The enactive naturalization of normativity: from self-maintenance to situated interactions.

The autopoietic enactive account of cognition explains the emergence of normativity in nature as the norm of self-maintenance of life. The autonomous nature of living agents implies that they can differentiate events and regulate their responses in terms of what is better or worse to maintain their own precarious identity. Thus, normative behavior emerges from living organisms. Under this basic understanding of normativity as self-maintenance, autopoietic enactivism defends a continuity between biological, cognitive, and social norms. The self-maintenance of an agent's sensorimotor identity establishes the cognitive norms that regulate its behavior, and the self-maintenance of its social identity determines the social norms. However, there is no clear explanation of how individuals, who by their very constitution are primarily moved to interact with the world under the norm of self-maintenance, could interact with the world driven by non-individual norms. Furthermore, understanding all normativity as self-maintenance makes it unclear how agents establish genuine social interactions and acquire habits that have no implication for their constitution as individuals. So, to face these challenges, I propose an alternative notion of normativity grounded on a Wittgensteinian, action-oriented, and pragmatic conception of meaning that distinguishes between an agent with a normative point of view and external normative criteria. I defend that a normative phenomenon is an interaction that is established by an individual point of view as defined by autopoietic enactivism and that is part of a self-maintaining system. The latter establishes the external normative criteria to evaluate the interaction, and it may or may not coincide with the identity of the interacting agent. Separating external normative criteria from the self-constitution of the interactant agent not only solves the challenge but potentially explains the situated and relational character of agency.

"It is not a scientific number it is just a feeling": Populating a multi-dimensional end-of-life decision framework using deliberative methods.

The capability approach is potentially valuable for economic evaluation at the end of life because of its conceptualization of wellbeing as freedom and the potential for capturing outcomes for those at end of life and those close to persons at the end of life. For decision making, however, this information needs to be integrated into current evaluation paradigms. This research explored weights for an integrated economic evaluation framework using a deliberative approach. Twelve focus groups were held (38 members of the public, 29 "policy makers," seven hospice volunteers); budget pie tasks were completed to generate weights. Constant comparison was used to analyze qualitative data, exploring principles behind individuals' weightings. Average weights elicited from members of the general population and policy makers for the importance that should be given to close persons (vs. patients) were very similar, at around 30%. A "sliding scale" of weights between health gain and the capability for a good death resulted from the policy maker and volunteer groups, with increasing weight given to the capability for a good death as the trajectory got closer to death. These weights can be used in developing a more comprehensive framework for economic evaluation at end of life.