Our autonomy can be compromised by limitations in our capacities, or by the power relationships within which we are embedded. If we insist that real consent requires full autonomy, then virtually no sex will turn out to be consensual. I argue that under conditions of compromised autonomy, consent must be socially and interpersonally scaffolded. To understand consent as an ethically crucial but nonideal concept, we need to think about how it is related to other requirements for ethical sex, such as (...) the ability to exit a situation, trust, safety, broader social support, epistemic standing in the community, and more. (shrink)

City Living is about urban spaces, urban dwellers, and how these spaces and people make, shape, and change one another. More people live in cities than ever before: more than 50% of the earth's people are urban dwellers. As downtown cores gentrify and globalize, they are becoming more diverse than ever, along lines of race, ethnicity, socioeconomic class, sexuality, and age. Meanwhile, we are in the early stages of what seems sure to be a period of intense civil unrest. During (...) such periods, cities generally become the primary sites where tensions and resistance are concentrated, negotiated, and performed. For all of these reasons, understanding cities and contemporary city living is pressing and exciting from almost any disciplinary and political perspective. Quill R Kukla offers the first systematic philosophical investigation of the nature of city life and city dwellers. The book draws on empirical and ethnographic work in geography, anthropology, urban planning, and several other disciplines in order to explore the impact that cities have on their dwellers and that dwellers have on their cities. It begins with a philosophical exploration of spatially embodied agency and of the specific forms of agency and spatiality that are distinctive of urban life. It explores how gentrification is enacted and experienced at the level of embodied agency, arguing that gentrifying spaces are contested territories that shape and are shaped by their dwellers. The book then moves to an exploration of repurposed cities, which are cities materially designed to support one sociopolitical order, but in which that order collapsed, leaving new dwellers to use the space in new ways. Through detailed original ethnography of the repurposed cities of Berlin and Johannesburg, Kukla makes the case that in repurposed cities, we can see vividly how material spaces shape and constrain the agency and experience of dwellers, while dwellers creatively shape the spaces they inhabit in accordance with their needs. The book concludes with a reconsideration of the right to the city, asking what would be involved in creating a city that enabled the agency and flourishing of all its diverse inhabitants. (shrink)

When I say “I know Sarah,” or “I know Berlin,” what sort of knowledge am I claiming? Such knowledge of a particular is, I claim, not reducible to either propositional knowledge-that or to traditional physical know-how. Mere, bare knowledge by acquaintance also does not capture the kind of knowledge being claimed here. Using knowledge of a place as my central example, I argue that this kind of knowledge-of, or “objectual knowledge” as it is sometimes called, is of a distinctive epistemological (...) sort. It is a genre of inherently first-personal aesthetic knowledge, but it also, like know-how, involves active skill. I end by exploring a couple of classic problems in aesthetic epistemology, applied to the case of knowledge-of as active aesthetic knowledge. (shrink)

When I say “I know Sarah,” or “I know Berlin,” what sort of knowledge am I claiming? Such knowledge of a particular is, I claim, not reducible to either propositional knowledge-that or to traditional physical know-how. Mere, bare knowledge by acquaintance also does not capture the kind of knowledge being claimed here. Using knowledge of a place as my central example, I argue that this kind of knowledge-of, or “objectual knowledge” as it is sometimes called, is of a distinctive epistemological (...) sort. It is a genre of inherently first-personal aesthetic knowledge, but it also, like know-how, involves active skill. I end by exploring a couple of classic problems in aesthetic epistemology, applied to the case of knowledge-of as active aesthetic knowledge. (shrink)

In Games: Agency as Art, Thi Nguyen has given us a deep and compelling picture of agency as much more layered, volatile, environment-dependent and discontinuous than it appears in most philosophical accounts. Games ‘inscribe … forms of agency into artifactual vessels’.1 1 When we play a game, we take up a form of agency, including a set of motivations, values and goals, which has been artificially provided by the game. Our purpose in playing, in the kinds of gameplay that interest (...) Nguyen, is to have the aesthetic experience of first-personally exercising the kind of agency sculpted by the game. As we move in and out of gameplay, we take up and drop values, motives, and goals that are provided to us by the game. Games can expand our autonomy and the richness of life by allowing us to practice different forms of agency, taking on different ends for the aesthetic experience of striving to meet them. While I am on board with these central moves of Nguyen’s book, in this essay I will argue that the situation is substantially messier than Nguyen portrays it as being. Game play, I will claim, is inextricably embedded and entangled in its larger social, material and cultural context. Conversely, I will argue, everyday life is routinely sculpted in ways Nguyen claims are distinctive of games. (shrink)

