This article describes a study that examined the experiences of 27 individuals who frequented an Open Access homeless shelter in Toronto, Canada. The overarching aim of this study was to map the social organisation of health care in Toronto, with particular regards to the ways in which literacy, or the lack of literacy, mediates the experiences of homeless individuals attempting to gain access to health care. While terms such as “literate” or “illiterate” might be seen to reflect an individual’s level (...) of acquired education or competence, critical social theorists argue that such terms instead more accurately reflect an individual’s relative class or position within the social hierarchy. Individuals who possess literacy are able to read into texts for their implicit understandings, directives, and power structures. Furthermore, they are able to translate and decode texts as potential pretexts for coordination or control. This study draws on a Freirean critical standpoint, which acknowledges that knowledge and power are inextricably interconnected. This study asked: How does literacy, or the lack of literacy, facilitate or impede access to health care for homeless individuals? What are the social consequences of illiteracy? (shrink)

Is racism an act of the will? A disease? A bad habit? A result of lost virtues or of historical economic forces? Can we reliably claim that racism is an affront to justice? How does our scientific understanding of "race" affect our ethical considerations? How can we ever know if we are acting from racist assumptions? With Leonard Harris, Naomi Zack, and Hugh Taft-Morales.

Is racism an act of the will? A disease? A bad habit? A result of lost virtues or of historical economic forces? Can we reliably claim that racism is an affront to justice? How does our scientific understanding of "race" affect our ethical considerations ? How can we ever know if we are acting from racist assumptions? With Leonard Harris, Naomi Zack, and Hugh Taft-Morales.

Population-level biomedical research offers new opportunities to improve population health, but also raises new challenges to traditional systems of research governance and ethical oversight. Partly in response to these challenges, various models of public involvement in research are being introduced. Yet, the ways in which public involvement should meet governance challenges are not well understood. We conducted a qualitative study with 36 experts and stakeholders using the World Café method to identify key governance challenges and explore how public involvement can (...) meet these challenges. This brief report discusses four cross-cutting themes from the study: the need to move beyond individual consent; issues in benefit and data sharing; the challenge of delineating and understanding publics; and the goal of clarifying justifications for public involvement. The report aims to provide a starting point for making sense of the relationship between public involvement and the governance of population-level biomedical research, showing connections, potential solutions and issues arising at their intersection. We suggest that, in population-level biomedical research, there is a pressing need for a shift away from conventional governance frameworks focused on the individual and towards a focus on collectives, as well as to foreground ethical issues around social justice and develop ways to address cultural diversity, value pluralism and competing stakeholder interests. There are many unresolved questions around how this shift could be realised, but these unresolved questions should form the basis for developing justificatory accounts and frameworks for suitable collective models of public involvement in population-level biomedical research governance. (shrink)

The mental health crisis and loneliness epidemic have sparked a growing interest in leveraging artificial intelligence (AI) and chatbots as a potential solution. This report examines the benefits and risks of incorporating chatbots in mental health treatment. AI is used for mental health diagnosis and treatment decision-making and to train therapists on virtual patients. Chatbots are employed as always-available intermediaries with therapists, flagging symptoms for human intervention. But chatbots are also sold as stand-alone virtual therapists or as friends and lovers. (...) There is evidence that these uses of AI and chatbots can provide better quality service, improve accessibility, and lower costs. The systems can reduce the stigma and shame of sharing their problems and leverage a mass of biometric and behavioral data to supplement self-reports. As the systems' intelligence rapidly improves, they will need to be rigorously tested for the accuracy and precision of their diagnoses and the quality of their interactions with patients. As chatbots become indistinguishable from humans and leverage their superhuman capacity to detect affect and draw on knowledge of a patient’s life, patients will be drawn to attribute personality to and relationship with the chatbot. Consequently, it will be essential to study what the “therapeutic alliance” with an actual human counselor provides and the risks of patients attributing such a relationship to a one-sided or “parasocial” relationship. (shrink)

Disturbances to one's sense of self, the feeling that one has ‘lost a part of oneself’ or that one ‘no longer feels like oneself,’ are frequently recounted throughout the bereavement literature. Engaging Allan Køster's important contribution to this issue, this article reinforces his suggestion that, by rupturing the existential texture of self-familiarity, bereavement can result in experiences of estrangement that can be meaningfully understood according to the concept of self-alienation. Nevertheless, I suggest that whilst Køster's relational interpretation of alienation as (...) the withdrawal of heteronomy can be applied to the experience of world-collapse in bereavement, what sets bereavement apart from other limit situations is the fact that it involves an intersubjective relation between the living and the dead. In contrast to Køster, therefore, I suggest that the experience of self-alienation that is distinctive to bereavement results from the fact that the bereaved is exposed to, and co-opted by, the absolute alterity of death itself. (shrink)

