When the COVID-19 surge hit New York City hospitals, the Division of Medical Ethics at Weill Cornell Medical College, and our affiliated ethics consultation services, faced waves of ethical issues sweeping forward with intensity and urgency. In this article, we describe our experience over an eight-week period (16 March through 10 May 2020), and describe three types of services: clinical ethics consultation (CEC); service practice communications/interventions (SPCI); and organizational ethics advisement (OEA). We tell this narrative through the prism of time, (...) describing the evolution of ethical issues and trends as the pandemic unfolded. We delineate three phases: anticipation and preparation, crisis management, and reflection and adjustment. The first phase focused predominantly on ways to address impending resource shortages and to plan for remote ethics consultation, and CECs focused on code status discussions with surrogates. The second phase was characterized by the dramatic convergence of a rapid increase in the number of critically ill patients, a growing scarcity of resources, and the reassignment/ redeployment of staff outside their specialty areas. The third phase was characterized by the recognition that while the worst of the crisis was waning, its medium- and long-term consequences continued to pose immense challenges. We note that there were times during the crisis that serving in the role of clinical ethics consultant created a sense of dis-ease as novel as the coronavirus itself. In retrospect we learned that our activities far exceeded the familiar terrain of clinical ethics consultation and extended into other spheres of organizational life in novel ways that were unanticipated before this pandemic. To that end, we defined and categorized a middle level of ethics consultation, which we have termed service practice communication intervention (SPCI). This is an underappreciated dimension of the work that ethics consult services are capable of in times of crisis. We believe that the pandemic has revealed the many enduring ways that ethics consultation services can more robustly contribute to the ethical life of their institutions moving forward. (shrink)

Mackenzie Graham has made an important contribution to the literature on decisionmaking for patients with disorders of consciousness. He argues, and I agree, that decisions for unresponsive patients who are known to retain some degree of covert awareness ought to focus on current interests, since such patients likely retain the kinds of mental capacities that in ordinary life command our current respect and attention. If he is right, then it is not appropriate to make decisions for such patients by (...) appealing to the values they had in the past, either the values expressed in an advance directive or the values recalled by a surrogate. There are two things I wish to add to the discussion. My first point is somewhat critical, for although I agree with his general conclusion about how, ideally, such decisions should be approached, I remain skeptical about whether his conclusion offers decisionmakers real practical help. The problem with these cases is that the evidence we have about the nature of the patient’s current interests is minimal or nonexistent. However—and this is important—Graham’s conclusion will be extremely relevant if in the future, our ability to communicate with such patients improves, as I hope it will. This leads to my second point. Graham’s conclusion illustrates a more general problem with our standard framework for decisionmaking for previously competent patients, a problem that has not been adequately recognized. So, in what follows, I explain the problem I see and offer some brief thoughts about solutions. (shrink)

Philip Reed argues that laws that grant people access to euthanasia on the basis of terminal illness are discriminatory. In support of this claim, he offers an argument by analogy: it would be discriminatory to offer a person access to euthanasia because they are women or because they are disabled, as such restricted access would send the message ‘that life as a woman or as a disabled person is (very often) not worth living’.1 And so it must also be discriminatory (...) to offer people access to euthanasia because they are terminally ill. Arguments by analogies are only as good as the analogies on which they are built. Having a terminal illness, I’m going to suggest, is not relevantly similar enough to either being disabled or being a member of an oppressed social group to make Reed’s claim compelling. Let’s explore each branch of the analogy in turn. Why think that terminal illness is relevantly unlike disability, in a way that makes offering access to euthanasia in the latter case discriminatory, but not the former? For one thing, terminal illness is necessarily time-limited. When my father was dying, he found himself in constant …. (shrink)

Contemporary literature in philosophy of action seems to be divided overthe place of action in the natural causal world. I think that a disagreementabout ontology underlies the division. I argue here that human action isproperly understood only by reference to a category of process or activity,where this is not a category of particulars.

