We suggest that there is confusion between why consciousness developed and what additional functions, through continued evolution, it has co-opted. Consider episodic memory. If we believe that episodic memory evolved solely to accurately represent past events, it seems like a terrible system—prone to forgetting and false memories. However, if we believe that episodic memory developed to flexibly and creatively combine and rearrange memories of prior events in order to plan for the future, then it is quite a good system. We (...) argue that consciousness originally developed as part of the episodic memory system—quite likely the part needed to accomplish that flexible recombining of information. We posit further that consciousness was subsequently co-opted to produce other functions that are not directly relevant to memory per se, such as problem-solving, abstract thinking, and language. We suggest that this theory is compatible with many phenomena, such as the slow speed and the after-the-fact order of consciousness, that cannot be explained well by other theories. We believe that our theory may have profound implications for understanding intentional action and consciousness in general. Moreover, we suggest that episodic memory and its associated memory systems of sensory, working, and semantic memory as a whole ought to be considered together as the conscious memory system in that they, together, give rise to the phenomenon of consciousness. Lastly, we suggest that the cerebral cortex is the part of the brain that makes consciousness possible, and that every cortical region contributes to this conscious memory system. (shrink)

Whether to treat autism as exculpatory in any given circumstance appears to be influenced both by models of autism and by theories of moral responsibility. This article looks at one particular combination of theories: autism as theory of mind challenges and moral responsibility as requiring appropriate experience of the reactive attitudes. In pursuing this particular combination of ideas, we do not intend to endorse them. Our goal is, instead, to explore the implications of this combination of especially prominent ideas about (...) autism and about moral responsibility. These implications can be quite serious and practical for autists and those who interact directly with autists, as well as for broader communities as they attend to the fair, compassionate, and respectful treatment of increasing numbers of autistic adults. We find that these theories point to a limited range of situations in which autists should not be blamed for transgressive actions for which neurotypical individuals should be blamed. We build on what others have written on these issues by bringing in a recent cognitive model of the role theory of mind plays in empathy, by discussing the social implications of the theoretical findings, and by raising questions about the compatibility of reactive attitude theories of moral responsibility with the neurodiversity approach to autism. (shrink)

Definitions of health and disease are of more than theoretical interest. Understanding what it means to be healthy has implications for choices in medical treatment, for ethically sound informed consent, and for accurate assessment of policies or programs. This deeper understanding can help us create more effective public policy for health and medicine. It is notable that such contentious legal initiatives as the Americans with Disability Act and the Patients' Bill of Rights fail to define adequately the medical terms on (...) which their effectiveness depends. In Ethics and the Metaphysics of Medicine, Kenneth Richman develops an "embedded instrumentalist" theory of health and applies it to practical problems in health care and medicine, addressing topics that range from the philosophy of science to knee surgery."Embedded instrumentalist" theories hold that health is a match between one's goals and one's ability to reach those goals, and that the relevant goals may vary from individual to individual. This captures the normative implications of the term health while avoiding problematic relativism. Richman's embedded instrumentalism differs from other theories of health in drawing a distinction between the health of individuals as biological organisms and the health of individuals as moral agents. This distinction illuminates many difficulties in patient-provider communication and helps us understand conflicts between promoting health and promoting ethically permissible behavior. After exploring, expanding, and defending this theory in the first part of the book, Richman examines its ethical implications, discussing such concerns as the connection between medical beneficence and respect for autonomy, patient-provider communication, living wills, and clinical education. (shrink)

Ethicists, researchers and policy makers have paid increasing attention to the ethical conduct of research, especially research involving human beings. Research performed with and by undergraduates poses a specific set of ethical challenges. These challenges are often overlooked by the research community because it is assumed that undergraduate student researchers do not have a significant impact on the research community and that their projects are not host to research posing important ethical issues. This paper identifies several features characteristic of research (...) in undergraduate environments. The paper pays special attention to selective small liberal arts colleges, an important segment of higher education in the US, and advocates integrating instruction in research ethics wherever undergraduates are engaged in research. (shrink)

As a neurodevelopmental condition that affects cognitive functioning, autism has been used as a test case for theories of moral responsibility. Most of the relevant literature focuses on autism’s impact on theory of mind and empathy. Here I examine aspects of autism related to executive function. I apply an account of how we might fail to be reasons responsive to argue that autism can increase the frequency of excuses for transgressive behavior, but will rarely make anyone completely exempt from moral (...) responsibility in general. On this account, although excuses may apply more often to autists than to others, the excuses that apply to autists are just the same excuses that can apply to anyone. (shrink)

