Are interpersonal affordances a distinct type of affordance, and if so, what is it that differentiates them from other kinds of affordances? In this paper, I show that a hard distinction between interpersonal affordances and other affordances is warranted and ethically important. The enactivist theory of participatory sense-making demonstrates that there is a difference in coupling between agent-environment and agent-agent interactions, and these differences in coupling provide a basis for distinguishing between the perception of environmental and interpersonal affordances. Building further (...) on this foundation for understanding interpersonal affordances, I argue that in line with some enactivist work on social cognition, interpersonal affordances ought to be considered as those that are afforded by agents and are recognized as such. Given this distinction, I also make the point that because our social conventions establish persons as more than mere agents, the direct perception of interpersonal affordances may also involve seeing others as embodied selves. Distinguishing between types of affordances thus also matters ethically: there can be harms done when an agent is not perceived as an agent, and there can be harms done when an agent is not perceived as a self. (shrink)

According to one influential view, requirements to elicit consent for medical interventions and other interactions gain their rationale from the respect we owe to each other as autonomous, or self-governing, rational agents. Yet the popular presumption that consent has a central role to play in legitimate intervention extends beyond the domain of cases where autonomous agency is present to cases where far from fully autonomous agents make choices that, as likely as not, are going to be against their own best (...) interest. The question how we should understand the rationale for eliciting consent in this range of ‘non-ideal’ cases is comparatively ill understood. In this paper, I explore the prospects of accounting for consent requirements in such ‘non-ideal’ cases by appealing to a set of agency-based interests; including an interest in playing a meaningful part in joint decisions affecting ourselves and others. (shrink)

I discuss Young’s “asymmetrical reciprocity” and apply it to an ethics of mental health care. Due to its emphasis on engaging with others through respectful dialogue in an inclusive manner, asymmetrical reciprocity serves as an appropriate framework for guiding caregivers to interact with their patients and to understand them in a morally responsible and appropriate manner. In Section 1, I define empathy and explain its benefits in the context of mental health care. In Section 2, I discuss two potential problems (...) surrounding empathy: the difficulty of perspectivetaking and “compassion fatigue.” In Section 3, I argue that these issues can be resolved if examined through the lens of an ethics of care. Reciprocal relationships between patients and caregivers are an important element in the development of an ethics of care. In Section 4, I introduce two models of reciprocity that can be applied to a health care context: Benhabib’s symmetrical reciprocity and Young’s asymmetrical reciprocity. In Section 5, I demonstrate how asymmetrical reciprocity cultivates empathy and, in Section 6 and Section 7, I show how it overcomes the objections of empathy and improves therapeutic relationships. (shrink)

The concept of “autonomy”, once at the core of the original enactivist proposal in The Embodied Mind, is nowadays ignored or neglected by some of the most prominent contemporary enactivists approaches. Theories of autonomy, however, come to fill a theoretical gap that sensorimotor accounts of cognition cannot ignore: they provide a naturalized account of normativity and the resources to ground the identity of a cognitive subject in its specific mode of organization. There are, however, good reasons for the contemporary neglect (...) of autonomy as a relevant concept for enactivism. On the one hand, the concept of autonomy has too often been assimilated into autopoiesis and the implications are not always clear for a dynamical sensorimotor approach to cognitive science. On the other hand, the foundational enactivist proposal displays a metaphysical tension between the concept of operational closure, deployed as constitutive, and that of structural coupling ; making it hard to reconcile with the claim that experience is sensorimotorly constituted. This tension is particularly apparent when Varela et al. propose Bittorio as a model of the operational closure of the nervous system as it fails to satisfy the required conditions for a sensorimotor constitution of experience. It is, however, possible to solve these problems by re-considering autonomy at the level of sensorimotor neurodynamics. Two recent robotic simulation models are used for this task, illustrating the notion of strong sensorimotor dependency of neurodynamic patterns, and their networked intertwinement. The concept of habit is proposed as an enactivist building block for cognitive theorizing, re-conceptualizing mental life as a habit ecology, tied within an agent’s behaviour generating mechanism in coordination with its environment. Norms can be naturalized in terms of dynamic, interactively self-sustaining, coherentism. This conception of autonomous sensorimotor agency is put in contrast with those enactive approaches that reject autonomy or neglect the theoretical resources it has to offer for the project of naturalizing minds. (shrink)

John Christman has argued that constitutively relational accounts of autonomy, as defended by some feminist theorists, are problematically perfectionist about the human good. I argue that autonomy is constitutively relational, but not in a way that implies perfectionism: autonomy depends on a dialogical disposition to hold oneself answerable to external, critical perspectives on one's action-guiding commitments. This type of relationality carries no substantive value commitments, yet it does answer to core feminist concerns about autonomy.