We often feel survivor guilt when the very circumstances that harm others leave us unscathed. Although survivor guilt is both commonplace and intelligible, it raises a puzzle for the standard philosophical account of guilt, according to which people feel guilt only when they take themselves to be morally blameworthy. The standard account implies that survivor guilt is uniformly unfitting, as people are not blameworthy simply for having fared better than others. In this paper, we offer a rival account of guilt, (...) the relational account of guilt, which makes sense of survivor guilt and other forms of guilt without self-blame while preserving the intelligibility of guilt about culpable wrongdoing. According to this account, guilt involves the feeling of being unable to justify ourselves to others, and we lack self-justification when we (however blamelessly) stand on the positive side of an undesirable asymmetry with them. When someone survives something that those around her do not, the disparity in outcome constitutes an asymmetry that is often undesirable, because it arises from luck or violates a requirement of solidarity. Thus, survivor guilt is often fitting. (shrink)

The question that will be the focus of this paper is this: what is the significance of disagreement between those who are epistemic peers? There are two answers to this question found in the recent literature. On the one hand, there are those who hold that one can continue to rationally believe that p despite the fact that one’s epistemic peer explicitly believes that not-p. I shall call those who hold this view nonconformists. In contrast, there are those who hold (...) that one cannot continue to rationally believe that p when one is faced with an epistemic peer who explicitly believes that not-p. I shall call those who hold this view conformists. Inthis paper, I shall argue that neither nonconformism nor conformism provides a plausible account of the epistemic significance of peer disagreement. I shall then develop my justificationist account of peer disagreement’s epistemic significance. Whereas current views maintain that disagreement, by itself, either simply does or does not possess epistemic power, my account holds that its epistemic power, or lack thereof, is explainable in terms of its interaction with other features,particularly the degree of justified confidence with which the belief in question is held and the presence of information that one possesses about one’s own epistemic situation. (shrink)

Testimony is an invaluable source of knowledge. We rely on the reports of those around us for everything from the ingredients in our food and medicine to the identity of our family members. Recent years have seen an explosion of interest in the epistemology of testimony. Despite the multitude of views offered, a single thesis is nearly universally accepted: testimonial knowledge is acquired through the process of transmission from speaker to hearer. In this book, Jennifer Lackey shows that this (...) thesis is false and, hence, that the literature on testimony has been shaped at its core by a view that is fundamentally misguided. She then defends a detailed alternative to this conception of testimony: whereas the views currently dominant focus on the epistemic status of what speakers believe, Lackey advances a theory that instead centers on what speakers say. The upshot is that, strictly speaking, we do not learn from one another's beliefs - we learn from one another's words. Once this shift in focus is in place, Lackey goes on to argue that, though positive reasons are necessary for testimonial knowledge, testimony itself is an irreducible epistemic source. This leads to the development of a theory that gives proper credence to testimony's epistemologically dual nature: both the speaker and the hearer must make a positive epistemic contribution to testimonial knowledge. The resulting view not only reveals that testimony has the capacity to generate knowledge, but it also gives appropriate weight to our nature as both socially indebted and individually rational creatures. The approach found in this book will, then, represent a radical departure from the views currently dominating the epistemology of testimony, and thus is intended to reshape our understanding of the deep and ubiquitous reliance we have on the testimony of those around us. (shrink)

This essay explores the speech act of dogwhistling (sometimes referred to as ‘using coded language’). Dogwhistles may be overt or covert, and within each of these categories may be intentional or unintentional. Dogwhistles are a powerful form of political speech, allowing people to be manipulated in ways they would resist if the manipulation was carried outmore openly—often drawing on racist attitudes that are consciously rejected. If philosophers focus only on content expressed or otherwise consciously conveyed they may miss what is (...) most powerful and pernicious in the speech of political culture. This essay is a call to start paying attention to these more covert speech acts, and a first attempt at beginning to theorize them. It argues that dogwhistles present a complex and interesting case for the philosopher of language, and explores their implications for democratic politics. (shrink)

