Disorders of consciousness and the permanent vegetative state -- Legal and political wrangling over Terri's life -- In context--law and ethics -- Terri's wishes -- The limits of evidence -- The implications of surrogacy -- Qualities of life -- Feeding -- The preservation of life -- Respect and care : an alternative framework.

Embedded pragmatic clinical trials (PCTs), like other types of randomized comparative-effectiveness research (CER) studies, are sometimes conducted without informed consent. Indeed, authors of both...

This paper evaluates four recent randomized clinical trials in which the informed consent of participants was either not sought at all, or else was conducted with critical information missing from the consent documents. As these studies have been taking place, various proposals to conduct randomized clinical trials without consent have been appearing in the medical literature. Some of the explanations offered for why it is appropriate to bypass consent or disclosure requirements appear to represent a fundamental misunderstanding of applicable government (...) regulations and even the research enterprise. Others are the result of conceptual disagreements about the importance and application of traditional research ethics norms to ‘comparative effectiveness research’ and modern research environments. Common among these explanations, however, is a failure to appreciate when a research intervention, rather than merely an observation or review of data, is taking place. Review committees and investigators are failing to see, or choosing to ignore, interventions in the lives of research subjects. When these studies have come to light, government agencies with oversight authority have done little or backed down. Prestigious medical journals have published research results knowing that the required consent was not obtained, or they have stood by the published studies even after the inadequacy of consent is discovered. This article critically examines this erosion of consent in theory and practice and calls for restoring the requirement of informed consent to its proper place as a priority in human subjects research. (shrink)

Many current abortion regulations represent an over-medicalization of abortion or a corruption of abortion's true medical nature, with disproportionate consequences to women with lower incomes and lesser means. This article explores the effects of unnecessary and harmful abortion restrictions on women living in poverty. A brief summary of the major abortion rights cases explains how the Constitution, as currently interpreted, vests the government and sometimes the medical profession with the power to protect women's health, rather than granting this power to (...) women themselves. The article then argues for a new approach for protecting women's health and respecting their dignity by reframing reproductive rights as health rights that women themselves can assert. (shrink)

The physician-researcher conflict of interest has thus far eluded satisfactory solution. Most attempts to deal with it focus on improving informed consent. But those attempts are not successful and may even make things worse. Research subjects are already voluntarily undertaking the risks of research — we should not ask them to go it alone — to undergo medical “treatment” without medical “care.” The only effective solution is that in much clinical research, each research subject should have a doctor independent from (...) the research study. (shrink)

The physician-researcher conflict of interest, a long-standing and widely recognized ethical challenge of clinical research, has thus far eluded satisfactory solution. The conflict is fairly straightforward. Medical research and medical therapy are distinct pursuits; the former is aimed at producing generalizable knowledge for the benefit of future patients, whereas the latter is aimed at addressing the individualized medical needs of a particular patient. When the physician-researcher combines these pursuits, he or she serves two masters and cannot — no matter how (...) well-intentioned — avoid the risk of compromising the duties owed in one of the professional roles assumed. Because of the necessary rigidity of a research protocol, the more demanding of the two masters is frequently the research.The problem of the physician-researcher conflict has been evident since the first attempts to regulate human research in the United States. Otto E. Guttentag, a physician at the University of California School of Medicine in San Francisco, addressed the conflict in a 1953Sciencemagazine article. (shrink)

Policies promoted and adopted for allocating ventilators during the COVID-19 pandemic have often prioritised healthcare workers or other essential workers. While the need for such policies has so far been largely averted, renewed stress on health systems from continuing surges, as well as the experience of allocating another scarce resource—vaccination—counsel revisiting the justifications for such prioritisation. Prioritising healthcare workers may have intuitive appeal, but the ethical justifications for doing so and the potential harms that could follow require careful analysis. Ethical (...) justifications commonly offered for healthcare worker prioritisation for ventilators rest on two social value criteria: instrumental value, also known as the ‘multiplier effect’, which may preserve the ability of healthcare workers to help others, and reciprocity, which rewards past usefulness or sacrifice. We argue that these justifications are insufficient to over-ride the common moral commitment to value each person’s life equally. Institutional policies prioritising healthcare workers over other patients also violate other ethical norms of the healthcare professions, including the commitment to put patients first. Furthermore, policy decisions to prioritise healthcare workers for ventilators could engender or deepen existing distrust of the clinicians, hospitals and health systems where those policies exist, even if they are never invoked. (shrink)

The medical profession has a tradition of presenting itself as exceptionally altruistic. This article challenges the idea that physicians are, or should be, more altruistic than other professionals or other people, and goes so far as to posit that even a professional aspiration of altruism can have negative consequences.

