Heideggerian philosophy is frequently chosen as a philosophical framing, and/or a hermeneutic analytical structure in qualitative nursing research. As Heideggerian philosophy is dense, there is merit in the development of scholarly resources that help to explain discrete Heideggerian concepts and to uncover their relevance to contemporary human experience. This paper uses a meta-synthesis methodology to pool and synthesise findings from 29 phenomenological research reports on Being-with in the nurse–patient relationship. We firstly considered and secured the most relevant Heideggerian elements to (...) nurse–patient Being-with. Under these deductive codes, we then inductively developed sub-themes that seemed to explain the multifaceted nature of Being-with, through a secondary analysis and synthesis of published data from 417 patient, carer and nurse participants. Dasein-with was enhanced when nurses had first-hand experience with a phenomenon. Nurses moved between the inauthentic they-mode, and the authentic self-mode. Through circumspection, technology and people were encountered environmentally feeding into nursing attention, assessment and communication. Nursing as a social arrangement was expressed through either leaping-in care or leaping-ahead care. There was a place for both inauthentic and authentic discourse that nurses wove through the ontic everydayness of nursing tasks. (shrink)

Volume 20, Issue 7, July 2020, Page 77-80.

When cognitive scientists are looking for the neural basis of consciousness or the computational processes underlying vision, what are they looking to find? I argue for a new account of this explanatory project in cognitive science (and the special sciences more generally) on which it is best understood on close analogy with causal explanation in the special sciences. Causal explanations cite causal difference-makers: they explain how certain events causally depend on other events. Generative explanations cite generative difference-makers: they explain how (...) certain events obtain in virtue of (and so are generated by) other events. I show how that this generative difference-making account (GDM) extends well regarded developments in philosophical work on causal explanation, helps to usefully clarify and expands the hypothesis space of a key project in cognitive science – that of understanding how underlying nonmental processes give rise to the mental, including consciousness. In section 2, I develop GDM by close analogy with causal explanation, and locate both of them as species of a more general project in the special sciences: that of discovering what makes a difference to what. In section 3, I motivate GDM by contrasting it with other rival accounts, including correlationist, identity, and grounding accounts, as well as Carl Craver’s constitutive relevance account. In section 4, I tie all of the strands of the preceding discussion together to show how GDM provides a new and compelling response to the so-called hard problem of consciousness. (shrink)

Between the years 1643 and 1649, Princess Elisabeth of Bohemia and René Descartes exchanged fifty-eight letters—thirty-two from Descartes and twenty-six from Elisabeth. Their correspondence contains the only known extant philosophical writings by Elisabeth, revealing her mastery of metaphysics, analytic geometry, and moral philosophy, as well as her keen interest in natural philosophy. The letters are essential reading for anyone interested in Descartes’s philosophy, in particular his account of the human being as a union of mind and body, as well as (...) his ethics. They also provide a unique insight into the character of their authors and the way ideas develop through intellectual collaboration. Philosophers have long been familiar with Descartes’s side of the correspondence. Now Elisabeth’s letters—never before available in translation in their entirety—emerge this volume, adding much-needed context and depth both to Descartes’s ideas and the legacy of the princess. Lisa Shapiro’s annotated edition—which also includes Elisabeth’s correspondence with the Quakers William Penn and Robert Barclay—will be heralded by students of philosophy, feminist theorists, and historians of the early modern period. (shrink)

This paper argues that a priori justification is, in principle, compatible with naturalism—if the a priori is understood in a way that is free of the inessential properties that, historically, have been associated with the concept. I argue that empirical indefeasibility is essential to the primary notion of the a priori ; however, the indefeasibility requirement should be interpreted in such a way that we can be fallibilist about apriori-justified claims. This fallibilist notion of the a priori accords with the (...) naturalist’s commitment to scientific methodology in that it allows for apriori-justified claims to be sensitive to further conceptual developments and the expansion of evidence. The fallibilist apriorist allows that an a priori claim is revisable in only a purely epistemic sense. This modal claim is weaker than what is required for a revisability thesis to establish empiricism, so fallibilist apriorism represents a distinct position. (shrink)

This book offers a balanced and comprehensive account of philosophical thought from the middle of the fourteenth century to the emergence of modern philosophy at the turn of the seventeenth century.

