Psychologists have generated numerous measures designed to capture the “spiritual,” “religious,” and “transcendent” structures of human cognition, emotion, and behavior. Researchers often identify...

Spirituality is an important, but oft-overlooked, aspect of the self that may affect college students’ wellbeing and belonging. Few studies have systematically examined closeness to God and spiritual struggles as predictors of college student wellbeing during early college, which is a critical window for identity development. Moreover, research exploring interactions between spiritual struggles and closeness to God in predicting wellbeing outcomes is scarce. We address these gaps in the literature with an analytic sample comprised of 839 first-year college participants who (...) identify as religious. The results of correlational analyses and linear mixed effect models are presented. Closeness to God was associated with greater wellbeing and belonging, and spiritual struggles were associated with lower wellbeing and belonging. In exploratory analyses, a moderating effect of closeness to God on the relation between spiritual struggles and negative outcomes was observed. Implications for higher education and college student development are discussed. (shrink)

In bioethics, discussions of justice have tended to focus on questions of fairness in access to health care: is there a right to medical treatment, and how should priorities be set when medical resources are scarce. But health care is only one of many factors that determine the extent to which people live healthy lives, and fairness is not the only consideration in determining whether a health policy is just. In this pathbreaking book, senior bioethicists Powers and Faden confront foundational (...) issues about health and justice. How much inequality in health can a just society tolerate. The audience for the book is scholars and students of bioethics and moral and political philosophy, as well as anyone interested in public health and health policy. (shrink)

Despite advances in palliative care, some patients still suffer significantly at the end of life. Terminal Sedation (TS) refers to the use of sedatives in dying patients until the point of death. The following limits are commonly applied: (1) symptoms should be refractory, (2) sedatives should be administered proportionally to symptoms and (3) the patient should be imminently dying. The term ‘Expanded TS’ (ETS) can be used to describe the use of sedation at the end of life outside one or (...) more of these limits.In this paper, we explore and defend ETS, focusing on jurisdictions where assisted dying is lawful. We argue that ETS is morally permissible: (1) in cases of non-refractory suffering where earlier treatments are likely to fail, (2) where gradual sedation is likely to be ineffective or where unconsciousness is a clinically desirable outcome, (3) where the patient meets all criteria for assisted dying or (4) where the patient has greater than 2 weeks to live, is suffering intolerably, and sedation is considered to be the next best treatment option for their suffering.While remaining two distinct practices, there is scope for some convergence between the criteria for assisted dying and the criteria for ETS. Dying patients who are currently ineligible for TS, or even assisted dying, should not be left to suffer. ETS provides one means to bridge this gap. (shrink)

Structural Injustice advances a theory of what structural injustice is and how it works. Powers and Faden present both a philosophically powerful, integrated theory about human rights violations and structural unfairness, alongside practical insights into how to improve them.

Military metaphors are pervasive in biomedicine, including HIV research. Rooted in the mind set that regards pathogens as enemies to be defeated, terms such as “shock and kill” have become widely accepted idioms within HIV cure research. Such language and symbolism must be critically examined as they may be especially problematic when used to express scientific ideas within emerging health-related fields. In this article, philosophical analysis and an interdisciplinary literature review utilizing key texts from sociology, anthropology, history, and Chinese and (...) African studies were conducted to investigate the current proliferation of military metaphors. We found the use of these metaphors to be ironic, unfortunate, and unnecessary. To overcome military metaphors we propose to give them less aggressive meanings, and/or replace them with more peaceful metaphors. Building on previous authors' work, we argue for the increased use of “journey” metaphors as meaningful, cross-culturally app... (shrink)

A growing body of literature argues that achieving radical change in the agri-food system requires a radical renegotiation of our relationship with the environment alongside a change in our thinking and approach to transformational food politics. This paper argues that relational approaches such as a more-than-human ethic of care (MTH EoC) can offer a different and constructive perspective to analyse agri-food system transformation because it emphasises social structures and relationships as the basis of environmental change. A MTH EoC has not (...) yet been applied to regenerative agriculture, yet other literature on regenerative agriculture suggests that care may be present in these spaces and calls for the need for social science analysis of the regenerative movement. This paper uses a MTH EoC lens to reveal a diverse array of ways in which power is and can be deployed for change in the regenerative agriculture movement in Aotearoa, New Zealand. Globally, regenerative agriculture tends to be analysed through positivist, scientific approaches that focus on biophysical markers of ecological improvement. Yet, a relational approach reveals how engagement in regenerative agriculture is creating significant shifts in mindset towards more holistic and relational understandings of biological and social ecosystems. A regenerative mindset framework is suggested as a method of understanding the connection between a regenerative form of thinking, being and doing for farmers. Interviews suggested that this shift in farmers’ socio-ecological relations is crucial to the transformational potential of regenerative agriculture. This paper argues that relational analyses such as the MTH EoC approach used to analyse regenerative agriculture in this research, refresh the way we analyse agri-food system change. They also are critical to guiding and supporting on-the-ground socio-ecological shifts that are necessary to see agricultural transformation. (shrink)