I argue that the concept of disease serves such radically different strategic purposes for different kinds of stakeholders that coming up with a unified philosophical definition of disease is hopeless. Instead, I defend a radically pluralist, pragmatist account of when it is appropriate to mobilize the concept of disease. I argue that it is appropriate to categorize a condition as a disease when it serves legitimate strategic goals to at least partially medicalize that condition, and when the condition is pathological (...) from inside the epistemology and metaphysics of medicine. While some conditions, like pancreatic cancer, are legitimate diseases from all stakeholders’ points of view and in any context, and while other conditions, like homosexuality, are not diseases from any legitimate point of view, there is a range of interesting, messy cases—including Deafness, autism, pre-hypertension, infertility, and ADHD, for example—whose disease status is irreducibly context-dependent and under contest. (shrink)

Traditional moral explorations of sexual violation are dyadic: they focus on the relationship between the perpetrator and the victim, considered in relative isolation. We argue that the moral texture of sexual violation and its fallout only shows up once we see acts of sexual violation as acts that occur within an ecosystem. An ecosystem is made up of dwellers and an environment embedded in a broad, thick, interdependent, and relatively stable web of norms, practices, environments, material and institutional structures. We (...) argue that many of the important and interesting harms wrought by sexual violation can only be understood as ecological harms. To illustrate this, we focus on sexual violations that occur within a specific type of ecosystem, namely an academic department with a graduate program. We examine the possible damaging effects of sexual violation on the ecology of a department. We also consider what makes an ecosystem resilient and relatively able to self-repair, and how sexual violation within an ecosystem may weaken its self-repairing resources. We show that looking at sexual violation through this ecological lens lets us identify harms that are otherwise obscured or difficult to locate. (shrink)

Discussions of uptake in the philosophy of language focus our attention on what role other people have in fixing the import, success, influence and social life of a speech act. The general idea in most discussions of uptake, despite their differences and disagreements, is whether and how an audience is cooperative or uncooperative when a speaker plays a critical role in how speech acts function. This essay is primarily concerned with “refusals”, or uncooperative uptakes. The essay analyzes the varieties of (...) refusal; when refusal is possible why it might be challenging and when it is ethical. It examines how and when the uptake of a speech act can constitute the pragmatic form and force of the original speech act. (shrink)

Maps provide us with an easily recognizable version of the new demarcation problem: On the one hand, we are all familiar with graphics and maps that unacceptably distort our perceptions without being technically inaccurate or fictive; indeed there are whole websites groups devoted to curating such images for fun. On the other hand, there are multiple unavoidably value-laden choices that must be made in the production of any map. Producing a map requires choosing everything from the colors and thicknesses of (...) the lines, the scale, the projection system, the categories and parameters represented, and much more. There is no neutral default for any of these choices, and all of them shape what information the map communicates. All the visual choices involved in producing a map enable some information to be conveyed at the cost of hiding or distorting other information, as map makers themselves routinely acknowledge and discuss. Hence there are no straightforward answers to questions about the line between distortion and legitimate representational choices. I explore three distinctive kinds of epistemic risks in map-making that generate special versions of the demarcation problem, which I dub aesthetic risk, categorization risk, and simplification risk. I argue that in each case, even good maps – maps that are accurate and epistemically valuable – have the potential to mislead us. I end by looking at maps that offer special epistemic benefits by making clear their own lack of value-neutrality while still being accurate and epistemically fecund. (shrink)

This issue of the Kennedy Institute of Ethics Journal offers essays about risk, social values, and how to act in the face of risk, especially when our risk assessments are socially freighted. It is made up of two clusters of related papers.The first cluster consists of two papers that explore the ways in which our risk assessments are shaped by moral panic around HIV, and its accompanying legacy of fear, homophobia, and stigma. These papers take up ethical and social dimensions (...) of PrEP and of blood donation in the face of social and medical policies based on risk distortions.The second cluster of papers is a back-and forth exchange in response to... (shrink)

