Where does the mind stop and the rest of the world begin? The question invites two standard replies. Some accept the demarcations of skin and skull, and say that what is outside the body is outside the mind. Others are impressed by arguments suggesting that the meaning of our words "just ain't in the head", and hold that this externalism about meaning carries over into an externalism about mind. We propose to pursue a third position. We advocate a very different (...) sort of externalism: an _active externalism_, based on the active role of the environment in driving cognitive processes. (shrink)

It is unclear whether someone’s responsibility for developing a disease or maintaining his or her health should affect what healthcare he or she receives. While this dispute continues, we suggest that, if responsibility is to play a role in healthcare, the concept must be rethought in order to reflect the sense in which many health-related behaviours occur repeatedly over time and are the product of more than one agent. Most philosophical accounts of responsibility are synchronic and individualistic; we indicate here (...) what paying more attention to the diachronic and dyadic aspects of responsibility might involve and what implications this could have for assessments of responsibility for health-related behaviour. (shrink)

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In applied ethics, debates about responsibility have been relentlessly individualistic and synchronic, even as recognition has increased in both philosophy and psychology that agency is distributed across time and individuals. I therefore warmly welcome Brown and Savulescu’s analysis of the conditions under which responsibility can be shared and extended. By carefully delineating how diachronic and dyadic responsibility interact with the long-established control and epistemic conditions, they lay the groundwork needed for identifying how responsibility may be inter-individual and intra-individual. Unsurprisingly, I (...) don’t agree with every aspect of their rich account. I strongly suspect that the privileged place the individual continues to occupy in their taxonomy is a residue of the kind of internalist intuitions which dominate WEIRD thinking.1 2 However, I won’t pursue this line of thought here. Instead, I apply Brown and Savulescu’s analysis. Moving beyond the programmatic level at which they develop their account, I will show how it provides a basis for excusing many individuals, focusing not on the dyadic level but the diachronic. Most of the …. (shrink)

Memory is a complex phenomenon, so the loss of memory that occurs in dementia is equally complex. Accounts that deny personhood to dementia sufferers typically fail to accommodate that complexity.

Decision-making capacity is the gatekeeping element for a patient’s right to self-determination with regard to medical decisions. A DMC evaluation is not only conducted on descriptive grounds but is an inherently normative task including ethical reasoning. Therefore, it is dependent to a considerable extent on the values held by the clinicians involved in the DMC evaluation. Dealing with the question of how to reasonably support clinicians in arriving at a DMC judgment, a new tool is presented that fundamentally differs from (...) existing ones: the U-Doc. By putting greater emphasis on the judgmental process rather than on the measurement of mental abilities, the clinician as a decision-maker is brought into focus, rendering the tool more of an evaluation guide than a test instrument. In a qualitative study, the perceived benefits of and difficulties with the tool have been explored. The findings show on the one hand that the evaluation aid provides basic orientation, supports a holistic perspective on the patient, sensitizes for ethical considerations and personal biases, and helps to think through the decision, to argue, and to justify one’s judgment. On the other hand, the room for interpretation due to absent operationalisations, related ambiguities, and the confrontation with one’s own subjectivity may be experienced as unsettling. (shrink)

Do we know what we're doing, and why? Psychological research seems to suggest not: reflection and self-awareness are surprisingly uncommon and inaccurate. John M. Doris presents a new account of agency and responsibility, which reconciles our understanding of ourselves as moral agents with empirical work on the unconscious mind.