This book is a collection of articles about communication and ethics in the field of medicine and health care. Common to all the articles is that they are not directly based on empirical investigations. The discussions refer to research, but this is research that has already been carried out and documented in existing literature. In this sense the articles belong to what is often called applied philosophy. All the articles address communicative and ethical challenges in patient interaction on the basis (...) of assumptions in modern moral philosophy and philosophy of language. There is a great need for literature that deals more comprehensively with the themes in this book than many introductory books do. It is particularly difficult to find suitable reading material that can be used in teaching at graduate and master levels. This book is designed to meet this need. It is suitable for use in all higher-level courses where the aim is to give students a theoretical understanding of ethical dilemmas and communicative challenges in health care. (shrink)

Reflections on an Interview with Jan Masschelein.

The paper explores consequences of applying the view that illness is negative first‐person experience in caring practice. The main reason this is an important issue is that it is empirically documented that patients conceive of illness in different ways. Communicating about illness in caring practice can therefore involve difficulties. I argue that many of these difficulties can be avoided if nurses focus directly on the extension of the concept of illness – patients’ experiences like the state of being in pain (...) – and not on how this extension is represented as (the intension) illness. This argument is compatible with different views on the nurse–patient relationship as a communicative process. All it requires is the acceptance of minimal assumptions about concepts and concept possession. The argument has a descriptive and a normative dimension. It is descriptive in the sense that it seeks to use concepts from philosophy of mind to explain how many nurses succeed in talking about illness without applying the concept of illness. It is normative in the sense that it provides a philosophical justification for this practice. (shrink)

In recent philosophy of mind a non-holistic view on concept possession, originally developed by Tyler Burge, has emerged as an alternative to holistic analyses of language mastery. The article discusses the implications of this view for analyses of communication in doctor—patient-interaction. The central question Burge's theory gives an answer to is this: to what extent must a doctor and a patient understand a medical term in the same way in order to communicate in the sense that they express the same (...) concept by the term? Many empirical studies have shown that patients do not, typically, understand medical terms in the same way as doctors they encounter. Holistic approaches therefore imply that doctors and patients seldom communicate. Burge's position, on the other hand, implies that it is sufficient that patients have a minimal understanding. In an important range of cases doctors can make sure that patients have a minimal understanding by being explicit about common dictionary definitions of the terms in question. (shrink)

In this paper, the aim is to study how the work organization in one specific company for one specific trade has changed over time and with these changes, the presence and absence of alienation of employees in this trade. Blauner’s U-shaped alienation development trend has been a reference in discussions on alienation. It displays a connection between the degree of alienation and technological development. The findings from this study verify the trend and the connection in the case company. However, although (...) the development trend may look similar to that of Blauner’s model, it is differently founded. Where previous studies highlight the production system, including technology, as crucial to the presence of alienation, this study documents that external conditions outside or partly outside the company’s control—such as digital information availability, product complexity, and quality requirements—will determine the presence of alienation. Thus, researchers should adjust the content of the concept of alienation accordingly. (shrink)

It is a fundamental assumption in nursing theory that it is important for nurses to understand how patients think about themselves and the contexts they are in. According to modern theories of hermeneutics, a nurse and a patient must share the same concepts in order to communicate beliefs with the same content. But nurses and patients seldom understand medical concepts in exactly the same way, so how can this communicative aim be achieved in interaction involving medical concepts? The article uses (...) a theory of concepts from recent cognitive science and philosophy of mind to argue that nurses and patients can share medical concepts despite the diversity of understanding. According to this theory, two persons who understand medical language in different ways will nevertheless possess the same medical concepts if they agree about the normative standards for the applications of the concepts. This entails that nurses and patients normally share medical concepts even though patients’ conceptions of disease and illness are formed in idiosyncratic ways by their social and cultural contexts. Several practical implications of this argument are discussed and linked to case studies. One especially important point is that nurses should seek to make patients feel comfortable with deferring to a medical understanding. In many cases, an adequate understanding of patients presupposes that nurses manage to do this. Another implication is that deference‐willingness to normative meaning is not equivalent to the actual application of concepts. Deference‐willingness should rather be thought of as a pre‐communicative attitude that it is possible for patients who are not fully able to communicate to possess. What is important is that nurses and patients have the intention of conforming to the same meaning. (shrink)

