Clinical medicine is the application of scientific principles, rules of thumb, and a store of practical wisdom embodied in narratives of individual cases to the care of a person who is ill. Physicians are taught to observe and report the individual case both as a means of fitting nomothetic generalizations to the given circumstances and as a way of refining those generalizations. This narrative construction of illness is a principal way of knowing in medicine. In this view, disease is not (...) so much an entity as an identifiable chronological organization of the events of illness, and medicine, rather than a science, a rational science-using activity in the service of the ill. Keywords: medical epistemology, casuistry, clinical judgment, narrative CiteULike Connotea Del.icio.us What's this? (shrink)

How Doctors Think defines the nature and importance of clinical judgment. Although physicians make use of science, this book argues that medicine is not itself a science but rather an interpretive practice that relies on clinical reasoning. A physician looks at the patient's history along with the presenting physical signs and symptoms and juxtaposes these with clinical experience and empirical studies to construct a tentative account of the illness. How Doctors Think is divided into four parts. Part one introduces the (...) concept of medicine as a practice rather than a science; part two discusses the idea of causation; part three delves into the process of forming clinical judgment; and part four considers clinical judgment within the uncertain nature of medicine itself. In How Doctors Think, Montgomery contends that assuming medicine is strictly a science can have adverse side effects, and suggests reducing these by recognizing the vital role of clinical judgment. (shrink)

In Moral Passages, Kathryn Pyne Addelson presents an original moral theory suited for contemporary life and its moral problems. Her basic principle is that knowledge and morality are generated in collective action, and she develops it through a critical examination of theories in philosophy, sociology and women's studies, most of which hide the collective nature and as a result hide the lives and knowledge of many people. At issue are the questions of what morality is, and how moral theories (...) (whether traditional or feminist) are implemented. Addelson takes up a large number of historical cases and contemporary social problems, including teen pregnancy, contraception and abortion, and gay rights. These cases allow her to see how the knowledge and lives of some people are declared deviant or immoral, while those of others appear to show the public consensus. One case she uses throughout the book is Margaret Sanger's early work on birth control with the anarcho-syndicalist movement--a revisionist history that reveals rather than hides the collective nature of morality and knowledge. Addelson shows how the usual individualist philosophies promote theories which hide the authority of the professionals who make them. A collectivist approach, she argues, must show the part professionals play in collective action. Her aim is to allow professional knowledge makers to be morally and intellectually responsible. Based on Addelson's twenty years of work in feminist philosophy and interactionist sociology as well as her long-standing involvement in women's community organization, Moral Passages investigates how morality and knowledge are collectively enacted in today's world. (shrink)

This book is a complete re-thinking of Aristotle's metaphysical theory of material substances. The view of the author is that the 'substances' are the living things, the organisms: chiefly, the animals. There are three main parts to the book: Part I, a treatment of the concepts of substance and nonsubstance in Aristotle's Categories; Part III, which discusses some important features of biological objects as Aristotelian substances, as analysed in Aristotle's biological treatises and the de Anima; and Part V, which attempts (...) to relate the conception of substance as interpreted so far to that of the Metaphysics itself. The main aim of the study is to recreate in modern imagination a vivid, intuitive understanding of Aristotle's concept of material substance: a certain distinctive concept of what an individual material object is. (shrink)

This book is a re-thinking of Aristotle's metaphysical theory of material substances. The view of the author is that the 'substances' are the living things, the organisms: chiefly, the animals. There are three main parts to the book: Part I, a treatment of the concepts of substance and nonsubstance in Aristotle's Categories; Part III, which discusses some important features of biological objects as Aristotelian substances, as analysed in Aristotle's biological treatises and the de Anima; and Part V, which attempts to (...) relate the conception of substance as interpreted so far to that of the Metaphysics itself. The main aim of the study is to recreate in modern imagination a vivid, intuitive understanding of Aristotle's concept of material substance: a certain distinctive concept of what an individual material object is. (shrink)

The UK Supreme Court in Montgomery v Lanarkshire Health Board adopts an approach to information disclosure in connection with clinical treatment that moves away from medical paternalism towards a more patient-centred approach. In doing so, it reinforces the protection afforded to informed consent and autonomous patient decision making under the law of negligence. However, some commentators have expressed a concern that the widening of the healthcare providers’ duty of disclosure may provide impetus, in future cases, for courts to adopt (...) a more rigorous approach to the application of causation principles. The aim would be to limit liability but, in turn, it would also limit autonomy protection. Such a restrictive approach has recently been adopted in Australia as a result of the High Court decision in Wallace v Kam. This paper considers whether such an approach is likely under English negligence law and discusses case law from both jurisdictions in order to provide a point of comparison from which to scope the post- Montgomery future. (shrink)

