In her 2018 book, What the Eyes Don’t See, Dr. Mona Hanna-Attisha wrote that it is the duty of doctors to speak out against injustice. In fact, no other physician or institution in Flint had done the research and spoken out, as a whistleblower, against the poisoning of Flint’s children by Michigan government. Why had Dr. Hannah-Attisha? Unfortunately, in the absence of a medical education system that teaches community-oriented primary health care in the tradition of the 1978 Alma Ata Declaration, (...) there is little reward in doing so. This article focuses on three movements that are challenging medical education orthodoxy: 1) primary health care 2) the medical humanities and 3) “Study Up your Town” medicine. How can we create a radical health pedagogy – one that draws the links between several pandemics raging across the planet: capitalist collapse, climate disruption, Covid-19, racism, and an emergent neoliberal fascism – to enable doctors, health professionals and citizens to see them as all of one piece? Medical educators must employ critical pedagogy to create legions of “constructive troublemakers” who challenge the social-structural obstacles that are driving millions to premature death. We have reached the “end times.” A new “planet medicine” is finally emerging. (shrink)

An anthropologist describes how he found himself at the vortex of a “clash of medical civilizations:” neoliberalism and the international primary health care movement. His involvement in a $6 million social change initiative in medical education became a basis to unlock the hidden tensions, contradictions and movements within the “primary care” phenomenon. The essay is structured on five ethnographic stories, situated on a continuum from “natural” species-level primary care to “unnatural” neoliberal primary care. Food is an element of all tales. (...) Taking the long view of history/prehistory permits us to better recognize ideological distortions in order to more capably transform medicine. (shrink)

Authors have a lot of leeway with regard to what they can make true in their story. In general, if the author says that p is true in the fiction we’re reading, we believe that p is true in that fiction. And if we’re playing along with the fictional game, we imagine that, along with everything else in the story, p is true. But there are exceptions to these general principles. Many authors, most notably Kendall Walton and Tamar Szabó Gendler, (...) have discussed apparent counterexamples when p is “morally deviant”. Many other statements that are conceptually impossible also seem to be counterexamples. In this paper I do four things. I survey the range of counterexamples, or at least putative counterexamples, to the principles. Then I look to explanations of the counterexamples. I argue, following Gendler, that the explanation cannot simply be that morally deviant claims are impossible. I argue that the distinctive attitudes we have towards moral propositions cannot explain the counterexamples, since some of the examples don’t involve moral concepts. And I put forward a proposed explanation that turns on the role of ‘higher-level concepts’, concepts that if they are satisfied are satisfied in virtue of more fundamental facts about the world, in fiction, and in imagination. (shrink)

Normative Externalism argues that it is not important that people live up to their own principles. What matters, in both ethics and epistemology, is that they live up to the correct principles: that they do the right thing, and that they believe rationally. This stance, that what matters are the correct principles, not one's own principles, has implications across ethics and epistemology. In ethics, it undermines the ideas that moral uncertainty should be treated just like factual uncertainty, that moral ignorance (...) frequently excuses moral wrongdoing, and that hypocrisy is a vice. In epistemology, it suggests we need new treatments of higher-order evidence, and of peer disagreement, and of circular reasoning, and the book suggests new approaches to each of these problems. Although the debates in ethics and in epistemology are often conducted separately, putting them in one place helps bring out their common themes. One common theme is that the view that one should live up to one's own principles looks less attractive when people have terrible principles, or when following their own principles would lead to riskier or more aggressive action than the correct principles. Another common theme is that asking people to live up to their principles leads to regresses. It can be hard to know what action or belief complies with one's principles. And now we can ask, in such a case should a person do what they think their principles require, or what their principles actually require? Both answers lead to problems, and the best way to avoid these problems is to simply say people should follow the correct principles. (shrink)

We provide a new interpretation of Zeno’s Paradox of Measure that begins by giving a substantive account, drawn from Aristotle’s text, of the fact that points lack magnitude. The main elements of this account are (1) the Axiom of Archimedes which states that there are no infinitesimal magnitudes, and (2) the principle that all assignments of magnitude, or lack thereof, must be grounded in the magnitude of line segments, the primary objects to which the notion of linear magnitude applies. Armed (...) with this account, we are ineluctably driven to introduce a highly constructive notion of (outer) measure based exclusively on the total magnitude of potentially infinite collections of line segments. The Paradox of Measure then consists in the proof that every finite or potentially infinite collection of points lacks magnitude with respect to this notion of measure. We observe that the Paradox of Measure, thus understood, troubled analysts into the 1880’s, despite their knowledge that the linear continuum is uncountable. The Paradox was ultimately resolved by Borel in his thesis of 1893, as a corollary to his celebrated result that every countable open cover of a closed line segment has a finite sub-cover, a result he later called the “First Fundamental Theorem of Measure Theory.” This achievement of Borel has not been sufficiently appreciated. We conclude with a metamathematical analysis of the resolution of the paradox made possible by recent results in reverse mathematics. (shrink)

