While agreeing with the main conclusion of Dominic Wilkinson and colleagues (Wilkinson, Butcherine, and Savulescu 2019), namely, that there is no moral difference between treatment withholding and withdrawal as such, we wish to criticize their approach on the basis that it treats the widespread acceptance of withdrawal aversion (WA) as a cognitive bias. Wilkinson and colleagues understand WA as “a nonrational preference for withholding (WH) treatment over withdrawal (WD) of treatment” (22). They treat WA as a (...) manifestation of loss aversion and refer to Kahneman and colleagues (1991), which defined this effect as follows: “the disutility of giving up an object is greater that the utility associated with acquiring it” (194). In a previous work, Wilkinson and Savulescu understood nonequivalence between treatment withholding and withdrawal as a reflection of slightly different, although related, phenomena: status quo bias or omission bias (Wilkinson and Savulescu 2012, 130–131). In neither of these two papers do they describe precisely the relation between these well-known psychological effects and WA, nor do they explain why they treat these effects as examples of nonrational preferences, despite the fact that these issues have been the subject of wide-ranging discussions on the intersection of psychology, economy, and philosophy. (shrink)

If a doctor is trying to decide whether or not to provide a medical treatment, does it matter ethically whether that treatment has already been started? Health professionals sometimes find it harder to stop a treatment (withdraw) than to refrain from starting the treatment (withhold). But does that feeling correspond to an ethical difference? In this article, we defend equivalence—the view that withholding and withdrawal of treatment are ethically equivalent when all other factors are equal. We argue that preference (...) for withholding over withdrawal could represent a form of cognitive bias—withdrawal aversion. Nevertheless, we consider whether there could be circumstances in which there is a moral difference. We identify four examples of conditional nonequivalence. Finally, we reflect on the moral significance of diverging intuitions and the implications for policy. We propose a set of practical strategies for helping to reduce bias in end-of-life decision making, including the equivalence test. (shrink)

Although a large number of literatures have explored the relationship between electronic communication during nonwork time and individual perception and behavior under the Western culture background, we still have some limitations on this topic under the cultural background of collectivism, dedication and “Guanxi” in China. Different from Western organizations, Chinese employees tend to put work first and are more inclusive of handling work tasks during nonwork time. This type of communication during nonwork time can significantly affect employees’ cognition, emotion and (...) behavior. From the perspective of Job Demands-Resources theory, this study constructs a double-edged model between electronic communication during nonwork time and employee withdrawal behavior. Sample data were collected from 516 employees with clear working time boundaries in China. The results indicate that electronic communication during nonwork time has a U-shaped effect on employee withdrawal behavior and an inverted U-shaped effect on employee’s cognition, namely job engagement. Job engagement plays a mediating role between them. Moreover, regulatory emotional self-efficacy has a moderating effect on the relationship between electronic communication during nonwork time and job engagement. These findings not only provide theoretical and practical implications for managers and employees on how to reduce withdrawal behaviors, but also advance our understanding of electronic communication during nonwork time in Chinese cultural context. (shrink)

I argue that the arguments brought by Counsel for M to the English Court of Protection are morally problematic in prioritising subjective interests that are the result of ‘consistent autonomous thought’ over subjective interests that are the result of a more limited cognitive perspective.

Withholding and withdrawing treatment are widely regarded as ethically equivalent in medical guidelines and ethics literature. Health care personnel, however, widely perceive moral differences between withholding and withdrawing. The proponents of equivalence argue that any perceived difference can be explained in terms of cognitive biases and flawed reasoning. Thus, policymakers should clear away any resistance to accept the equivalence stance by moral education. To embark on such a campaign of changing attitudes, we need to be convinced that the ethical (...) analysis is correct. Is it? In this article, I take a closer look at the moral relation between withholding and withdrawing. My conclusion is that withholding and withdrawing are not in general ethically equivalent. Thus, medical guidelines should be rewritten, and rather than being “educated” away from their sound judgments, medical professionals and patients should have nuanced medico-ethical discussions regarding withholding and withdrawing treatment. (shrink)

Insults elicit intense emotion. This study tests the hypothesis that one's social image, which is especially salient in honour cultures, influences the way in which one reacts to an insult. Seventy-seven honour-oriented and 72 non-honour oriented participants answered questions about a recent insult episode. Participants experienced both anger and shame in reaction to the insult. However, these emotions resulted in different behaviours. Anger led to verbal attack (i.e., criticising, insulting in return) among all participants. This relationship was explained by participants’ (...) motivation to punish the wrongdoer. Shame, on the other hand, was moderated by honour. Shame led to verbal disapproval of the wrongdoers behaviour, but only among the honour-oriented participants. This relationship was explained by these participants’ motivation to protect their social image. By contrast, shame led to withdrawal among non-honour-oriented participants. (shrink)

