In this paper I take up John Searle's account of ?Background capacities? to render intelligible the presupposed and hidden aspects of the background conditions that enable the performance of skilled movement. The paper begins with a review of Searle's initial account of Background capacities and how this picture can be applied to account for skilled movement in sport. Then an objection to this picture is addressed, claiming that Searle's initial picture might ?overrepresentationalise? background conditions. (...) Moreover, this objection prompts how Searle has modified his initial picture of background conditions in accordance with his more recent ?connection principle?. Searle's recent account of background conditions is then elaborated and discussed in the second half of the paper. The discussion emphasises three distinct levels of analysis in Searle's framework necessary to a full understanding of his background conditions: (i) the neurophysiological level; (ii) the descriptive higher-order practical skill level; and (iii) the logical level of integration. It is argued that Searle's logical framework is found plausible, but that more work is needed to better understand the background conditions of skilled movement in terms of neurophysiological capacities and practical skills from both scientific and philosophical perspectives. (shrink)

Zusammenfassung Verschiedene Studien zur Sportpartizipation zeigen auf, dass insbesondere Mädchen und Frauen mit Migrationshintergrund in Sportvereinen proportional untervertreten sind. Während die Ursachen für die geringe Teilhabe am organisierten Sport in zahlreichen Analysen auf Seiten der Mädchen und Frauen mit Migrationshintergrund verortet werden, wird hingegen die Integrationsfähigkeit von Sportvereinen bislang kaum differenziert betrachtet. Der vorliegende Beitrag nimmt darum den Sportverein in seinen spezifischen Organisationsstrukturen in den Blick. Auf der Grundlage eines organisationstheoretischen Zugangs werden die Strukturen von Sportvereinen dahingehend be­leuchtet, inwieweit diese (...) Integration überhaupt zulassen. Im Zuge dieser Analyse werden Barrieren identifiziert, die die Integration von Mädchen und Frauen mit Migrationshintergrund in den Verein stören, erschweren oder verhindern können. Gleichzeitig werden Möglichkeitsbedingungen für die Integration der Zielgruppe benannt und in der Organisationsstruktur von Sportvereinen verortet. (shrink)

Background Researchers are required to determine whether a person has capacity to consent to a research study before they are able to participate. The Mental Capacity Act and accompanying Code of Practice for England and Wales provide some guidance on this process, but researchers have identified that it can be difficult to determine capacity to consent when a person has complex cognitive or communication needs. This study aimed to understand the experiences and opinions of researchers who recruit people with (...) dementia to research projects, to inform the future development of training resources. Methods A mixed method, cross-sectional, electronic survey was circulated via social media and research networks in England and Wales. The survey remained open for ten weeks and included open and closed questions exploring respondents’ confidence in determining capacity in the context of recruiting people with dementia to consent, their views on training and support they have experienced and their suggestions for future training and support needs. Results 60 respondents completed the survey from across England and Wales. Although 75% of respondents had experience of determining capacity to consent with people with dementia to research, only 13% rated themselves as feeling ‘very confident’ in this. Qualitative content analysis of open responses led to the generation of six themes, explaining researchers’ confidence, competence and future training needs in this area: (1) Researcher uncertainties, (2) Lack of time, (3) Balancing information complexity with accessibility, (4) Gatekeepers, (5) Existing enablers and (6) Envisioning future training. Conclusions Researchers would benefit from specific training in undertaking conversations around consent with people with dementia. People with dementia may have fluctuating capacity, and despite support from caregivers, researchers have little practical guidance on methods of determining a person’s ability to understand or appreciate the information they have provided during the consent process. Given the development of large complex trials within dementia research, there is an urgency to develop specific and practical guidance and training for researchers working with people with dementia and their families. (shrink)

Background. The increased number of clinical trials taking place in developing countries and the complexity of trial protocols mandate that local ethics review committees reviewing them have the capacity to ensure that they are conducted to the highest ethical standards.Methods. The Kenya AIDS Vaccine Initiative Institute of Clinical Research and the Kenyan National Council for Science and Technology embarked on an exercise to enhance the capacity of ERCs in Kenya to review such protocols. This process involved conducting an audit (...) of all ERCs in the country, and performing training needs assessments to identify knowledge and capacity gaps. Information obtained was used to develop training materials for ERC members at workshops conducted in different parts of the country.Results. Five accredited and 13 non-accredited ERCs were identified. Four of the accredited ERCs were located in the capital city of Kenya, Nairobi. The most common challenges cited by participants during the needs assessments were excess workload, and a lack of co-ordination and/or communication between the ERCs. Subsequently, 140 ERC members from 17 institutions across the country were trained as follows: 36 from institutions in the western part of Kenya, 38 from institutions in the south-eastern coastal region, 38 from the eastern region and 44 from Nairobi.Conclusion. The KAVI-ICR and the NCST have developed training modules for training ERC members in Kenya and are in the process of developing a manual to train members. The Kenyan experience may be used to enhance the capacity of ERCs in the East African region. (shrink)

For people with Bipolar Affective Disorder, a self-binding (advance) directive (SBD), by which they commit themselves to treatment during future episodes of mania, even if unwilling, can seem the most rational way to deal with an imperfect predicament. Knowing that mania will almost certainly cause enormous damage to themselves, their preferred solution may well be to allow trusted others to enforce treatment and constraint, traumatic though this may be. No adequate provision exists for drafting a truly effective SBD and efforts (...) to establish such provision are hampered by very valid, but also paralysing ethical, clinical and legal concerns. Effectively, the autonomy and rights of people with bipolar are being 'protected' through being denied an opportunity to protect themselves. From a standpoint firmly rooted in the clinical context and experience of mania, this article argues that an SBD, based on a patient-centred evaluation of capacity to make treatment decisions (DMC-T) and grounded within the clinician-patient relationship, could represent a legitimate and ethically coherent form of self-determination. After setting out background information on fluctuating capacity, mania and advance directives, this article proposes a framework for constructing such an SBD, and considers common objections, possible solutions and suggestions for future research. (shrink)

Background In Canadian jurisdictions without specific legislation pertaining to research consent, the onus is placed on researchers to determine whether a child is capable of independently consenting to participate in a research study. Little, however, is known about how child health researchers are approaching consent and capacity assessment in practice. The aim of this study was to explore and describe researchers' current practices. Methods The study used a qualitative descriptive design consisting of 14 face-to-face interviews with child health researchers (...) and research assistants in Southern Ontario. Transcribed interviews were analysed for common themes. Results Procedures for assessing capacity varied considerably from the use of age cutoffs to in-depth engagement with each child. Three key issues emerged from the accounts: (1) requirements that consent be provided by a single person thwarted researchers' abilities to support family decision-making; (2) little practical distinction was made between assessing if a child was capable, versus determining if study information had been adequately explained by the researcher; and (3) participants' perceived that review boards' requirements may conflict with what they considered ethical consent practices. Conclusion The results suggest that researchers' consent and capacity knowledge and skills vary considerably. Perceived discrepancies between ethical practice and ethics boards' requirements suggest the need for dialogue, education and possibly ethics board reforms. Furthermore we propose, where appropriate, a ‘family decision-making’ model that allows parents and their children to consent together, thereby shifting the focus from separate assent and consent procedures to approaches that appropriately engage the child and family. (shrink)