Epistemologists spend a great deal of time thinking about how we should respond to our evidence. They spend far less time thinking about the ways that evidence can be acquired in the first place. This is an oversight. Some ways of acquiring evidence are better than others. Many normative epistemologies struggle to accommodate this fact. In this article I develop one that can and does. I identify a phenomenon – epistemic feedback loops – in which evidence acquisition has gone awry, (...) with the result that even beliefs based on the evidence are irrational. Examples include evidence acquired under the influence of confirmation bias and evidence acquired under the influence of cognitively penetrated experiences caused by implicit bias. I then develop a theoretical framework which enables us to understand why beliefs that are the outputs of epistemic feedback loops are irrational. Finally, I argue that many popular approaches to epistemic normativity may need to be abandoned on the grounds that they cannot comfortably explain feedback loops. The scope of this last claim is broad: it includes almost all contemporary theories of justified/rational belief and of the epistemology of cognitive penetration. (shrink)

Epistemologists often appeal to the idea that a normative theory must provide useful, usable, guidance to argue for one normative epistemology over another. I argue that this is a mistake. Guidance considerations have no role to play in theory choice in epistemology. I show how this has implications for debates about the possibility and scope of epistemic dilemmas, the legitimacy of idealisation in Bayesian epistemology, uniqueness versus permissivism, sharp versus mushy credences, and internalism versus externalism.

Recently, dramatic price increases by several pharmaceutical companies have provoked public outrage. These scandals raise questions both about how pharmaceutical firms should be regulated and about how pharmaceutical executives ethically ought to make pricing decisions when drug prices are largely unregulated. Though there is an extensive literature on the regulatory question, the ethical question has been largely unexplored. This article defends a Kantian approach to the ethics of pharmaceutical pricing in an unregulated market. To the extent possible, pharmaceutical companies must (...) price drugs so that those who genuinely need them can get them without financial ruin. This requirement is an ethical side constraint, like the moral prohibitions on deception and theft, that takes precedence over a business’s interest in maximizing profit. That said, the requirement’s application is sensitive to the need to recoup the costs of research and to produce a return that financially justifies the original investment. It may not be either feasible or desirable for government to attempt to enforce the ethical requirements concerning just pharmaceutical pricing. Either price regulation or subsidy could fulfill government’s obligation to protect patients from being objectionably vulnerable to pricing decisions by private companies. (shrink)

When a loved one dies, it is common for the bereaved to feel profoundly lonely, disconnected from the world with the sense that they no longer belong. In philosophy, this experience of ‘loss and loneliness’ has been interpreted according to both a loss of possibilities and a loss of the past. But it is unclear how these interpretations apply to the distinctive way in which loss and loneliness manifest in old age. Drawing on the phenomenological analyses of old age given (...) by de Beauvoir and Améry, I consider how the diminishment of the capacity for projection and recollection complicate recent interpretations of loss and loneliness, whilst nevertheless reinforcing the conclusion that in old age subjectivity is necessarily impoverished. Developing a critical stance on de Beauvoir and Améry’s underlying conception of subjectivity, I turn to Levinas in considering whether or not there is a way to reimagine subjectivity such that the estrangement and alienation of older adults might be ameliorated rather than exacerbated. Grounded in the passive body-in-itself rather than the self-transcending capacity of the body-for-itself, I suggest it becomes possible to reconceptualise the experience of loss and loneliness in old age; both in terms of what is lost and what needs to be restored if older adults are to be helped to find themselves at home in the world in the midst of, and indeed because of, manifold loss. (shrink)

