This essay argues that there are theoretical benefits to keeping distinct—more pervasively than the literature has done so far—the psychological states of imagining that p versus believing that in-the-story p, when it comes to cognition of fiction and other forms of narrative. Positing both in the minds of a story’s audience helps explain the full range of reactions characteristic of story consumption. This distinction also has interesting conceptual and explanatory dimensions that haven’t been carefully observed, and the two mental state (...) types make distinct contributions to generating emotional responses to stories. Finally, the differences between the mental states illuminate how a given story can be both shared with others and at the same time experienced as personal. (shrink)

[OPEN ACCESS TARGET ARTICLE WITH COMMENTARIES AND RESPONSE] We develop a new model of how human agency-detection capacities and other socio-cognitive biases are involved in forming religious beliefs. Crucially, we distinguish general religious beliefs (such as *God exists*) from personal religious beliefs that directly refer to the agent holding the belief or to her peripersonal time and space (such as *God appeared to _me_ last night*). On our model, people acquire general religious beliefs mostly from their surrounding culture; however, people (...) use agency-intuitions and other low-level experiences to form personal religious beliefs. We call our model the Interactive Religious Experience Model (IREM). IREM inverts received versions of Hyperactive Agency-Detection Device Theory (HADD Theory): instead of saying that agency-intuitions are major causes of religious belief in general, IREM says that general belief in supernatural agents causes people to seek situations that trigger agency-intuitions and other experiences, since these enable one to form personal beliefs about those agents. In addition to developing this model, we (1) present empirical and conceptual difficulties with received versions of HADD Theory, (2) explain how IREM incorporates philosophical work on indexical belief, (3) relate IREM to existing anthropological and psychological research, and (4) propose future empirical research programs based on IREM. (shrink)

This paper explains a fallacy that often arises in theorizing about human minds. I call it the Factual Belief Fallacy. The Fallacy, roughly, involves drawing conclusions about human psychology that improperly ignore the large backgrounds of mostly accurate factual beliefs people have. The Factual Belief Fallacy has led to significant mistakes in both philosophy of mind and cognitive science of religion. Avoiding it helps us better see the difference between factual belief and religious credence; seeing that difference in turn enables (...) us to pose interesting normative questions about various mental states labeled “belief.”. (shrink)

Here we explore whether mental training in the form of meditation can help to overcome age-related attentional decline. We compared performance on the attentional blink task between three populations: A group of long-term meditation practitioners within an older population, a control group of age-matched participants and a control group of young participants. Members of both control groups had never practiced meditation. Our results show that long-term meditation practice leads to a reduction of the attentional blink. Meditation practitioners taken from an (...) older population showed a reduction in blink as compared to a control group taken from a younger population, whereas, the control group age-matched to the meditators’ group revealed a blink that was comparatively larger and broader. Our results support the hypothesis that meditation practice can: alter the efficiency with which attentional resources are distributed and help to overcome age-related attentional deficits in the temporal domain. (shrink)

In an earlier issue, I argue (2014) that psychology and epistemology should distinguish religious credence from factual belief. These are distinct cognitive attitudes. Levy (2017) rejects this distinction, arguing that both religious and factual “beliefs” are subject to “shifting” on the basis of fluency and “intuitiveness.” Levy’s theory, however, (1) is out of keeping with much research in cognitive science of religion and (2) misrepresents the notion of factual belief employed in my theory. So his claims don’t undermine my distinction. (...) I conclude by suggesting some approaches to empirically testing our views. (shrink)

Research on social transmission suggests that people preferentially transmit information about threats and social interactions. Such biases might be driven by the arousal that is experienced as part of the emotional response triggered by information about threats or social relationships. The current studies tested whether preferences for transmitting threat-relevant information are consistent with a functional motive to recruit social support. USA residents were recruited for six online studies. Studies 1a and 1B showed that participants more often chose to transmit positive, (...) low-arousal vignettes. Studies 2A and 2B showed higher intentions to transmit emotional vignettes to friends. Study 4 showed a preference for transmitting stories that participants had modified and were therefore novel and unique. Studies 2A and 3 suggest that motivations for seeking social support might influence transmission preferences. Overall, the findings are not easily accounted for by any of the major theories of social transmission. We discuss limitations of the current studies and directions for further research. (shrink)

