We describe a case of an elderly patient suffering from advanced dementia whose chronic confusion has become a source of frustration for her caregivers. Mrs. M experiences a touching interaction with a new nurse who takes a different approach with her. We describe this interaction and elaborate upon it by drawing from Catholic social teaching and the philosophy of play. Cases like these do not involve dramatic or esoteric ethical problematics, but rather the sort of dilemma born of the everyday (...) tragedies of lingering illness, aging and caretakers’ fatigue. Nathan’s approach offers a different way of seeing and being with the wearisome patient. (shrink)

De Marco et al 1 argue that the standard account of medical ‘invasiveness’ (as ‘incision’ or ‘insertion’) fails to capture three aspects of its existing use, namely that invasiveness can come in degrees, often depends on features of alternative medical interventions and can be non-physical. They propose a new schematic account that suggests that medical interventions can possess ‘basic invasiveness’ (which can come in degrees and of which they suggest at least two types: physical and mental), and ‘threshold invasiveness’ which (...) can depend on the alternatives a specific intervention is being compared with. While we agree that the standard account of invasiveness fails to capture existing use and are supportive of their aim, here we express scepticism about the practical utility of De Marco et al ’s revised account. Our scepticism concerns the application of De Marco et al’s revised account in the narrow context of clinician–patient communication and deliberation about medical interventions within clinical practice, which we see as a crucial context for its use. While De Marco et al do not specify the contexts in which their revised account could be used, we assume from their discussion of treatment interventions (e.g. non-invasive prenatal testing, ventilation) and their comparison to ‘more or less invasive’ options, that at least one of the purposes in mind for …. (shrink)

What makes for a good education? What does one need to count as well-educated? Knowledge, to be sure. But knowledge is easily forgotten, and today's knowledge may be obsolete tomorrow. Skills, particularly in critical thinking, are crucial as well. But absent the right motivation, graduates may fail to put their skills to good use. In this book, Nathan King argues that intellectual virtues-traits like curiosity, intellectual humility, honesty, intellectual courage, and open-mindedness-are central to any education worthy of the name. (...) Further, such virtues are crucial to our functioning well in everyday life, in areas as diverse as personal relationships, responsible citizenship, civil discourse, and personal success. Our struggles in these areas often result from a failure to think virtuously. Drawing upon recent work in philosophy and psychology, King paints a portrait of virtuous intellectual character-and of the vices such a character opposes. Filled with examples and applications, this book introduces readers to the intellectual virtues: what they are, why they matter, and how we can grow in them. (shrink)

A correct observation to the effect that a does not exist, where ‘a’ is a singular term, could be true on any of a variety of grounds. Typically, a true, singular negative existential is true on the unproblematic ground that the subject term ‘a’ designates something that does not presently exist. More interesting philosophically is a singular, negative existential statement in which the subject term ‘a’ designates nothing at all. Both of these contrast sharply with a singular, negative existential in (...) which the subject term is a name from fiction. I argue that such singular, negative existential statements are false. My account of fictional characters differs significantly from Kripke’s. It is shown that an objection to my account rests on a serious misunderstanding. Finally, a crucial aspect of the account is emphasized. (shrink)

I describe a realist, ontologically objective interpretation of probability, "far-flung frequency (FFF) mechanistic probability". FFF mechanistic probability is defined in terms of facts about the causal structure of devices and certain sets of frequencies in the actual world. Though defined partly in terms of frequencies, FFF mechanistic probability avoids many drawbacks of well-known frequency theories and helps causally explain stable frequencies, which will usually be close to the values of mechanistic probabilities. I also argue that it's a virtue rather than (...) a failing of FFF mechanistic probability that it does not define single-case chances, and compare some aspects of my interpretation to a recent interpretation proposed by Strevens. (shrink)

Toward a theory of n-tuples of individuals and concepts as surrogates for Russellian singular propositions and singular concepts. Alonzo Church proposed a powerful and elegant theory of sequences of functions and their arguments as singular-concept surrogates. Church’s account accords with his Alternative (0), the strictest of his three competing criteria for strict synonymy. The currently popular objection to strict criteria like (0) on the basis of the Russell-Myhill paradox is misguided. Russell-Myhill is not a problem specifically for Alternative (0). Rather (...) it is a disproof of unrestricted concept comprehension. Unrestricted comprehension is also inconsistent with facts about sets of properties. It is demonstrated furthermore that the principal rival conception of propositions, as classes of possible worlds, is subject to a fatal philosophical collapse: It follows on that conception, given that each of us is fallible, that everyone believes everything. Although it is far superior to its principal rival conception, Church’s proposed theory is vulnerable under (0) to a version of Russell’s notorious Gray’s /Elegy/ objection. Some amendments to Church’s proposal are proffered that address Russell’s objection, including an amendment first proposed in the present author’s /Frege’s Puzzle/ (1986). Church’s response (personal correspondence) is considered. (shrink)

