It is fundamental assumption in nursing theory that it is important for nurses to understand how patients experience states of ill health. This assumption is often related to aims of empathic understanding, but normative principles of social interpretation can have an important action‐guiding role whenever nurses seek to understand patients’ subjective horizons on the basis of active or passive expressions of meaning. The aim of this article is to present a philosophical theory of concept possession and to argue that it (...) can shed light on how nurses should seek to understand patients’ subjective perspectives on the meaning of illness. The two basic ideas in the theory are that patients’ beliefs and thoughts about their experiences involve concepts and that concepts can be communicated on the basis of shared implicit conceptions of what they mean. These conditions of understanding have a striking application: nurse‐patient communication is limited by many contextual factors, but it is often possible for nurses to detect shared implicit conceptions of the meaning of concepts of disease and illness. Furthermore, by acting as sympathetic linguistic experts and creating an atmosphere for dialogue, nurses can make patients feel comfortable about deferring to medical explanations of meaning that can constitute a communicative platform. The last part of the article uses a number of cases studies to show how these implications can be implemented as conceptual tools for securing meaningful communication about illness experiences in patient dialogue. (shrink)

Influential holistic analyses of patient perspectives assume that the concepts that patients associate with medical terms are formed by their total social and cultural contexts. Holistic analyses presuppose conceptual role semantics in the sense that they imply that a medical term must have the same role for a nurse and a patient in order for them to associate the same concept with the term. In recent philosophy of mind, social externalism has emerged as a non‐holistic alternative to conceptual role theories. (...) According to social externalism, a nurse and a patient express the same concept by a term if they both have a minimal or better understanding of the term. Three arguments in favour of social externalism are presented in connection with nurse–patient interaction. The first concerns successful communication, the second focuses on belief reports made by patients and the third centres on the need for including medical terms in medical discourse. Finally, the practical implications of the arguments are clarified. The most important of these is that, in cases of misunderstanding, a nurse should not conform to a patient's idiosyncratic understanding, but instead correct the mistaken applications of the term in question. (shrink)

Tyler Burge has in many writings distinguished between mental content externalism based on incorrect understanding and mental content externalism based on partial but not incorrect understanding. Both and have far-reaching implications for analyses of communication and concept possession in various expert-layperson relations, but Burge and his critics have mainly focused on . This article first argues that escapes the most influential objection to . I then raise an objection against Burge’s argument for . The objection focuses on Burge’s claim that (...) a person with a partial understanding of a term in our community expresses our standard concept because he is willing to defer to our standard understanding, while his “Putnamian” twin in a counterfactual community does not. The problem with Burge’s argument for this claim is that he does not consider the possibility that the person in our community and the twin would defer to the same understanding if they were presented with the same alternatives. Drawing from widespread dispositional assumptions about meaning, I argue that Burge must accept that they express the same concept if they would defer to the same understanding. The article closes with an examination on various ways the externalist may attempt to avoid this problem and concludes that none of them succeeds. (shrink)

It has been a fundamental assumption in management theory that communication is a key condition for successful management. This assumption has been linked to Habermas’ model of communicative rationality, but it is very difficult for managers to implement this model in real-life leadership relations. The reason is that practical obstacles, resource limitations and knowledge gaps make it impossible to achieve Habermas’ ideal aim of ‘shared horizons’. The article argues that it is possible for managers to meet fundamental communication conditions in (...) employee interaction and other forms of leadership relations if the holistic concept of a shared horizon is replaced with an idea of contextual agreement. Within this alternative conceptual framework, a key strategic aim for managers is to communicate as well as realistically possible how organisational strategies and action-guiding principles are justified. This presupposes that managers are able to uncover ‘hidden’ language meaning and transcend contextual power relations. Within a speech act theory of meaning, the article articulates three basic communication conditions that can function as conceptual tools for achieving these communicative aims. (shrink)

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

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

I argue that we are sometimes morally responsible for having and using (or not using) our concepts, despite the fact that we generally do not choose to have them or have full or direct voluntary control over how we use them. I do so by extending an argument of Angela Smith's; the same features that she says make us morally responsible for some of our attitudes also make us morally responsible for some of our concepts. Specifically, like attitudes, concepts can (...) be (a) conceptually and rationally connected to our evaluative judgments, (b) in principle subject to rational revision (reasons‐responsive), and (c) the basis for actual and potential moral assessments of people that we have good reasons to endorse. Thus, we are open to moral appraisal on the basis of having and using (or not using) our concepts when they reflect our evaluative judgments, though even then it is not always appropriate to praise or blame us on that basis. (shrink)