Boredom is an affective experience that can involve pervasive feelings of meaninglessness, emptiness, restlessness, frustration, weariness and indifference, as well as the slowing down of time. An increasing focus of research in many disciplines, interest in boredom has been intensified by the recent Covid-19 pandemic, where social distancing measures have induced both a widespread loss of meaning and a significant disturbance of temporal experience. This article explores the philosophical significance of this aversive experience of ‘pandemic boredom.’ Using Heidegger’s work as (...) a unique vantage point, this article draws on survey data collected by researchers in an ongoing project titled ‘Experiences of Social Distancing During the Covid-19 Pandemic’ to give an original phenomenological interpretation of the meaninglessness and monotony of pandemic boredom. On a Heideggerian interpretation, pandemic boredom involves either a situative confrontation with relative meaninglessness that upholds our absorption in the everyday world, or an existential confrontation with absolute meaninglessness that forces us to take up the question of our existence. Arguing that boredom during the pandemic makes this distinction difficult to sustain, I consider some of the ways in which pandemic boredom might be seen to expose and then exceed the distinctive methodological limitations of Heidegger’s philosophical interpretation of boredom. (shrink)

Increasingly the body is a possession that does not belong to us. It is bought and sold, bartered and stolen, marketed wholesale or in parts. The professions - especially reproductive medicine, transplant surgery, and bioethics but also journalism and other cultural specialists - have been pliant partners in this accelerating commodification of live and dead human organisms. Under the guise of healing or research, they have contributed to a new 'ethic of parts' for which the divisible body is severed from (...) the self, torn from the social fabric, and thrust into commercial transactions -- as organs, secretions, reproductive capacities, and tissues -- responding to the dictates of an incipiently global marketplace. Breaking with established approaches which prioritize the body as 'text', the chapters in this book examine not only images of the body-turned-merchandise but actually existing organisms considered at once as material entities, semi-magical tokens, symbolic vectors and founts of lived experience. The topics covered range from the cultural disposal and media treatment of corpses, the biopolitics of cells, sperm banks and eugenics, to the international trafficking of kidneys, the development of 'transplant tourism', to the idioms of corporeal exploitation among prizefighters as a limiting case of fleshly commodity. This insightful and arresting volume combines perspectives from anthropology, law, medicine, and sociology to offer compelling analyses of the concrete ways in which the body is made into a commodity and how its marketization in turn remakes social relations and cultural meanings. (shrink)

The neurodiversity paradigm is presented by its proponents as providing a philosophical foundation for the activism of the neurodiversity movement. Its central claims are that autism and other neurodivergent conditions are not disorders because they are not intrinsically harmful, and that they are valuable, natural and/or normal parts of human neurocognitive variation. This paper: (a) identifies the non‐disorder claim as the most central of these, based on its prominence in the literature and connections with the practical policy claims that the (...) paradigm is supposed to support; (b) describes the heterogeneity of autism at the behavioural and causal levels, and argues that at the behavioural level this encompasses ways of being autistic that are harmful in ways that cannot be not wholly attributed to discrimination or unjust social arrangements, challenging the claim that autism is not a disorder; (c) considers and rejects responses to this challenge based on separation of high‐ and low‐functioning autism, separation of autism from co‐occurring conditions, and viewing autism as part of an individual’s identity. Two of these responses fail for reasons that are themselves connected with the behavioural and/or causal heterogeneity of autism. (shrink)

This entirely new work guides the reader through the most basic systems of modal propositional logic up to systems of modal predicate with identity, dealing with both technical developments and discussing philosophical applications.

Daniel Greco (forthcoming) argues that there cannot be epistemic dilemmas. I argue that he is wrong. I then look in detail at a would-be epistemic dilemma and argue that no non-dilemmic approach to it can be made to work. Along the way, there is discussion of octopuses, lobsters, and other ‘inscrutable cognizers’; the relationship between evaluative and prescriptive norms; a failed attempt to steal a Brueghel; epistemic and moral blame and residue; an unbearable guy who thinks he’s God’s gift to (...) women; excuses; stupid games involving hats; radical permissivism; how I’ll never be able to afford to buy a house in Hampstead; and many other exciting topics. (shrink)

Drawing on resources from both the Analytical and Continental traditions, Form and World argues that a comprehension of Kant's aesthetics is necessary for grasping the scope and force of his epistemology. Fiona Hughes draws on phenomenological and aesthetic resources to bring out the continuing relevance of Kant's project. One of the difficulties faced in reading the Critique of Pure Reason is finding a way of reading the text as one continuous discussion. This book offers a reading at each stage (...) of Kant's epistemological argument, showing how various elements of Kant's argument, often thought of as extraneous or indefensible, can be integrated. This incisive study, arguing for the centrality of aesthetics in philosophy, and within experience in general, challenges a blind spot in the Anglo-American tradition of philosophy and will contribute to a growing interest in the general significance of aesthetic culture. (shrink)

I consider a number of reasons one might think we should only accept epistemic dilemmas in our normative epistemology as a last resort and argue that none of them is compelling.

