Sedation and care at the end of life

This special issue of Theoretical Medicine and Bioethics takes up the question of palliative sedation as a source of potential concern or controversy among Christian clinicians and thinkers. Christianity affirms a duty to relieve unnecessary suffering yet also proscribes euthanasia. Accordingly, the question arises as to whether it is ever morally permissible to render dying patients unconscious in order to relieve their suffering. If so, under what conditions? Is this practice genuinely morally distinguishable from euthanasia? Can one ever aim directly at making a dying person unconscious, or is it only permissible to tolerate unconsciousness as an unintended side effect of treating specific symptoms? What role does the rule of double effect play in making such decisions? Does spiritual or psychological suffering ever justify sedation to unconsciousness? What are the theological and spiritual aspects of such care? This introduction describes how the authors in this special issue wrestle with such questions and shows how each essay relates to the author’s individual position on palliative sedation, as developed in greater detail within his contribution.     

Consensus and Cognitivism in Habermas’s Discourse Ethics

Abstract

Habermas asserts that his discourse ethics rests on two main commitments:

1. Moral judgements have cognitive content analogous to truth value; and

2. moral justification requires real-life discourse. Habermas elaborates on the second claim by making actual consensus a necessary condition of normative validity. I argue that Habermas’s two commitments sit uneasily together. The second entails that his cognitivism is revisionist in the sense that it must reject the law of the excluded middle. Moreover, Habermas’s argument in defence of the need for real-life discourse is unconvincing and his derivation of the principle which requires consensus is fallacious.

     

Reconsidering the role of language in medicine

Background

Despite an expansive literature on communication in medicine, the role of language is dealt with mostly indirectly. Recently, narrative medicine has emerged as a strategy to improve doctor-patient communication and integrate patient perspectives. However, even in this field which is predicated on language use, scholars have not specifically reflected on how language functions in medicine.

Methods

In this theoretical paper, the authors consider how different models of language use, which have been proposed in the philosophical literature, might be applied to communication in medicine. In particular, the authors contrast the traditional, indexical thesis of language with new models that focus on interpretation instead of standardization.

Results

The authors demonstrate how paying close attention to the role of language in medicine provides a philosophical foundation for supporting recent changes in doctor-patient communication. In particular, interpretive models are at the foundation of new approaches such as narrative medicine, that emphasize listening to patient stories, rather than merely collecting information.

Conclusion

Ultimately, debates regarding the role of language which have largely resided in non-medical literatures, have important implications for describing communication in medicine. In particular, interpretive models of language use provide an important rationale for facilitating a more robust dialogue between doctors and patients.

     

Feminist Relational Discourse Analysis: putting the personal in the political in feminist research

Discourse analysis is a useful and flexible method for exploring power and identity. While there are many forms of discourse analysis, all agree that discourse is the central site of identity construction. However, recent feminist concerns over power, agency, and resistance have drawn attention to the absence of participants’ first-hand experiences within broad discursive accounts (Lafrance &; McKenzie-Mohr 2014 Boonzaier, F 2014, ‘Talking against dominance: South African women resisting dominant discourse in narratives of violence’, in S McKenzie-Mohr &; MN Lafrance (eds.), Women voicing resistance: discursive and narrative explorations, Routledge, Hove, pp. 102–20.[Crossref] , [Google Scholar]; Saukko 2008 Saukko, P 2008, The anorexic self: a personal, political analysis of a diagnostic discourse, State University of New York Press, Albany. [Google Scholar]). For those with an interest in power relations, such as feminist researchers, this is a problematic silence which renders the personal functions of discourse invisible. In this article, we argue that the “personal” and “political” are inextricable, and we make a case for putting the “personal” into broader discursive frameworks of understanding. Further, we assert that feminist research seeking to account for identity must more explicitly aim to capture this interplay. To this end, we argue that voice is the key site of meaning where this interplay can be captured, but that no clear analytical framework currently exists for producing such an account. In response, we propose Feminist Relational Discourse Analysis (FRDA) as a voice-centered analytical approach for engaging with experience and discourse in talk. We then set out clear guidance on how to do FRDA, as applied in the context of women working in U.K. policing. Finally, we conclude that by prioritizing voice, FRDA invites new and politicized feminist readings of power, agency, and resistance, where the voices of participants remain central to the discursive accounts of researchers.     