This paper investigates the adequacy of evidential relevance relations proposed by Glymour and others. These accounts incorporate, as a necessary condition, what I call the Positive Instance Condition (PIC): the evidence statement and auxiliary assumptions entail a "positive instance" of the hypothesis. I argue that any account which incorporates PIC as a necessary condition while allowing "bootstrap testing" is doomed to fail. A nonbootstrapping evidential relevance relation of similar form is proposed, and it is argued that, in addition to avoiding (...) published counter examples, this new relation meets two general requirements which, if not met, would undermine the ability of any account that incorporates PIC to accord with our intuitions of evidential relevance. (shrink)

BackgroundEthical and regulatory guidance on the collection and use of human biospecimens for research forms an essential component of national health systems in Sub-Saharan Africa, where rapid advances in genetic- and genomic-based technologies are fueling clinical trials involving HBS and the establishment of large-scale biobanks.MethodsAn extensive multi-level search for publicly available ethics regulatory guidance was conducted for each SSA country. A second review documented active trials listed in the WHO International Clinical Trials Registry Platform as of January 2015 in which (...) HBS collection was specified in the protocol. Findings were combined to determine the extent to which countries that are study sites for HBS-related research are supported by regulatory guidance language on the collection, use, ownership and storage of biospecimens.ResultsOf the 49 SSA countries, 29 had some form of national ethics guidance, yet only 17 provided language relating to HBS-related research, with specific guidance on consent, ownership, reuse, storage, and export/import/transfer. Ten countries accounted for 84 % of the active clinical trials involving the collection of HBS in SSA. All except one of these countries were found to have some national guidance in the form of regulations, codes of ethics, and/or standard operating procedures; however, only seven of the ten offered any language specific to HBS.ConclusionsDespite the fact that the bulk of registered clinical trials in SSA involving HBS, as well as existing and proposed sites for biorepositories under the H3Africa Initiative, are currently situated in countries with the most complete ethics and regulatory guidance, variability in the regulations themselves may create challenges for planned and future pan-African collaborations and may require legislative action at the national level to revise. Countries in SSA that still lack regulatory guidance on HBS will require extensive health system strengthening in ethics governance before they can be full participants in the modern research enterprise. (shrink)

I Deliberation, Practical Syllogisms , and Intuition. Introduction Aristotle's views on moral reasoning are a difficult and much disputed subject. ...

Suppose that you have deeply personal information that you do not want to share. Further suppose that this information could help others, perhaps even saving their lives. Should you reveal the information or keep it secret? With the increasing prevalence of genetic testing, more and more people are finding themselves in this situation. Although a patient's genetic results are potentially relevant to all her biological family members, her first‐degree relatives—parents, children, and full siblings—are most likely to be affected. This is (...) especially true for genetic mutations—like those in the BRCA1 and BRCA2 genes—that are associated with a dramatically increased risk of disease. Fortunately, people are usually willing to share results with their at‐risk relatives. Occasionally, however, a patient refuses to disclose her findings to anyone outside her clinical team. Ethicists have written little on patients’ moral duties to their at‐risk relatives. Moreover, the few accounts that have been advanced are problematic. Some unnecessarily expose patients’ genetic information to relatives who are unlikely to benefit from it, and others fail to ensure that patients’ most vulnerable relatives are informed of their genetic risks. Patients’ duty to warn can be defended in a way that avoids these problems. I argue that the duty to share one's genetic results is grounded in the principle of rescue—the idea that one ought to prevent, reduce, or mitigate the risk of harm to another person when the expected harm is serious and the cost or risk to oneself is sufficiently moderate. When these two criteria are satisfied, a patient will most likely have a duty to warn. (shrink)