Constitutivist accounts in metaethics explain the normative standards in a domain by appealing to the constitutive features of its members. The success of these accounts turns on whether they can explain the connection between normative standards and the nature of individuals they authoritatively govern. Many such explanations presuppose that any member of a norm-governed kind must minimally satisfy the norms governing its kind. I call this the Threshold Commitment, and argue that constitutivists should reject it. First, it requires constitutivists to (...) restrict the scope of their explanatory ambitions, because it is not plausibly true of social kinds. Second, despite the frequent reliance on physical artifacts in constitutivists’ illustrations of the Threshold Commitment, it counter-intuitively entails that physical artifacts can cease to exist without being physically destroyed. Third, it misconstrues the normative force of authoritative norms on very defective kind-members because it locates this force not in the norm, but in the threat of non-existence. Fortunately, constitutivism can be decoupled from the Threshold Commitment, and I close by sketching a promising alternative account. (shrink)

There is conflicting experimental evidence about whether the “stakes” or importance of being wrong affect judgments about whether a subject knows a proposition. To date, judgments about stakes effects on knowledge have been investigated using binary paradigms: responses to “low” stakes cases are compared with responses to “high stakes” cases. However, stakes or importance are not binary properties—they are scalar: whether a situation is “high” or “low” stakes is a matter of degree. So far, no experimental work has investigated the (...) scalar nature of stakes effects on knowledge: do stakes effects increase as the stakes get higher? Do stakes effects only appear once a certain threshold of stakes has been crossed? Does the effect plateau at a certain point? To address these questions, we conducted experiments that probe for the scalarity of stakes effects using several experimental approaches. We found evidence of scalar stakes effects using an “evidence seeking” experimental design, but no evidence of scalar effects using a traditional “evidence-fixed” experimental design. In addition, using the evidence-seeking design, we uncovered a large, but previously unnoticed framing effect on whether participants are skeptical about whether someone can know something, no matter how much evidence they have. The rate of skeptical responses and the rate at which participants were willing to attribute “lazy knowledge”—that someone can know something without having to check—were themselves subject to a stakes effect: participants were more skeptical when the stakes were higher, and more prone to attribute lazy knowledge when the stakes were lower. We argue that the novel skeptical stakes effect provides resources to respond to criticisms of the evidence-seeking approach that argue that it does not target knowledge. (shrink)

The increasing complexity of human subjects research and its oversight has prompted researchers, as well as institutional review boards, to have a forum in which to discuss challenging or novel ethical issues not fully addressed by regulations. Research ethics consultation services provide such a forum. In this article, we rely on the experiences of a national Research Ethics Consultation Collaborative that collected more than 350 research ethics consultations in a repository and published 18 challenging cases with accompanying ethical commentaries to (...) highlight four contexts in which REC can be a valuable resource. REC assists: 1) investigators before and after the regulatory review; 2) investigators, IRBs, and other research administrators facing challenging and novel ethical issues; 3) IRBs and investigators with the increasing challenges of informed consent and risk/benefit analysis; and 4) in providing flexible and collaborative assistance to overcome study hurdles, mediate conflicts within a team, or directly engage with research participants. Institutions that have established, or plan to establish, REC services should work to raise the visibility of their service and engage in open communication with existing clinical ethics consult services as well as the IRB. While the IRB system remains the foundation for the ethical review of research, REC can be a valuable service for investigators, regulators, and research participants aligned with the goal of supporting ethical research. (shrink)

This paper provides an argument for a more socially relevant philosophy of science (SRPOS). Our aims in this paper are to characterize this body of work in philosophy of science, to argue for its importance, and to demonstrate that there are significant opportunities for philosophy of science to engage with and support this type of research. The impetus of this project was a keen sense of missed opportunities for philosophy of science to have a broader social impact. We illustrate various (...) ways in which SRPOS can provide social benefits, as well as benefits to scientific practice and philosophy itself. Also, SRPOS is consistent with some historical and contemporary goals of philosophy of science. We’re calling for an expansion of philosophy of science to include more of this type of work. In order to support this expansion, we characterize philosophy of science as an epistemic community and examine the culture and practices of philosophy of science that can help or hinder research in this area. (shrink)