In this issue's lead article, "Adolescent Medical Transition is Ethical: An Analogy with Reproductive Health," Florence Ashley argues that insofar as we accept that abortion and birth control can be ethical interventions for adolescents, so, by analogy, should we treat interventions such as puberty blockers that aid in gender transition as ethical. None of these interventions treat illness or pathology, but rather they operate on healthy bodies, not in order to cure, but in order to help patients live in line (...) with their fundamental self-conception and to realize their embodied goals. Parenting, pregnancy, and gender all go to the heart of our embodied identities and sense of self, they point out. Moreover, Ashley... (shrink)

All five articles in this issue consider, in different ways, what it takes to respect an individual’s humanity; each one offers a broader conception of human regard than is standard in the practical ethics literature. Respectively, they explore how truth-telling, providing appropriate treatment for those with substance use disorders, enabling real reproductive choice and control, and providing meaningful access to the internet all form important parts of what it takes to treat people as fully human and to care for their (...) well-being. All are grounded not just in abstract rights arguments, but in attention to the empirical and social conditions of... (shrink)

It is with great pleasure and a sense of urgency that we present this KIEJ double issue on ethical issues raised by the COVID-19 pandemic. The sheer range of ethical concerns raised by the pandemic, combined with the speed with which these problems emerged, is staggering and unprecedented in our generation. We have tried to give space to papers that raise immediately pressing ethical issues that have not received much discussion in popular media. Topics range from fundamental questions about how (...) we set up our public health infrastructure, to ethical issues in scientific communication and the translation of science into policy, to the impact of the pandemic on people with intellectual disabilities, to the ethics of... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:The Maternal Imprint: The Contested Science of Maternal-Fetal Effects (2021) by Sarah RichardsonQuill KuklaQuill Kukla, review of Sarah Richardson's The Maternal Imprint: The Contested Science of Maternal-Fetal Effects (2021)I had been eagerly anticipating the release of Sarah Richardson's meticulously researched The Maternal Imprint: The Contested Science of Maternal-Fetal Effects (2021) for several years, and I was not disappointed. A leading feminist scholar of the history and philosophy (...) of science, Richardson traces the scientific history of the idea that pregnant people's bodies control the future health, character, and well-being of their offspring. She also explores how this science is translated into social messaging and shaped by social ideology. Richardson delves into the details of the methodology, motivations, results, and communication of the science of maternal influences. She reveals a history of shaky results, contested methods, and socially loaded messaging, unified by a sustained interest in framing maternal bodies as sites of risk and responsibility for birth outcomes.A central narrative of the book is that the perceived location and mechanism through which pregnant bodies control fetal development keeps shifting around; over time, scientists have located this maternal influence in the uterine environment, the cytoplasm, the methylation of DNA, maternal nutrition, and even in the emotions, thoughts, and imagination of the mother, among other locations.1 Each time a version of the maternal influence hypothesis re-emerges, targeting a different bodily location and mechanism, it comes along with similar social messaging: pregnant people are distinctively responsible for the 'quality' of their children; their bodies are distinctive sites of risk, in need of social management; and their influence can be understood and controlled independent of the context in which they live. Given how many times this scientific hypothesis and its accompanying social messaging has died and been reborn, it is hard not to conclude, with Richardson, that background ideology compels us to keep searching for new stories that take this same form. The idea that pregnant people's bodies are understood as decontextualized and heightened sites of risk and responsibility for birth outcomes, in need of systematic discipline (both self-discipline and social discipline) in order to ensure their production of proper offspring, is one that has been explored [End Page e-1] in quite a bit of depth within feminist theory and reproductive ethics over the last thirty years. To name just a few, Barbara Duden's Disembodying Women: Perspectives on Pregnancy and the Unborn (1993), Deborah Lupton's "Risk and the Ontology of Pregnant Embodiment" (1999), Lisa Mitchell's Baby's First Picture: Ultrasound and the Politics of Fetal Subjects (2001), and my own Mass Hysteria: Medicine, Culture, and Mothers' Bodies (2005) are all works firmly within this tradition. What is new about Richardson's book is not the development and exploration of this cultural narrative and imaginary, but rather her rigorous and skillful analysis of the science that has grown out of and undergirded it. Richardson is a masterful writer, who makes scientific details comprehensible and fascinating. Her historical and epistemological analyses of exactly what shaped the science at each stage, what each scientific iteration did and didn't manage to show, and how these different scientific movements were translated into public messaging, is sharp and compelling. Richardson shows us the inner workings of how scientific programs build momentum; how scientists make methodological decisions; and how results feed into ongoing research programs. From this book, we also develop a rich sense of just how much uncertainty is baked into the science of human development, and how both scientific and public excitement about a given research program are mostly independent of the success and security of the science that comes out of it. The book traces 150 years of the history of the science of maternal influences, culminating in the current focus on epigenetics—which, like various past maternal influence theories, has ignited our broader social imagination. Epigenetics, roughly, is the study of molecular changes outside our DNA that control how genes express themselves. Environmental stimuli (such as stress) can cause changes in methylation, and thereby influence the expression of the genome: "Epigenetic markers that help determine whether a... (shrink)