I raise the question of what cognitive attitude self-deception brings about. That is: what is the product of self-deception? Robert Audi and Georges Rey have argued that self-deception does not bring about belief in the usual sense, but rather “avowal” or “avowed belief.” That means a tendency to affirm verbally (both privately and publicly) that lacks normal belief-like connections to non-verbal actions. I contest their view by discussing cases in which the product of self-deception is implicated in action in a (...) way that exemplifies the motivational role of belief. Furthermore, by applying independent criteria of what it is for a mental state to be a belief, I defend the more intuitive view that being self-deceived that p entails believing that p. Beliefs (i) are the default for action relative to other cognitive attitudes (such as imagining and hypothesis) and (ii) have cognitive governance over the other cognitive attitudes. I explicate these two relations and argue that they obtain for the product of self-deception. (shrink)

Some conspicuous characteristics of argumentation as we all know this phenomenon from our shared everyday experiences are in my view vital to its theoretical treatment because they should have methodological consequences for the way in which argumentation research is conducted. To start with, argumentation is in the first place a communicative act complex, which is realized by making functional verbal communicative moves.

The recent claiming of Simone de Beauvoir's legacy by French feminists for a policy of assimilation of Muslim women to Western models of self and society reduces the complexity and richness of Beauvoir's views in inacceptable ways. This article explores to what extent a politics of difference that challenges the ideals and political strategies of abstract liberalism can be extracted from and legitimized by the philosophies of Simone de Beauvoir and Jean-Paul Sartre. Without assuming their thought is identical, we can (...) read them as elucidating each other and as implicitly exposing weak and strong points in their respective philosophies on ethnocultural relations and social identities. (shrink)

Sometimes people posit "beliefs" to explain mundane instrumental actions (e.g., Neil believes the switch is connected to the light, so he flipped the switch to illuminate the room). Sometimes people posit "beliefs" to explain group affiliation or identity (e.g., in order to belong to the Christian Reformed Church Neil must believe that God is triune). If we set aside the commonality of the word "belief," we can pose a crucial question: Is the cognitive attitude typically involved in the first "light (...) switch" sort of case the same as the cognitive attitude typically involved in the second "Trinity" sort of case? Or: Is mundanely believing the same cognitive relation as groupishly believing? In this essay, I argue that the answer is no. Mundane Beliefs play their instrumental roles well if they are true, and their manner of processing is accordingly sensitive to evidence. Groupish Beliefs play their identity-constituting roles well if they are distinctive, and their manners of processing accordingly allow for and often support distortions of evidence and truth. The manners of processing are thus so different that--despite the common word "belief"--philosophy of mind and epistemology would do well to recognize distinct cognitive attitudes. (shrink)

Recent analysis of genome sequences has identified individuals that are healthy despite carrying severe disease‐associated mutations. A possible explanation is that these individuals carry a second genomic perturbation that can compensate for the detrimental effects of the disease allele, a phenomenon referred to as suppression. In model organisms, suppression interactions are generally divided into two classes: genomic suppressors which are secondary mutations in the genome that bypass a mutant phenotype, and dosage suppression interactions in which overexpression of a suppressor gene (...) rescues a mutant phenotype. Here, we describe the general properties of genomic and dosage suppression, with an emphasis on the budding yeast. We propose that suppression interactions between genetic variants are likely relevant for determining the penetrance of human traits. Consequently, an understanding of suppression mechanisms may guide the discovery of protective variants in healthy individuals that carry disease alleles, which could direct the rational design of new therapeutics. (shrink)

In this article , I first engage in some conceptual clarification of what the words "imagine," "imagining," and "imagination" can mean. Each has a constructive sense, an attitudinal sense, and an imagistic sense. Keeping the senses straight in the course of cognitive theorizing is important for both psychology and philosophy. I then discuss the roles that perceptual memories, beliefs, and genre truth attitudes play in constructive imagination, or the capacity to generate novel representations that go well beyond what's prompted by (...) one's immediate environment. (shrink)

The development of neonatology and the establishment of neonatal intensive care units has led to a vast array of new medical ethical problems and dilemmas centered around discontinuing treatment or nontreatment decisions. Neonatology has become one of the fields that has made clear that medical success is only rarely nonproblematic. The new technology can be a blessing for some, but it may also become a sad experience to others, with life-long repercussions.The ethical problems of neonatology transcend national boundaries. Nevertheless, there (...) are differences in approach among various countries. In The Netherlands, the ethical deliberations have been a matter of public debate, but most of the decision making is left to the medical profession; these decisions are considered too harsh for the general public. Recently, two developments have emerged. The Royal Dutch Medical Association and the Dutch Pediatrics Society have published reports with guidelines and ethical reflections. Over the same period of time, cases have been brought to court for legal analysis and the development of case precedence. (shrink)

The development and management of the Covid-19 outbreak in the Netherlands is described. The “intelligent lockdown” was aimed at minimizing new infections and limiting the number of deaths, while keeping the economy running as much as possible. Changes in consumer behavior, exit strategy, and lessons learned are considered.

