While there seems to be much evidence that perceptual states can occur without being conscious, some theorists recently express scepticism about unconscious perception. We explore here two kinds of such scepticism: Megan Peters and Hakwan Lau's experimental work regarding the well-known problem of the criterion -- which seems to show that many purported instances of unconscious perception go unreported but are weakly conscious -- and Ian Phillips' theoretical consideration, which he calls the 'problem of attribution' -- the worry that many (...) purported examples of unconscious perception are not perceptual, but rather merely informational and subpersonal. We argue that these concerns do not undermine the evidence for unconscious perception and that this sceptical approach results in a dilemma for the sceptic, who must either deny that there is unconscious mentality generally or explain why perceptual states are unique in the mind such that they cannot occur unconsciously. Both options, we argue, are problematic. (shrink)

According to what Birch (2022) calls the theory-heavy approach to investigating nonhuman-animal consciousness, we select one of the well-developed theories of consciousness currently debated within contemporary cognitive science and investigate whether animals exhibit the neural structures or cognitive abilities posited by that theory as sufficient for consciousness. Birch argues, however, that this approach is in general problematic because it faces what he dubs the dilemma of demandingness—roughly, that we cannot use theories that are based on the human case to assess (...) consciousness in nonhuman animals and vice versa. We argue here that, though this dilemma may problematize the application of many current accounts of consciousness to nonhuman animals, it does not challenge the use of standard versions of the higher-order thought theory (“HOTT”) of consciousness, according to which a creature is in a conscious mental state just in case it is aware of being in that state via a suitable higher-order thought (“HOT”). We show this in two ways. First, we argue that, unlike many extant theories of consciousness, HOTT is typically motivated by a commonsense, and more importantly, neutral condition on consciousness that applies to humans and animals alike. Second, we offer new empirical and theoretical reasons to think that many nonhuman animals possess the relevant HOTs necessary for consciousness. Considering these issues not only reveals the explanatory power of HOTT and some of its advantages over rival accounts, but also enables us to further extend and clarify the theory. (shrink)

It is often assumed that perceptual experience provides evidence about the external world. But much perception can occur unconsciously, as in cases of masked priming or blindsight. Does unconscious perception provide evidence as well? Many theorists maintain that it cannot, holding that perceptual experience provides evidence in virtue of its conscious character. Against such views, I challenge here both the necessity and, perhaps more controversially, the sufficiency of consciousness for perception to provide evidence about the external world. In addition to (...) motivating and defending the idea that unconscious perception can and does often provide evidence, I observe that whether or not perceptual phenomenology is relevant to the evidentiary status of perception depends on the nature of consciousness. And I argue that a well-supported theory of consciousness—higher-order thought theory—invites a striking conclusion: that perceptual phenomenology is not on its own sufficient to provide for evidence of the external world. (shrink)

Perceptual experiences justify beliefs. A perceptual experience of a dog justifies the belief that there is a dog present. But there is much evidence that perceptual states can occur without being conscious, as in experiments involving masked priming. Do unconscious perceptual states provide justification as well? The answer depends on one’s theory of justification. While most varieties of externalism seem compatible with unconscious perceptual justification, several theories have recently afforded to consciousness a special role in perceptual justification. We argue that (...) such views face a dilemma: either consciousness should be understood in functionalist terms, in which case our best current theories of consciousness do not seem to imbue consciousness with any special epistemic features, or it should not, in which case it is mysterious why only conscious states are justificatory. We conclude that unconscious perceptual justification is quite plausible. (shrink)

Distinguishes two senses of 'judgment' on the one hand as meaning a state of 'conviction' or 'belief', and on the other hand as meaning an act of 'affirmation' or 'assertion'. Certainly conviction and assertion stand in close relation to each other, but they delineate two heterogeneous logical spheres, and thereby divide the total field of the theory of judgment into two neighbouring but separate sub-fields. Once this is done it is shown to have implications for our understanding especially of the (...) phenomenon of negation, and of the distinction between negation as affirmation of a negative state of affairs, and negation as act of contradicting the judgment someone else has made. (shrink)