We would like to thank […] for their thoughtful engagement with our paper. In the end, we do not think that they have demonstrated substantive tensions in our view, but explaining why this is so gi...

This is my reply to commentators in the symposium on my book, GAMES: AGENCY AS ART. The symposium features commentary by Thomas Hurka, Quill Kukla, and Alva Noe, and originally appeared in Analysis 81 (2).

I explore how gender can shape the pragmatics of speech. In some circumstances, when a woman deploys standard discursive conventions in order to produce a speech act with a specific performative force, her utterance can turn out, in virtue of its uptake, to have a quite different force—a less empowering force—than it would have if performed by a man. When members of a disadvantaged group face a systematic inability to produce a specific kind of speech act that they are entitled (...) to perform—and in particular when their attempts result in their actually producing a different kind of speech act that further compromises their social position and agency—then they are victims of what I call discursive injustice. I examine three examples of discursive injustice. I contrast my account with Langton and Hornsby's account of illocutionary silencing. I argue that lack of complete control over the performative force of our speech acts is universal, and not a special marker of social disadvantage. However, women and other relatively disempowered speakers are sometimes subject to a distinctive distortion of the path from speaking to uptake, which undercuts their social agency in ways that track and enhance existing social disadvantages. (shrink)

Social constructionists maintain that we invent the properties of the world rather than discover them. Is reality constructed by our own activity? Do we collectively invent the world rather than discover it? André Kukla presents a comprehensive discussion of the philosophical issues that arise out of this debate, analysing the various strengths and weaknesses of a range of constructivist arguments and arguing that current philosophical objections to constructivism are inconclusive. However, Kukla offers and develops new objections to constructivism, (...) distinguishing between the social causes of scientific beliefs and the view that all ascertainable facts are constructed. (shrink)

Mothers serve as an important layer of the health-care system, with special responsi-bilities to care for the health of families and nations. In our social discourse, we tend to treat maternal “choices” as though they were morally and causally Self-contained units of influence with primary control over children's health. In this essay, I use infant feeding as a lens for examining the ethical contours of mothers’ caretaking practices and responsibilities, as they are situated within cultural meanings and institutional pressures. I (...) give a close critical reading of the content and strategy of the new breastfeeding advocacy campaign sponsored by the United States Department of Health and Human Services. I argue that the campaign is unlikely to substantially increase breastfeeding rates, unresponsive and even hostile to many women's actual concerns about breastfeeding, and well positioned to produce shame and compromise agency among the women it targets. (shrink)

: The standard bioethics account is that respecting patient autonomy means ensuring patients make their own decisions. In fact, respecting patient autonomy often has more to do with the overall shape and meaning of patients' health care regimes, and sometimes, at least, patients will very reasonably defer to medical authority.

The standard bioethics account is that respecting patient autonomy means ensuring that patients make their own decisions, and that requires that they give informed consent. In fact, respecting autonomy often has more to do with the overall shape and meaning of their health care regimes. Ideally, patients will sometimes take control of their health care but sometimes defer to medical authority. The physician's task is, in part, to inculcate patients into the appropriate good health care regimes.

Euthanasia and assisted suicide was openly permitted but not technically legal in the Netherlands for decades. In 2002, it was formally legalised through the Termination of Life on Request and Assisted Suicide Review Procedures Act, subject to two main criteria: the patient had to be capable of making voluntary decisions and the patient had to experience unbearable suffering without prospect of improvement. Within the Netherlands, EAS has wide acceptance, and the public in general seems to favour a liberal interpretation of (...) both of these requirements. Physicians are expected to use ‘their own moral compass’ to decide about personal participation, and it is generally possible and permissible to find a substitute physician if the patient meets the legally required criteria but the physician is not comfortable assisting. Over the years, multiple quantitative and qualitative studies have explored the Dutch practice of EAS,1–3 but relatively little is known about the edges of what counts as meeting these criteria and how acceptable the practice is for physicians who participate. The study by Snijdewind et al gives a glimpse of these boundaries and suggests that at least sometimes the criteria are being stretched and adapted to meet the perceived needs of patients, and some participating physicians are relatively uncomfortable with some of the requests with which they are faced.4 Just how rare or common these ‘edgy’ cases are within the larger practice of EAS in the Netherlands cannot be answered by …. (shrink)

