To practise ‘fairly and justly’ a clinician must balance the needs of both the many and the few: the individual patient in front of them, and the many unseen patients in the waiting room, and in the county. They must consider the immediate clinical needs of those in the present, and how their actions will impact on future patients. The good medical practice guidance ‘Make the care of your patient your first concern’ provides no guidance on how doctors should act (...) when they care for multiple patients with conflicting needs. Moreover, conflicting needs extend far past simply those between different patients. At an organisational level, financial obligations must be balanced with clinical ones; the system must support those who work within it in a variety of roles; and, finally, in order for a healthcare service to be sustainable, the demands of current and future generations must be balanced.The central problem, we propose, is that there is no shared philosophical framework on which the provision of care or the development of health policy is based, nor is there a practical, fair and transparent process to ensure that the service is equipped to deal justly with new challenges as they emerge. Many philosophers have grappled with constructing a set of principles which would lead to a ‘good’ society which is just to different users; prominent among them is Rawls.Four important principles can be derived using a Rawlsian approach: equity of access, distributive justice, sustainability and openness. However, Rawls’ approach is sometimes considered too abstract to be applied readily to policymaking; it does not provide clear guidance for how individuals working within existing institutions can enact the principles of justice. We therefore combine the principles derived from Rawls with Scanlonian contractualism: by demanding that decisions are made in a way which cannot be ‘reasonably rejected’ by different stakeholders, we ensure that conflicting needs are considered robustly.We demonstrate how embedding this framework would ensure just policies and fair practice. We illustrate this by using examples of how it would help prevent injustice among different socioeconomic groups, prevent intergenerational injustice and prevent injustice in a crisis, for example, as we respond to new challenges such as COVID-19.Attempts to help individual doctors practise fairly and justly throughout their professional lives are best focused at an institutional or systemic level. We propose a practical framework: combining Scanlonian contractualism with a Rawlsian approach. Adopting this framework would equip the workforce and population to contribute to fair policymaking, and would ultimately result in a healthcare system whose practice and policies—at their core—were just. (shrink)

As many studies around the theme of ‘too much medicine’ attest, investigations are being ordered with increasing frequency; similarly the threshold for providing treatment has lowered. Our contention is that trust is a significant factor in influencing this, and that understanding the relationship between trust and investigations and treatments will help clinicians and policymakers ensure ethical decisions are more consistently made. Drawing on the philosophical literature, we investigate the nature of trust in the patient–doctor relationship, arguing that at its core (...) it involves a transfer of discretion. We show that there is substantial empirical support for the idea that more trust will reduce the problem of too much medicine. We then investigate ways in which trust can be built, concentrating on issues of questioning, of acknowledging uncertainty and of shouldering responsibility for it. We argue that offering investigations or treatments as a way of generating trust may itself be an untrustworthy way of proceeding, and that healthcare systems should provide the institutional support for facilitating continuity, questioning and the entrusting of uncertainty. (shrink)

We explore whether a Rawlsian approach might provide a guiding philosophy for the development of a healthcare system, in particular with regard to resolving tensions between different groups within it. We argue that an approach developed from some of Rawls’ principles – using his ‘veil of ignorance’ and both the ‘difference’ and ‘just savings’ principles which it generates – provides a compelling basis for policy making around certain areas of conflict. We ask what policies might be made if those making (...) them did not know if one was patient, doctor, nurse or manager – in this generation or the next. We first offer a brief summary of Rawls’ approach and how we intend to extrapolate from it. We examine how this adapted Rawlsian framework could be applied to specific examples of conflict within healthcare; we demonstrate how this framework can be used to develop a healthcare service which is both sustainable (in its training and treatment of staff, and in encouraging research and innovation) and open (to protect the powers and opportunities of those using the health service). We conclude that while Rawls’ approach has previously been rejected as a means to address specific healthcare decisions, an adapted veil of ignorance can be a useful tool for the consideration of how a just health service should be constructed and sustained. Turning the theoretical into the practical (and combining Rawls’ thought experiment with Scanlonian contractarianism), managers, doctors, patients, carers and nurses could come together and debate conflicting issues behind a hypothetical veil. (shrink)

