As John McMillan notes in January’s editorial, 1 many countries are reflecting on how they responded to the COVID-19 pandemic, what went wrong and how responses to such system shocks can be better managed in the future. However, while it is tempting to think that the COVID-19 pandemic is over and that what is now needed is a reflection on how countries could have responded better, some of the underlying issues and problems COVID-19 both highlighted and created are still with (...) us. The legacy of the pandemic has continued particularly for healthcare workers at all levels, who have had to continue providing services with little time to rest and reflect and with new ‘shocks’ to the systems to cope with. For example, in England, industrial action by junior doctors has put already fragile systems under pressure, and the issues that staff are campaigning about remain unaddressed. Many of... (shrink)

People should be allowed to decide how and where they wish to be tested for HIV without there being a formal requirement for pretest counsellingIn his paper, Ethics of HIV testing in general practice without informed consent, Fraser argues that pretest counselling and informed consent are pillars of the ethical conduct of HIV testing. In my response I want to look critically at these contentions. While I will agree with Fraser that it is always necessary to get informed consent from (...) a patient for an HIV test I will argue that an emphasis on pretest counselling as a prerequisite for testing can actually undermine a patient’s autonomy, the very principle that informed consent seeks to promote.This response will start with an analysis of Case Two as this highlights the fundamental importance of informed consent. It will then go on to look at Case One and show how the special application of informed consent in the field of HIV testing can, in certain circumstances, lead to a reduction in patient autonomy.CASE TWOIn Fraser’s second case a 43 year old married clergyman presented with a recurrent infection of his little toe and the preliminary lab reports queried Kaposi’s sarcoma. The general practitioner thought that because of the patient’s lifestyle there was little risk of HIV infection, “suggesting the possibility of HIV, when it is unexpected and the risk low, can in itself cause anxiety and distress”. On these grounds the GP did not call the patient in for an HIV test.Some might argue that the GP should have tested the clergyman. This could have been done in one of two ways: by seeking his explicit consent for an HIV test, or by getting blanket consent for a range of tests, including HIV, without HIV being explicitly mentioned. …. (shrink)

Humans, like other primates, are intensely social creatures. One of the major functions of our brains must be to enable us to be as skilful in social interactions as we are in our interactions with the physical world. Furthermore, any differences between human brains and those of our nearest relatives, the great apes, are likely to be linked to our unique achievements in social interaction and communication rather than our motor or perceptual skills. Unique to humans is the ability to (...) mentalise, that is to perceive and communicate mental states, such as beliefs and desires. A key problem facing science is to uncover the biological mechanisms underlying our ability to read other minds and to show how these mechanisms evolved. To solve this problem we need to do experiments in which people interact with one another rather than behaving in isolation. Such experiments are now being conducted in increasing numbers and many of the leading exponents of such experiments have contributed to this volume. 'The Neuroscience of Social Interactions' will be an important step in uncovering the biological mechanisms underlying social interactions - undoubtedly one of the major programmes for neuroscience in the 21st century. (shrink)

Clark acknowledges but resists the indirect mind–world relation inherent in prediction error minimization (PEM). But directness should also be resisted. This creates a puzzle, which calls for reconceptualization of the relation. We suggest that a causal conception captures both aspects. With this conception, aspects of situated cognition, social interaction and culture can be understood as emerging through precision optimization.

Humans have been shown capable of performing many cognitive tasks using information of which they are not consciously aware. This raises questions about what role consciousness actually plays in cognition. Here, we explored whether participants can learn cue-target contingencies in an attentional learning task when the cues were presented below the level of conscious awareness, and how this differs from learning about conscious cues. Participants’ manual (Experiment 1) and saccadic (Experiment 2) response speeds were influenced by both conscious and unconscious (...) cues. However, participants were only able to adapt to reversals of the cue-target contingencies (Experiment 1) or changes in the reliability of the cues (Experiment 2) when consciously aware of the cues. Therefore, although visual cues can be processed unconsciously, learning about cues over a few trials requires conscious awareness of them. Finally, we discuss implications for cognitive theories of consciousness. (shrink)