: Mothers serve as an important layer of the health-care system, with special responsibilities to care for the health of families and nations. In our social discourse, we tend to treat maternal "choices" as though they were morally and causally self-contained units of influence with primary control over children's health. In this essay, I use infant feeding as a lens for examining the ethical contours of mothers' caretaking practices and responsibilities, as they are situated within cultural meanings and institutional pressures. (...) I give a close critical reading of the content and strategy of the new breastfeeding advocacy campaign sponsored by the United States Department of Health and Human Services. I argue that the campaign is unlikely to substantially increase breastfeeding rates, unresponsive and even hostile to many women's actual concerns about breastfeeding, and well positioned to produce shame and compromise agency among the women it targets. (shrink)

Scientific realists have argued that the truth(likeness) of our theories provides the only explanation for the success of science. I consider alternative explanations proposed by antirealists. I endorse Leplin's contention that neither van Fraassen's Darwinist explanation nor Laudan's methodological explanation provides the sort of explanatory alternative which is called for in this debate. Fine's suggestion--that the empirical adequacy of our theories already explains their success--is more promising for antirealists. Leplin claims that this putative explanation collapses into realism on one reading (...) and into vacuity on another reading. But his analysis conflates three doctrines into two, and one of the three avoids both realism and vacuity. (shrink)

This paper discusses a crisis of accountability that arises when scientific collaborations are massively epistemically distributed. We argue that social models of epistemic collaboration, which are social analogs to what Patrick Suppes called a “model of the experiment,” must play a role in creating accountability in these contexts. We also argue that these social models must accommodate the fact that the various agents in a collaborative project often have ineliminable, messy, and conflicting interests and values; any story about accountability in (...) a massively distributed collaboration must therefore involve models of such interests and values and their methodological and epistemic effects. (shrink)

Voluntary active euthanasia and physician-assisted suicide remain technically illegal in the Netherlands, but the practices are openly tolerated provided that physicians adhere to carefully constructed guidelines. Harsh criticism of the Dutch practice by authors in the United States and Great Britain has made achieving a balanced understanding of its clinical, moral, and policy implications very difficult. Similar practice patterns probably exist in the United States, but they are conducted in secret because of a more uncertain legal and ethical climate. In (...) this manuscript, we plan to compare end-of-life care in the United States and the Netherlands with regard to underlying values, justifications, and practices. We will explore the risks and benefits of each system for a real patient who was faced with a common end-of-life clinical dilemma, and close with challenges for public policies in both countries. (shrink)

What do Jerry Fodor and Bas van Fraassen, the archetypical scientific realist and his antirealist shadow, have in common? They’re both defenders of the theory-observation distinction. It isn’t surprising that a realist and an antirealist should agree about something; but it is curious that van Fraassen’s and Fodor’s defenses of the theory-observation distinction play diametrically opposite roles in their philosophical agendas. Van Fraassen needs it to support his antirealism; Fodor wants it in support of his realism. Van Fraassen needs the (...) distinction in order to protect antirealism from the charge of incoherence. Antirealists wish to ascribe a more exalted status to the observational import of a theory than to its nonobservational claims. Van Fraassen’s version of the antirealist thesis is that belief in observational claims is rationally warranted under some logically and nomologically possible conditions, whereas belief in theoretical claims is never warranted. This identifies the species of antirealism at issue as epistemic antirealism. This position would be a nonstarter if the observational import couldn’t be distinguished from the rest. And, in fact, denying the coherence of the theory-observation distinction has been a popular realist gambit in the debate about scientific realism. (shrink)

This paper offers some critical thoughts concerning the concept of "civic" or "political" friendship within commercial societies. In response to Badhwar's suggestion (2008) that the "free market" provides the best opportunities for political friendship, I argue that civic philia cannot be reduced to a form of "market-friendship." This was already apparent to early advocates of the market who recognized the fragility of friendship under capitalism. Subsequent attempts to address this dilemma bring into focus the deficiency of market friendships and the (...) concept of friendship more broadly. In conclusion, I argue that Kant's attempt to circumscribe friendship for the sake of "civility" contains the seeds of friendship's renewal. (shrink)