The AHP Code of Ethics requires members to serve the best interests of their clients, be clear and honest with them, and keep their secrets confidential. Members pledge to represent their skills and qualifications honestly and to make appropriate referrals to others more qualified when out of their depth.AHP stands for “Associated Hair Professionals,” or hair stylists, but their Code of Ethics looks a lot like the Hippocratic Oath and the current Principles of Medical Ethics of the American Medical Association. (...) All of these ethics statements emphasize honesty, confidentiality, competence, serving patients’ best interests, and willingness to refer to other qualified professionals. But it’s not just doctors and hair professionals who have Codes of Ethics. The SPCP — Society of Permanent Cosmetic Professionals —requires its members to “maintain high professional standards consistent with sound practices,” “conduct business relationships in a manner that is fair to all,” and avoid false or misleading statements to the effect that the application of permanent makeup is not tattooing, not permanent, and not painful. (shrink)

This paper explains why informed consent for randomized comparative effectiveness research must include risks of standard care. Disclosures of such risks are both legally and ethically required and, for reasons discussed in the paper, should remain so.

Lantos and Feudtner argue that SUPPORT was an instance of CER and that CER differs from research involving unproven, experimental therapies because it exposes research subjects to the same risks patients regularly face in clinical practice. Like many defenders of SUPPORT, they formally acknowledge the study as research but want it to be thought of as clinical care. They develop an appealing argument, but it is misleading. Whatever doctors might have done in clinical practice, their choice of target range within (...) the study and for study participants was influenced by research aims. Just as in research involving unproven, experimental therapies, the care of patients in SUPPORT was altered for the goal of obtaining knowledge to help future patients. (shrink)

The Office for Human Research Protections was correct in determining that the consent forms for the National Institutes of Health -sponsored SUPPORT study were seriously flawed. Several articles defended the consent forms and criticized the OHRP's actions. Disagreement focuses on three central issues: how risks and benefits should be described in informed consent documents; the meaning and application of the concept of “standard of care” in the context of research; and the proper role of OHRP. Examination of the consent forms (...) reveals that they failed to disclose the reasonably foreseeable risks of the experimental interventions in the study, as well as the potential for differences in the degree of risk between these interventions. Although the concept of “standard of care” may be helpful in determining the ethical acceptability of other aspects of research, such as clinical equipoise, it is not helpful in discussing consent requirements. (shrink)

A recent legal case involving an ambiguous diagnosis in a woman with a severe disorder of consciousness raises pressing questions about treatment withdrawal in a time when much of what experts know about disorders of consciousness is undergoing revision and refinement. How much should diagnostic certainty about consciousness matter? For the judge who refused to allow withdrawal of artificial nutrition and hydration, it was dispositive. Rather than relying on substituted judgment or best interests to determine treatment decisions, he ruled that (...) withdrawal was categorically prohibited, even as he concluded that Hannah Capes was more likely than not in a permanent vegetative state. In many jurisdictions, his decision would likely be consistent with existing law. Evolving technological advances have demonstrated that biologically distinct diagnoses incorporated into state laws may be difficult to establish even under ideal conditions. We offer the Capes case for purposes of examining the consequences of enshrined legal distinctions between permanent vegetative state and other severe disorders of consciousness. Insistence on proof of the permanent absence of consciousness before treatment withdrawal is allowed fails to respect the rights of persons with disorders of consciousness. Even the well-established rights to treatment withdrawal for those in a permanent vegetative state may be in jeopardy if reform is not undertaken. (shrink)

The question, what makes a clinician a healer? may evoke the image of a devoted physician paying a critically important home visit at the end of a long day or the image of an astute nurse—steadfast, empathic, anticipating the patient's needs before they become apparent to others. But health care is no longer provided by lone doctors or nurses. In the modern health care system, multiple professionals must work together to provide safe and effective care. The moral nature of healing (...) has not changed. But what is required of clinicians to facilitate healing has. To be a healer today, a clinician must be a good team player. Medical students have opened our eyes to this new reality. Building on their observations, we articulate a view that, over and above the role of teamwork in providing technically appropriate care and preventing errors, health care requires teamwork to promote healing. Being a good team player is now a moral imperative because it makes an essential contribution to healing. (shrink)