A key question for cognitive theories of reasoning is whether logical reasoning is inherently a sentential linguistic process or a process requiring spatial manipulation and search. We addressed this question in an event-related fMRI study of syllogistic reasoning, using sentences with and without semantic content. Our findings indicate involvement of two dissociable networks in deductive reasoning. During content-based reasoning a left hemisphere temporal system was recruited. By contrast, a formally identical reasoning task, which lacked semantic content, activated a parietal system. (...) The two systems share common components in bilateral basal ganglia nuclei, right cerebellum, bilateral fusiform gyri, and left prefrontal cortex. We conclude that syllogistic reasoning is implemented in two distinct systems whose engagement is primarily a function of the presence or absence of semantic content. Furthermore, when a logical argument results in a belief–logic conflict, the nature of the reasoning process is changed by recruitment of the right prefrontal cortex. (shrink)

In this paper we examine the functional anatomy of volition, as revealed by modern brain imaging techniques, in conjunction with neuropsychological data derived from human and non-human primates using other methodologies. A number of brain regions contribute to the performance of consciously chosen, or ‘willed', actions. Of particular importance is dorsolateral prefrontal cortex , together with those brain regions with which it is connected, via cortico-subcortical and cortico-cortical circuits. That aspect of free will which is concerned with the voluntary selection (...) of one action rather than another critically depends upon the normal functioning of DLPFC and associated brain regions. Disease, or dysfunction, of these circuits may be associated with a variety of disorders of volition: Parkinson's disease, ‘utilization’ behaviour, ‘alien’ and ‘phantom’ limbs, and delusions of ‘alien control’ . Brain imaging has allowed us to gain some access to the pathophysiology of these conditions in living patients. At a philosophical level, the distinction between ‘intentions to act', and ‘intentions in action’ may prove particularly helpful when addressing these complex disturbances of human cognition and conscious experience. The exercise and experience of free will depends upon neural mechanisms located in prefrontal cortex and associated brain systems. (shrink)

The distinction between bottom-up and top-down control of action has been central in cognitive psychology, and, subsequently, in functional neuroimaging. While the model has proven successful in describing central mechanisms in cognitive experiments, it has serious shortcomings in explaining how top-down control is established. In particular, questions as to what is at the top in top-down control lead us to a controlling homunculus located in a mythical brain region with outputs and no inputs. Based on a discussion of recent brain (...) imaging experiments, we argue for the need to factor the interaction between the experimenter and the experimental participant into a realistic understanding of top-down control. We suggest these interactions involve a ‘sharing of scripts’ for perception and action that may be described as ‘top-top processes.’ We thereby expand the understanding of the homunculus to include elements of social cognition. This conceptual reconfiguration may grant some sort of asylum for a—not very omnipotent—homunculus. (shrink)

Mentalizing refers to our ability to read the mental states of other agents and engages many neural processes. The brain's mirror system allows us to share the emotions of others. Through perspective taking, we can infer what a person currently believes about the world given their point of view. Finally, the human brain has the unique ability to represent the mental states of the self and the other and the relationship between these mental states, making possible the communication of ideas.

Over the last 20 years the comparator model for delusions of control has received considerable support in terms of empirical studies. However, the original version clearly needs to be replaced by a model with a much greater degree of sophistication and specificity. Future developments are likely to involve the specification of the role of dopamine in the model and a generalisation of its explanatory power to the whole range of positive symptoms. However, we will still need to explain why symptoms (...) can be so variable and we still do not understand the origin of the most mysterious symptom of all: thought insertion. (shrink)

Patients with delusions of control are abnormally aware of the sensory consequences of their actions and have difficulty with on-line corrections of movement. As a result they do not feel in control of their movements. At the same time they are strongly aware of the action being intentional. This leads them to believe that their actions are being controlled by an external agent. In contrast, the normal mark of the self in action is that we have very little experience of (...) it. Most of the time we are not aware of the sensory consequences of our actions or of the various subtle corrections that we make during the course of goal-directed actions. We know that we are agents and that we are successfully causing the world to change. But as actors we move through the world like shadows glimpsed only occasional from the corner of an eye. (shrink)