This important text introduces students to both feminism and other social and political theories via an examination of the inter-relationship between different feminist positions and key contemporary debates. The book takes each debate in turn, outlines the main themes, discusses different feminist responses and evaluates the implications for real-life political and social issues. This user-friendly structure effectively redraws the map of contemporary feminist thought, offering a fresh and succinct summary of an extensive range of material and graphically demonstrating the ongoing (...) relevance and value of a feminist perspective. (shrink)

Melds philosophical analysis with early cinematic history to develop a fresh theory of the notion of comedy.

This provocative book paved the way for nursing research informed by f eminist scholarship, critical theory, and post-modern thought. Controv ersial then, relevant today.

The purpose of this article is to assess Rosabeth Moss Kanter's work on tokenism in light of more than a decade of research and discussion. While Kanter argued that performance pressures, social isolation, and role encapsulation were the consequences of disproportionate numbers of women and men in a workplace, a review of empirical data concludes that these outcomes occur only for token women in gender-inappropriate occupations. Furthermore, Kanter's emphasis on number balancing as a social-change strategy failed to anticipate backlash from (...) dominants. Blalock's theory of intrusiveness suggests that surges in the number of lower-status members threaten dominants, thereby increasing gender discrimination in the forms of sexual harassment, wage inequities, and limited opportunities for promotion. Although Kanter's analysis of the individual consequences of tokenism was compelling to researchers and organizational change agents, continued reliance on numbers as the theoretical cause of, and as the solution to, gender discrimination in the workplace neglects the complexities of gender integration. (shrink)

What is it to base a belief on reasons? Existing attempts to give an account of the basing relation encounter a dilemma: either one appeals to some kind of neutral process that does not adequately reflect the way basing is a content‐sensitive first‐personal activity, or one appeals to linking or bridge principles that over‐intellectualize and threaten regress. We explain why this dilemma arises, and diagnose the commitments that are key obstacles to providing a satisfactory account. We explain why they should (...) be rejected anyway, and then offer a new, knowledge‐first virtue epistemological theory of the basing relation that shows how we can substantially theorize about mental processes without these commitments. The resulting view plausibly captures the way in which basing is an inherently mental and content‐sensitive process. (shrink)

What considerations place genuine constraints on an adequate semantics for normative and evaluative expressions? Linguists recognize facts about ordinary uses of such expressions and competent speakers’ judgments about which uses are appropriate. The contemporary literature reflects the widespread assumption that linguists don’t rely upon an additional source of data—competent speakers’ judgments about possible disagreement with hypothetical speech communities. We have several good reasons to think that such judgments are not probative for semantic theorizing. Therefore, we should accord these judgments no (...) probative value for the development of a semantics for our moral terms. Such judgments can no longer be presumed to put pressure on theories according to which our moral expressions share a semantics with ordinary, descriptive terms. Many rivals to pure, Descriptivist theories count among their advantages the ability to accommodate these judgments. If these judgments have no probative value, such theories lose an important source of support. (shrink)

This article analyses the two main rhetorical techniques of “argumentation” and “persuasion” employed in politico-philosophical debates recorded in early Chinese argumentative texts of the Warring States period. Through the analysis of pertinent case studies drawn from the received literature, the contribution explores the formal, structural, and grammatical features of these techniques, with attention paid to the wide selection of rhetorical and literary devices they make use of. It also further provides an overview of the historical and socio-cultural background against which (...) such techniques developed among so called “wandering persuaders”, who were travelling from court to court to offer their services as political advisors and diplomats to the local rulers of the time. (shrink)