Relationalism holds that perceptual experiences are relations between subjects and perceived objects. But much evidence suggests that perceptual states can be unconscious. We argue here that unconscious perception raises difficulties for relationalism. Relationalists would seem to have three options. First, they may deny that there is unconscious perception or question whether we have sufficient evidence to posit it. Second, they may allow for unconscious perception but deny that the relationalist analysis applies to it. Third, they may offer a relationalist explanation (...) of unconscious perception. We argue that each of these strategies is questionable. (shrink)

According to Rosenthal's higher-order thought (HOT) theory of consciousness, one is in a conscious mental state if and only if one is aware of oneself as being in that state via a suitable HOT. Several critics have argued that the possibility of so-called targetless HOTs—that is, HOTs that represent one as being in a state that does not exist—undermines the theory. Recently, Wilberg (2010) has argued that HOT theory can offer a straightforward account of such cases: since consciousness is a (...) property of mental state tokens, and since there are no states to exhibit consciousness, one is not in conscious states in virtue of targetless HOTs. In this paper, I argue that Wilberg's account is problematic and that Rosenthal's version of HOT theory, according to which a suitable HOT is both necessary and sufficient for consciousness, is to be preferred to Wilberg's account. I then argue that Rosenthal's account can comfortably accommodate targetless HOTs because consciousness is best understood as a property of individuals, not a property of states. (shrink)

BACKGROUND: Little is known about how hospitalized patients share decisions with physicians. METHODS: We conducted an observational study of patient-doctor communication on an inpatient medicine service among 18 hospitalized patients and 9 physicians. A research assistant (RA) approached newly hospitalized patients and their physicians before morning rounds and obtained consent. The RA audio recorded morning rounds, and then separately interviewed both patient and physician. Coding was done using integrated analysis. RESULTS: Most patients were white (61%) and half were female. Most (...) physicians were male (66%) and of Southeast Asian descent (66%). All physicians explained the plan of care to the patients; most believed that their patient understood. However, many patients did not. Physicians rarely asked the patient for their opinion. In all those cases, the decision had been made previously by the doctors. No decisions were made with the patient. Patients sometimes disagreed. CONCLUSIONS: Shared decision-making may not be the norm in hospital care. Although physicians do explain treatment plans, many hospitalized patients do not understand enough to share in decisions. When patients do assert their opinion, it can result in conflict. PRACTICE IMPLICATIONS: Some hospitalized patients are interested in discussing treatment. Improving hospital communication can foster patient autonomy. (shrink)

I offer here a new hypothesis about the nature of implicit attitudes. Psy- chologists and philosophers alike often distinguish implicit from explicit attitudes by maintaining that we are aware of the latter, but not aware of the former. Recent experimental evidence, however, seems to challenge this account. It would seem, for example, that participants are frequently quite adept at predicting their own perfor- mances on measures of implicit attitudes. I propose here that most theorists in this area have nonetheless overlooked (...) a commonsense distinction regarding how we can be aware of attitudes, a difference that fundamentally distinguishes implicit and explicit attitudes. Along the way, I discuss the implications that this distinction may hold for future debates about and experimental investigations into the nature of implicit attitudes. (shrink)

I discuss here the nature of nonconscious mental states and the ways in which they may differ from their conscious counterparts. I first survey reasons to think that mental states can and often do occur without being conscious. Then, insofar as the nature of nonconscious mentality depends on how we understand the nature of consciousness, I review some of the major theories of consciousness and explore what restrictions they may place on the kinds of states that can occur nonconsciously. I (...) close with a discussion of what makes a state mental, if consciousness is not the mark of the mental. (shrink)

Many have claimed that epistemic rationality sometimes requires us to have imprecise credal states (i.e. credal states representable only by sets of credence functions) rather than precise ones (i.e. credal states representable by single credence functions). Some writers have recently argued that this claim conflicts with accuracy-centered epistemology, i.e., the project of justifying epistemic norms by appealing solely to the overall accuracy of the doxastic states they recommend. But these arguments are far from decisive. In this essay, we prove some (...) new results, which show that there is little hope for reconciling the rationality of credal imprecision with accuracy-centered epistemology. (shrink)