Trust has become an important aspect of evaluating the relationship between lay public and technology implementation. Experiences have shown that a focus on trust provides a richer understanding of reasons for backlashes of technology in society than a mere focus of public understanding of risks and science communication. Therefore, trust is also widely used as a key concept for understanding and predicting trust or distrust in emerging technologies. But whereas trust broadens the scope for understanding established technologies with well-defined questions (...) and controversies, it easily fails to do so with emerging technologies, where there are no shared questions, a lack of public familiarity with the technology in question, and a restricted understanding amongst social researchers as to where distrust is likely to arise and how and under which form the technology will actually be implemented. Rather contrary, ‘trust’ might sometimes even direct social research into fixed structures that makes it even more difficult for social research to provide socially robust knowledge. This article therefore suggests that if trust is to maintain its important role in evaluating emerging technologies, the approach has to be widened and initially focus not on people’s motivations for trust, but rather the object of trust it self, as to predicting how and where distrust might appear, how the object is established as an object of trust, and how it is established in relation with the public. (shrink)

Harald Grimen: Hva er tillit. Universitetsforlaget, 2009. 151 sider.

ABSTRACTRoy Bhaskar's concrete utopianism assumes that a key role for intellectuals, given the current precarious situation of humanity, is the envisaging of alternative possible futures, coherently grounded in the deep structure of what already exists, which includes what people already know and have. Without this grounding, people will not be able to make a persuasive case for change. With this grounding, and by combining the realism of the intellect with the optimism of the will, they may be able to usher (...) in a future of which the youthful Marx said ‘the world has long since dreamed’. This paper is both motivated by Bhaskar's position, and takes it as its starting point. I therefore begin by presenting three scenarios for the world's future, which I take to be real possibilities. I consider which of these possibilities would be worth striving for, and in so doing, I introduce a strategy that I take to be a means to that end. Specifically, this strategy involves harmonizing interventions with critical realist eco-philosophical ambitions. I argue that such interventions should therefore have an interdisciplinary framework, be dedicated to an ethics of dialogue and care, and be directed by dialectical change and learning. (shrink)

When information activated in memory involves emotional associations, the ability to shift attention away from an emotional cue is impaired compared to an emotionally neutral cue. The purpose of the present study was to investigate how emotional stimuli modulate attentional processes, and how this is reflected in localised brain electrical activity. Eight emotion and eight neutral words served as cues in a covert attention spatial orienting task. The cues were either valid or invalid indicators of which hemifield the target would (...) be presented to. In the remaining trials, no cue was presented prior to the target. Twenty subjects were instructed to manually respond to the target as fast as possible. Event-related potentials (ERPs) showed an enhanced P3 component to the emotion words. The ERPs to the target showed enhanced P1 and P3 components on invalid trials, with emotional cues. There were faster reaction times (RTs) to validly cued targets, but only when the emotion words served as cues. The results demonstrated that the emotional cues elicited sustained focused attention, facilitating an engage mechanism of spatial orienting. (shrink)

The potential of mitigating the spreading rate and consequences of the coronavirus disease 2019 currently depends on adherence to sanitary protocols. The current study aimed to investigate the role of fatalism and comparative optimism for adherence to COVID-19 protocols. We also tested whether these factors are directly associated with adherence or associated through attitudinal mediation. The results were based on a web survey conducted among university students in Tehran, Iran. The respondents completed a multidimensional measure of fatalism and measures of (...) comparative optimism, attitudes toward COVID-19 health measures, and adherence. The estimated structural equation model explained approximately 40% of the total variance in attitudes toward COVID-19 protocols and adherence. As expected, high internality was associated with stronger adherence, whereas luck was associated with weaker adherence. Comparative optimism was more strongly associated with adherence than fatalism, and somewhat unexpectedly comparative optimism was associated with stronger adherence. Analyses of direct and indirect effects suggested that fatalism was mainly mediated through attitudes, whereas comparative optimism had both direct and mediated effects. The findings are discussed in relation to the role of these social psychological factors for COVID-19 mitigation. (shrink)

Reinforcement learning systems usually assume that a value function is defined over all states that can immediately give the value of a particular state or action. These values are used by a selection mechanism to decide which action to take. In contrast, when humans and animals make decisions, they collect evidence for different alternatives over time and take action only when sufficient evidence has been accumulated. We have previously developed a model of memory processing that includes semantic, episodic and working (...) memory in a comprehensive architecture. Here, we describe how this memory mechanism can support decision making when the alternatives cannot be evaluated based on immediate sensory information alone. Instead we first imagine, and then evaluate a possible future that will result from choosing one of the alternatives. Here we present an extended model that can be used as a model for decision making that depends on accumulating evidence over time, whether that information comes from the sequential attention to different sensory properties or from internal simulation of the consequences of making a particular choice. We show how the new model explains both simple immediate choices, choices that depend on multiple sensory factors and complicated selections between alternatives that require forward looking simulations based on episodic and semantic memory structures. In this framework, vicarious trial and error is explained as an internal simulation that accumulates evidence for a particular choice. We argue that a system like this forms the “missing link” between more traditional ideas of semantic and episodic memory, and the associative nature of reinforcement learning. (shrink)

