Socially extended knowledge has recently received much attention in mainstream epistemology. Knowledge here is not to be understood as wholly realised within a single individual who manipulates artefacts or tools but as collaboratively realised across plural agents. Because of its focus on the interpersonal dimension, socially extended epistemology appears to be a promising approach for investigating the deeply social nature of epistemic practices. I believe, however, that this line of inquiry could be made more fruitful if it is connected with (...) the critical notion of epistemic responsibility, as developed in feminist responsibilism. According to feminist responsibilists, at the core of epistemic responsibility is a critical disposition toward correcting epistemic injustice. This epistemic idea is highly relevant to the epistemological context of illness, where patient testimony is often disregarded. Hence, though restricted to the epistemological context of the experience of illness, this chapter delves into epistemic injustice and its robust mechanisms. I thus explore what responsible epistemic practices should involve in order to redress that injustice and how epistemic responsibility should be socially extended. The discussion proceeds as follows. First, by relying on Arthur Frank’s innovative work on illness narratives, I focus on chaotic bodily messages from patients overwhelmed by suffering and then explain why these messages should count as genuine narratives or testimonies despite their inarticulateness. Second, I elaborate on how epistemic injustice concerning such narratives (i.e., chaos narratives) is produced and reproduced, in particular how both a dominant sociocultural norm and our inherent vulnerability can contribute to its production and reproduction. Finally, I propose an extended form of epistemic responsibility that ameliorates this aspect. Laying particular emphasis on the epistemic role of mature empathy, I characterise the extended epistemic responsibility in terms of extended empathic knowledge. (shrink)

In this paper I develop a phenomenology of falling ill by presenting, interpreting and developing the basic model we find in Jean-Paul Sartre's Being and Nothingness. The three steps identified by Sartre in this process are analysed, developed further and brought to a five- step model: pre-reflective experience of discomfort, lived, bodily discomfort, suffered illness, disease pondering, and disease state. To fall ill is to fall victim to a gradual process of alienation, and with each step this alienating process is (...) taken to a new qualitative level. Consequently, the five steps of falling ill have not only a contingent chronological order but also a kind of logical order, in that they typically presuppose each other. I adopt Sartre's focus on embodiment as the core ground of the alienation process, but point out that the alienation of the body in illness is not only the experience of a psychic object, but an experience of the independent life of one's own body. This facticity of the body is the result neither of the gaze of the other person, nor of a reflection adopting the outer perspective of the other in an indirect way, but is a result of the very otherness of one's own body, which addresses and plagues us when we fall ill. I use examples of falling ill and being a patient to show how a phenomenology of falling ill can be helpful in educating health-care personnel about the ways of the lived body. (shrink)

The very idea of mental illness is contested. Given its differences from physical illnesses, is it right to count it, and particular mental illnesses, as genuinely medical as opposed to moral matters? One debate concerns its value-ladenness, which has been used by anti-psychiatrists to argue that it does not exist. Recent attempts to define mental illness divide both on the presence of values and on their consequences. Philosophers and psychiatrists have explored the nature of the general kinds that mental illnesses (...) might comprise, influenced by psychiatric taxonomies such as the Diagnostic and Statistical Manual and the International Classification of Diseases, and the rise of a rival biological ‘meta-taxonomy’: the Research Domain Criteria (RDoC). The assumption that the concept of mental illness has a culturally invariant core has also been questioned. This book serves as a guide to these contested debates. (shrink)

In this article I respond to Björn Hofmann’s criticism of some elements in my theory of health. Hofmann’s main objective is to question “Nordenfelt’s basic premise that you can be ill without having negative first-person experiences, and to investigate the consequences of abandoning the premise.” One of Hofmann’s critical points is that my theory of health does not lend voice to the individual. My response is essentially conducted in four steps: (1) I question the aim of conceptual analysis that Hofmann (...) proposes for the analysis of the notion of health. (2) I maintain that my analysis, in spite of Hofmann’s contention, lends voice to the individual. It does so via my notion of subjective illness but also via my notion of vital goal. (3) I argue that conditions, such as coma, paralysis and mania are salient instances of ill health and that these may become neglected if the use of the terms “ill” and “illness” is restricted to instances where negative subjective experiences are present. (4) I rehearse my main arguments for selecting disability as the core element of ill health and respond to Hofmann’s contention that persons who are in great pain can sometimes nevertheless perform perfectly. (shrink)