Peter van Inwagen contends that nonresponsibility transfers across deterministic relations. Suppose it does. If the facts of the past and the laws of nature entail every truth about what one does, and no one is even in part morally responsible for the past and the laws, then no one is even in part morally responsible for what one does. This argument, the Direct Argument, has drawn various critics, who have attempted to produce counterexamples to its core inference principle. This article (...) considers two notable efforts, one by John Martin Fischer and Mark Ravizza and another by David Widerker. It shows that neither is sufficient to reject the Direct Argument. The article then proceeds to challenge the argument in a novel fashion. Van Inwagen has not given us good reason to think that the principle in question has an adequate anchor in our inferential practices, especially in light of the dialectical context with the compatibilist. Hence, it is not the compatibilists' burden to produce counterexamples to it. Rather, it is van Inwagen's burden to produce relevant confirming instances of it. (shrink)

We trace the genealogy of wisdom to show that its status in epistemological and management discourse has gradually declined since the Scientific Revolution. As the status of wisdom has declined, so the status of rational science has grown. We argue that the effects on the practice of management of the decline of wisdom may impede management practice by clouding judgment, degrading decision making, and compromising ethical standards. We show that wisdom combines transcendent intellection and rational process with ethics to provide (...) a balanced and integrated way of knowing, deciding, and acting for managers in a complex and uncertain business environment. Finally, we discuss the role and value of wisdom across a range of business functions including knowledge management, strategic management, leadership and international business. (shrink)

In this paper, we explore how a conversational theory of moral responsibility can provide illuminating resources for building a theory about the nature and norms of moral forgiveness.

This accessible work of scholarship brings a pragmatist ecofeminist perspective to discussions around animal rights, animal welfare, and animal ethics. Rather than seek absolute moral stands regarding human and animal relationships, and rather than trying to end such relationships altogether, the books urges us to make existing relations better.

We applaud Ray and Cooper (2024) for emphasizing environmental health as a bioethics issue. As a team of interdisciplinary pediatric researchers and providers who are part of an institutional clima...

This book explores an important issue within the free will debate: the relation between free will and moral responsibility.

Two conceptual strands of research within the field of cathedral studies have theorised the capacity of Anglican cathedrals to engage more successfully than parish churches with the wider non-churchgoing community. One strand has explored mobilising cathedral metaphors, and the other strand has explored the notion of implicit religion. Both strands illuminate the power of events and installations to soften the boundaries between common ground and sacred space. Drawing on a quantitative survey among 978 people who attended the pre-Christmas son et (...) lumiere at Liverpool Cathedral during December 2022, the present study analyses the qualitative responses of 123 participants who never attend church services. Three categories of themes emerged from these data, concerning the Cathedral itself, the installation, and discordant experience.Contribution: Situated within the science of cathedral studies, this article draws on original qualitative data to illuminate the experiences of participants who never attend church services when engaging with the pre-Christmas son et lumiere at a major cathedral. Conceptualised within the framework of implicit religion, these data confirmed how the son et lumiere succeeded in softening boundaries between the sacred and the secular and provided a deeply moving experience. As one participant said, ‘I am not religious, but I had the best experience ever’. (shrink)

This book contains twelve chapters by leading and up-and-coming philosophers on metaepistemology, that is, on the nature, existence and authority of epistemic facts. One of the central divides in metaepistemology is between epistemic realists and epistemic anti-realists. Epistemic realists think that epistemic facts exist independently of human judgements and practices, and that they have authority over our judgements and practices. Epistemic anti-realists think that, if epistemic facts exist at all, they are grounded in human judgements and practices, and gain any (...) authority they have from our judgements and practices. This book considers both epistemic realist and anti-realist perspectives, as well as perspectives that 'transcend' the realism/anti-realism dichotomy. As such, it constitutes the 'state of the art' with regard to metaepistemology, and will shape the debate in years to come. (shrink)

