SummaryThe dichotomy between ‘scientific’ and ‘practical’ approaches to guideline development is false and divisive. Instead we should concentrate on developing mechanisms to develop and implement valid guidelines to improve patient care. The development of valid guidelines requires considerable expertise and is time consuming and expensive. It is most efficiently done at a regional or national level. The implementation of valid guidelines requires local action including the identification and modification of valid guidelines and a coordinated evidence-based implementation strategy (Grimshaw & Eccles (...) 1998). (shrink)

A Charter on Medical Professionalism (CMA) has just recently been developed internationally, and the Canadian Medical Association is calling for public dialogue on medical professionalism now that reforms in the Canadian system of health care are imminent. We posit that good practices are at issue; we outline the essence of these in general and also specifically in the knowing, teaching and intervening components of practice. We also see challenges not to, but in, medical professionalism – first and foremost in the (...) profession's definition of good practices and the payer's confinement of insurance coverage to these. (shrink)

The concept of luck has played an important role in debates concerning free will and moral responsibility, yet participants in these debates have relied upon an intuitive notion of what luck is. Neil Levy develops an account of luck, which is then applied to the free will debate. He argues that the standard luck objection succeeds against common accounts of libertarian free will, but that it is possible to amend libertarian accounts so that they are no more vulnerable to (...) luck than is compatibilism. But compatibilist accounts of luck are themselves vulnerable to a powerful luck objection: historical compatibilisms cannot satisfactorily explain how agents can take responsibility for their constitutive luck; non-historical compatibilisms run into insurmountable difficulties with the epistemic condition on control over action. Levy argues that because epistemic conditions on control are so demanding that they are rarely satisfied, agents are not blameworthy for performing actions that they take to be best in a given situation. It follows that if there are any actions for which agents are responsible, they are akratic actions; but even these are unacceptably subject to luck. Levy goes on to discuss recent non-historical compatibilisms, and argues that they do not offer a viable alternative to control-based compatibilisms. He suggests that luck undermines our freedom and moral responsibility no matter whether determinism is true or not. (shrink)

‘Of course laniabor is not a name.’ Thus very recently Cristiano Castelletti in a discussion of this notorious acrostic, which he associates with Aratean ἄρρητον and Virgilian MA VE PV. If, however, laniabor is itself ‘not a name’, the aim of the present annotatiuncula is to argue that it is an etymological play on a ‘name’. Laniabor spans the description of Amycus’ cave, which is adorned with the dismembered limbs of his victims: Amycus himself will shortly suffer the same fate (...) at Pollux’ hands. The name ‘Amycus’ was etymologized from ἀμύσσω, which exactly matches lanio. Hence by a cutely etymological jeu onomastique ‘Tearer’ says ‘I'll be torn’. (shrink)

Neuroscience has dramatically increased understanding of how mental states and processes are realized by the brain, thus opening doors for treating the multitude of ways in which minds become dysfunctional. This book explores questions such as when is it permissible to alter a person's memories, influence personality traits or read minds? What can neuroscience tell us about free will, self-control, self-deception and the foundations of morality? The view of neuroethics offered here argues that many of our new powers to read (...) ,alter and control minds are not entirely unparalleled with older ones. They have, however, expanded to include almost all our social, political and ethical decisions. Written primarily for graduate students, this book will appeal to anyone with an interest in the more philosophical and ethical aspects of the neurosciences. (shrink)

Philosophical tradition and conspiracy theorists converge in suggesting that ordinary people ought to do their own research, rather than accept the word of others. In this paper, I argue that it’s no accident that conspiracy theorists value lay research on expert topics: such research is likely to undermine knowledge, via its effects on truth and justification. Accepting expert testimony is a far more reliable route to truth. Nevertheless, lay research has a range of benefits; in particular, it is likely to (...) lead to greater understanding, even when it does not lead to knowledge. I argue that we can reap most of the genuine benefits of lay research while minimizing the risks by engaging in exploratory, rather than truth-directed, inquiry. To engage in exploratory inquiry is to engage dogmatically, expecting to be unable to confirm the expert view or to disconfirm rivals. (shrink)

