What is the relation between scientific explanation and understanding? The thesis investigates a notion of understanding that is believed to be central to scientific explanation. The role of understanding in explanation is double: it is both an essential component, as well as a criterion, by which we select bona fide explanations from non-explanations. The model of explanation that is outlined in the thesis is a version of the unificationist model of explanation. In the thesis, this model is compared to Hempel's (...) covering law model. The two models share some assumptions, but as it turns out, the unificationist model has more resources and is better suited to meet some of the objections that have been thought to be detrimental to the covering law model. The final part of the thesis is an investigation of theory reduction. The contention is that reduction is best accounted for as a sort of explanation, and it is argued that as such, it is best understood within the framework of the unificationist model of explanation that is outlined in the first part of the thesis. (shrink)

This paper defends a unificationist theory of explanation. I first explore the notion of understanding entrenched by the unificationist. Then I present an overview of various kinds of causal statements and explanations. It is claimed that only genuine causal law statements have explanatory power. Finally, I attempt to fit causal explanations into the unificationist theory of explanation. In this way, I try to provide an account of how causal explanations provide understanding of the phenomena that they explain.

It is observed that in ordinary everyday causal explanations often just one causal factor is mentioned. One causal factor carries the explanatory burden, even if there are several causal factors that are responsible for the event to be explained. This paper deals with the question of how to account for this explanatory selection. I argue for a pragmatic stance towards explanation, that we must attend to the question–answer situation as a whole and the context of the explanation. The context of (...) an explanation includes the inquirer's and the explainer's beliefs and presuppositions relevant for the explanation-seeking question, and these are encoded in a reference class. Furthermore I argue that the explanation-giving answer contains an implicit counterfactual claim, the explanation-giving counterfactual. The solution to the problem of explanatory selection is to be found in the presuppositions encoded by the reference class and the eg-counterfactual. In short we select as explanatory that factor which, together with the presupposition encoded in the reference class we believe will make the eg-counterfactual true. (shrink)

I explore how we negotiate sexual encounters with one another in language and consider the pragmatic structure of such negotiations. I defend three theses: Discussions of consent have dominated the philosophical and legal discourse around sexual negotiation, and this has distorted our understanding of sexual agency and ethics. Of central importance to good-quality sexual negotiation are sexual invitations and gift offers, as well as speech designed to set up safe frameworks and exit conditions. Sexual communication that goes well does not (...) just prevent harm; it enables forms of agency, pleasure, and fulfillment that would not otherwise be possible. (shrink)

When patients have progressive and incurable dementia, should their advance directives always be followed? Contra Dworkin, Dresser argues that when patients remain able to enjoy and participate in their lives, directives to hasten death should sometimes be disregarded.

I explore the role that values and interests, especially ideological interests, play in managing and balancing epistemic risks in medicine. I will focus in particular on how diseases are identified and operationalized. Before we can do biomedical research on a condition, it needs to be identified as a medical condition, and it needs to be operationalized in a way that lets us identify sufferers, measure progress, and so forth. I will argue that each time we do this, we engage in (...) epistemic risk balancing that inevitably draws upon values and interests, often including social and ideological values. My main interest here is in the conceptualization of infertility as a disease. Infertility is a rich test case for exploring the interplay between interests and epistemic risk management. There is no uncontested or standardized definition of infertility. The various definitions of it are internally ambiguous and tension-ridden, and in spectacular contradiction with one another. Many interest groups who are invested in framing infertility as a pressing problem deserving of social and medical redress are quick to insist that it is a legitimate ‘disease,’ but they cannot agree on which disease it is, what its symptoms or diagnostic markers are, or even what its basic ontology is. I suggest that there are political explanations for this epistemic mess. Indeed, I contend that there are good scientific and ethical reasons to reduce away the category of ‘infertility,’ especially understood as a scientific or medical category; I argue that we should excise the concept from our research and clinical practices. (shrink)