BackgroundInternationally, patient access to notes is increasing. This has been driven by respect for patient autonomy, often recognised as a primary tenet of medical ethics: patients should be able to access their records to be fully engaged with their care. While research has been conducted on the impact of patient access to outpatient and primary care records and to patient portals, there is no such review looking at access to hospital medical records in real time, nor an ethical analysis of (...) the issues involved in such a change in process.MethodsThis study employed a systematic review framework in two stems, to integrate literature identified from two searches: Medline, CINAHL and Scopus databases were conducted, (for (1) hospitalised patients, patient access to records and its effects on communication and trust within the doctor-patient relationship; and (2) patient access to medical records and the ethical implications identified). The qualitative and quantitative results of both searches were integrated and critically analysed.Results3954 empirical and 4929 ethical studies were identified; 18 papers representing 16 studies were identified for review (12 empirical and 6 ethical). The review reveals a consensus that our current approach to giving information to patients – almost exclusively verbally – is insufficient; that patient access to notes is a welcome next step for patient-centred care, but that simply allowing full access, without explanation or summary, is also insufficient. Several ethical implications need to be considered: increased information could improve patient trust and knowledge but might transfer an (unwelcome) sense of responsibility to patients; doctors and patients have conflicting views on how much information should be shared and when; sharing written information might increase the already significant disparity in access to health care, and have unforeseen opportunity costs. The impact on medical practice of sharing notes in real time will also need to be evaluated.ConclusionsThe review presents encouraging data to support patient access to medical notes. However, sharing information is a critical part of clinical practice; changing how it is done could have significant empirical and ethical impacts; any changes should be carefully evaluated. (shrink)

Our topic here is uncertainty, especially as this arises in medicine. We are concerned with the uncertainty of diagnosis and of prognosis, and about how this should be communicated and shared between a doctor and patient. We are concerned with the idea that the doctor might rightly take responsibility for some of that uncertainty, in the sense that they may manage it when the patient is unwilling or unable to do so. And we are concerned with the implications that this (...) has for informed consent, for shared decision making, and for other normative dimensions of the doctor–patient relationship. Most centrally we argue that it is best understood, not in terms of informed consent, but in terms of informed trust. (shrink)

Both ethicists and lawyers accept that a provider – be it a researcher or a clinician – should provide sufficient information for a reasonable person to make an informed decision about whether they wish to go ahead with the proposed intervention or treatment.1 They are bound to do so both because they have an ethical responsibility to preserve the individual’s autonomous decision making, and, in many countries, because the law obliges them to. In this month’s issue of the JME, three (...) articles tackle ethical issues relating to consent in different contexts. Overarching these analyses is the pragmatic question of whether the process of taking consent in itself might alter the outcomes, and whether, in doing so, it can undermine the initial therapeutic or research goal – so creating another ethical question of what to prioritise. Psilocybin is entering Phase III trials to evaluate its effect on treatment resistant depression and cancer related depression and anxiety; earlier trials have shown sustained symptom reduction in these populations. Smith and Sisti examine whether a form of enhanced consent is ethically required for these drugs.2 They explore how to adequately consent for ‘therapeutic touch’ in a future altered state; the rare but significant mental health risks including trauma re-exposure; and the potential for a personality change given the intense experiences which many subjects have reported. They illustrate the potential for personality change with an example regarding the spiritual experiences which can occur with serotonergic psychedelics, and suggest that ‘agnostic or atheist patients may take the development of a newfound sense of spirituality or belief in God to …. (shrink)

In this issue of the Journal of Medical Ethics arguments are cogently made that sustainability and solidarity should be considered as core medical ethical principles, and that more explicit attention should be given to the complex context in which a decision is made.

Joshua Parker has made many interesting points, and we welcome the opportunity to develop the ideas of ‘Too Much Medicine, Not Enough Trust’. We will address: (i) the asymmetry between the trust that patients extend to doctors, and the trust that doctors extend to patients; (ii) our reasons for doubting that litigation or complaints reflect a betrayal of the patient–doctor relationship and (iii) the importance of institutional trust, both for the doctor and the patient.