In this article we survey six recent developments in the philosophical literature on free will and moral responsibility: (1) Harry Frankfurt's argument that moral responsibility does not require the freedom to do otherwise; (2) the heightened focus upon the source of free actions; (3) the debate over whether moral responsibility is an essentially historical concept; (4) recent compatibilist attempts to resurrect the thesis that moral responsibility requires the freedom to do otherwise; (5) the role of the control condition in free (...) will and moral responsibility, and finally (6) the debate centering on luck. (shrink)

Empirical work on motivated reasoning suggests that our judgments are influenced to a surprising extent by our wants, desires and preferences (Kahan 2016; Lord, Ross, and Lepper 1979; Molden and Higgins 2012; Taber and Lodge 2006). How should we evaluate the epistemic status of beliefs formed through motivated reasoning? For example, are such beliefs epistemically justified? Are they candidates for knowledge? In liberal democracies, these questions are increasingly controversial as well as politically timely (Beebe et al. 2018; Lynch forthcoming, 2018; (...) Slothuus and de Vreese 2010). And yet, the epistemological significance of motivated reasoning has been almost entirely ignored by those working in mainstream epistemology. We aim to rectify this oversight. Using politically motivated reasoning as a case study, we show how motivated reasoning gives rise to three distinct kinds of skeptical challenges. We conclude by showing how the skeptical import of motivated reasoning has some important ramifications for how we should think about the demands of intellectual humility. (shrink)

This paper is about two topics: metaepistemological absolutism and the epistemic principles governing perceptual warrant. Our aim is to highlight—by taking the debate between dogmatists and conservativists about perceptual warrant as a case study—a surprising and hitherto unnoticed problem with metaepistemological absolutism, at least as it has been influentially defended by Paul Boghossian as the principal metaepistemological contrast point to relativism. What we find is that the metaepistemological commitments at play on both sides of this dogmatism/conservativism debate do not line (...) up with epistemic relativism nor do they line up with absolutism, at least as Boghossian articulates this position. What this case study reveals is the need in metaepistemological option space for the recognition of a weaker and less tendentious form of absolutism, what we call “environment relativism”. On this view, epistemic principles are knowable, objective, and they can serve as the basis of particular epistemic evaluations, but their validity is relative to the wider global environment in which they are applied. (shrink)

Scientific Essentialism defends the view that the fundamental laws of nature depend on the essential properties of the things on which they are said to operate, and are therefore not independent of them. These laws are not imposed upon the world by God, the forces of nature or anything else, but rather are immanent in the world. Ellis argues that ours is a dynamic world consisting of more or less transient objects which are constantly interacting with each other, and whose (...) identities depend on their roles in these processes. Natural objects must behave as they do, because to do otherwise would be contrary to their natures. The laws of nature are, therefore, metaphysically necessary, and consequently, there are necessary connections between events. Brian Ellis calls for the rejection of the theory of Humean Supervenience and an implementation of a new kind of realism in philosophical analysis. (shrink)

Feminist epistemologies hold that differences in the social locations of inquirers make for epistemic differences, for instance, in the sorts of things that inquirers are justified in believing. In this paper we situate this core idea in feminist epistemologies with respect to debates about social constructivism. We address three questions. First, are feminist epistemologies committed to a form of social constructivism about knowledge? Second, to what extent are they incompatible with traditional epistemological thinking? Third, do the answers to these questions (...) raise serious problems for feminist epistemologies? We argue that some versions of two of the main strands in feminist epistemology – feminist standpoint theory and feminist empiricism – are committed to a form of social constructivism, which requires certain departures from traditional epistemological thinking. But we argue that these departures are less problematic than one might think. Thus, (some) feminist epistemologies provide a plausible way of understanding how (some) knowledge might be socially constructed. (shrink)

This paper applies Edward Craig’s and Bernard Williams’ ‘genealogical’ method to the debate between relativism and its opponents in epistemology and in the philosophy of language. We explain how the central function of knowledge attributions -- to ‘flag good informants’ -- explains the intuitions behind five different positions (two forms of relativism, absolutism, contextualism, and invariantism). We also investigate the question whether genealogy is neutral in the controversy over relativism. We conclude that it is not: genealogy is most naturally taken (...) to favour an anti-realism about epistemic norms. And anti-realism threatens absolutism. (shrink)

