My starting point is what I call the Normative Authority Conception of justification, where S is justified in their belief that p at t (to some degree n) if and only if their believing that p at t is not ruled out by epistemic norms that have normative authority over S at t. With this in mind, this paper develops an account of doxastic justification by first developing an account of the normative authority of epistemic norms. Drawing from (...) work in political philosophy, I argue that (a) the cognitive and evaluative commitments and concerns behind our actual practices of holding each other and ourselves accountable for our beliefs reveal which epistemic norms we have consented to be under, and that (b) it is because we have consented to be under the authority of these norms – by actually holding ourselves and others accountable to them – that they in turn have normative authority over us. By connecting the authority of epistemic norms to the authority we have over ourselves in this way, the resulting account of doxastic justification (i) explains why it can be appropriate to criticize, resent, or sanction someone for having unjustified beliefs, (ii) avoids the phenomena of normative alienation and normative parochialism, and (iii) respects the social and collective nature of epistemic justification. (shrink)

Philosophy &Public Affairs, Volume 52, Issue 1, Page 69-100, Winter 2024.

An episiotomy is ‘an intrapartum procedure that involves an incision to enlarge the vaginal orifice,’1 and is primarily justified as a way to prevent higher degrees of perineal trauma or to facilitate a faster birth in cases of suspected fetal distress. Yet the effectiveness of episiotomies is controversial, and many professional bodies recommend against the routine use of episiotomies. In any case, unconsented episiotomies are alarmingly common, and some care providers in obstetric settings often fail to see consent as (...) necessary in context. In their article, ‘The ethics of consent during labour and birth: episiotomies,’ van der Pijl et al reiterate that consent is necessary for episiotomies. They specify, further, that the antenatal period is crucial for exchanging information, establishing trust between the birthing subject and provider, and exploring the birthing subject’s—rather than the care provider’s—values and preferences regarding episiotomies. They recommend an individualised approach, which would enable birthing subjects to choose how and when they want to give consent. I applaud van der Pijl et al on their practicable recommendations regarding consent for episiotomies. This is certainly a step in the right direction where respect for birthing subjects’ bodily autonomy and integrity is concerned. Still, we must be reminded that consent alone is not coextensive with autonomy. The conditions for securing informed consent in healthcare does not guarantee that one’s decision is truly reflective of their values. After all, even valid consent does not rule out ‘normatively significant external influence’.2 Consent acquisition for obstetric procedures present no …. (shrink)

The debate on the ‘right to know’ has simmered on for over 30 years. New examples where a right to be informed is contrasted to a right to be kept in ignorance occasionally surface and spark disagreement on the extent to which patients and research subjects have a right to be self-determining concerning the health related information they receive. Up until now, however, this debate has been unsatisfactory with regard to the question what type of rights—if any—are in play here (...) and to what extent they can provide a normative basis for informed consent. This paper provides an analysis of informed consent in the context of ‘epistemic interventions’: interventions which involve the communication of information. First, I offer an analysis of the concept of a ‘right not to know’ in the context of consent to epistemic interventions. I argue that the scope of the consent is determined by the extent to which this intervention can be seen as an infringement of the private sphere. After that I show how this analysis affects the scope and standards of informed consent. (shrink)

It is widely accepted that consent is a normative power. For instance, consent can make an impermissible act permissible. In the words of Heidi Hurd, it “turns a trespass into a dinner party... an invasion of privacy into an intimate moment.” In this chapter, I argue against the assumption that consent has such robust powers for moral transformation. In particular, I argue that there is a wide range of sex that harms or wrongs victims despite being consensual. (...) Moreover, these cases are not limited to those where con- sent is vitiated by background conditions. I start by calling this category of consensual sex Bad Sex. I then distinguish subspecies of this category, including psychological pressure, social coercion, and epistemically unsafe sex. I end by responding to an objection on which we should treat at least some subspecies of Bad Sex as rape. Though this alternative proposal is often motivated by ameliorative and strategic considerations, I argue that such considerations actually count against collapsing the categories of Bad Sex and rape. (shrink)

Until recently, epistemology was largely caught in the grips of an epistemically unrealistic radical epistemological individualism on which the beliefs and testimony of others were of virtually no epistemic significance. Thankfully, epistemologists have bucked the individualist trend, acknowledging that one person's belief or testimony that P might offer another person prima facie epistemic reasons – or social evidence as I call it – to believe P. In this paper, I discuss the possibility and conditions under which beliefs and (...) testimony act as social evidence, in particular, beliefs and testimony regarding the existence of God. The epistemic egoist maintains that one must possess positive reasons in favor of other people's reliability or trustworthiness before their beliefs and testimony offer prima facie social evidence. The epistemic universalist, on the other hand, argues that the beliefs of all others are prima facie credible and should be treated accordingly. All this will set up subsequent discussion of the epistemic significance of common consent or widespread belief in God. I show how common consent arguments assume the epistemic universalist's account of the conditions under which the beliefs and testimony of others acquire reason-giving force as social evidence. (shrink)