Most recent accounts of personal autonomy acknowledge that the social environment a person lives in, and the personal relationships she entertains, have some impact on her autonomy. Two kinds of conceptualizing social conditions are traditionally distinguished in this regard: Causally relational accounts hold that certain relationships and social environments play a causal role for the development and on-going exercise of autonomy. Constitutively relational accounts, by contrast, claim that autonomy is at least partly constituted by a person’s social environment or standing. (...) The central aim of this paper is to raise the question how causally and constitutively relational approaches relate to the fact that we exercise our autonomy over time. I argue that once the temporal scope of autonomy is opened up, we need not only to think differently about the social dimension of autonomy. We also need to reconsider the very distinction between causally and constitutively relational accounts, because it is itself a synchronic (and not a diachronic) distinction. (shrink)

As yet, there is no enactive account of social cognition. This paper extends the enactive concept of sense-making into the social domain. It takes as its departure point the process of interaction between individuals in a social encounter. It is a well-established finding that individuals can and generally do coordinate their movements and utterances in such situations. We argue that the interaction process can take on a form of autonomy. This allows us to reframe the problem of social cognition as (...) that of how meaning is generated and transformed in the interplay between the unfolding interaction process and the individuals engaged in it. The notion of sense-making in this realm becomes participatory sense-making. The onus of social understanding thus moves away from strictly the individual only. (shrink)

This paper challenges the exclusion of patients from epistemic practices in psychiatry by examining the creation and revision processes of the Diagnostic and Statistical Manual of Mental Disorders (DSM), a document produced by the American Psychiatric Association that identifies the properties of mental disorders and thereby guides research, diagnosis, treatment, and various administrative tasks. It argues there are epistemic—rather than exclusively social/political—reasons for including patients in the DSM revision process. Individuals with mental disorders are indispensable resources to enhance psychiatric epistemology, (...) especially in the context of the crisis, controversy, and uncertainty surrounding mental health research and treatment. (shrink)

A good therapeutic relationship in mental health services is a predictor of positive clinical outcomes for people who seek help for distressing experiences, such as voice hearing and paranoia. One factor that may affect the quality of the therapeutic relationship and raises further ethical issues is the impact of the clinical encounter on users’ sense of self, and in particular on their sense of agency. In the paper, we discuss some of the reasons why the sense of epistemic agency may (...) be especially fragile in young people with unusual experiences and beliefs. We argue that it is important to identify and avoid behaviours that can undermine young people’s contributions as epistemic agents in the clinical encounter. (shrink)

Since the revolutionary mood of the 1960s, patient-centered mental health care and a research emphasis on service users as experts by experience have emerged hand in hand with a view of service users as consumers. What happens to knowledge derived from firsthand experience when mental health users become experts and actively choose care? What kind of perspective do service users pursue on psychological distress? These are important questions in a field where psychiatric expertise on mental illness is socially structured and (...) constrained as an intra-personal disturbance of the mind. We argue that experience experts have lost a coherent perspective on care and health. We illustrate this by rationally reconstructing how the interpersonal view of mental health first gained and then lost coherence between the conception of mental health, the practice of mental health care, and the user experience. Harry Stack Sullivan’s interpersonal theory was a paradigm case for such coherence. The inclusion of mental health consumers as ‘experts by experience’ in the mental health field took place at the cost of Sullivan’s coherent interpersonal theory. Service users who interact side by side with medical experts as experience experts are constrained by the evidence-based imperative and consumerism. Service users are caught up in a race among experts to gain knowledge about mental problems from a third-person perspective instead of from first-person experience. To make a contribution service users have more to gain from a research approach that appreciates that they are persons among persons rather than experts among experts. (shrink)