This essay applies John Searle’s account of weakness of will to explore the classical Chinese problem of weak-willed action. Searle’s discussion focuses on the shortcomings of the Western classical model of rationality in explaining weakness of will, so he naturally says little about the practical ethical problem of overcoming weak-willed action, the focus of the relevant Chinese texts. Yet his theory of action, specifically his notion of the Background, suggests a compelling approach to the practical issue, one that converges (...) with a plausible account of the classical Chinese conception of agency. On this approach, the practical problem is due to weaknesses of the self in carrying out intentions. The key to overcoming the problem lies not in restructuring the agent’s affective states, as suggested by prominent interpreters of Chinese thought such as David Nivison, but in strengthening the agent’s Background capacities, much as we do when mastering new skills. (shrink)

John Searle claims that intentional states require a set of non-intentional background capacities in order to function. He insists that this 'Background' should be construed naturalistically, in terms of the causal properties of biological brains. This paper examines the relationship between Searle's conception of the Background and his commitment to biological naturalism. It is first observed that the arguments Searle ventures in support of the Background's existence do not entail a naturalistic interpretation. Searle's claim that (...) external realism is part of the Background is then addressed. It is shown that this claim implies an implicit understanding of reality, which is presupposed by the intelligibility of any objective, scientific description. As a consequence, Searle's account of the Background's role is incompatible with his insistence that it can be comprehensively characterized in terms of biological capacities. I conclude by showing that, if the tension is resolved by rejecting biological naturalism, Searle's position takes a substantial step in the direction of Heideggerian phenomenology, a move Searle has emphatically resisted in his various exchanges with Hubert Dreyfus. (shrink)

This essay applies John Searle’s account of weakness of will to explore the classical Chinese problem of weak-willed action. Searle’s discussion focuses on the shortcomings of the Western classical model of rationality in explaining weakness of will, so he naturally says little about the practical ethical problem of overcoming weak-willed action, the focus of the relevant Chinese texts. Yet his theory of action, specifically his notion of the Background, suggests a compelling approach to the practical issue, one that converges (...) with a plausible account of the classical Chinese conception of agency. On this approach, the practical problem is due to weaknesses of the self in carrying out intentions. The key to overcoming the problem lies not in restructuring the agent’s affective states, as suggested by prominent interpreters of Chinese thought such as David Nivison, but in strengthening the agent’s Background capacities, much as we do when mastering new skills. (shrink)

This is a detailed exposition and development of some of the epistemic implications of John R. Searle's ontology of the "Background" of communication. Detailed references are made to Searle's more recent and therefore lesser known relevant works, including his 1992 text. The Rediscovery of the Mind, and The Construction of Social Reality, published in 1995. 'Communication' refers to the intentional action of an individual speaker to let another individual know the contents of the speaker's subjective conscious mental state, by (...) way of producing a linguistic utterance made in one or the other conventional language, as well as to the intentional action of the addressee to interpret the contents of the speaker's subjective conscious mental state expressed in the production of the speaker's utterance. The notion of "Background" occupies a central position in Searle's work: it is defined as a speaker's own set of nonconscious, innate and/or acquired neurophysiological capacities that ultimately determine the contents of the speaker's intended utterance meaning on a particular occasion. The speaker is not aware of the actual set of Background capacities effective on a particular occasion, and so the Background is wholly inexplicit in the utterance produced publicly. All members of the human species share some fundamental Background capacities which makes communication at all possible. However, the interpreter's attribution of his/her own Background to the interlocutor--the primary method employed in communication--is not always justified, given the potential dissimilarities in individual speaker's own Backgrounds. This work provides a detailed assessment of how speakers' Backgrounds both enable and at the same time potentially undermine the possibility of successful communication. (shrink)

In regard to the explanation of actions that are governed by institutional rules, John R. Searle introduces the notion of a mental “background” that is supposed to explain how persons can acquire the capacity of following such rules. I argue that Searle’s internalism about the mind and the resulting poverty of his conception of the background keep him from putting forward a convincing explanation of the normative features of institutional action. Drawing on competing conceptions of the background (...) of Heidegger and Wittgenstein, I propose to revise Searle’s conception. The background of institutional agency can only provide a convincing explanation if it includes the context of actions and intersubjective structures of a shared life-world. I suggest that a further development of this idea would lead to the identification of the background with a web of social recognition. (shrink)

Various forms of life have been existing on earth for hundreds of millions of years and the long history has seen the development of life from single cell organisms to invertebrates to vertebrates and to humans the truly intelli gent beings The biological organizations of various species from the lowest to the highest di er in their complexities and sizes Such di erences in internal complexity manifest in the di erences in overt behaviors and intelligence and generally speaking organizational complexities (...) of various species are propor tionate with capabilities displayed by respective species However a gap seems to exist when one goes from high vertebrate animals to humans in that a con scious rational capacity is readily available to human beings that does not seem to be present in any other animals no matter how high they are on the evolutionary hierarchy There is a qualitative di erence Yet strange enough there is no known qualitative di erence between the biological make up of hu man brains and animal brains So the questions are Where does the di erence lie What is the key to the emergence of rational thinking and intelligence.. (shrink)

This paper deals with the particularities of vagueness in law. Thereby the question of the law’s capacity for vagueness is closely related to the question of the impact of vagueness in law, since exaggerated vagueness combined with the elasticity of legal interpretation methodology may affect the constitutional principles of legal certainty, the division of powers, and the binding force of statute. To represent vagueness and the instability of legal concepts and rules, a Hyperbola of Meaning is introduced, opposing Heck’s metaphor (...) of a core and a periphery of meaning. Furthermore, evidence is provided that the use of vague legal concepts and the capability of legal methodology to affect the specific meaning of those concepts, may give rise to astonishing and irrational changes of meaning of the law. Finally the paper sets out in search of an added value of vagueness in law, and weighs several stated pros and contras of vagueness. The paper is written against a background of the German speaking realm. (shrink)

John Searle’s “thesis of the Background” is an attempt to articulate the role of nonintentional capacities---know-how, skills, and abilities---in constituting intentional phenomena. This essay applies Searle’s notion of the Background to shed light on the Daoist notion of w’u-w’ei---“non-action” or non-intentional action---and to help clarify the sort of activity that might originally have inspired the w’u-w’ei ideal. I draw on Searle’s work and the original Chinese sources to develop a defensible conception of a w’u-w’ei-like state that may (...) play an intrinsically and instrumentally valuable role in the exercise of agency. At the same time, however, I argue that Searle’s view that “Intentionality rises to the level of the Background abilities” convincingly explains why the conception of w’u-w’ei presented in ancient texts is untenable. W’u-w’ei-like states can generally occur only as components of an intentional flow of activity, and thus they are not fundamentally nonintentional. (shrink)