The goal of this paper is to give an account of the pragmatic and social function of slurs, taken as speech acts. I develop a theory of the distinctive illocutionary force and pragmatic structure of slurs. I argue that slurs help to produce subjects who occupy social identities carved out by pernicious ideologies, and that they do this whether or not anyone involved intends for the slur to work that way or has any particular feelings or conscious thoughts associated with (...) using or being targeted by the slur. I offer an Althusser‐inspired account of what an ideology is, as well as of the mechanisms by which slurs can serve to cue and strengthen ideologies. A slur, I argue, is a kind of interpellation, which reduces its target to a generic identity and derogates and subordinates its target. I explore how slurs and ideologies work in tandem to constitute and fortify one another. I end by applying my account to see how well it fits and helps illuminate three quite different, especially complex slurs. (shrink)

Mass Hysteria examines the medical and cultural practices surrounding pregnancy, new motherhood, and infant feeding. Late eighteenth century transformations in these practices reshaped mothers' bodies, and contemporary norms and routines of prenatal care and early motherhood have inherited the legacy of that era. As a result, mothers are socially positioned in ways that can make it difficult for them to establish and maintain healthy and safe boundaries and appropriate divisions between public and private space.

Ghostwriting scandals are pervasive in industry-funded biomedical research, and most responses to them have presumed that they represent a sharp transgression of the norms of scientific authorship. I argue that in fact, ghostwriting represents a continuous extension of current socially accepted authorship practices. I claim that the radically collaborative, decentralized, interdisciplinary research that forms the gold standard in medicine is in an important sense unauthored, and that this poses a serious problem in applied social epistemology. It is no easy matter (...) to find procedural or architectural solutions that can secure epistemic trust and accountability for collaborative publishing in biomedicine. (shrink)

Wilfrid Sellars's iconic exposé of the ‘myth of the given’ taught us that experience must present the world to us as normatively laden, in the sense that the contents of experience must license inferences, rule out and justify various beliefs, and rationalize actions. Somehow our beliefs must be governed by the objects as they present themselves to us. Often this requirement is cashed out using language that attributes agent-like properties to objects: we are described as ‘accountable to’ objects, while objects (...) ‘hold us’ to standards, and so forth. But such language is either deeply anti-naturalistic or trades on a set of metaphors in need of a literal translation. We offer an explanation of how the material features of the world, as received in experience, can rationally constrain our beliefs and practices—one that makes no recourse to this imagery. In particular, we examine the structure of ostensive practices (that is, practices of directing one another's attention to objects and features of the world) and the distinctive role they play in making us jointly beholden to how things actually are. (shrink)

As a culture, we have a tendency to measure motherhood in terms of a set of signal moments that have become the focus of special social attention and anxiety; we interpret these as emblematic summations of women's mothering abilities. Women's performances during these moments can seem to exhaust the story of mothering, and mothers often internalize these measures and evaluate their own mothering in terms of them. "Good" mothers are those who pass a series of tests—they bond properly during their (...) routine ultrasound screening, they do not let a sip of alcohol cross their lips during pregnancy, they give birth vaginally without pain medication, they do not offer their child an artificial nipple during the first six months, they feed their children maximally nutritious meals with every bite, and so on. This reductive understanding of mothering has had counterproductive effects upon health care practice and policy, encouraging measures that penalize mothers who do not live up to cultural norms during signal moments, while failing to promote extended narratives of healthy mothering. (shrink)

Epistemologists generally think that genuine warrant that is available to anyone must be available to everyone who is exposed to the relevant causal inputs and is able and willing to properly exercise her rationality. The motivating idea behind this requirement is roughly that an objective view is one that is not bound to a particular perspective. In this paper I ask whether the aperspectivality of our warrants is a precondition for securing the objectivity of our claims. I draw upon a (...) Sellarsian account of perception in order to argue that it is not; rather, inquirers can have contingent properties and perspectives that give them access to forms of rational warrant and objective knowledge that others do not have. The universal accessibility of reasons, on my account, is not a precondition for the legitimacy of any actual warrant, but rather a regulative ideal governing inquiry and communication. (shrink)

