While it is widely acknowledged that knowledge can be acquired via testimony, it has been argued that understanding cannot. While there is no consensus about what the epistemic relationship of understanding consists in, I argue here that regardless of how understanding is conceived there are kinds of understanding that can be acquired through testimony: easy understanding and easy-s understanding. I address a number of aspects of understanding that might stand in the way of being able to acquire understanding through testimony, (...) focusing on understanding ’s paradigmatic form and what it means to say that in order to understand something you need to “grasp” some information or the relationship between bits of information. I argue that in cases of both easy and easy-s understanding, no aspect of understanding stands in the way of it being able to acquire it through testimony. As a result, while not all understanding be acquired through testimony in all instances and for all subjects, this failure of acquisition is only a product of the complexity of the relevant information or one’s unfamiliarity with it, and not a product of the epistemic relationship of understanding. (shrink)
Recently, there has been growing concern that increased partisanship in news sources, as well as new ways in which people acquire information, has led to a proliferation of epistemic bubbles and echo chambers: in the former, one tends to acquire information from a limited range of sources, ones that generally support the kinds of beliefs that one already has, while the latter function in the same way, but possess the additional characteristic that certain beliefs are actively reinforced. Here I argue, (...) first, that we should conceive of epistemic bubbles and echo chambers as types of epistemically pernicious groups, and second, that while analyses of such groups have typically focused on relationships between individual members, at least part of what such groups epistemically pernicious pertains to the way that members rely on the groups themselves as sources of information. I argue that member reliance on groups results in groups being attributed a degree of credibility that outruns their warrant, a process I call groupstrapping. I argue that by recognizing the groupstrapping as an illicit method of forming and updating beliefs we can make progress on some of the open questions concerning epistemically pernicious groups. (shrink)
Knowledge of the ethical and legal basis of medicine is as essential to clinical practice as an understanding of basic medical sciences. In the UK, the General Medical Council requires that medical graduates behave according to ethical and legal principles and must know about and comply with the GMC’s ethical guidance and standards. We suggest that these standards can only be achieved when the teaching and learning of medical ethics, law and professionalism are fundamental to, and thoroughly integrated both vertically (...) and horizontally throughout, the curricula of all medical schools as a shared obligation of all teachers. The GMC also requires that each medical school provides adequate teaching time and resources to achieve the above. We reiterate that the adequate provision and coordination of teaching and learning of ethics and law requires at least one full-time senior academic in ethics and law with relevant professional and academic expertise. In this paper we set out an updated indicative core content of learning for medical ethics and law in UK medical schools and describe its origins and the consultative process by which it was achieved. (shrink)
ABSTRACTConventional wisdom holds that there is no lucky knowledge: if it is a matter of luck, in some relevant sense, that one's belief that p is true, then one does not know that p. Here I will argue that there is similarly no lucky understanding, at least in the case of one type of luck, namely environmental luck. This argument has three parts. First, we need to determine how we evaluate whether one has understanding, which requires determining what I will (...) call understanding's evaluative object. I argue that as the evaluative object of knowledge is a belief in a proposition, the evaluative object of understanding is a mental representation of a relational structure. Next, I show that arguments that environmental luck is incompatible with understanding miss the mark by considering cases in which one has a belief in a proposition is lucky to be true, instead of ones in which one's mental representation of a relational structure is lucky to obtain. I agree, then, with those who argue that one can have understanding when one's beliefs are environmentally lucky to be true, but that this compatibility is not relevant when considering the question of whether one can have environmentally lucky understanding. I then present what I take to be a properly constructed case which shows the incompatibility of environmental luck with understanding. (shrink)
While social epistemologists have recently begun addressing questions about whether groups can possess beliefs or knowledge, little has yet been said about whether groups can properly be said to possess understanding. Here I want to make some progress on this question by considering two possible accounts of group understanding, modeled on accounts of group belief and knowledge: a deflationary account, according to which a group understands just in case most or all of its members understand, and an inflationary account, according (...) to which a group’s understanding does not depend solely on whether its members understand. I argue that both accounts face problems. The deflationary account has two such problems: aggregation problems that are familiar from discussions of group belief, and the problem of different bases, wherein members possess understanding for different but consistent reasons. The inflationary account faces what I call the problem of distributed grasping: while it is widely accepted that understanding requires a kind of “grasping”, it is hard to make sense of how this requirement could be met at the group level while not necessarily being met by any individual member. Despite its problems, I make a case for the inflationary account. This will require addressing the problem of distributed grasping: to do this, I propose a different way of thinking about the grasping relation at the group level, such that it is constituted by a dependency relationship between members. (shrink)