Implicit attitudes are mental states that appear sometimes to cause agents to act in ways that conflict with their considered beliefs. Implicit attitudes are usually held to be mere associations between representations. Recently, however, some philosophers have suggested that they are, or are very like, ordinary beliefs: they are apt to feature in properly inferential processing. This claim is important, in part because there is good reason to think that the vocabulary in which we make moral assessments of ourselves and (...) of others is keyed to folk psychological concepts, like ‘belief’, and not to concepts that feature only in scientific psychology: if implicit attitudes are beliefs there is a prima facie case for thinking that they can serve as the basis for particular kinds of moral assessment. In this paper I argue that while implicit attitudes have propositional structure, their sensitivity and responsiveness to other mental representations is too patchy and fragmented for them to properly be considered beliefs. Instead, they are a sui generis kind of mental state, a state I dub patchy endorsements. (shrink)

There is a robust scientific consensus concerning climate change and evolution. But many people reject these expert views, in favour of beliefs that are strongly at variance with the evidence. It is tempting to try to explain these beliefs by reference to ignorance or irrationality, but those who reject the expert view seem often to be no worse informed or any less rational than the majority of those who accept it. It is also tempting to try to explain these beliefs (...) by reference to epistemic overconfidence. However, this kind of overconfidence is apparently ubiquitous, so by itself it cannot explain the difference between those who accept and those who reject expert views. Instead, I will suggest that the difference is in important part explained by differential patterns of epistemic deference, and these patterns, in turn, are explained by the cues that we use to filter testimony. We rely on cues of benevolence and competence to distinguish reliable from unreliable testifiers, but when debates become deeply politicized, asserting a claim may itself constitute signalling lack of reliability. (shrink)

Archetypal psychology suggests the possibility of a leadership archetype representing the unconscious preferences of human beings as a species about the appropriate relationships between leaders and followers. Mythological analysis compared God’s leadership in the Abraham myth with modern visionary, ethical and situational leadership to find similarities reflecting continuities in human thinking about leadership over as long as 3600 years. God’s leadership behavior is very modern except that God is generally more relationship oriented. The leadership archetype that emerges is of a (...) leader that develops his/her follower by reliably maintaining a vision, behaving according to firm ethical values even when it weakens the leader’s authority, accepting suffering when the follower is unreliable, and always forgiving even when the follower behaves with hubris in an attempt to overthrow the leader. If God’s leadership principles were mandatory in management, many dysfunctional leaders would be disqualified and many of the negative consequences of poor leadership might be averted. (shrink)

In the letter which initiated his correspondence with Paulinus of Nola Jerome deplores the propensity of the inexpert to pontificate on scripture. Three kinds of incompetence are denounced. The second takes the following form: ‘alii discunt – pro pudor!–a feminis, quod viros doceant’. As in the other two denunciations, Jerome has chosen to express himself in general terms; scholars have nonetheless assumed that here a specific individual is meant. Nautin argued that with these words Jerome was attacking Rufinus, who is (...) here represented as being intellectually dependent on his patroness Melania. More recently Testard has maintained that Jerome's criticism is in fact directed against Ambrose. However Nautin's view that Rufinus is the target has now been re-affirmed by Rebenich. The purpose of the present note is to draw attention to a piece of evidence which has hitherto been overlooked; it would seem to indicate that the object of Jerome's attack cannot be Rufinus. (shrink)

Ethical debates over the use of mental health knowledge and practice at the Guantánamo Bay detention facility have mostly revolved around military clinicians sharing detainee medical information with interrogators, falsifying death certificates in interrogations, and disagreements over whether the Central Intelligence Agency’s “enhanced interrogation techniques” violated bioethical principles to do no harm. However, debates over the use of magnetic resonance imaging in the mental health evaluations of detainees have received little attention. This paper provides the first known analysis of such (...) debates over MRI use in the case of Abd al-Rahim al- Nashiri. Through a close reading of open-source legal documents such as defense motions, prosecution motions, judge rulings, and al-Nashiri’s mental health evaluation, debates over MRI use become interpretive contests over the very meanings of mental illness and the extent to which MRI results can verify whether he was tortured in CIA custody. Such work can revitalize interest in the neuroethics of national security. (shrink)