Translational science is a 21st century mission. Government officials and industry leaders are making huge investments in an attempt to transform more basic science discoveries into therapeutic applications. Scientists and policymakers express great excitement about the medical advances that could come with the current bench-to-bedside campaign.A key step in translational science is the move from animal and other preclinical studies to initial human testing. Researchers ability to predict human effects is limited, and first-in-human tests present significant uncertainty. Participants in this (...) form of research face risks and can experience serious, even lethal, harm. Well-known incidents involving Jolee Mohr and Jesse Gelsinger, as well as subjects in the 2006 study of the investigational agent TGN1412, show the dangers that can arise in early human research.The bench-to-bedside campaign will need many volunteers to participate in early human testing. Investigators and regulators must not allow the policy enthusiasm for translational science to overshadow the commitment to protect human subjects. Participants in exploratory research are diverse and as a group lack characteristics usually associated with vulnerable populations, such as impaired decisional ability or economic or educational disadvantage. (shrink)

Philosophers have often posited a foundational calling voice, such that hearing its call constitutes subjects as responsive and responsible negotiators of normative claims. I give the name ldquo;transcendental conscience to that which speaks in this founding, constitutive voice. The role of transcendental conscience is not – or not merely – to normatively bind the subject, but to constitute the possibility of the subject's being bound by any particular, contentful normative claims in the first place. I explore the ontological and temporal (...) status of transcendental conscience, using Heidegger's account of conscience in Being and Time as my textual touchstone. I ask what performative structure the call of conscience might have that would enable it to constitute normative responsiveness, and I raise some temporal conundrums surrounding this structure. I argue that it is incoherent to attempt to give a literal, chronological account of the origin of normative grip and response. I suggest that we can best understand the founding calls of conscience, not as literal events occurring in regular time, but as events that can only show up retrospectively, as occurring in an ever-receding, unlocalizable past, and that these calls can only be figured mythically and metaphorically. Appropriating a Derridean term, I claim that the voice of transcendental conscience must be that of a lsquo;ghost, whose call binds us by haunting us – a haunting that is no less transcendentally necessary for its inability to be translated into a literal historical event. (shrink)

The 21st-century translational science campaign could lead to an increase in first-in-human trials. As tests of investigational interventions move from the laboratory to human research, scientists, officials, and review committees should address ongoing concerns about the ethics of FIH trials. In this article, I describe three ethical considerations relevant to all FIH trials: the requirement for adequate preclinical research; study design safeguards; and choice of subject population. I also examine specific ethical considerations relevant to the three subject populations involved in (...) FIH research. I recommend a variety of actions that could increase subject protection and the value of the information generated in FIH trials. (shrink)

Care workers and families often engage in deception in everyday interactions with people affected by dementia. While benevolent deception can be justified, there are often more respectful and less risky ways to help people with dementia seeking to make sense of their lives.

Fear of dementia leads some people to demand an opportunity to choose death over life with the illness. They want the power to make advance euthanasia directives and to refuse hand feeding at some point in the dementia process. But the choices we make in advance aren't always suited to the people we become. Experts and family members say people with dementia often adapt, becoming content with their lives. People should care about their future selves with dementia. Their advance instructions (...) about dementia care should give others freedom to respond to the up‐to‐date information required for good medical decision‐making. (shrink)

Under current U.S. law, physicians may prescribe drugs and devices in situations not covered on the label approved by the Food and Drug Administration. Those supporting this system say that requiring FDA approval for off-label uses would unnecessarily impede the delivery of benefits to patients. Patients do benefit from off-label prescribing that is supported by sound scientific and medical evidence. In the absence of such evidence, however, off-label prescribing can expose patients to risky and ineffective treatments. The medical community and (...) federal authorities should more actively promote patients' interests in receiving beneficial off-label treatments. To exercise responsible self-regulation, members of the medical community must determine whether available evidence justifies specific off-label uses and must promote information-gathering when the evidence is inadequate. Physicians should also discuss with patients the uncertainties accompanying off-label uses. Federal authorities should more closely monitor the effects of off-label prescribing and adopt other measures to reduce harm and enhance benefits produced by off-label prescribing. (shrink)