Background: The transition to child care is a challenging time in a child’s life and leads to elevated levels of cortisol. These elevations may be influenced by the quality of the mother-child-relationship. However, remarkably little is known about cortisol production in response to the beginning of child care among children-at-risk such as children with an immigrant background. However, attending kindergarten or any other child day-care institution can for example have a compensating effect on potential language deficits thus improving (...) the educational opportunities of these children. Method: Data of a subsample of N = 24 “hard-to-reach” mother-child dyads was collected in the context of the psychoanalytic early prevention project “First Steps”. The project focuses on the earliest integration of children with an immigrant background by supporting parenting capacities in the critical phase of migration and early parenthood. Children’s hair cortisol concentration (HCC) was assessed one week before (mean age = 38.77 months) and three months after kindergarten entry (mean age = 42.26 months). Hair analysis was conducted for both times of measurement, reflecting the first 3 months after kindergarten entry and 3 months prior. Furthermore, the emotional quality of the mother-child-relationship was assessed with the help of the Emotional Availability Scales (EAS) shortly before kindergarten entry when the children were about three years old (mean age = 37.2). Results and Conclusion: Children’s mean cumulated HCC was higher after kindergarten entry than before. The increase correlated negatively with several dimensions of the EAS. Repeated measures ANCOVA revealed that particularly responsive children and children who had experienced less intrusive mother-child-relationships demonstrated lower elevations in HCC after kindergarten entry. Furthermore, a decreased EA score was found in all EA dimensions, besides the dimension “mother’s non-hostility”, indicating problematic EA within the mother-child-relationships of the sample. The results suggest that children with an immigrant background who experience more emotional available mother-child-relationships seem to regulate stress induced by kindergarten entry more effectively, indicated by lower cortisol elevations after entry. This implicates that supporting early mother-child-relationships by intervention may have a positive effect on the children’s ability to regulate stress induced by kindergarten entry thus promoting child development. (shrink)

We welcome Tomasello’s new book on the natural history of human morality as an important confirmation of the evolutionary approach, which sees adaptive behaviors and their psychological underpinnings as linked to a species’ socioecology (the package of subsistence, social, mating, and rearing systems). This perspective automatically leads to the conclusion that the basic set of moral preferences is a straightforward human adaptation to the derived cooperative foraging niche of nomadic foragers, which involves a high degree of interdependence. We provide more (...) background information in support of this evolutionary approach, call for work on defining the contents of the innate core of moral preferences it implies, and urge philosophers to pursue its implications more seriously. Tomasello also offers a historical reconstruction, but his scenario is not compatible with recent comparative data showing a surprising overlap with aspects of human morality, nor does it fit the currently best-supported evolutionary scenario of hominin foraging. We offer a better-fitting alternative, but also call for more behavioral work in child development and on nonhuman primates to improve this reconstruction. (shrink)

Background As more people are living longer, they become frail and are affected by multi-morbidity, resulting in increased demands from the ambulance service. Being vulnerable, older patients may have reduced decision-making capacity, despite still wanting to be involved in decision-making about their care. Their needs may be complex and difficult to assess, and do not always correspond with ambulance assessment protocols. When needing an ambulance, older patients encounter ambulance clinicians who are under high workloads and primarily consider themselves as (...) emergency medical care providers. This situates them in the struggle between differing expectations, and ethical conflicts may arise. To resolve these, providing ethical care, focussing on interpersonal relationships and using ethical competence is needed. However, it is not known whether ambulance clinicians possess the ethical competence required to provide ethical care. Thus, the aim of this study was to deductively explore their ethical competence when caring for older patients with reduced decision-making ability. Methods A qualitative deductive and exploratory design was used to analyse dyadic interviews with ambulance clinicians. A literature review, defining ethical competence as comprising ethical sensitivity, ethical knowledge, ethical reflection, ethical decision-making, ethical action and ethical behaviour, was used as a structured categorization matrix for the analysis. Results Ambulance clinicians possess ethical competence in terms of their ethical knowledge, highlighting the need for establishing an interpersonal relationship with the older patients. To establish this, they use ethical sensitivity to interpret the patients’ needs. Doing this, they are aware of their ethical behaviour, signifying how they must act respectfully and provide the necessary time for listening and interacting. Conclusions Ambulance clinicians fail to see their gut feeling as a professional ethical competence, which might hinder them from reacting to unethical ways of working. Further, they lack ethical reflection regarding the benefits and disadvantages of paternalism, which reduces their ability to perform ethical decision-making. Moreover, their ethical knowledge is hampered by an ageist approach to older patients, which also has consequences for their ethical action. Finally, ambulance clinicians show deficiencies regarding their ethical reflections, as they reflect merely on their own actions, rather than on their values. (shrink)

In this article, we describe a project in which philosophy, in combination with methods drawn from mental modeling, was used to structure dialogue among stakeholders in a region-scale climate adaptation process. The case study we discuss synthesizes the Toolbox dialogue method, a philosophically grounded approach to enhancing communication and collaboration in complex research and practice, with a mental modeling approach rooted in risk analysis, assessment, and communication to structure conversations among non-academic stakeholders who have a common interest in planning for (...) a sustainable future. We begin by describing the background of this project, including details about climate resiliency efforts in West Michigan and the Toolbox dialogue method, which was extended in this project from academic research into community organization involving the West Michigan Climate Resiliency Framework Initiative. This extension involved application of several methods, which are the focus of the Methods section. We then present and discuss preliminary results that suggest the potential for philosophical dialogue to enhance mutual understanding in complex community initiatives that focus on sustainable responses to climate change. Overall, the article supplies a detailed, instructive example of how philosophy can support policy-relevant decision-making processes at the community level. (shrink)

Background: Many people participating in dementia research may lack capacity to give informed consent and the relationship between cognitive function and capacity remains unclear. Recent changes in the law reinforce the need for robust and reproducible methods of assessing capacity when recruiting people for research.Aims: To identify numbers of capacitous participants in a pragmatic randomised trial of dementia treatment; to assess characteristics associated with capacity; to describe a legally acceptable consent process for research.Methods: As part of a pragmatic randomised (...) controlled trial of Ginkgo biloba for mild-moderate dementia, we used a consenting algorithm that met the requirements of existing case law and the exigencies of the new Mental Capacity Act. We decided who had capacity to give informed consent for participation in the trial using this algorithm and sought predictors of capacity.Results: Most participants with mild-moderate dementia in this trial were unable to give informed consent according to the legal criteria. When adjusted for confounding, the Mini Mental State examination did not predict the presence of capacity.Conclusion: Cognitive testing alone is insufficient to assess the presence of capacity. Researchers and clinicians need to be aware of the challenging processes regarding capacity assessment. We outline a procedure which we believe meets the ethical and legal requirements. (shrink)