Something Was Lost in Freud’s <Emphasis Type="Italic">Beyond the Pleasure Principle</Emphasis>: A Ferenczian Reading*

Freud’s Beyond the Pleasure Principle (1920) brought a lot of new possibilities to psychoanalytic theory, but also a series of losses. While I recognize the importance of the death drive as a metapsychological construct, I argue that the first thing that went missing with the arrival of this groundbreaking Freudian text is the theorization of the ego instincts or the self-preservative drives. Freud never articulated some plausible inheritors of the ego instincts. I follow the Budapest School, and especially the voice of Sándor Ferenczi, for addressing this loss. The second thing that went missing after Beyond the Pleasure Principle is our openness in thinking through repetition. With the seductive formulation of the “daemonic” repetition in this 1920 text, our theoretical imagination around repetition seems to have been affected. I draw on the work of Sándor Ferenczi for exploring new forms of repetition. Finally, I offer a Ferenczian re-reading of the Freudian Nachträglichkeit, which I see as crucial in the process of pluralizing our thinking on repetition.     

On Making Reparation to the Analyst's Idolized Countertransference: Commentary on Paper by Dana Amir

Dana Amir's paper, “The Chameleon Language of Perversion,” provides an opportunity to consider the discourse of perversion on two fronts: as a stalled mode of representation in the articulation of desire (Freud, 1905 Freud, S. 1905. Three essays on the theory of sexuality. Standard Edition, 7: 136–248.  [Google Scholar]) and as an elusive harbinger of normative discourse in the psychoanalyst's countertransference. By drawing us into the intricacies of perverse communication, her paper invites us to elaborate a relational perspective on perversion that accounts for both qualities of discourse. I use clinical vignettes to argue that by holding the double meaning of countertransference, as discourse that aims for affect to be contained and represented and as a way of knowing endowed by the analyst's occupation of normative discourse, the relational analyst may coax perversion from inert scene into the domain of object representation, making reparation to the idolized countertransference (Khan, 1989) so as to vest chameleon language with intersubjective capacity for recognition and meaning.     

‘God’s got your back’: teenage boys talk about God

This paper reports on ongoing research that has gathered data from 1100 boys, between 15‐ and 18‐years‐old, on the ways in which they experience and express spirituality. The paper is set against the background of a previous paper in this journal (Engebretson, 2004 Engebretson, K. 2004. Teenage boys, spirituality and religion. International Journal of Children’s Spirituality, 9(3): 263–278.  [Google Scholar]), that introduced the research and gave its theoretical framework. The focus of this paper is on the boys’ articulated experiences of the transcendent. The paper reports on these, claiming that transcendent experiences occurred for the boys in times that involved risk, fear, challenge, need and loss. Their sense of God was personal, one who was always there, who understood, who listened, who cared and protected. The paper then critically analyses why a much smaller percentage of boys who were given the opportunity to answer these questions did so, in comparison with the much higher percentage who answered the other questions on the questionnaire. Finally, questions are posed that will guide the research as it continues.     

Appraisal of Research Depends Upon its Conceptualization

Smedslund and Ross (2014) have offered us an interesting opinion article concerning the usefulness of empirical research for psychological practice. Appraisal of research is obviously contingent upon the way it is conceptualized and although the authors are involved with rather different kinds of practical problems they nevertheless conceptualize research in exactly the same way. This entails a possible mismatch between questions asked and methods used to answer them. I will try to add to the discussion by examining more closely how the authors conceptualize research and discuss the problems of mismatch between questions, methods, methodology, and epistemology. I claim that the authors’ view of research misses some important aspects of scientific reasoning and follows an unjustified epistemological position. Part of the arising controversy is a rather natural consequence of this but could be overcome by reconsidering the aims of science and getting epistemology, methodology and questions in line. Although I focus on the specific article and the authors’ positions, I hold that the issues discussed are common and general.     