McCoy, Liu, Lutz, and Sisti (2020) raise concerns about “partial representation,” in which nonelected advocates or advocacy organizations fail to engage and hold themselves accountable to the full range of people they purport to represent. They are right to point out that the autism community is vulnerable to partial representation. This open peer commentary notes some elements among those engaged with autism that may not fit under the type of “federated model” of representation McCoy, et al recommend. Advocates should tread (...) carefully to avoid some types of harm that do not arise when forming federations on other topics. The influence of antivaxxers and other questionable or harmful movements might even lead us to think, despite the value of open debate and engagement, that there is benefit to partial representation if it prevents potential harms that could arise from legitimizing dangerous practices. (shrink)

In a time when we as a society are in the process of deciding what our basic rights to health care are, it is critically important for us to have a full and complete understanding of what constitutes health. We argue for an analysis of health according to which certain states are healthy not in themselves but because they allow an individual to reach actual goals. Recognizing that the goals of an individual considered from the point of view of biology (...) and the goals of the same individual considered as an agent in the world might be different, we introduce a distinction between the health of an individual qua organism and the health of an individual qua person. We then argue that this distinction characterizes the evaluations made by patients and healthcare providers better than the widely discussed distinction between disease and illness. (shrink)

Michelle Garcia Winner’s Social Thinking Curriculum is widely used by schools across the USA and has garnered attention internationally. The curriculum addresses social language and behavior deficits among those on the autism spectrum. Although many embrace this curriculum without reservation, the emphasis on social conformity, including avoiding behaviors that make others uncomfortable, merits scrutiny. Individuals who have difficulty understanding social cues and conventions can derive tremendous benefit from learning to fit in, for example, or learning what is likely to make (...) others uncomfortable and why. However, too much emphasis on pleasing others can reinforce undesirable tendencies. For example, autism is already linked to avoidant personality disorder. An emphasis on avoiding making others uncomfortable may also inhibit the development of principled ethical thinking and action. Reframing social thinking to treat it not (or not only) as an end in itself, but as a way to achieve a variety of social and personal goals would go a long way toward addressing the weaknesses of the Social Thinking Curriculum. (shrink)

This paper responds to Goodwin Liu's argument in Volume II of this Journal that a pedagogy must be supported by an appropriate theory of knowledge, and that the epistemology which best supports the service-learning pedagogy is anti-foundational pragmatism. The author shows that Liu's characterization of the pragmatist model of knowledge does not avoid the dualism which he sees as a fault of the traditional epistemology. After suggesting a remedy to this, the author then extends Liu's argument by indicating the limits (...) to what the appropriately modified epistemological support will sanction. These limits are shown to be more restrictive than Liu suggests. The result is an improved philosophical justification of the service-learning pedagogy and some suggestions for evaluating proposed curriculum. (shrink)

This chapter addresses ethical issues for informed consent when recruiting autistic participants for research. The process of informed consent for participation in research involves some abilities, such as dialogue and understanding the intentions of the researchers, that can be especially challenging when autistic individuals are being asked to participate. This chapter reviews these abilities, and suggests ways to provide meaningful support to promote autonomy and help researchers meet their responsibilities. Beyond these more general challenges, it explores Hans Jonas’s suggestion that (...) true informed consent for research requires that participants identify with the goals of the researchers. Given the plurality of perspectives on how to respond to autism, Jonas’s ideas point to additional ethical concerns that can arise when autistic people are recruited for research on autism. (shrink)

In an earlier Dissecting Bioethics contribution, Debra J. H. Mathews, Joseph J. Fins, and Eric Racine challenge standard ways of thinking about the therapeutic misconception in the context of consent for research participation. They propose that instead of demanding “rational congruence” between how researchers and participants conceive of a given protocol, we should accept a less stringent standard of “reasonable coherence.” While Mathews, Fins, and Racine (MFR) provide some important insights, their proposal needs refinement. There is room for a wide (...) but not unlimited range of participant hopes and motivations. However, their model of reasonable coherence is too weak a standard for whether participants have adequate understanding of the scientific goals of a protocol. By the time participants are recruited for medical research, the goals of the protocol, having been set and agreed to through accepted scientific processes, are no longer open for alternate interpretations. This paper discusses this and other objections to MFR’s proposal. It then suggests that a concept of “deal breakers” might be useful in this context. (shrink)

Howard Brody identifies “drug-centered care” as a contrast to “patient-centered care” and asks whether drug-centered care promotes the same outcomes that justify patient-centered care—health and dignity for patients and virtue in providers. Answering in the negative, Brody provides a sobering account of how the pharmaceutical industry molds our disease concepts and our perspectives on medications as medical tools. Brody’s new concept was set up to fail, much as if he had named it “money-centered care” or simply “bad care.” This essay (...) asks whether there is a way to reconceptualize drug-centered care such that, even if it does not promote health, dignity, and virtue, it is at least not obviously at odds with these goals. I identify four ways to show that drug-centered care has, in limited cases, morally legitimate application. I show that whether the morally legitimate application of drug-centered care is in the service of health per se, enhancement or quality of life depends on the theoretical background adopted. (shrink)