The notion of belief appears frequently in cognitive science. Yet it has resisted definition of the sort that could clarify inquiry. How then might a cognitive science of belief proceed? Here we propose a form of pluralism about believing. According to this view, there are importantly different ways to "believe" an idea. These distinct psychological kinds occur within a multi-dimensional property space, with different property clusters within that space constituting distinct varieties of believing. We propose that discovering such property clusters (...) is empirically tractable, and that this approach can help sidestep merely verbal disputes about what constitutes “belief.”. (shrink)

When someone says she believes that God exists, is she expressing the same kind of mental state as when she says she thinks that a lake bigger than Lake Michigan exists⎯i.e., does she refer to the same kind of cognitive attitude in both cases? Using evidence from linguistic corpora (Study 1) and behavioral experiments (Studies 2-4), the current work provides evidence that individuals typically use the word “believe” more in conjunction with statements about religious credences and “think” more in conjunction (...) with factual statements, pointing to two different understandings of claims made with these two terms. These patterns do not appear to reflect low-level differences based on the amount of consensus surrounding a particular claim, the extent to which the truth of a particular claim is known to the participant, or linguistic differences between religious and factual statements. We discuss implications of these findings for religious cognition (e.g., as supporting the theory that religious credences are qualitatively distinct from factual beliefs) as well as cognitive processes more broadly. Finally, we relate the present findings to prior theoretical work on differences between factual belief and religious credence. (shrink)

Imagination contributes to human agency in ways that haven't been well understood. I argue here that pathways from imagistic imagining to emotional engagement support three important agential capacities: 1. bodily preparedness for potential events in one's nearby environment; 2. evaluation of potential future action; and 3. empathy-based moral appraisal. Importantly, however, the kind of pathway in question (I-C-E-C: imagining-categorization-emotion-conceptualization) also enables engagement with fiction. So human enchantment with fiction is a consequence of imaginative pathways that make us the kind of (...) agents we are. Finally, I use this approach to address imaginative resistance and the paradox of fiction. [The version archived here is a penultimate draft. Please email me at [email protected] to receive a pdf of the final in accordance with fair use.]. (shrink)

In this Part II, I investigate different approaches to the question of what makes imagining different from belief. I find that the sentiment-based approach of David Hume falls short, as does the teleological approach, once advocated by David Velleman. I then consider whether the inferential properties of beliefs and imaginings may differ. Beliefs, I claim, exhibit an anti-symmetric inferential governance over imaginings: they are the background that makes inference from one imagining to the other possible; the reverse is not true, (...) and this allows us to distinguish the two attitudes. I then go on to consider the action theory of imagining and the role that imaginings play in generating emotion. (shrink)

In response to an accusation of having said something inappropriate, the accused may exploit the difference between the explicit contents of their utterance and its implicatures. Widely discussed in the pragmatics literature are those cases in which arguers accept accountability only for the explicit contents of what they said while denying commitment to the implicature. In this paper, we sketch a fuller picture of commitment denial. We do so, first, by including in our discussion not just denial of implicatures, but (...) also the mirror strategy of denying commitment to literal meaning and, second, by classifying strategies for commitment denial in terms of classical rhetorical status theory. In addition to providing a systematic categorization of our data, this approach offers some clues to determine when such a defence strategy is a reasonable one and when it is not. (shrink)

This paper claims that the standard characterization of the motivational role of belief should be supplemented. Beliefs do not only, jointly with desires, cause and rationalize actions that will satisfy the desires, if the beliefs are true; beliefs are also the practical ground of other cognitive attitudes, like imagining, which means beliefs determine whether and when one acts with those other attitudes as the cognitive inputs into choices and practical reasoning. In addition to arguing for this thesis, I take issue (...) with Velleman's argument that belief and imagining cannot be distinguished on the basis of motivational role. (shrink)