We read commentaries on our feature article ‘The ethics of consent during labour and birth: episiotomies’1 with gratitude and interest. Nearly all commenting authors agree that consent for in-labour procedures is necessary and ideally given at the point of intervening. Both Shalowitz & Ralston and Stirrat note that this is already required by professional statements and guidelines in the USA2 and UK3, respectively, but also note that practice does not yet conform. The Americans authors helpfully emphasise the importance (...) of multilevel institutional measures for closing this gap, including consent policies and reporting mechanisms, as well as ongoing education.2 The UK writer seconds the role for education within wider shared decision-making and informed choice approaches, and generously commends our paper for close study by all maternity care providers. Others add a cautionary note. Lee applauds all our recommendations, but notes our proposals cannot fully secure autonomy because of, among others, epistemic injustice and other power differentials.4 Kumar-Hazard and Dahlen worry that opt-out consent is equal to substitute decision-making; weakens women’s rights; and is open to abuse.5 Nelson and Clough object to our willlingness to work within a flawed conceptual framework, which ought to be challenged.6 We agree that there are limits to what our proposal can do. It cannot rectify unequal distributions of epistemic credibilities, either in general or in any particular interaction. Risk communication is never neutral;7 “even the most well-meaning healthcare professionals could unwittingly wield influence over birthing women’s …. (shrink)

Since its advent in the 20th century, informed consent has become a cornerstone of ethical healthcare, and obtaining it a core obligation in medical contexts. In my dissertation, I aim to examine the theoretical underpinnings of informed consent and identify what values it is taken to protect. I will suggest that the fundamental motivation behind informed consent rests in something I’ll call bodily self-sovereignty, which I argue involves a coupling of two groups of values: autonomy and non-domination (...) on the one hand, and self-ownership and personal integrity on the other. I will then go on to consider two 'case studies' I take to shed light on what is at stake in securing informed consent - consent in psychiatrically ill populations, and consent to interventions that involve the modification of the genetic germline. (shrink)

Informed consent is a central concept for empirical and theoretical research concerning pregnancy management decisions and is often taken to be one of the more fundamental goals of the profession of genetic counseling. Tellingly, this concept has been seen by disability communities as salutary, despite longstanding critiques made by disability activists, advocates, and scholars concerning practices involved in genetic counseling more generally. In this chapter, we show that the widespread faith in informed consent is misleading and can be (...) detrimental to the practice of genetic counseling as guided by concerns of justice and equity. We proceed in two steps. First, we explain how informed consent is flawed as a practical concept. Second, we show how the inadequacy of informed consent illuminates the animating core of disability critiques of genetic counseling: the issue of ableism. We argue that the problem of ableism cannot be solved with informed consent because it is not merely a problem of information, but also of epistemic schemas. We suggest that what we call critically informed consent is better suited to move genetic counseling from being aware of the problem of ableism to becoming actively anti-ableist. (shrink)

This volume considers forms of information manipulation and restriction in contemporary society. It explores whether and when manipulation of the conditions of inquiry without the consent of those manipulated is morally or epistemically justified. The contributors provide a wealth of examples of manipulation, and debate whether epistemic paternalism is distinct from other forms of paternalism debated in political theory. Special attention is given to medical practice, for science communication, and for research in science, technology, and society. Some of (...) the contributors argue that unconsenting interference with people’s ability of inquire is consistent with, and others that it is inconsistent with, efforts to democratize knowledge and decision-making. -/- These differences invite theoretical reflection regarding which goods are fundamental, whether there is a clear or only a moving boundary between informing and instructing, and whether manipulation of people’s epistemic conditions amounts to a type of intellectual injustice. The collection pays special attention to contemporary paternalistic practices in big data and scientific research, as the way in which the flow of information or knowledge might be curtailed by the manipulations of a small body of experts or algorithms. (shrink)

This volume considers forms of information manipulation and restriction in contemporary society. It explores whether and when manipulation of the conditions of inquiry without the consent of those manipulated is morally or epistemically justified. The contributors provide a wealth of examples of manipulation, and debate whether epistemic paternalism is distinct from other forms of paternalism debated in political theory. Special attention is given to medical practice, science communication, and research in science, technology, and society. Some of the contributors (...) argue that unconsenting interference with or "conceptual engineering" of people’s beliefs and ability of inquire is consistent with, and others that it is inconsistent with, efforts to democratize knowledge and decision-making. (shrink)