Scholars have mostly analyzed information from mental health practitioners, attorneys, and institutions to critique mental health practices in the War on Terror. These sources offer limited insights into the suffering of detainees. Detainee accounts provide novel information based on their experiences at Guantánamo. Mohamedou Ould Slahi’s Guantánamo Diary is the only text from a current detainee that provides a first-person account of his interrogations and interactions with health professionals. Despite being advertised as a diary, however, it has undergone redaction from (...) American government officials. This article examines Slahi’s account of his interrogations and representations of mental health at Guantánamo and considers its role within the narrative function of the nation. At stake is the right of detainees to narrate, scholars to critique medical practices in the War on Terror, and the nation’s attempts to control its narration. (shrink)

Where was your soul before you were born? If your soul is immortal, did it have a "life" prior to birth? Did you choose your life and parents? Is reincarnation real? Elizabeth and Neil Carman, the authors of Cosmic Cradle, address these questions through interviews with adults and children who report pre-birth experiences (PBEs) not based on regression, hypnosis, or drugs. Instead, interviewees recall their pre-birth existence completely sober and awake. In contrast to near-death experiences (NDEs), which have been (...) well documented to show us what the soul experiences after death, PBEs throw light upon our lives before birth. People with NDEs sense that they "return home" when their spirits cross to the other side. What is the nature of this place we "return" to? PBEs suggest that we come from the same place we return to: we come from the Light and return to the Light. The same eternal "you" progresses through life before life, human life, and life after death. This new edition of Cosmic Cradle explores your soul's journey into your mother's womb--where your soul comes from, the origin and purpose of your life, and the process by which you entered an earthly body. In pre-birth communications, parents meet a soul seeking to cross over from the heavenly realm to human birth. Persons with pre-birth memories recall existence in a luminous world before birth, in which they preview the upcoming life with a Divine Planner, and recall how they journeyed to their mothers' wombs. Contents Foreword by Bernie Siegel, MD Introduction: Amnesia of Our Spiritual Origins Part One: Pre-Birth Memory 1. Children as Messengers 2. Memories of the Cosmic Cradle 3. “I Was in Your Tummy Twice” 4. Scanning Soul Plans: Contemporary Pre-Birth Memories 5. Welcome to Planet Earth 6. Shirley Temple and the Blue Bird 7. Our Soul as a Tiny Spaceship 8. I Saw All My Costumes Part Two: Pre-Birth Communications 9. Souls Waiting in the Wings for Birth 10. Soul as a Sphere of Light 11. Cosmic Conception 12. Miscarriages and Stillbirths in the Light of Pre-Birth Plans 13. Conversations with Unborn Children Part Three: Pre-Birth Wisdom down through History 14. Spirit-Children Down Under 15. Lodge of the Great Manitou 16. The Cosmic Designer 17. Travelers from the Light 18. Journey from Forgetting to Remembering. (shrink)

Rich with historical and cultural value, these works are published unaltered from the original University of Minnesota Press editions.

Public support for responses to the coronavirus pandemic has sharply diverged on partisan lines in many countries, with conservatives tending to oppose lockdowns, social distancing, mask mandates and vaccines, and liberals far more supportive. This polarization may arise from the way in which the attitudes of each side is echoed back to them, especially on social media. In this paper, I argue that echo chambers are not to blame for this polarization, even if they are causally responsible for it. They (...) are not to blame, because belief calibration in an echo chamber is a rational process; moreover, the epistemically constitutive properties of echo chambers are not optional for epistemically social animals like us. There is no special problem of echo chambers; rather, there is a problem of misleading evidence (especially higher-order evidence). Accordingly, we ought to respond to misinformation about COVID neither by attempting to dismantle echo chambers nor by attempting to make people more rational, but rather by attempting to supplant unreliable higher-order evidence with better evidence. (shrink)