The relation between the Greek and Judeo-Christian traditions is "the great problem" of Western philosophy, according to Emmanuel Levinas. In this book Brian Schroeder, Silvia Benso, and an international group of philosophers address the relationship between Levinas and the world of ancient thought. In addition to philosophy, themes touching on religion, mythology, metaphysics, ontology, epistemology, ethics, and politics are also explored. The volume as a whole provides a unified and extended discussion of how an engagement between Levinas and thinkers (...) from the ancient tradition works to enrich understandings of both. This book opens new pathways in ancient and modern philosophical studies as it illuminates new interpretations of Levinas' ethics and his social and political philosophy. (shrink)

We live in a world of crowds and corporations, artworks and artifacts, legislatures and languages, money and markets. These are all social objects — they are made, at least in part, by people and by communities. But what exactly are these things? How are they made, and what is the role of people in making them? In The Ant Trap, Brian Epstein rewrites our understanding of the nature of the social world and the foundations of the social sciences. Epstein (...) explains and challenges the three prevailing traditions about how the social world is made. One tradition takes the social world to be built out of people, much as traffic is built out of cars. A second tradition also takes people to be the building blocks of the social world, but focuses on thoughts and attitudes we have toward one another. And a third tradition takes the social world to be a collective projection onto the physical world. Epstein shows that these share critical flaws. Most fundamentally, all three traditions overestimate the role of people in building the social world: they are overly anthropocentric. Epstein starts from scratch, bringing the resources of contemporary metaphysics to bear. In the place of traditional theories, he introduces a model based on a new distinction between the grounds and the anchors of social facts. Epstein illustrates the model with a study of the nature of law, and shows how to interpret the prevailing traditions about the social world. Then he turns to social groups, and to what it means for a group to take an action or have an intention. Contrary to the overwhelming consensus, these often depend on more than the actions and intentions of group members. (shrink)

In a series of works Sosa (in: Knowledge in perspective, Cambridge University Press, Cambridge, 1991; A virtue epistemology: apt belief and reflective knowledge, Oxford University Press, Oxford, 2007; Reflective knowledge: apt belief and reflective knowledge, Oxford University Press, Oxford, 2009; ‘How Competence Matters in Epistemology’, Philos Perspect 24(1):465–475, 2010; Knowing full well, Princeton University Press, Princeton, 2011; Judgment and agency, Oxford University Press, Oxford, 2015; Epistemology, Princeton University Press, Princeton, 2017) has defended the view that there are two kinds or (...) ‘grades’ of knowledge, animal and reflective. One of the most persistent critics of Sosa’s attempts to bifurcate knowledge is Kornblith (in: Greco (ed) Ernest sosa and his critics, Wiley, Hoboken, 2004; ‘Sosa in Perspective’, Philos Stud 144(1):127–136, 2009; On reflection, Oxford University Press, Oxford, 2012). Our aim in this paper is to outline and evaluate Kornblith’s criticisms. We will argue that, while they raise a range of difficult (exegetical and substantive) questions about Sosa’s ‘bi-level’ epistemology, Sosa has the resources to adequately respond to all of them. Thus, this paper is a (qualified) defence of Sosa’s bi-level epistemology. (shrink)

At the start of the twenty-first century, warnings have been raised in some quarters about how - by intent or by mishap - advances in biotechnology and related ...

What role, if any, should the government perform in a society? Two very different answers to this question have been provided by John Rawls and Robert Nozick. For Rawls, the government plays an important role in ensuring that the principles of justice are realized in the workings of society. For Nozick, the role of government is limited to that of providing protection. The debate over these two views has led to the questioning of the entire liberal doctrine, a questioning that (...) has taken place not only within intellectual circles, but also within the society at large. (shrink)

This paper reflects on some of the risks and requirements of engagingin feminist pedagogy. Feminist pedagogy seeks to promote an interactive classroom, encourage a de‐centered approach to the teaching and learning process, and take differences seriously. Some of these practices may pose risks for the practitioner in an established academic environment where one may be expected to make “pobjective” judgments and assign grades without regard for difference; where pedagogy designed to encourage an interactive classroom may be taken as indicating lack (...) of “expertise” which is often only recognized as such in authoritative assertiveness. If there is a backlash against critiques of the canon and experimentalism in pedagogy, can feminist pedagogy be a coherent practice in today's academic institutions? (shrink)

Eating animals acts as mirror and representation of patriarchal values. Meat eating is the re-inscription of male power at every meal. The patriarchal gaze sees not the fragmented flesh of dead animals but appetizing food. If our appetites re-inscribe patriarchy, our actions regarding eating animals will either reify or challenge this received culture. If meat is a symbol of male dominance then the presence of meat proclaims the disempowering of women.