I argue against various versions of the ‘attitude’ view of consent and of the ‘action’ view of consent: I show that neither an attitude nor an action is either necessary or sufficient for consent. I then put forward a different view of consent based on the idea that, given a legitimate epistemic context, absence of dissent is sufficient for consent: what is crucial is having access to dissent. In the latter part of the paper (...) I illustrate my view of consent by applying it to the case of consenting to being an organ donor. (shrink)

Epistemic paternalism is the practice of interfering with someone’s inquiry, without their consent, for their own epistemic good. In this chapter, I explore the relationship between epistemic paternalism and two other epistemological theses: epistemic permissivism and standpoint epistemology. I argue that examining this relationship is fruitful because it sheds light on a series of cases in which epistemic paternalism is unjustified and brings out notable similarities between epistemic permissivism and standpoint epistemology.

BackgroundThis essay provides an ethical and conceptual argument for the use of informed consent prior to the diagnosis of brain death. It is meant to enable the family to make critical end-of-life decisions, particularly withdrawal of life support system and organ donation, before brain death is diagnosed, as opposed to the current practice of making such decisions after the diagnosis of death. The recent tragic case of a 13-year-old brain-dead patient in California who was maintained on a ventilator for (...) over 2 years illustrates how such a consent would have made a crucial difference.MethodsConceptual, philosophical, and ethical analysis.ResultsI first consider a conceptual justification for the use of consent for certain non-beneficial and unwanted medical diagnoses. I suggest that the diagnosis of brain death falls into this category for some patients. Because the diagnostic process of brain death lacks the transparency of traditional death determination, has a unique epistemic structure and a complex risk-benefit profile which differs markedly from case to case, and presents conflicts of interest for physicians and society, I argue that pre-diagnostic counseling and informed consent should be part of the diagnostic process. This approach can be termed as “allow cardiac death”, whose parallel logic with “allow natural death” is discussed. I also discuss potential negative impacts on organ donation and health care cost from this proposal and offer possible mitigation. I show that the pre-diagnostic counseling can improve the possibility for well-thought-out decisions regarding organ donation and terminating life-support system in cases of hopeless prognosis. This approach differs conceptually from the pluralism of the definition of death, such as those in New Jersey and Japan, and it upholds the Uniform Determination of Death Act.ConclusionsMy intention is not to provide an instant panacea for the ongoing impasse of the brain death debate, but to point to a novel conceptual ground for a more pragmatic, and more patient- and family-centered approach. By enabling the family to consent to or decline the diagnostic process of brain death, but not to choose the definition of death, it upholds the current legal definition of death. (shrink)

In this article I engage Susan Brison’s “What’s Consent Got to Do with It?” by offering multiple contributions regarding the limitations of the language and culture of consent. I begin by briefly appreciating what consent reveals to us morally about the harms of nonconsensual sex. I then offer five points regarding the language and culture of consent: (1) Conceptualizing rape as nonconsensual sex hides from view the moral harm of having one’s will subjugated by another. (2) (...) The framework of consent renders women’s desires insignificant and invisible. (3) Epistemic gaslighting represents one major and underappreciated form of epistemic injustice that consent-based views of rape propagate. (4) Consent-centered accounts of sexual violence impede our ability to imagine better sexual futures. And (5) consent not only functions to normalize gender-based violence but also to normalize other forms of violence, such as those that erupt in light of race, ability, nationality, weight, and age. (shrink)

This paper discusses the issue of overriding the right of individual consent to participation in cluster randomised trials (CRTs). We focus on CRTs testing the efficacy of non-pharmaceutical interventions. As an example, we consider school closures during the COVID-19 pandemic. In Norway, a CRT was promoted as necessary for providing the best evidence to inform pandemic management policy. However, the proposal was rejected by the Norwegian Research Ethics Committee since it would violate the requirement for individual informed consent. (...) This sparked debate about whether ethics stand in the way of evidence-based health policy, since the Norwegian Research Ethics law’s strict requirements for individual consent make it practically impossible to carry out CRTs of public health interventions. We argue that, in the case of the school closure trial, the suggested CRT would not have eliminated an epistemic gap and thus would not have justified the violation of consent rights. First, we focus on the methodological challenges to estimating quantifiable effects of school closures in the specific case of an airborne infectious disease. Second, in line with Evidential Pluralism, we highlight the value of alternative lines of evidence for informing school closure policy in a pandemic. In general, we propose that a trial requiring the waiver of participants’ consent rights must be highly likely to eliminate an epistemic gap. We elaborate on the practical aspects of this criterion and discuss the potential advantages of adding it to the Ottawa Statement on the Ethical Design and Conduct of Cluster Randomized Trials. (shrink)