In this issue of The Journal of Medical Ethics, xxx and colleagues report a randomized trial of the influence of default options on delivery room management of an extremely premature infant. They report that among respondents to the hypothetical vignette, those who received the resuscitation default were significantly more likely to choose resuscitation compared with those who were told that the default was comfort care. While the results warrant attention and further investigation, several methodological shortcomings limit the conclusions that can (...) be drawn from this study. (shrink)

Voluntary active euthanasia (VAE) and physician-assisted suicide (PAS) remain technically illegal in the Netherlands, but the practices are openly tolerated provided that physicians adhere to carefully constructed guidelines. Harsh criticism of the Dutch practice by authors in the United States and Great Britain has made achieving a balanced understanding of its clinical, moral, and policy implications very difficult. Similar practice patterns probably exist in the United States, but they are conducted in secret because of a more uncertain legal and ethical (...) climate. In this manuscript, we plan to compare end-of-life care in the United States and the Netherlands with regard to underlying values, justifications, and practices. We will explore the risks and benefits of each system for a real patient who was faced with a common end-of-life clinical dilemma, and close with challenges for public policies in both countries. (shrink)

Palliative care and hospice should be the standards of care for all terminally ill patients. The first place for clinicians to go when responding to a request for assisted death is to ensure the adequacy of palliative interventions. Although such interventions are generally effective, a small percentage of patients will suffer intolerably despite receiving state-of-the-art palliative care, and a few of these patients will request a physician-assisted death. Five potential “last resort” interventions are available under these circumstances: (1) accelerating opioids (...) for pain or dyspnea; (2) stopping potentially life-prolonging therapies; (3) voluntarily stopping eating and drinking; (4) palliative sedation (potentially to unconsciousness); and (5) physician-assisted death. Patient, family, and clinicians should search for the least harmful way to respond to intolerable end-of-life suffering in ways that are effective and also respect the values of the major participants. A system that allows an open response to such cases ultimately protects patients by ensuring a full clinical evaluation and search for alternative responses, while reinforcing the need to be responsive and to not abandon. (shrink)

What do Jerry Fodor and Bas van Fraassen, the archetypical scientific realist and his antirealist shadow, have in common? They’re both defenders of the theory-observation distinction. It isn’t surprising that a realist and an antirealist should agree about something; but it is curious that van Fraassen’s and Fodor’s defenses of the theory-observation distinction play diametrically opposite roles in their philosophical agendas. Van Fraassen needs it to support his antirealism; Fodor wants it in support of his realism. Van Fraassen needs the (...) distinction in order to protect antirealism from the charge of incoherence. Antirealists wish to ascribe a more exalted status to the observational import of a theory than to its nonobservational claims. Van Fraassen’s version of the antirealist thesis is that belief in observational claims is rationally warranted under some logically and nomologically possible conditions, whereas belief in theoretical claims is never warranted. This identifies the species of antirealism at issue as epistemic antirealism. This position would be a nonstarter if the observational import couldn’t be distinguished from the rest. And, in fact, denying the coherence of the theory-observation distinction has been a popular realist gambit in the debate about scientific realism. (shrink)

In my career as a primary care physician and as a palliative care consultant, I have assisted many patients to die with their full consent. None of them wanted to die, and all would have chosen other paths had their disease not been so severe and irreversible. To a person, none of these patients thought of themselves as “suicidal,” and they would have found that label preposterous and demeaning. In fact, the kind of personal disintegration that the label implies is (...) just what is trying to be prevented by those choosing this possibility. So on behalf of patients who have chosen this option, I reject the title of this debate as it unnecessarily tars the discussion with the suggestion of mental illness. In my primary care practice, I have also met many patients who were “suicidal” in the mental health sense of the word, and rest assured I have assisted none of them to die. In fact, I have at times had them involuntarily hospitalized to prevent them from carrying out their wishes. (shrink)

Why be a scientific realist? The predominant motivation is explanationist: we need realism to understand the successfulness of science. Why be an antirealist? The predominant motivation is skeptical: theory systematically exceeds the reach of empirical warrant. Antirealists deny that explanatory power is evidential; realists deny that the reach of empirical warrant summarily terminates at the boundary of the observable. But these counterarguments are mere protection of philosophical stances to which the adversaries independently incline.