The accusation of virtue signalling is typically understood as a serious charge. Those accused usually respond by attempting to show that they are doing no such thing. In this paper, I argue that we ought to embrace the charge, rather than angrily reject it. I argue that this response can draw support from cognitive science, on the one hand, and from social epistemology on the other. I claim that we may appropriately concede that what we are doing is virtue signalling, (...) because virtue signalling is morally appropriate. It neither expresses vices, nor is hypocritical, nor does it degrade the quality of public moral discourse. Signalling our commitment to norms is a central and justifiable function of moral discourse, and the same signals provide evidence that is appropriately taken into account in forming moral beliefs. (shrink)

The question of the psychopath's responsibility for his or her wrongdoing has received considerable attention. Much of this attention has been directed toward whether psychopaths are a counterexample to motivational internalism (MI): Do they possess normal moral beliefs, which fail to motivate them? In this paper, I argue that this is a question that remains conceptually and empirically intractable, and that we ought to settle the psychopath's responsibility in some other way. I argue that recent empirical work on the moral (...) judgments of psychopaths provides us with good reason to think that they are not fully responsible agents, because their actions cannot express the kinds of ill-will toward others that grounds attributions of distinctively moral responsibility. I defend this view against objections, especially those due to an influential account of moral responsibility that holds that moral knowledge is not necessary for responsibility. (shrink)

There is good evidence that many people harbour attitudes that conflict with those they endorse. In the language of social psychology, they seem to have implicit attitudes that conflict with their explicit beliefs. There has been a great deal of attention paid to the question whether agents like this are responsible for actions caused by their implicit attitudes, but much less to the question whether they can rightly be described as racist in virtue of harbouring them. In this paper, I (...) attempt to answer this question using three different standards, providing by the three dominant kinds of accounts of racism. I argue that on none of these accounts should agents like this be described as racists. However, it would be misleading to say, without qualification, that they are not racists. On none of these accounts are agents like this entirely off the hook. (shrink)

Anti-realism is a doctrine about logic, language, and meaning that is based on the work of Wittgenstein and Frege. In this book, Professor Tennant clarifies and develops Dummett's arguments for anti-realism and ultimately advocates a radical reform of our logical practices.

Much of what we know we know through testimony, and knowing on the basis of testimony requires some degree of trust in speakers. Trust is therefore very valuable. But in trusting, we expose ourselves to risks of harm and betrayal. It is therefore important to trust well. In this paper, I discuss two recent cases of the betrayal of trust in (broadly) academic contexts: one involving hoax submissions to journals, the other faking an identity on social media. I consider whether (...) these betrayals suggest that we ought to be less trusting in contexts like these. I argue that we should not: the acquisition of knowledge is dependent on trust, and we cannot intentionally reduce the extent to which we trust in these kinds of contexts without risking destroying it utterly. Instead, we must trust in our epistemic networks and the way they work to filter out deception. (shrink)

Some philosophers have criticized the use of psychopharmaceuticals on the grounds that even if these drugs enhance the person using them, they threaten their authenticity. Others have replied by pointing out that the conception of authenticity upon which this argument rests is contestable; on a rival conception, psychopharmaceuticals might be used to enhance our authenticity. Since, however, it is difficult to decide between these competing conceptions of authenticity, the debate seems to end in a stalemate. I suggest that we need (...) not resolve this debate to end the stalemate. New technologies which alter the self can be understood within the framework of the first conception of authenticity, I suggest, not as threatening the authentic self, but rather as bringing the outward appearance of the self into line with its deepest essence. Since psychopharmaceutical use can plausibly be understood on this model, it can be seen as enhancing our authenticity on either conception. (shrink)

Discussions of virtue signaling to date have focused exclusively on the signaling of the moral virtues. This article focuses on intellectual virtue signaling: the status-seeking advertising of supposed intellectual virtues. Intellectual virtue signaling takes distinctive forms. It is also far more likely to be harmful than moral virtue signaling, because it distracts attention from genuine expertise and gives contrarian opinions an undue prominence in public debate. The article provides a heuristic by which to identify possible instances of intellectual virtue signaling. (...) When people with no relevant expertise rapidly move to offer their opinions on a wide range of topics as soon as these topics become fashionable or newsworthy, and especially when these opinions are contrarian, we should suspect them of intellectual virtue signaling. (shrink)