With new technologies come new ethical challenges. Often, we can apply previously established principles, even though it may take some time to fully understand the detail of the new technology - or the questions that arise from it. The International Commission on Radiological Protection, for example, was founded in 1928 and has based its advice on balancing the radiation exposure associated with X-rays and CT scans with the diagnostic benefits of the new investigations. They have regularly updated their advice as (...) evidence has accumulated and technologies have changed,1 and have been able to extrapolate from well-established ethical principles. Other new technologies lend themselves less well to off-the-peg ethical solutions. In several articles in this edition the ethical challenges associated with the use of artificial intelligence in medicine are addressed. Although multiple ethical codes and guidelines have been written on the use and development of AI, Hagendorf noted that many of them reiterated a ‘ deontologically oriented, action-restricting ethic based on universal abidance of principles and rules’. 2 Applying pre-existing ethical frameworks to artificial intelligence is problematic for several reasons. In particular, AI has two characteristics which are very different from the current clinical practice on which traditional medical ethics are based: 1. The so called ‘black box’ of deep learning, whereby a deep neural network is trained to iteratively adapt to make …. (shrink)

Inadequate diet is the leading risk factor for morbidity and mortality worldwide. However, approaches to identifying inadequate diets in clinical practice remain inconsistent, and dietary interventions frequently focus on facilitating ‘healthy choices’, with limited emphasis on structural constraints. We examine the ethical implications of introducing a routine question in the medical history about ability to access food. Not collecting data on food security means that clinicians are unable to identify people who may benefit from support on an individual level, unable (...) to consider relevant dietary risk factors for disease and disease progression and unable to monitor population trends and inequalities in dietary access in order to design effective policy interventions. We argue that the current lack of routine screening for food insecurity is inconsistent with our approach to other health behaviours, as well as with doctors’ frequent informal role as gatekeepers to the food aid system, and recent calls for governmental action on food insecurity and health inequalities from individual clinicians and professional bodies. Potential ethical barriers to asking patients about food security are addressed, including concerns about stigma, limiting autonomy, fair resource allocation, unclear professional remits and clinicians’ ability to offer effective interventions. We suggest that there is an ethical imperative for doctors to ask patients about their ability to access healthy food. Gathering this data provides a valuable first step in re-framing the social determinants of health as modifiable risks, rather than inevitable inequities. No data are available. (shrink)

In a recent response to our paper on developing a philosophical framework to guide the design and delivery of a just health service, Sarela raises several objections. We feel that although Sarela makes points which are worthy of discussion, his critique does not undermine either the need for, or the worth of, our proposed model. First, the law does not negate the need for ethics in determining just healthcare policy. Reliance on legal processes can drive inappropriate focus on ensuring policies (...) avoid judicial review, as opposed to ensuring they are truly just; the law affords protection against unjust policies but does not put a commitment to avoiding them at the heart of policy-making. We defend the need for Scanlonian supplementation by emphasising the practical value of adding a step based on reasonable rejection, particularly in ensuring that the views of vulnerable stakeholders are robustly considered. We discuss the similarities and differences between the work of Daniels and Sen in considering the relationship between health and opportunity, concluding that Sen’s capability approach is both valuable and compatible with our proposed model. Finally, the practical use of our model requires consideration of what constitutes a reasonable person. Our model is explicitly intended to help develop a healthcare system which is just to all its users. With this in mind, we suggest that those involved in decision-making should meet Scanlon’s definition of reasonable: they should be motivated to justify their actions to, and seek agreement with, others. (shrink)