Broadly speaking, a naturalistic approach to epistemology seeks to explain human knowledge – and justification in particular – as a phenomenon in the natural world, in keeping with the tenets of naturalism. Naturalism is typically defined, in part, by a commitment to scientific method as the only legitimate means of attaining knowledge of the natural world. Naturalism is often thought to entail empiricism by virtue of this methodological commitment. However, scientific methods themselves may incorporate a priori elements, so empiricism does (...) not follow from the methodological commitments of naturalism alone. And given a suitably-naturalistic conception of the a priori, a priori forms of justification may be compatible with naturalism generally. A priori justification is, in principle, compatible with naturalism – and hence naturalistic epistemologies – if the a priori is understood in a way that is free of some of the inessential properties that have been associated with the concept. I argue that some of the more prominent strategies for accommodating normative notions within a naturalistic framework allow for the possibility of a priori justification. These include reliabilism, instrumental rationality, and nonfactualism about justification. A priori justification thus need not be seen as standing in opposition to all naturalistic epistemologies. It is only with nonnormative naturalistic epistemologies that a priori justification per se is incompatible, and this only because the notion of justification itself has no role to play within a nonnormative approach to epistemology. (shrink)

The phenomenon of industrial melanism became widely acknowledged as a well-documented example of natural selection largely as a result of H.B.D. Kettlewell’s pioneering research on the subject in the early 1950s. It was quickly picked up by American biology textbooks starting in the early 1960s and became ubiquitous throughout the 1970s, 1980s and 1990s. While recent research on the phenomenon broadly supports Kettlewell’s explanation of IM in the peppered moth, which in turn has strengthened this example of natural selection, textbook (...) IM entries have actually declined in recent years in favor of other examples. In a previous paper, we drew attention to the pivotal role visual aspects played in the introduction of IM into textbook accounts. The present article continues this investigation by analyzing textual passages on industrial melanism within a stratified random sample of textbooks from the 1960s to the 2000s. The fact that this example of natural selection was included by multiple publishers independently, in a short period of time, makes it uniquely qualified for a textbook study of this kind. The purpose of the present project was to determine whether these textbooks contain what has come to be known as the standard peppered moth story. Three complete series were also inspected for change across time. Our analysis focused on the amount of text devoted to industrial melanism; what specific science content elements were present; and what, if any, nature of science aspects were included. The study documents an increase in the amount of text devoted to industrial melanism over the decades. In spite of this increase, only modest changes in science content and NOS aspects were found. (shrink)

Applying Aesthetics to Everyday Life surveys current debates in the field of everyday aesthetics, examining its history, methodology and intersections with cognate research areas. Lisa Giombini and Adrián Kvokacka bring together an international team of renowned scholars who are shaping the present and future of the discipline. They demonstrate how the historical origins of everyday aesthetics emerges across the history of Western aesthetic thought, from Renaissance thinkers to the modern German philosophers Baumgarten, Kant and Heidegger. Chapters shed light on (...) the field's methodological underpinnings, tracing its theoretical foundations back to epistemology and ethics and assess the potential of everyday aesthetics as a theoretical tool. They reveal its interdisciplinary nature and how it assists various fields of inquiry, including environmental and urban aesthetics, conservation ethics and the philosophy of art. Through fresh explorations of its origins, background and contemporary developments, this collection advances a new definition of everyday aesthetics and provides a cutting edge reflection on the world we inhabit today. (shrink)

I argue that epistemic failings are a significant and underappreciated moral hazard in the financial services industry. I argue further that an analysis of these epistemic failings and their means of redress is best developed by identifying policies and procedures that are likely to facilitate good judgment. These policies and procedures are “best epistemic practices.” I explain how best epistemic practices support good reasoning, thereby facilitating accurate judgments about risk and reward. Failures to promote and adhere to best epistemic practices (...) contributed to the 2008 financial crisis. I identify and discuss some of the ways in which best epistemic practices were violated in the events that led to the crisis, with a focus on the role of the credit rating agencies. I go on to discuss some of the ways in which these failings have been redressed. I conclude by observing how proactive regulation for best epistemic practices might help us to anticipate and avoid future crises. (shrink)