Epistemic paternalism occurs when a decision is made for an agent which helps them arrive at the truth, though they didn’t consent to that decision (and sometimes weren’t even aware of it). Common defenses of epistemic paternalism claim that it can help promote positive veritistic results. In other words, epistemic paternalism is often good for inquiry. I argue that there is often a better alternative available to epistemic paternalism in the form of what I call (...) Open Group Inquiry. I then examine how Open Group Inquiry can be applied to cases of religious inquiry, while noting that epistemic paternalism is impermissible in cases of general religious inquiry. I argue that in the case of religious inquiry, there are serious questions about what constitutes evidence along with how to evaluate it. Rather than posing a particular worry for Open Group Inquiry, I suggest these questions pose a problem for religious inquiry in general. I conclude that while it very much matters how concepts like religious knowledge, religious faith, scepticism, etc., are defined, these considerations may well pave the way for a novel argument for religious scepticism. (shrink)

This paper is particularly concerned with shame, sometimes considered the ‘master emotion’, and its possible role in affecting the consent process, specifically where that shame relates to the issue of diminished health literacy. We suggest that the absence of exploration of affective issues in general during the consent process is problematic, as emotions commonly impact upon our decision-making process. Experiencing shame in the healthcare environment can have a significant influence on choices related to health and healthcare, and may (...) lead to discussions of possibilities and alternatives being closed off. In the case of impaired health literacy we suggest that it obstructs the narrowing of the epistemic gap between clinician and patient normally achieved through communication and information provision. Health literacy shame prevents acknowledgement of this barrier. The consequence is that it may render consent less effective than it otherwise might have been in protecting the person's autonomy. We propose that the absence of consideration of health literacy shame during the consent process diminishes the possibility of the patient exerting full control over their choices, and thus bodily integrity. (shrink)

Unlike its friendly cousin the placebo effect, the nocebo effect (the effect of expecting a negative outcome) has been almost ignored. Epistemic and ethical confusions related to its existence have gone all but unnoticed. Contrary to what is often asserted, adverse events following from taking placebo interventions are not necessarily nocebo effects; they could have arisen due to natural history. Meanwhile, ethical informed consent (in clinical trials and clinical practice) has centred almost exclusively on the need to inform (...) patients about intervention risks with patients to preserve their autonomy. Researchers have failed to consider the harm caused by the way in which the information is conveyed. In this paper, I argue that the magnitude of nocebo effects must be measured using control groups consisting of untreated patients. And, because the nocebo effect can produce harm, the principle of non-maleficence must be taken into account alongside autonomy when obtaining (ethical) informed consent and communicating intervention risks with patients. (shrink)

The demand for informed consent in clinical medicine is usually justified on the basis that it promotes patient autonomy. In this article I argue that the most effective way to promote autonomy is to improve patient understanding in order to reduce the epistemic disparity between patient and medical professional. Informed consent therefore derives its moral value from its capacity to reduce inequalities of power as they derive from epistemic inequalities. So in order for a patient to (...) have given informed consent, she must understand the treatment. I take this to mean that she has sufficient knowledge of its causal mechanisms and has accepted the explanations in which the treatment is implicated. If this interpretation of informed consent is correct, it is unethical for medical professionals to offer or endorse ‘alternative medicine’ treatments, for which there is no known causal mechanism, for if they do, they may end up widening the epistemic disparity. In this way, informed consent may be understood as an effective way of ruling out particular treatments in order to improve patient autonomy and maintain trust in the medical profession. (shrink)

Epistemic paternalism is usually understood as interference in the inquiry of another person without their consent, but for their own good. The epistemic good is often treated in the tradition of “veritism” which means the pursuit of truth. The article argues that one of the options for justifying epistemic paternalism can be epistemic akrasia, that manifests itself either in the acceptance of opposing views, or the inability to draw conclusions from already accepted premises, or the (...) refusal to adhere to higher-order epistemic attitudes. Correcting such behavior requires an expansive interpretation of epistemic paternalism while respecting safeguards that protect such personal values as freedom and autonomy. (shrink)

Despite US policy documents which recommend that in areas of environmental risk, interaction between scientific experts and the public move beyond the so-called “Decide, Announce, and Defend model,” many current public involvement policies still do not guarantee meaningful public participation. In response to this problem, various attempts have been made to define what counts as sufficient or meaningful participation and free informed consent from those affected. Though defining “meaningfulness” is a complex task, this paper explores one under-examined dimension that (...) concerns the relationship between consent and the idea that citizens should be sufficiently informed: epistemic capacity. This paper will look at some of the work on meaningful participation and consent, give a definition of epistemic capacity, and argue that only a community with sufficient epistemic capacity can have the understanding and competence to give informed enough consent and thus participate meaningfully. (shrink)