Scope Processing in Chinese

The standard view maintains that quantifier scope interpretation results from an interaction between different modules: the syntax, the semantics as well as the pragmatics. Thus, by examining the mechanism of quantifier scope interpretation, we will certainly gain some insight into how these different modules interact with one another. To observe it, two experiments, an offline judgment task and an eye-tracking experiment, were conducted to investigate the interpretation of doubly quantified sentences in Chinese, like Mei-ge qiangdao dou qiang-le yi-ge yinhang (Every robber robbed a bank). According to current literature, doubly quantified sentences in Chinese like the above are unambiguous, which can only be interpreted as ‘for every robber x, there is a bank y, such that x robbed y–surface scope reading), contrary to their ambiguous English counterparts, which also allow the interpretation that ‘there is a bank y, such that for every robber x, x robbed y–inverse scope reading). Specifically, three questions were examined, that is, (i) What is the initial reading of doubly quantified sentences in Chinese? (ii) Whether inverse scope interpretation can be available if appropriate contexts are provided? (iii) What are the processing time courses engaged in quantifier scope interpretation? The results showed that (i) Initially, the language processor computes the surface scope representation and the inverse scope representation in parallel, thus, doubly quantified sentences in Chinese are ambiguous; (ii) The discourse information is not employed in initial processing of relative scope, it serves to evaluate the two representations in reanalysis; (iii) The lexical information of verbs affects their scope-taking patterns. We suggest that these findings provide evidence for the Modular Model, one of the major contenders in the literature on sentence processing.     

Human Cognition in Context: On the Biologic,Cognitive and Social Reconsideration of Meaning as Making Sense of Action

The aim of this special issue of IPBS has been to explore concrete and explicit alternatives to cognitivism. Indeed, in our editorial introduction we set out to give a brief survey of the numerous criticisms that have been made of understanding the mind this way (Ibáñez and Cosmelli, Integrative Psychological and Behavioral Sciences, 2008). Thus in what sense do the contributions here presented succeed in providing novel alternatives, moving into original and potentially generative domains of inquiry? While much remains to be done, we believe that they make significant headway in more than one sense. We do believe, however, that there is one locus that furnishes a convergence ground that is worth considering seriously: the problem of meaning. Meaning as making sense of contextualized action seems to cross the domains of intentionality, intersubjectivity and ecology of mind. The development of multilevel approaches, as the authors here exemplify, argues for a novel research agenda.     

Modeling Unicorns and Dead Cats: Applying Bressan’s ML<Superscript><Emphasis Type="Italic">ν</Emphasis></Superscript> to the Necessary Properties of Non-existent Objects

Should objects count as necessarily having certain properties, despite their not having those properties when they do not exist? For example, should a cat that passes out of existence, and so no longer is a cat, nonetheless count as necessarily being a cat? In this essay I examine different ways of adapting Aldo Bressan’s ML ^ν so that it can accommodate an affirmative answer to these questions. Anil Gupta, in The Logic of Common Nouns, creates a number of languages that have a kinship with Bressan’s ML ^ν , three of which are also tailored to affirmatively answering these questions. After comparing their languages, I argue that metaphysicians and philosophers of language should prefer ML ^ν to Gupta’s languages in most applications because it can accommodate essential properties, like being a cat, while being more uniform and less cumbersome.     

Axiomatizing Jaśkowski’s Discussive Logic $$\mathbf {D_2}$$

We outline the rather complicated history of attempts at axiomatizing Ja?kowski’s discussive logic \(\mathbf {D_2}\) and show that some clarity can be had by paying close attention to the language we work with. We then examine the problem of axiomatizing \(\mathbf {D_2}\) in languages involving discussive conjunctions. Specifically, we show that recent attempts by Ciuciura are mistaken. Finally, we present an axiomatization of \(\mathbf {D_2}\) in the language Ja?kowski suggested in his second paper on discussive logic, by following a remark of da Costa and Dubikajtis. We also deal with an interesting variant of \(\mathbf {D_2}\), introduced by Ciuciura, in which negation is also taken to be discussive.     