A significant portion of the scholarship in analytic philosophy of psychiatry has been devoted to the problem of what kind of kind psychiatric disorders are. Efforts have included descriptive projects, which aim to identify what psychiatrists in fact refer to when they diagnose, and prescriptive ones, which argue over that to which diagnostic categories should refer. In other words, philosophers have occupied themselves with what I call “diagnostic kinds”. However, the pride of place traditionally given to diagnostic kinds in psychiatric (...) research has recently come under attack, most notably by a recent initiative of the National Institute of Mental Health, the Research Domain Criteria Project, that seeks to exclude diagnostic categories from experimental designs and focus on other sorts of psychiatric kinds. I argue that philosophical accounts privileging diagnostic kinds must respond to this new line of criticism, and conclude that philosophers need to either counter psychiatrists’ growing suspicion about the hegemony of diagnostic categories in the clinic and the laboratory, or join in redirecting their efforts toward the development of robust accounts of other sorts of psychiatric objects and processes. (shrink)

The nature of moral action versus moral judgment has been extensively debated in numerous disciplines. We introduce Virtual Reality moral paradigms examining the action individuals take in a high emotionally arousing, direct action-focused, moral scenario. In two studies involving qualitatively different populations, we found a greater endorsement of utilitarian responses–killing one in order to save many others–when action was required in moral virtual dilemmas compared to their judgment counterparts. Heart rate in virtual moral dilemmas was significantly increased when compared to (...) both judgment counterparts and control virtual tasks. Our research suggests that moral action may be viewed as an independent construct to moral judgment, with VR methods delivering new prospects for investigating and assessing moral behaviour. (shrink)

Philosophers of science are increasingly arguing for the importance of doing scientifically- and socially-engaged work, suggesting that we need to reduce barriers to extra-disciplinary engagement and broaden our impact. Yet, we currently lack empirical data to inform these discussions, leaving a number of important questions unanswered. How common is it for philosophers of science to engage other communities, and in what ways are they engaging? What barriers are most prevalent when it comes to broadly disseminating one’s work or collaborating with (...) others? To what extent do philosophers of science actually value an engaged approach? Our project addresses this gap in our collective knowledge by providing empirical data regarding the state of philosophy of science today. We report the results of a survey of 299 philosophers of science about their attitudes towards and experiences with engaging those outside the discipline. Our data suggest that a significant majority of philosophers of science think it is important for non-philosophers to read and make use of their work; most are engaging with communities outside the discipline; and many think philosophy of science, as a discipline, has an obligation to ensure it has a broader impact. Interestingly, however, many of these same philosophers believe engaged work is generally undervalued in the discipline. We think these findings call for cautious optimism on the part of those who value engaged work—while there seems to be more interest in engaging other communities than many assume, significant barriers still remain. (shrink)

The paper identifies the phenomenal rise of increasingly invasive forms of elective cosmetic surgery targeted primarily at women and explores its significance in the context of contemporary biotechnology. A Foucauldian analysis of the significance of the normalization of technologized women's bodies is argued for. Three "Paradoxes of Choice" affecting women who "elect" cosmetic surgery are examined. Finally, two utopian feminist political responses are discussed: a Response of Refusal and a Response of Appropriation.

The failure of psychiatry to validate its diagnostic constructs is often attributed to the prioritizing of reliability over validity in the structure and content of the Diagnostic and Statistical Manual of Mental Disorders. Here I argue that in fact what has retarded biomedical approaches to psychopathology is unwarranted optimism about diagnostic discrimination: the assumption that our diagnostic tests group patients together in ways that allow for relevant facts about mental disorder to be discovered. I consider the Research Domain Criteria framework (...) as a new paradigm for classifying objects of psychiatric research that solves some of the challenges brought on by this assumption. (shrink)

While acknowledging Hannah Arendt's keen philosophical and political insights, Kathryn T. Gines claims that there are some problematic assertions and oversights regarding Arendt’s treatment of the "Negro question." Gines focuses on Arendt's reaction to the desegregation of Little Rock schools, to laws making mixed marriages illegal, and to the growing civil rights movement in the south. Reading them alongside Arendt's writings on revolution, the human condition, violence, and responses to the Eichmann war crimes trial, Gines provides a systematic analysis (...) of anti-black racism in Arendt’s work. (shrink)