Autism provides a model for exploring the nature of self‐consciousness: self‐consciousness requires the ability to reflect on mental states, and autism is a disorder with a specific impairment in the neurocognitive mechanism underlying this ability. Experimental studies of normal and abnormal development suggest that the abilities to attribute mental states to self and to others are closely related. Thus inability to pass standard ‘theory of mind’ tests, which refer to others’ false beliefs, may imply lack of self‐consciousness. Individuals who persistently (...) fail these tests may, in the extreme, be unable to reflect on their intentions or to anticipate their own actions. In contrast, individuals with high‐functioning autism or Asperger syndrome often possess a late‐acquired, explicit theory of mind, which appears to be the result of effortful learning. An experimental study with three people with Asperger syndrome suggested that level of performance on standard theory of mind tasks was strongly related to the ability to engage in introspection. Qualitative differences in the introspections of high‐functioning people with autism are also reflected in autobiographical accounts which may give a glimpse of what it is like to be autistic. (shrink)

Like any discipline, bioethics is a developing field of academic inquiry; and recent trends in scholarship have been towards more engagement with empirical research. This ‘empirical turn’ has provoked extensive debate over how such ‘descriptive’ research carried out in the social sciences contributes to the distinctively normative aspect of bioethics. This paper will address this issue by developing a practical research methodology for the inclusion of data from social science studies into ethical deliberation. This methodology will be based on a (...) naturalistic conception of ethical theory that sees practice as informing theory just as theory informs practice – the two are symbiotically related. From this engagement with practice, the ways that such theories need to be extended and developed can be determined. This is a practical methodology for integrating theory and practice that can be used in empirical studies, one that uses ethical theory both to explore the data and to draw normative conclusions. (shrink)

Freedom of conscience is a core element of human rights respected by most European countries. It allows abortion through the inclusion of a conscience clause, which permits opting out of providing such services. However, the grounds for invoking conscientious objection lack clarity. Our aim in this paper is to take a step in this direction by carrying out a systematic review of reasons by midwives and nurses for declining, on conscience grounds, to participate in abortion. We conducted a systematic review (...) of ethical arguments asking, “What reasons have been reported in the argument based literature for or against conscientious objection to abortion provision by nurses or midwives?” We particularly wanted to identify any discussion of the responsibilities of midwives and nurses in this area. Search terms were conscientious objection and abortion or termination and nurse or midwife or midwives or physicians or doctors or medics within the dates 2000–2016 on: HEIN legal, Medline, CINAHL, Psychinfo, Academic Search Complete, Web of Science including publications in English, German and Dutch. Final articles were subjected to a rigorous analysis, coding and classifying each line into reason mentions, narrow and broad reasons for or against conscientious objection. Of an initial 1085 articles, 10 were included. We identified 23 broad reasons, containing 116narrow reasons and 269 reason mentions. Eighty one narrow reasons argued in favour of and 35 against conscientious objection. Using predetermined categories of moral, practical, religious or legal reasons, “moral reasons” contained the largest number of narrow reasons. The reasons and their associated mentions in this category outnumber those in the sum of the other three categories. We identified no absolute argument either for or against conscientious objection by midwives or nurses. An invisibility of midwives and nurses exists in the whole debate concerning conscientious objection reflecting a gap between literature and practice, as it is they whom WHO recommend as providers of this service. While the arguments in the literature emphasize the need for provision of conscientious objection, a balanced debate is necessary in this field, which includes all relevant health professionals. (shrink)

Cognitive neuroscience aspires to explain how the brain produces conscious states. Many people think this aspiration is threatened by the subjective nature of introspective reports, as well as by certain philosophical arguments. We propose that good neuroscientific explanations of conscious states can consolidate an interpretation of introspective reports, in spite of their subjective nature. This is because the relative quality of explanations can be evaluated on independent, methodological grounds. To illustrate, we review studies that suggest that aspects of the feeling (...) of being in control of one's bodily movement can be explained in terms of the complex and surprising way the brain predicts movement. This is a modest type of functional, contrastive explanation. Though we do not refute the threatening philosophical arguments, we show that they do not apply to this type of explanation. (shrink)

Defending first-person introspective access to own mental states, we argue against Carruthers' claim of mindreading being prior to meta-cognition and for a fundamental difference between how we understand our own and others' mental states. We conclude that a model based on one mechanism but involving two different kinds of access for self and other is sufficient and more consistent with the evidence.