BackgroundWhether patients in the vegetative state (VS), minimally conscious state (MCS) or the clinically related locked-in syndrome (LIS) should be kept alive is a matter of intense controversy. This study aimed to examine the moral attitudes of lay people to these questions, and the values and other factors that underlie these attitudes.MethodOne hundred ninety-nine US residents completed a survey using the online platform Mechanical Turk, comprising demographic questions, agreement with treatment withdrawal from each of the conditions, agreement with a (...) series of ethical principles and three personality tests.ResultsMore supported treatment withdrawal from VS (40.2 % agreed, 17.6 % disagreed) than MCS (20.6 %, 41.2 %) or LIS (25.3 %, 35.8 %). Agreement with treatment withdrawal was negatively correlated with religiosity (r = −0.272, P < 0.001), though showed no significant relationship with need for cognition or empathy, and only a partial association with utilitarian judgment in a standard moral dilemma. Support for treatment withdrawal was most strongly associated with endorsement of the importance of patient autonomy, dignity, suffering, best interests. Distributive justice was not given significant weight by most. Importantly, agreement with treatment withdrawal was noticeably higher when considered from a first as opposed to third person perspective for VS (Z = −6.056, P < 0.001), MCS (Z = −6.746, P < 0.001) and LIS (Z = −6.681, P < 0.001).ConclusionLay attitudes to withdrawal of treatment in brain damaged patients are largely shaped by values similar to those central to the secular ethical debate. Neither traditional values such as the sanctity of life nor utilitarian values relating to resource allocation seem to play a central role. Far greater weight is given to autonomy, which may explain why participants were far more willing to endorse withdrawal of treatment when the issue was presented in the first person, or in relation to a concrete case involving a patient’s explicit wishes. Surveys focusing on abstract cases presented in the third person may not provide an accurate picture of lay attitudes to these critical ethical questions. (shrink)

While many have suggested that to withdraw medical interventions is ethically equivalent to withholding them, the moral complexity of actually withdrawing life supportive interventions from a patient cannot be ignored. Utilizing interplay between expository and narrative styles, and drawing upon our experiences with patients, families, nurses, and physicians when life supports have been withdrawn, we explore the changeable character of boundaries in end-of-life situations. We consider ways in which boundaries imply differences – for example, between cognition and performance – and (...) how the encounter with boundaries can generate altered meanings important for understanding decisions and actions in these contexts. We conclude that the reliance on mere roles to support the moral weight of withdrawing medical interventions is inadequate. Roles that lead us to such moments are exceeded by the responsibility encountered in such moments. And here, we suggest, is the momentous character of withdrawal: it presents the grave astonishment, the trembling awe, in the not-being-there of the other in death. (shrink)

At some point during the 1950s, mainstream American philosophy of science began increasingly to avoid questions about the role of non-cognitive values in science and, accordingly, increasingly to avoid active engagement with social, political and moral concerns. Such questions and engagement eventually ceased to be part of the mainstream. Here we show that the eventual dominance of 'value-free' philosophy of science can be attributed, at least in part, to the policies of the U.S. National Science Foundation's "History and Philosophy (...) of Science" sub-program. In turn, the sub-program's policies were set by logical empiricists who espoused value-free philosophy of science; these philosophers' actions, we also point out, fit a broad pattern, one in which analytic philosophers used institutional control to marginalize rival approaches to philosophy. We go on to draw on existing knowledge of this pattern to suggest two further, similar, contributors to the withdrawal from value-laden philosophy of science, namely decisions by the editors of Philosophy of Science and by the editors of The Journal of Philosophy. Political climate was, we argue, at most an indirect contributor to the withdrawal and was neither a factor that decided whether it occurred nor one that was sufficient to bring it about. Moreover, we argue that the actions at the National Science Foundation went beyond what was required by its senior administrators and are better viewed as part of what drove, rather than as what was being driven by, the adoption of logical empiricism by the philosophy of science community. (shrink)

Although machine intelligence is increasingly employed in healthcare, the realm of decision-making in medical ethics remains largely unexplored from a technical perspective. We propose an approach based on fuzzy cognitive maps (FCMs), which builds on Beauchamp and Childress’ prima-facie principles. The FCM’s weights are optimized using a genetic algorithm to provide recommendations regarding the initiation, continuation, or withdrawal of medical treatment. The resulting model approximates the answers provided by our team of medical ethicists fairly well and offers a (...) high degree of interpretability. Possible applications of such a system include informal guidance on medical ethics dilemmas as well as educational purposes. (shrink)