Background: Research involving adults lacking mental capacity relies on the involvement of a proxy or surrogate, although this raises a number of ethical concerns. Empirical studies have examined attitudes towards proxy decision-making, proxies’ authority as decision-makers, decision accuracy, and other relevant factors. However, a comprehensive evidence-based account of proxy decision-making is lacking. This systematic review provides a synthesis of the empirical data reporting the ethical issues surrounding decisions made by research proxies, and the development of a conceptual framework of (...) proxy decision-making for research. Methods: A systematic review was conducted according to PRISMA guidelines. Databases including MEDLINE, EMBASE, and CINAHL were searched using a combination of search terms, and empirical data from eligible studies were retrieved. The review followed the framework synthesis approach to refine and develop a conceptual framework. Results: Thirty-four studies were included in the review. Two dimensions of proxy decision-making emerged. The ethical framing criteria of decision-making used by proxies: use of a substituted judgement, use of a best interests approach, combination of substituted judgement and best interests, and ‘something else’, and the active elements of proxy decision-making: ‘knowing the person’, patient-proxy relationship, accuracy of the decision, and balancing risks, benefits and burdens, and attitudes towards proxy decision-making. Interactions between the framing criteria and the elements of decision-making are complex and contextually-situated. Conclusions: The findings from this systematic review challenge the accepted reductionist account of proxy decision-making. Decision-making by research proxies is highly contextualized and multifactorial in nature. The choice of proxy and the relational features of decision-making play a fundamental role: both in providing the proxy’s authority as decision-maker, and guiding the decision-making process. The conceptual framework describes the relationship between the framing criteria used by the proxy, and the active elements of decision-making. Further work to develop, and empirically test the proposed framework is needed. (shrink)

Background In end-of-life situations, the phrase “do everything” is sometimes invoked by physicians, patients, or substitute decision-makers, though its meaning is ambiguous. We examined instances of the phrase “do everything” in the archive of the Ontario Consent and Capacity Board in Canada, a tribunal with judicial authority to adjudicate physician–patient conflicts in order to explore its potential meanings. Methods We systematically searched the CCB’s online public archive from its inception to 2018 for any references to “do everything” in the (...) context of critical care medicine and end-of-life care. Two independent assessors reviewed decisions, collected characteristics, and identified key themes. Results Of 598 cases in the archive, 41 referred to “do everything” in end-of-life situations. The phrase was overwhelmingly invoked by SDMs, typically to advocate for life-prolonging measures that contradicted physician advice. Physicians generally related “doing everything” to describe the interventions they had already performed, using it to recommend focusing on patients’ quality of life. SDMs were generally reluctant to accept death, whereas physicians found prolonging life at all costs to be morally distressing. The CCB did not interpret appeals to “do everything” legally but followed existing laws by deferring to patients’ prior wishes whenever known, or to concepts of “best interests” when not. The CCB generally recommended against life-prolonging measures in these cases, focusing on patients’ “well-being” and “best interests.” Conclusions In this unique sample of cases involving conflict surrounding resuscitation and end-of-life care, references to “do everything” highlighted conflicts over quantity versus quality of life. These appeals were associated with signs of cognitive distress on the behalf of SDMs who were facing the prospect of a patient’s death, whereas physicians identified moral distress related to the prolongation of patients’ suffering through their use of life-sustaining interventions. This divergence in perspectives on death versus suffering was consistently the locus of conflict. These findings support the importance of tools such as the Serious Illness Conversation Guide that can be used by physicians to direct conversations on the patients’ goals, wishes, trade-offs, and to recommend a treatment plan that may include palliative care. Trial Registration Not applicable. (shrink)

Difficulties understanding speech form one of the most prevalent complaints among older adults. Successful speech perception depends on top-down linguistic and cognitive processes that interact with the bottom-up sensory processing of the incoming acoustic information. The relative roles of these processes in age-related difficulties in speech perception, especially when listening conditions are not ideal, are still unclear. In the current study, we asked whether older adults with a larger working memory capacity process speech more efficiently than peers with lower capacity (...) when speech is presented in noise, with another task performed in tandem. Using the Eye-tracking of Word Identification in Noise Under Memory Increased Load an adapted version of the “visual world” paradigm, 36 older listeners were asked to follow spoken instructions presented in background noise, while retaining digits for later recall under low or high memory load. In critical trials, instructions directed listeners’ gaze to pictures of objects whose names shared onset or offset sounds with the name of a competitor that was displayed on the screen at the same time. We compared listeners with different memory capacities on the time course for spoken word recognition under the two memory loads by testing eye-fixations on a named object, relative to fixations on an object whose name shared phonology with the named object. Results indicated two trends. For older adults with lower working memory capacity, increased memory load did not affect online speech processing, however, it impaired offline word recognition accuracy. The reverse pattern was observed for older adults with higher working memory capacity: increased task difficulty significantly decreases online speech processing efficiency but had no effect on offline word recognition accuracy. Results suggest that in older adults, adaptation to adverse listening conditions is at least partially supported by cognitive reserve. Therefore, additional cognitive capacity may lead to greater resilience of older listeners to adverse listening conditions. The differential effects documented by eye movements and accuracy highlight the importance of using both online and offline measures of speech processing to explore age-related changes in speech perception. (shrink)

The main goal of this article consists in addressing two fundamental issues of consciousness research and cognitive science, namely, the question of why declarative memory functions are inextricably linked with phenomenal awareness and the question of the physical basis of memory traces. The presented approach proposes that high-level cognitive processes involving consciousness employ a universal mechanism by means of which they access and modulate an omnipresent background field that is identified with the zero-point field (ZPF) specified by stochastic electrodynamics, (...) a branch of physics that deals with the universal principles underlying quantum systems. In addition to its known physical properties and memory capacities, the ZPF is hypothesized to be an immanently sentient medium. It is propounded that linking up to a particular field mode of the ZPF activates a particular phenomenal nuance, implying that the phase-locked coupling of a set of field modes, i.e., the formation of a so-called ZPF information state, constitutes an appropriate mechanism for the amalgamation of elementary shades of consciousness into a complex state of consciousness. Since quantum systems rest exactly on this mechanism, conscious memory processes in the brain are expected to differ from unconscious processes by the presence of the typical features of many-body quantum systems, particularly long-range coherence and attractor formation, which is supported by a huge body of empirical evidence. On this basis, the conceptual framework set out in this article paves the way for a new understanding of the brain as a write-read head interacting with the ZPF, leading to self-consistent interpretations of the neural correlates of memory formation and memory retrieval and explaining why these memory processes are closely intertwined with phenomenal awareness. In particular, the neural correlates suggest that the brain produces consciously perceived memory traces by writing sequences of information states into the ZPF and retrieves consciously experienced memory traces by reading sequences of information states from the ZPF. Using these theoretical foundations, altered states of consciousness and memory disorders can be traced back to impairments of the ZPF write-read mechanism. The mechanism should reveal itself through characteristic photon emissions, resulting in testable predictions. (shrink)