Austrian immigration authorities frequently reject the family reunion applications of immigrant workers. They justify their decisions not only on legal grounds but also on the basis of their own often prejudiced judgements of the applicants' ability to `integrate' into Austrian society. A discourse-historical method is combined with systemic-functionally oriented methods of text analysis to study the official letters which notify immigrant workers of the rejection of their family reunion applications. The systemic-functionally oriented methods are used in a detailed analysis of (...) a sample of rejection letters while the discourse-historical method allows this analysis to be intertextually connected to other related genres of discourse and strategies of argumentation, and to the history of post-war immigration in Austria generally. (shrink)

We argue that many intuitions do not have conscious propositional contents. In particular, many of the intuitions had in response to philosophical thought experiments, like Gettier cases, do not have such contents. They are more like hunches, urgings, murky feelings, and twinges. Our view thus goes against the received view of intuitions in philosophy, which we call Mainstream Propositionalism. Our positive view is that many thought-experimental intuitions are conscious, spontaneous, non-theoretical, non-propositional psychological states that often motivate belief revision, but they (...) require interpretation, in light of background beliefs, before a subject can form a propositional judgment as a consequence of them. We call our view Interpretationalism. We argue (i) that Interpretationalism avoids the problems that beset Mainstream Propositionalism and (ii) that our view meshes well with empirical results in contemporary cognitive science. (shrink)

Als Plato de hedendaagse academie zou aanschouwen, zou hij niet alleen stomverbaasd zijn over de massificatie en de byzantijnse bureaucratie, maar gezien het ethische doel van de universiteit zou hij ook reden hebben om bezorgd te zijn.

Three puzzles about self-deception make this mental phenomenon an intriguing explanatory target. The first relates to how to define it without paradox; the second is about how to make sense of self-deception in light of the interpretive view of the mental that has become widespread in philosophy; and the third concerns why it exists at all. In this paper I address the first and third puzzles. First, I define self-deception. Second, I criticize Robert Trivers' attempt to use adaptionist evolutionary psychology (...) to solve the third puzzle (existence). Third, I sketch a theory to replace that of Trivers. Self-deception is not an adaptation, but a spandrel in the sense that Gould and Lewontin give the term: a byproduct of other features of human (cognitive) architecture. Self-deception is so undeniable a fact of human life that if anyone tried to deny its existence, the proper response would be to accuse this person of it. (Allen Wood, 1988). (shrink)

Health technology assessment (HTA) is often biased in the sense that it neglects relevant perspectives on the technology in question. To incorporate different perspectives in HTA, we should pursue agreement about what are relevant, plausible, and feasible research questions; interactive technology assessment (iTA) might be suitable for this goal. In this way a kind of procedural ethics is established. Currently, ethics too often is focussed on the application of general principles, which leaves a lot of confusion as to what really (...) is the matter in specific cases; in an iTA clashes of values should not be approached by use of such ethics. Instead, casuistry, as a tool used within the framework of iTA, should help to articulate and clarify what is the matter, as to make room for explication and consensus building. (shrink)

A computational theory of consciousness should include a quantitative measure of consciousness, or MoC, that (i) would reveal to what extent a given system is conscious, (ii) would make it possible to compare not only different systems, but also the same system at different times, and (iii) would be graded, because so is consciousness. However, unless its design is properly constrained, such an MoC gives rise to what we call the boundary problem: an MoC that labels a system as conscious (...) will do so for some – perhaps most – of its subsystems, as well as for irrelevantly extended systems (e.g., the original system augmented with physical appendages that contribute nothing to the properties supposedly supporting consciousness), and for aggregates of individually conscious systems (e.g., groups of people). This problem suggests that the properties that are being measured are epiphenomenal to consciousness, or else it implies a bizarre proliferation of minds. We propose that a solution to the boundary problem can be found by identifying properties that are intrinsic or systemic: properties that clearly differentiate between systems whose existence is a matter of fact, as opposed to those whose existence is a matter of interpretation (in the eye of the beholder). We argue that if a putative MoC can be shown to be systemic, this ipso facto resolves any associated boundary issues. As test cases, we analyze two recent theories of consciousness in light of our definitions: the Integrated Information Theory and the Geometric Theory of consciousness. (shrink)

This paper claims that the standard characterization of the motivational role of belief should be supplemented. Beliefs do not only, jointly with desires, cause and rationalize actions that will satisfy the desires, if the beliefs are true; beliefs are also the practical ground of other cognitive attitudes, like imagining, which means beliefs determine whether and when one acts with those other attitudes as the cognitive inputs into choices and practical reasoning. In addition to arguing for this thesis, I take issue (...) with Velleman's argument that belief and imagining cannot be distinguished on the basis of motivational role. (shrink)