ABSTRACTAt present, the consequences and functions of experiences of shame are not yet well understood. Whereas psychology literature typically portrays shame as being bad for social relations, motivating social avoidance and withdrawal, there are recent indications that shame can be reinterpreted as having clear social tendencies in the form of motivating approach and social affiliation. Yet, until now, no research has ever put these alternative interpretations of shame-motivated behaviours directly to the test. The present paper presents such a test (...) by studying the extent to which shame motivates a preference for social withdrawal versus a preference for social approach. Two studies using different shame inductions both showed people experiencing shame to prefer to be together with others over being alone. In addition, the preference for a social situation was found to be unique for shame; it was not found for the closely related emotion of gui... (shrink)

Drawing on the theory of cognitive-affective processing system and that of construal level, we propose a moderated mediation model illustrating the relationship among abusive supervision, shame, construal level, and work withdrawal. We tested this model with a two-source time-lagged survey of 387 employees from 129 work teams in central and East China. Results revealed that abusive supervision had a positive association with the emotion of shame and supported the mediating role of shame linking abusive supervision to work (...) class='Hi'>withdrawal. Besides, our findings supported the buffering effect of construal level on the shame-work withdrawal relationship as well as the indirect relationship between abusive supervision and work withdrawal channeled through the emotion of shame. (shrink)

The valence–arousal conflict theory assumes that both valence and arousal will trigger approaching or withdrawing tendencies. It also predicts that the speed of processing emotional stimuli will depend on whether valence and arousal trigger conflicting or congruent motivational tendencies. However, most previous studies have provided evidence of the interaction between valence and arousal only, and have not provided direct proof of the interactive links between valence, arousal and motivational tendencies. The present study provides direct evidence for the relationship between approach– (...) class='Hi'>withdrawal tendencies and the valence–arousal conflict. In an empirical test, participants were instructed to judge the valence of emotional words after visual–spatial cues that appeared to be either approaching or withdrawing from participants. A three-way interaction was observed such that the response time was shorter if participants responded to a negative high-arousal stimulus after a withdrawing cue, or to a positive low-arousal stimulus after an approaching cue. These findings suggest that the approach–withdrawal tendency indeed plays a crucial role in valence–arousal conflict, and that the effect depends on the congruency of valence, arousal and tendency at an early stage of processing. (shrink)

In The Netherlands, it is openly acknowledged that the parents' ability to take care of their child plays a role in the decision-making process over administration of life-prolonging treatment to severely defective newborn babies. Unlike other aspects of such decision-making process up until the present time, the ‘ability to take care’ has not received specific attention in regulation or in empirical research. The present study is based on interviews with neonatologists in two Dutch NICUs concerning their definition of the ability (...) to take care and its relevance in non-treatment decisions. All of the respondents think that the ability to take care consists of more than one factor. Most doctors mention the parents' emotional state, social network and cognitive abilities. Some doctors mention the presence of psychological conditions in the parents, their financial situation and physical condition. A few refer to the parents' experience and age, their chances to have another baby and their cultural background. Most doctors think the ability to take care has a secondary relevance in the decision-making process, while the primary concern is assessing the condition of the child. A substantial minority thinks the ability to take care does not play any role, while one doctor thinks it is a factor of primary importance. The study constitutes an important stepping-stone for future research in The Netherlands and elsewhere. (shrink)

According to the reading offered here, Descartes' use of the meditative mode of writing was not a mere rhetorical device to win an audience accustomed to the spiritual retreat. His choice of the literary form of the spiritual exercise was consonant with, if not determined by, his theory of the mind and of the basis of human knowledge. Since Descartes' conception of knowledge implied the priority of the intellect over the senses, and indeed the priority of an intellect operating independently (...) of the senses, and since, in Descartes' view, the untutored individual was likely to be nearly wholly immersed in the senses, a procedure was needed for freeing the intellect from sensory domination so that the truth might be seen. Hence, the cognitive exercises of the Meditations, modeled not on the sense- and imagination-based exercises of Ignatius of Loyola, but on the Augustinian procedure of turning away from the senses and imagination to perceive the unpicturable with the fleshless eye of the mind. In accordance with this reading, the function of Descartes' skeptical arguments is not to introduce skepticism so that it can be defeated but to aid the meditator in withdrawing the mind from the senses in order to attend to truths of the pure intellect. These truths then offer the basis for a new natural philosophy, including a new theory of the senses. (shrink)

