to a constructivist perspective, the notions of causal connection and causal selection, and to some practical and normative consequences of our analysis. We conclude (a) that AD is not a specific disease entity with one specific cause, (b) that the idea of a single (sufficient) cause can still function as a heuristic tool in AD research and practice, and (c) that a “belief” in causation can go together with the notions of multicausality and probability. (shrink)

Social health disparities are increasing in most countries around the world. During the past two decades, a large amount of evidence has emerged about the health consequences of social inequalities. Despite such evidence, the concept of medical fairness, as traditionally defined by the World Medical Association, has remained unchallenged and even reinforced by some scholars who emphasize that doctors should remain neutral to the socioeconomic status of their patients when providing clinical care. The inconsistency between public health and clinical care (...) perspectives raises tension between a narrow interpretation of the ethics of justice, which stresses the importance of equality and impartiality, and the ethics of care, which highlights the importance of particularity and individuality in clinical practice. This article analyzes the concept of medical fairness using the emerging evidence that demonstrates the impact of social health disparities on clinical care. It proposes a new approach of medical fairness based on equity rather than on equality and provides a consistent ethical framework based on Paul Ricoeur’s three levels of medical judgments. This integrative framework provides a better balance between public health and clinical care in medical practice. (shrink)

The notion of home is well known from our everyday experience, and plays a crucial role in all kinds of narratives about human life, but is hardly ever systematically dealt with in the philosophy of medicine and health care. This paper is based upon the intuitively positive connotation of the term “home.” By metaphorically describing the goal of palliative care as “the patient’s coming home,” it wants to contribute to a medical humanities approach of medicine. It is argued that this (...) metaphor can enrich our understanding of the goals of palliative care and its proper objectives. Four interpretations of “home” and “coming home” are explored: (1) one’s own house or homelike environment, (2) one’s own body, (3) the psychosocial environment, and (4) the spiritual dimension, in particular, the origin of human existence. Thinking in terms of coming home implies a normative point of view. It represents central human values and refers not only to the medical-technical and care aspects of health care, but also to the moral context. (shrink)

Illative combinatory logic consists of the theory of combinators or lambda calculus extended by extra constants (and corresponding axioms and rules) intended to capture inference. The paper considers 4 systems of illative combinatory logic that are sound for first-order propositional and predicate calculus. The interpretation from ordinary logic into the illative systems can be done in two ways: following the propositions-as-types paradigm, in which derivations become combinators, or in a more direct way, in which derivations are not translated. Both translations (...) are closely related in a canonical way. In a preceding paper, Barendregt, Bunder and Dekkers, 1993, we proved completeness of the two direct translations. In the present paper we prove completeness of the two indirect translations by showing that the corresponding illative systems are conservative over the two systems for the direct translations. In another version, DBB (1997), we shall give a more direct completeness proof. These papers fulfill the program of Church and Curry to base logic on a consistent system of $\lambda$ -terms or combinators. Hitherto this program had failed because systems of ICL were either too weak (to provide a sound interpretation) or too strong (sometimes even inconsistent). (shrink)

Sentences containing pronouns and indefinite noun phrases can be said toexpress open propositions, propositions which display gaps to be filled.This paper addresses the question what is the linguistic content ofthese expressions, what information they can be said to provide to ahearer, and in what sense the information of a speaker can be said tosupport their utterance. We present and motivate first order notions ofcontent, update and support. The three notions are each defined in acompositional fashion and brought together within a (...) single and coherentframework. (shrink)

In the current debate about the pros and cons of routine (nonreligious) neonatal circumcision (RNC), the emphasis is on medical justifications for the practice. Questions of human rights also are widely discussed. However, even if the alleged medical benefits of RNC were to outweigh the harms and risks, this is not a sufficient justification for RNC. The practice of RNC is questionable from a variety of viewpoints including not only the ideal of evidence-based medicine and human rights considerations, but also (...) the notion of respect for bodily integrity. (shrink)