The editors of the _Journal of Medical Ethics_ support the call of the UK Health Alliance on Climate for urgent action to ensure that the current Conference of the Parties to the United Nations Framework Convention on Climate Change ‘finally delivers climate justice for Africa and vulnerable countries’. 1 As they note ‘Africa has suffered disproportionately although it has done little to cause the crisis’. The burden of climate change has thus far fallen disproportionately on Global South countries. The monsoon (...) in Pakistan this year killed over 1100 people and the public health implications of the flooding might affect the health of over 5 million people. 2 The South Asian monsoon impacts the lives of a billion people and the flooding associated with wet seasons is likely to occur eight times more frequently in future years than at present. 3 For many pacific islands such as Kiribati,... (shrink)

Here we present the personal perspectives of two authors on the important and unfortunately frequent scenario of ambulance clinicians facing a deceased individual and family members who do not wish them to attempt cardiopulmonary resuscitation. We examine the professional guidance and the protection provided to clinicians, which is not matched by guidance to protect family members. We look at the legal framework in which these scenarios are taking place, and the ethical issues which are presented. We consider the interaction between (...) ethics, clinical practice and the law, and offer suggested changes to policy and guidance which we believe will protect ambulance clinicians, relatives and the patient. (shrink)

BackgroundDoctors and the Sri Lanka Medical Association recognise the importance of do not attempt cardiopulmonary resuscitation decisions and disclosure; however, few previous studies exist examining these practices in Sri Lanka. Resuscitation decisions have seen significant changes in the UK in recent years, with a legal imperative for clear communication and a move to understand patients’ preferred outcomes before recommending clinical guidance.MethodsParticipants from two Sri Lankan hospitals were selected purposively to represent a range of specialties and seniorities for semi-structured interview.ResultsFifteen participants (...) of varying seniorities were recruited. Practice of do not resuscitate and informing patients is highly variable; there is no definitive guidance published on best practice of these issues in Sri Lanka. Participants felt that inpatients were generally not aware of their medical conditions or treatments. With the poor social and palliative care service provision in Sri Lanka comes... (shrink)

This document is designed to give guidance on assessing researchers in bioethics/medical ethics. It is intended to assist members of selection, confirmation and promotion committees, who are required to assess those conducting bioethics research when they are not from a similar disciplinary background. It does not attempt to give guidance on the quality of bioethics research, as this is a matter for peer assessment. Rather it aims to give an indication of the type, scope and amount of research that is (...) the expected in this field. It does not cover the assessment of other activities such as teaching, policy work, clinical ethics consultation and so on, but these will be mentioned for additional context. Although it mentions the UK’s Research Excellence Framework, it is not intended to be a detailed analysis of the place of bioethics in the REF. (shrink)

This chapter provides an introduction to higher-order metaphysics as well as to the contributions to this volume. We discuss five topics, corresponding to the five parts of this volume, and summarize the contributions to each part. First, we motivate the usefulness of higher-order quantification in metaphysics using a number of examples, and discuss the question of how such quantifiers should be interpreted. We provide a brief introduction to the most common forms of higher-order logics used in metaphysics, and indicate a (...) number of questions which can be raised in such systems using logical vocabulary alone. Using a further example, we return to applications of higher-order logics in metaphysics. We also mention key developments in the history of higher-order logic as it pertains to metaphysics. Finally, we mention certain arguments which have been raised against the use of higher-order logic, and some ways of responding to them. (shrink)

This paper considers how cognitive architecture impacts and constrains the rational requirement to respond to reasons. Informational encapsulation and its close relative belief fragmentation can render an agent’s own reasons inaccessible to her, thus preventing her from responding to them. For example, someone experiencing imposter phenomenon might be well aware of their own accomplishments in certain contexts but unable to respond to those reasons when forming beliefs about their own self-worth. In such cases, are our beliefs irrational for failing to (...) respond to our own reasons? Or are they excused on grounds of the reasons’ inaccessibility? I argue that in such cases, the rational status of the belief that fails to respond to reasons is modulated by the degree of encapsulation of the system that produces it. Yet because our cognitive systems are rarely perfectly encapsulated, our failures to respond to reasons are almost always irrational to some degree. (shrink)