Philosophers and bioethicists have mostly given up on human dignity. As a concept, dignity has seemed obscure and unintelligible, or forbidden because of its connection with theology. Here I take a fresh look, and identify two families of dignity concepts: dignity as arche and dignity as telos. Arche draws on the idea of an origin or source, as in ‘archetype’ or ‘archeology.’ Dignity as arche refers to the qualities inherent in a being that is the source (the arche) of our (...) duties to that being. Dignity as telos is the endpoint (telos) that we try to promote in our patients and in ourselves. I illustrate these ideas using examples from Frances Hodgson Burnett’s book for young readers, A Little Princess. Identifying these two families of dignity concepts helps to identify the dignity-related tasks for psychotherapists. These are to help patients recognise, connect with, and respect their own dignity as arche, and to help them realise their own dignity as telos. Revisiting Maslow’s hierarchy of needs helps us to see how these tasks also apply to the broader goals of healthcare. (shrink)

People with disabilities (PWD) comprise a significant part of the population yet experience some of the most profound health disparities. Among the greatest barriers to quality care are inadequate health professions education related to caring for PWD. Drawing upon the expertise of health professions educators in medicine, public health, nursing, social work, and physician assistant programs, this forum showcases innovative methods for teaching core disability skills and concepts grounded in disability studies and the health humanities. Each of the essays offers (...) practical guidance for developing curricular interventions appropriate for students at various levels of training and familiarity with disability to be implemented in classroom discussions, case-based learning, lectures, panels, and clinical simulations across the full spectrum of pre-health and health professions education. (shrink)

First Published in 2004. Routledge is an imprint of Taylor & Francis, an informa company.

For decades scholars thought they knew Hume's position on the existence of causes and objects he was a sceptic. However, this received view has been thrown into question by the `new readings of Hume as a sceptical realist. For philosophers, students of philosophy and others interested in theories of causation and their history, The New Hume Debate is the first book to fully document the most influential contemporary readings of Hume's work. Throughout, the volume brings the debate beyond textual issues (...) in Hume to contemporary philosophical issues concerning causation and knowledge of the external world and issues in the history of philosophy, offering the reader a model for scholarly debate. This revised paperback edition includes three new chapters by Janet Broughton, Peter Kail and Peter Millican. Contributors: Kenneth A. Richman, Barry Stroud, Galen Strawson, Kenneth P. Winkler, John P. Wright, Simon Blackburn, Edward Craig, Martin Bell, Daniel Flage, Anne Jaap Jacobson, Rupert Read, Janet Broughton, Peter Millican, Peter Kail. (shrink)

According to classical theism, the universe depends on God in a way that goes beyond mere (efficient) causation. I have previously argued that this ‘deep dependence’ of the universe on God is best understood as a type of grounding. In a recent paper in this journal, Aaron Segal argues that this doctrine of deep dependence causes problems for creaturely free will: if our choices are grounded in facts about God, and we have no control over these facts, then we (...) do not control our choices and are therefore not free. This amounts to a grounding analogue of the Consequence Argument for the incompatibility of free will and determinism. If successful, it would have application beyond classical theism: similar concerns would apply to any view that takes our choices to be grounded in a deeper reality which is beyond our control. However, I show that the argument is not successful. Segal’s Grounding Consequence Argument is so closely analogous to the Causal Consequence Argument that any response to the one provides a response to the other. As a result, if you don’t think that prior causes (whether deterministic or indeterministic) undermine free will, you shouldn’t think that prior grounds undermine free will. (shrink)

The heart of Richard Kenneth Atkins’s Peirce and the Conduct of Life: Sentiment and Instinct in Ethics and Religion is an interpretation and defense of Peirce’s sentimental conservatism, as well as an extension of that idea to Peirce’s philosophy of religion and to the casuistic approach to practical ethics. “A Defense of Peirce’s Sentimental Conservatism” is the explicit title of the second of the book’s six chapters. But the only chapter in which Peirce’s sentimental conservatism does not itself appear (...) to play an explicit role is chapter five, “Self-Control and Moral Responsibility”, which is perhaps the chapter that reads most as a stand-alone work (even though the first chapter is the... (shrink)