ABSTRACT In ethics, the use of empirical data has become more and more popular, leading to a distinct form of applied ethics, namely empirical ethics. This ‘empirical turn’ is especially visible in bioethics. There are various ways of combining empirical research and ethical reflection. In this paper we discuss the use of empirical data in a special form of Reflective Equilibrium (RE), namely the Network Model with Third Person Moral Experiences. In this model, the empirical data consist of the moral (...) experiences of people in a practice. Although inclusion of these moral experiences in this specific model of RE can be well defended, their use in the application of the model still raises important questions. What precisely are moral experiences? How to determine relevance of experiences, in other words: should there be a selection of the moral experiences that are eventually used in the RE? How much weight should the empirical data have in the RE? And the key question: can the use of RE by empirical ethicists really produce answers to practical moral questions? In this paper we start to answer the above questions by giving examples taken from our research project on understanding the norm of informed consent in the field of pediatric oncology. We especially emphasize that incorporation of empirical data in a network model can reduce the risk of self‐justification and bias and can increase the credibility of the RE reached. (shrink)

Dutch developments on euthanasia have drawn much attention over the years. Defenders and opponents have been telling very different stories about the practice of euthanasia and the frequency of cases, and the Dutch government has been struggling with the legal and moral problems involved. Concern about the procedures followed by physicians as well as questions on the “real” figures led the government to decide to organize an epidemiological study on the extent and the decision making. The results of the study (...) were published in November 1991. Interpretation of the data may lead to a final settlement of the debate on euthanasia and has inevitably led to a revival of the moral debate of the 1970s. For the moment it has been decided that euthanasia will remain officially illegal under the Penal Code. However, in cases where euthanasia does occur, Attorneys General will continue to check the procedures followed by physicians to ensure no abuses have occurred and to safeguard physicians against prosecution. In this contribution, we discuss the development and intertwinement of legal, medical, and moral aspects of euthanasia in The Netherlands and the effects of the empirical studies of 1991, both on definitions and procedures for medical decisions at the end of life. (shrink)

The WWW is increasingly used as a tool and platform for survey research. Several principles have been developed to deal with the new challenges posed to researchers conducting online surveys. In this paper, we discuss some of the challenges we encountered in all phases of our Web based survey conducted in 2004/2005 among nearly 10,000 respondents in six European countries. We argue how and to what extent we applied the principles and methodologies of online surveys to meet the challenges, ranging (...) from composing sampling frames, questionnaire construction, addressing potential respondents, questionnaire distribution, response rate improvement, to data cleaning and data processing. When relevant, we discuss the differences between the six countries involved. It is concluded that many if not most of the problems encountered in online surveys are solved when taking into account the principles that guide the conduct of conventional surveys. (shrink)

Three puzzles about self-deception make this mental phenomenon an intriguing explanatory target. The first relates to how to define it without paradox; the second is about how to make sense of self-deception in light of the interpretive view of the mental that has become widespread in philosophy; and the third concerns why it exists at all. In this paper I address the first and third puzzles. First, I define self-deception. Second, I criticize Robert Trivers’ attempt to use adaptionist evolutionary psychology (...) to solve the third puzzle (existence). Third, I sketch a theory to replace that of Trivers. Self-deception is not an adaptation, but a spandrel in the sense that Gould and Lewontin give the term: a byproduct of other features of human (cognitive) architecture.Self-deception is so undeniable a fact of human life that if anyone tried to deny its existence, the proper response would be to accuse this person of it. (Allen Wood, Citation 1988 ). (shrink)

In this Editor’s column I suggest a more modern aesthetics, in order to fill in some of the promise the current Special Issue on The Birth of the Discipline has in store for us. I base my suggestion more on Kant and Aristotle, though.

Homelessness is an obvious moral challenge, given the fact that it is a problem that millions of people in the developed world have to deal with on a daily basis. In the relatively scarce literature on this subject, there appear to be—roughly—three main approaches, namely, what I will refer to as the “difference approach,” the “liberal approach” and the “care approach.” In the paper I will critically review these three moral perspectives on the issue of homelessness. I will argue that (...) the difference approach and the liberal approach in the end are unconvincing. Homelessness can hardly be interpreted in terms of an internally valued group identity nor in terms of autonomy and its preconditions. I will defend a version of the care approach instead, an approach that focuses on the concrete and particular needs of the homeless. (shrink)