This paper explores the factors that contribute to the degree of a mood disorder patient’s self- insight, defined here as her understanding of the particular contingencies of her life that are responsive to her personal identity, interpersonal relationships, illness symptoms, and the relationship between these three necessary components of her lived experience. I consider three factors: (i) the Diagnostic Statistical Manual of Mental Disorders (DSM), (ii) the DSM culture, and (iii) the cognitive architecture of the self. I argue that the (...) symptom-based descriptions of mood disorders which eliminate the subjective features of the patient’s illness experience, in conjunction with the features of the DSM-culture and the cognitive biases that guide the patient, contribute to the impoverishment of her self-insight. The resulting impoverished self-insight would prevent her from developing resourceful responses to her interpersonal problems. In analyzing how these factors combine to influence the patient’s self-insight, I distinguish the therapeutic impact of receiving a psychiatric diagnosis, which facilitates patient’s clinical treatment, from its reflective impact, how the diagnosis informs the patient’s reflection on who she is, how her mental disorder is expressed, and how her interpersonal relationships proceed. I substantiate my argument by considering a patient’s memoir of psychopathology. (shrink)

The goal of my comments regarding the case study of Eve Hyde — presented in the introduction of this symposium — is not first and foremost to resolve the conflict between individual autonomy and medical paternalism regarding non-consensual psychiatric treatment. Instead, the goal is to step back far enough from what is generally accepted as the morally appropriate basis for non-consensual psychiatric treatment, including involuntary hospitalization and medication, and to ask very basic questions about when patients may permissibly be treated (...) without their consent. My goal, in short, is Socratic — to explore aspects of what we take for granted in order better to determine whether we ought to take them for granted. Commentators routinely urge that it is morally permissible forcibly to treat psychiatric patients, such as Eve Hyde, in order to preserve the patient’s best interests and restore the patient’s autonomy. Such arguments typically specify duties of beneficence toward others, while appreciating personal autonomy as a positive value to be weighed against other factors. (shrink)

Chapter 51 focuses on the subjective side of alcoholism, specifically about what memoirs of alcoholism teach about alcoholism, and argue that a common theme in many memoirs is that drinking, sometimes heavy drinking, a prerequisite of addiction, was modelled, endorsed, and eventually achieved in a way that involves deep identification, and also argues that alcoholic memoirs, even assuming that they suffer from objectivity problems such as the latter, nonetheless serve an important function, and not just whatever cathartic function they serve (...) for the author. (shrink)

Current theories of social cognition are mainly based on a representationalist view. Moreover, they focus on a rather sophisticated and limited aspect of understanding others, i.e. on how we predict and explain others’ behaviours through representing their mental states. Research into the ‘social brain’ has also favoured a third-person paradigm of social cognition as a passive observation of others’ behaviour, attributing it to an inferential, simulative or projective process in the individual brain. In this paper, we present a concept of (...) social understanding as an ongoing, dynamical process of participatory sense-making and mutual incorporation. This process may be described (1) from a dynamical agentive systems point of view as an interaction and coordination of two embodied agents; (2) from a phenomenological approach as a mutual incorporation, i.e. a process in which the lived bodies of both participants extend and form a common intercorporality. Intersubjectivity, it is argued, is not a solitary task of deciphering or simulating the movements of others but means entering a process of embodied interaction and generating common meaning through it. This approach will be further illustrated by an analysis of primary dyadic interaction in early childhood. (shrink)

Focusing on political and interpersonal conflict in the U.S., particularly racial conflict, but with an eye to similar conflicts throughout the world, we argue that the enactive approach to mind as life can be elaborated to provide an exigent framework for present social-political problems. An enactive approach fills problematic lacunae in the Western philosophical ethics project by offering radically refigured notions of responsibility and language. The dual enactive, participatory insight is that interactional responsibility is not singular and language is not (...) an individual property or ability, something that someone simply and uniformly 'has' or 'controls'. These points have not been integrated into our self-understanding as moral actors, to everyone’s detriment. We first advocate for adequate appreciation of Colombetti and Torrance’s 2009 suggestion that participatory sense-making necessarily implies shared responsibility for interactional outcomes. We argue that the enactive approach presents open-ended cultivation of virtue as embodied, contextualized, and dynamic know-how and destabilizes an individualist metaphysics. Putting this framework to work, we turn to the interactional challenges of conversations that concern differences and that involve potentially oppositional parties, offering a reading of Claudia Rankine’s Just Us. Finally, we make explicit Rankine’s normative project of mindful navigation of multiple perspectives in an interaction. We abstract three interrelated spheres of participatory intervention: location, language, and labor. These also indicate routes for empirical investigation into complex perspective-taking in dynamic interactions. (shrink)