In 1990 Edward Craig published a book called Knowledge and the State of Nature in which he introduced and defended a genealogical approach to epistemology. In recent years Craig’s book has attracted a lot of attention, and his distinctive approach has been put to a wide range of uses including anti-realist metaepistemology, contextualism, relativism, anti-luck virtue epistemology, epistemic injustice, value of knowledge, pragmatism and virtue epistemology. While the number of objections to Craig’s approach has accumulated, there has been no sustained (...) attempt to develop answers to these objections. In this paper we provide answers to seven important objections in the literature. (shrink)

What does an Alaskan look like? When asked to visualize someone from Alaska, the image most people conjure up is one of a face lost in a parka, surrounded by snow. Missing from this image is the vibrant diversity of those who call themselves Alaskans, as well as the true essence of the place. Brian Adams, a rising star in photography, aims to change all this with his captivating new collection, I Am Alaskan. In this full-color tribute, Adams entices (...) us to reconsider our ideas of this unique and compelling land and its equally individual residents. He captures subjects on urban streets and in rural villages, revealing what daily life in Alaska is really like. The portraits focus on moments both ordinary and extraordinary, serious and playful, while capturing Alaskans at their most natural. Subjects range from Alaska Native villagers to rarely seen portraits of famous Alaskans, including Sarah Palin, Vic Fischer, and Lance Mackey. Through photographs, Adams also explores his own half-Iñupiat, half-American Alaska identity in the process, revealing how he came to define himself and the state in which he lives. Frame by frame, Adams powerfully and honestly shows what it means to be an Alaskan. (shrink)

"Brian Orend's The Morality of War promises to become the single most comprehensive and important book on just war for this generation. It moves far beyond the review of the standard just war categories to deal comprehensively with the new challenges of the conflict with terrorism. It thoughtfully reviews every major military conflict of the past few decades, mining them for implications of the evolving tradition of just war thinking. It concludes with a critical engagement with the major alternatives (...) to just war thinking: pacifism and 'realism.' It is, in short, the most comprehensive and thoughtful assessment of all aspects of just war since Michael Walzer's classic Just and Unjust Wars." - Martin L. Cook, United States Air Force Academy. (shrink)

Despite the ongoing consideration of the ethical nature of human resource management (HRM), little research has been conducted on how morality and ethics are represented in the discourse, activities and lived experiences of human resource (HR) professionals. In this paper, we connect the thinking and lived experiences of HR professionals to an alternative ethics, rooted in the work of Bauman (Modernity and the Holocaust, Polity Press, Cambridge, 1989; Theory, Culture and Society 7:5-38, 1990; Postmodern Ethics, Blackwell, Oxford, 1991; Approaches to (...) Social Enquiry, Polity Press, Cambridge, 1993; Life in Fragments, Blackwell, Oxford, 1995) and Levinas (Otherwise than Being, or, Beyond Essence, Duquesne University Press, Pittsburgh, PA, 1998). We argue that the study of HRM and ethics should be contextualized within the discourses used, the practices and activities of HR professionals. Through the analysis of interview data from 40 predominantly Canadian HR practitioners and managers we experiment with Bauman's notion of 'moral impulse' to help us understand how HRM is both a product and perpetuator of moral neutralization in organizations. We suggest that HRM as it is practiced is concerned with distancing, depersonalizing, and dissembling, and acts in support of the 'moral' requirements of business, not of people. However, we also recognize that HR practitioners and managers are often confronted with and conflicted by actions and decisions that they are required to take, therefore opening possibilities and hope for an alternative ethical HRM. (shrink)

Abstract Kant claims that the basis of a judgment of taste is a merely subjective representation and that the only merely subjective representations are feelings of pleasure or displeasure. Commentators disagree over how to interpret this claim. Some take it to mean that judgments about the beauty of an object depend only on the state of the judging subject. Others argue instead that, for Kant, the pleasure we take in a beautiful object is best understood as a response to its (...) qualities, and that, accordingly, feelings of pleasure or displeasure are no different from other representations, such as colors or smells. While I agree that the judgment of taste is best understood as asserting a claim about an object's qualities, I argue that the distinction Kant makes between feelings of pleasure or displeasure and other representations should not be ignored. I show that one's liking or disliking for an object is merely subjective in the sense that its significance depends on what one has made of oneself through one's aesthetic education. The judgment of taste, then, is merely subjective because one must first become the kind of person whose feelings have the right significance at the right time before one can determine whether an object's qualities make it beautiful. (shrink)