Consciousness, or its lack, is often invoked in debates in applied and normative ethics. Conscious beings are typically held to be significantly more morally valuable than non-consious, so that establishing whether a being is conscious becomes of critical importance. In this paper, I argue that the supposition that phenomenal consciousness explains the value of our experiences or our lives, and the moral value of beings who are conscious, is less well-grounded than is commonly thought. A great deal of what matters (...) to us and about us can be explained by functional and representational properties that may not be sufficient for phenomenal consciousness. I conclude with some reflections on how these claims might affect debates in ethics. (shrink)

I develop an account of weakness of the will that is driven by experimental evidence from cognitive and social psychology. I will argue that this account demonstrates that there is no such thing as weakness of the will: no psychological kind corresponds to it. Instead, weakness of the will ought to be understood as depletion of System II resources. Neither the explanatory purposes of psychology nor our practical purposes as agents are well-served by retaining the concept. I therefore suggest that (...) we ought to jettison it, in favour of the vocabulary and concepts of cognitive psychology. (shrink)

Abstract The typical explanation of an event or process which attracts the label ‘conspiracy theory’ is an explanation that conflicts with the account advanced by the relevant epistemic authorities. I argue that both for the layperson and for the intellectual, it is almost never rational to accept such a conspiracy theory. Knowledge is not merely shallowly social, in the manner recognized by social epistemology, it is also constitutively social: many kinds of knowledge only become accessible thanks to the agent's embedding (...) in an environment that includes other epistemic agents. Moreover, advances in knowledge typically require ongoing immersion in this social environment. But the intellectual who embraces a conspiracy theory risks cutting herself off from this environment, and therefore epistemically disabling herself. Embracing a conspiracy theory therefore places at risk the ability to engage in genuine enquiry, including the enquiry needed properly to evaluate the conspiracy theory. (shrink)

In this article we survey six recent developments in the philosophical literature on free will and moral responsibility: (1) Harry Frankfurt's argument that moral responsibility does not require the freedom to do otherwise; (2) the heightened focus upon the source of free actions; (3) the debate over whether moral responsibility is an essentially historical concept; (4) recent compatibilist attempts to resurrect the thesis that moral responsibility requires the freedom to do otherwise; (5) the role of the control condition in free (...) will and moral responsibility, and finally (6) the debate centering on luck. (shrink)

The extended mind thesis is the claim that mental states extend beyond the skulls of the agents whose states they are. This seemingly obscure and bizarre claim has far-reaching implications for neuroethics, I argue. In the first half of this article, I sketch the extended mind thesis and defend it against criticisms. In the second half, I turn to its neuroethical implications. I argue that the extended mind thesis entails the falsity of the claim that interventions into the brain are (...) especially problematic just because they are internal interventions, but that many objections to such interventions rely, at least in part, on this claim. Further, I argue that the thesis alters the focus of neuroethics, away from the question of whether we ought to allow interventions into the mind, and toward the question of which interventions we ought to allow and under what conditions. The extended mind thesis dramatically expands the scope of neuroethics: because interventions into the environment of agents can count as interventions into their minds, decisions concerning such interventions become questions for neuroethics. (shrink)

Recent work in neuroimaging suggests that some patients diagnosed as being in the persistent vegetative state are actually conscious. In this paper, we critically examine this new evidence. We argue that though it remains open to alternative interpretations, it strongly suggests the presence of consciousness in some patients. However, we argue that its ethical significance is less than many people seem to think. There are several different kinds of consciousness, and though all kinds of consciousness have some ethical significance, different (...) kinds underwrite different kinds of moral value. Demonstrating that patients have phenomenal consciousness — conscious states with some kind of qualitative feel to them — shows that they are moral patients, whose welfare must be taken into consideration. But only if they are subjects of a sophisticated kind of access consciousness — where access consciousness entails global availability of information to cognitive systems — are they persons, in the technical sense of the word employed by philosophers. In this sense, being a person is having the full moral status of ordinary human beings. We call for further research which might settle whether patients who manifest signs of consciousness possess the sophisticated kind of access consciousness required for personhood. (shrink)