Descartes with his sharp separation of the mental and the physical set the stage for the philosophy of mind for the next 350 years. Philosopher Patrick T. Mackenzie finds in the later writings of Wittgenstein the suggestion that Descartes got off on the wrong foot. Following Wittgenstein's lead, Mackenzie argues that instead of analyzing our human nature as a composite of mind and body, we should view ourselves as whole persons. One of the dividends of this approach to (...) the mind-body problem is that it provides us with a resolution to the problem of human freedom—i.e., how can a human being be free if his or her body (including the brain) belongs to a deterministic world? Mackenzie here argues that the person is largely free even though the movements of the body are determined by neurophysiological events. He takes the same approach to the philosophy of mind as that taken by M.R.Bennett and P.M.S.Hacker in their recent and controversial book, The Philosophical Foundations of Neuroscience. Mackenzie's approach is, however, much more accessible. Students of philosophy and philosophers interested in the problem of human freedom will welcome Mackenzie's fresh approach, especially those disenchanted by the present list of mind-body "isms.". (shrink)

In The Bodhisattva’s Brain: Buddhism Naturalized, Owen Flanagan undertakes a project of what he calls ‘cosmopolitan philosophy’, with an aim to develop and interrogate a naturalized Buddhism. A project of naturalization requires a conception of naturalism that can serve as a hermeneutic and philosophical standard against which certain things may be judged naturalistically acceptable or unacceptable. On Flanagan’s account, Buddhism ‘naturalized’ is primarily a Buddhism, “without the mind-numbing and wishful hocus-pocus.” Instead, he sets out to sketch a version of Buddhism (...) (or a new view inspired by it) that is consistent with neo-Darwinian evolutionary theory and scientific materialism, including ‘neurophysicalism’ or the view that “mental events are brain events.” However, classical Buddhist philosophers rejected materialism on philosophical, not merely dogmatic, grounds. In contemporary terms, Buddhist philosophers saw that phenomenal consciousness, intentionality, and mental causation present serious problems for materialism. So, rather than dismissing Buddhist anti-materialist accounts of mind as simply ‘hocus-pocus’, in this chapter takes up the question of whether and how these views might inform a naturalistic Buddhist philosophy. The question, then, is whether a naturalistic Buddhism requires some form of neurophysicalism. It is argued that it does not, by way of examining two distinct versions of naturalistic, but non-physicalist accounts of consciousness reconstructed from the Indian Buddhist tradition. The first, drawing on the work of Dharmakīrti, is a form of trope dualism. The second, drawing on the work of Śāntarakṣita, is a form of pragmatic pluralism that gives a central place to consciousness. And while these two accounts are distinct, and in some important respects incompatible, what they have in common is the idea that consciousness is both non-physical and fully natural. (shrink)

Intuitively, there is a difference between knowledge and mere belief. Contemporary philosophical work on the nature of this difference has focused on scenarios known as “Gettier cases.” Designed as counterexamples to the classical theory that knowledge is justified true belief, these cases feature agents who arrive at true beliefs in ways which seem reasonable or justified, while nevertheless seeming to lack knowledge. Prior empirical investigation of these cases has raised questions about whether lay people generally share philosophers’ intuitions about these (...) cases, or whether lay intuitions vary depending on individual factors (e.g. ethnicity) or factors related to specific types of Gettier cases (e.g. cases that include apparent evidence). We report an experiment on lay attributions of knowledge and justification for a wide range of Gettier Cases and for a related class of controversial cases known as Skeptical Pressure cases, which are also thought by philosophers to elicit intuitive denials of knowledge. Although participants rated true beliefs in Gettier and Skeptical Pressure cases as being justified, they were significantly less likely to attribute knowledge for these cases than for matched true belief cases. This pattern of response was consistent across different variations of Gettier cases and did not vary by ethnicity or gender, although attributions of justification were found to be positively related to measures of empathy. These findings therefore suggest that across demographic groups, laypeople share similar epistemic concepts with philosophers, recognizing a difference between knowledge and justified true belief. (shrink)

Substitution and simple sentences -- Simple sentences and semantics -- Simple sentences and implicatures -- The enlightenment problem and a common assumption -- Abandoning (EOI) -- Beyond matching propositions -- App. A : extending the account -- App. B : belief reporting.