Abstract:Epistemic paternalism occurs when evidence is withheld or shaped in particular ways in order to help an agent arrive at the truth, but this is done without their consent (and sometimes without their knowledge). While general defenses of epistemic paternalism are garnering more attention in the recent literature, little has been said regarding the practice in religious contexts. We explore a defense of epistemic paternalism in religious settings inspired by the work of the medieval Islamic philosopher (...) Averroes. According to Averroes, epistemic paternalism is permissible in cases where it would help a layperson arrive at religious knowledge via imagination because they are incapable of arriving at it by demonstration. We conclude by explaining how the distinction between imagination and demonstration can be used to justify epistemic paternalism in contemporary settings. (shrink)

In ‘The ethics of consent during labour and birth: episiotomies,’ van der Pijl et al 1 respond to the prevalence of unconsented procedures during labour, proposing a set of necessary features for adequate consent to episiotomy. Their model emphasises information sharing, value exploration and trust between a pregnant person and their healthcare provider(s). While focused on consent to episiotomy, van der Pijl et al contend their approach may be applicable to consent for other procedures during labour (...) and beyond pregnancy-related care. One feature of their model for adequate informed consent is trust in the systems in which prenatal and labour and delivery care are provided. Yet, for some pregnant persons, mistrust in health systems is a reasonable sequela of experiences like racism and epistemic injustice. For a programme in which trust is central to adequate consent, it is important to identify—and counter—forms of mistrust toward pregnant persons within healthcare and acknowledge and rectify reasonable mistrust of pregnant persons toward healthcare. Like other kinds of healthcare disparities, van der Pijl et al note that ‘the burden of unconsented procedures is not evenly distributed over groups’ and tracks with ‘racial, socioeconomic and other disparities in maternity care’. They are drawing on data from a less diverse context than the one …. (shrink)

Unlike its friendly cousin the placebo effect, the nocebo effect has been almost ignored. Epistemic and ethical confusions related to its existence have gone all but unnoticed. Contrary to what is often asserted, adverse events following from taking placebo interventions are not necessarily nocebo effects; they could have arisen due to natural history. Meanwhile, ethical informed consent has centred almost exclusively on the need to inform patients about intervention risks with patients to preserve their autonomy. Researchers have failed (...) to consider the harm caused by the way in which the information is conveyed. In this paper, I argue that the magnitude of nocebo effects must be measured using control groups consisting of untreated patients. And, because the nocebo effect can produce harm, the principle of non-maleficence must be taken into account alongside autonomy when obtaining informed consent and communicating intervention risks with patients. There are no data in this work. (shrink)

Requiring family authorization for apnea testing subtracts health professionals control over death determination, a procedure that has traditionally been considered a matter of clinical expertise alone. In this commentary, we first provide evidence showing that health professionals’ (HPs) disposition to act on death determination without family’s prior consent could be much lower than that referred to by Berkowitz and Garrett (2020). We hypothesize that HPs may have reservations about their own expertise as regards death, and may thus hesitate to (...) impose their views on patients’ families. We then address the theoretical question of clinical expertise in death determination by distinguishing judgments about facts (e.g., the presence or absence of spontaneous breathing) from interpretations given of these facts (i.e., their meaning for the vital status of an individual). We argue that, while clinicians may claim some expert authority on the former, they hold no particular authority on the latter. (shrink)

Package leaflets belong to the complex communication system related to the minimization and prevention of pharmaceutical risk. Their legal nature is not exhausted by safety regulation though: as a privileged form of product instruction, they are also subject to liability regulation with a consequent reallocation of damage responsibility through risk disclosure. This article presents the results of a doctoral dissertation devoted to the legal and communicative analysis of PL information. After illustrating the articulation of pharmaceutical risk through risk prevention norms, (...) the paper goes on with a discussion of the PL role within the therapeutic decision as a complementary vehicle to doctor’s information. It results that the liability framework in which both information channels are embedded determines a communication model, which far from promoting a shared decision process, radicalizes the two-step communication structure typical of the informed consent model inherited by surgery judicature. The second part investigates PL information as a source of knowledge updating through the methodological tools provided by Bayesian decision theory. Finally, an empirical study conducted over a sample of 55 drug consumers investigates the impact of PL information on drug risk perception and its perceived value to therapeutic decision. (shrink)

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)