Perceptual experiences are not immediately responsive to reasons. You see a stick submerged in a glass of water as bent no matter how much you know about light refraction. Due to this isolation from reasons, perception is traditionally considered outside the scope of epistemic evaluability as justified or unjustified. Is perception really as independent from reasons as visual illusions make it out to be? I argue no, drawing on psychological evidence from perceptual learning. The flexibility of perceptual learning is a (...) way of responding to new epistemic reasons. The resulting perceptual experiences are epistemically evaluable as justified or unjustified. (shrink)

Philosophical and sociological approaches in technology have increasingly shifted toward describing AI (artificial intelligence) systems as ‘(moral) agents,’ while also attributing ‘agency’ to them. It is only in this way – so their principal argument goes – that the effects of technological components in a complex human-computer interaction can be understood sufficiently in phenomenological-descriptive and ethical-normative respects. By contrast, this article aims to demonstrate that an explanatory model only achieves a descriptively and normatively satisfactory result if the concepts of ‘(moral) (...) agent’ and ‘(moral) agency’ are exclusively related to human agents. Initially, the division between symbolic and sub-symbolic AI, the black box character of (deep) machine learning, and the complex relationship network in the provision and application of machine learning are outlined. Next, the ontological and action-theoretical basic assumptions of an ‘agency’ attribution regarding both the current teleology-naturalism debate and the explanatory model of actor network theory are examined. On this basis, the technical-philosophical approaches of Luciano Floridi, Deborah G. Johnson, and Peter-Paul Verbeek will all be critically discussed. Despite their different approaches, they tend to fully integrate computational behavior into their concept of ‘(moral) agency.’ By contrast, this essay recommends distinguishing conceptually between the different entities, causalities, and relationships in a human-computer interaction, arguing that this is the only way to do justice to both human responsibility and the moral significance and causality of computational behavior. (shrink)

Many philosophers subscribe to the view that philosophy is a priori and in the business of discovering necessary truths from the armchair. This paper sets out to empirically test this picture. If this were the case, we would expect to see this reflected in philosophical practice. In particular, we would expect philosophers to advance mostly deductive, rather than inductive, arguments. The paper shows that the percentage of philosophy articles advancing deductive arguments is higher than those advancing inductive arguments, which is (...) what we would expect from the vantage point of the armchair philosophy picture. The results also show, however, that the percentages of articles advancing deductive arguments and those advancing inductive arguments are converging over time and that the difference between inductive and deductive ratios is declining over time. This trend suggests that deductive arguments are gradually losing their status as the dominant form of argumentation in philosophy. (shrink)

According to a traditional picture, perception and belief have starkly different epistemic roles. Beliefs have epistemic statuses as justified or unjustified, depending on how they are formed and maintained. In contrast, perceptions are “unjustified justifiers.” Core cognition is a set of mental systems that stand at the border of perception and belief, and has been extensively studied in developmental psychology. Core cognition's borderline states do not fit neatly into the traditional epistemic picture. What is the epistemic role of these states? (...) Focusing on the core object system, the author argues that core object representations have epistemic statuses like beliefs do, despite their many prototypically perceptual features. First, the author argues that it is a sufficient condition on a mental state's having an epistemic status as justified or unjustified that the state is based on reasons. Then the author argues that core object representations are based on reasons, through an examination of both experimental results and key markers of the basing relation. The scope of mental states that are subject to epistemic evaluation as justified or unjustified is not restricted to beliefs. (shrink)

The “received wisdom” in contemporary analytic philosophy is that intuition talk is a fairly recent phenomenon, dating back to the 1960s. In this paper, we set out to test two interpretations of this “received wisdom.” The first is that intuition talk is just talk, without any methodological significance. The second is that intuition talk is methodologically significant; it shows that analytic philosophers appeal to intuition. We present empirical and contextual evidence, systematically mined from the JSTOR corpus and HathiTrust’s Digital Library, (...) which provide some empirical support for the second rather than the first hypothesis. Our data also suggest that appealing to intuition is a much older philosophical methodology than the “received wisdom” alleges. We then discuss the implications of our findings for the contemporary debate over philosophical methodology. (shrink)

Do epistemic and aesthetic values ever conflict? The answer might appear to be no, given that background knowledge generally enhances aesthetic experience, and aesthetic experience in turn generates new knowledge. As Keats writes, ‘Beauty is truth, truth beauty’ (Keats, 1996). Contra this line of thought, I argue that epistemic and aesthetic values can conflict when we over-rely on aesthetically enhancing background beliefs. The true and the beautiful can pull in different directions, forcing us to choose between flavours of normativity.