C.S. Peirce held what is nowadays called a “commitment view” of assertion. According to this type of view, assertion is a kind of act that is determined by its “normative effects”: by asserting a proposition one undertakes certain commitments, typically to be able to provide reason to believe what one is asserting, or, in Peirce’s words, one “takes responsibility” for the truth of the proposition one asserts. Despite being an early adopter of the view, if Peirce’s commitment view of assertion (...) is mentioned at all in contemporary discussions it is only in passing. His view is, however, far more complex and nuanced than he has been given credit for. My primary goal here, then, is to get a better understanding of Peirce’s version of a commitment view of assertion. I also argue that figuring out the details of Peirce’s theory of assertion can also provide us with a viable way to respond to problems that contemporary commitment views of assertion face. (shrink)
The COVID-19 pandemic will generate vexing ethical issues for the foreseeable future and many journals will be open to content that is relevant to our collective effort to meet this challenge. While the pandemic is clearly the critical issue of the moment, it’s important that other issues in medical ethics continue to be addressed as well. As can be seen in this issue, the Journal of Medical Ethics will uphold its commitment to publishing high quality papers on the full array (...) of medical ethics. At the same time, JME aims to be a premiere home for ground-breaking scholarship on the ethical issues raised by COVID-19. Toward this end, we have a number of papers that are freely available online and for which production has been fast-tracked.1–5 A challenge for authors who want to write about the pandemic is the rapidly evolving nature of the situation and the time it takes for journal content to be reviewed and published, even when fast-tracked. For that reason, all authors who would like to submit a paper on the pandemic can also submit a post to the JME blog prior to submitting a full paper to the journal. Those interested in writing for the JME blog should contact one of its editors, Hazem Zohny or Mike King. Over the last 3 weeks, 30 high-quality commentaries on the pandemic have been posted to the blog. These posts are circulated widely via the JME Twitter and Facebook feeds and have stimulated significant …. (shrink)
It is has been argued that there is a problem with moral testimony: testimony is deferential, and basing judgments and actions on deferentially acquired knowledge prevents them from having moral worth. What morality perhaps requires of us, then, is that we understand why a proposition is true, but this is something that cannot be acquired through testimony. I argue here that testimony can be both deferential as well as cooperative, and that one can acquire moral understanding through cooperative testimony. The (...) problem of moral testimony is thus not a problem with testimony generally, but a problem of deferential testimony specifically. (shrink)
While the topic of assertion has recently received a fresh wave of interest from Peirce scholars, to this point no systematic account of Peirce’s view of assertion has been attempted. We think that this is a lacuna that ought to be filled. Doing so will help make better sense of Peirce’s pragmatism; further, what is hidden amongst various fragments is a robust pragmatist theory of assertion with unique characteristics that may have significant contemporary value. Here we aim to uncover this (...) theory, and to show that assertion for Peirce is not a mere corollary of pragmatic conceptions of truth, judgement, and belief, but is rather a central aspect of his philosophy. (shrink)
Ethics in nursing: continuity and change -- Cultural issues, methods and approaches to nursing ethics -- Nursing ethics: what do we mean by 'ethics'? -- Becoming a nurse and member of the profession -- Power and responsibility in nursing practice and management -- Professional responsibility and accountability in nursing -- Classical areas of controversy in nursing and biomedical ethics -- Direct responsibility in nurse/patient relationships -- Conflicting demands in nursing groups of patients -- Ethics in healthcare management: research, evaluation and (...) performance management -- The political ethics of healthcare: health policies and resource allocation -- Corporate ethics in healthcare: strategic planning and ethical policy development -- Making moral decisions and being able to justify our actions -- The relevance of moral theory: justifying our ethical policies. (shrink)
A perennial problem in social epistemology is the problem of expert testimony, specifically expert testimony regarding scientific issues: for example, while it is important for me to know information pertaining to anthropogenic climate change, vaccine safety, Covid-19, etc., I may lack the scientific background required to determine whether the information I come across is, in fact, true. Without being able to evaluate the science itself, then, I need to find trustworthy expert testifiers to listen to. A major project in social (...) epistemology has thus become determining what the markers of trustworthiness are that laypersons can appeal to in order to identify and acquire information from expert testifiers. At the same time, the ways in which we acquire scientific information has changed significantly, with much of it nowadays being acquired in online environments. While much has been said about the potential pitfalls of seeking information online, little has been said about how the nature of seeking information online should make us think about the problem of expert testimony. Indeed, it seems to be an underlying assumption that good markers of trustworthiness apply equally well when seeking information from expert testifiers in online and offline environments alike, and that the new challenges and opportunities presented by online environments merely affects the methods by which we can acquire evidence of said trustworthiness. Here I argue that in making this assumption one risks failing to account for how unique features of the ways in which we acquire information online affect how we evaluate the trustworthiness of experts. Specifically, I argue for two main claims: first, that the nature of information-seeking online is such that the extent to which information is susceptible to manipulation is a dominant marker of trustworthiness; second, as a result, one will be more likely to seek out a particular kind of expert testifier in online environments, what I call a cooperative as opposed to preemptive expert. The result is that criteria for expert trustworthiness may look significantly different when acquiring information online as opposed to offline. (shrink)