Many theorists maintain that perceptual experience exhibits the what is often called the phenomenology of particularity: that in perceptual experience it phenomenally seems that there are particular things. Some urge that this phenomenology demands special accounts of perception on which particulars somehow constitute perceptual experience, including versions of relationalism, on which perception is a relation between perceivers and particular perceived objects, or complex forms of representationalism, on which perception exhibits demonstrative or special particular-involving types of content. I argue here that (...) no such account required. I develop and defend a novel account of such phenomenology, grounded in the higher-order theory of consciousness. In short, this view holds that the phenomenology of particularity arises because suitable higher-order states make it appear to one that one is in perceptual relations to particulars, even if perception is not in any way constituted by particulars. I argue that this account has many advantages and avoids problems that other theories of such phenomenology face. (shrink)

The last decade has witnessed the beginnings of a remarkable convergence of Husserlian phenonenology and analytic philosophy of language, and the present volumes provide original and important texts of the phenomenological philosophy of language. Powerfully influenced by the writings of the early Husserl, Reinach fashioned Husserl’s ideas into a rigorous analytical methodology of his own, which he applied in particular to problems in logic and the theory of knowledge, and to the philosophies of law and psychology. The central role of (...) the concept of state of affairs in Reinach’s philosophy will bring to mind immediately the formal ontology of Wittgenstein’s Tractatus. Reinach’s most significant contribution, however, is contained in his The a priori foundations of civil law (1913), above all in the detailed analysis of the a priori structure of the act of promising. This amounts to an elaborate phenomenological theory of speech acts which anticipates, and in some respects goes beyond, the later theories of Austin and Searle. The present edition is in two volumes. Volume 1, which includes a biographical and thematic introduction by the editors, contains critical editions of those pieces published by Reinach himself. Volume II is a collection of all those items in Reinach’s surviving Nachlass which are in publishable form, including a number of important pieces not hitherto obtainable on such themes as ethical predicates, speech acts (“soziale Akte”), perception and the theory of number, together with a comprehensive sketch of the problems in the theory of knowledge, logic and ethics. Appended to this is a text-critical apparatus which also contains extensive discussions of the origins and sources of the materials in question. (shrink)

According to a traditional view, perceptual experiences are composites of distinct sensory and cognitive components. This dual-component theory has many benefits; in particular, it purports to offer a way forward in the debate over what kinds of properties perceptual experiences represent. On this kind of view, the issue reduces to the questions of what the sensory and cognitive components respectively represent. Here, I focus on the former topic. I propose a theory of the contents of the sensory aspects of perceptual (...) experience that provides clear criteria for identifying what kinds of properties they represent. (shrink)

Virtue-based moral cognitivism holds that at least some of the value of some art consists in conveying knowledge about the nature of virtue and vice. We explore here a challenge to this view, which extends the so-called situationist challenge to virtue ethics. Evidence from social psychology indicates that individuals’ behavior is often susceptible to trivial and normatively irrelevant situational influences. This evidence not only challenges approaches to ethics that emphasize the role of virtue but also undermines versions of moral cognitivism, (...) because the value of art cannot consist in teaching us about traits that do not exist. We thus recommend a new account of the cognitive value of art: art teaches how context and character interact to produce action. (shrink)

Regional aspects of science communication represent a potential asset and as such are quite suitable topic for further examination with respect to future social and economic development in Prague based on the city's main development strategies. Closer analysis of SCIP aspects at re- gional level can present a suitable complement for development of suitable measures and projects of the regional innovation and education policies. This study focuses on research questions related to regional dimension of science communication, its impacts and suitable (...) tools. Document analysis and questionnaire distributed among selected experts were chosen as tools for elaboration of the study. Results suggest that regional dimension of science communication policy and initiatives is a relevant one in case of Prague. However, the attention given to this topic by national and regional authorities is unsatisfactory resulting in lack of co-ordination of activities of the respective stakeholders. Impacts of SCIP, as far as causality can be identified, lie in encouraging young people in their interest in science, increasing awareness of general public in science-related issues and explaining role of science in society and problems that science is facing. To maximise effects of science communication there is a space for national and regional authorities to play an integrating role. Given the concentration of SCIP actors, the City of Prague could aspire to develop its science communication policy in order to promote itself as a Central European centre of science. (shrink)