My research focuses on developing a pragmatist model of utopia informed by certain elements of contemporary feminist thought. I believe this model is more productive than previous end-state and anarchist models of utopia. Specifically, this pragmatist model is able to address the issues of diversity, difference, and social stability without requiring, as many models of utopia do, conformity or central control. Rather than seeing the issues of gender, race, and cultural plurality as the obstacles to making a better world, on (...) the pragmatist model these are the very components necessary for developing a more enriching human experience. ;The philosophical issue that prompts this research is the question of how we should live--the question of what comprises the good life. Utopian writing takes up this very question and presents various pictures of the "good life" as an ongoing live concern, not just as a theoretical concern. Utopian visions have been denigrated for being, among other things, authoritarian, manipulative, and static visions. While many of these criticisms are warranted, I present what I take to be a more constructive model that answers these criticisms. ;My dissertation draws on the work of John Dewey to develop a pragmatic model of utopia and then on the work of several contemporary feminist writers to explore what feminist thought can contribute to this model. While Dewey does not consider himself a utopian theorist, and his individual works do not necessarily qualify as utopian literature, I believe his work as a whole does. His theory of democracy and education pulls together his view of how the world could and should be. Similarly, the feminist writers I draw on do not necessarily consider themselves utopian theorists but their work focuses on problems with how the world has been and they propose hypotheses for making it different and, in their eyes, better. I believe my use of these works to develop a model of utopia will allow people to once again see utopian thought as a useful tool of political philosophy and social reform, and no longer just as proposing threatening dreams of manipulation and control. (shrink)

What is it to be morally responsible for something? Recent philosophical work reveals considerable disagreement on the question. Indeed, some theorists claim to distinguish several varieties of moral responsibility, with different conditions that must be satisfied if one is to bear responsibility of one or another of these kinds. -/- Debate on this point turns partly on disagreement about the kinds of responses made appropriate when one is blameworthy or praiseworthy. It is generally agreed that these include "reactive attitudes" such (...) as resentment and gratitude, but theorists disagree about the nature of these attitudes. They dispute the connections between moral responsibility, desert, and the justification of punishment as well. -/- Many theorists take it that, whatever the appropriate responses are, they are responses to an agent's "quality of will," but there is no consensus on what this comes to. Are the agent's beliefs about the moral status of her behavior what matter, or is it what she cares about, or what she judges important? -/- This volume presents twelve original essays from participants in these debates. The contributors include prominent established figures as well as influential younger philosophers. A substantive introduction by the editors surveys recent debates and situates the contributions within it. (shrink)

When making substituted judgments for incapacitated patients, surrogates often struggle to guess what the patient would want if they had capacity. Surrogates may also agonize over having the (sole) responsibility of making such a determination. To address such concerns, a Patient Preference Predictor (PPP) has been proposed that would use an algorithm to infer the treatment preferences of individual patients from population-level data about the known preferences of people with similar demographic characteristics. However, critics have suggested that even if such (...) a PPP were more accurate, on average, than human surrogates in identifying patient preferences, the proposed algorithm would nevertheless fail to respect the patient’s (former) autonomy since it draws on the ‘wrong’ kind of data: namely, data that are not specific to the individual patient and which therefore may not reflect their actual values, or their reasons for having the preferences they do. Taking such criticisms on board, we here propose a new approach: the Personalized Patient Preference Predictor (P4). The P4 is based on recent advances in machine learning, which allow technologies including large language models to be more cheaply and efficiently ‘fine-tuned’ on person-specific data. The P4, unlike the PPP, would be able to infer an individual patient’s preferences from material (e.g., prior treatment decisions) that is in fact specific to them. Thus, we argue, in addition to being potentially more accurate at the individual level than the previously proposed PPP, the predictions of a P4 would also more directly reflect each patient’s own reasons and values. In this article, we review recent discoveries in artificial intelligence research that suggest a P4 is technically feasible, and argue that, if it is developed and appropriately deployed, it should assuage some of the main autonomy-based concerns of critics of the original PPP. We then consider various objections to our proposal and offer some tentative replies. (shrink)