This chapter discusses three puzzles about practical conditionals and inferences and shows how the flexible, contextualist semantic framework for “ought”. The chapter develops elsewhere resolves all three puzzles more satisfactorily than any of its three most prominent rivals, the relativist account of Niko Kolodny and John MacFarlane, the wide-scoping account of John Broome, and the “trying on” account of James Dreier. The chapter first introduces the puzzle cases and six desiderata for their solutions, and then shows how only flexible contextualism (...) about “ought” is able to resolve each while satisfying all six desiderata. (shrink)

Here’s a nice, simple view. Knowing that p is the sole fundamental aim and achievement in the epistemic domain. It is a manifestation of epistemic competence, and we can metaphysically explain both the existence and the normative status of all other epistemic states in terms of knowledge and the competence it manifests. In this paper I will defend this view from a challenge from Ernest Sosa that knowledge is too weak and primitive to do the work the Simple View asks (...) it to do. He claims that we not only need knowing that p, but also reflectively knowing that p and knowing full well that p. I argue that Sosa is mistaken. Good old knowledge, what Sosa calls animal knowledge, when properly understood, can do all of the work that reflective knowledge and knowing full well are supposed to do. Knowledge, at least in the epistemic domain, is all you need. In section 1, I explain in more detail the challenge that Sosa poses for the Simple View, and consequently my direct virtue epistemology. I then explain Sosa’s accounts of reflective knowledge and knowing full well, further clarifying the debate. In sections 2, 3, and 4, I consider Sosa’s arguments that reflective knowledge and knowing full well are distinctive epistemic achievements. Section 2 addresses his argument from the epistemic evaluability of suspending belief. Section 3 addresses his arguments for the claim that a variety of cases can only be adequately accounted for by invoking these other states. Section 4 addresses his arguments about the role of reflective knowledge in rebutting dream skepticism. Responding to Sosa’s arguments also helps to clarify certain features of knowledge and epistemic competence. I conclude by reviewing these features. (shrink)

Essays discuss euthanasia and the medical, legal, and ethical controversies surrounding it.

The aim of this study was interpret the existential construct of family caring following Acute Coronary Syndrome. Family support is known to have a positive impact on recovery and adjustment after cardiac events. Few studies provide philosophically-based, interpretative explorations of carer experience following a spouse’s ischaemic event. As carer experiences, behaviours and meaning-making may impact on the quality of the support they provide to patients, further understanding could improve both patient outcomes and family experience. Fourteen spouses of people experiencing Acute (...) Coronary Syndrome in Sydney, Australia were engaged in a single, semi-structured interview. Interviews were audio-recorded and transcribed verbatim. Data were analysed using hermeneutic interpretation within a Heideggerian phenomenological framework. Acute Coronary Syndrome disrupts lived temporality, and the projected potential for carers’ being-alongside. Carers experienced an existential uncertainty that arose from difficulty in diagnosis, and situated fear as an attuned, being-towards-death. They constructed protective strategies to insulate their partner and themselves from further stress and risk, however, unclear boundaries for protection heightened carer anxiety. The existential structure of care included one of two possible Heideggerian modes: leaping-in care was a dominating mode that required a high level of carer vigilance; leaping-ahead care was a metaphorical walking alongside, as carers gave back control, freeing opportunities for the person to ‘own’ care. Supporting carers through the intensive phase of leaping-in care, and equipping them for informed leaping-ahead care should be a focus in both the acute and post-discharge care phases. (shrink)

This essay is part of a dossier on Cristina Lafont's book Democracy without Shortcuts.