Virginia Woolf, in A Room of One’s Own, asked why there were no women writers before 1800. If she had been thinking about philosophers instead of writers in the traditional women’s areas of plays and fiction, she might have asked why there were no women philosophers at all, for I suspect that most people would find it very hard to name a woman philosopher before the present day. To help her in answering her question, she invented a fictional character, Judith (...) Shakespeare, a sister to William Shakespeare. The conditions of Judith’s life made it impossible for her to write, and so Woolf speculated that the women who would have been writers did not lead the kinds of lives that permitted them to realize their talents. Woolf’s image of Judith Shakespeare is a very powerful one but her speculation is only half right. There undoubtedly were many women in the past who would have been talented writers or philosophers if their lives had been different, but Judith Shakespeare’s image can also blot out our knowledge of women who, contrary to Woolf’s speculation, did exist and did write. Indeed, we know now there were even women who wrote philosophy. These women were in many ways exceptional, for Woolf is quite right that most women did not live either with enough privacy or with enough income to allow them to write. Often, they were members of the aristocracy, whose position enabled them to behave eccentrically, sometimes to be able to demand privacy, and sometimes to be able to invite contacts with leading intellectuals. Quite often, these women were childless, which in an age before birth control made them exceptions to the general rule, and at a time when many women were bearing their last child in their forties, was the only thing that could have given them private time. Nevertheless, research in the last ten or fifteen years has uncovered the work of quite a number of these women: for example, Princess Elizabeth of Bohemia, the Electress Sophie, Queen Christina of Sweden, Queen Sophie Charlotte of Prussia, Anne, Lady Conway, Mary Astell, Damaris, Lady Masham, Catharine Trotter Cockburn, Emilie du Chatelet, Catherine Macaulay, Lady Mary Shepherd, and many more. Woolf’s question then comes up again in a slightly different form. Why is it that the work of these women was for so long unknown? Why do so many people even today remain ignorant of the existence of women philosophers before the present day? I am not going to answer this question directly; in fact, I suspect it has multiple answers. Instead, I am going to present a case study from amongst all the cases of all of these women. I hope by considering the history of this woman, and, in particular, considering the way in which she was read, it will be possible to gain some insights into the ways in which women have failed to be incorporated into philosophical history. The woman I am going to discuss is Lady Mary Shepherd. Mary Shepherd actually falls outside of Woolf’s target date of 1800, since she flourished in the first half of the nineteenth century, but this merely reflects my point about the greater ignorance that prevails about women in philosophy. (shrink)

Lois Shepherd's book If That Ever Happens to Me: Making Life and Death Decisions after Terri Schiavo demonstrates a great appreciation for the unresolved conflicts over end-of-life care revealed by the Schiavo case. Through detailed analysis, this book debunks the claim that the controversy defied an established consensus concerning the appropriateness of withdrawing medically administered nutrition and hydration. Arguments that settled legal standards provided a stalwart framework for that consensus failed to appreciate the variations and limitations of those (...) norms. Shepherd challenges the notion that we professionals—doctors, lawyers, judges, and bioethicists—had authoritatively resolved the moral and social .. (shrink)

A commentary on “Were There ‘Additional Foreseeable Risks’ in the SUPPORT Study?,” by Henry J. Silverman and Didier Dreyfuss; “SUPPORT: Risks, Harms, and Equipoise,” by Robert M. Nelson; “The Controversy over SUPPORT Continues and the Hyperbole Increases,” by Alan R. Fleischman; and “SUPPORT and Comparative Effectiveness Trials: What's at Stake?,” by Lois Shepherd, all in the January‐February 2015 issue.