Isaac Levi (1980) targets an implicit tension in C.S. Peirce’s epistemology, one that exists between the need to always be open-minded and aware of our propensity to make mistakes so that we do not “block the road of inquiry,” and the need to treat certain beliefs as infallible and to doubt only in a genuine way so that inquiry can proceed in the first place. Attempts at alleviating this tension have typically involved interpreting Peirce as ascribing different normative standards to (...) different areas of inquiry. I argue here that such “double-standard” interpretations face significant problems. I offer instead an interpretation of Peirce on which the differences between different areas of inquiry are descriptive rather than normative. Such a view resolves Levi’s tension while interpreting Peirce as consistently subscribing to one normative standard for all inquiry. (shrink)
I argue here for a view I call epistemic separabilism , which states that there are two different ways we can be evaluated epistemically when we assert a proposition or treat a proposition as a reason for acting: one in terms of whether we have adhered to or violated the relevant epistemic norm, and another in terms of how epistemically well-positioned we are towards the fact that we have either adhered to or violated said norm. ES has been appealed to (...) most prominently in order to explain why epistemic evaluations that conflict with the knowledge norm of assertion and practical reasoning nevertheless seem correct. Opponents of such a view are committed to what I call epistemic monism , which states that there is only one way we can be properly evaluated as epistemically appropriate asserters and practical reasoners, namely in terms of whether we have adhered to or violated the relevant norm. Accepting ES over EM has two significant consequences: first, a “metaepistemological” consequence that the structure of normative epistemic evaluations parallels that found in other normative areas , and second, that the knowledge norms of assertion and practical reasoning are no worse off than any alternatives in terms of either explanatory power or simplicity. (shrink)
In addition to being a founder of American pragmatism, Charles Sanders Peirce was a scientist and an empiricist. A core aspect of his thoroughgoing empiricism was a mindset that treats all attitudes as revisable. His fallibilism seems to require us to constantly seek out new information, and to not be content holding any beliefs uncritically. At the same time, Peirce often states that common sense has an important role to play in both scientific and vital inquiry, and that there cannot (...) be any “direct profit in going behind common sense.” Our question is the following: alongside a scientific mindset and a commitment to the method of inquiry, where does common sense fit in? Peirce does at times directly address common sense; however, those explicit engagements are relatively infrequent. In this paper, we argue that getting a firm grip on the role of common sense in Peirce’s philosophy requires a three-pronged investigation, targeting his treatment of common sense alongside his more numerous remarks on intuition and instinct. By excavating and developing Peirce’s concepts of instinct and intuition, we show that his respect for common sense coheres with his insistence on the methodological superiority of inquiry. We conclude that Peirce shows us the way to a distinctive epistemic position balancing fallibilism and anti-scepticism, a pragmatist common sense position of considerable interest for contemporary epistemology given current interest in the relation of intuition and reason. (shrink)
One prominent argument for pragmatic encroachment (PE) is that PE is entailed by a combination of a principle that states that knowledge warrants proper practical reasoning, and judgments that it is more difficult to reason well when the stakes go up. I argue here that this argument is unsuccessful. One problem is that empirical tests concerning knowledge judgments in high-stakes situations only sometimes exhibit the result predicted by PE. I argue here that those judgments that appear to support PE are (...) better interpreted not as judgments that the epistemic demands for knowing increase as one’s practical situation becomes more demanding, but instead as judgments reflecting a different kind of normative epistemic evaluation, namely whether one is acting in an epistemically responsible way. The general idea is that when someone treats a proposition as a reason for acting we can evaluate them epistemically both in terms of whether they know that proposition, as well as in terms of whether they are acting on their knowledge in the right kind of way. My charge against the PE proponent, then, is that she is interpreting judgments that are indicative of whether we are adhering to certain normative epistemic requirements generally as being indicative of whether we have knowledge specifically. There are, however, normative epistemic requirements that make demands of us that are indicative of something other than our possession of knowledge. (shrink)
Concepts such as disease and health can be difficult to define precisely. Part of the reason for this is that they embody value judgments and are rooted in metaphor. The precise meaning of terms like health, healing and wholeness is likely to remain elusive, because the disconcerting openness of the outlook gained from experience alone resists the reduction of first-person judgments (including those of religion) to third-person explanations (including those of science).