In this article, we address the relevance of J.S. Mill’s political philosophy for a framework of public health ethics. In contrast to some readings of Mill, we reject the view that in the formulation of public policies liberties of all kinds enjoy an equal presumption in their favor. We argue that Mill also rejects this view and discuss the distinction that Mill makes between three kinds of liberty interests: interests that are immune from state interference; interests that enjoy a presumption (...) in favor of liberty; and interests that enjoy no such presumption. We argue that what is of focal importance for Mill in protecting liberty is captured by the essential role that the value of self-determination plays in human well-being. Finally, we make the case for the plausibility of a more complex and nuanced Millian framework for public health ethics that would modify how the balancing of some liberty and public health interests should proceed by taking the thumb off the liberty end of the scale. Mill’s arguments and the legacy of liberalism support certain forms of state interference with marketplace liberties for the sake of public health objectives without any presumption in favor of liberty. (shrink)

This paper discusses an analogical argument for the compatibility of the evidential argument from evil and skeptical theism. The argument is based on an alleged parallel between the paradox of the preface and the case of apparently pointless evil. I argue that the analogical argument fails, and that the compatibility claim is undermined by the epistemic possibility of inaccessible reasons for permitting apparently pointless evils. The analogical argument fails, because there are two crucial differences between the case of apparently pointless (...) evil and the case of the preface. First, in the preface case, our non-cumulative evidence supports a claim of error, whereas the analogical argument is based on the idea that our non-cumulative evidence supports the success claim that there’s at least one instance of truly pointless evil. Second, our non-cumulative evidence of error in the case of the preface rests on a track record establishing author fallibility; in the case of apparently pointless evils, there is no relevant track record to support the claim that some apparently pointless evils are truly pointless. These differences, together with certain plausible assumptions about our fallibility and reliability with respect to propositions about evil, also indicate that inaccessible reasons for permitting apparently pointless evil are epistemically possible. Given the epistemic possibility of such reasons, we’re in no position to judge whether such reasons are present in every case no matter how large the set of such evils may be. (shrink)

The field of management has had difficulty embracing the concept of Machiavellianism despite the myriad of studies produced by other fields of social science. It appears that Machiavellianism as a unitary personality construct has limited efficacy in the complex world of organizations. The authors suggest a multidimensional approach to understanding the impact of an individual's threat to organizational functioning. Viewing the construct as discontinuous with two manifestations, predatory and benign, suggestions are made as to the location within organizations where such (...) individuals may be found. A research approach is also suggested. (shrink)

Technological advances in genetic testing have enabled prospective parents to learn about their risk of passing a genetic condition to their future children. One option for those who want to ensure that their biological children do not inherit a genetic condition is to create embryos through in vitro fertilisation and use a technique called preimplantation genetic testing to screen embryos for genetic abnormalities before implantation. Unfortunately, due to its high cost, IVF-with-PGT is out of reach for the vast majority of (...) Americans. This article addresses an issue that has been underexplored in the medical ethics literature: the lack of insurance coverage for IVF-with-PGT.Within the US system, a key concept in insurance is that of medically necessary care, which broadly consists of diagnostic services and treatment services. In this article, I argue that IVF-with-PGT could be classified as either a diagnostic service or as a treatment service. To make this case, I show that IVF-with-PGT is similar to other types of services that are often covered by US insurance providers. In light of these similarities, I argue that the current system is inconsistent with respect to what is—and is not—covered by insurance. To promote consistency and fairness in coverage, like cases should be treated alike—starting with greater coverage for IVF-with-PGT. (shrink)

Recent calls have been made to move professional standards to a more principles-based perspective, supposing that emphasizing broad principles would eliminate the legalistic focus that rules may encourage, and accountants’ behavior would be more ethical and uniformly so. However, this supposition has yet to be empirically tested. The AICPA Code of Professional Conduct (Code) provides guidance in both forms: principles and rules. This experiment examines how the form of the Code affects independence judgments in a client acceptance context. We also (...) examine the potential for levels of moral development to influence the effectiveness of the Code.We find that subjects are more likely to consider their independence impaired, and are more likely to reject a questionable audit engagement, when rules-based (principles-based) reasoners are provided with Code rules (principles). Given the popularity of the view that rules-based standards are undesirable, these findings have significant implications for the profession as principles-based ethical standards are discussed. (shrink)