One of humans’ distinctive cognitive abilities is that they develop an array of capacities through an enculturation process. In “Cognition as a Social Skill,” Sally points to one of the dangers associated with enculturation: ideological oppression. To conceptualize how such oppression takes root, Haslanager appeals to notions of mindshaping and social coordination, whereby people participate in oppressive social practices unthinkingly or even willingly. Arguably, an appeal to mindshaping provides a new kind of argument, grounded in philosophy of mind, which supports (...) the claims that feminist and anti-racist want to defend. However, some theorists worry that Haslanger’s account does not shed much light on how individuals could exert their agency to resist oppression. I argue that enactivist conceptions of mindshaping and habit can help us to make sense of the power of social influences and how they have the potential to both enable and undermine cognition and agency. This moves us toward increased understanding of the workings of social oppression—distinguishing between constructive and enabling forms of heteronomy, and overdetermining and pernicious modes that lead to atrophied moral cognition and a narrowing of the field of affordances. (shrink)

This paper reformulates some of the questions raised by extended mind theorists from an enactive, life/mind continuity perspective. Because of its reliance on concepts such as autopoiesis, the enactive approach has been deemed internalist and thus incompatible with the extended mind hypothesis. This paper answers this criticism by showing (1) that the relation between organism and cogniser is not one of co-extension, (2) that cognition is a relational phenomenon and thereby has no location, and (3) that the individuality of a (...) cogniser is inevitably linked with the question of its autonomy, a question ignored by the extended mind hypothesis but for which the enactive approach proposes a precise, operational, albeit non-functionalist answer. The paper raises a pespective of embedded and intersecting forms of autonomous identity generation, some of which correspond to the canonical cases discussed in the extended mind literature, but on the whole of wider generality. In addressing these issues, this paper proposes unbiased, non-species specific definitions of cognition, agency and mediation, thus filling in gaps in the extended mind debates that have led to paradoxical situations and a problematic over-reliance on intutions about what counts as cognitive. (shrink)

In the recent history of psychology and cognitive neuroscience, the notion of habit has been reduced to a stimulus-triggered response probability correlation. In this paper we use a computational model to present an alternative theoretical view (with some philosophical implications), where habits are seen as self-maintaining patterns of behavior that share properties in common with self-maintaining biological processes, and that inhabit a complex ecological context, including the presence and influence of other habits. Far from mechanical automatisms, this organismic and self-organizing (...) concept of habit can overcome the dominating atomistic and statistical conceptions, and the high temporal resolution effects of situatedness, embodiment and sensorimotor loops emerge as playing a more central, subtle and complex role in the organization of behavior. The model is based on a novel “iterant deformable sensorimotor medium” (IDSM), designed such that trajectories taken through sensorimotor-space increase the likelihood that in the future, similar trajectories will be taken. We couple the IDSM to sensors and motors of a simulated body and environment and show that under certain conditions, the IDSM forms self-maintaining patterns of activity that operate across the IDSM, the body, and the environment. We present various environments and the resulting habits that form in them. The model acts as an abstraction of habits at a much needed sensorimotor “meso-scale” between microscopic neuron-based models and macroscopic descriptions of behavior. Finally, we discuss how this model and extensions of it can help us understand aspects of behavioral self-organization, historicity and autonomy that remain out of the scope of contemporary representationalist frameworks. (shrink)

It is plausible to think that part of what it is to be an autonomous agent is to adequately respond to important changes in one’s circumstances. The agent who has set her own course in life, but is unable to recognize and respond appropriately when evidence arises indicating the need to reconsider and perhaps adjust her plan, lacks an important form of personal autonomy. However, this “evidence-responsiveness” aspect of autonomy has not yet been adequately analyzed. Most autonomy theorists ignore it (...) altogether and the few who have addressed it have failed to give a satisfactory account. In this paper, I first examine an evidence-responsiveness condition proposed by Arneson. I argue there that while Arneson’s condition provides a valuable framework in which to examine evidence-responsiveness, there are several crucial issues that it either fails to address at all or else fails to adequately resolve. That condition is therefore in need of further elaboration and refinement. I then examine a recent article in this journal by Blöser, Schöpf, and Willaschek which develops an account of autonomy that I argue can usefully be understood as employing and elaborating upon the general framework offered by Arneson. I argue that while the elaboration Blöser and her co-authors provide Arneson’s condition is instructive, it is inadequate in several important ways which indicate the form a more satisfactory evidence-responsiveness condition will take. I go on to develop such a condition and conclude by highlighting the advantages to be gained by including that condition in a complete theory of autonomy. (shrink)