This article draws on a five-year, multi-sited transnational research project on the global traffic in human organs, tissues, and body parts from the living as well as from the dead as a misrecognized form of human sacrifice. Capitalist expansion and the spread of advanced medical and surgical techniques and developments in biotechnology have incited new tastes and traffic in the skin, bones, blood, organs, tissues, marrow and reproductive and genetic marginalized other. Examples drawn from recent ethnographic research in Israel, the (...) Palestinian Authority and Turkey serve to cast light on the dark side of organs harvesting and transplantation. The article focuses on the dangers of the `fetishized kidney' for both sellers and buyers, for whom this new commodity has become an organ of opportunity and an organ of last resort. The bodily sacrifice is disguised as a donation, rendered invisible by its anonymity, and hidden under the medical rhetoric of `life saving' and `gift giving'. It suggests that the ultimate fetish as recognized long ago by Ivan Illich is the idea of `life' as object of manipulation. (shrink)

Survivors of trauma commonly report feeling as though a part of themselves has died. This article provides a theoretical interpretation of this phenomenon, drawing on Waldenfels' notion of the split self. We argue that trauma gives rise to an explicit tension between the lived and corporeal body which is so profoundly distressing that it can be experienced by survivors as the death of part of oneself. We explore the ways in which this is manifest in the posttraumatic phenomena of dissociation; (...) indescribability; and the fragmentation and repetition of time. Acknowledging that the traumatic loss of part of oneself involves significant grief, we then consider whether the bereavement literature might be helpfully applied. We focus specifically upon the continuing bonds model, which emphasizes an ongoing and meaningful relationship with the deceased through an active process of memorializing. In considering how this might be appropriated to the death of the self in trauma, we suggest that the development of an intrapersonal relationship between parts lost and living might, over time, offer a unique way in which to adapt to loss and approach the future. (shrink)

What can textual combinations, format, and size tell us about the worldviews of the donors, scribes, and readers of medieval Chinese Buddhist manuscripts? How can material sources inform us about the ways adherents both perceived and actively shaped their traditions? This essay offers answers to these questions through analysis of several manuscripts of the Scripture on the Cause and Effects of Wholesome and Unwholesome Acts (Shan’e yinguo jing 善惡因果經, T no. 2881), discovered in the Dunhuang Library Cave. The text was (...) likely composed in Chinese, and it first appears in Buddhist catalogs in the year 695 ce. Extant manuscripts of Cause and Effects appear in both scroll and booklet formats and number at least fifty-two in total, a significant number that attests to the popularity of the text. This essay analyzes the textual content and literary techniques, relating both to physical aspects of the manuscripts. It examines the textual and the material together through the mediating concept of practice—in this case, medieval Chinese reading practices. (shrink)

Psychiatry uncomfortably spans biological and psychosocial perspectives on mental illness, an idea central to Engel's biopsychosocial paradigm. This paradigm was extremely ambitious, proposing new foundations for clinical practice as well as a non-reductive metaphysics for mental illness. Perhaps given this scope, the approach has failed to engender a clearly identifiable research programme. And yet the view remains influential. We reassess the relevance of the biopsychosocial paradigm for psychiatry, distinguishing a number of ways in which it could be (re)conceived.

Near the middle of his first discussion with Lysis, Socrates asks an odd question—he asks if Lysis’ mother lets him play with her loom or touch her woolworking tools (208d1-e2). It is one of many odd questions, of course, but it is odd nonetheless. Odd, and also funny: it is the one of just two comments in the book that makes Lysis laugh. This question, I argue, reveals the profound depth of Socrates’ inquiry about Lysis’ views about himself and his (...) loved ones. Indeed, the challenge is so profound that at first the only response is laughter. One aspect is a challenge to certain ideals of masculinity, and so I briefly discuss Athenian conceptions of gender and masculinity, along with some Platonic questioning of these conceptions. Reading the Lysis through the lens of gender reveals not only the continued relevance of such a lens, but also the intensity of Socrates’ work, which calls into question basic social structures and markers of identity, like gender, in its pursuit of a liberatory turn to philosophy. We gain insight into his challenge to Athenian understanding of masculinity by observing the way that Socrates’ argumentation undermines much of it, and we more fully appreciate Socrates’ arguments if we see that they intend to subvert gendered expectations. The setting of the dialogue, the questions Socrates asks, and the responses from Lysis all reinforce that what is at stake in the text is Lysis’ character, including his masculinity. (shrink)