Background: This study attempts to understand if medical providers beliefs about the moral permissibility of honoring patient-directed refusals of life-sustaining treatment (LST) are tied to their beliefs about the patient’s decision-making capacity. The study aims to answer: 1) does concern about a patient’s treatment decision-making capacity relate to beliefs about whether it is morally acceptable to honor a refusal of LST, 2) are there differences between provider types in assessments of decision-making capacity and the moral permissibility to refuse LST, (...) and 3) do provider demographics impact beliefs about decision-making capacity and the moral permissibility to refuse LST. Methods: A mixed-methods survey using Likert assessment and vignette-based questions was administered to medical providers within a single health system in the upper Midwest (N = 714) to assess their perspectives on the moral acceptance and decision-making capacity in cases of withholding and withdrawing treatment and suicide. Results: Behavioral health providers report accepting of the moral permissibility of suicide (91.2%) more than either medical providers (77.2%) or surgeons (74.4%) (n = 283). Decision-making capacity was questioned more in the vignettes of the patients refusing life-saving surgery (36%) and voluntarily starvation (40.8%) than in the vignette of the patient requesting to deactivate a pacemaker (13%) (n = 283). Behavioral health providers were more concerned about the capacity to refuse life-saving surgery (55.9%) than medical providers (33.8%) or surgeons (23.1%) (n = 283). Conclusions: Respondents endorse the moral permissibility of persons to withhold or withdraw from treatment regardless of motive. Clinical concerns about a patient’s treatment decision-making capacity do not strongly correlate to views about the moral permissibility of honoring refusals of LST. Different provider types appear to have different thresholds for when to question treatment decision-making capacity. Behavioral health providers tend to question treatment decision-making capacity to refuse LST more than non-behavioral health providers. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Schizophrenic Delusions, Embodiment, and the BackgroundGiovanni Stanghellini (bio)Keywordsschizophrenia, delusion, embodiment, common sense, phenomenologyIn their article Delusions, Certainty, and the Background, Rhodes and Gipps (2008) argue for a Background theory of delusions. Their central argument may be summed up as follows:• The formation and maintenance of delusions becomes intelligible once they are seen to reflect a basic disturbance. When studying delusions, the focus should be on providing an (...) adequate framework for understanding, rather than providing empirical hypotheses to be tested.• The basic disturbance in delusions, and insanity in general, is not a deficiency in reasoning or a defect in the content of experience, but rather something more fundamental.• Delusions––this is their central claim––are caused by a failure of the Bedrock of beliefs (Wittgenstein) or the Background (Searle) to adequately inform or constrain the process of belief formation.• Our Bedrock certainties are defined––following Wittgenstein––as ultimately constituted by our ability to act in the world and demonstrate our primary engagement with the world. They are born out of our everyday experience of the world, conveying our direct, pre-reflective, and practical grasp of the world, rather than expressing judgments we make about it.• Similarly, the Background is defined as those abilities and dispositions that are neither representations nor rules, that function before we can make sense of our experiences.• Wittgenstein’s Bedrock and Searle’s Background in great part overlap with Blankenburg’s pre-reflective natural self-evidence and Stanghellini’s common sense, namely, our own unreflecting know-how, a set of nonpropositional skills, capacities, and dispositions that attune us with the world.• Without a fully functioning Background, the distinctions between imaginary and real (mind and world), self and non-self, and cause and coincidence fail to be adequately drawn within experience. Also, grasping the meaning of others’ behaviors and a weakening of contextual influences are entailed by an erosion of Background sensibilities.I feel extremely sympathetic to this account and, as Rhodes and Gipps report, there are remarkable points of overlap between their and my own ideas about the formation of schizophrenic delusions. I would like to add some comments on the main theories on the basic disorders entailed in the pathogenesis of delusions and conclude with some suggestions to integrate the Background theory of delusions. [End Page 311]Syntagmatic Versus Paradigmatic Models of DelusionsLet me raise first an epistemological point: paradigmatic models of delusions––defining what a delusion is in itself and what are its borders with similar phenomena––proved to be unsatisfactory in psychopathology. As Schneider and Huber (1975) put it more that 40 years ago, “[w]hat counts in delusions is not the delusion itself... but snagging the course of the lived experience, rather than its product” (p. 2042). What we do need, to understand what delusions really are, are syntagmatic models how––delusions (in this case, delusions in persons with schizophrenia) are connected to other phenomena within a structure or a process. What we should look for, then, are the phenomena that contribute as motivationally (or causally) necessary vulnerability, that is, the basic disturbance for the development of delusions. This logically implies that we need studying delusions in fieri, or the pathways that lead to delusions themselves. I subscribe to the principle that studying delusion by merely concentrating exclusively on its crystallized forms would be like studying stroke victims to know more about hypertension (Parnas and Sass 2001). This methodological move from crystallized delusions to delusions in-the-making is quintessential to define the subtle, basic, phenomenal invariant core that characterizes a given psychopathological phenomenon and that emerges across the manifold facets of the phenomenon itself and shapes them and keeps them meaningfully interconnected.A syntagmatic model should account for (at least) the following features of schizophrenic delusions:• abnormalities in symbolization (loss of commonsense meaning of a given thing or fact),• formal aspects (e.g., revelation character, experience of centrality), and• specificity of content (e.g., metaphysical tinge).It should also be compatible with those phenomena like self-disorders (loss of sense of ownership and of agency) that are entailed in most schizophrenic symptoms (e.g., verbal–acoustic hallucinations and experiences of alien control). Finally, it should keep meaningfully... (shrink)

This article outlines challenges to benefitting developing countries that are hosts of international research. In the context of existing guidance and frameworks for benefit‐sharing, it aims to provoke dialog about socioeconomic factors and other background conditions that influence what constitute benefits in a given host setting, and about the proportionality between benefits to hosts and benefits to sponsors and researchers. It argues that capacity‐building for critical thinking and negotiation in many developing country governments, institutions, and communities is a benefit (...) because it can help to overcome background conditions that impinge on equitable international research negotiations, partnerships, and benefits. Enhancing the capacity for both critical thinking and negotiation can, like other targets of capacity‐building, nurture respectful and trusting partnerships that benefit all stakeholders in international research. (shrink)

Reigning orthodoxy in the philosophical study of human rational capacities, such as being able to act intentionally and to reason, is to characterize them in causal psychological terms. That is, to analyze these capacities in terms of mental states and their causal relations. It is against this background that the work of G.E.M. Anscombe has gained renewed interest. The main goal of this chapter is twofold. First, I will explicate Anscombe’s philosophical approach by analyzing her account of (...) intentional action and by relating it to the misperceptions of that account in (the history of) the philosophy of action. Importantly, Anscombe holds that an analysis of intentional action in terms of what it is, e.g., an event with certain specific features, cannot provide non-circular explanations. Instead, following Aristotle, Thomas Aquinas and Wittgenstein, Anscombe seeks to explicate intentional action in terms of its form, i.e., the way in which it exists. The second aim of the chapter is to show the import of Anscombe’s approach by applying it to the philosophy of reasoning. After discussing two main problems for the current orthodox view in epistemological debates on reasoning, I will propose an alternative Anscombe-inspired view of reasoning. In this so-called form view of reasoning, reasoning is characterized as a tool to drag out implications, embodied in judgments of the form p as following from q. The upshot of the chapter is that concepts of our rational capacities do not depict certain psychological states or processes, but rather our involvement with rational connections that exist in our lives and practices. (shrink)