Recent calls have been made to move professional standards to a more principles-based perspective, supposing that emphasizing broad principles would eliminate the legalistic focus that rules may encourage, and accountants’ behavior would be more ethical and uniformly so. However, this supposition has yet to be empirically tested. The AICPA Code of Professional Conduct (Code) provides guidance in both forms: principles and rules. This experiment examines how the form of the Code affects independence judgments in a client acceptance context. We also (...) examine the potential for levels of moral development to influence the effectiveness of the Code.We find that subjects are more likely to consider their independence impaired, and are more likely to reject a questionable audit engagement, when rules-based (principles-based) reasoners are provided with Code rules (principles). Given the popularity of the view that rules-based standards are undesirable, these findings have significant implications for the profession as principles-based ethical standards are discussed. (shrink)

When new drugs are approved by the Food and Drug Administration, the default assumption is that they will be available by prescription only, safe for use exclusively under clinical supervision. The paternalism underlying this default must be interrogated in order to ensure appropriate respect for patient autonomy. Upon closer inspection, prescription requirements are justified when nonprescription status would risk harm to third parties and when a large segment of the population would struggle to exercise their autonomy in using a drug (...) safely and effectively on their own. Although these justifications can support prescription status for many drugs, we propose that reversing the FDA's current default to instead begin with a presumption in favor of over‐the‐counter status is the best way to avoid interference with valid claims of patient autonomy. Under this approach, a range of drug products could be considered for an OTC switch, including oral contraceptives, statins, and HIV‐prevention drugs. (shrink)

This paper discusses the nature of competitiveness and argues that being competitive does not essentially involve a strong desire to win or to outperform others. The appeal of the ‘desire-to-win’ analysis of competitiveness can be explained away provided we distinguish between virtuous and vicious competitiveness. It is conceivable that a virtuously competitive athlete lack a strong desire to win or to outperform others. Moreover, there is empirical evidence that virtuous competitiveness and vicious competitiveness are distinct character traits. If being virtuously (...) competitive does not require a strong desire to win, then being competitive simpliciter does not require this. Other recent accounts, e.g. Kretchmar 2012 and Russell 2014, may appear to support the desire-to-win analysis, but careful reflection reveals that this is not the case. (shrink)

We are grateful to the commentators on our article1 for their thoughtful engagement with the ethical and clinical complexity of expanded terminal sedation (ETS) in end-of-life care. We will start by noting some points of common ground, before moving on to the more challenging ways in which TS might be permissibly expanded. First, several commentators pointed out, and we completely concur, that it is important to provide patients with full information about their end-of-life options, including the ‘outcomes, uncertainties and costs (...) of ETS’.2 Where possible, they should be given time to ‘process their feelings and to reflect on how they wish to live in their last few days, weeks or months’.3 Furthermore, where patients receive sedation, it will be critical that they receive appropriate medical and nursing care to prevent physical complications such as pressure ulcers.2 This would be no different from other patients who are in states of reduced consciousness from disease. We acknowledge that there are heightened risks with earlier and more rapid TS, including the potential loss of spiritual and social moments,4 as well as the meaning that can be derived from conscious existential distress.3 However, while these conscious experiences might be valuable to some, others might weigh them less highly against the foreseen …. (shrink)

In "Pursuits of Wisdom," John Cooper brings this crucial question back to life. This marvelous book will shape the way we think about and engage with ancient philosophical traditions.

: The increasing reliance upon, and perhaps the growing public and professional skepticism about, the special expertise of bioethicists suggests the need to consider the limits of moral expertise. For all the talk about method in bioethics, we, bioethicists, are still rather far off the mark in understanding what we are doing, even when we may be going about what we are doing fairly well. Quite often, what is most fundamentally at stake, but equally often insufficiently acknowledged, are inherently political, (...) essentially contested visions of the most compelling and attractive forms of life for individuals and social organization. The current situation in bioethics parallels similar debates in eighteenth-century jurisprudence, especially Jeremy Bentham's withering critique of the prevalent forms of judicial argument and his own, equally unsuccessful, attempt to develop a decision-making procedure in ethics that would operate on a plane above politics. The risk, both then and now, is that we will fail to appreciate the wide range of reasonable disagreement that will remain past the point of extended reflection and discussion. (shrink)