Sometimes form-meaning mappings in language are not arbitrary, but iconic: they depict what they represent. Incorporating iconic elements of language into a compositional semantics faces a number of challenges in formal frameworks as evidenced by the lengthy literature in linguistics and philosophy on quotation/direct speech, which iconically portrays the words of another in the form that they were used. This paper compares the well-studied type of iconicity found with verbs of quotation with another form of iconicity common in sign languages: (...) classifier predicates. I argue that these two types of verbal iconicity can, and should, incorporate their iconic elements in the same way using event modification via the notion of a context dependent demonstration. This unified formal account of quotation and classifier predicates predicts that a language might use the same strategy for conveying both, and I argue that this is the case with role shift in American Sign Language. Role shift is used to report others’ language and thoughts as well as their actions, and recently has been argued to provide evidence in favor of Kaplanian “monstrous” indexical expressions. By reimagining role shift as involving either quotation for language demonstrations or “body classifier” predicates for action demonstrations, the proposed account eliminates one major argument for these monsters coming from sign languages. Throughout this paper, sign languages provide a fruitful perspective for studying quotation and other forms of iconicity in natural language due to their lack of a commonly used writing system which is otherwise often mistaken as primary data instead of speech, the rich existing literature on iconicity within sign language linguistics, and the ability of role shift to overtly mark the scope of a language report. In this view, written language is merely a special case of a more general phenomenon of sign and speech demonstration, which accounts more accurately for natural language data by permitting more strict or loose verbatim interpretations of demonstrations through the context dependent pragmatics. (shrink)

Open Access: What if it doesn’t get better? Against more hopeful and optimistic views that it is not just ideal but possible to put an end to what John Rawls calls “the great evils of human history,” I aver that when it comes to evils caused by human beings, the situation is hopeless. We are better off with the heavy knowledge that evils recur than we are with idealizations of progress, perfection, and completeness; an appropriate ethic for living with such (...) heavy knowledge, which I call an ‘Imperfectionist Ethic,’ could include resisting evils, improving the lives of victims, and even enjoying ourselves. Better conceptions of the objects of hope, and the good life, inform a praxis-centered, nonideal ethic, supportive of sustained moral motivation, resilience, and even cheer. I connect elements of stoic and pessimistic philosophy in order to outline some normative recommendations for living with evils. A praxis-centered ethic would helpfully adjust our expectations from changing an uncontrollable future, to developing better skills for living in a world that exceeds our control. (shrink)

Online shaming is a subject of import for social philosophy in the Internet age, and not simply because shaming seems generally bad. I argue that social philosophers are well-placed to address the imaginal relationships we entertain when we engage in social media; activity in cyberspace results in more relationships than one previously had, entailing new and more responsibilities, and our relational behaviors admit of ethical assessment. I consider the stresses of social media, including the indefinite expansion of our relationships and (...) responsibilities, and the gap between the experiences of those shamed and the shamers’ appreciation of the magnitude of what they do when they shame; I connect these to the literature suggesting that some intuitions fail to guide our ethics. I conclude that we each have more power than we believe we do or than we think carefully about exerting in our online imaginal relations. Whether we are the shamers or the shamed, we are unable to control the extent to which intangible words in cyberspace take the form of imaginal relationships that burden or brighten our self-perceptions. (shrink)

Although the American Philosophical Association has more than 11,000 members, there are still fewer than 125 Black philosophers in the United States, including fewer than thirty Black women holding a PhD in philosophy and working in a philosophy department in the academy.1The following is a “musing” about how I became one of them and how I have sought to create a positive philosophical space for all of us.

This book explores the dynamic relationship between myth and philosophy in the Presocratics, the Sophists, and in Plato - a relationship which is found to be more extensive and programmatic than has been recognized. The story of philosophy's relationship with myth is that of its relationship with literary and social convention. The intellectuals studied here wanted to reformulate popular ideas about cultural authority and they achieved this goal by manipulating myth. Their self-conscious use of myth creates a self-reflective philosophic sensibility (...) and draws attention to problems inherent in different modes of linguistic representation. Much of the reception of Greek philosophy stigmatizes myth as 'irrational'. Such an approach ignores the important role played by myth in Greek philosophy, not just as a foil but as a mode of philosophical thought. The case studies in this book reveal myth deployed as a result of methodological reflection, and as a manifestation of philosophical concerns. (shrink)

The authors examine the nature of the relationship between social science and philosophy and address the sort of work social science should do, and the role and sorts of claims that an accompanying philosophy should engage in. In particular, the authors reintroduce the question of ontology, an area long overlooked by philosophers of social science, and present a cricital engagement with the work of Roy Bhaskar. The book argues against the excesses of philosophising and commits itself to a philosophical approach (...) more deeply grounded in the social sciences. (shrink)