How are we meant to behave? And how are we to defend whatever answer we give? Morals and Consent grounds our notion of morality in natural evolution, and from that basis, Malcolm Murray shows why contractarianism is a far more viable moral theory than is widely believed. The scope of Morals and Consent has two main parts: theory and application. In his discussion of theory, Murray defends contractarianism by appealing to evolutionary game theory and metaethical analyses. His main (...) argument is that we are not going to find morality as an objective fact in the world, and that instead, we can understand morality as a reciprocal cooperative trait. From this minimal moral architecture, Murray derives his innovative consent principle. The application of the theory, detailing what contractarians can – or ought to – say about moral matters, takes up the greater portion of the work. Murray offers a trenchant examination of what moral constraints we can claim concerning death, sex, beneficence, and liberty. By focusing on evolutionary contractarianism and the epistemic justification of our moral claims – or lack thereof – Malcolm Murray’s Morals and Consent is a serious advance in the field of applied ethics and fills an important void. (shrink)

This essay examines several ethical and epistemological issues that arise when philosophers conduct empirical research focused on, or in collaboration with, community groups seeking to bring about systemic change. This type of research can yield important policy lessons about effective community-driven reform and how to incorporate the voices of marginalized citizens in public policy debates. Community-based reform efforts are also particularly ripe for philosophical analysis since they can demonstrate the strengths and shortcomings of democratic and egalitarian ideals. This type of (...) research also raises unique ethical dilemmas that challenge central tenets of research ethics. We focus on two foundational questions: What does informed consent mean in the context of community-based research when CBR may dissolve differences between researcher and research participant, and its parameters can be hard to delineate? And what ethical, democratic, and epistemic issues arise when conducting research with and on community groups, given potentially competing commitments to respect the epistemological contributions of all participants while also meeting research norms to warrant findings and conclusions? Our examination has two aspects: we grapple with these issues through examples from our work to reveal their significance in our own philosophic practice, and more broadly, to reveal their significance as problems within traditional research ethics. We believe that this approach will demonstrate the utility of philosophic engagement with dilemmas in research ethics as a reflective matter, and in the course of empirical research itself. (shrink)

Rape and sexual assault are major problems. In the majority of sexual assault cases consent is the central issue. Consent is, to borrow a phrase, the ‘moral magic’ that converts an impermissible act into a permissible one. In recent years, a handful of companies have tried to launch consent apps which aim to educate young people about the nature of sexual consent and allow them to record signals of consent for future verification. Although ostensibly aimed (...) at addressing the problems of rape and sexual assault on university campuses, these apps have attracted a number of critics. In this paper, I subject the phenomenon of consent apps to philosophical scrutiny. I argue that the consent apps that have been launched to date are unhelpful because they fail to address the landscape of ethical and epistemic problems that arise in the typical rape or sexual assault case: they produce distorted and decontextualised records of consent which may in turn exacerbate the other problems associated with rape and sexual assault. Furthermore, because of the tradeoffs involved, it is unlikely that app-based technologies could ever be created that would significantly address the problems of rape and sexual assault. (shrink)

This paper attempts to establish the epistemological import and limits of informed consent in clinical research. It points out that informed consent is a necessary requirement in clinical research because it ensures adequate participation of care receivers in issues relating to their health. Besides ensuring that care receivers have knowledge of whatever medical intervention they are consenting to, informed consent, as an ideal, provides assurance that care receivers and others are neither coerced nor deceived. While the question (...) of the value of informed consent in health care delivery is not so much controverted, in contest is the question of whether or not complete and wholly specifically informed consent can indeed be realized in medical intervention. Two orientations are identified in this debate. One insists that an individual will be able to make an informed decision and make reasonable choices amongst alternatives when fully informed. The other orientation sees as an epistemic illusion, achieving full informed consent, and rather opts for informed request. This paper examines this debate by clarifying the notion of informed consent, its components and its nexus with knowledge. The position of the paper is that informed consent is not only an ethical ideal in clinical research and health care; it is also an epistemic virtue that must be continuously strived towards. This paper establishes that health care receivers can only have an epistemic claim of their medical situation if all requirements of informed consent in health care delivery such as provision of adequate information, the risk and benefits of treatment, avoidance of vague/ambiguous statements, voluntariness, etc. are met. (shrink)

