Patients requesting and receiving euthanasia for psychiatric disorders in the Netherlands.

BACKGROUND: Euthanasia and assisted suicide (EAS) for patients with psychiatric disorders occupies a prominent place in the public debate, but little is known about the psychiatric patients requesting and receiving EAS. OBJECTIVE: To compare the social demographic and psychiatric profile of the patients who make a request for EAS and those who receive it. METHOD: We carried out a review of records from 1122 patients with psychiatric disorders who have filed a potentially eligible request for EAS at Expertise Centrum for Euthanasia (EE) in the period 2012-2018. FINDINGS: The majority of the patients requesting EAS were single females, living independently with a comorbid diagnosis of depression with a history of undergoing psychiatric treatment for more than 10 years. From the small number of patients who went on to receive EAS in our sample, the majority were also single women, with a diagnosis of depressive disorder. A small subgroup of patients whose diagnoses included somatic disorders, anxiety disorders, obsessive-compulsive disorders and neurocognitive disorders were over-represented in the group of patients receiving EAS compared with the applicant group. CONCLUSION: The average demographic and psychiatric profile of patients requesting and receiving EAS were found to be broadly similar. The majority of patients requesting EAS had received a comorbid diagnosis, making this a difficult-to-treat patient group. Only a small number of patients requesting had their requests granted. Patients from different diagnostic groups showed patterns in why their requests were not granted. CLINICAL IMPLICATIONS: Many of the patients who withdrew their requests for EAS benefited from being able to discuss dying with end of life experts at EE. Health professionals can make a difference to a vulnerable group of patients, if they are trained to discuss end of life.

An academic survey on theoretical foundations, common assumptions and the current state of consciousness science.

We report the results of an academic survey into the theoretical and methodological foundations, common assumptions, and the current state of the field of consciousness research. The survey consisted of 22 questions and was distributed on two different occasions of the annual meeting of the Association of the Scientific Study of Consciousness (2018 and 2019). We examined responses from 166 consciousness researchers with different backgrounds (e.g. philosophy, neuroscience, psychology, and computer science) and at various stages of their careers (e.g. junior/senior faculty and graduate/undergraduate students). The results reveal that there remains considerable discussion and debate between the surveyed researchers about the definition of consciousness and the way it should be studied. To highlight a few observations, a majority of respondents believe that machines could have consciousness, that consciousness is a gradual phenomenon in the animal kingdom, and that unconscious processing is extensive, encompassing both low-level and high-level cognitive functions. Further, we show which theories of consciousness are currently considered most promising by respondents and how supposedly different theories cluster together, which dependent measures are considered best to index the presence or absence of consciousness, and which neural measures are thought to be the most likely signatures of consciousness. These findings provide us with a snapshot of the current views of researchers in the field and may therefore help prioritize research and theoretical approaches to foster progress.

Reconceiving representation-hungry cognition: an ecological-enactive proposal.

Enactive approaches to cognitive science aim to explain human cognitive processes across the board without making any appeal to internal, content-carrying representational states. A challenge to such a research programme in cognitive science that immediately arises is how to explain cognition in so-called 'representation-hungry' domains. Examples of representation-hungry domains include imagination, memory, planning and language use in which the agent is engaged in thinking about something that may be absent, possible or abstract. The challenge is to explain how someone could think about things that are not concretely present in their environment other than by means of an internal mental representation. We call this the 'Representation-Hungry Challenge' (RHC). The challenge we take up in this article is to show how hunger for representations could possibly be satisfied by means other than the construction and manipulation of internal representational states. We meet this challenge by developing a theoretical framework that integrates key ideas drawn from enactive cognitive science and ecological psychology. One of our main aims is thus to show how ecological and enactive theories as non-representational and non-computational approaches to cognitive science might work together. From enactive cognitive science, we borrow the thesis of the strict continuity of lower and higher cognition. We develop this thesis to argue against any sharp conceptual distinction between higher and lower cognition based on representation-hunger. From ecological psychology, we draw upon our earlier work on the rich landscape of affordances. We propose thinking of so-called representation-hungry cognition in terms of temporally extended activities in which the agent skilfully coordinates to a richly structured landscape of affordances. In our framework, putative cases of representation-hungry cognition are explained by abilities to coordinate nested activities to an environment structured by interrelated socio-material practices. The RHC has often figured in arguments for the limitations of non-representational approaches to cognitive science. We showcase the theoretical resources available to an integrated ecological-enactive approach for addressing this type of sceptical challenge.