Despite increased calls for hospital ethics committees to serve as default decision-makers about life-sustaining treatment for unrepresented patients who lack decision-making capacity or a surrogate decision-maker and whose wishes regarding medical care are not known, little is known about how committees currently function in these cases. This was a retrospective cohort study of all ethics committee consultations involving decision-making about LST for unrepresented patients at a large academic hospital from 2007 to 2013. There were 310 ethics committee consultations, twenty-five of (...) which involved unrepresented patients. In thirteen cases, the ethics consultants evaluated a possible substitute decision-maker identified by social workers and/or case managers. In the remaining cases, the ethics consultants worked with the medical team to contact previous healthcare professionals to provide substituted judgement, found prior advance care planning documents, or identified the patient’s best interest as the decision-making standard. In the majority of cases, the final decision was to limit or withdraw LST or to change code status to Do Not Resuscitate/Do Not Intubate. Substitute decision-makers who had been evaluated through the ethics consultation process and who made the final decision alone were more likely to continue LST than cases in which physicians made the final decision. In our centre, the primary role of ethics consultants in decision-making for unrepresented patients is to identify appropriate decision-making standards. In the absence of other data suggesting that ethics committees, as currently constituted, are ready to serve as substitute decision-makers for unrepresented patients, caution is necessary before designating these committees as default decision-makers. (shrink)

This paper is a contribution to our understanding of the technical concept of given in Greek mathematical texts. By working through mathematical arguments by Menaechmus, Euclid, Apollonius, Heron and Ptolemy, I elucidate the meaning of given in various mathematical practices. I next show how the concept of given is related to the terms discussed by Marinus in his philosophical discussion of Euclid’s Data. I will argue that what is given does not simply exist, but can be unproblematically assumed or produced (...) through some effective procedure. Arguments by givens are shown to be general claims about constructibility and computability. The claim that an object is given is related to our concept of an assignment—what is given is available in some uniquely determined, or determinable, way for future mathematical work. (shrink)

One controversy about the existence of so called evolutionary forces such as natural selection and random genetic drift concerns the sense in which such “forces” can be said to interact. In this paper I explain how natural selection and random drift can interact. In particular, I show how population-level probabilities can be derived from individual-level probabilities, and explain the sense in which natural selection and drift are embodied in these population-level probabilities. I argue that whatever causal character the individual-level probabilities (...) have is then shared by the population-level probabilities, and that natural selection and random drift then have that same causal character. Moreover, natural selection and drift can then be viewed as two aspects of probability distributions over frequencies in populations of organisms. My characterization of population-level probabilities is largely neutral about what interpretation of probability is required, allowing my approach to support various positions on biological probabilities, including those which give biological probabilities one or another sort of causal character. ‡This paper has benefited from feedback on and discussions of this and earlier work. I want to thank André Ariew, Matt Barker, Lindley Darden, Patrick Forber, Nancy Hall, Mohan Matthen, Samir Okasha, Jeremy Pober, Robert Richardson, Alex Rosenberg, Eric Seidel, Denis Walsh, and Bill Wimsatt. †To contact the author, please write to: Department of Philosophy, University of Alabama at Birmingham, HB 414A, 900 13th Street South, Birmingham, AL 35294-1260; e-mail: [email protected]. (shrink)

Much recent work in virtue epistemology has focused on the analysis of such intellectual virtues as responsibility, conscientiousness, honesty, courage, open-mindedness, firmness, humility, charity, and wisdom. Absent from the literature is an extended examination of perseverance as an intellectual virtue. The present paper aims to fill this void. In Sect. 1, I clarify the concept of an intellectual virtue, and distinguish intellectual virtues from other personal characters and properties. In Sect. 2, I provide a conceptual analysis of intellectually virtuous perseverance (...) that places perseverance in opposition to its vice -counterparts, intransigence and irresolution. The virtue is a matter of continuing in one’s intellectual activities for an appropriate amount of time, in the pursuit of intellectual goods, despite obstacles to one’s attainment of those goods. In Sect. 3, I explore relations between intellectually virtuous perseverance and other intellectual virtues. I argue that such perseverance is necessary for the possession and exercise of several other intellectual virtues, including courage. These connections highlight the importance of perseverance in a comprehensive account of such virtues. (shrink)

