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

Objective: To report results from a national survey of coordinators and managers of clinical research studies in the US on their perceptions of and experiences with scientific misconduct.Methods: Data were collected using the Scientific Misconduct Questionnaire-Revised. Eligible responses were received from 1645 of 5302 surveys sent to members of the Association of Clinical Research Professionals and to subscribers of Research Practitioner, published by the Center for Clinical Research Practice, between February 2004 and January 2005.Findings: Overall, the perceived frequency of misconduct (...) was low. Differences were noted between workplaces with regard to perceived pressures on investigators and research coordinators, and on the effectiveness of the regulatory environment in reducing misconduct. First-hand experience with an incident of misconduct was reported by 18% of respondents. Those with first-hand knowledge of misconduct were more likely to report working in an academic medical setting, and to report that a typical research coordinator would probably do nothing if aware that a principal investigator or research staff member was involved in an incident of misconduct.Conclusion: These findings expand the knowledge on scientific misconduct by adding new information from the perspective of research coordinators. The findings provide some data supporting the influence of workplace climate on misconduct and also on the perceived effectiveness of institutional policies to reduce scientific misconduct. (shrink)

(revisions posted 12/5/2006) to appear in Internalism and Externalism in Semantics and Epistemology, ed. by Sanford Goldberg (to be published by Oxford in 2006 or 2007) Michael McKinsey formulated an argument that raises a puzzle about the relation between externalism about content and our introspective awareness of content. The puzzle goes like this: it seems like I can know the contents of my thoughts by introspection alone; but philosophical reflection tells me that the contents of those thoughts are externalist, and (...) so I couldn. (shrink)

Our experiences with many sorts of evils yield debates about the role of forgiveness as a possible moral response. These debates include (1) the preliminary question whether evils are, by definition, unforgivable, (2) the contention that evils may be forgivable but that forgiveness cannot entail reconciliation with one’s evildoer, (3) the concern that only direct victims of evils are in a position to decide if forgiveness is appropriate, (4) the conceptual worry that forgiveness of evil may not be genuine or (...) complete if hard feelings recur, (5) the interest of many in holding that forgiveness is never required, and (6) the concern that analyses of evil ought to prioritize the suffering, and credit the perspectives, of victims of evils, in tension with the possibility that forgiveness concerns the well-being of offenders. In this paper, I critically evaluate these concerns from the perspective of nonideal theory. I conclude that crediting victims’ perspectives is importantly basic to empirically informed moral theory, and that objections to forgiveness including (1) evil’s unforgivability ignore victims’ differing accounts. When we take actualities and experiences to be informative and central, some of the usual debates become less pressing, perhaps even moot. (shrink)

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

I am persuaded both by the theory of evil advanced by Claudia Card in The Atrocity Paradigm and by the idea that there are evils done to the environment; however, I argue that the theory of evil she describes has difficulty living up to her claim that it "can make sense of ecological evils the victims of which include trees and even ecosystems" (2002, 16). In this paper, I argue that Card's account of evil does not accommodate the kinds of (...) harms inflicted on ecosystems and such nonhuman individuals as trees. I consider the possibility that Card intends a much broader version of evils than the language of the atrocity paradigm lets on, with its attention to sentience and dignity. I'm so persuaded by the atrocity paradigm, however, that I retain the centrality of suffering and introduce the idea that atrocities are intuitively massive, that is, done to groups or generations and not an individual person, animal or tree, so that the paradigm encourages us to think of evil as it relates to far more holistic entities which include the sentient. Evil may require the sort of suffering that only sentience can give rise to, which is not to say we let out trees but says rather that it is impossible to identify wrongs to ecosystems and groups that are not also intertwined with the fates of their sentient dependents. I conclude that Card is right to emphasize victims' suffering as a chief component of evil, and that the ontology of what constitutes a victim must be interpreted broadly, not the notion of suffering. (shrink)

The article “Revive and Refuse: Capacity, Autonomy, and Refusal of Care After Opioid Overdose,” Marshall et al. (2024) highlights the critical issue of care after an opioid overdose. “Revive and Re...

Pretty much everyone knows that our genes have at least something to do with how able or how high achieving we are. Some believe that we should not speak of this common knowledge, nor inquire into how genetic influence works or what it might mean. If we do not keep an open mind to the fact of genetic influence on academic achievement, however, then we cannot explore its possible implications. And if we do not consider the implications, then we cannot, (...) as a society, harness any potential benefits or avoid possible pitfalls. So that's what this essay is about—exploring what behavioral genetics research might be able to offer to educational theory, policy, and practice.We cannot yet use biological information to make accurate predictions for all children. We do know, however, that academic achievement is heritable, which is to say that differences between individuals are influenced by differences in their DNA. If genes are part of the problem for some pupils (to take the negative spin on this), then it seems likely that studying them could be part of a solution. And that's what behavioral geneticists are trying to do—to chart and understand pathways from DNA to behavior and to identify interventions that can maximize outcomes for all. The fact is, though, that we have an awfully long way to go. (shrink)

Values -- Tolerance -- Tolerant people -- Being tolerant of family -- Being tolerant of friends -- Being tolerant of neighbours -- Ways to be tolerant -- Being aware of others -- Respecting different kinds of families -- Accepting other cultures -- Including others -- Learning from others -- Being patient -- Personal set of values.