I motivate and defend a previously underdeveloped functionalist account of the metaphysics of color, a view that I call ‘quality-space functionalism’ about color. Although other theorists have proposed varieties of color functionalism, this view differs from such accounts insofar as it identifies and individuates colors by their relative locations within a particular kind of so-called ‘quality space’ that reflects creatures’ capacities to discriminate visually among stimuli. My arguments for this view of color are abductive: I propose that quality-space functionalism best (...) captures our commonsense conception of color, fits with many experimental findings, coheres with the phenomenology of color experience, and avoids many issues for standard theories of color such as color physicalism and color relationalism. (shrink)

Representationalism holds that a perceptual experience's qualitative character is identical with certain of its representational properties. To date, most representationalists endorse atomistic theories of perceptual content, according to which an experience's content, and thus character, does not depend on its relations to other experiences. David Rosenthal, by contrast, proposes a view that is naturally construed as a version of representationalism on which experiences’ relations to one another determine their contents and characters. I offer here a new defense of this holistic (...) representationalism, arguing that some objections to atomistic views are best interpreted as supporting it. (shrink)

David Rosenthal explains conscious mentality in terms of two independent, though complementary, theories—the higher-order thought (“HOT”) theory of consciousness and quality-space theory (“QST”) about mental qualities. It is natural to understand this combination of views as constituting a kind of representationalism about experience—that is, a version of the view that an experience’s conscious character is identical with certain of its representational properties. At times, however, Rosenthal seems to resist this characterization of his view. We explore here whether and to what (...) extent it makes sense to construe Rosenthal’s views as representationalist. Our goal is not merely terminological—discerning how best to use the expression ‘representationalism’. Rather, we argue that understanding Rosenthal’s account as a kind of representationalism permits us not only to make sense of broader debates within the philosophy of mind, but also to extend and clarify aspects of the view itself. (shrink)

Mandik (2012)understands color-consciousness conceptualism to be the view that one deploys in a conscious qualitative state concepts for every color consciously discriminated by that state. Some argue that the experimental evidence that we can consciously discriminate barely distinct hues that are presented together but cannot do so when those hues are presented in short succession suggests that we can consciously discriminate colors that we do not conceptualize. Mandik maintains, however, that this evidence is consistent with our deploying a variety of (...) nondemonstrative concepts for those colors and so does not pose a threat to conceptualism. But even if Mandik has shown that we deploy such concepts in these experimental conditions, there are cases of conscious states that discriminate colors but do not involve concepts of those colors. Mandik’s arguments sustain only a theory in the vicinity of conceptualism: The view that we possess concepts for every color we can discriminate consciously, but need not deploy those concepts in every conscious act of color discrimination. (shrink)

In his paper “There It Is” and his précis “There It Was,” Benj Hellie develops a sophisticated semantics for perceptual justification according to which perceptions in good cases can be explained by intentional psychology and can justify beliefs, whereas bad cases of perception are defective and so cannot justify beliefs. Importantly, Hellie also affords consciousness a central role in rationality insofar as only those good cases of perception within consciousness can play a justificatory function. In this commentary, I reserve judgment (...) regarding Hellie’s treatment of the rational difference between good and bad cases, but I argue there can be what he views as good cases of perceptual justification outside of consciousness. (shrink)