There's heated debate around whether people who did terrible things in the past, at a time when there was widespread acceptance of such actions, are appropriately blamed by us, on the grounds they weren't really morally ignorant, or their ignorance was itself culpable. I point to puzzles that arise if we blame them. We need to explain how they could act so badly if they weren't fully ignorant. I argue that plausible answers to that question entail that they're not blameworthy, (...) or that we lack standing to blame them. (shrink)

An influential model holds that obsessive–compulsive disorder is caused by distinctive personality traits and belief biases. But a substantial number of sufferers do not manifest these traits. I propose a predictive coding account of the disorder, which explains both the symptoms and the cognitive traits. On this account, OCD centrally involves heightened and dysfunctionally focused attention to normally unattended sensory and motor representations. As these representations have contents that predict catastrophic outcomes, patients are disposed to engage in behaviors and mental (...) rituals designed to forestall these outcomes or to produce more precise information. The same representations also cause the cognitive traits characteristic of sufferers. (shrink)

So-called downshifters seek more meaningful lives by decreasing the amount of time they devote to work, leaving more time for the valuable goods of friendship, family and personal development. But though these are indeed meaning-conferring activities, they do not have the right structure to count as superlatively meaningful. Only in work – of a certain kind – can superlative meaning be found. It is by active engagements in projects, which are activities of the right structure, dedicated to the achievement of (...) goods beyond ourselves, that we make our lives superlatively meaningful. (shrink)

The recent debate over the moral responsibility of psychopaths has centered on whether, or in what sense, they understand moral requirements. In this paper, I argue that even if they do understand what morality requires, the content of their actions is not of the right kind to justify full-blown blame. I advance two independent justifications of this claim. First, I argue that if the psychopath comes to know what morality requires via a route that does not involve a proper appreciation (...) of what it means to cause another harm or distress, the content of violations of rules against harm will be of a lower grade than the content of similar actions by normal individuals. Second, I argue that in order to intend a harm to a person?that is, to intend the distinctive kind of harm that can only befall a person?it is necessary to understand what personhood is and what makes it valuable. The psychopath's deficits with regard to mental time travel ensure that s/he cannot intend this kind of harm. (shrink)

Doxastic responsibility matters, morally and epistemologically. Morally, because many of our intuitive ascriptions of blame seem to track back to agents’ apparent responsibility for beliefs; epistemologically because some philosophers identify epistemic justification with deontological permissibility. But there is a powerful argument which seems to show that we are rarely or never responsible for our beliefs, because we cannot control them. I examine various possible responses to this argument, which aim to show either that doxastic responsibility does not require that we (...) control our beliefs, or that as a matter of fact we do exercise the right kind of control over our beliefs. I argue that the existing arguments are all wanting: in fact, our lack of control over our beliefs typically excuses us of responsibility for them. (shrink)

Neil Van Leeuwen argues that many religious people do not act and infer as we would expect believers to act and infer, and on this basis argues that they are not genuine believers. They take some other, nondoxastic, attitude to the claims they profess to believe. In this short commentary, I argue that in many (but far from all) such cases, the content, and not the attitude, explains the departures from the inferential and behavioral stereotype we associate with belief.

The widespread conviction that we are living in a post-truth era rests on two claims: that a large number of people believe things that are clearly false, and that their believing these things reflects a lack of respect for truth. In reality, however, fewer people believe clearly false things than surveys or social media suggest. In particular, relatively few people believe things that are widely held to be bizarre. Moreover, accepting false beliefs does not reflect a lack of respect for (...) truth. Almost everyone’s beliefs are explained by rationally warranted trust in some sources rather than others. This allows us to explain why people have false beliefs. (shrink)

Actions performed in a state of automatism are not subject to moral evaluation, while automatic actions often are. Is the asymmetry between automatistic and automatic agency justified? In order to answer this question we need a model or moral accountability that does justice to our intuitions about a range of modes of agency, both pathological and non-pathological. Our aim in this paper is to lay the foundations for such an account.