Recent debate on the nature of probabilities in evolutionary biology has focused largely on the propensity interpretation of fitness (PIF), which defines fitness in terms of a conception of probability known as “propensity”. However, proponents of this conception of fitness have misconceived the role of probability in the constitution of fitness. First, discussions of probability and fitness have almost always focused on organism effect probability, the probability that an organism and its environment cause effects. I argue that much of the (...) probability relevant to fitness must be organism circumstance probability, the probability that an organism encounters particular, detailed circumstances within an environment, circumstances which are not the organism’s effects. Second, I argue in favor of the view that organism effect propensities either don’t exist or are not part of the basis of fitness, because they usually have values close to 0 or 1. More generally, I try to show that it is possible to develop a clearer conception of the role of probability in biological processes than earlier discussions have allowed. (shrink)

It has been argued that biological fitness cannot be defined as expected number of offspring in all contexts. Some authors argue that fitness therefore merely satisfies a common schema or that no unified mathematical characterization of fitness is possible. I argue that comparative fitness must be relativized to an evolutionary effect; thus relativized, fitness can be given a unitary mathematical characterization in terms of probabilities of producing offspring and other effects. Such fitnesses will sometimes be defined in terms of probabilities (...) of effects occurring over the long term, but these probabilities nevertheless concern effects occurring over the short term. †To contact the author, please write to: Department of Philosophy, University of Alabama at Birmingham, HB 414A, 900 13th Street South, Birmingham, AL 35294‐1260; e‐mail: [email protected]. (shrink)

This book addresses the most important questions asked about higher education: What should its content be? What should we educate for, and why? What constitutes a meaningful liberal education, as distinct from mere training for a vocation? These and many other questions are addressed by Reuben Abel, M.H. Abrams, Robert L. Bartley, Ronald Berman, Also S. Bernardo, Wm. Theodore deBary, Gray Dorsey, Joseph Dunner, Nathan Glazer, Feliks Gross, Gertrude Himmelfarb, Gerald Holton, Sidney Hook, Charles Issawi, Montimer R. Kadish, (...) Paul Oscar Krissteller, paul Kurtz, Herbert I. London, Ernest Nagel, Henry R. Novotny, Frederick A. Olafson, Michael Rabin, Howard B. Radest, Joseph J. Schwab, Robert F. Sexton, Thomas Sowell, John B. Stephenson, and Miro M. Todorovich. (shrink)

A key question has been underexplored in the literature on conscientious objection: if a physician is required to perform ‘medical activities,’ what is a medical activity? This paper explores the question by employing a teleological evaluation of medicine and examining the analogy of military conscripts, commonly cited in the conscientious objection debate. It argues that physicians (and other healthcare professionals) can only be expected to perform and support medical acts – acts directed towards their patients’ health. That is, physicians cannot (...) be forced to provide or support services that are not medical in nature, even if such activities support other socially desirable pursuits. This does not necessarily mean that medical professionals cannot or should not provide non-medical services, but only that they are under no obligation to provide them. (shrink)

Contemporary Western culture is experiencing a heightened awareness of religious diversity. This article surveys a range of possible responses to such diversity, and distinguishes between responses that concern the salvation or moral transformation of persons (soteriological views) and those that concern the alethic or epistemic status of religious beliefs (doctrinal views). After providing a brief taxonomy of these positions and their possible relations to one another, the article focuses primarily on competing views about the truth and rationality of religious beliefs (...) (e.g., pluralism, exclusivism, and skepticism). Here a heavy emphasis is placed on arguments for and against the rationality and moral propriety of retaining one's religious beliefs in the face of disagreement. The article surveys some of the more prominent arguments from the literature on this topic and closes with suggestions for further research. (shrink)

and was correct to conclude that the way a biological population is described should affect conclusions about whether natural selection occurs, but wrong to conclude that natural selection is therefore not a cause. After providing a new argument that ignored crucial biological details, I give a biological illustration that motivates a fairly extreme dependence on description. I argue that contrary to an implication of , biologists allow much flexibility in describing populations, as contemporary research on recent human evolution shows. Properly (...) understood, such description-dependence is consistent with descriptions capturing different causal relations involving the same population. I thus show that Walsh’s arguments fail for reasons that have not previously been understood; I argue that Walsh’s more recent “Sure Thing” argument fails for similar reasons. The resulting view provides a new perspective on causation in evolutionary processes. (shrink)

_Shusterman’s Somaesthetics_ is a wide-ranging collection of penetrating essays by twelve scholars examining in rich detail the many dimensions of philosopher Richard Shusterman’s pragmatism and somaesthetics, complemented by his own chapter of responses to these scholars.