Within philosophy of medicine it has been a widespread view that there are important theoretical and practical reasons for clarifying the nature of basic health concepts like disease, illness and sickness. Many theorists have attempted to give definitions that can function as general standards, but as more and more definitions have been rejected as inadequate, pessimism about the possibility of formulating plausible definitions has become increasingly widespread. However, the belief that no definitions will succeed since no definitions have succeeded is (...) an inductive objection, open to realist responses. The article argues that an influential argument from philosophy of language constitutes a more fundamental objection. I use disease as an example and show that this argument implies that if a common understanding of disease can be analysed into a definition, then this is a non-trivial definition. But any non-trivial analysis must be viciously circular: the analysis must presuppose that disease can be defined, but this is what the analysis is supposed to yield as a result. This means, the article concludes, that disease and other controversial health concepts do not have analyses grounded in a common language. Stipulative and contextual definitions can have local significance, but the normative roles of such definitions are at the same time limited. (shrink)

Tyler Burge has argued that an incorrect understanding of a word can be sufficient for possessing the concept the word literally expresses. His well-known 'arthritis' case involves a patient who understands 'arthritis' incorrectly, but who nevertheless, according to Burge, possesses the concept arthritis. Critics of Burge have objected that there is an alternative concept that best matches the patient's understanding and that this, therefore, is the patient's concept. The paper first argues that Burge's response to this objection is unconvincing. A (...) better response is then developed. It is argued that there is no alternative concept that matches the incorrect understanding, since the patient thinks he has a partial understanding. This, together with points about ordinary psychological explanation and modes of presentations of concepts, establish that it is impossible to undermine Burge's social externalism by appealing to the idea that an alternative concept matches the incorrect understanding. (shrink)

ABSTRACTPatric Baert suggests that ‘encountering difference’, as we might when immersing ourselves in new cultural settings, allows us to redescribe and reconceptualise ourselves, our culture and our surroundings. By so doing, individuals can learn to see themselves, their own culture and their own presuppositions from a different point of view. They can then contrast their interpretations with alternative forms of life; and this is a requirement both for learning about themselves and coming to understand others. There is evidence that such (...) learning can reduce animosity towards others and encourage reciprocity. In this paper, I discuss the possibility that such an approach could also be useful if applied to the more-than-human world, as an antidote to nature’s exploitation by humans. I therefore argue that we need to ‘encounter difference’ with nature’s forms, which will allow us to learn from it. The meaning and implications of such ‘encountering difference’ will be developed in relation to Bhaskar’s philosophy of metaReality. (shrink)

Hilary Kornblith argues that many traditional philosophical accounts involve problematic views of reflection (understood as second-order mental states). According to Kornblith, reflection does not add reliability, which makes it unfit to underlie a separate form of knowledge. We show that a broader understanding of reflection, encompassing Type 2 processes, working memory, and episodic long-term memory, can provide philosophy with elucidating input that a restricted view misses. We further argue that reflection in fact often does add reliability, through generalizability, flexibility, and (...) creativity that is helpful in newly encountered situations, even if the restricted sense of both reflection and knowledge is accepted. And so, a division of knowledge into one reflexive (animal) form and one reflective form remains a plausible, and possibly fruitful, option. (shrink)

Hilary Putnam’s influential analysis of the ‘division of linguistic labour’ has a striking application in the area of doctor–patient interaction: patients typically think of themselves as consumers of technical medical terms in the sense that they normally defer to health professionals’ explanations of meaning. It is at the same time well documented that patients tend to think they are entitled to understand lay health terms like ‘sickness’ and ‘illness’ in ways that do not necessarily correspond to health professionals’ understanding. Drawing (...) on recent philosophical theories of concept possession, the article argues that this disparity between medical and lay vocabulary implies that it is, in an important range of cases, easier for doctors to create a communicative platform of shared concepts by using and explaining special medical expressions than by using common lay expressions. This conclusion is contrasted with the view that doctors and patients typically understand each other when they use lay vocabulary. Obviously, use of expressions like ‘sickness’ or ‘illness’ does not necessarily lead to poor communication, but it is important that doctors have an awareness of how patients interpret such terms. (shrink)