This book is the result of a three-year study undertaken by a multidisciplinary working party of the Institute of Medical Ethic (UK). The group was chaired by a moral theologian, and its members included biological and ethological scientists, toxicologists, physicians, veterinary surgeons, an expert in alternatives to animal use, officers of animal welfare organizations, a Home Office Inspector, philosophers, and a lawyer. Coming from these different backgrounds, and holding a diversity of moral views, the members produced the agreed report as (...) a result of detailed and rigorous discussions. The book sets out facts about animal experiments and about animal abilities to experience pain, distress and anxiety. There is a detailed examination of the moral claims related to the benefits likely to accrue from animal research, and of strategies for weighing these benefits against the harm caused to animals, in order to decide whether particular research projects ought or ought not to proceed. This leads to consideration of the statutory and non-statutory controls which safeguard standards in such research. The final section explores a variety of philosophical arguments about the use of animals in research, and offers a philosophical justification for the Working Party's more practical conclusions. Written in clear, nontechnical language, this book is accessible to lay people as well as to scientists. It is the first such document to emerge from a meeting of people with such widely differing views on this highly controversial subject, and represents a major contribution towards informing and raising the quality of contemporary debate. The book is unique in drawing together material and ideas never before found in one volume. It will interest a broad spectrum of readers, from ethicists and animal rights advocates to scientific researchers and laboratory administrators, along with general readers concerned about this compelling issue. (shrink)
Medical ethics, principles, persons, and perspectives is discussed under three headings: History, Theory, and Practice. Under Theory, the author will say something about some different approaches to the study and discussion of ethical issues in medicine—especially those based on principles, persons, or perspectives. Under Practice, the author will discuss how one perspectives based approach, hermeneutics, might help in relation first to everyday ethical issues and then to public controversies. In that context some possible advantages of moving from controversy to conversation (...) will be explored; and that will then be illustrated with reference to a current controversy about the use of human embryos in stem cell therapy research. The paper begins with history, and it begins in the author’s home city of Edinburgh. (shrink)
ABSTRACT Although in recent years Christine Ladd-Franklin has received recognition for her contributions to logic and psychology, her role in late nineteenth- and early twentieth-century philosophy, as well as her relationship with American pragmatism, has yet to be fully appreciated. My goal here is to attempt to better understand Ladd-Franklin’s place in the pragmatist tradition by drawing attention to her work on the nature and unity of the proposition. The question concerning the unity of the proposition – namely, the problem (...) of how to determine what differentiates a mere collection of terms from a unified and meaningful proposition – received substantial attention in Ladd-Franklin’s time, and would continue to interest analytic philosophers well into the twentieth century. I argue that Ladd-Franklin had a distinct theory of the proposition and solution to the problem of the unity of the proposition that she developed over the course of her writings on logic and philosophy. In spelling out her views, I will also show her work interacted with and influenced that of the pragmatist who was her greatest influence, C.S. Peirce. (shrink)
The history of the Institute of Medical Ethics has been well recorded. Accounts of its origins in the London Medical Group were published in an academic paper of 2003,1 in the transcript of a Wellcome Witnesses to Twentieth Century Medicine Seminar in 20072 and in a chapter of the 2009 Cambridge World History of Medical Ethics.3 In 2013, 50 years since the inauguration of its first series of lectures and symposia, the LMG as an organisation no longer exists, but its (...) aspirations and achievements are alive and well, both in the Journal of Medical Ethics and in the IME, now exploring a new phase as a membership organisation. Other papers in this issue will discuss the history and prospects of the Journal and Institute. But the LMG, similar medical groups in all other British medical schools and the Society for the Study of Medical Ethics from which the IME derived also have a significant continuing life in the thinking and practice of many medical and healthcare professionals who participated in their activities, and then in turn on those influenced by their thinking and practice. The LMG, it could be said, is ‘no more’ an organisation ‘Now but a whole climate of opinion’.4A bottom-up evolutionThe first medical students to be involved in the LMG may not have foreseen its influence on their future careers, but many were aware of being part of something new and exciting. One of those with whom the first lecture series was planned was Margaret Lloyd . "The beginning of the LMG in 1963 was an exciting time for medical students in London. As a mature student entering St Mary's Hospital Medical School … ". (shrink)
A practical and thought provoking introduction to the most important ethical issues in medicine today. Over 700 entries, from short essays to brief definitions of key terms and concepts, have been contributed by leading clinicians and medical ethicists.