_ Source: _Page Count 22 Analysis of the concept of habit has been relatively neglected in the contemporary analytic literature. This paper is an attempt to rectify this lack. The strategy begins with a description of some paradigm cases of habit which are used to derive five features as the basis for an explicative definition. It is argued that habits are social, acquired through repetition, enduring, environmentally activated, and automatic. The enduring nature of habits is captured by their being dispositions (...) of a certain sort. This is a realist account of habits insofar as the dispositions put forward must fit into some recognizable underlying system – in the case of humans a biological system – to fill the role as set out by the definition. This role is wide-ranging; in addition to the familiar cases of habitual behavior, habitual activities also include thinking, perceiving, feeling, and willing. (shrink)

In this paper, we start exploring the affective and ethical dimension of what De Jaegher and Di Paolo (Phenomenology and the Cognitive Sciences, 6:485–507, 2007 ) have called ‘participatory sense-making’. In the first part, we distinguish various ways in which we are, and feel, affectively inter-connected in interpersonal encounters. In the second part, we discuss the ethical character of this affective inter-connectedness, as well as the implications that taking an ‘inter-(en)active approach’ has for ethical theory itself.

1. Imagine the following hypothetical scenario: Sarah is often called an expert on depression: after all, she graduated from medical school and has a PhD in neuroscience. She knows all theories of...

Affordances are possibilities for action offered by the environment. Recent research on affordances holds that there are differences in how people experience such possibilities for action. However, these differences have not been properly investigated. In this paper I start by briefly scrutinizing the existing literature on this issue, and then argue for two claims. First, that whether an affordance solicits action or not depends on its relevance to the agent’s concerns. Second, that the experiential character of how an affordance solicits (...) action depends on the character of the concern to which it is relevant. Concerns are conceived of as bodily forms of responsiveness, and solicitations are experienced through this responsiveness. The main aim of this paper is to make clear that an understanding of experiential differences in solicitations has to be based on a phenomenological appreciation of how one experiences one’s responsiveness to those solicitations. In the remainder of the paper I show how such a phenomenological appreciation reveals several characteristics of our responsiveness and I briefly explore three of them: valence, force and mineness. In the final section I discuss the self-referentiality of affordances in light of the current proposal, and argue that this self-referentiality is broader than is typically acknowledged. (shrink)

Despite the growing interest and supporting evidence for person-centered care, there is still a fundamental disagreement about what makes healthcare person-centered. In this article, we define PCC as operating with three fundamental conditions: personal, participatory and holistic. To further understand these concepts, we develop a framework based on the theory of affordances, which we apply to the healthcare case of rehabilitation and a concrete experiment on social interactions between persons with cerebral palsy and physio- and occupational therapists. Based on the (...) application of the theory, we argue that in order for healthcare to be considered as PCC, professionals need to adopt a personalistic attitude in their care, defined in terms of mutual affordances: how the professional and the person of care acknowledges each other as a person in an interaction. In opposition, we define the functionalistic attitude in terms of object affordances, those related to a concrete goal. We show that PCC requires a balance of personalistic and functionalistic attitudes, since this contributes to a participatory and holistic conception of, and interaction with, the person of care. (shrink)

This paper explores why ethical issues associated with mental illness have been generally neglected in the literature and texts of the discipline of bioethics. I argue that the reasons for this are both philosophical and structural, involving the philosophical framework of principlism in bioethics, in particular the privileging of the principle of autonomy, and the institutional location and disciplinary boundaries of bioethics as a profession. Other contributing factors include developments outside of bioethics, in medicine and law and in the delivery (...) patterns and funding sources of mental health services, and above all the pervasive stigma that attaches to mental illness. My goal is to show both how the attention bioethics could bring would benefit this neglected area of health care, and why attending to the issues surrounding mental illness would benefit bioethics in meeting its professional obligations as the public voice on matters of ethical significance in health care. (shrink)

_ Source: _Page Count 22 Analysis of the concept of habit has been relatively neglected in the contemporary analytic literature. This paper is an attempt to rectify this lack. The strategy begins with a description of some paradigm cases of habit which are used to derive five features as the basis for an explicative definition. It is argued that habits are social, acquired through repetition, enduring, environmentally activated, and automatic. The enduring nature of habits is captured by their being dispositions (...) of a certain sort. This is a realist account of habits insofar as the dispositions put forward must fit into some recognizable underlying system – in the case of humans a biological system – to fill the role as set out by the definition. This role is wide-ranging; in addition to the familiar cases of habitual behavior, habitual activities also include thinking, perceiving, feeling, and willing. (shrink)