: The shepherd embodies a strange and disturbing society. Isolated, marginal, it forms a world apart and evolves in a wild space where mountains, valleys, meadows or forests make up the framework of its activity. In this non-domesticated nature the human presence is suspect. This confusing being is very often represented with an animalized, almost monstrous or deformed body which becomes a metaphor for social order. This grotesque body translates the prejudices of urbanites and elites. It fuels sexual fantasies (...) and symbolizes the disturbances of the natural and social order: freed from the laws of the city, it can try to seduce the young ladies and be insolent in front of the knights. It is a threat to the established order. But the shepherd also carries virtues. It is a model of Christian life: humility and holiness. It belongs to an original humanity, the form closest to divine creation. Two styles of representation of the shepherd therefore oppose the extremes. From texts from the end of the Middle Ages, we will see how the shepherd is an imaginary in opposition to an organized society but that his image has evolved positively until becoming the guardian of traditions and a being who lives in harmony with nature. Key words: stereotypes, shepherd, savagery, holiness, littérature, Middle Ages. Résumé: Le berger incarne une société étrange et inquiétante. Isolé, marginal, il forme un monde à part et évolue dans un espace sauvage où les montagnes, vallées, prés ou forêts composent le cadre de son activité. Dans cette nature non domestiquée la présence humaine est suspecte. Cet être déroutant est bien souvent représenté avec un corps animalisé, quasi monstrueux ou déformé qui devient une métaphore de l’ordre social. Ce corps grotesque traduit les préjugés des urbains et des élites. Il alimente les fantasmes sexuels et symbolise les dérèglements de l’ordre naturel et social : affranchi des lois de la cité, il peut tenter de séduire les demoiselles et se montrer insolent face aux chevaliers. C’est une menace contre l’ordre établi. Mais le berger est également porteur de vertus. C’est un modèle de vie chrétienne : humilité et sainteté. Il appartient à une humanité originelle, forme la plus proche de la création divine. Deux styles de représentation du berger opposent donc les extrêmes. A partir de textes de la fin du Moyen Age, nous verrons comment le berger est un imaginaire en opposition avec une société organisée mais que son image a évolué positivement jusqu’à devenir le gardien des traditions et un être qui vit en harmonie avec la nature. Mots clés : stéréotypes, berger, sauvagerie, sainteté, littérature, Moyen Age. Resumen. El pastor encarna una sociedad extraña y perturbadora. Aislado, marginal, forma un mundo aparte y evoluciona en un espacio salvaje donde montañas, valles, praderas o bosques conforman el marco de su actividad. En esta naturaleza no domesticada, la presencia humana es sospechosa. Este ser confuso a menudo se representa con un cuerpo animalizado, casi monstruoso o deformado que se convierte en una metáfora del orden social. Este cuerpo grotesco traduce los prejuicios de los urbanitas y las élites. Alimenta las fantasías sexuales y simboliza las perturbaciones del orden natural y social: liberado de las leyes de la ciudad, puede tratar de seducir a las jóvenes y ser insolente frente a los caballeros. Es una amenaza para el orden establecido. Pero el pastor también posee virtudes. Es un modelo de vida cristiana, de humildad y santidad. Pertenece a una humanidad original, la forma más cercana a la creación divina. Dos estilos de representación del pastor, por lo tanto, se oponen. A partir de los textos del final de la Edad Media, analizamos la imagen del pastor en oposición a toda sociedad organizada y la evolución positiva de su figura hasta convertirse en guardián de las tradiciones y en un ser que vive en armonía con la naturaleza. Palabras clave: estereotipos, pastor, salvajismo, santitad, literatura, Edad Media. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Michael L. MarkPatrice Madura Ward-SteinmanI met Michael Mark at the first Philosophy of Music Education conference held at Indiana University in the summer of 1990. I was a doctoral student at IU then and had studied the writings of many of the conference presenters and so the experience of hearing and meeting them in person was a heady one, indeed. I will never forget those impressions of Phil Alperson, (...) Wayne Bowman, Allen Britton, David Elliott, Peter Kivy, Gerard Knieter, Thomas Regelski, Bennett Reimer, John Shepherd, Ann Stokes, Eleanor Stubley, Keith Swanwick, and many others.I was interested in meeting Michael after hearing his response to the presentation of one of my favorite IU professors of musicology, Austin Caswell. Caswell’s provocative paper, “How We Got into Canonicity and What it has Done to Us: An American Music Historian’s View of Music in Academia,” claimed that “the effect of canonicity on American musical life is destructive,” while Michael’s response was characterized by his style of writing that I came to recognize over the decades as distinct, calm, logical, methodical, and based in an extraordinarily wide and deep wealth of historical knowledge. While I greatly admired my rebellious and passionate professor’s views and temperament which were not unlike my own, I also appreciated hearing Michael’s measured and thoughtful response. Thus began my friendship with Michael, who, I learned, was not only a professor [End Page 92] and dean at Towson State University but also an avid big band woodwind doubler who showed interest in my doctoral research in the art of vocal jazz improvisation. That friendship lasted for almost twenty-eight years and we enjoyed memorable reunions at other conferences. For example, there was the ISPME conference held at UCLA where he invited me to dinner with his good friend and connoisseur of fine wines, Bennett Reimer, and the ISPME conference in Helsinki where, after I tripped and severely broke my ankle, requiring surgery, Michael, Estelle Jorgensen, Iris Yob, and two then-doctoral students (Kasia Bugaj and Leonard Tan) visited me in the Helsinki hospital.When I began teaching at the University of Southern California in 1995, it was fortuitous that Michael’s brother, Brian, lived in the Los Angeles area. His frequent visits allowed him to make several guest lectures to my graduate research methods classes, very welcome opportunities. After one of those lectures, I relayed the history of my family’s ballroom in the Chicago area that was open for business with big band music from 1929 until 1967. He asked if I had any artifacts from Madura’s Danceland, and when I mentioned my father’s stacks of dusty record books, newsletters, photos, and posters in our basement, he became very enthusiastic and told me that I had a “gold mine” of an archive with which to write a book about the place! As a trained quantitative researcher, I began to explore the record books to analyze trends in band pay over the Depression and World War II years.1 Over the next ten years, with help from Michael’s regular prodding and encouragement, I organized the large archive into the history of Madura’s Danceland.2 I owe this personally important accomplishment to Michael Mark.Michael invited me (in his endearing way which I could not refuse) to coauthor a music education textbook with him3 and our writing partnership went so smoothly that he invited me to co-author the 4th edition of his Contemporary Music Education.4 Although our writing styles and areas of expertise were very different, I learned much from his narrative approach which included illustrative scenarios, interviews, and the informal use of contractions, a style of writing that was not second nature for me. We wrote both books without meeting in person, except to celebrate the publication of the first at the Metropolitan Art Museum café in New York with our beloved spouses, Lois Mark and David Ward-Steinman.Dr. Michael L. Mark will long be remembered for his many books, chapters, and articles on the history of music education and his many symposium presentations; for his university teaching and administrative achievements; and for his... (shrink)