John Searle''s hypothesis of the Background seems to conflict with his initial representationalism according to which each Intentional state contains a particular content that determines its conditions of satisfaction. In Section I of this essay I expose Searle''s initial theory of Intentionality and relate it to Edmund Husserl''s earlier phenomenology. In Section II I make it clear that Searle''s introduction of the notion of Network, though indispensable, does not, by itself, force us to modify that initial theory. However, a (...) comparison of this notion to the notion of horizon from Husserl''s later phenomenology and an interpretation of Husserl''s conception of the determinable X as providing a solution to the problem of perceptual misidentification lead me to conclude that in his discussion of ''twin examples'' Searle had better modified his initial theory. Finally, I critically examine Searle''s claim that anyone who tries seriously to follow out the threads in the Network will eventually reach a bedrock of non-Intentional capacities. In Section III I show in detail, partly in a rather Husserlian vein, that Searle''s four official arguments for the Background thesis, though containing some very valuable contributions to a theory of linguistic skills, are not convincing at all if they are to be understood as going beyond the scope of Searle''s ''content-cum-Network'' picture of Intentionality. The upshot of these considerations is that the Background thesis should be read as a thesis concerning the causal neurophysiological preconditions of human Intentionality rather than concerning the logical properties of Intentional states in general. Recently Searle himself has come to the same result, but he does not say for which reasons. The present essay makes it clear why Searle just had to arrive at this important result. (shrink)

Efforts to bring science into early 19th century breeding practices in Central Europe, organised from Brno, the Hapsburg city in which Mendel would later turn breeding experiments into a body of timeless theory, are here considered as a significant prelude to the great discovery. During those years prior to Mendel's arrival in Brno, enlightened breeders were seeking ways to regulate the process of heredity, which they viewed as a force to be controlled. Many were specialising in sheep breeding for the (...) benefit of the local wool industry while others were showing an interest in commercial plants, especially fruit trees and vines, and later cereals. Breeders explained their problems in regulating heredity in terms of climatic influences disruption due to crossing sports or saltations. Practical experience led them to the concepts of 'inheritance capacity' and the 'mutual elective affinity' of parents. The former was seen to differ among individuals and also among traits; the latter was proposed as a means of adding strength to heredity. The breeders came to recognise that traits might be hidden and yet transmitted as a 'potential' to future generations. They also grew to understand that heredity would be strengthened when a quality was 'fixed' within a lineage by 'pure blood relations.' Continued selection of the desired quality might then lead to 'a higher perfection.' But the ultimate 'physiological' question about breeding, 'what is inherited and how?,' found no answer. Major figures in this development included Abbot Napp, the one who asked this question and who was due to receive Mendel into the monastery in 1843, and Professor Diebl whose lectures on agriculture and natural science at the Brno Philosophical Institute Mendel would attend in 1846. Here we analyse their progress in theorizing about breeding up until about 1840. In discussing this development, we refer to certain international contacts, especially with respect to information transfer and scientific education, within the wider context of the late Enlightenment. (shrink)

This paper tries to investigate the future development tendency of five typical industries in China and find out whether there exists a different innovation strategy preference between Chinese firms of low- and high-knowledge density industry in the background of low-carbon sustainable development. First, this paper finds that the innovation driven-based trend of industrial development is further accelerated in China. Firms in industries with high knowledge and technology density, such as specialized-supplier, scale-intensive, and science-based industries, are more likely to choose (...) exploratory innovation strategy than exploitative innovation strategy. Firms in industries with low knowledge and technology density like service- and supplier-dominated industries are more likely to choose the exploitative innovation strategy. Second, results indicate that exploratory innovation can bring higher technological innovation performance than exploitative innovation. And the effect of the ambidextrous strategy is better than the single exploitative strategy in industries with high knowledge and technology density like specialized-supplier, scale-intensive, and science-based industries. Third, this paper suggests that innovation strategy preference plays a mediating role between industry type and technology innovation and a moderating effect of knowledge management capacity between innovation strategy and firms’ technology innovation. (shrink)

The upheavals of late eighteenth century Europe encouraged people to demand greater liberties, including the freedom to explore the natural world, individually or as part of investigative associations. The Moravian Agricultural and Natural Science Society, organized by Christian Carl André, was one such group of keen practitioners of theoretical and applied scientific disciplines. Headquartered in the “Moravian Manchester” Brünn, the centre of the textile industry, society members debated the improvement of sheep wool to fulfil the needs of the Habsburg armies (...) fighting in the Napoleonic Wars. Wool, as the raw material of soldiers' clothing, could influence the war’s outcome. During the early nineteenth century, wool united politics, economics, and science in Brno, where breeders and natural scientists investigated the possibilities of increasing wool production. They regularly discussed how “climate” or “seed” characteristics influenced wool quality and quantity. Breeders and academics put their knowledge into immediate practice to create sheep with better wool traits through consanguineous matching of animals and artificial selection. This apparent disregard for the incest taboo, however, was viewed as violating natural laws and cultural norms. The debate intensified between 1817 and 1820, when a Hungarian veteran soldier, sheep breeder, and self-taught natural scientist, Imre Festetics, displayed his inbred Mimush sheep, which yielded wool extremely well suited for the fabrication of light but strong garments. Members of the Society questioned whether such “bastard sheep” would be prone to climatic degeneration, should be regarded as freaks of nature, or could be explained by natural laws. The exploration of inbreeding in sheep began to be distilled into hereditary principles that culminated in 1819 with Festetics’s “laws of organic functions” and “genetic laws of nature,” four decades before Gregor Johann Mendel’s seminal work on heredity in peas. (shrink)

Cognitive and rational assessments of competence do not fully capture the way in which individuals normally make decisions. Human beings have always used stories to explain their experiences and values. Narrative ethics should be used to understand the perspective in context of a patient whose competence is in question, and so avoid a destructive clash. Psychiatry and professionals within it also have a narrative that may join with that of science, but there is no special privilege for these narratives unless (...) survival is at stake. The narrative approach should be used to try to make different stories compatible. This article examines the background to this approach, and indicates some ways in which it could be used in the specific cases addressed in the series. (shrink)

Efforts to bring science into early 19th century breeding practices in Central Europe, organised from Brno, the Hapsburg city in which Mendel would later turn breeding experiments into a body of timeless theory, are here considered as a significant prelude to the great discovery. During those years prior to Mendel's arrival in Brno, enlightened breeders were seeking ways to regulate the process of heredity, which they viewed as a force to be controlled. Many were specialising in sheep breeding for the (...) benefit of the local wool industry while others were showing an interest in commercial plants, especially fruit trees and vines, and later cereals. Breeders explained their problems in regulating heredity in terms of (1) climatic influences (2) disruption due to crossing (3) sports or saltations. Practical experience led them to the concepts of 'inheritance capacity' and the 'mutual elective affinity' of parents. The former was seen to differ among individuals and also among traits; the latter was proposed as a means of adding strength to heredity. The breeders came to recognise that traits might be hidden and yet transmitted as a 'potential' to future generations. They also grew to understand that heredity would be strengthened when a quality was 'fixed' within a lineage by 'pure blood relations.' Continued selection of the desired quality might then lead to 'a higher perfection.' But the ultimate 'physiological' question about breeding, 'what is inherited and how?,' found no answer. Major figures in this development included Abbot Napp, the one who asked this question and who was due to receive Mendel into the monastery in 1843, and Professor Diebl whose lectures on agriculture and natural science at the Brno Philosophical Institute Mendel would attend in 1846. Here we analyse their progress in theorizing about breeding up until about 1840. In discussing this development, we refer to certain international contacts, especially with respect to information transfer and scientific education, within the wider context of the late Enlightenment. (shrink)