The social impacts of computer technology are often glorified in public discourse, but there is growing concern about its actual effects on society. In this article, we ask: how does “consent” as an analytical framework make visible the social dynamics and power relations in the capture, extraction, and labor of data science knowledge production? We hypothesize that a form of boundary violation in data science workplaces—gender harassment—may correlate with the ways humans’ lived experiences are extracted to produce Big Data. (...) The concept of consent offers a useful way to draw comparisons between gender relations in data science and the means by which machines are trained to learn and reason. Inspired by how Big Tech leaders describe unsupervised machine learning, and the co-optation of “revolutionary” rhetoric they use to do so, we introduce a concept we call “techniques of invisibility.” Techniques of invisibility are the ways in which an extreme imbalance between exposure and opacity, demarcated along fault lines of power, are fabricated and maintained, closing down the possibility for bidirectional transparency in the production and applications of algorithms. Further, techniques of invisibility, which we group into two categories—epistemic injustice and the Brotherhood—include acts of subjection by powerful actors in data science designed to quell resistance to exploitative relations. These techniques may be useful in making further connections between epistemic violence, sexism, and surveillance, sussing out persistent boundary violations in data science to render the social in data science visible, and open to scrutiny and debate. (shrink)

Mindfulness exercises are presented as being compatible with almost any spiritual, religious or philosophical beliefs. In this paper, we argue that they in fact involve imagining and conceptualising rather striking and controversial claims about the self, and the self’s relationship to thoughts and feelings. For this reason, practising mindfulness exercises is likely to be in tension with many people’s core beliefs and values, a tension that should be treated as a downside of therapeutic interventions involving mindfulness exercises, not unlike a (...) side effect. Clients ought to be informed of these metaphysical aspects of the exercises, and mental health providers ought to take them into account in assessing which course of treatment to recommend. Given these concerns, the casual way in which mindfulness exercises are presently distributed by mental health providers to the general public is inappropriate. (shrink)

In this paper, I discuss rape myths and mythologies, their negative effects on rape and sexual assault complainants, and how they prejudicially construct women qua women. The backdrop for the analysis is the Belfast Rugby Rape Trial, which took place in 2018. Four men, two of whom were well-known rugby players, were acquitted of rape and sexual assault in a nine-week criminal trial that dominated local, national and international attention. The acquittal resulted in ‘I Believe Her’ rallies and protests across (...) Northern Ireland. Of concern were the deeply sexist and misogynistic text exchanges among the acquitted about the complainant and women more generally. One month after the trial, the Criminal Justice Board of Northern Ireland commissioned an independent review of the arrangements to deliver justice in cases of serious sexual offences. The Gillen Review proposed 16 key recommendations, among them measures to dispel rape myths and the role that Relationship and Sex Education in schools could play in combatting these myths. I will explore these issues using Miranda Fricker's construction of epistemic injustice. I argue that there is little appreciation of the profound impact that routine testimonial injustice—where the credibility of a speaker is deflated or undermined on account of her social identity—can have on the wellbeing of speakers and how it ramifies with other forms of injustice. To illustrate, I draw on neurological explanations to show why attributions of sexual consent are unjustly sustained in cases of rape and sexual assault. (shrink)

On many science-related policy questions, the public is unable to make informed decisions, because of its inability to make use of knowledge obtained by scientists. Philip Kitcher and James Fishkin have both suggested therefore that on certain science-related issues, public policy should not be decided on by actual democratic vote, but should instead conform to the public’s counterfactual informed democratic decision. Indeed, this suggestion underlies Kitcher’s specification of an ideal of a well-ordered science. This article argues that this suggestion misconstrues (...) the normative significance of CIDDs. At most, CIDDs might have epistemic significance, but no authority or legitimizing force. (shrink)

Shared decision-making involves health professionals and patients/clients working together to achieve true person-centred health care. However, this goal is infrequently realized, and most barriers are unknown. Discussion between philosophers, clinicians, and researchers can assist in confronting the epistemic and moral basis of health care, with benefits to all. The aim of this paper is to describe what shared decision-making is, discuss its necessary conditions, and develop a definition that can be used in practice to support excellence in maternity care. (...) Discussion between the authors, with backgrounds in philosophy, clinical maternity care, health care management, and maternity care research, assisted the team to confront established norms in maternity care and challenge the epistemic and moral basis of decision-making for caesarean section. The team concluded that shared decision-making must start in pregnancy and continue throughout labour and birth, with equality in discourse facilitated by the clinician. Clinicians have a duty of care for the adequacy of women's knowledge, which can only be fulfilled when relevant knowledge is offered freely and when personal beliefs and biases that may impinge on decision-making (defeaters) are disclosed. Informed consent is not shared decision-making. Key barriers include existing cultural norms of “the doctor knows best” and “patient acquiescence” that prevent defeaters being acknowledged and discussed and can lead to legal challenges, overuse of medical intervention and, in some areas, obstetric violence. Shared decision-making in maternity care can thus be defined as an enquiry by clinician and expectant woman aimed at deciding upon a course of care or none, which takes the form of a dialogue within which the clinician fulfils their duty of care to the client's knowledge by making available their complete knowledge (based on all types of evidence) and expertise, including an exposition of any relevant and recognized potential defeaters. Research to develop measurement tools is required. (shrink)

Nowadays the argument for the existence of God based on the common consent of mankind is taken to be so bad that contemporary atheists do not even bother to mention it. And it seems very few theists think that the argument is worth defending. In this paper I shall argue to the contrary: not only is the argument better than usually thought, but widespread belief in God constitutes a prima facie defeater for every reasonable atheist.