There have been many discussions recently from philosophers, cognitive scientists, and psychologists about group polarization, particularly with regards to political issues and scientific issues that have become markers of social identity, such as anthropogenic climate change and vaccine hesitancy. Online and social media environments in particular have received a lot of attention in these discussions, both because of people’s increasing reliance on such environments for receiving and exchanging information, and because such environments often allow individuals to selectively interact with those (...) who are like-minded. My goal here is to argue that the group epistemologist can facilitate understanding the kinds of factors that drive group polarization in a way that has been overlooked by the existing research. Specifically, I argue that polarization can occur in part because of the ways that members of a group treat the group itself (as opposed to an individual member within that group) as a source of information, and in doing so makes their own position, as well as that of the group, more extreme. I refer to this as a structural factor in driving polarization, as it is a factor that is produced by the general nature of the relationship between a group and its members. (shrink)
Take pragmatic encroachment to be the view that whether one knows that p is determined at least in part by the practical consequences surrounding the truth of p. This view represents a significant departure from the purist orthodoxy, which holds that only truth-relevant factors determine whether one knows. In this chapter I consider some consequences of accepting pragmatic encroachment when applied to problems of political knowledge and political ignorance: first, that there will be cases in which it will not be (...) practically rational to acquire political knowledge when the stakes surrounding one’s political actions are high; second, that political knowledge can be more easily acquired when one values the welfare of others less; and third, that pragmatic encroachment may fail to account for a form of epistemic injustice when it comes to evaluating the political knowledge of members of marginalized groups. I argue that while these consequences are undesirable, the extent to which the pragmatic encroacher is committed to them depends both on the details of the theory, as well as the extent to which one considers political knowledge to be important. (shrink)
This penetrating book sheds light on the psychology of fundamentalism, with a particular focus on those who become extremists and fanatics. What accounts for the violence that emerges among some fundamentalist groups? The contributors to this book identify several factors: a radical dualism, in which all aspects of life are bluntly categorized as either good or evil; a destructive inclination to interpret authoritative texts, laws, and teachings in the most literal of terms; an extreme and totalized conversion experience; paranoid thinking; (...) and an apocalyptic world view. After examining each of these concepts in detail, and showing the ways in which they lead to violence among widely disparate groups, these engrossing essays explore such areas as fundamentalism in the American experience and among jihadists, and they illuminate aspects of the same psychology that contributed to such historical crises as the French Revolution, the Nazi movement, and post-Partition Hindu religious practice. (shrink)
An Institute of Medical Ethics working party argues that an ethically desirable relationship of mutual empowerment between patient and clinician is more likely to be achieved if patients understand the ground rules of medical confidentiality. It identifies and illustrates ambiguities in the General Medical Council's guidance on AIDS and confidentiality, and relates this to the practice of different doctors and specialties. Matters might be clarified, it suggests, by identifying moral factors which tend to recur in medical decisions about maintaining or (...) breaching confidentiality. The working party argues that two such factors are particularly important: the patient's need to exercise informed choice and the doctor's primary responsibility to his or her own patients. (shrink)
Even before it had been developed there had already been skepticism among the general public concerning a vaccine for COVID-19. What are the factors that drive this skepticism? While much has been said about how political differences are at play, in this article I draw attention to two additional factors that have not received as much attention: witnessing the fallibility of the scientific process play out in real time, and a perceived breakdown of the distinction between experts and non-experts.