Philosophers and scientists have across the ages been amazed about the fact that development and learning often lead to not just a merely incremental and gradual change in the learner but sometimes to a result that is strikingly different from the learner’s original situation: amazed, but at times also worried. Both philosophical and cognitive neuroscientific insights suggest that experts appear to perform ‘different’ tasks compared to beginners who behave in a similar way. These philosophical and empirical perspectives give some (...) insight into what happens when a novice is transitioning to a stage of expertise. Generally, this implies that increased skill and expertise support better results and a more flexible performance, in part because these allow an agent to withdraw part of her attention and other cognitive resources from the tasks involved, enabling her to devote those resources to supporting, or completely different, tasks. As positive as these developments appear, these changes have also raised concerns. The main concern is whether gaining expertise is like raising a ‘cognitive monster’ which escapes the individual’s conscious control and influences her actions with undesirable automatisms. If so, we should ask ourselves whether experts are capable of taming this monster. The answer appears initially not to be positive. Indeed, it has been noted that since it is difficult for experts to withhold automatic responses this can lead to inflexibility or performance that is only optimal under certain conditions, because it is limited to a specific domain, often context-dependent, biased and inflexible. In what follows, I will consider this challenge of protecting expertise and harnessing this brittleness from philosophical and cognitive neuroscientific perspectives. Taking into account that action is in general determined by a multitude of factors, with learning and development affecting how these factors exert their influence, a philosophical question is how this complex and dynamic process can be explained and subsequently, how controlling it might be understood. First, though, I will present the issue at hand more closely: should we appreciate expertise if it is similar to growing a ‘cognitive monster’? Second, I will introduce the framework of a “Sculpted Space of Actions” (Keestra, 2014), which I developed in order to explain how the challenge of selecting an adequate option for action is facilitated by expertise as it helps to constrain the space of potential action options. Subsequently, the question is raised of how such a Sculpted Space of Actions influences an expert’s engagement with specific situations, like teaching students in a classroom setting. It will be argued that a well prepared expert—teacher or otherwise— is not only able to rely upon her routines but will at the same time be more perceptive and attentive to unforeseen events and actions, according to the recent cognitive neuroscientific theory of Predictive Processing. Integrating the theory of Predictive Processing with the Sculpted Space of Actions framework, I conclude that expertise contributes to adaptive and flexible responses to specific contexts, yet only if it is associated with explicit planning and articulation of situation specific intentions—the latter effectively putting the cognitive monster at rest for a while. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Journal of the History of Philosophy 43.1 (2005) 83-105 [Access article in PDF] Does Malebranche Need Efficacious Ideas? The Cognitive Faculties, the Ontological Status of Ideas, and Human Attention Susan Peppers-Bates But whatever effort of mind I make, I cannot find an idea of force, efficacy, of power, save in the will of the infinitely perfect Being. Malebranche, Elucidation 15 One of the signatures of 17th century rationalists (...) is their replacement of the Scholastics's dependence on the deliverances of the senses with a dependence on the deliverances of the intellect as the key to gaining knowledge.1 Correct use of the intellect leading to freedom from the passions and to certain knowledge figures prominently in the works of Spinoza and Leibniz. Descartes's Meditations uses skeptical doubt to withdraw the mind from the senses, and his reliance on the meditative genre not only reveals to his readers the intellect as a distinct source of knowledge, but also trains them to use properly their will or faculty of judgment. Commentators have argued persuasively that overthrowing the sense-based epistemology and metaphysics of the Aristotelians depended on "discovering" the primacy of one's intellect over the senses, and using the deliverances of the mind to establish solid foundations for a new metaphysics and epistemology.2 Indeed, [End Page 83] outlining the proper use of the mind's faculties arguably lay at the basis of the Cartesian program in particular. This importance can be seen in Arnauld and Nicole's influential Port-Royal Logic, which aimed at training its readers in the proper use of the intellect.3Few would question Nicolas Malebranche's inclusion in the rationalist tradition.4 For while Malebranche famously takes ideas out of the Cartesian mind and transports them to God's—thus privileging the divine over the natural light—he shares Descartes's belief that our intellect, not our senses, holds the key to metaphysical truths such as the essence of matter, the mind-body distinction, and the existence of God.5 Yet, recently, Nicholas Jolley has contended that Malebranche's later commitment to "efficacious ideas" undermines his earlier belief in the power of the cognitive faculties: he believes that Malebranche abandons his view that the mind makes "real use" of the intellect to know intelligible objects.6 Jolley's position builds upon Alquié and Robinet's claims that around 1694-95 Malebranche moved from a vision "in" God to a vision "by" God. Now God's ideas act on and modify the soul with both sensations and intellectual concepts, rather than the human intellect contemplating ideas in the Divine Reason.7Alquié and Robinet argue that Malebranche, pushed by the battles with Arnauld and Régis over the status of ideas, introduced the language of "efficacious" ideas to explain how the union of the human and the divine mind is supposed to work.8 Robinet in particular suggests that in cashing out the metaphor of God enlightening human minds, Malebranche moved from a static "ontologist" view of idea-objects in God to an active "illuminationist" view whereby divine ideas cause(intellectual [End Page 84] and sensory) perception by modifying the soul.9 Once one accepts this view of the place and function of efficacious ideas in Malebranche's metaphysics, it seems natural to accept Jolley's declaration that the only way for the mind to apprehend ideas in God is if those ideas "act directly on the mind; [if] they thereby cause cognitive states to arise in a substance which is devoid of all genuine cognitive capacities of its own."10 Indeed, Jolley suggests that Malebranche ultimately made the soul passive in all its states, including its volitional ones.11In this paper, I argue that a strong interpretation of efficacious ideas, whereby they appear to become true causal agents, must be rejected precisely because it pushes us into an incorrect reading of Malebranche's theory of the divine and human faculties. Making ideas true causal agents within God privileges divine reason at the... (shrink)