Medicine does not usually consider the human body from an aesthetic point of view. This article explores the notion of the lived body as aesthetic object in anthropological medicine, concentrating on the views of Buytendijk and Straus on human uprightness and gracefulness. It is argued that their insights constitute a counter-balance to the way the human body is predominantly approached in medicine and medical ethics. In particular, (1) the relationship between anthropological, aesthetic and ethical norms, (2) the possible danger of (...) a naturalistic fallacy, (3) the implications for the care of disabled people and (4) the intrinsic aesthetic quality of the human body are dealt with. (shrink)

The purpose of this paper is to elaborate on the notion of clinical medicine as a hermeneutical enterprise and to bridge the gap between the general perspectives of hermeneutics and the particularities of medical practice. The case of a patient with low back pain is analyzed. The discussion centers around the metaphor of the patient as a text and a model of five social discourses about low back pain. The problems addressed are: (1) the nature of a moral experience, (2) (...) the variety of available texts, (3) the difference between the doctor's and patient's narratives, and (4) the patient's and doctor's responsibility regarding the existential, biographical meaning of an illness. Although many problems are left unsolved, it is argued that from a philosophical point of view the notion of medicine as a hermeneutical enterprise opens up the possibility of gaining insight in the foundations of the clinical encounter. (shrink)

In this paper, I want to contribute to understanding and improving on Keenan'sintriguing equivalence result about reducible type quantifiers (Keenan, 1992).I give an alternative proof of his result which generalizes to type quantifiers, andI show how the reduction of a reducible type quantifier to (the composition of) ntype quantifiers can be effected.

With this paper I aim to demonstrate that a look beyond the Aristotelian square of opposition, and a related non-conservative view on logical determiners, contributes to both the understanding of Aristotelian syllogistics as well as to the study of quantificational structures in natural language.

With the rapid advance of bio-genetic technology, it will soon be possible for parents to design children who are born with certain genetic traits. This raises the question whether parents should be allowed to use this technology to engineer their children as they please. In this context it is often thought and argued that liberalism, which has a reputation for being permissive of all kinds of practices, grants parents the right to do so. However, I will argue that, on an (...) understanding of liberalism that is identical to the one used by the defenders of genetic design, liberals should wary of such practices. Liberalism, in its most general form, requires that any time individuals exercise power over others they justify it without relying on any particular conception of what a good life is. When we design children to have certain traits that are only useful for realising some conceptions of the good life, we are implicitly endorsing those conceptions. Hence this practice cannot be justified in neutral terms, and liberals should be sceptical of it. Only when we engineer our children to have traits that are useful for all conceptions of the good life can liberals allow the use of this new technology. Indeed, liberalism holds that this is morally required. (shrink)

This paper presents a case study of the South African operation of a logistics company, operating in a context of short-termism and under-performance. Frustration with managing in this context, and concern that this environment might erode the customer value proposition, prompted an exploration of the question: “How can the business prioritise its investment in intangibles to support sustainable growth in an environment of short-termism and sub-par business performance?” The study followed an inductive grounded theory approach and began with an exploration (...) of the system of short-termism as it was being experienced by the management team. This evolved in an iterative process to include an exploration of the customer value proposition, the organisation’s capabilities and the system of investment in intangibles. Data were collected over a period of 6 months, across a series of four stages as the management team grappled with the short-term financial objectives imposed on them. The data categories were used to develop 214 propositions across all stages. Through the four stages, four artefacts were developed from the propositions a causal loop diagram of the system of short-termism; a documented value proposition; an assessment of the health of the business’ capitals; and a multi-year intangibles investment programme. The findings indicate that a focus on investment in intangible assets can play a vital role in stimulating sustainable value creation in an environment of historically poor returns on investment and pressure for short-term financial results. It is suggested that investment in intangibles can be introduced as a multi-year capabilities investment plan. The study succeeded in getting investment in intangibles approved and the implication is that long-term decision-making can co-exist in an environment of short-termism and low growth. (shrink)

In recent years, we have witnessed the emergence of political activism through an irruption of citizen movements – 5M or Occupy–, the birth of new political platforms –5 Stelle, Zyrisa, Podemos– and the rise of new direct action groups, such as Anonymous, Stop-Evictions Movements, cooperatives, to name just a few. In some countries this activism has not just placed substantial pressure on traditional actors of representative democracy and governments, but has also opened up opportunities for structural changes in the policymaking (...) context and procedures (García Marzá, 2012). (shrink)