Civil society organizations (CSOs) have significantly impacted on the politics of health research and the field of bioethics. In the globalHIVepidemic,CSOs have served a pivotal stakeholder role. The dire need for development of new prevention technologies has raised critical challenges for the ethical engagement of community stakeholders inHIVresearch. This study explored the perspectives ofCSOrepresentatives involved inHIVprevention trials (HPTs) on the impact of premature trial closures on stakeholder engagement. Fourteen respondents fromSouthAfrican and internationalCSOs representing activist and advocacy groups, community mobilisation initiatives, (...) and human and legal rights groups were purposively sampled based on involvement inHPTs. Interviews were conducted fromFebruary‐May 2010. Descriptive analysis was undertaken across interviews and key themes were developed inductively.CSOrepresentatives largely described positive outcomes of recent microbicide andHIVvaccine trial terminations, particularly inSouthAfrica, which they attributed to improvements in stakeholder engagement. Ongoing challenges to community engagement included the need for principled justifications for selective stakeholder engagement at strategic time‐points, as well as the need for legitimate alternatives toCABs as mechanisms for engagement. Key issues forCSOs in relation to research were also raised. (shrink)

Once symbolized by a burning armchair, experimental philosophy has in recent years shifted away from its original hostility to traditional methods. Starting with a brief historical review of the experimentalist challenge to traditional philosophical practice, this chapter looks at research undercutting that challenge, and at ways in which experimental work has evolved to complement and strengthen traditional approaches to philosophical questions.

In _Aesthetics and Material Beauty_, Jennifer A. McMahon develops a new aesthetic theory she terms Critical Aesthetic Realism - taking Kantian aesthetics as a starting point and drawing upon contemporary theories of mind from philosophy, psychology, and cognitive science. The creative process does not proceed by a set of rules. Yet the fact that its objects can be understood or appreciated by others suggests that the creative process is constrained by principles to which others have access. According to her (...) update of Kantian aesthetics, beauty is grounded in indeterminate yet systematic principles of perception and cognition. However, Kant’s aesthetic theory rested on a notion of indeterminacy whose consequences for understanding the nature of art were implausible. McMahon conceptualizes "indeterminacy" in terms of contemporary philosophical, psychological, and computational theories of mind. In doing so, she develops an aesthetic theory that reconciles the apparent dichotomies which stem from the tension between the determinacy of communication and the indeterminacy of creativity. Dichotomies such as universality and subjectivity, objectivity and autonomy, cognitivism and non-cognitivism, and truth and beauty are revealed as complementary features of an aesthetic judgment. (shrink)

Williams explains why there might have been some point to a linguistic approach in ethics. I suggest that there might be some point to paying attention to an ethical dimension in philosophy of language. I shall consider words that I label ‘derogatory’, and questions they raise about linguistic meaning.

This paper provides a general introduction to the use of causal models in the metaphysics of causation, specifically structural equation models and directed acyclic graphs. It reviews the formal framework, lays out a method of interpretation capable of representing different underlying metaphysical relations, and describes the use of these models in analyzing causation.

Introduction -- Elucidating complexity theories -- Complexity in the natural sciences -- Complexity in social theory -- Towards transdisciplinarity -- Complexity in philosophy: complexification and the limits to knowledge -- Complexity in ethics -- Earth in the anthropocene -- Complexity and climate change -- American dreams, ecological nightmares and new visions -- Complexity and sustainability: wicked problems, gordian knots and synergistic solutions -- Conclusion.