As research into Alzheimer's disease and other dementing disorders becomes more complex, risky, invasive, and commonplace, the need intensifies for discussion of the ethics of involving persons with dementia in research, specifically research of greater than minimal risk and of no expected direct benefit to the subject. Reviewing such studies pushes our traditional analysis tools to their limits. Simply balancing and prioritizing the basic ethical principles of respect for persons, beneficence, and justice that serves us well in reviewing the vast (...) majority of studies is inadequate when reviewing research of such ethical complexities as studies with marked risks and no expectation of direct benefit to subjects unable to consent or withdraw. Moving up to the level of theory, placing these principles within the commonly applied frameworks of consequentialism, deontology, or virtue ethics bring us no closer to reducing the tensions such research creates between upholding individual autonomy and advancing society's need to learn how to treat and cure these devastating diseases. What is needed is the introduction of more contemporary moral analyses. Specifically, we need to become more inclusive of the diversity of values perspectives of our general citizenry. In more theoretical terms, we ought to elevate to a more central role a communitarian perspective and a feminist ethics emphasis on relationships and context as we rush to keep in step, ethically, with this rapidly expanding area of medical inquiry. (shrink)

Since Darwin, the idea of psychological continuity between humans and other animals has dominated theory and research in investigating the minds of other species. Indeed, the field of comparative psychology was founded on two assumptions. First, it was assumed that introspection could provide humans with reliable knowledge about the causal connection between specific mental states and specific behaviors. Second, it was assumed that in those cases in which other species exhibited behaviors similar to our own, similar psychological causes were at (...) work. In this paper. we show how this argument by analogy is flowed with respect to the case of second-order mental states. As a test case, we focus on the question of how other species conceive of visual attention, and in particular whether chimpanzees interpret seeing as a mentalistic event involving internal states of perception, attention, and belief. We conclude that chimpanzees do not reason about seeing in this manner, and indeed, there is considerable reason to suppose that they do not harbor representations of mental states in general. We propose a reinterpretation model in which the majority of the rich social behaviors that humans and other primates share in common emerged long before the human lineage evolved the psychological means of interpreting those behaviors in mentalistic terms. Although humans, chimpanzees, and most other species may be said to possess mental states, humans alone may have evolved a cognitive specialization for reasoning about such states. (shrink)

The paper intends to identify some particular basic assumptions, approaches and means of proceeding, which are spontaneously shared by philosophers, sociologists and historians of science, besides the common interchange of meta-notions describing science. To this end, the specific subject matter, scope, meta-cognitive goals and methodological background of each of the three domains of science study is first outlined. Only two shared proceedings are further discussed in details: the objective attitude, called 'playing a stranger', and the historiographers' involvement in demarcational (...) problem resolution. A far-reaching prospect is finally suggested for philosophers and historiographers: methodological partnership, leading towards the elaboration of an impending integral metatheory of science. (shrink)