Timothy Williamson has argued that in the debate on modal ontology, the familiar distinction between actualism and possibilism should be replaced by a distinction between positions he calls contingentism and necessitism. He has also argued in favor of necessitism, using results on quantified modal logic with plurally interpreted second-order quantifiers showing that necessitists can draw distinctions contingentists cannot draw. Some of these results are similar to well-known results on the relative expressivity of quantified modal logics with so-called inner and outer (...) quantifiers. The present paper deals with these issues in the context of quantified modal logics with generalized quantifiers. Its main aim is to establish two results for such a logic: Firstly, contingentists can draw the distinctions necessitists can draw if and only if the logic with inner quantifiers is at least as expressive as the logic with outer quantifiers, and necessitists can draw the distinctions contingentists can draw if and only if the logic with outer quantifiers is at least as expressive as the logic with inner quantifiers. Secondly, the former two items are the case if and only if all of the generalized quantifiers are first-order definable, and the latter two items are the case if and only if first-order logic with these generalized quantifiers relativizes. (shrink)

What kinds of mental states can be based on epistemic reasons? The standard answer is only beliefs. I argue that perceptual states can also be based on reasons, as the result of crossmodal interactions. A perceptual state from one modality can provide a reason on which an experience in another modality is based. My argument identifies key markers of the basing relation and locates them in the crossmodal Marimba Illusion (Schutz & Kubovy 2009). The subject’s auditory experience of musical tone (...) duration is based on the reason provided by her visual representation of the length of the musician’s gesture and other stored perceptual principles. (shrink)

The role of audiences in mathematical proof has largely been neglected, in part due to misconceptions like those in Perelman and Olbrechts-Tyteca which bar mathematical proofs from bearing reflections of audience consideration. In this paper, I argue that mathematical proof is typically argumentation and that a mathematician develops a proof with his universal audience in mind. In so doing, he creates a proof which reflects the standards of reasonableness embodied in his universal audience. Given this framework, we can better understand (...) the introduction of proof methods based on the mathematician’s likely universal audience. I examine a case study from Alexander and Briggs’s work on knot invariants to show that we can fruitfully reconstruct mathematical methods in terms of audiences. (shrink)

Tae Wan Kim, John Hooker, and Thomas Donaldson make an attempt, in recent articles, to solve the alignment problem. As they define the alignment problem, it is the issue of how to give AI systems moral intelligence. They contend that one might program machines with a version of Kantian ethics cast in deontic modal logic. On their view, machines can be aligned with human values if such machines obey principles of universalization and autonomy, as well as a deontic utilitarian principle. (...) Programming machines to do so might be useful, in their view, for applications such as future autonomous vehicles. Their proposal draws both on traditional logic-based and contemporary connectionist approaches, to fuse factual information with normative principles. I will argue that this approach makes demands of machines that go beyond what is currently feasible, and may extend past the limits of the possible for AI. I also argue that a deontological ethics for machines should place greater stress on the formula of humanity of the Kantian categorical imperative. On this principle, one ought never treat a person as a mere means. Recognition of what makes a person a person requires ethical insight. Similar insight is needed to tell treatment as a means from treatment as a mere means. The resources in Kim, Hooker, and Donaldson’s approach is insufficient for this reason. Hesitation regarding deployment of autonomous machines is warranted in light of these alignment concerns. (shrink)

A novel problem or task may seem difficult at first, but with enough practice, it can become easy and routine. Practice and the process of learning is often accompanied by some mild cognitive uneas...