Perhaps more controversial than whether physicalism is true is what exactly would have to be true for physicalism to be true. Everyone agrees that, intuitively at least, physicalism is the thesis that there is nothing over and above the physical. The disagreements arise in how to get beyond this intuitive formulation. Until about ten years ago, participants in this debate were concerned primarily with answering two questions. First, what is it for a property, kind, relation, or individual to be a (...) physical one? (shrink)

When it originated in the late 19th century, psychometrics was a field with both a scientific and a social mission: psychometrics provided new methods for research into individual differences, and at the same time, these psychometric instruments were considered a means to create a new social order. In contrast, contemporary psychometrics - due to its highly technical nature and its limited involvement in substantive psychological research - has created the impression of being a value-free discipline. In this article, we develop (...) a contrasting characterization of contemporary psychometrics as a value-laden discipline. We expose four such values: that individual differences are quantitative (rather than qualitative), that measurement should be objective in a specific sense, that test items should be fair, and that utility of a model is more important than its truth. Our goal is not to criticize psychometrics for employing these values, but rather to bring them into the open and to show that these values are not inevitable and are in need of systematic evaluation. (shrink)

When two actors have the same mental state but one happens to harm another person (unlucky actor) and the other one does not (lucky actor), the latter elicits a milder moral judgement. To understand how this outcome effect would affect post-harm interactions between victims and perpetrators, we examined how the social role from which transgressions are perceived moderates the outcome effect, and how outcome effects on moral judgements transfer to agentic and communal interpersonal goals. Three vignette experiments (N = 950) (...) revealed similar outcome effects on moral judgement across social roles. In contrast, outcome effects on agentic and communal goals varied by social role: victims exhibited the strongest outcome effects and perpetrators the weakest, with bystanders falling in between. Moral judgement did not mediate the effects of outcome severity on interpersonal goals. We discuss the possibility that outcome severity raises normative expectations regarding post-harm interactions that are unrelated to moral considerations. (shrink)

This article examines birthday party decorations as a way of understanding the materiality and religious place-making of an expanding Baptist congregation in central Sweden in the early twentieth century. The fiftieth birthday party for Magnus Johanson, held at Salem Chapel in Falun, Dalarna county, in 1906, was decorated with birch branches, large Swedish flags and bunting and an elaborately laid table featuring coffee cups and refreshments. From an analysis of these material elements and a deeper investigation into the lives of (...) Johanson and his wife Kristina, it can be seen that evangelicals had a flexible approach to their ‘sacred’ spaces. Social activities and the act of decorating them created not only a sense of congregational fellowship and belonging but also the opportunity for congregations to display their connection to external cultural and political identities. Through the construction of chapel buildings and their subsequent decoration, male and female members were able to demonstrate a complementary creativity. Together they contributed to the cre-ation of Salem as a multi-purpose, comfortable and accepted place within Falun’s evolving religious landscape. (shrink)

In the last few decades, religious and secular thinkers have tackled the world's escalating environmental crisis by attempting to develop an ecological ethic that is both scientifically accurate and free of human-centered preconceptions. This groundbreaking study shows that many of these environmental ethicists continue to model their positions on romantic, pre-Darwinian concepts that disregard the predatory and cruelly competitive realities of the natural world. Examining the work of such influential thinkers as James Gustafson, Sallie McFague, Rosemary Radford Ruether, John Cobb, (...) Peter Singer, and Holmes Rolston, Sideris proposes a more realistic ethic that combines evolutionary theory with theological insight, advocates a minimally interventionist stance toward nature, and values the processes over the products of the natural world. (shrink)

This article analyzes organizational mechanisms, and their contexts, leading to gender inequality among stockbrokers in two large brokerages. Inequality is the result of gender differences in sales, as both firms use performance-based pay, paying entirely by commissions. This article develops and tests whether performance-support bias, whereby women receive inferior sales support and sales assignments, causes the commissions gap. Newly available data on the brokerages’ internal transfers of accounts among brokers allows measurement of performance-support bias. Gender differences in the quality and (...) quantity of transferred accounts provide a way to measure gender differences in the assignment of sales opportunities and support. Sales generated from internally transferred accounts, controlling for the accounts’ sales histories, provide a “natural experiment” testing for gender differences in sales capacities. The evidence for performance-support bias is women are assigned inferior accounts and women produce sales equivalent to men when given accounts with equivalent prior sales histories. (shrink)

Do you love animals? Do you enjoy making sure animals and people are safe? Read this book to learn about becoming an animal control officer.