This very long book sets out to track and trace the working-class men and, less commonly, women who, against the limited expectations of their social position, learned Greek and Latin as an aspiration for personal change. The ideology of the book is clear and welcome: these figures “offer us a new ancestral backstory for a discipline sorely in need of a democratic makeover.” The book's twenty-five chapters explore how classics and class were linked in the educational system of Britain and (...) in its cultural performativity: Is he a gentleman? Does he have Greek? became the paradigmatic questions, as the study of classics became a sign of cultural attainment and social exclusion. This book sets out to explore the counterstory of the cobblers and shepherds who, like Jude the Obscure, fought against society's oppressiveness to access classical learning.The book's breadth is exemplary. It looks at the issue through genres and media, through different communities and national identities, through the prosopography of ragged-trousered philanthropists, beggar-lecturers, body-building performers, and through other institutions and people who helped, including adult-education teachers, kind bosses, supportive vicars, and fiery communists. This breadth, and the fascinating research that it encapsulates, will make this book a fantastic resource for future scholarship: it outlines the richness of a field that has been all too rarely explored properly. If you do not know Stephen Duck, “the thresher poet,” or Hawkie, the crutch-wielding beggar who performed from the books he sold on the streets of Glasgow, then this book is the place to the meet them. The cast list alone is worth the entrance ticket.Yet this very breadth is also the source of the book's limitations. The sheer number of cases listed, treated at similar length and depth, repeatedly conceals the complexity and even the interest of individual figures or events. So, the numerous representations of Vesuvius in shows around London in the first half of the nineteenth century—after the discoveries at Pompeii—are duly noted as a source of excitement and knowledge about antiquity, but against the recent treatment by Clare Pettitt in Serial Forms (which came out the same year) this mere noting looks desperately thin. There is little discussion of how the characters themselves talked about or negotiated class. This deficiency is particularly important for someone like Charles Kingsley, who was very active in the Chartist movement but also became Queen Victoria's chaplain and the professor of history at Cambridge. There are hilarious descriptions of Kingsley's stammering engagement with the working-class leaders he actively supported, which capture how awkward the interaction of classes could be even and especially when the participants shared a goal of transformation. (Ed Richardson's Classical Victorians: Scholars, Scoundrels and Generals in the Pursuit of Antiquity is good on these moments of awkwardness but is one of several books whose absence from the notes looks pointed.) The authors list cases of working men who were picked up by fashionable society as poets or scholars, many of whom were dropped almost as quickly back into penury—but the telling description of such a case in Kingsley's Alton Locke is passed over, although it reveals an acute self-consciousness about such narratives in a best-selling novel.The very structure of the book tends toward listing cases rather than analyzing them in depth. It is not clear why “Shoemaker classicists” should take up a chapter, bar there having been some. Nor is it clear why some figures are not included. John Brown was an uneducated Scottish shepherd who taught himself Greek, Latin, and Hebrew. He was discovered by a professor, one John Pringle, when he went into a shop to buy a secondhand Greek Testament (though his own church thought this newfound and inexplicable linguistic brilliance suspicious or even satanic). Brown went on to write the wonderfully titled The Self-Interpreting Bible, which remained in print and sold very widely for more than a century after its publication in 1778—especially after it was championed by the evangelical preacher Charles Simeon. It is a pity that Brown escaped the authors’ net, but religion, one of the main reasons to learn the classical languages, is downplayed throughout this study, although its imbrication with classics is everywhere in evidence. The book, significantly enough, leads rather toward a rosy-eyed depiction of posh classical communists like Geoffrey de Ste. Croix and George Thompson, and other such heroes of the authors.The authors are much more at home in the years of ardent republicanism in the decades on either side of the turn of the nineteenth century and in the beginning of the twentieth century, when socialism and communism became embedded in British life. The last half of the nineteenth century, when classics really established itself institutionally as a discipline, and its revolutionary potential moved away from the zeal of the Romantic philhellenists into the artistic idealism of a Richard Wagner or the sexual freedom of an Oscar Wilde, are less adequately explored. The huge attendance at art galleries and the Great Exhibition at Crystal Palace as a route to encountering the past of antiquity in material form are barely addressed (Kate Nichols's Greece and Rome at the Crystal Palace would have helped); nor do shows like Astley's Circus get air time (Rachel Bryant Davies's Troy, Carthage, and the Victorians is revealing). It is particularly noticeable in such a voluminous study that there is no discussion of how turning to Greek was a crucial route for the self-understanding of what was considered transgressive male sexuality—and for a particular engagement between the classes. To understand the social force of classics requires a deeper appreciation of the dynamics between conservatism and transformation, disciplinarity and self-discovery. The big picture of how classics matters is lost in the gems picked out by the authors. Gems they are, but their facets need more attention and their setting a broader perspective. (shrink)