Perception provides us with access to the external world, but that access is shaped by our own experiential histories. Through perceptual learning, we can enhance our capacities for perceptual discrimination, categorization, and attention to salient properties. We can also encode harmful biases and stereotypes. This article reviews interdisciplinary research on perceptual learning, with an emphasis on the implications for our rational and normative theorizing. Perceptual learning raises the possibility that our inquiries into topics such as epistemic justification, aesthetic criticism, and (...) moral knowledge should include not only an examination of cognition but also of perception. (shrink)

The world provides us with an ocean of opportunities for fitting emotion. But we are beings with limited emotional resources, so missed opportunities are common. This chapter argues that these failures to take up fitting emotions are very frequently unfitting in their own right—so frequently, in fact, that most of us lead lives replete with unfitting absences of emotion. It begins by showing that, whenever an emotion can be unfitting in virtue of being too weak, the absence of that emotion (...) can also be unfitting, and for just the same reason. But emotional responses to a host of everyday objects—a funny joke, a nasty insult, and so on—can be unfittingly weak. This means that failures to respond emotionally to an enormous host of everyday objects are similarly unfitting. (shrink)

This article explores the extent to which consumers consider ethics in luxury goods consumption. In particular, it explores whether there is a significant difference between consumers’ propensity to consider ethics in luxury versus commodity purchase and whether consumers are ready to purchase ethical-luxury. Prior research in ethical consumption focuses on low value, commoditized product categories such as food, cosmetics and high street apparel. It is debatable if consumers follow similar ethical consumption patterns in luxury purchases. Findings indicate that consumers’ propensity (...) to consider ethics is significantly lower in luxury purchases when compared to commoditized purchases and explores some of the potential reasons for this reduced propensity to identify or act upon ethical issues in luxury consumption. (shrink)

Recognizing and aligning individuals’ unique adaptive beliefs or “priors” through cooperative communication is critical to establishing a therapeutic relationship and alliance. Using active inference, we present an empirical integrative account of the biobehavioral mechanisms that underwrite therapeutic relationships. A significant mode of establishing cooperative alliances—and potential synchrony relationships—is through ostensive cues generated by repetitive coupling during dynamic touch. Established models speak to the unique role of affectionate touch in developing communication, interpersonal interactions, and a wide variety of therapeutic benefits for (...) patients of all ages; both neurophysiologically and behaviorally. The purpose of this article is to argue for the importance of therapeutic touch in establishing a therapeutic alliance and, ultimately, synchrony between practitioner and patient. We briefly overview the importance and role of therapeutic alliance in prosocial and clinical interactions. We then discuss how cooperative communication and mental state alignment—in intentional communication—are accomplished using active inference. We argue that alignment through active inference facilitates synchrony and communication. The ensuing account is extended to include the role of tactile afferents in realizing the beneficial effect of therapeutic synchrony. We conclude by proposing a method for synchronizing the effects of touch using the concept of active inference. (shrink)

Language provides rich social information about its speakers. For instance, adults and children make inferences about a speaker's social identity, geographic origins, and group membership based on her language and accent. Although infants prefer speakers of familiar languages, little is known about the developmental origins of humans’ sensitivity to language as marker of social identity. We investigated whether 9-month-olds use the language a person speaks as an indicator of that person's likely social relationships. Infants were familiarized with videos of two (...) people who spoke the same or different languages, and then viewed test videos of those two individuals affiliating or disengaging. Results suggest that infants expected two people who spoke the same language to be more likely to affiliate than two people who spoke different languages. Thus, infants view language as a meaningful social marker and use language to make inferences about third-party social relationships. (shrink)

This paper investigates the relationship between economic theory and theories of justice in the design of public policy. In particular, it focuses on the role of mechanism design in policy contexts beset with issues of social, racial and distributive justice. Economists’ involvement in redesigning Boston’s algorithm for allocating K-12 students to public schools serves as an instructive case study. The paper draws on the distinction betweenideal theoryandnon-ideal theoryin political philosophy and the concept ofperformativityin economic sociology to argue that mechanism design (...) can enact elaborate ideal theories of justice. Anormative gapthus emerges between the goals of the policymakers and the objectives of economic designs. As a result, mechanism design may obstruct stakeholders’ avenues for normative criticism of public policies, and serve as a technology of depoliticization. (shrink)

Propositional quantifiers are quantifiers binding proposition letters, understood as variables. This Element introduces propositional quantifiers and explains why they are especially interesting in the context of propositional modal logics. It surveys the main results on propositionally quantified modal logics which have been obtained in the literature, presents a number of open questions, and provides examples of applications of such logics to philosophical problems.