With regard to organ donation, Germany is an ‘opt-in’ country, which requires explicit consent from donors. The relatives are either asked to decide on behalf of the donors’ preferences, if these are unknown or if the potential donor has explicitly transferred the decision to them. At the core of this policy lies the sociocultural and moral premise of a rational, autonomous individual, whose rights require legal protection in order to guarantee a voluntary decision. In concrete transplantation practices, the family (...) plays an even more important role. Potential donors and their families decide while being embedded in relations, a point which does still not gain full recognition. This particular discrepancy between policy and practice creates conflicts, which remain taboos of academic inquiry and public discourse. Our analysis shows a plurality of the family’s role in the transplantation process, which reveals an inner tension of the organ donation system. This tension provokes epistemic opacity on the one hand and different collective strategies as responses to discursive exclusion on the other. In future deliberations about organ donation, it is important to create spaces for open discussion, but also practices of communicative engagement, which take care of the needs and emotions attached to taboos. (shrink)

This paper defends the epistemic account of the normativity of requests. The epistemic account says that a request does not create any reasons and thus does not have any special normative power. Rather, a request gives reasons by revealing information which is normatively relevant. I argue that compared to competing accounts of request normativity, especially those of David Enoch and James H.P. Lewis, the epistemic account gives better answers to cases of insincere requests, is simpler, and does (...) a better job incorporating the importance of relationships. I also defend the epistemic account from three objections: that requests are important because they constitute consent, that requests and wishes must be normatively different, and that some requests do not provide any new information. (shrink)

The essay focuses on controversies where the debated issues are complex, the exchange involves several participants, and extends over long periods. Examples include the Methodenstreit, the Hering-Helmholtz controversy or the debates over Newton’s or Darwin’s views. In these cases controversies lasted for several generations, and polarisation is a recurring trait of the exchanges. The reconstructions and evaluations of the partly polemical exchanges also exhibit heterogeneity and polarisation. Although I pick an early example of the Newtonian controversies, Darwin’s argument in The (...) Origin of Species can also be variously reconstructed. When scientific controversies that involve complex utterances are investigated, a specific problem arises, as in these situations the protagonist presenting a bundle of claims to a non-unified audience cannot fully control meaning-attribution of his utterances, and, given what we know about individual cognition, the more heterogeneous audience he succeeds in persuading, the less clear the meaning becomes. While the acceptance of a position increases potential for action, the growth in consent comes together with a fuzzy content. To problematise the role of polarisation, the significance of this description with respect to knowledge-production is investigated from both an individual and a social epistemological standpoint to answer the question: How is rhetoric epistemic in cases when at least two views on a given issue are seen as persuasively supported by communities? If engaging in a controversy is a means-to-an-end activity aimed at persuasion, directed at achieving attitude-change in recipients, how does the argumentative goal of an individual translate to epistémé in extended scientific controversies? (shrink)

This essay defends the view that “modern science,” as with modernity in general, is a polycentered phenomenon, something that appears in different forms at different times and places. It begins with two ideas about the nature of rational scientific inquiry: Karin Knorr Cetina's idea of “epistemic cultures,” and Philip Kitcher's idea of science as “a system of public knowledge,” such knowledge as would be deemed worthwhile by an ideal conversation among the whole public under conditions of mutual engagement. This (...) account of the nature of scientific practice provides us with a new perspective from which to understand key elements in the philosophical project of Jaina logicians in the seventh, eighth, and ninth centuries c.e. Jaina theory seems exceptionally well targeted onto two of the key constituents in the ideal conversation—the classification of all human points of view and the representation of end states of the deliberative process. The Buddhist theory of the Kathāvatthu contributes to Indian epistemic culture in a different way: by supplying a detailed theory of how human dialogical standpoints can be revised in the ideal conversation, an account of the phenomenon Kitcher labels “tutoring.” Thus science in India has its own history, one that should be studied in comparison and contrast with the history of science in Europe. In answer to Joseph Needham, it was not ‘modern science’ which failed to develop in India or China but rather non-well-ordered science, science as unconstrained by social value and democratic consent. What I argue is that this is not a deficit in the civilisational histories of these countries, but a virtue. (shrink)