Off-label prescribing is an integral part of contemporary medicine. Many patients benefit when they receive drugs or devices under circumstances not specified on the label approved by the Food and Drug Administration. An off-label use may provide the best available intervention for a patient, as well as the standard of care for a particular health problem. In oncology, pediatrics, geriatrics, obstetrics, and other practice areas, patient care could not proceed without off-label prescribing. When scientific and medical evidence justify off-label uses, (...) physicians promote patients’ interests by prescribing products off label.Off-label prescribing can also harm patients, however. The potential for harm is greatest when an offlabel use lacks a solid evidentiary basis. A 2006 study examining prescribing practices for 169 commonly prescribed drugs found high rates of off-label use with little or no scientific support. Researchers examining off-label use in U.S. children’s hospitals concluded, “[W]e still have incomplete knowledge about the safety and efficacy of many medications commonly used to treat children across a range of drug classes and clinical diagnoses.”. (shrink)

Subject perspectives : the missing element in research ethics -- Personal knowledge and study participation -- The everyday ethics of human research -- The hidden world of subjects : rule-breaking in clinical trials -- Participants as partners in genetic research -- Terminally ill patients and the right to try experimental drugs -- Embedded ethics in developing country research -- Research subjects as literary subjects -- How to hear subjects.

Epistemologists generally think that genuine warrant that is available to anyone must be available to everyone who is exposed to the relevant causal inputs and is able and willing to properly exercise her rationality. The motivating idea behind this requirement is roughly that an objective view is one that is not bound to a particular perspective. In this paper I ask whether the aperspectivality of our warrants is a precondition for securing the objectivity of our claims. I draw upon a (...) Sellarsian account of perception in order to argue that it is not; rather, inquirers can have contingent properties and perspectives that give them access to forms of rational warrant and objective knowledge that others do not have. The universal accessibility of reasons, on my account, is not a precondition for the legitimacy of any actual warrant, but rather a regulative ideal governing inquiry and communication. (shrink)

Over the last several years, as cesarean deliveries have grown increasingly common, there has been a great deal of public and professional interest in the phenomenon of women 'choosing' to deliver by cesarean section in the absence of any specific medical indication. The issue has sparked intense conversation, as it raises questions about the nature of autonomy in birth. Whereas mainstream bioethical discourse is used to associating autonomy with having a large array of choices, this conception of autonomy does not (...) seem adequate to capture concerns and intuitions that have a strong grip outside this discourse. An empirical and conceptual exploration of how delivery decisions ought to be negotiated must be guided by a rich understanding of women's agency and its placement within a complicated set of cultural meanings and pressures surrounding birth. It is too early to be 'for' or 'against' women's access to cesarean delivery in the absence of traditional medical indications – and indeed, a simple pro- or con- position is never going to do justice to the subtlety of the issue. The right question is not whether women ought to be allowed to choose their delivery approach but, rather, taking the value of women's autonomy in decision-making around birth as a given, what sorts of guidelines, practices, and social conditions will best promote and protect women's full inclusion in a safe and positive birth process. (shrink)

This volume explores the relationship between Kant's aesthetic theory and his critical epistemology as articulated in the Critique of Pure Reason and the Critique of the Power of Judgment. The essays, written specially for this volume, explore core elements of Kant's epistemology, such as his notions of discursive understanding, experience, and objective judgment. They also demonstrate a rich grasp of Kant's critical epistemology that enables a deeper understanding of his aesthetics. Collectively, the essays reveal that Kant's critical project, and the (...) dialectics of aesthetics and cognition within it, is still relevant to contemporary debates in epistemology, philosophy of mind, and the nature of experience and objectivity. The book also yields important lessons about the ineliminable, yet problematic place of imagination, sensibility and aesthetic experience in perception and cognition. (shrink)

In The Harm Principle, Personal Identity and Identity-Relative Paternalism,1 Wilkinson offers a thoughtful argument about medical decision-making and Derek Parfit’s reductionist account of personal identity. I agree that Parfit’s account can contribute to the ethical analysis of patients’ choices. My own work in this area emphasises challenges the reductionist account presents to conventional understanding of advance treatment directives, particularly in cases involving people with dementia.2 I have also urged people making directives to consider the harm their directives could impose on (...) future selves with dementia.3 But as Wilkinson points out, Parfit’s account has implications in other medical contexts as well. Wilkinson presents examples of people making medical decisions that could impose serious harm on their future selves. These examples consider decisions made before a health crisis. Another kind of case involves people in the midst of illness who face a series of ongoing care choices. As people in this situation adjust to their …. (shrink)