This chapter explores a philosophical hypothesis about the nature of (some) probabilities encountered in social sciences. It should be of interest to those with philosophical concerns about the foundations of probability, and to social scientists and philosophers of science who are somewhat puzzled by the nature of probability in social domains. As will become clear below, the chapter is not intended as a contribution to an empirical methodology such as a particular way of applying statistics.

It’s recently been argued that biological fitness can’t change over the course of an organism’s life as a result of organisms’ behaviors. However, some characterizations of biological function and biological altruism tacitly or explicitly assume that an effect of a trait can change an organism’s fitness. In the first part of the paper, I explain that the core idea of changing fitness can be understood in terms of conditional probabilities defined over sequences of events in an organism’s life. The result (...) is a notion of “conditional fitness” which is static but which captures intuitions about apparent behavioral effects on fitness. The second part of the paper investigates the possibility of providing a systematic foundation for conditional fitness in terms of spaces of sequences of states of an organism and its environment. I argue that the resulting “organism–environment history conception” helps unify diverse biological perspectives, and may provide part of a metaphysics of natural selection. (shrink)

It is commonly thought that logic, whatever it may be, is normative. While accounting for the normativity of logic is a challenge for any view of logic, in this paper I argue that it is particularly problematic for certain types of logical pluralists, due to what I call the normative problem for logical pluralism. I introduce the NPLP, distinguish it from other problems that logical pluralists may face, and show that it is unsolvable for one prominent type of logical pluralism.

A new philosophical analysis is provided of the notorious Sleeping Beauty Problem. It is argued that the correct solution is one-third, but not in the way previous philosophers have typically meant this. A modified version of the Problem demonstrates that neither self-locating information nor amnesia is relevant to the core Problem, which is simply to evaluate the conditional chance of heads given an undated Monday-or-Tuesday awakening. Previous commentators have failed to appreciate the significance of the information that Beauty gains upon (...) waking, and which is relevant to the conditional chance of heads: de re acquaintance with the awakening itself and the non-locating knowledge that it is an experimental awakening. David Lewis and company are committed to several unjustifiable and unacceptable probability assessments. Previous commentators have in effect confused the information that Beauty undergoes this particular experimental awakening for the information that she undergoes some experimental awakening or other. Lewis in particular thereby illegitimately tips the scales both in favor of heads and in favor of Monday. The Sleeping Beauty Problem is equivalent to a ball-in-urn word problem in elementary probability theory. (shrink)

The “somewhat vague, intuitive” notion from computability theory of an effective procedure (method) or algorithm can be fairly precisely defined even if it is not sufficiently formal and precise to belong to mathematics proper (in a narrow sense)—and even if (as many have asserted) for that reason the Church–Turing thesis is unprovable. It is proved logically that the class of effective procedures is not decidable, i.e., that no effective procedure is possible for ascertaining whether a given procedure is effective. This (...) undecidability result is proved directly from the notion itself of an effective procedure, without reliance on any (partly) mathematical lemma, conjecture, or thesis invoking recursiveness or Turing-computability. In fact, there is no reliance on anything very mathematical. The proof does not even appeal to a precise definition of ‘effective procedure’. Instead, it relies solely and entirely on a basic grasp of the intuitive notion of an effective procedure. Though the result that effectiveness is undecidable is not surprising, it is also not without significance. It has the consequence, for example, that the solution to a decision problem, if it is to be complete, must be accompanied by a separate argument that the proposed ascertainment procedure invariably terminates with the correct verdict. (shrink)

Much recent work in virtue epistemology has focused on the analysis of such intellectual virtues as responsibility, conscientiousness, honesty, courage, open-mindedness, firmness, humility, charity, and wisdom. Absent from the literature is an extended examination of perseverance as an intellectual virtue. The present paper aims to fill this void. In Sect. 1, I clarify the concept of an intellectual virtue, and distinguish intellectual virtues from other personal traits and properties. In Sect. 2, I provide a conceptual analysis of intellectually virtuous perseverance (...) that places perseverance in opposition to its vice-counterparts, intransigence and irresolution. The virtue is a matter of continuing in one’s intellectual activities for an appropriate amount of time, in the pursuit of intellectual goods, despite obstacles to one’s attainment of those goods. In Sect. 3, I explore relations between intellectually virtuous perseverance and other intellectual virtues. I argue that such perseverance is necessary for the possession and exercise of several other intellectual virtues, including courage. These connections highlight the importance of perseverance in a comprehensive account of such virtues. (shrink)

Musing for Puncta special issue on "Critically Sick: New Phenomenologies Of Illness, Madness, And Disability.".