This is the first modern edition of the works of Lady Mary Shepherd, one of the most important women philosophers of the early modern period. Shepherd has been widely neglected in the history of philosophy, but her work engaged with the dominant philosophers of the time - among them Hume, Berkeley, and Reid. In particular, her 1827 volume Essays on the Perception of an External Universe outlines a theory of causation, perception, and knowledge which Shepherd presents as (...) an alternative to what she sees as the mistaken views of Berkeley and Hume. What she ultimately presents is an original and systematic metaphysics and epistemology. Shepherd's Essays consists of two parts. The first is a theory of perception and knowledge of the external world, which is designed to rebut idealism and skepticism about the external world and show that our ordinary beliefs are based on reason. The second is a collection of essays on topics in metaphysics and epistemology, including the immateriality and eternity of the mind, the relationship between mind and body, the possibility of miracles, the association of ideas, the relationship between physical and mathematical reasoning, and the epistemology of testimony. Antonia LoLordo's edition of Shepherd's Essays includes scholarly notes throughout the text that provide historical and philosophical context and expand on the major concepts of Shepherd's system. Her extensive introduction to Shepherd's life and works surveys some of the major points of Shepherd's system, points out directions for future research, and offers guidance for readers planning to teach her work in their courses. This volume is an invaluable primary resource for scholars, graduate students, and undergraduates interested in metaphysics, epistemology, and early modern philosophy. (shrink)

Mary Shepherd's An Essay upon the Relation of Cause and Effect, first published in 1824, was a pioneering work in metaphysics and epistemology. Together with her 1827 Essays on the Perception of an External Universe, they make her one of the most important philosophers of her era. Although widely neglected by the history of philosophy in the decades after her death, her works have recently begun to attract the attention and sustained study they deserve. In the course of her (...) writings, Shepherd offers trenchant and detailed rebuttals of the arguments and conclusions of many prominent predecessors-including George Berkeley, Thomas Reid, Dugald Stewart, Thomas Brown, William Lawrence, and especially David Hume-but she is no merely negative thinker. On the contrary, her critiques are always in the service of her own distinctive and highly original doctrines, which are of striking contemporary interest. Appearing two hundred years after its original publication, this is the first full modern edition of her first book, which presents and defends the theory of causation and scientific knowledge that constitutes the cornerstone of her entire philosophy. The edition includes an extensive introduction and scholarly notes throughout that provide historical and philosophical context while explaining the central ideas of the work. It also includes Shepherd's two essays published in 1828 and all of her known letters-all but one of them published here for the first time-which shed significant additional light on her philosophical ideas. (shrink)

The Shape of Agency offers interlinked explanations of the basic building blocks of agency, as well as its exemplary instances. The first part offers accounts of a collection of related phenomena that have long troubled philosophers of action: control over behaviour, non-deviant causation, and intentional action. These accounts build on earlier work in the causalist tradition, and undermine the claims made by many that causalism cannot offer a satisfying account of non-deviant causation, and therefore fails as an account of intentional (...) action. The second part turns to modes of agentive excellence—ways that agents display quality of form—providing a novel account of skill, including an account of the ways that agents display more or less skill. Shepherd discusses the role of knowledge in skill, and concludes that while knowledge is often important, it is inessential. This leads to a discussion of the way that knowledge of action and knowledge of how to act informs action execution. Knowledgeable action includes a unique epistemic underpinning: in knowledgeable action, the agent has authoritative knowledge of what she is doing and how she is doing it when and because she is poised to control her action by way of practical reasoning. (shrink)

The rise of experimental philosophy has placed metaphilosophical questions, particularly those concerning concepts, at the center of philosophical attention. X-phi offers empirically rigorous methods for identifying conceptual content, but what exactly it contributes towards evaluating conceptual content remains unclear. We show how x-phi complements Rudolf Carnap’s underappreciated methodology for concept determination, explication. This clarifies and extends x-phi’s positive philosophical import, and also exhibits explication’s broad appeal. But there is a potential problem: Carnap’s account of explication was limited to empirical and (...) logical concepts, but many concepts of interest to philosophers are essentially normative. With formal epistemology as a case study, we show how x-phi assisted explication can apply to normative domains. (shrink)

It seems obvious that phenomenally conscious experience is something of great value, and that this value maps onto a range of important ethical issues. For example, claims about the value of life for those in a permanent vegetative state, debates about treatment and study of disorders of consciousness, controversies about end-of-life care for those with advanced dementia, and arguments about the moral status of embryos, fetuses, and non-human animals arguably turn on the moral significance of various facts about consciousness. However, (...) though work has been done on the moral significance of elements of consciousness, such as pain and pleasure, little explicit attention has been devoted to the ethical significance of consciousness. In this book Joshua Shepherd presents a systematic account of the value present within conscious experience. This account emphasizes not only the nature of consciousness, but the importance of items within experience such as affect, valence, and the complex overall shape of particular valuable experiences. Shepherd also relates this account to difficult cases involving non-humans and those with disorders of consciousness, arguing that the value of consciousness influences and partially explains the degree of moral status a being possesses, without fully determining it. The upshot is a deeper understanding of both the moral importance of phenomenal consciousness and its relations to moral status. This book will be of great interest to philosophers and students of ethics, bioethics, philosophy of psychology, philosophy of mind and cognitive science. (shrink)