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

Consider the skeptic about the external world. Let’s straightaway concede to such a skeptic that perception gives us no conclusive or certain knowledge about our surroundings. Our perceptual justification for beliefs about our surroundings is always defeasible—there are always possible improvements in our epistemic state which would no longer support those beliefs. Let’s also concede to the skeptic that it’s metaphysically possible for us to have all the experiences we’re now having while all those experiences are false. Some philosophers dispute (...) this, but I do not. The skeptic I want to consider goes beyond these familiar points to the much more radical conclusion that our perceptual experiences can’t give us any knowledge or even justification for believing that our surroundings are one way rather than another. (shrink)

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

I offer a brief survey of thematic elements in contemporary literature on forgiveness and then an overview of the responses to that literature comprising the contents of this volume. I concentrate on the extent to which work in moral psychology provides a needed corrective to some excesses in philosophical aversion to empirically informed theorizing. I aim to complicate what has been referred to at times as the standard or classic view, by which philosophers often mean the predominant view of forgiveness (...) in the first half of the thirty-year boom in contemporary philosophy of forgiveness. I conclude by enjoining philosophers to further consider psychological contexts in which forgiveness may be seen primarily as a commitment rather than primarily as an emotional state. (shrink)

The Catholic Tradition requires the faithful to form and follow their conscience. This is the case even with the recognition that consciences can be malformed and one can make errors in practical judgments. Water Shaping Stone examines various aspects of this tradition regarding conscience by using, among other sources, twentieth-century magisterial documents, theologians' works, and Scripture. Kathryn Lilla Cox argues that while the Magisterium retains teaching authority, and a responsibility to help form consciences through its teaching, focusing only on (...) the Magisterium leads to incomplete formation. A more holistic vision of conscience formation means considering the formation of the moral agent to be a multifaceted process that draws on, for example, teaching, prayer, rituals, Scripture, practices, and virtues, along with relationships with the Triune God and communities of accountability. This vision of conscience formation retains the magisterial teaching authority while acknowledging discipleship as the theological basis for making and assessing practical judgments of conscience. (shrink)

"Change is not merely necessary to life--it is life." That's Alvin Toffler, characteristically stating the profound in a profoundly direct way. And yes, even when we see change coming--as we're about to graduate from school, take a new job, get married--it's still not so easy to accept. And when we don't see it coming--oof, we have an even harder time. Here to help us embrace change and defuse its unsettling power is Change Happens, a full-color illustrated gift book to consult, (...) to share, to give, and to keep on a night table. Curated by Kathryn and Ross Petras, the ultimate connoisseurs of quotes whose books and calendars have over 4.5 million copies in print, these words of wisdom inspire us to be open to change and remind us that nothing positive in life ever happens without it. Arranged alphabetically by subject--including Adapting, Curveballs, Faith, Letting Go, Regrets, Second Chances, Vulnerability--it's a book to turn to in moments of need, when offering advice to a friend or loved one, when urging a child to find the courage to take a step, when marking an important occasion. (shrink)

The author develops her account of Claudia Card's ethical work as nonideal ethical theory (NET). She clarifies Card's role in ethical theorizing of the recent past, partly in order to brief the unfamiliar reader on Card's ethics and nonideal theory, and partly to enter Card's contributions into the story of nonideal theory's emergence in philosophy. She then recommends, to other NET philosophers, the prioritization of (i) Card's rejection of the "administrative point of view", and (ii) Card's focus on "intolerable harms" (...) as critical to excellent ethical theorizing. She ends with the observation that NET may helpfully point toward reasons to take a pessimistic stance toward moral progress as elaborated in some classic texts in political philosophy; her appreciation of Card's insights yields a variety of pessimism that Card herself did not share. (shrink)

_the a priori role_ (for word T). For instance, perhaps anyone who understands the word _water_ is able to know, without appeal to any further a posteriori information, that _water_ refers to the clear, drinkable natural kind whose instances are predominant in our oceans and lakes (if _water_ refers at all.

Something about this argument sounds funny. As we’ll see, though, it takes some care to identify exactly what Moore has done wrong. Iwill assume that Moore knows premise (2) to be true. One could inquire into how he knows it, and whether that knowledge can be defeated; but Iwon’t. I’ll focus instead on what epistemic relations Moore has to premise (1) and to his conclusion (3). It may matter which epistemic relations we choose to consider. Some philosophers will diagnose Moore’s (...) argument using Contextualist machinery. They’ll say. (shrink)

Marketers use autobiographical advertising as a means to create nostalgia for their products. This research explores whether such referencing can cause people to believe that they had experiences as children that are mentioned in the ads. In Experiment 1, participants viewed an ad for Disney that suggested that they shook hands with Mickey Mouse as a child. Relative to controls, the ad increased their confidence that they personally had shaken hands with Mickey as a child at a Disney resort. The (...) increased confidence could be due to a revival of a true memory or the creation of a new, false one. In Experiment 2, participants viewed an ad for Disney that suggested that they shook hands with an impossible character (e.g., Bugs Bunny). Again, relative to controls, the ad increased confidence that they personally had shaken hands with the impossible character as a child at a Disney resort. The increased confidence is consistent with the notion that autobiographical referencing can lead to the creation of false or distorted memory. ᭧ 2002 John Wiley & Sons, Inc. (shrink)

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

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

This article surveys work in epistemology since the mid-1980s. It focuses on contextualism about knowledge attributions, modest forms of foundationalism, and the internalism/externalism debate and its connections to the ethics of belief.

Feminist philosophy is now an established subdiscipline, but it began as an effort to transform the profession. Academics and activists worked together to make the new courses, and feminist theory was tested in the streets. As time passed, the "second wave" receded, but core elements of feminist theory were preserved in the academy. How can feminist philosophers today continue the early efforts of changing profession and the society, hand in hand with women outside the academy.

Nearly $2 trillion is spent annually in the U.S. treating chronic illness — yet accessibility to quality health care services in rural communities for the chronically ill and dying remains problematic. Unique barriers present special challenges to a meaningful discussion of and subsequent strategies for addressing these issues in the context of increasingly scarce resources.

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

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

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

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