A step towards a theory of consciousness would be to characterise the effect of consciousness on information processing. One set of results suggests that the effect of consciousness is to interfere with computations that are optimally performed non-consciously. Another set of results suggests that conscious, system 2 processing is the home of norm-compliant computation. This is contrasted with system 1 processing, thought to be typically unconscious, which operates with useful but error-prone heuristics. -/- These results can be reconciled by separating (...) out two different distinctions: between conscious and non-conscious representations, on the one hand, and between automatic and deliberate processes, on the other. This pair of distinctions is used to illuminate some existing experimental results and to resolve the puzzle about whether consciousness helps or hinders accurate information processing. This way of resolving the puzzle shows the importance of another category, which we label ‘type 0 cognition’, characterised by automatic computational processes operating on non-conscious representations. (shrink)

In 2008 UK legislation was amended to enable the use of deferred consent for paediatric emergency care (EC) trials in recognition of the practical and ethical difficulties of obtaining prospective consent in an emergency situation. However, ambiguity about how to make deferred consent acceptable to parents, children and practitioners remains. In particular, little is known about practitioners’ views and experiences of seeking deferred consent in this setting.

We have only limited awareness of the system by which we control our actions and this limited awareness does not seem to be concerned with the control of action. Awareness of choosing one action rather than another comes after the choice has been made, while awareness of initiating an action occurs before the movement has begun. These temporal differences bind together in consciousness the intention to act and the consequences of the action. This creates our sense of agency. Activity in (...) the anterior cingulate cortex and medial prefrontal cortex is associated with awareness of our own actions and also occurs when we think about the actions of others. I propose that the mechanism underlying awareness of how our own intentions lead to actions can also be used to represent the intentions that underlie the actions of others. This common system enables us to communicate mental states and thereby share our experiences. (shrink)

Why are humans so clever? This book explores the idea that this cleverness has evolved through the increasing complexity of social groups. It brings together contributions from leaders in the field, examining social intelligence in different animal species and exploring its development, evolution and the brain systems upon which it depends.

In this paper, we attempt to make a distinction between egocentrism and allocentrism in social cognition, based on the distinction that is made in visuo-spatial perception. We propose that it makes a difference to mentalizing whether the other person can be understood using an egocentric (‘‘you'') or an allocentric (‘‘he/ she/they'') stance. Within an egocentric stance, the other person is represented in relation to the self. By contrast, within an allocentric stance, the existence or mental state of the other person (...) needs to be represented as independent from the self. We suggest here that people with Asperger syndrome suffer from a disconnection between a strong naı¨ve egocentric stance and a highly abstract allocentric stance. We argue that the currently used distinction between first-person and third-person perspective-taking is orthogonal to the distinction between an egocentric and an allocentric stance and therefore cannot serve as a critical test of allocentrism. (shrink)

The literature on patient public involvement and engagement (PPIE) in health research has grown significantly in the last decade, with a diverse range of definitions and topologies promulgated. This has led to disputes over what the central functions and purpose of PPIE in health research is, and this in turn makes it difficult to assess and evaluate PPIE in practice. This paper argues that the most important function of PPIE is the attempt to make health research more democratic. Bringing this (...) function to the fore and locating PPIE in the wider context of changes in contemporary forms of democratic engagement provides greater conceptual clarity over what PPIE in research should be trying to achieve. Conceptualizing PPIE as a form of democratization has a number of benefits. First, theories of what are appropriate, normatively justifiable and workable criteria for PPIE practices can be developed, and this can provide tools to address the legitimacy and accountability questions that have troubled the PPIE community. Second, this work can be used to form the basis of a research agenda to investigate how PPIE in health research operates, and how it can facilitate and/or improve democratic processes in health research. (shrink)

There is certainly a need for a framework to guide the study of the physiological mechanisms underlying the experience of music and the emotions that music evokes. However, this framework should be organised hierarchically, with musical anticipation as its fundamental mechanism.