In this article we elaborate on the concept of mature care, in which reciprocity is crucial. Emphasizing reciprocity challenges other comprehensions where care is understood as a one-sided activity, with either the carer or the cared for considered the main source of knowledge and sole motivation for caring. We aim to demonstrate the concept of mature care’s advantages with regard to conceptualizing the practice of care, such as in nursing. First, we present and discuss the concept of mature care, then (...) we apply the concept to two real life cases taken from the field of acute psychiatry. In the first example we demonstrate how mature care can grasp tacit reciprocal aspects in caring. In the other, we elucidate a difficulty related to the concept, namely the lack of reciprocity and interaction that affects some relationships. (shrink)

BackgroundPsychiatric staff members have the power to decide the options that frame encounters with patients. Intentional as well as unintentional framing can have a crucial impact on patients’ opportunities to be heard and participate in the process. We identified three dominant ethical perspectives in the normative medical ethics literature concerning how doctors and other staff members should frame interactions in relation to patients; paternalism, autonomy and reciprocity. The aim of this study was to describe and analyse statements describing real work (...) situations and ethical reflections made by staff members in relation to three central perspectives in medical ethics; paternalism, autonomy and reciprocity.MethodsAll staff members involved with patients in seven adult psychiatric and six child and adolescent psychiatric clinics were given the opportunity to freely describe ethical considerations in their work by keeping an ethical diary over the course of one week and 173 persons handed in their diaries. Qualitative theory-guided content analysis was used to provide a description of staff encounters with patients and in what way these encounters were consistent with, or contrary to, the three perspectives.ResultsThe majority of the statements could be attributed to the perspective of paternalism and several to autonomy. Only a few statements could be attributed to reciprocity, most of which concerned staff members acting contrary to the perspective. The result is presented as three perspectives containing eight values.•Paternalism; 1) promoting and restoring the health of the patient, 2) providing good care and 3) assuming responsibility.•Autonomy; 1) respecting the patient’s right to self-determination and information, 2) respecting the patient’s integrity and 3) protecting human rights.•Reciprocity; 1) involving patients in the planning and implementation of their care and 2) building trust between staff and patients.ConclusionsPaternalism clearly appeared to be the dominant perspective among the participants, but there was also awareness of patients’ right to autonomy. Despite a normative trend towards reciprocity in psychiatry throughout the Western world, identifying it proved difficult in this study. This should be borne in mind by clinics when considering the need for ethical education, training and supervision. (shrink)

Abstract.The United Kingdom Department of Health initiative on “The Expert Patient” (2001) reflects recent trends in political philosophy, ethics and health services research. The overall objective of the initiative is to encourage patients, particularly those suffering from chronic conditions to become more actively involved in decisions concerning their treatment. In doing so there would be (perhaps) an expectation of better patient compliance and (arguably) a resultant improvement in quality of life. Despite these anticipated beneficial influences on health outcomes, there may (...) be a danger that such initiatives are being carried along by the general swell of enthusiasm for recognising and facilitating the claims of disadvantaged or discriminated against groups. What more attractive than that patients should be “liberated” from what might be seen as the oppression of medical paternalism? To a great extent the potential for success of the Expert Patient venture turns on:(a) whether and to what extent a patient can be considered truly to be an expert and (b) full acceptance by the medical and heath care professions of allowing patients a more equitable and positive role.Whilst clearly the patient is an expert in the hermeneutic sense – it is they and they alone who experience their illness – there is nevertheless a risk of confusing experience with expertise. Experience limited to an individual does not of itself give rise to the generalisations that underlie reliable clinical treatment. Neither do the vast majority of patients possess the physiological and pharmacological knowledge to fully appreciate the biological nature of their illness nor the basis, risks or limitations of therapeutic measures. Might the notion of “The Expert Patient” as informed co-decision maker become a well-meaning but rather vacuous aspiration similar to that of informed consent? Even worse, could patient “empowerment” have a deleterious effect? The paper reviews some of the major issues and concludes that the expert patient initiative could have benefits for both patients and health professionals if operated on the basis of concordance: an informed collaborative alliance that optimises the potential benefits of medical care. (shrink)