Review of The New Hume Debate Revised Edition Edited By Rupert Read, Kenneth Richman: Pub: 2000 -/- '... The editors have done an excellent job of choosing and presenting some of the more important papers on this subject. The volume contains a useful bibliography and a citation index. ... There is also a helpful introduction, written by Richman, which provides a synopsis of the individual papers in this volume. A few important contributions are not included in the (...) collection ... Nevertheless, all the papers that are included are well worthwhile and serve the editors’ stated aim in their Preface, which is to offer “insights not only into the most difficult issues of the interpretation of some of Western philosophy’s most vital texts, but also into an absolutely central example of the relevance of the philosophical history of philosophy to contemporary philosophy, in . . . accessible form.” ' . (shrink)

The concept of lying is generally assumed to be closely related to the concept of assertion. However, the literature on lying has focused almost exclusively on lies expressed by unqualified assertions. Sometimes a speaker chooses to qualify her assertion by hedging, making her utterance a hedged declarative. This paper defends the thesis that lies can be expressed by untruthful hedged declaratives, and explores the implications of this thesis for the definition of lying. Many standard approaches to the definition of lying (...) allow lies to be expressed by untruthful hedged declaratives, which may explain why these cases have been ignored in the literature. However, untruthful hedged declaratives present a problem for a recently-proposed theory that analyzes lying in terms of the Knowledge Norm of Assertion. According to this theory, a necessary condition on lying is that in asserting that p, the speaker represents herself as knowing that p; however, in making an untruthful hedged declarative a speaker represents herself as having an epistemic attitude weaker than knowledge. The fact that such a theory fails to adequately explain untruthful hedged declaratives provides a reason to prefer alternative theories of lying. The discussion draws out some important observations about the concepts of lying, assertion, belief, and the relations between them. (shrink)

It is widely agreed among broadly Anselmian theists that God is in some sense the 'delimiter of possibilities.' In other words, the scope of possibility is explained by the manner in which the universe emanates from God. However, existing accounts of God's role here—in terms of freedom, choice, or power—face serious difficulties. The present paper provides a new account of God's role as the delimiter of possibilities in terms of the different manner in which the non-actuality of non-actual states of (...) affairs is explained. Intuitively and metaphorically, we can think of the menu of states of affairs being 'whittled down' in successive stages of a process of divine decision-making, with the different species of impossibility corresponding to when and how the states of affairs are ruled out. I argue that this approach provides genuine contingency while also preserving the Principle of Sufficient Reason. (shrink)

We consider two categorical syllogisms, valid or invalid, to be equivalent if they can be transformed into each other by certain transformations, going back to Aristotle, that preserve validity. It is shown that two syllogisms are equivalent if and only if they have the same models. Counts are obtained for the number of syllogisms in each equivalence class. For a more natural development, using group-theoretic methods, the space of syllogisms is enlarged to include nonstandard syllogisms, and various groups of transformations (...) on that space are studied. (shrink)

How do we know right from wrong? Do we even have moral knowledge? Moral epistemology studies these and related questions about our understanding of virtue and vice. It is one of philosophy’s perennial problems, reaching back to Plato, Aristotle, Aquinas, Locke, Hume and Kant, and has recently been the subject of intense debate as a result of findings in developmental and social psychology. Throughout the book Zimmerman argues that our belief in moral knowledge can survive sceptical challenges. He also draws (...) on a rich range of examples from Plato’s Meno and Dickens’ David Copperfield to Bernard Madoff and Saddam Hussein. (shrink)

This collection of essays is the first of its kind to focus on the relationship between composition and identity. Twelve original articles--written by internationally renowned scholars and rising stars in the field--argue for and against the controversial doctrine that composition is identity.--Provided by publisher.

Physicians generally recommend that patients resuscitated with naloxone after opioid overdose stay in the emergency department for a period of observation in order to prevent harm from delayed sequelae of opioid toxicity. Patients frequently refuse this period of observation despiteenefit to risk. Healthcare providers are thus confronted with the challenge of how best to protect the patient’s interests while also respecting autonomy, including assessing whether the patient is making an autonomous choice to refuse care. Previous studies have shown that physicians (...) have widely divergent approaches to navigating these conflicts. This paper reviews what is known about the effects of opioid use disorder on decision-making, and argues that some subset of these refusals are non-autonomous choices, even when patients appear to have decision making capacity. This conclusion has several implications for how physicians assess and respond to patients refusing medical recommendations after naloxone resuscitation. (shrink)

Bayesian Conditionalization is a widely used proposal for how to update one’s beliefs upon the receipt of new evidence. This is in part because of its attention to the totality of one’s evidence, which often includes facts about what one’s new evidence is and how one has come to have it. However, an increasingly popular position in epistemology holds that one may gain new evidence, construed as knowledge, without being in a position to know that one has gained this evidence. (...) These are cases of KK-Failure, cases where one knows p but is not in a position to know that one knows p. This paper assumes that certain KK-Failures are possible and argues that Conditionalization goes wrong in those cases. (shrink)