The problem of diachronic personal identity is this: what explains why a person P1 at time T1 is numerically identical with a person P2 at a later time T2, even if they are not at those times qualitatively identical? One traditional explanation is the soul theory, according to which persons persist in virtue of their nonphysical souls. I argue here that this view faces a new and arguably insuperable dilemma: either souls, like physical bodies, change over time, in which case (...) the soul theory faces an analogue problem of diachronic soul identity, or souls, unlike physical bodies, do not change over time, in which case the soul theory cannot explain why souls relate to particular bodies over time and so at best only partially explains personal identity. I conclude that the soul theory fares no better than physicalist-friendly accounts of personal identity such as bodily- or psychological-continuity-based views. (shrink)

How to participate proactively in a process of change and transformation, to shape our path within an uncertain future? With this publication, the State Of The Art Network marks a waypost on a journey which started in 2018, when like-minded Nordic and Baltic art organisations and professionals initiated this network as a multidisciplinary collaboration facing the Anthropocene. Over five years, ten organisations and around 80 practitioners from different disciplines, like the arts, natural sciences and humanities came together, online and in (...) person, for workshops, seminars and discussions. The aim was to find ways to create resilience and concrete actions on how to live through the change in culture, economy and the environment and to find concrete, hands-on methods to deal with the Anthropocene and the environmental crisis. As an outcome of this process, this publication takes a closer look at how we as practising artists, researchers and cultural actors can create elements for critical thinking and doing which can assist us in navigating the complexities of the present. -/- Edited for the State Of The Art Network by Erich Berger, Mari Keski-Korsu, Marietta Radomska and Line Thastum. -/- Produced and published by Bioart Society 2023. (shrink)

Consciousness is central to our lived experience. It is unsurprising, then, that the topic has captivated many students, neuroscientists, philosophers, and other theorists working in cognitive science. But consciousness may seem especially difficult to explain. This is in part because the term “consciousness” has been used in many different ways. The goal of this chapter is to explore several kinds of consciousness: what theorists have called “creature,” “phenomenal,” “access,” “state,” “transitive,” “introspective,” and “self” consciousness. The basic distinctions among these kinds (...) of consciousness are described in Section 1. Section 2 raises potential challenges for explaining these varieties of consciousness and describes a few current theories of them. Section 3 closes the chapter by exploring directions for future work in the cognitive science of consciousness. Along the way, some of the possible interrelationships among these kinds of consciousness are discussed. (shrink)

An estimated 700,000 people in the United States have "long COVID," that is, symptoms of COVID-19 persisting beyond three weeks. COVID-19 and its long-term sequelae are strongly influenced by social determinants such as poverty and by structural inequalities such as racism and discrimination. Primary care providers are in a unique position to provide and coordinate care for vulnerable patients with long COVID. Policy measures should include strengthening primary care, optimizing data quality, and addressing the multiple nested domains of inequity.

One of the best-known principles of halakha is that Shabbat is violated to save a life. Who does this saving and how do we know that a life is in danger? What categories of illness violate Shabbat and who decides? A historical-sociological analysis of the roles played by Jew, non-Jew, and physician according to the approach of “medical cosmology” can help us understand the differences in the approach of the Shulchan Aruch compared to later decisors (e.g., the Mishnah Berurah). Such (...) differences illuminate how premodern medical triage coexisted with a different halakhic understanding than that of the biomedical age. (shrink)

One of the most promising theories of consciousness currently available is higher-order thought (“HOT”) theory, according to which consciousness consists in having suitable HOTs regarding one’s mental life. But critiques of HOT theory abound. We explore here three recent objections to the theory, which we argue at bottom founder for the same reason. While many theorists today assume that consciousness is a feature of the actually existing mental states in virtue of which one has experiences, this assumption is in tension (...) with the underlying motivations for HOT theory and arguably false. We urge that these objections, though sophisticated, trade on this questionable conception of consciousness, thereby begging the question against HOT theory. We then explain how HOT theory might instead understand consciousness. (shrink)

According to David Rosenthal’s higher-order thought (HOT) theory of consciousness, a mental state is conscious just in case one is aware of being in that state via a suitable HOT. Jesse Mulder (2016) recently objects: though HOT theory holds that conscious states are states that it seems to one that one is in, the view seems unable to explain how HOTs engender such seemings. I clarify here how HOT theory can adequately explain the relevant mental appearances, illustrating the explanatory power (...) of HOT theory. (shrink)

Kants Musikästhetik wird weithin unterschätzt. Dabei bietet sie die entscheidenden Ansätze zur Befreiung der Musik aus den Fängen der Nachahmungsästhetik, wie sie vor allem E.T.A.Hoffman kongenial umgesetzt hat.