When the first issue of this journal was published in April 1975 its inaugural editorial stated: "The aim of the Journal of Medical Ethics is to provide a forum for the reasoned discussion of moral issues arising from the provision of medical care. It will hold no brief for one particular professional, political, or religious viewpoint. The articles it publishes will identify current problems, present factual information, and clarify different moral assumptions. To fulfil these aims the Editors can call on (...) the resources of the disciplines of law, philosophy, and theology, as well as on the whole range of medical and paramedical specialties.1"This prospectus well expressed the ethos of the journal's original publisher, the Society for the Study of Medical Ethics , and was clearly reflected in the content and style of the journal's early issues. It was also reflected in the journal's authorship, which included many leading medical and other academics and professionals of the time, who demonstrated lively engagement with a variety of emerging moral issues. In due course such issues would be well recognised as the substance of ‘medical ethics’, but in 1975, as the editorial also noted, that ‘phrase’ could still ‘create misunderstandings and provoke suspicions (especially perhaps among medical …. (shrink)
In their responses to my article “Epistemically Pernicious Groups and the Groupstrapping Problem” (Boyd, 2018), Bert Baumgaertner (“Groupstrapping, Boostrapping, and Oops-strapping: A Reply to Boyd”) and C. Thi Nguyen (“Group-strapping, Bubble, or Echo Chamber?”) have raised interesting questions and opened lines of inquiry regarding my discussion of what I hope to be a way to help make sense of how members of groups can continue to hold beliefs that are greatly outweighed by countervailing evidence (e.g. antivaxxers, climate-change deniers, etc.). Here (...) I respond to these arguments and suggestions by providing three new reasons to believe that groupstrapping as I describe it occurs in epistemically pernicious groups. (shrink)
That they are ‘following the science’ has become the watchword of many politicians during the present pandemic, especially when imposing or prolonging lockdowns or other liberty-restricting regulations. The scientists who advise politicians however are usually careful to add that the decision what to restrict and when is ultimately a political one. In science, as in medical practice, there is a delicate balance to be maintained between confidence in the best available information, and the necessary caveat that the assumptions and calculations (...) on which that information is based are subject to further scientific enquiry. For politicians and the public, moreover, as for patients, whether those informing them are judged to be trustworthy is a necessary consideration, a judgement determined by a variety of personal and political contingencies and circumstances. Ethics, by contrast, unable to appeal to scientific consensus or political authority, let alone a confidence-inspiring bedside manner, must rest the case for its essentially contestable assumptions and arguments being judged trustworthy, on its willingness to admit all reasoned voices to a conversation that is potentially unending, but in the process often highly enlightening. That conversation is contributed to in this issue of the Journal by several reasoned voices, mostly on ethical aspects of the COVID-19 pandemic. Relevant to issues on which politicians claim to be ‘following the science’, but also raising fundamental ethical questions, is this month’s feature article. In Ethics of Selective Restriction of Liberty in a Pandemic, 1 Cameron and colleagues consider ‘if and when it may be ethically acceptable to impose selective liberty-restricting measures in order to reduce the negative impacts of a pandemic by preventing particularly vulnerable groups [for example, the elderly in COVID-19] of the community from contracting the disease’ [and thereby, for example, increasing …. (shrink)
In modern cities, many old or abandoned buildings occupy valuable land without providing a comparably valuable service. In the past they have often met with the fate of being demolished and replaced, but modern day sentiment, be it foolhardy nostalgia or legitimate concern for architectural heritage, often leads to a building’s refurbishment. As a result, buildings save themselves from the wrecking ball by providing a service that satiates modern day demand.
The coronavirus pandemic has brought to public attention a variety of questions long debated in medical ethics, but now given both added urgency and wider publicity. Among these is triage, with its origins in deciding which individual lives are to be saved on a battlefield, but now also concerned with the allocation of scarce resources more generally. On the historical battlefield, decisions about whom to treat first – neither those who would survive without treatment, nor those who would not survive (...) even with treatment, but those who needed treatment to survive – was facilitated by military discipline and the limited effectiveness of treatments available. In the allocation of scarce resources today, by contrast, such decisions are subject to intense public and political scrutiny, and the range of effective treatments available has immeasurably diminished the proportion of ‘those who would not survive even with treatment’. If triage decisions are to be made, they now need to be justified in the arena of public opinion by moral arguments which are also politically persuasive. A number of different aspects of what is required for this endeavour are examined in the first five contributions to this issue of the Journal. In ‘Should age matter in COVID-19 triage? A deliberative study ’1, Kuylen and colleagues report on a deliberative study of public views in the UK, in which participants ‘generally accepted the need for triage but strongly rejected ’fair innings’ and ’life projects’ principles as justifications for age-based allocation,…preferring to maximise the number of lives rather than life years saved’; and concerned that in any resolution ‘utilitarian considerations of efficiency should be tempered with a concern for equality and vulnerability’. A similar concern to temper utilitarian considerations, in this case with an Aristotelian view of the common good as ‘the good life for …. (shrink)