BackgroundThis case report discusses an ethical communication dilemma in prehospital patient interaction, involving a patient who was about to board a plane at a busy airport. The article argues that the situation raised dilemmas about communication, patient autonomy and paternalism. Paramedics should be able to find good solutions to these dilemmas, but they have not received much attention in the literature on prehospital ambulance work.Case presentationThe patient had chest pains that were consistent with serious heart disease, but she wanted to (...) catch her plane and was unwilling to let paramedics assess her heart activity by means of an electrocardiogram (ECG). The paramedics had to decide, there and then, whether the patient’s refusal to submit to an ECG should be respected, or whether they should set the patient’s expressed wishes aside by exercising verbal power and persuasive communication techniques. The paramedics chose to do the latter. It later turned out that the patient was grateful that the paramedics had been very direct, almost brutal, in their communication. When the patient regained her autonomy, she saw clearly that taking time to obtain and monitor an ECG was the best option for her.ConclusionLooking forward in time might be a good professional strategy for deciding whether ethical paternalism in communication is justified. If there is good reason to believe that patients who later regain their autonomy will agree that paternalistic verbal actions were in their best interests, and if acting in accordance with patients’ preferences can have severe negative health consequences for them, then paramedics have good reason to believe that ethical paternalism is justified. (shrink)

The generality problem is commonly considered to be a critical difficulty for reliabilism. In this paper, we present a dynamical perspective on the problem in the spirit of naturalized epistemology. According to this outlook, it is worth investigating how token belief-forming processes instantiate specific types in the biological agent’s cognitive architecture and background experience, consisting in the process of attractor-guided neural activation. While our discussion of the generality problem assigns “scientific types” to token processes, it represents a unified account in (...) the sense that it incorporates contextual and common sense features emphasized by other authors. (shrink)

Hilary Kornblith argues that many traditional philosophical accounts involve problematic views of reflection. According to Kornblith, reflection does not add reliability, which makes it unfit to underlie a separate form of knowledge. We show that a broader understanding of reflection, encompassing Type 2 processes, working memory, and episodic long-term memory, can provide philosophy with elucidating input that a restricted view misses. We further argue that reflection in fact often does add reliability, through generalizability, flexibility, and creativity that is helpful in (...) newly encountered situations, even if the restricted sense of both reflection and knowledge is accepted. And so, a division of knowledge into one reflexive form and one reflective form remains a plausible, and possibly fruitful, option. (shrink)

A fundamental aim in caring practice is to understand patients' experiences of ill‐health. These experiences have a qualitative content and cannot, unlike thoughts and beliefs with conceptual content, directly be expressed in words. Nurses therefore face a variety of interpretive challenges when they aim to understand patients' subjective perspectives on disease and illness. The article argues that theories on social simulation can shed light on how nurses manage to meet these challenges. The core assumption of social simulationism is that we (...) do not understand other people by forming mental representations of how they think, but by putting ourselves in their situation in a more imaginative way. According to simulationism, any attempt to understand a patient's behavior is made on the basis of simulating what it is like to be that patient in the given context. The article argues that this approach to social interpretation can clarify how nurses manage to achieve aims of patient understanding, even when they have limited time to communicate and incomplete knowledge of patients' perspectives. Furthermore, simulation theory provides a normative framework for interpretation, in the sense that its theoretical assumptions constitute ideals for how nurses should seek to understand patients' experiences of illness. (shrink)

Innovation plays a central role in economic development, at regional and national level. The paper takes a practical approach to innovation and the support of entrepreneurship, based on experience of facilitating two contrasting networks of enterprises. Action research is seen as having a central role, but with different approaches according to the innovation process concerned, and the part of the process.

Investigating random homicides involves constructing models of an odd sort. While the differences between these models and scientific models are radical, calling them models is justified both by functional and structural similarities. Serial homicide investigations illustrate the marked difference between theoretical models in science and the models applied in these criminal investigations. This is further illustrated by considering Glymourian bootstrapping in attempts to solve such homicides. The solutions that result differ radically from explanations in science that are confirmed or disconfirmed (...) by occurrences. Unlike the scientist, the flatfoot gumshoe is also barefoot: he is bereft of a general, determinative theoretical frame. This result shows that criminal investigations do not apply science in the Galilean sense. (shrink)