Although the teaching of medical ethics and law in medical education is an old story that has been told many times in medical literature, recent studies show that medical students and physicians lack confidence when faced with ethical dilemmas and medico-legal issues. The adverse events rates and medical lawsuits are on the rise whereas many medical errors are mostly due to negligence or malpractices which are preventable. While it is true that many medical schools teach their students medical law and (...) ethics, there are wide variations in what is being taught because there is no universally agreed syllabus. Yet the knowledge of medical law and ethics is closely relevant to the medical profession and that failure in abiding the law may result in serious civil or even criminal consequences. While this paper does not propose to lay detailed analysis of the relevant areas of law or ethics, it proposes to cover some legal areas so as to highlight and bring to attention the need for a medical law and ethics course. This article also considers the problems faced and recommendation as to future directions to be taken with respect to teaching medical law and ethics. It concludes with a suggested course outline for the teaching of medical law and ethics. (shrink)

With the help of the current experiment, we wanted to learn more about the impact of visually demanding vs. cognitively demanding secondary tasks on the attention allocation of older pedestrians during the phase of traffic perception within the process of road crossing. For this purpose, we used two different road crossing tasks as well as two different secondary tasks. The road crossing “stop task” was a signal detection task, where an approaching car had to be detected. The road crossing “go (...) task” was a dynamic visual search task, where the resolution of a busy road situation had to be identified. The visual secondary task was a static visual search task and the cognitive secondary task was a 1-back task. One younger group and one older group of participants completed the tasks as single vs. dual-tasks in all possible combinations. Performance was measured through errors and response time; in addition, the subjective workload was assessed via NASA-TLX. Analyses show that the visual secondary task reduces performance in the road crossing more strongly than the cognitive task, while the visual task itself is less impaired by the road crossing tasks than is the cognitive task. Overall, performance diminishes from single to dual-task completion. Results further indicate age effects in terms of increased errors and response time for older compared to younger participants. In addition to these age effects, age-specific dual-task effects emerge for response time in the go task along with the visual task as well as for response time in the cognitive task along with the go task. Subjective workload is higher in the dual-task conditions than in the single tasks. Findings are discussed with regard to theoretical and practical implications. (shrink)

This essay examines the determination by Cartesians to explain the maternal imagination's alleged role in the formation of birthmarks and the changing notion of monstrosity. Cartesians saw the formation of birthmarks as a challenge through which to demonstrate the heuristic capacity of mechanism. Descartes claimed to be able to explain the transmission of a perception from the mother's imagination to the fetus' skin without having recourse to the little pictures postulated by his contemporaries. La Forge offered a detailed account stating (...) that the failure to explain the maternal imagination's impressions would cast doubt on mechanism. Whereas both characterized the birthmark as a deformation or monstrosity in miniature, Malebranche attributed a role to the maternal imagination in fashioning family likenesses. However, he also charged the mother's imagination with the transmission of original sin. (shrink)

Children’s fine motor skills link to cognitive development, however, research on their involvement in language processing, also with adults, is scarce. Lexical items are processed differently depending on the degree of sensorimotor information inherent in the words’ meanings, such as whether these imply a body-object interaction or a body-part association. Accordingly, three studies examined whether lexical processing was affected by FMS, BOIness, and body-part associations in children and adults. Analyses showed a differential link between FMS and lexical processing as a (...) function of age. Whereas response latencies indicated that children’s FMS were associated with “hand” words, adults’ FMS linked to the broader concept of BOI. Findings have implications for shared activation theories positing that FMS support lexical processing. (shrink)

In the article “On Avoiding Deep Dementia,” Norman Cantor defends a position that I suspect many readers share. In my years writing and speaking on advance directives and dementia, I've found that most people support one of two positions. They are convinced either that advance choices should control the treatment dementia patients receive or that the welfare of a person with dementia should sometimes take priority over earlier choices. As Cantor points out, I support the second position.I agree with several (...) of Cantor's arguments. Where Cantor and I part ways is over the degree of control that advance directives should exert over the care of persons with moderate dementia. Although I don't welcome the prospect of living with dementia, I believe that people with the condition should be represented in the debate over treatment standards. It's not surprising that many, perhaps most, people unaffected by dementia think that their preferences should control the care they would receive as dementia patients. But people taking this position are neglecting the concerns and interests they may have as dementia patients. (shrink)