Epistemic means and ends: a reply to Hofmann

How is epistemic justification related to knowledge? Is it, as widely thought, constitutive of knowledge? Is it merely a means to knowledge, or merely a means to something else, such as truth? In a recent article in this journal, Hofmann (2005, Synthese, 146(3), 357–369) addresses these questions in attempting to defend an important argument articulated by Sartwell (1992, The Journal of Philosophy, 89(4), 167–180) and reconstructed and criticized by Le Morvan (2002, Erkenntnis: An International Journal of Analytic Philosophy, 56(2), 151–168). This Sartwellian argument purported to show that, since epistemic justification is of merely instrumental value, it is not constitutive of knowledge. In this paper, I argue that Hofmann’s defense of Sartwell fails, but that its failure brings to light some important lessons concerning the nature of justification and its relationship to truth and knowledge.     

Emotional cues do not increase the likelihood of tip-of-the-tongue states

In a recent article, Schwartz (Psychonomic Bulletin & Review 17:82?C87, 2010) reported the effects of emotion on tip-of-the-tongue states (TOTs). He found increased TOTs for emotion-inducing questions, as well as a carryover effect in which high TOT rates were observed following emotion-inducing questions. In the present study, we sought to replicate these findings while controlling for word frequency, but we found an increased TOT rate neither for emotion-inducing questions nor following emotion-inducing questions. We report three attempts to replicate Schwartz??s (Psychonomic Bulletin & Review 17:82?C87, 2010) effect that focused on systematic differences in word frequency between stimulus sets in the original study; none of the key findings reported by Schwartz (Psychonomic Bulletin & Review 17:82?C87, 2010) were found in any of the experiments. These results fail to support prior claims concerning the effects of emotion on TOTs Schwartz (Psychonomic Bulletin & Review 17:82?C87, 2010). The discussion focuses on the importance of controlling for systematic differences in word characteristics between groups of items.     

Language and Extra-linguistic Reality in Bhartṛhari’s Vākyapadīya

Relation between language and extra-linguistic reality is an important problem of Bhart?hari’s linguistic philosophy. In the ‘Vākyapadīya,’ this problem is discussed several times, but in accordance with the general perspectivist trend of Bhart?hari’s philosophy each time it is framed through different concepts and different solutions are provided. In this essay, an attempt is undertaken to summarize the variety of different and mutually exclusive views on language and extra-linguistic reality in VP and to formulate the hidden presuppositions on which the actual viewpoints expressed in the kārikās are based. As a result, the following approaches are formulated: (A1) Language is coextensive with external reality. (A2a) Language, designated as kalpanā/vikalpa, is distinct from reality. (A2b) Language refers to the secondary/metaphorical reality (upacārasattā/aupacārikī sattā). (A3) Language and reality somehow correlate, because otherwise, practical/linguistic activity (vyavahāra) would be impossible. The origin of these approaches and their affinities with different schools of Indian philosophy (Nyāya-Vai?e?ika and Buddhist Pramā?avāda) are examined. Approach (A3), according to which correlation between language and reality is functional and not ontological, seems very close to Dharmakīrti’s concept of arthakriyā. This approach accords with Bhart?hari’s perspectivist philosophical strategy. It enabled him to explain how effective linguistic activity is possible, capturing language in its dynamic aspect, without limitative static ontological constructions.     

The logic of how-questions

Philosophers and scientists are concerned with the why and the how of things. Questions like the following are so much grist for the philosopher’s and scientist’s mill: How can we be free and yet live in a deterministic universe?, How do neural processes give rise to conscious experience?, Why does conscious experience accompany certain physiological events at all?, How is a three-dimensional perception of depth generated by a pair of two-dimensional retinal images?. Since Belnap and Steel’s pioneering work on the logic of questions, Van Fraassen has managed to apply their approach in constructing an account of the logic of why-questions. Comparatively little, by contrast, has been written on the logic of how-questions despite the apparent centrality of questions such as How is it possible for us to be both free and determined? to philosophical enterprise.¹ In what follows I develop a logic for how-questions of various sorts including how-questions of cognitive resolution, how-questions of manner, how-questions of method, of means, and of mechanism.     