By the time this issue of the Journal is published, the world will have moved on. More will be known, than at the time of writing this, about how medicine and societies are responding to the ethical challenges presented by the COVID-19 coronavirus pandemic. In his guest editorial,, Dominic Wilkinson writes from the perspective of a UK clinician and ethicist facing the then still impending likelihood that ‘the number of critically ill patients will overwhelm the capacity of intensive care units’ (...) and that ‘it will simply not be possible to provide mechanical ventilation to every patient who might need it’. The ‘unpalatable question’ for clinicians then will be ‘which patient to save’? In his response to this question, Wilkinson identifies benefit and fairness as the key ethical values at stake in such triage decisions: ‘how much ethical weight is given to each of these values’, he argues, will depend not only on the need to find a fair balance between them, but also on the availability of resources. ‘As resources become more limited’, he writes, ‘there is some need to temper equality with benefit’. In the limited provision of publicly funded intensive care, there already exists ’a need to decline admission to intensive care for some patients who have a low probability of survival, or of benefiting from the treatment’: but ‘in a situation where resources are overwhelmed, and choice cannot be avoided’, he argues, the ethical balance must shift to emphasizing benefit’, which in practice means prioritising ‘those patients who have the highest chance of surviving’, or ‘a shorter duration of intensive care stay’. Wilkinson does not …. (shrink)
This symposium discussed bioethics teaching, research and documentation and also research ethics committees. An international convention for the protection of the integrity of the human body was called for, as was a new European Committee on Ethics. 'The genetic impact' was a major preoccupation of the symposium.
An Institute of Medical Ethics working party supports the view that explicit permission should normally be sought in the case of testing for HIV antibody. It discusses this in relation to anonymised HIV testing for epidemiological purposes, concluding that this is to be welcomed, given certain safeguards. It next argues that pregnant women may have a greater and more immediate need than others to know their HIV status. It concludes that this need does not justify testing them without their permission, (...) but can be met by voluntary diagnostic testing on an 'opting-out' basis, supported by adequate briefing. (shrink)
We are often, as agents, responsible for the things we do and say. This responsibility can come in a number of different forms: here I propose and defend a view of how we are epistemically responsible for our actions and assertions. In other normative areas, we can be responsible for our actions when those actions violate a norm (for example, we can be morally responsible when we violate some moral norm). I argue that we can similarly be epistemically responsible when (...) we violate a norm of assertion or action, norms that tell us how epistemically well-positioned we need to be towards a proposition in order to assert it or treat it as a reason for acting. I first defend a structure of epistemic norms that allows for the possibility of epistemic responsibility, and then propose a notion of epistemic responsibility itself. -/- We can, and do, evaluate actions and assertions in a specifically epistemic way: we judge that someone should not have acted on the basis of unreliable information, that someone should not have asserted something they knew was false, etc. These kinds of evaluations lead us to believe that proper action and assertion have some basic epistemic requirements, what are called norms of assertion and action. In order to defend a notion of epistemic responsibility, I first establish a general claim about the ways that we make epistemic evaluations in relation to these norms. Many who argue for a particular epistemic norm of action or assertion endorse what I call epistemic monism, the view that all epistemic evaluations of actions or assertions must be explained solely in terms of whether they have adhered to their respective norm. I argue that epistemic monism is false. Instead, I defend epistemic separability, the view that we make two different kinds of epistemic evaluations: one that pertains to whether one has adhered to an epistemic norm, and one that pertains to whether one has reason to think they are adhering to or violating the relevant norm. In my defense of epistemic separability I appeal to arguments from luminosity failure – the claim that for any given epistemic relationship we can have with a proposition we can have good reason to believe that we fail to be in it – and empirical arguments that show that we only have fallible access to our own mental states. These arguments show that we can violate an epistemic norm while having good reason to think otherwise and, in turn, shows that we can be evaluated not only in terms of whether we have adhered to or violated that norm, but also in terms of whether we are responsible for doing so. I argue that whether one’s action is epistemically responsible depends on whether one fulfils the epistemic commitments one makes in performing that action. These commitments consist in being able to provide reasons to believe that one has adhered to the norm governing the action one performs, according to a standard imposed by the situation in which one acts. Thus in more epistemically demanding situations – those in which there are high expectations that we be able to show that we have adhered to the relevant epistemic norm – it will be more difficult to act in an epistemically responsible way. Accepting a notion of epistemic responsibility (and, with it, rejecting epistemic monism) has significant consequences for a number of current debates in epistemology. The first pertains to the debate concerning the correct epistemic norm of assertion and practical reasoning. Many proposed norms are argued to be inadequate on the basis of an inability to explain intuitive epistemic evaluations solely in terms of the conditions set forth in the norms. Epistemic separability, however, implies that the structure of this dialectic is misguided, as we can perhaps accommodate problematic judgments in terms of evaluations of responsibility. The second consequence pertains to arguments for contemporary theories of knowledge. Again, such theories are judged by their ability to accommodate intuitive attributions of knowledge. However, I argue that many of the evaluations that serve as the basis for such theories are better interpreted not as judgments about whether one has knowledge, but as judgments about whether one is acting in an epistemically responsible way. Recognizing a notion of epistemically responsible action thus calls into question both the plausibility of a number of contemporary theories of knowledge, as well as the way in which we go about doing epistemology in general. (shrink)
Based on a study undertaken by the Institute of Medical Ethics and the Royal College of Nursing, this book examines what nurses, midwives and health visitors are taught about ethics in the UK. It defines ethics and related terms and discusses their relevance to the practice of nursing.