While the richness of Heideggerian philosophy is attractive as a healthcare research framework, its density means authors rarely utilise its fullest possibilities as an hermeneutic analytic structure. This article aims to clarify Heideggerian hermeneutic analysis by taking one discrete element of Heideggerian philosophy (Being-towards-death), and using it’s clearly defined structure to conduct a meta-synthesis of Heideggerian phenomenological studies on the experience of living with a potentially life-limiting illness. The findings richly illustrate Heidegger’s philosophy that there is either an inauthentic positioning (...) towards death, or an authentic positioning towards death with a proposition that (1) death is certain; (2) death is indefinite; (3) death is non-relational; and (4) death is not-to-be-outstripped. None of the 29 included studies on the experience of a confrontation with death fully utilised this framework, despite claiming a grounding in Heideggerian thought. This demonstrates the value in modelling how Heideggerian existential structures can be used proactively as analytical ‘hooks’ for data in research claiming a basis in this philosophy and/or method. By modelling the potential application of an important Heideggerian philosophical construct to published qualitative data, this meta-synthesis has revealed new domains and more nuanced understandings of the temporal structure of Being-towards-death. Such an approach helps to more fully unveil the existential concerns of people at the core of interpretative phenomenological enquiry and may provide a blueprint to map either primary or synthesised data to other key ontological existentials. (shrink)

The responsible research and innovation framework seeks to bring science closer to society, with scientific research conducted not just for the benefit of society, but with role players in society engaging with scientists on research and innovation at every stage. A central focus of the RRI framework is the approach taken to embed these concepts in the higher education training of science students. In this study the direct engagement between science students and the public is explored as an opportunity for (...) achieving RRI learning outcomes. The study also explores the potential benefits that such direct engagement with the public holds for postgraduate biotechnology students. The case study described here suggests that even brief interactions with the public through science engagement activities such as “Speed-Date-a-Scientist” can contribute towards affirmation of choice of career, students’ motivation as researchers and shaping of their identity as scientists, important processes in their own learning to become scientists. Students also indicated a greater sense of motivation to do research that benefits the public, resonating with RRI learning outcomes. (shrink)

This new anthology of early modern philosophy enriches the possibilities for teaching this period by highlighting not only metaphysics and epistemology, but also new themes such as virtue, equality and difference, education, the passions, and love. It contains the works of forty-three philosophers, including traditionally taught figures such as Descartes, Spinoza, Leibniz, Locke, Berkeley, Hume, and Kant, as well as less familiar writers such as Lord Shaftesbury, Anton Amo, Julien Offray de La Mettrie, and Denis Diderot. It also highlights the (...) contributions of women philosophers, including Margaret Cavendish, Anne Conway, Gabrielle Suchon, Sor Juana Inéz de la Cruz, and Emilie Du Châtelet. (shrink)

We draw on three illustrative vignettes to examine how REBs manage participants’ agency in the context of qualitative research. We ask: Who owns a participant’s consent? Central to informed consent is the principle of Respect for Persons, which privileges the autonomy of individuals to make decisions about what happens (or not) to them. Yet, REBs sometimes require researchers to get permission from organizations to conduct research on their current and former members, even when the research is not about those organizations. (...) Our aim is to raise awareness about the inherent contradictions of this practice and to consider guidelines for determining the appropriateness of involving organizations that may be tangentially connected to the research objectives or potential participants. (shrink)