While epistemic democrats have claimed that majority rule recruits the wisdom of the crowd to identify correct answers to political problems, the conjecture remains abstract. This article illustrates how majority rule leverages the epistemic capacity of the electorate to practically enhance the instrumental value of elections. To do so, we identify a set of sufficient conditions that effect such a majority rule mechanism, even when the decision in question is multidimensional. We then look to the case of sociotropic economic voting (...) in US presidential elections to provide empirical tractability for these conditions. We find that absent such an epistemic capacity a number of presidential elections might well have been decided differently. By generating clear conditions for the plausibility of claims made by epistemic democrats, and demonstrating their correspondence to empirical data, this article strengthens the broader instrumental grounds recommending democracy. (shrink)

A fun piece discussing the challenges to and prospects of building machines that are able to produce and understand natural language.

Agent-based models have played a prominent role in recent debates about the merits of democracy. In particular, the formal model of Lu Hong and Scott Page and the associated “diversity trumps ability” result has typically been seen to support the epistemic virtues of democracy over epistocracy (i.e., governance by experts). In this paper we first identify the modeling choices embodied in the original formal model and then critique the application of the Hong-Page results to philosophical debates on the relative merits (...) of democracy. In particular we argue that the “best-performing agents” in Hong-Page model should not be interpreted as experts. We next explore a closely related model in which best-performing agents are more plausibly seen as experts and show that the diversity trumps ability result fails to hold. However, with changes in other parameters (such as the deliberation dynamic) the diversity trumps ability result is restored. The sensitivity of this result to parameter choices illustrates the complexity of the link between formal modeling and more general philosophical claims; we use this debate as a platform for a more general discussion of when and how agent-based models can contribute to philosophical discussions. (shrink)

Some theorists have recently raised doubts about much of the experimental evidence purporting to demonstrate the existence of unconscious perception. In our (2019) in this journal, we argued some of these considerations are not decisive. Phillips (forthcoming a) replies thoughtfully to our paper, concluding that he is unconvinced by our arguments. Phillips maintains that the view that perception is invariably conscious remains, as he puts it, the “default” hypothesis both within the folk understanding and experimental study of perception. There is (...) much to agree with in Phillips’ piece, but there remain some substantive points of disagreement, which we outline here. (shrink)

Patient centred diagnosis is best practised through shared decision making; an iterative dialogue between doctor and patient, whichrespects a patient’s needs, values, preferences, and circumstances. -/- Shared decision making for diagnostic situations differs fundamentally from that for treatment decisions. This has important implications when considering its practical application. -/- The nature of dialogue should be tailored to the specific diagnostic decision; scenarios with higher stakes or uncertainty usually require more detailed conversations.

The UN Convention against Torture defines torture as “any act by which severe pain or suffering, whether physical or mental, is intentionally inflicted on a person” by someone acting in an official capacity for purposes such as obtaining a confession or punishing or intimidating that person.1 It is unethical for healthcare professionals to participate in torture, including any use of medical knowledge or skill to facilitate torture or allow it to continue, or to be present during torture.2-7 Yet medical participation (...) in torture has taken place throughout the world and was a prominent feature of the US interrogation practice in military and Central Intelligence Agency (CIA) detention facilities in the years after the attacks of 11 September 2001.8-11 Little attention has been paid, however, to how a regime of torture affects the ability of health professionals to meet their obligations regarding routine clinical care for detainees. -/- The 2016 release of previously classified portions of guideline from the CIA regarding medical practice in its secret detention facilities sheds light on that question. These show that the CIA instructed healthcare professions to subordinate their fundamental ethical obligations regarding professional standards of care to further the objectives of the torturers. (shrink)