The extensive involvement of nonconscious processes in human behaviour has led some to suggest that consciousness is much less important for the control of action than we might think. In this article I push against this trend, developing an understanding of conscious control that is sensitive to our best models of overt action control. Further, I assess the cogency of various zombie challenges—challenges that seek to demote the importance of conscious control for human agency. I argue that though nonconscious contributions (...) to action control are evidently robust, these challenges are overblown. (shrink)

Many think that a specific aspect of phenomenal consciousness – valenced or affective experience – is essential to consciousness’s moral significance (valence sentientism). They hold that valenced experience is necessary for well-being, or moral status, or psychological intrinsic value (or all three). Some think that phenomenal consciousness generally is necessary for non-derivative moral significance (broad sentientism). Few think that consciousness is unnecessary for moral significance (non-necessitarianism). In this paper I consider the prospects for these views. I first consider the prospects (...) for valence sentientism in light of Vulcans, beings who are conscious but without affect or valence of any sort. I think Vulcans pressure us to accept broad sentientism. But I argue that a consideration of explanations for broad sentientism opens up possible explanations for non-necessitarianism about the moral significance of consciousness. That is, once one leans away from valence sentientism because of Vulcans, one should feel pressure to accept a view on which consciousness is not necessary for well-being, moral status, or psychological intrinsic value. (shrink)

Necessarily, if S lacks the ability to exercise control, S is not an agent. If S is not an agent, S cannot act intentionally, responsibly, or rationally, nor can S possess or exercise free will. In spite of the obvious importance of control, however, no general account of control exists. In this paper I reflect on the nature of control itself. I develop accounts of control ’s exercise and control ’s possession that illuminate what it is for degrees of control (...) —that is, the degree of control an agent possesses or exercises in a given circumstance—to vary. Finally, I demonstrate the usefulness of the account on offer by showing how it generates a solution to a long-standing problem for causalist theories of action, namely, the problem of deviant causation. (shrink)

I argue that the neural realizers of experiences of trying are not distinct from the neural realizers of actual trying . I then ask how experiences of trying might relate to the perceptual experiences one has while acting. First, I assess recent zombie action arguments regarding conscious visual experience, and I argue that contrary to what some have claimed, conscious visual experience plays a causal role for action control in some circumstances. Second, I propose a multimodal account of the experience (...) of acting. According to this account, the experience of acting is a temporally extended, co-conscious collection of agentive and perceptual experiences, functionally integrated and structured both by multimodal perceptual processing as well as by what an agent is, at the time, trying to do. (shrink)

Consciousness-based approaches to non-human moral status maintain that consciousness is necessary for (some degree or level of) moral status. While these approaches are intuitive to many, in this paper I argue that the judgment that consciousness is necessary for moral status is not secure enough to guide policy regarding non-humans, that policies responsive to the moral status of non-humans should take seriously the possibility that psychological features independent of consciousness are sufficient for moral status. Further, I illustrate some practical consequences (...) of calling consciousness-based views into question. (shrink)

In this paper, I offer evidence that folk views of free will and moral responsibility accord a central place to consciousness. In sections 2 and 3, I contrast action production via conscious states and processes with action in concordance with an agent's long-standing and endorsed motivations, values, and character traits. Results indicate that conscious action production is considered much more important for free will than is concordance with motivations, values, and character traits. In section 4, I contrast the absence of (...) consciousness with the presence of consciousness in behaviorally identical agents. Most participants attribute free will to conscious agents, but not to nonconscious agents. Focusing in particular on two leading views of free will and moral responsibility, namely, Deep Self and Reasons-Responsive Views, I argue that these results present philosophers of mind and action with the following explanatory burden: develop a substantive theory of the connection between consciousness on the on.. (shrink)

I seek an explanation for the etiology and the function of mind wandering episodes. My proposal – which I call the cognitive control proposal – is that mind wandering is a form of non-conscious guidance due to cognitive control. When the agent’s current goal is deemed insufficiently rewarding, the cognitive control system initiates a search for a new, more rewarding goal. This search is the process of unintentional mind wandering. After developing the proposal, and relating it to literature on mind (...) wandering and on cognitive control, I discuss explanations the proposal affords, testable predictions the proposal makes, and philosophical implications the proposal has. (shrink)

What are the folk-conceptual connections between free will and consciousness? In this paper I present results which indicate that consciousness plays central roles in folk conceptions of free will. When conscious states cause behavior, people tend to judge that the agent acted freely. And when unconscious states cause behavior, people tend to judge that the agent did not act freely. Further, these studies contribute to recent experimental work on folk philosophical affiliation, which analyzes folk responses to determine whether folk views (...) are consistent with the view that free will and determinism are incompatible (incompatibilism) or with the opposite view (compatibilism). Conscious causation of behavior tends to elicit pro-free will judgments, even when the causation takes place deterministically. Thus, when controlling for consciousness, many folk seem to be compatibilists. However, participants who disagree with the deterministic or cognitive scientific descriptions given of human behavior tend to give incompatibilist responses. (shrink)