Physical activity is important for managing the side effects and long-term outcomes of cancer treatment, yet many adolescents and young adults diagnosed with cancer are not meeting PA guidelines. Body image and social support are two factors that can influence PA behavior and require further attention in this population. The purpose of this study was to examine the associations between body image, social support, and PA among AYAs. An online cross-sectional survey administered through the Research Electronic Data Capture platform was (...) used to assess self-reported body image, social support, and PA in AYAs. Based on findings from path analyses, body image and social support were directly associated with PA. Social support was also directly associated with body image. However, there were no indirect effects. These findings provide preliminary support for the influential role of appearance and fitness body-related emotions and cancer-specific social support on PA. The results have important implications for the development of targeted strategies aimed at improving body image and social support, with the overall goal of increasing AYAs’ PA. (shrink)

Many of the contemporary disagreements regarding privacy are conceptual in nature. They concern the meaning or definition of privacy and the analytic basis of distinguishing privacy rights from other kinds of rights recognized within moral, political, or legal theories. The two main alternatives within this debate include reductionist views, which seek a narrow account of the kinds of invasions or intrusions distinctly involving privacy losses, and anti-reductionist theories, which treat a much broader array of interferences with a person as separate (...) and irreducible kinds of privacy invasions. Other theorists have expressed doubts about the prospects for achieving greater analytical precision even within a fairly expansive anti-reductionist approach. However, a reductionist privacy definition is defended in this article, and its primary theoretical virtues are its ability to unify and explain the insights of several competing definitions and its role in developing an account of privacy rights that is both internally coherent and consistent with a plausible understanding of the theoretical basis for a number of related rights. (shrink)

In some cases where we are faced with a decision of whether to prioritize identified lives over statistical lives, we have no basis for assigning specific probabilities to possible outcomes. Is there any reason to prioritize either statistical or identified lives in such cases? The ‘uncertainty argument’ purports to show that, provided we embrace ex ante contractualism, we should prioritize saving identified lives in such cases. The argument faces two serious problems. First, it relies on the principle of indifference, and (...) as such it leads to inconsistent assignments of epistemic probability to possible outcomes. Moreover, even if the uncertainty argument can be reformulated in order to avoid reliance on the principle of indifference, the uncertainty in such cases still undermines any judgment of which course of action – saving a statistical, or rather an identified life – involves the greater burden. The indeterminacy involved in the statistical group might be thought to undermine the argument that application of the principle of indifference leads to inconsistency in this case, but the thought that it does rests on a misunderstanding of the relationship between indeterminacy and reference. (shrink)

It appears that there is an inconsistency in combining epistemic contextualism with a plausible closure principle for knowledge and the view that knowledge is factive. I discuss the proposal that in order to avoid inconsistency the contextualist should reject closure and retain factivity. The proposal offers an alternative to closure and an argument that warrant fails to transmit through inference in the relevant cases. I criticize both accounts. The proposed alternative to closure is not well motivated and leaves unresolved the (...) question of why standard closure should not hold. The argument that warrant does not transmit is based on an inaccurate model of warrant transmission. An important lesson that emerges is that known propositions themselves can serve as warrant for further propositions, which may be known provided they are competently deduced from the former. Indeed it is arguably the factivity of knowledge that accounts for the fact that known propositions themselves serve as warrant. Thus, the strategy of rejecting closure while retaining factivity is a bad one not merely because the proposed alternatives to standard closure are inadequate and transmission failure in relevant cases would not imply closure failure, but because factivity ensures that warrant transmission worries in the relevant cases are unfounded. (shrink)

Articles by Lyn Horn and Alison Thompson highlight several points crucial to understanding how our theory figures in wider debates about social justice as well as the particular relevance of our theory for assessing the overall practice of public health (Horn, 2013; Thompson, 2013). We begin with these two articles, first to respond to and concur with many of their central points, and second to set the stage for dealing more efficiently with some points raised in the other articles.