Daniel Dennett's distinction between personal and subpersonal explanations was fundamental in establishing the philosophical foundations of cognitive science. Since it was first introduced in 1969, the personal/subpersonal distinction has been adapted to fit different approaches to the mind. In one example of this, the ‘Pittsburgh school’ of philosophers attempted to map Dennett's distinction onto their own distinction between the ‘space of reasons’ and the ‘space of causes’. A second example can be found in much contemporary philosophy of psychology, where Dennett's (...) distinction has been presumed to be equivalent to Stephen Stich's distinction between doxastic and subdoxastic states. Both these interpretations of the personal/subpersonal distinction, and also Dennett's own philosophical views of the mind, go beyond the personal/subpersonal distinction itself. They each involve supplementing the distinction between personal and subpersonal explanations with metaphysical claims about the relationship between the two kinds of explanation and the entities they posit. (shrink)

This is evident, for example, in the contribution it has made to the emancipation of repressed social classes.

In this paper, I claim that the personal/subpersonal distinction is first and foremost a distinction between two kinds of psychological theory or explanation: it is only in this form that we can understand why the distinction was first introduced, and how it continues to earn its keep. I go on to examine the different ontological commitments that might lead us from the primary distinction between personal and subpersonal explanations to a derivative distinction between personal and subpersonal states. I argue that (...) on one of the most common metaphysical interpretations of the explanatory distinction, talk of a distinction between personal and subpersonal states simply makes no sense. When people insist on applying the personal/subpersonal terminology to psychological states, I allow that they are often making a genuine distinction, but one that it is best understood in terms of Stich's (1978) distinction between doxastic and subdoxastic states. I end the paper by considering some other common misinterpretations of the personal/subpersonal distinction, such as those involving consciousness, normativity, or autonomy. (shrink)

Reprint of the Knopf edition of 1972 with a new introduction by Fritz Stern. Now printed on acid-free paper. Annotation copyrighted by Book News, Inc., Portland, OR.

Is there a parallel between climate change and our body’s temperature or non-compliance and failure to act on global warming? This paper proposes a model which describes the human body as part of N...

Testimonial accounts of mathematical problem choice typically rely on intrinsic constraints. They focus on the worth of the problem and feelings of beauty. These are often developed as both descriptive and normative constraints on problem choice. In this paper, I aim to add an extrinsic constraint of no less importance: the assurance of contact of minds with a desired audience. A number of elements for the relationship between mathematician and his audience make up this contact. This constraint stems from the (...) mathematician’s role as an arguer, as one of the pre-requisites to argumentation is contact of minds. I examine two exceptional cases which fail to be explained by intrinsic constraints on motivation and posit how this contact could influence usual cases. While not the only constraint or drive in problem choice, establishing contact of minds plays an important role worth further examination. (shrink)

We provide a novel articulation of the epistemic peril of p-hacking using three resources from philosophy: predictivism, Bayesian confirmation theory, and model selection theory. We defend a nuanced position on p-hacking: p-hacking is sometimes, but not always, epistemically pernicious. Our argument requires a novel understanding of Bayesianism, since a standard criticism of Bayesian confirmation theory is that it cannot represent the influence of biased methods. We then turn to pre-analysis plans, a methodological device used to mitigate p-hacking. Some say that (...) pre-analysis plans are epistemically meritorious while others deny this, and in practice pre-analysis plans are often violated. We resolve this debate with a modest defence of pre-analysis plans. Further, we argue that pre-analysis plans can be epistemically relevant even if the plan is not strictly followed—and suggest that allowing for flexible pre-analysis plans may be the best available policy option. (shrink)