While recent history has seen significant debate concerning the nature and extension of essence, comparatively little attention has been paid to the epistemology of essence. This is strange, as, plausibly, what answers we give to the metaphysical questions about essence will (or should) be partially constrained by our essence epistemology. Here, I aim to go some way towards filling this lacuna. In particular, I here argue that there is no plausible epistemic story available for non-modal accounts of essence. In particular, (...) existing accounts of essence epistemology cannot explain how we are able to know that something is genuinely essential, rather than merely necessary. One consequence is that modal accounts of essence – which only needs to supply an epistemology for a non-hyperintensional notion – look that much more plausible. (shrink)

Evolutionary discussions regarding the relationship between social status and fertility in the contemporary U.S. typically claim that the relationship is either negative or absent entirely. The published data on recent generations of Americans upon which such statements rest, however, are solid with respect to women but sparse and equivocal for men. In the current study, we investigate education and income in relation to age at first child, childlessness, and number of children for men and women in two samples—one of the (...) general American population and one of graduates of an elite American university. We find that increased education is strongly associated with delayed childbearing in both sexes and is also moderately associated with decreased completed or near-completed fertility. Women in the general population with higher adult income have fewer children, but this relationship does not hold within all educational groups, including our sample with elite educations. Higher-income men, however, do not have fewer children in the general population and in fact have lower childlessness rates. Further, higher income in men is positively associated with fertility among our sample with elite educations as well as within the general population among those with college educations. Such findings undermine simple statements on the relationship between status and fertility. (shrink)

Alonzo Church famously provided three principal competing criteria for “strict synonymy,” i.e., sameness of semantic content. These are his Alternatives (0), (1), and (2)—numbered in order of increasing course-grainedness of content. On Alternative (2), expressions are deemed strictly synonymous iff they are logically equivalent. This criterion seems hopeless as an account of the objects of propositional attitude. On Alternative (1), expressions are deemed synonymous iff they are λ-convertible. Alternative (1) also evidently conflicts with discourse about the attitudes. On Alternative (0), (...) expressions are deemed strictly synonymous iff they are “synonymously isomorphic” in Church’s sense. On Alternative (0), semantic content is so fine-grained that not even “Romeo loves Juliet” and “Juliet is loved by Romeo” qualify as strictly synonymous. A fourth alternative, here called “Alternative (3),” deems expressions strictly synonymous iff they are co-intensional, i.e., they have the same semantic extension with respect to the same possible worlds. This criterion’s notion of content is even more course grained than that of Alternative (2). Several objections to Alternative (3) are considered. (This article is wholly contained within the author’s more definitive essay, “Singular Concepts”.). (shrink)

I define a concept of causal probability and apply it to questions about the role of probability in evolutionary processes. Causal probability is defined in terms of manipulation of patterns in empirical outcomes by manipulating properties that realize objective probabilities. The concept of causal probability allows us see how probabilities characterized by different interpretations of probability can share a similar causal character, and does so in such way as to allow new inferences about relationships between probabilities realized in different chance (...) setups. I clarify relations between probabilities and properties defined in terms of them, and argue that certain widespread uses of computer simulations in evolutionary biology show that many probabilities relevant to evolutionary outcomes are causal probabilities. This supports the claim that higher-level properties such as biological fitness and processes such as natural selection are causal properties and processes, contrary to what some authors have argued. (shrink)

We are living at the dawn of the first truly scientific picture of the universe-as-a-whole, yet people are still dragging along prescientific ideas about God that cannot be true and are even meaningless in the universe we now know we live in. This makes it impossible to have a coherent big picture of the modern world that includes God. But we don't have to accept an impossible God or else no God. We can have a real God if we redefine (...) God in light of knowledge no one ever had before. The key question is, “Could anything actually exist in the scientific universe that is worthy of the name, God?” My answer is yes: God is an “emergent phenomenon,” as real as the global economy or the government or the worldwide web, which are all emergent phenomena. But God arose from something deeper: the complex interactions of all humanity's aspirations. An emerging God has enormous implications. (shrink)