I argue against traditional virtue epistemology on which knowledge is a success due to a competence to believe truly, by revealing an in-principle problem with the traditional virtue epistemologist’s explanation of Gettier cases. The argument eliminates one of the last plausible explanation of Gettier cases, and so of knowledge, in terms of non-factive mental states and non-mental conditions. I then I develop and defend a different kind of virtue epistemology, on which knowledge is an exercise of a competence to know. (...) I show how the account, while circular, is not viciously so. It explains both how knowledge is a mental state, as well as the relationship between knowledge and justification, including justified false beliefs and Gettier cases. Moreover, although direct virtue epistemology is compatible with many views on the nature of belief, it can explain how knowledge might be metaphysically more fundamental than belief as well. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reifying Relevance in Mild Cognitive Impairment:An Appeal for Care and CautionJanice E. Graham (bio) and Karen Ritchie (bio)KeywordsAlzheimer’s disease, construction, dementia, market forces, mild cognitive impairmentWe thank the reviewers for their thoughtful comments that probe shadowy areas in our argument, and we welcome this opportunity to elucidate our position. First, we are not repudiating the natural and social facts of pathologic brain degeneration and the physical and cognitive impairments (...) that manifest in people affected by dementia disorders. We are, however, questioning the epistemology, politics, and persistence by some to harden the construct of mild cognitive impairment (MCI) prematurely as a "natural" precursor to dementia. We suggested insufficiencies in viewing MCI as prodromal to Alzheimer's disease (AD; Graham and Ritchie 2006, 36), and pointed to evidence for the prognostic irrelevance of some MCI subcategories (35). The commentators have read our manuscript as suggesting that AD and MCI are different kinds, and that a diagnosis of AD is more "real" than that of MCI. But AD is also fraught with classification issues, as we describe in the section of our paper that deals with consensus committees, published practice guidelines, and the determination of treatment efficacy. Like MCI, AD is a heterogeneous condition, but unlike MCI, AD is a constructed practical kind that does some "work" beyond essentialist (neural degeneration, brain atrophy) claims. Its criteria identify people with well-defined dementia symptoms and multiple cognitive and functional impairments who are in need of, and benefit from, support. Even with these criteria, however, there have been great attempts to achieve definitional accuracy in dementia diagnoses. Practical refinements to the differential diagnosis of dementia based on solid research evidence have made way for more specific recognitions of vascular dementias, dementia of the Lewy body type, and other subtypes beyond AD. So AD too has been subject to more careful, more cautious operationalization in recent years, with research supporting multiple factors and the comorbidity of several types (kinds) of dementia in any one individual.Our paper takes up concerns that are not resolved for dementia and suggests that the nascent category of MCI is still so insufficiently defined as to be ambiguous, and as such, is in danger of identifying individuals with what will be, and has [End Page 57] already been, linked to a debilitating and deeply stigmatizing and fatal disorder (AD). We are not contesting the reality that some people begin to display early signs of cognitive loss, nor are we suggesting that symptoms be ignored; as researchers, we stand behind the careful tracking of symptoms and signs in patients and research participants as an essential clinical and research practice. In a era where the public has been made wary of the potentially fatal effects of new treatments whose more careful scrutiny in specific populations would have saved lives (e.g., Fontanarosa, Rennie, and DeAngelis 2004; Psaty and Furberg 2005), and made all the more popular by what Kramer coined "diagnostic bracket creep" (1993, 15), we are questioning the drivers and value of a premature diagnostic classification whose definitional accuracy is neither sufficient nor effective for specific identification of individuals.That matters of fact are constructed does not take away from their natural fact. Some people have subjective reports or show objective evidence of cognitive decline while having preserved activities of daily living—the construction of this evidence indicates they are not normal and they are not demented. Based on such evidence, where then does the balance of probability for MCI lie? A multidisciplinary international group of experts gathered in Stockholm in 2003 to discuss MCI concepts (Winblad et al. 2004). They acknowledged that the heterogeneous etiology of MCI contributes to "some confusion concerning the specific boundaries of the condition", stating that this "not normal, not demented" condition is nonetheless "useful both clinically and as a research entity" (p. 241). Importantly, they concluded that MCI needs "better definition" (p. 246). It was at this stage that we first wrote our manuscript, and in the subsequent two years we have eagerly awaited new studies, and the recognition of flexible, practical subtypes to evolve.We state "that MCI cannot be considered to be a separate clinical entity" (Graham and... (shrink)