In this chapter we examine the role of synaesthesia research within the broader context of the science of the mind and in particular the scientific study of consciousness. We argue that synaesthesia could be used as a model problem for the scientific study of consciousness, offering a novel perspective on perception, awareness and even social cognition. We highlight some of the lessons we have learnt from studying synaesthesia and areas in which we see synaesthesia research generating further insights into understanding (...) consciousness in the future. These include: Individual differences in conscious experience, the neural correlates of consciousness, how we construct the perceived world, and the development of consciousness. (shrink)

This paper examines a legal case arising from a workplace grievance that progressed to being heard at the UK’s Supreme Court. The case of Doogan and Wood versus Greater Glasgow and Clyde Health Board concerned two senior midwives in Scotland, both practicing Roman Catholics, who exercised their perceived rights in accordance with section 4 of the Abortion Act not to participate in the treatment of women undergoing abortions. The key question raised by this case was: “Is Greater Glasgow and Clyde (...) Health Board entitled to require the midwives to delegate, supervise and support staff in the treatment of patients undergoing termination of pregnancy?” The ethical issues concerning conscientious objection to abortion have been much debated although the academic literature is mainly concerned with the position of medical practitioners rather than what the World Health Organization terms “mid-level professionals” such as midwives. This paper examines the arguments put forward by the midwives to justify their refusal to carry out tasks they felt contravened their legal right to make a conscientious objection. We then consider professional codes, UK legislation and church legislation. While the former are given strong weighting the latter was been ignored in this case, although cases in other European countries have been prevented from escalating to such a high level by the intervention of prominent church figures. The paper concludes by stating that the question put to the courts remains as yet unanswered but offers some recommendations for future policy making and research. (shrink)

This paper examines a legal case arising from a workplace grievance that progressed to being heard at the UK’s Supreme Court. The case of Doogan and Wood versus Greater Glasgow and Clyde Health Board concerned two senior midwives in Scotland, both practicing Roman Catholics, who exercised their perceived rights in accordance with section 4 of the Abortion Act not to participate in the treatment of women undergoing abortions. The key question raised by this case was: “Is Greater Glasgow and Clyde (...) Health Board entitled to require the midwives to delegate, supervise and support staff in the treatment of patients undergoing termination of pregnancy?” The ethical issues concerning conscientious objection to abortion have been much debated although the academic literature is mainly concerned with the position of medical practitioners rather than what the World Health Organization terms “mid-level professionals” such as midwives. This paper examines the arguments put forward by the midwives to justify their refusal to carry out tasks they felt contravened their legal right to make a conscientious objection. We then consider professional codes, UK legislation and church legislation. While the former are given strong weighting the latter was been ignored in this case, although cases in other European countries have been prevented from escalating to such a high level by the intervention of prominent church figures. The paper concludes by stating that the question put to the courts remains as yet unanswered but offers some recommendations for future policy making and research. (shrink)

We have only limited awareness of the system by which we control our actions and this limited awareness does not seem to be concerned with the control of action. Awareness of choosing one action rather than another comes after the choice has been made, while awareness of initiating an action occurs before the movement has begun. These temporal differences bind together in consciousness the intention to act and the consequences of the action. This creates our sense of agency. Activity in (...) the anterior cingulate cortex and medial prefrontal cortex is associated with awareness of our own actions and also occurs when we think about the actions of others. I propose that the mechanism underlying awareness of how our own intentions lead to actions can also be used to represent the intentions that underlie the actions of others. This common system enables us to communicate mental states and thereby share our experiences. (shrink)

In their paper Horton et al argue that it is acceptable to contact an anonymous egg-donor to facilitate diagnostic genetic testing for the donor conceived child, despite the donor, ‘indicating on a historical consent form that she did not wish to take part in future research, and that she did not wish to be informed if she was found to be a carrier of a “harmful inherited condition”’. There are a number of claims embedded in Horton et al’s position that (...) it is acceptable to contact the donor and request that she at least think about participating in genetic testing. In this response. I will go through their main claims and argue that the area of genomic medicine does not justify exceptions to general consent conditions as the authors suppose and conclude that the donor should not be contacted. I will then go on to suggest a policy change that would address Horton et al’s concerns but would not involve over-riding any previously expressed wishes. (shrink)