This paper provide the first extended discussion in the philosophical literature of the epistemic significance of the phenomenon of “being known” and the relationship it has to reparations that are distinctively epistemic. Drawing on a framework provided by the United Nations of the “right to know,” it is argued that victims of gross violations and injustices not only have the right to know what happened, but also the right to be known—to be a giver of knowledge to others about their (...) own experiences. It is shown that such victims can suffer epistemic wrongs by being rendered invisible, vilified or demonized, or systematically distorted, and that these ways of not being known demand epistemic reparations. While there are traditional reparations that are epistemic in nature, such as memorialization and education, it is argued that there is a prior and arguably more important epistemic reparation—knowing victims of gross violations and injustices in the sense of bearing witness. The paper concludes with a sketch of an epistemological picture to underwrite this notion of epistemic reparations, one that significantly expands the traditional picture by including epistemic duties that are imperfect in nature and concern actions in addition to beliefs. (shrink)

Jennifer Hornsby offers here detailed discussions of ontology, human agency, and everyday psychological explanation. In her distinctive view of questions about the mind's place in nature she argues for a particular position in philosophy of mind: naive naturalism.

In this collection of original essays, international scholars put Asian traditions, such as Hinduism, Buddhism, Daoism, and Confucianism, into conversation with one or more contemporary feminist philosophies, founding a new mode of inquiry that attends to diverse voices and the complex global relationships that define our world. -/- These cross-cultural meditations focus on the liberation of persons from suffering, oppression, illusion, harmful conventions and desires, and other impediments to full personhood by deploying a methodology that traverses multiple philosophical styles, historical (...) texts, and frames of reference. Hailing from the discipline of philosophy in addition to Asian, gender, and religious studies, the contributors offer a fresh take on the classic concerns of free will, consciousness, knowledge, objectivity, sexual difference, embodiment, selfhood, the state, morality, and hermeneutics. One of the first anthologies to embody the practice of feminist comparative philosophy, this collection creatively and effectively engages with global, cultural, and gender differences within the realms of scholarly inquiry and theory construction. -/- http://cup.columbia.edu/book/978-0-231-16624-9/asian-and-feminist-philosophies-in-dialogue. (shrink)

The dominant approach to assessing decision-making capacity in medicine focuses on determining the extent to which individuals possess certain core cognitive abilities. Critics have argued that this model delivers the wrong verdict in certain cases where patient values that are the product of mental disorder or disordered affective states undermine decision-making without undermining cognition. I argue for a re-conceptualization of what it is to possess the capacity to make medical treatment decisions. It is, I argue, the ability to track one’s (...) own personal interests at least as well as most people can. Using this idea, I demonstrate that it is possible to craft a solution for the problem cases—one that neither alters existing criteria in dangerous ways (e.g. does not open the door to various kinds of abuse) nor violates widely accepted ethical constraints on decision-making assessment. (shrink)

A disjunctivist conception of acting for reasons is introduced by way of showing that a view of acting for reasons must give a place to knowledge. Two principal claims are made. 1. This conception has a rôle analogous to that of the disjunctive conception that John McDowell recommends in thinking about perception; and when the two disjunctivist conceptions are treated as counterparts, they can be shown to have work to do in combination. 2. This conception of acting for reasons safeguards (...) the connection between considerations that move us to act in particular ways and considerations that favour our acting in particular ways. (shrink)

How, in a secular world, should we resolve ethically controversial and troubling issues relating to health care? Should we, as some argue, make a clean sweep, getting rid of the Hippocratic ethic, such vestiges of it as remain? Jennifer Jackson seeks to answer these significant questions, establishing new foundations for a traditional and secular ethic which would not require a radical and problematic overhaul of the old. These new foundations rest on familiar observations of human nature and human needs. (...) Jackson presents morality as a loose anatomy of constituent virtues that are related in different ways to how we fare in life, and suggests that in order to address problems in medical ethics, a virtues-based approach is needed. Throughout, attention is paid to the role of philosophy in medical ethics, and how it can be used to clarify key notions and distinctions that underlie current debates and controversial issues. By reinstating such concepts as justice, cardinal virtue, and moral duty, Jackson lays the groundwork for an ethics of health care that makes headway toward resolving seeming dilemmas in medical ethics today. This penetrating and accessible book will be invaluable to students of sociology and health care, as well as those who are interested in the ethical uncertainties faced by the medical world. (shrink)