We argue that any strong version of a knowledge condition on intentional action, the practical knowledge principle, on which knowledge of what I am doing (under some description: call it A-ing) is necessary for that A-ing to qualify as an intentional action, is false. Our argument involves a new kind of case, one that centers the agent’s control appropriately and thus improves upon Davidson’s well-known carbon copier case. After discussing this case, offering an initial argument against the knowledge condition, and (...) discussing recent treatments that cover nearby ground, we consider several objections. One we consider at some length maintains that although contemplative knowledge may be disconnected from intentional action, specifically practical knowledge of the sort Anscombe elucidated escapes our argument. We demonstrate that this is not so. Our argument illuminates an important truth, often overlooked in discussions of the knowledge-intentional action relationship: intentional action and knowledge have different levels of permissiveness regarding failure in similar circumstances. (shrink)

Recent work in cognitive science suggests that conscious thought plays a much less central role in the production of human behavior than most think. Partially on the basis of this work, Peter Carruthers has advanced the claim that humans never consciously decide to act. This claim is of independent interest for action theory, and its potential truth poses a problem for theories of free will and autonomy, which often take our capacity to consciously decide to be of central importance. In (...) this article, I examine the nature of conscious deciding and I argue that Carruthers fails to establish the claim that humans never consciously decide to act. (shrink)

In this paper I explore the relationship between skill and sensitivity to reasons for action. I want to know to what degree we can explain the fact that the skilled agent is very good at performing a cluster of actions within some domain in terms of the fact that the skilled agent has a refined sensitivity to the reasons for action common to the cluster. The picture is a little bit complex. While skill can be partially explained by sensitivity to (...) reasons – a sensitivity often produced by rational practice – the skilled human agent, because imperfect, must navigate a trade-off between full sensitivity and a capacity to succeed. (shrink)

It is well known that the nature of consciousness is elusive, and that attempts to understand it generate problems in metaphysics, philosophy of mind, psychology, and neuroscience. Less appreciated are the important – even if still elusive – connections between consciousness and issues in ethics. In this chapter we consider three such connections. First, we consider the relevance of consciousness for questions surrounding an entity’s moral status. Second, we consider the relevance of consciousness for questions surrounding moral responsibility for action. (...) Third, we consider the relevance of consciousness for the acquisition of moral knowledge. (shrink)

Schlusslogische Letztbegründung is a collection of essays in honor of Kurt Walter Zeidler. Mr. Zeidler is a distinguished Kant- and Neo-Kantian-scholar who has reconstructed Kant's concept of transcendental logic in connection with the logic of the concept of Hegel and the logic of symbolization of Peirce. (cf. Zeidler: Grundriss der transzendentalen Logik, 3rd ed., Wien 2017) He has most notably inquired intensively into the relation of transcendental logic to philosophy of science (cf. Zeidler: Prolegomena zur Wissenschaftstheorie, Wien 2000) and to (...) phenomenology (cf. Zeidler: Vermittlungen. Zum antiken und neueren Idealismus, Wien 2016). He has also published several studies on Neo-Kantianism (cf. Zeidler: Provokationen. Zu Problemen des Neukantianismus, Wien 2018). This is refelected in the collection of essays by distinguished scholars who discuss and critically examine Zeidler's work. It includes contributions by Steinar Mathisen (Oslo), Wolfdietrich Schmied-Kowarzik (Vienna), Werner Flach (Lichtenau), Thomas Knoppe (Straberg), Geert Edel (Wyk/Föhr), Martin Bunte (Münster), Reinhard Hiltscher (Dresden), Walter Tydecks (Bensheim), Christian Krijnen (Amsterdam), Hartwig Wiedebach (Zürich), Max Gottschlich (Linz), Thomas Sören Hoffmann (Hagen), Rudolf Meer (Kaliningrad), Hans-Jürgen Müller (Frankfurt am Main), Robert König (Vienna), Ulrich Blau (Marburg), Karen Gloy (Luzern/Munich), Reinhold Breil (Aachen), Erhard Oeser (Vienna), Hans-Dieter Klein (Vienna), Hans Martin Dober (Tübingen), Kurt Walter Zeidler (Vienna) and Lois Marie Rendl (Vienna). (shrink)

Here, I review work from three lines of research in cognitive science often taken to threaten free will and moral responsibility. This work concerns conscious deciding, the experience of acting, and the role of largely unnoticed situational influences on behavior. Whether this work in fact threatens free will and moral responsibility depends on how we ought to interpret it, and depends as well on the nature of free and responsible behavior. I discuss different ways this work has been interpreted and (...) argue that though work on conscious deciding and the experience of acting presents no real threat, work on situational influences is more difficult to dismiss. This work may present a real threat, and it may require us to revise our commonsense understanding of free and responsible behavior. But this work may also present ways to augment free and responsible behavior. Determining whether and how advancing science threatens, enhances, or simply describes free will is an ongoing task for scientists and philosophers alike. (shrink)