Argumentum ad Verecundiam: New Gender-based Criteria for Appeals to Authority

In his influential work on critical argumentation, Douglas Walton explains how to judge whether an argumentum ad verecundiam (appeal to authority) is fallacious or legitimate. He provides six critical questions and a number of ancillary sub-questions to guide the identification of reasonable appeals to authority. While it is common for informal logicians to acknowledge the role of bias in sampling procedures (which are supposed to select statistically random samples) and hypothesis confirmation (which tends to be self-serving), there is a conspicuous lack of discourse on the effect of identity prejudice on judgments of authority, even though this is a well-documented factor in attributing credibility, expertise, trustworthiness, and professional competence to oppressed groups. This could result in faulty judgments of ad verecundiam fallacy. Focusing on gender bias, I review recent works in feminist epistemology—particularly those of Miranda Fricker (2007) and Helen Longino (2002)—to develop three gender-based critical questions to supplement Walton’s original list of six. This addition will help us to identify erroneous dismissals of appeals to authority based on epistemic injustice and epistemic irresponsibility on the part of the speaker or knowledge community. This project promotes the overlapping aims of feminist epistemology and informal logic.     

On the ethical analysis of value issues in public decision-making

Abstract

The nature, methodology, importance and implications of an ethical analysis of value issues pertaining to public decision-making is not evident. In this paper I would like to address these issues by posing the following questions:

• Why is it important to focus on values in any process of public decision-making?

• What is the nature of an ethical analysis of the value issues involved?

• What is the basis, if any, for ethical analysis that moves beyond relativism and subjectivity?

• What difference can such an ethical analysis make to public decision-making?

During the course of discussing these issues, the question “What is ethics?” will be addressed in passing, as well as the usual objections against ethics and the consideration of value issues in public decision-making, namely that

• values cannot be analysed and discussed objectively

• values and ethics are relative to people and cultures

• value and ethical questions cannot be settled in a rational manner

• ethics cannot provide answers

• arguments about value and ethical issues move in circles, taking us nowhere

• values and ethics are so intertwined with emotions and biases that one cannot take them seriously in any process of public decision-making.

     

Written Language Is as Natural as Spoken language: A Biolinguistic Perspective

A commonly held belief is that language is an aspect of the biological system since the capacity to acquire language is innate and evolved along Darwinian lines. Written language, on the other hand, is thought to be an artifact and a surrogate of speech; it is, therefore, neither natural nor biological. This disparaging view of written language, even though propounded by some renowned linguists and biologists, has not gained universal acceptance. Dissenters such as linguists from the Prague circle who claim that written language is an independent system that deserves a status equivalent to that of spoken language have developed their argument along linguistic parameters. The present article also endeavors to show that written language is as natural as spoken language but does so from a biolinguistic perspective. Biolinguistics defines language as a product of biological adaptation in the Darwinian sense (Givon, 2002 Givon, T. 2002. Bio-linguistics, Philadelphia: John Benjamins.  [Google Scholar]) and considers language to be innate and species specific (Jenkins, 2000 Jenkins, L. 2000. Biolinguistics, Cambridge: Cambridge University Press. [Crossref] , [Google Scholar]). The present article presents evidence to show that, similar to spoken language, written language has adaptive value, evolved over time, and is relatively independent of spoken language. The Egyptian hieroglyphic writing, which has a history of about 4,000 years, is used for examining the proposition that written language evolved along Darwinian lines as much as spoken language did. It is concluded that written language is yet another manifestation of the natural endowment of the human mind and may not be treated as a proxy for speech. The educational implication is that, in literacy instruction, written language should be given as much importance in today's schools as elements of spoken language, such as phoneme awareness and phonological awareness.