Hume’s argument against believing the testimony of miracles is the most influential treatment of the topic, but there is not yet a consensus on how to interpret his argument. Two arguments are attributed to him. First, Hume seems to start with the infrequency of miracles and uses this to infer that the testimony of a miracle is exceedingly unlikely, and this then creates strong but defeasible evidence against the testimony of any miracle. Second, perhaps Hume takes the constancy of our (...) experience of the laws of nature as decisive or indefeasible evidence against the testimony of any miracle. I explain the basis for each of these interpretations of Hume’s argument, and then develop a novel criticism of his view: namely, any inductive inference depends on the relevant similarity between the observed and the unobserved, but we may have reason for thinking that purported miracles are not relevantly similar, and thus our past experience cannot be used as reliable evidence about the testimony of (some) miracles. (shrink)

Quine’s criterion of theoretical ontological commitment is subject to a variety of interpretations, all of which save one yield incorrect verdicts. Moreover, the interpretation that yields correct verdicts is not what Quine meant. Instead the intended criterion unfairly imputes ontological commitments to theories that lack those commitments and fails to impute commitments to theories that have them. Insofar as Quine’s criterion is interpreted so that it yields only correct verdicts, it is trivial and of questionable utility. Moreover, the correct criterion (...) invokes analyticity, a notion that Quine spent most of his life tirelessly combating. This yields a dilemma for Quinean philosophy: Either his criterion of ontological commitment is incorrect, or else Quine is committed to a traditional philosophical notion that he emphatically rejected as disreputable. (shrink)

This paper concerns the semantics of coordinated if-clauses, as in (1)-(2). It is argued that the meanings of such sentences are explained straightforwardly on theories of conditionals that tie their non- monotonic behaviour to the if-clause itself (e.g. Schlenker 2004, but not theories that tie it to a (covert) modal operator (e.g. Kratzer 1981; 1991). Coordinated if-clauses are revealing of the fine-grained compositional semantics of conditionals.

Stigma taints individuals with a spoiled identity and loss of status or discrimination. This article is the first to examine the stigma attached to abortion and surrogacy and consider how law may stigmatize women for failing to conform to social expectations about maternal roles. Courts should consider evidence of stigma when evaluating laws regulating abortion or surrogacy to determine whether these laws are based on impermissible gender stereotyping.

BACKGROUND Patients with chronic pain face significant barriers in finding clinicians to manage long-term opioid therapy (LTOT). For patients on LTOT, it is increasingly common to have them sign opioid treatment agreements (OTAs). OTAs enumerate the risks of opioids, as informed consent documents would, but also the requirements that patients must meet to receive LTOT. While there has been an ongoing scholarly discussion about the practical and ethical implications of OTA use in the abstract, little is known about how clinicians (...) use them and if OTAs themselves modify clinician prescribing practices. OBJECTIVE To determine how clinicians use OTAs and the potential impacts of OTAs on opioid prescribing. DESIGN We conducted qualitative analysis of four focus groups of clinicians from a large Midwestern academic medical center. Groups were organized according to self-identified prescribing patterns: two groups for clinicians who identified as prescribers of LTOT, and two who did not. PARTICIPANTS 17 clinicians from General Internal Medicine, Family Medicine, and Palliative Care were recruited using purposive, convenience sampling. APPROACH Discussions were recorded, transcribed, and analyzed for themes using reflexive thematic analysis by a multidisciplinary team. KEY RESULTS Our analysis identified three main themes: (1) OTAs did not influence clinicians’ decisions whether to use LTOT generally but did shape clinical decision-making for individual patients; (2) clinicians feel OTAs intensify the power they have over patients, though this was not uniformly judged as harmful; (3) there is a potential misalignment between the intended purposes of OTAs and their implementation. CONCLUSION This study reveals a complicated relationship between OTAs and access to pain management. While OTAs seem not to impact the clinicians’ decisions about whether to use LTOT generally, they do sometimes influence prescribing decisions for individual patients. Clinicians shared complex views about OTAs’ purposes, which shows the need for more clarity about how OTAs could be used to promote shared decision-making, joint accountability, informed consent, and patient education. (shrink)

Sarah McGrath has recently defended a disagreement-based argument for skepticism about moral knowledge. If sound, the argument shows that our beliefs about controversial moral issues do not amount to knowledge. In this paper, I argue that McGrath fails to establish her skeptical conclusion. I defend two main claims. First, the key premise of McGrath’s argument is inadequately supported. Second, there is good reason to think that this premise is false.