In contemporary bioethics, the autonomy of the patient has assumed considerable importance. Progressing from a more limited notion of informed consent, shared decision making calls upon patients to voice the desires and preferences of their authentic self, engaging in choice among alternatives as a way to exercise deeply held values. One influential opinion in Jewish bioethics holds that Jewish law, in contradistinction to secular bioethics, limits the patient's exercise of autonomy only in those instances in which treatment choices are sensitive (...) to preferences. Here, we analyze a discussion in the Mishna, a foundational text of rabbinic Judaism, regarding patient autonomy in the setting of religiously mandated fasting, and commentaries in the Babylonian and Palestinian Talmuds, finding both a more expansive notion of such autonomy and a potential metaphysical grounding for it in the importance of patient self-knowledge. (shrink)

Although phenomenal consciousness strikes many as quite mysterious, many think that it must also be quite significant. Some have urged, for example, that consciousness is the ground of moral value...

Working memory, an important posit in cognitive science, allows one to temporarily store and manipulate information in the service of ongoing tasks. Working memory has been traditionally classified as an explicit memory system – that is, as operating on and maintaining only consciously perceived information. Recently, however, several studies have questioned this assumption, purporting to provide evidence for unconscious working memory. In this paper, we focus on visual working memory and critically examine these studies as well as studies of unconscious (...) perception that seem to provide indirect evidence for unconscious working memory. Our analysis indicates that current evidence does not support an unconscious working memory store, though we offer independent reasons to think that working memory may operate on unconsciously perceived information. (shrink)

In a rigorous systematic review, Dukhanin and colleagues categorize metrics and evaluative tools of the engagement of patient, public, consumer, and community in decision-making in healthcare institutions and systems. The review itself is ably done and the categorizations lead to a useful understanding of the necessary elements of engagement, and a suite of measures relevant to implementing engagement in systems. Nevertheless, the question remains whether the engagement of patient representatives in institutional or systemic deliberations will lead to improved clinical outcomes (...) or increased engagement of individual patients themselves in care. Attention to the conceptual foundations of patient engagement would help make this systematic review relevant to the clinical care of patients. (shrink)

We discuss the role of prior authorization (PA) in supporting patient-centered care (PCC) by directing health system resources and thus the ability to better meet the needs of individual patients. We begin with an account of PCC as a standard that should be aimed for in patient care. In order to achieve widespread PCC, appropriate resource management is essential in a healthcare system. This brings us to PA, and we present an idealized view of PA in order to argue how (...) at its best, it can contribute to the provision of PCC. PA is a means of cost saving and as such it has mixed success. The example of the US demonstrates how implementation of PA has increased health inequalities whereas best practice has the potential to reduce them. In contrast, systems of universal coverage, like those in Europe, may use the cost savings of PA to better address individuals' care and PCC. The conclusion we offer therefore is an optimistic one, pointing towards areas of supportive overlap between PCC and PA where usually the incongruities are most evident. (shrink)

Public discussions of political and social issues are often characterized by deep and persistent polarization. In social psychology, it’s standard to treat belief polarization as the product of epistemic irrationality. In contrast, we argue that the persistent disagreement that grounds political and social polarization can be produced by epistemically rational agents, when those agents have limited cognitive resources. Using an agent-based model of group deliberation, we show that groups of deliberating agents using coherence-based strategies for managing their limited resources tend (...) to polarize into different subgroups. We argue that using that strategy is epistemically rational for limited agents. So even though group polarization looks like it must be the product of human irrationality, polarization can be the result of fully rational deliberation with natural human limitations. (shrink)

The Repugnant Conclusion served an important purpose in catalyzing and inspiring the pioneering stage of population ethics research. We believe, however, that the Repugnant Conclusion now receives too much focus. Avoiding the Repugnant Conclusion should no longer be the central goal driving population ethics research, despite its importance to the fundamental accomplishments of the existing literature.