Ethnic minority status and female gender convey a risk for suicidal behavior, yet research of suicidality of ethnic minority female immigrants is scarce. The authors of this article conducted qualitative interviews with 15 young women in the Netherlands, who either had attempted suicide or contemplated suicide, and analyzed these in a narrative psychology tradition. Suicidality was associated with despair and frustration over the violation of the women’s personal autonomy and self-integrity regarding strategic life choices. Autonomy restrictions and violations followed two (...) patterns, which are interconnected with four criteria regarding the capacity for autonomy. Findings are discussed with referral to Durkheim and feminist theories of autonomy. (shrink)

Philosophizing, according to E. Martens, can be seen as an elemental cultural technology, like arithmetic or writing, which both can and should be acquired in childhood. Martens is proposing here an understanding of philosophy that attributes value not only to the content canon, but also to the process itself, as Wittgenstein, for one, also did when he stated in the Tractatus Logico-Philosophicus, “Philosophy is not a doctrine, but an activity.” For Socrates, this activity consisted in “giving an account of ourselves, (...) our knowledge, our way of life.” In Nietzsche’s view, the precondition for this kind of accounting is the personal capacity for self-distancing, which allows us to grasp our quite individual primal experiences of emotion, perception, sudden illuminations of insight, and so on, as general concepts and logical structures. (shrink)

With growing uncertainty about the evolution of the global landscape, it is of great practical significance to explore the nonlinear dynamic adjustment relationship among the world oil market, the global bulk shipping market, the stock market, and economic growth in China. This paper applied the TVP-SV-VAR model and selected quarterly data from 1998 to 2020 to explore the dynamics. The results indicated that the impact intensity of BDI on China’s economy had a “positive” to “negative” change in different lag periods. (...) This was mainly due to the fact that the negative impact of higher freight prices on China’s economy outweighed the positive impact of higher trade volumes on China’s economy. The impact intensity of BDI on GDP had a distinct medium- to long-term effect. A positive BDI shock had a dampening effect on stock prices in the short and medium term, while a positive BDI shock could promote stock market prosperity in the long-term perspective. The impulse responses of SSE and GDP to BDI showed that the external shipping market shocks to China’s stock market and economic growth gradually became smaller over time. For impulse response at three different time points, the impact intensity of the BDI to GDP varied at different time points, with the largest shock during the financial crisis in 2008, followed by the shock during the oil price crash in 2014, and the smallest during the COVID-19 epidemic. This demonstrated that the external shipping market’s influence on Chinese economic growth and stock market has gradually weakened over time, illustrating the enhancement of Chinese risk-resilience capacity. (shrink)

Climate change has historically been an evolutionary determinant for our species, affecting both hominin evolutionary innovations and extinction rates, and the early waves of migration and expansion outside Africa. Today Homo sapiens has turned itself into a major geological force, able to cause a biodiversity crisis comparable to previous mass extinction events, shaping the Earth surface and impacting biogeochemical cycles and the climate at a global level. We argue that anthropogenically-driven climate change must be understood in terms of a monumental (...) niche construction process, generating long-term ecological inheritance and eco-evolutionary feedbacks that are putting our health and well-being and those of future generations at risk. We then list five major sources of climate change counter-intuitiveness, highlighting how evolved cognitive biases and heuristics may stand in the way of providing effective responses within tight deadlines. Drawing on our framing of the climate breakdown, we finally call for an evolutionary perspective in approaching the adaptive challenge posed by climate change: we argue that putting the brakes on a genuine self-endangering evolutionary trap ultimately depends on our counteractive niche constructing abilities, played at the level of our institutional and innovation capacity. (shrink)

At present, the Chinese government is trying to resolve various social contradictions, such as people’s ever-growing need for a better life and unbalanced and inadequate development. To do so, urban governance practices including holistic governance, decentralized and interconnected governance, multiple participatory governance, and smart governance have been developed in China. Urban smart governance supported by mobile Internet, the Internet of Things, quantum computing, big data, artificial intelligence, and other information technologies has also entered the field of vision of academics and (...) administrators. However, the research and practice on the integration of organizational structure and smart governance technology for urban governance in China are still insufficient. Hence, this paper proposes the design of the organizational structure of an urban smart governance platform and presents the “1 + N” integrated smart information platform and the “power-sharing linkage, one-center and dual-track” platform construction command system. In this system, the functional module of the information platform for smart urban governance is elaborated. This paper contributes to promoting the modernization of China’s urban governance capacity, which can enhance social equity and social order, promote social democracy and rule of law, and enhance the efficiency of urban governance. (shrink)

The sensorimotor theory of perceptual consciousness offers a form of enactivism in that it stresses patterns of interaction instead of any alleged internal representations of the environment. But how does it relate to forms of enactivism stressing the continuity between life and mind? We shall distinguish sensorimotor enactivism, which stresses perceptual capacities themselves, from autopoietic enactivism, which claims an essential connection between experience and autopoietic processes or associated background capacities. We show how autopoiesis, autonomous agency, and affective (...) dimensions of experience may fit into sensorimotor enactivism, and we identify differences between this interpretation and autopoietic enactivism. By taking artificial consciousness as a case in point, we further sharpen the distinction between sensorimotor enactivism and autopoietic enactivism. We argue that sensorimotor enactivism forms a strong default position for an enactive account of perceptual consciousness. (shrink)

The most influential theory of law in current analytic legal philosophy is legal positivism, which generally understands law to be a kind of institution. The most influential theory of institutions in current analytic social philosophy is that of John Searle. One would hope that the two theories are compatible, and in many ways they certainly are. But one incompatibility that still needs ironing out involves the relation of the social rule that undergirds the validity of any legal system (H.L.A. Hart's (...) rule of recognition) to Searle's notion of codification: the idea that institutions need official declarations of their constitutive rules in order to enjoy the full benefits of institutions. The incompatibility arises from the fact that, in order to do its institutional work, the basic validity rule must be codified in Searle's sense—yet, given the particular role it has in legal positivism, it may be impossible to codify in the Searlean sense. In this paper I develop the incompatibility in detail, consider and reject consigning the basic validity rule to Searle's “Background” capacities that support institutional facts, and conclude that the best route to eliminating it while doing a minimum of damage to the two theories is to make a slight emendation to Searle's theory of institutions. (shrink)