Melancholia is an attunement of despair and despondency that can involve radical disruptions to temporal experience. In this article, I extrapolate from the existing analyses of melancholic time to examine some of the important existential implications of these temporal disruptions. In particular, I focus on the way in which the desynchronization of melancholic time can complicate the melancholic’s relation to death and, consequently, to the meaning and significance of their life. Drawing on Heidegger’s distinction between death and demise, I argue (...) that melancholic time leaves the melancholic in an impossible state of existing, where they are both unable to live and unable to die. Turning to the role of the physician, I consider the significant role that clinical interventions might have in resynchronizing the melancholic with time and examine these ideas further through a case study on physician-assisted suicide. In so doing, I demonstrate that the desynchronization of melancholic time should indeed be understood as a matter of life and death. (shrink)

Enlightenment values are built around the presumption of an independent rational self, citizen, consumer and pursuer of self-interest. Even the authoritarian and communitarian variants of the Enlightenment presumed the existence of autonomous individuals, simply arguing for greater weight to be given to their collective interests. Since Hume, however, radical Enlightenment empiricists have called into question the existence of a discrete, persistent self. Today neuroscientific reductionism has contributed to the rejection of an essentialist model of personal identity. Contemporary transhumanism has yet (...) to grapple with the radical consequences of the erosion of liberal individualism on their projects of individually chosen enhancement and longevity. Most transhumanists still reflect an essentialist idea of personal identity, even as they embrace projects of radical cognitive enhancement that would change every constituent element of consciousness. Transhumanists need to grapple with how their projects and ethics would change if personal identity is an arbitrary, malleable fiction. (shrink)

Artworks at Lascaux and other late Palaeolithic caves integrate geological features or “relief” of the cave wall in a way that suggests a symbiotic relation between nature and culture. I argue this qualifies as “receptivity to a situation,” which is neither fully active nor merely passive and emerges as a necessary element of the intentions made apparent by such cave art. I argue against prominent interpretations of cave art, including the shamanist account and propose a structural interpretation attentive to particular (...) cases. Seen in this way, cave art displays intentions that are analyzable as having a tripartite structure: mentally directed, embedded in actions and receptive to a situation. Moreover, the latter is the medium through which the other two elements are conjoined. Drawing on a range of archaeological and philosophical resources from both analytical philosophy and phenomenology, I argue that what I call cave art’s “intentional story” is important for the philosophy of intentions more generally. (shrink)

In their recent article, ‘Why lockdown of the elderly is not ageist and why levelling down equality is wrong’, Savulescu and Cameron argue for selective isolation of the elderly as an alternative to general lockdown. An important part of their argument is the claim that the latter amounts to ‘levelling down equality’ and that this is ‘unethical’ or even ‘morally repugnant’. This response argues that they fail to justify either part of this claim: the claim that levelling down is always (...) morally wrong is subject to challenges that Savulescu and Cameron do not consider; and a policy of maintaining general lockdown does not constitute levelling down, as it provides absolute benefits to those who would be worse off under selective isolation. (shrink)

Many business transactions and employment contracts are wrongfully exploitative despite being consensual and beneficial to both parties, compared with a nontransaction baseline. This form of exploitation can present governments with a dilemma. Legally permitting exploitation may send the message that the public condones it. In some economic conditions, coercively enforced antiexploitation law may harm the people it is intended to help. Under these conditions, a way out of the dilemma is to enact laws with provisions that lack coercive enforcement. Noncoercive (...) law would convey the state’s condemnation of wrongful exploitation without risking the harmful effects of coercively enforced law. It would also give firms and their agents a way of explaining nonexploitative pricing decisions to investors, and it may help give precise content to the moral duty to set prices and wages fairly. Governments should thus consider noncoercive law a viable component of their responses to exploitation. (shrink)

In this paper I explain and defend a version of illocutionary pluralism called illocutionary relativism. I use this position to explain Rae Langton’s now-famous example of a woman who is illocutionarily disabled in her attempt to refuse sex. Illocutionary relativism gives us the tools to explain both why the woman refused and why she is illocutionarily disabled. I base my explanation of illocutionary relativism in background literature in speech act theory from Austin and Sbisa. Finally, I close by pointing out (...) some implications for how we should understand consent. (shrink)