Deprescribing is the term used to describe the process of withdrawal of an inappropriate medication supervised by a clinician. This article presents a discussion of how the Four Principles of biomedical ethics that may guide medical practitioners’ prescribing practices apply to deprescribing medications in older adults. The view of deprescribing as an act creates stronger moral duties than if viewed as an omission. This may explain the fear of negative outcomes which has been reported by prescribers as a barrier (...) to deprescribing. Respecting the autonomy of older adults is complex as they may not wish to be active in the decision-making process; they may also have reduced cognitive function and family members may therefore have to step in as surrogate decision-makers. Informed consent is intended as a process of information giving and reflection, where consent can be withdrawn at any time. However, people are rarely updated on the altered risks and benefits of their long-term medications as they age. Cessation of inappropriate medication use has a large financial benefit to the individual and the community. However, the principle of justice also dictates equal rights to treatment regardless of age. (shrink)

Aim: To elicit preferences for prognostic information, attitudes towards withdrawal of life-sustaining treatment (WLST) and perspectives on acceptable quality of life after post-anoxic coma within the adult general population of Germany, Italy, the Netherlands and the United States of America. Methods: A web-based survey, consisting of questions on respondent characteristics, perspectives on quality of life, communication of prognostic information, and withdrawal of life-sustaining treatment, was taken by adult respondents recruited from four countries. Statistical analysis included descriptive analysis and (...) chi2-tests for dierences between countries. Results: In total, 2012 respondents completed the survey. In each country, at least 84% indicated they would prefer to receive early prognostic information. If a poor outcome was predicted with some uncertainty, 37-54% of the respondents indicated that WLST was not to be allowed. A conscious state with severe physical and cognitive impairments was perceived as acceptable quality of life by 17–44% of the respondents. Clear differences between countries exist, including respondents from the U.S. being more likely to allow WLST than respondents from Germany (OR = 1.99, p < 0.001) or the Netherlands (OR = 1.74, p < 0.001) and preferring to stay alive in a conscious state with severe physical and cognitive impairments more than respondents from Italy (OR = 3.76, p < 0.001), Germany (OR = 2.21, p < 0.001), or the Netherlands (OR = 2.39, p < 0.001). Conclusions: Over one-third of the respondents considered WLST unacceptable when there is any remaining prognostic uncertainty. Respondents had a more positive perspective on acceptable quality of life after coma than what is currently considered acceptable in medical literature. This indicates a need for a closer look at the practice of WLST based on prognostic information, to ensure responsible use of novel prognostic tests. (shrink)

Peripersonal space (PPS) is frequently defined as a plastic, pragmatic and goal-directed multisensory buffer that connects the brain-body with its immediate environment. While such characterisations indicate that peripersonal spatiality is profoundly embodied and enactive, comparatively few attempts have aimed to systematically synthesise PPS literature with compatible phenomenological accounts of lived space provided by Heidegger and Merleau-Ponty. Moreover, in traditional cognitive neuroscience, neurophysiological activity is thought to map onto discrete ‘cognitive correlates’. In contemporary 4E approaches to cognition, however, phenomenology-derived (...) notions such as ‘pre-reflective cognition’ and ‘motor-intentionality’ frequently appear, yet their neural correlates may be comparatively difficult to pin down. Pre-reflectively, agents seemingly do not thematise spatial properties as operationalised in key experimental paradigms (e.g., spatial rotation tasks) but are instead inherently spatially embedded within the world. To refine this distinction, I survey how tools co-determine this distinctly spatial ‘world-embeddedness’ using a neurophenomenological methodology (Varela, _Journal of Consciousness Studies, 3_(4), 330–349, 1996 ). Specifically, I conduct two neurophenomenological analyses of tool-perception and tool-use, examining both how distance modulates affordance-perception and how tool-use remaps bodily space via the withdrawal of tools from intentional-objects into co-constituting motor-intentionality itself. I conclude by briefly distinguishing this interpretation of spatial cognition from cognitivist frameworks. Thereafter, I briefly highlight the temporal scaffolding underlying PPS while conceptually grounding my account within Embodied Simulation Theory (Gallese, _Reti, Saperi, Linguaggi_, (1), 31–46, 2018 ). What is at stake is thus both an explicitly embodied-enactive account of bodily space that is qualitative and situational instead of quantitative and positional, as well as a viable, interdisciplinary strategy for unifying pre-reflective cognition with neurophysiological data. (shrink)