The last decades have seen a rising philosophical interest in the phenomenology of skill acquisition. One central topic in this work is the relation between the athlete's background capacities and foreground attention as an invariant feature of skilful movements. The purpose of this paper is to examine further this gestalt relation from the perspective of Merleau-Ponty's phenomenological account of embodied learning and a classical notion from philosophy of sport, namely ?sweet tension of uncertainty of outcome?. In the first (...) part we will explicate how Merleau-Ponty understands embodied learning as a form of gestalt switch that allows the athlete to perceive the world more meaningfully in relation to an ongoing movement project. That is, a skilled athlete perceives more and better opportunities for actions. In the second part, we revisit the classical notion of ?sweet tension of uncertainty of outcome? developed by Kretchmar. This phrase is attributed to the indeterminate back and forth rallies between sport contestants, and to persons facing a sport situation that produces an ambiguity as to whether one will succeed in one's task. In the third part, we then juxtapose Merleau-Ponty's notion of embodied learning and the notion of sweet tension from philosophy of sport in order to draw out the relations between the two notions. In addition, in much of the philosophical work on skill acquisition (for instance in Merleau-Ponty and his much-cited commentator, Hubert Dreyfus) the distinction between everyday skills (such as walking and opening doors) and sport skills is collapsed. Our discussion aims to show that by introducing the notion of ?sweet tension? to the literature on phenomenology of skill acquisition, we are able to highlight a phenomenological difference between everyday skills and sport skills. (shrink)

Background. Africa has seen an increase in the number of health research projects being conducted on the continent, particularly clinical trials. Ideally, this should be accompanied by a commensurate improvement in research ethics review capacity to competently provide the much-required research ethics oversight. Unfortunately, this is not the case in many African countries, which are still grappling with weak research ethics oversight capacity, not only at national level but also at institutional level. Objectives. To describe the proposal by Kenya’s (...) national research ethics regulatory authority, the National Commission for Science Technology and Innovation (NACOSTI), to build the capacity of its National Scientific and Ethics Committee (NSEC), tasked with providing the required research ethics oversight in the country. Methods. This is the proposal submitted by NACOSTI to the European and Developing Countries Clinical Trials Partnership for funding of a project entitled ‘Strengthening Research Ethics and Oversight in Kenya’ (STReK). It describes the activities involved to strengthen the NSEC to provide the required research ethics in the country, and to build the research ethics capacity of research ethics committees (RECs) it has accredited, through training and mentorship programmes, to enable them to efficiently review research proposals. Results. Proposed activities of the project are presented. Implementation of the activities described is ongoing. Conclusion. Lessons learnt in this regard may be of benefit to other research ethics regulatory authorities in resource-constrained countries aiming to strengthen their research ethics oversight capacity. (shrink)

Background:A high prevalence of cognitive impairment and frailty complicates the feasibility of advance care planning in the long-term-care population.Research aim:To identify challenges in implementing the ‘Let Me Decide’ advance care planning programme in long-term-care.Research design:This feasibility study had two phases: (1) staff education on advance care planning and (2) structured advance care planning by staff with residents and families.Participants and research context:long-term-care residents in two nursing homes and one community hospital.Ethical considerations:The local research ethics committee granted ethical approval.Findings:Following implementation, (...) over 50% of all residents had completed some form of end-of-life care plan. Of the 70 residents who died in the post-implementation period, 14% had no care plan, 10% (with capacity) completed an advance care directive and lacking such capacity, 76% had an end-of-life care plan completed for them by the medical team, following discussions with the resident (if able) and family. The considerable logistical challenge of releasing staff for training triggered development of an e-learning programme to facilitate training.Discussion:The challenges encountered were largely concerned with preserving resident’s autonomy, avoiding harm and suboptimal or crisis decision-making, and ensuring residents were treated fairly through optimisation of finite resources.Conclusions:Although it may be too late for many long-term-care residents to complete their own advance care directive, the ‘ Let Me Decide’ programme includes a feasible and acceptable option for structured end-of-life care planning for residents with variable capacity to complete an advance care directive, involving discussion with the resident (to the extent they were able) and their family. While end-of-life care planning was time-consuming to deliver, nursing staff were willing to overcome this and take ownership of the programme, once the benefits in improved communication and enhanced peace of mind among all parties involved became apparent in practice. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:“No One Is Psychotic in My Presence”S. Nassir Ghaemi (bio)Keywordsexistentialism, Semrad, delusions, psychosis, empathy, HavensWe are all prone to make wrong judgments about others (and ourselves) based on inaccurate (or insufficient) information. I recently had this experience with a relative, who cited a number of behaviors as reasons for him to make a rather harsh judgment about my internal mental states. Before hearing his rationale—and despite my belief that (...) he was wrong—I had to reserve some doubt that I might, unconsciously, have those disagreeable habits that my kind relative ascribed to me. But after I heard his explanation, the only possibility that seemed to fit was psychosis (in him, not me); because I was rather certain that he did not have a psychotic illness, I had to conclude that he had beliefs that served his own purposes in some way, although they were simply wrong.We all do this, all the time (perhaps this is the source of the wisdom behind a peasant woman’s admonition to Maxim Gorky: “Remember, above all, do not judge: that is the Devil’s work” [Gorky 1949]).But we do not all have delusions, at least in the sense that delusions are supposed to mark out psychiatric illnesses. Rhodes and Gipps (2008) make this point in their critique of cognitive theories of delusion: “One (‘rationalist’) line of research has explored to what extent people with psychotic delusions may have a malfunction in their reasoning processes (Garety and Hemsley 1994). Another (‘empiricist’) approach has it that delusions are a product of normal reasoning processes running on data provided by abnormal perceptual experiences (Maher 1988, 1999).” Both approaches identify abnormal kinds of reasoning in persons with psychosis, most of which are shared with the normal population (like my relative). But: “the question needs to be asked as to why, in many cases, clear counter-evidence has no effect in correcting the delusional belief. Confirmation bias after all itself only explains why people may not look for disconfirming evidence (Wason 1968), and does not explain why people may fail to believe it when they happen upon or are presented with it” (Rhodes and Gipps 2008, 306).This gets to the distinction between non-bizarre and bizarre delusions (a distinction that the authors do not make in their paper): Non-bizarre delusions seem completely explainable on cognitive grounds—they are not incredibly irrational (my relative’s perspective is logically plausible), yet they are just wrong (it is empirically false, I think). (Another example: I could plausibly believe that the FBI has me—a Shiite Muslim Middle Eastern male who hails from the Axis of Evil—under surveillance; it would simply be false, or not). On the other hand, the authors’ examples of delusions are both bizarre and wrong at first glance, not because they are illogical (in their conceptual associations), but simply because they just seem wrong without [End Page 315] much need to explain why (unlike my relative’s theories): “What, then, needs accounting for is why deluded persons do not themselves recognize the following: the unlikeliness of their belief, the insufficiency of the grounds they provide, the unlikeliness of their premises when they provide them (as well as their conclusions), the greater likelihood that the evidence they adduce was (for example) hallucinated rather than perceived, and so on” (Rhodes and Gipps 2008, 297).The authors turn first to Ludwig Wittgenstein, then John Searle—the former for the notion that we have “Bedrock certainties” that are founded on having served us in acting in the world (these beliefs do not require rational or empirical justification), the latter for the notion of a Background “defined as those abilities and dispositions which themselves are neither representations nor rules, yet that we need to hypothesize as functioning before we can make sense of everyday perception, thinking and language” (Searle 1995, 129). Go mow the lawn, we say, presuming that scissors will not be used:The capacity to discern what counts as the relevant context is itself a Background capacity that cannot, on pains of an infinite regress of an infinity of disambiguations, be understood as consisting in further propositional knowledge. The cultural ‘common sense... (shrink)