Novel nanomedical interventions require human testing to evaluate their safety and effectiveness. To establish a proper evidentiary basis for human trials, nanomedical innovations must first be subjected to animal and other laboratory testing. But it is uncertain whether the traditional laboratory approaches to safety evaluation will supply adequate information on nanotechnology risks to humans. This uncertainty, together with other features of nanomedical innovation, heightens the ethical challenges in conducting FIH nanotrials.

The biomedical literature and popular media are full of upbeat reports about the health benefits we can expect from medical innovations using nanotechnology. Some particularly enthusiastic reports portray nanotechnology as one of the innovations that will lead to a significantly extended human life span. Extreme enthusiasts predict that nanotechnology “will ultimately enable us to redesign and rebuild, molecule by molecule, our bodies and brains….”Nanomaterials have special characteristics that could contribute to improved patient care. But the same characteristics that make nanotechnology (...) promising also present risks to humans exposed to nanomaterials. A failure to appreciate these risks could jeopardize the research effort. As others have pointed out, if nanomedical interventions produce unexpected human harm, a loss of public and government support for nanomedicine is likely to follow.Like other forms of medical innovation, novel nanomedical interventions require human testing to evaluate their safety and effectiveness. (shrink)

When Sandra Harding called for an epistemology of science whose systematic attention to the gendered Status of epistemic agents renders it ‘less partial and distorted’ than ‘traditional’ epistemologies, some commentators recoiled in horror. Propelled by ‘a mad form of the genetic fallacy’ they said, she descends ‘the slide to an arational account of science.’ On a less melodramatic reading, feminist epistemologies such as Harding's advocate not irrationalism, but senses of rationality more expanded than those which they associate with ‘traditional’ epistemology.

: The way patients make health care decisions is much more complicated than is often recognized. Patient autonomy allows both that patients will sometimes defer to clinicians and that they should sometimes be active inquirers, ready to question their clinicians and do some independent research. At the same time, patients' active inquiry requires clinicians' support.

Background: Since presenteeism is related to numerous negative health and work-related effects, measures are required to reduce it. There are initial indications that how an organization deals with health has a decisive influence on employees’ presenteeism behavior.Aims: The concept of health-promoting collaboration was developed on the basis of these indications. As an extension of healthy leadership it includes not only the leader but also co-workers. In modern forms of collaboration, leaders cannot be assigned sole responsibility for employees’ health, since the (...) leader is often hardly visible or there is no longer a clear leader. The study examines the concept of health-promoting collaboration in relation to presenteeism. Relationships between health-promoting collaboration, well-being and work ability are also in focus, regarding presenteeism as a mediator.Methods: The data comprise the findings of a quantitative survey of 308 employees at a German university of applied sciences. Correlation and mediator analyses were conducted.Results: The results show a significant negative relationship between health-promoting collaboration and presenteeism. Significant positive relationships were found between health-promoting collaboration and both well-being and work ability. Presenteeism was identified as a mediator of these relationships.Conclusion: The relevance of health-promoting collaboration in reducing presenteeism was demonstrated and various starting points for practice were proposed. Future studies should investigate further this newly developed concept in relation to presenteeism. (shrink)

: The principle of equipoise traditionally is grounded in the special obligations of physician-investigators to provide research participants with optimal care. This grounding makes the principle hard to apply in contexts with limited health resources, to research that is not directed by physicians, or to non-therapeutic research. I propose a different version of the principle of equipoise that does not depend upon an appeal to the Hippocratic duties of physicians and that is designed to be applicable within a wider range (...) of research contexts and types—including health services research and research on social interventions. I consider three examples of ethically contentious research trials conducted in three different social settings. I argue that in each case my version of the principle of equipoise provides more plausible and helpful guidance than does the traditional version of the principle. (shrink)

Volume 20, Issue 5, June 2020, Page 20-22.