Epidemics, the medical historian Charles Rosenberg argued, typically have four Acts, as in a play. In Act I, which he termed ‘Progressive revelation’, ‘merchants’, ‘municipal authorities’ and ‘the complacency of ordinary men and women’, alike are reluctant to acknowledge an epidemic because of its threat to their ‘economic and institutional interests’ and to ‘their accustomed way of doing things’: gradually however, ‘inexorably accumulating deaths and sicknesses’ bring ‘ultimate, if unwilling, recognition’. In Act II, ‘Managing randomness’, ‘collective agreement’ is sought on (...) an ‘explanatory framework’ to manage the epidemic’s ‘dismaying arbitrariness’. Such frameworks, in previous centuries mainly religious, are now more ‘secular and mechanistic’, but again also moral and social: explanation for example of the ‘differential susceptibility of particular individuals’ is sought in terms of ‘risk-enhancing behaviour’ and ‘style of life’, but also of environmental and social factors, such as ‘residence and occupation’, providing ‘a vehicle for social criticism as well as a rationale for social control’. In Act III, ‘Negotiating public response’, pressure is generated for ‘decisive and visible community response’, often taking the form of ‘collective rites integrating cognitive and emotional elements’. Such rites, including not only ‘the imposition of a quarantine’ and ‘procedures to cleanse and disinfect’, but also religious, or now more often moral or social rituals, afford ‘the reassurance of familiar frames of explanation and logically consequent policies that provide both meaning and the promise of efficacy’. Finally, In Act IV, ‘Subsidence and retrospection’, ‘incidence of the disease gradually declines’, and questions are raised ‘for retrospective moral judgement’ about ‘what “lasting impact” particular incidents have had and what “lessons” have been learnt. Have the dead died in vain? Has a heedless society reverted to its accustomed ways of doing things as soon as denial became once more a …. (shrink)
In the late 1980s, an Institute of Medical Ethics working party on the teaching of medical ethics defined the subject as follows.1 Medical Ethics, it stated, has ‘two meanings’: ‘traditionally’ it ‘has referred to the standards of professional competence and conduct which the medical profession requires of its members’; ‘increasingly’, it ‘refers to the study of ethical or moral problems raised by the practice of medicine’. Thirty years on, teaching, learning and research in medical ethics retains this dual emphasis on (...) the normative as well as the problematic. In the same vein, most papers in this issue of the Journal raise ethically problematic questions which have practical moral implications for what eventually ought, or ought not to be done, to or by individuals or populations in the context of healthcare. The urgent need for a well-argued medical ethics was acknowledged by the IME working party when it observed that many of the problems now ‘increasingly’ raised by the practice of medicine ‘cannot be resolved simply by appealing to professional codes, or to science, religion, the law or even common sense’. Such problems, the report added, ‘often arise… when principles previously accepted begin to be questioned, or are understood imperfectly or even misrepresented’. That these categories remain relevant, again is illustrated by papers in this issue. At the most fundamental, if also perhaps the most speculative level, are questions previously asked about the moral status of consciousness in animals or in non-communicating brain-injured patients for example, but now also being asked in relation to cerebral organoids or ‘mini-brains’. As Lavazza and Massimini explain in their ground-breaking paper on the subject organoids are ‘three-dimensional biological structures grown in vitro from different kinds of stem-cells that self-organise mimicking real organs with specific cell-types’: these now …. (shrink)