Background Doctors often deal with end-of-life issues other than assisted death, such as incompetent patients and treatment withdrawal, including food and fluids. Methods A link to a questionnaire was sent by email three times, at one-week intervals, to the doctors registered in the Northern Section of the Portuguese Medical Association. Results The questionnaire was returned by 1148 (9%) physicians. This study shows that only a minority of Portuguese doctors were willing to administer drugs in lethal doses to cognitively incompetent (...) patients at the request of a family member or other close person, and even less would do it on their initiative. Most doctors favored the withdrawal of life support measures in advanced and progressive diseases at the patient’s request. Still, much fewer doctors agreed with the suspension of supportive life measures at the request of a family member, another close person, or by their own unilateral decision. However, fewer agreed with that action concerning the rest of the food and fluids. Portuguese doctors favor the administration of drugs for suffering control, even foreseeing they could shorten life. Conclusion Most doctors in this study respect patients’ autonomy but disagree with measures decided by others that have an impact on patients’ survival. They also agree with the administration of drugs for suffering control, even considering the possibility of shortening life. (shrink)

In this paper we focus on a kind of perceptual states that we call perceptual motivations, that is, perceptual experiences that plausibly motivate us to act, such as itching, perceptual salience and pain. Itching seems to motivate you to scratch, perceiving a stimulus as salient seems to motivate you to attend to it and feeling a pain in your hand seems to motivate actions such as withdrawing from the painful stimulus. Five main accounts of perceptual motivation are available: Descriptive, Conative, (...) Imperativist, Reflexive and Dual Content views. Some of these have been developed in detail and others are natural extensions of existing views. However, we argue that none provides a satisfactory account of the target perceptual states. Driven by the failings of each account, we identify three conditions that any satisfactory theory of perceptual motivation must meet: Direct Motivational Force, Non-Obligatory Force and Intention-Independent Influence. Then we offer an account that attempts to fulfil these conditions: the Affordance Model. This model of perceptual motivation is premised on the claim that each of the target states involves the perception of a specific affordance for action and the triggering of Automatic Motor Initiations (AMIs). We suggest that AMIs can explain the motivational force of these perceptual states. (shrink)

Chris Frith has argued that a loss of the sense of agency is central to schizophrenia. This suggests a connection between hallucinations and delusions on the one hand, and the misidentification of the subject’s imaginings as perceptions and beliefs on the other. In particular, understanding the mechanisms that underlie imagination may help us to explain the puzzling phenomena of thought insertion and withdrawal. Frith sometimes states his argument in terms of a loss of metarepresentational capacity in schizophrenia. I argue (...) that this formulation is unhelpful. (shrink)

Shame has been found to promote both approach and withdrawal behaviours. Shame theories have not been able to explain how shame can promote such contrasting behaviours. In the present article, the authors provide an explanation for this. Shame was hypothesised to activate approach behaviours to restore the threatened self, and in situations when this is not possible or too risky, to activate withdrawal behaviours to protect the self from further damage. Five studies with different shame inductions and different (...) dependent measures confirmed our predictions. We therefore showed that different behavioural responses to shame can be understood in terms of restore and protect motives. Implications for theory and behavioural research on shame are discussed. (shrink)

First-person methodologies have been criticized for their inability to arrive at reliable and verifiable knowledge of the contents of conscious experience. Consciousness, however, is not its contents, but the cognitive capacity that makes those contents available. That capacity is directly and uniquely accessible to first-person inquiry, provided a suitable methodology can be developed. As a framework for such inquiry, this paper distinguishes two structures that give rise to conscious contents: narrative and story. While narratives are told, stories are inhabited. (...) Stories are fundamental to conscious experience: an event is conscious only if it fits the presently unfolding story. While third-person inquiry relies on withdrawing from story into narrative, first-person inquiry can take place within the story. In place of the reductive objectivity of third-person science, first-person inquiry can cultivate an engaged objectivity, immersed in the story but not bound to it, that makes the phenomenon of consciousness available to be known. Communities of inquiry practising such a first-person style of inquiry could develop criteria for assessing advances in knowledge and for research programmes appropriate to furthering such advances. (shrink)

Major depression is a prevalent mental disorder that leads to persistent negative mood and tremendous suffering in affected individuals. However, the biological realization of this disorder and associated symptom clusters remain poorly understood. Recently, phenomenological accounts of major depressive disorder and contributions to the emerging predictive processing account have provided valuable insights into the phenomenological and neuro-functional components that lead to manifestations of major depressive episodes. The purpose of this paper is to weave together these different strands of research to (...) develop a predictive processing account of major depressive disorder. In doing so, I will relate personal-level descriptions of associated phenomenal experiences to a sub-personal-level predictive processing account of the functional realization of major depression. I will argue that pervasive symptoms of the disorder, which include a diminished sense of agency, fatigue, social withdrawal, and rumination, are integrated by existential feelings of loss and impossibility. These phenomenal experiences, I will argue, are associated with dysfunctional processes of prediction error minimization, which are characterized by an overall decrease of the causal contributions of active inference and by distorted precision estimates. The emerging account promises to contribute to a better understanding of the complex processes that give rise to depressive experiences. (shrink)