Do epistemic intuitions tell us anything about knowledge? Stich has argued that we respond to cases according to our contingent cultural programming, and not in a manner that tends to reveal anything significant about knowledge itself. I’ve argued that a cross-culturally universal capacity for mindreading produces the intuitive sense that the subject of a case has or lacks knowledge. This paper responds to Stich’s charge that mindreading is cross-culturally varied in a way that will strip epistemic intuitions of their evidential (...) value. I argue that existing work on cross-cultural variation in mindreading favors my position over Stich’s. (shrink)

Wherever philosophers disagree, one of the things at issue is likely to be what they disagree about, itself. In addition to asking whether moral realism is true, and which forms of moral realism are more likely to be true than others, we can also ask what it would mean for some form of moral realism to be true. The usual aspiration of such inquiry is to find definitions that all can agree on, so that we can use terms in a (...) uniform way. But we doubt that this aspiration is always possible, or even desirable. It will be our goal in this chapter to sketch out some of our reasons for such skepticism, and to lay out a picture of what philosophical inquiry can look like in metaethics and beyond, even when it is impossible to reach uniform agreement on the terms of the debate. (shrink)

In this article I explore various facets of Nozick’s famous thought experiment involving the experience machine. Nozick’s original target is hedonism—the view that the only intrinsic prudential value is pleasure. But the argument, if successful, undermines any experientialist theory, i.e. any theory that limits intrinsic prudential value to mental states. I first highlight problems arising from the way Nozick sets up the thought experiment. He asks us to imagine choosing whether or not to enter the machine and uses our choice (...) (or rather the choice he assumes most people will have) as evidence against experientialist theories. But for this strategy to succeed it must be possible to distinguish between self-interested and non-self-interested reasons for declining to enter the machine, and there is no obvious way to do this without begging the question against the hedonist. In successive sections I then (a) consider a common misconception of Nozick’s conclusion (that he thinks machine life is the worst life), (b) consider different intuitions about what is important to well-being but missing from machine life, and finally (c) explain what “the experience requirement” is, and describe its relationship to debates about experientialist theories. (shrink)

To what extent should we trust our natural instincts about knowledge? The question has special urgency for epistemologists who want to draw evidential support for their theories from certain intuitive epistemic assessments while discounting others as misleading. This paper focuses on the viability of endorsing the legitimacy of Gettier intuitions while resisting the intuitive pull of skepticism – a combination of moves that most mainstream epistemologists find appealing. Awkwardly enough, the “good” Gettier intuitions and the “bad” skeptical intuitions seem to (...) be equally strong. This chapter argues that it is not a coincidence that these two types of intuition register with equal force: they are generated by a common mechanism. However, the input to this mechanism is interestingly different in the two types of case, and different in a way that can support the mainstream view that Gettier cases tell us something about knowledge where skeptical intuitions involve systematic error. (shrink)

Robinson argues that by certain threshold criteria, pregnant women qualify for a higher moral status by reason of their pregnancies. While her intention is to make this a status upgrade for women, we worry that it may result in a status downgrade for women as a class, by presupposing and reinforcing women’s value in relation to their reproductive labour. Historically, central to feminist analysis is resistance to reductive accounts of women in relation to their reproductivity. For example, de Beauvoir addressed (...) men’s transcendence and contrasted it with women’s immanence, a status distinction possible because women are mired in expectations that they will marry, produce children and remain in the domestic realm; and for her part, Firestone argued that biological reproduction underlies women’s inferiority to men and that ‘The reproduction of the species by one sex for the benefit of both (should) be replaced by…artificial reproduction’1 2 Her concern was to liberate women from expectations of biological reproduction so their productive value in society is not reduced to their reproductive contributions. A formidable body of analysis in this same vein cautions against collapsing the value of women into their pregnancies, so much so that some commentators even distinguish ‘mothering’ from gestation.3 Robinson’s argument that pregnant women qualify at a higher threshold of personhood emphasises …. (shrink)