I argue that psychology and epistemology should posit distinct cognitive attitudes of religious credence and factual belief, which have different etiologies and different cognitive and behavioral effects. I support this claim by presenting a range of empirical evidence that religious cognitive attitudes tend to lack properties characteristic of factual belief, just as attitudes like hypothesis, fictional imagining, and assumption for the sake of argument generally lack such properties. Furthermore, religious credences have distinctive properties of their own. To summarize: factual beliefs (...) are practical setting independent, cognitively govern other attitudes, and are evidentially vulnerable. By way of contrast, religious credences have perceived normative orientation, are susceptible to free elaboration, and are vulnerable to special authority. This theory provides a framework for future research in the epistemology and psychology of religious credence. (shrink)

Perceptual experience can be explained by contextualized brain dynamics. An inner loop of ongoing activity within the brain produces dynamic patterns of synchronization and de- synchronization that are necessary, but not sufficient, for visual experience. This inner loop is controlled by evolution, development, socialization, learning, task and perception- action contingencies, which constitute an outer loop. This outer loop is sufficient, but not necessary, for visual experience. Jointly, the inner and outer loop may offer sufficient and necessary conditions for the emergence (...) of visual experience. This hypothesis has methodological, empirical, theoretical, and philosophical implications. (shrink)

From 1991 to 1994 the Dutch Health Insurance Council financed research on Extracorporeal Membrane Oxygenation (ECMO). This is a technique for providing cardiopulmonary bypass to patients with pulmonary and/or cardiac failure. Most often, these patients are premature neonates. During ECMO, blood is drained from the right atrium, pumped along a membrane where gas exchange takes place, and then redirected to the aorta. To prevent blood clotting, heparin is added. However, with the heparin added, the risk of hemorrhage is considerably increased. (...) Therefore, both the chance of surviving and the chance of severe disability are higher with ECMO than with conventional treatment (i.e., ventilator support). (shrink)

From 1991 to 1994 the Dutch Health Insurance Council financed research on Extracorporeal Membrane Oxygenation . This is a technique for providing cardiopulmonary bypass to patients with pulmonary and/or cardiac failure. Most often, these patients are premature neonates. During ECMO, blood is drained from the right atrium, pumped along a membrane where gas exchange takes place, and then redirected to the aorta. To prevent blood clotting, heparin is added. However, with the heparin added, the risk of hemorrhage is considerably increased. (...) Therefore, both the chance of surviving and the chance of severe disability are higher with ECMO than with conventional treatment. (shrink)

In ethics, the use of empirical data has become more and more popular, leading to a distinct form of applied ethics, namely empirical ethics. This ‘empirical turn’ is especially visible in bioethics. There are various ways of combining empirical research and ethical reflection. In this paper we discuss the use of empirical data in a special form of Reflective Equilibrium (RE), namely the Network Model with Third Person Moral Experiences. In this model, the empirical data consist of the moral experiences (...) of people in a practice. Although inclusion of these moral experiences in this specific model of RE can be well defended, their use in the application of the model still raises important questions. What precisely are moral experiences? How to determine relevance of experiences, in other words: should there be a selection of the moral experiences that are eventually used in the RE? How much weight should the empirical data have in the RE? And the key question: can the use of RE by empirical ethicists really produce answers to practical moral questions?In this paper we start to answer the above questions by giving examples taken from our research project on understanding the norm of informed consent in the field of pediatric oncology. We especially emphasize that incorporation of empirical data in a network model can reduce the risk of self‐justification and bias and can increase the credibility of the RE reached. (shrink)

It is not uncommon for patients with advanced disease to express a wish to hasten death. Qualitative studies of the WTHD have found that such a wish may have different meanings, none of which can be understood outside of the patient’s personal and sociocultural background, or which necessarily imply taking concrete steps to ending one’s life. The starting point for the present study was a previous systematic review of qualitative studies of the WTHD in advanced patients. Here we analyse in (...) greater detail the statements made by patients included in that review in order to examine their moral understandings and representations of illness, the dying process and death. We identify and discuss four classes of assumptions: assumptions related to patients’ moral understandings in terms of dignity, autonomy and authenticity; assumptions related to social interactions; assumptions related to the value of life; and assumptions related to medicalisation as an overarching context within which the WTHD is expressed. Our analysis shows how a philosophical perspective can add to an understanding of the WTHD by taking into account cultural and anthropological aspects of the phenomenon. We conclude that the knowledge gained through exploring patients’ experience and moral understandings in the end-of-life context may serve as the basis for care plans and interventions that can help them experience their final days as a meaningful period of life, restoring some sense of personal dignity in those patients who feel this has been lost. (shrink)