I argue that the effectiveness of forgiveness in the healing of relationships is dependent on both the givers and recipients of forgiveness understanding that once it has been granted, forgiveness is not normally able to be retracted. When we forgive, we make a firm commitment not to return to our former state of moral resentment against the offender, replacing it by good-will. This commitment can be broken only where the forgiving party makes some significant cognitive adjustment to her appraisal (...) of either the offender or the offence, believing that her original forgiveness was granted in error. I reject the view that forgiveness can lapse or be withdrawn on the basis of a return of hurt or disappointed feelings, arguing that these do not amount to a restoration of the resentment that is extinguished when forgiveness is granted. I contend that a person who ‘forgives’ and later takes back that ‘forgiveness’ because certain negative feelings have returned either did not genuinely forgive in the first place or shows that she has not fully grasped the nature of forgiveness. (shrink)

Specified meet contraction is the operation defined by the identity where ∼ is full meet contraction and f is a sentential selector, a function from sentences to sentences. With suitable conditions on the sentential selector, specified meet contraction coincides with the partial meet contractions that yield a finite-based contraction outcome if the original belief set is finite-based. In terms of cognitive realism, specified meet contraction has an advantage over partial meet contraction in that the selection mechanism operates on sentences (...) rather than on temporary infinite structures (remainders) that are cognitively inaccessible. Specified meet contraction provides a versatile framework in which other types of contraction, such as severe withdrawal and base-generated contraction, can be expressed with suitably chosen properties of the sentential selector. (shrink)

The question of what makes someone the same person through time and change has long been a preoccupation of philosophers. In recent years, the question of what makes ordinary or lay people judge that someone is—or isn’t—the same person has caught the interest of experimental psychologists. These latter, empirically oriented researchers have sought to understand the cognitive processes and eliciting factors that shape ordinary people’s judgments about personal identity and the self. Still more recently, practitioners within an emerging discipline, (...) experimental philosophical bioethics or “bioxphi”—the focus of this chapter—have adopted a similar aim and employed similar methodologies, but with two distinctive features: (a) a special concern for enhanced ecological validity in the examples and populations studied; and (b) an interest in contributing to substantive normative debates within the wider field of bioethics. Our aim in this chapter is to sample illustrative work on personal identity in bioxphi, explore how it relates to studies in psychology covering similar terrain, and draw out the implications of this work for matters of bioethical concern. In pursuing these issues, we highlight recent work in bioxphi that includes the perceived validity of advance directives following neurodegeneration, the right of psychologically altered study participants to withdraw from research, how drug addiction may cause one to be regarded by others as “a completely different person,” the effect of deep-brain stimulation on perceptions of the self, and the potential influence of moral enhancement interventions on intuitive impressions of a person’s character. (shrink)

Recent neuroscientific evidence brings into question the conclusion that all aspects of consciousness are gone in patients who have descended into a persistent vegetative state (PVS). Here we summarize the evidence from human brain imaging as well as neurological damage in animals and humans suggesting that some form of consciousness can survive brain damage that commonly causes PVS. We also raise the issue that neuroscientific evidence indicates that raw emotional feelings (primary-process affects) can exist without any cognitive awareness of (...) those feelings. Likewise, the basic brain mechanisms for thirst and hunger exist in brain regions typically not damaged by PVS. If affective feelings can exist without cognitive awareness of those feelings, then it is possible that the instinctual emotional actions and pain "reflexes" often exhibited by PVS patients may indicate some level of mentality remaining in PVS patients. Indeed, it is possible such raw affective feelings are intensified when PVS patients are removed from life-supports. They may still experience a variety of primary-process affective states that could constitute forms of suffering. If so, withdrawal of life-support may violate the principle of nonmaleficence and be tantamount to inflicting inadvertent "cruel and unusual punishment" on patients whose potential distress, during the process of dying, needs to be considered in ethical decision-making about how such individuals should be treated, especially when their lives are ended by termination of life-supports. Medical wisdom may dictate the use of more rapid pharmacological forms of euthanasia that minimize distress than the de facto euthanasia of life-support termination that may lead to excruciating feelings of pure thirst and other negative affective feelings in the absence of any reflective awareness. (shrink)