Formal semantics - the scientific study of meaning in natural language - is one of the most fundamental and long-established areas of linguistics. This Handbook offers a comprehensive, yet compact guide to the field, bringing together research from a wide range of world-leading experts. Chapters include coverage of the historical context and foundation of contemporary formal semantics, a survey of the variety of formal/logical approaches to linguistic meaning and an overview of the major areas of research within current semantic theory, (...) broadly conceived. The Handbook also explores the interfaces between semantics and neighbouring disciplines, including research in cognition and computation. This work will be essential reading for students and researchers working in linguistics, philosophy, psychology and computer science. (shrink)

In his concept of an anthropological physiology, F.J.J. Buytendijk has tried to lay down the theoretical and scientific foundations for an anthropologically-oriented medicine. The aim of anthropological physiology is to demonstrate, empirically, what being specifically human is in the most elementary physiological functions. This article contains a sketch of Buytendijk''s life and work, an overview of his philosophical-anthropological presuppositions, an outline of his idea of an anthropological physiology and medicine, and a discussion of some episternological and methodological problems. It is (...) demonstrated that Buytendijk''s design of an anthropological physiology is fragmentary and programmatic and that his methodology offers few points of contact for specific anthropological experimental research.Notwithstanding, it is argued that Buytendijk''s description of the subjective, animated body forms a pre-eminent point of reference for all research in physiology and psychology in which the specific human aspect is not ignored beforehand. (shrink)

A detailed description of an as yet unrecorded astrolabe quadrant in a private collection is presented. A date between 1291 and 1310 is deduced from the calendrical data engraved on it. The characteristics of the newly recorded instrument have been compared with those of six other medieval astrolabe quadrants. The newly recorded instrument appears to present an early, if not the earliest, stage of development in the history of the astrolabe quadrant. In the comparison the newly recorded instrument is also (...) distinguished by the red and black colours applied to differentiate between the superposed scales of the astrolabe quadrant. The names and the positions of the stars on the instruments were used to establish a connection between two of the instruments studied, those in Rouen and Oxford, and a manuscript tradition on the construction of the astrolabe quadrant, exemplified by MS Oxford Ashmole 1522. The data on three other astrolabe quadrants are shown to stem from star lists in treatises on astrolabes. For two instruments, those dated earliest and latest, no such connection was found. Some star names on the newly recorded instrument have hitherto not been recorded. Finally, the competence of the later medieval artisans has been investigated by analysing the accuracy of these instruments. (shrink)

Digital energy platforms play a central role in the transition toward a more sustainable energy system. This research explores the effect of digital energy platforms on public values. We developed and tested a novel public value framework, combining values already embedded in energy and digitalization regulations and emerging values that have become more relevant in recent debates. We analyzed value changes and potential value tensions. We found that sustainability is prioritized, security is broadened to include cybersecurity, and values relevant for (...) digital technologies, such as control over technology, have also become relevant for the energy system. This has resulted in three value tensions: preserving a well-functioning energy system, self-determination, and ensuring a level playing field and public control. A sustainable energy system requires governments to address these value changes, value tensions, and connected societal and political challenges related to the implementation of digital energy platforms. (shrink)

Illative combinatory logic consists of the theory of combinators or lambda calculus extended by extra constants (and corresponding axioms and rules) intended to capture inference. In a preceding paper, [2], we considered 4 systems of illative combinatory logic that are sound for first order intuitionistic propositional and predicate logic. The interpretation from ordinary logic into the illative systems can be done in two ways: following the propositions-as-types paradigm, in which derivations become combinators, or in a more direct way, in which (...) derivations are not translated. Both translations are closely related in a canonical way. In the cited paper we proved completeness of the two direct translations. In the present paper we prove that also the two indirect translations are complete. These proofs are direct whereas in another version, [3], we proved completeness by showing that the two corresponding illative systems are conservative over the two systems for the direct translations. Moreover we shall prove that one of the systems is also complete for predicate calculus with higher type functions. (shrink)

In this paper we generalize the pigeonhole principle by using isols as our fundamental counting tool.