We argue that extreme endurance sport can be valuable for some nonhuman animals. To make the case, we focus specifically on dogsled racing. We argue that, given certain views about the nature of self-affirmation, perceptual agency, and affordances, sled dogs are capable of realizing significant value through extreme endurance running. Because our focus is on the axiological question of the nature of the value of the sport for its participants, we do not claim that extreme dogsledding is ethical; indeed, we (...) acknowledge the morally objectionable aspects of the practice in its current form. Still, we offer our argument as a critical step in providing an adequate moral justification for a reformed model of dogsled racing. If it is permissible, that is likely because it offers some significant benefits to sled dogs. Given some assumptions about sled dogs’ capacity to be guided by both internal and external affordances, those benefits include self-affirmation. (shrink)

The use of targets to direct public health programmes, particularly in global initiatives, has become widely accepted and commonplace. This paper is an ethical analysis of the utilisation of targets in global public health using our fieldwork on and experiences with voluntary medical male circumcision initiatives in Kenya. Among the many countries involved in VMMC for HIV prevention, Kenya is considered a success story, its programmes having medically circumcised nearly 2 million men since 2007. We describe ethically problematic practices in (...) Kenyan VMMC programmes revealed by our fieldwork, how the problems are related to the pursuit of targets and discuss possible approaches to their management. Although the establishment and pursuit of targets in public health can have many benefits, assessments of target-driven programmes tend to focus on quantifiable outcomes rather than the processes by which the outcomes are obtained. However, in order to speak more robustly about programmatic ‘success’, and to maintain community trust, it is vital to ethically evaluate how a public health initiative is actually implemented in the pursuit of its targets. (shrink)

: The focus of questions of justice in health policy has shifted during the last 20 years, beginning with questions about rights to health care, and then, by the late 1980s, turning to issues of rationing. More recently, attention has focused on alternatives to cost-effectiveness analysis. In addition, health inequalities, and not just inequalities in access to health care, have become the subject of moral analysis. This article examines how such trends have transformed the philosophical landscape and encouraged some in (...) bioethics to seek guidance on normative questions from outside of the contours of traditional philosophical arguments about justice. (shrink)

We aren’t particularly sympathetic to modal realism (MR). Still, it isn’t clear to us that David Lewis argues for it in the wrong way. “The hypothesis is serviceable,” he says, “and that is a reason to think that it is true” (1986, p. 3). Let’s grant him the first claim: MR is serviceable, which is to say that it allows us “to reduce the diversity of notions we must accept as primitive, and thereby to improve the unity and economy of (...) the theory that is our professional concern – total theory, the whole of what we take to be true” (1986, p. 4). Our interest here is in the second claim, the thesis to the effect that a hypothesis’s being serviceable can provide reason to believe it. A number of philosophers maintain that this latter is false; others insist that it’s of no help to Lewis. So on one basis or the other, they conclude that Lewis’ argument for MR doesn’t get off the ground.1 We disagree. Our aim here is to show that there isn’t a cogent objection to Lewis’ use of serviceability that doesn’t rely a premise that he is justified in rejecting. (shrink)

Modern life is full of examples of environmentally-mediated “group harms” – what Derek Parfit describes as harms produced by “what we all do together.” Typically, the harms are unintended and arise from the uncoordinated actions of many individuals. Their actions ordinarily are not inherently wrong, no one’s action causes harm to an identifiable individual, and prevention of the expected harm is unlikely unless all, or nearly everyone, reduce or cease to engage in activities that collectively and cumulatively result in harm. (...) Unless the individual’s action is likely to make a difference to the outcome, it is often argued that it is not clear what, if anything, makes it wrong or a breach of personal moral responsibility. Activities that result in climate change and agricultural practices commonly employed within the global system of food production are prominent examples. There are several well-known strategies for dealing with such cases, but often they rest on idealized assumptions regarding the impact that one individual can have, provide answers suitable only in counterfactual circumstances, or rely on the kinds of principles of justice that make it difficult to identify clearly and address directly many important moral problems. The task of this chapter is to examine these strategies and propose alternative freestanding practical principles that can guide our efforts to address the world as we find it and explain the sense of wrongness individuals often experience. (shrink)

We show that Lewis’s modal realism, and his serviceability-based argument for it, cohere with his epistemological contextualism. Modal realism explains why serviceability-based reasoning in metaphysics might be reliable, while Lewis’s contextualism explains why Lewis can properly ignore the possibility that serviceability isn’t reliable, at least when doing metaphysics. This is because Lewis’s contextualism includes a commitment to a kind of pragmatic encroachment, so that whether a subject knows can depend on how much is at stake with respect to whether the (...) belief is true or false. Accordingly, we suggest that Lewis can count as knowing that serviceability is a reliable guide to truth in metaphysics, since the stakes are generally low there, and so can be justified in believing that modal realism is true based on its serviceability. (shrink)