Aims and Objectives. This article uses the concept of embodiment to demonstrate a conceptual approach to applied phenomenology. -/- Background. Traditionally, qualitative researchers and healthcare professionals have been taught phenomenological methods, such as the epoché, reduction, or bracketing. These methods are typically construed as a way of avoiding biases so that one may attend to the phenomena in an open and unprejudiced way. However, it has also been argued that qualitative researchers and healthcare professionals can benefit from phenomenology’s well-articulated theoretical (...) framework, which consists of core concepts, such as selfhood, empathy, temporality, spatiality, affectivity, and embodiment. -/- Design. This is a discursive article that demonstrates a conceptual approach to applied phenomenology. -/- Method. To outline and explain this approach to applied phenomenology, the Discussion section walks the reader through four stages of phenomenology, which progress incrementally from the most theoretical to the most practical. -/- Discussion. Part one introduces the philosophical concept of embodiment, which can be applied broadly to any human subject. Part two shows how philosophically trained phenomenologists use the concept of embodiment to describe general features of illness and disability. Part three illustrates how the phenomenological concept of embodiment can inform empirical qualitative studies and reflects on the challenges of integrating philosophy and qualitative research. Part four turns to phenomenology’s application in clinical practice and outlines a workshop model that guides clinicians through the process of using phenomenological concepts to better understand patient experience. -/- Conclusion and Relevance to Clinical Practice. A conceptual approach to applied phenomenology provides a valuable alternative to traditional methodological approaches. Phenomenological concepts provide a foundation for better understanding patient experience in both qualitative health research and clinical practice, and therefore provide resources for enhancing patient care. (shrink)

Philosophy of Medicine has for a long time been preoccupied with analyzing the concepts of health, disease and illness. Relatively speaking, the concept of medicine itself has received very little attention. This paper is a contribution to the relatively neglected debate about the nature of medicine. Building on the work of Alex Broadbent (Broadbent, 2018a, b), Chadwin Harris (Harris, 2018) and Thaddeus Metz (Metz, 2018), in this paper I question the persuasiveness of Broadbent’s account of the “core business” of (...) medicine, The Inquiry Thesis, and propose an alternative: a revised version of The Curative Thesis, which I coin The Best Available Intervention Thesis. Crudely, this suggests that Medicine is the sustained and organised effort to determine and prescribe the best available treatment (curative or preventative) for patients. (shrink)

In this paper I develop a phenomenology of falling ill by presenting, interpreting and developing the basic model we find in Jean-Paul Sartre’s Being and Nothingness ( 1956 ). The three steps identified by Sartre in this process are analysed, developed further and brought to a five-step model: (1) pre-reflective experience of discomfort, (2) lived, bodily discomfort, (3) suffered illness, (4) disease pondering, and (5) disease state. To fall ill is to fall victim to a gradual process of alienation, and (...) with each step this alienating process is taken to a new qualitative level. Consequently, the five steps of falling ill have not only a contingent chronological order but also a kind of logical order, in that they typically presuppose each other. I adopt Sartre’s focus on embodiment as the core ground of the alienation process, but point out that the alienation of the body in illness is not only the experience of a psychic object, but an experience of the independent life of one’s own body. This facticity of the body is the result neither of the gaze of the other person, nor of a reflection adopting the outer perspective of the other in an indirect way, but is a result of the very otherness of one’s own body, which addresses and plagues us when we fall ill. I use examples of falling ill and being a patient to show how a phenomenology of falling ill can be helpful in educating health-care personnel (and perhaps also patients) about the ways of the lived body. (shrink)

A fundamental aim in caring practice is to understand patients' experiences of ill‐health. These experiences have a qualitative content and cannot, unlike thoughts and beliefs with conceptual content, directly be expressed in words. Nurses therefore face a variety of interpretive challenges when they aim to understand patients' subjective perspectives on disease and illness. The article argues that theories on social simulation can shed light on how nurses manage to meet these challenges. The core assumption of social simulationism is that (...) we do not understand other people by forming mental representations of how they think, but by putting ourselves in their situation in a more imaginative way. According to simulationism, any attempt to understand a patient's behavior is made on the basis of simulating what it is like to be that patient in the given context. The article argues that this approach to social interpretation can clarify how nurses manage to achieve aims of patient understanding, even when they have limited time to communicate and incomplete knowledge of patients' perspectives. Furthermore, simulation theory provides a normative framework for interpretation, in the sense that its theoretical assumptions constitute ideals for how nurses should seek to understand patients' experiences of illness. (shrink)

One of the most pervasive messages in modern advertising, both public and private, is that good health is something to strive for. Thus, the condition of our bodies and how the medical fraternity can impact on us is never far from our thoughts. Central to this interaction between doctor, patient, and society is a core group of terms that frame our discussions of sickness and health. Of particular interest to philosophers of medicine, the way we use and recognise the (...) differences between these terms has implications for how we decode the medical encounter. In this essay, three terms, disease, illness, and symptoms will be analysed to develop an argument for the continued separation and appreciation of them as distinct, although imbricated, concepts crucial to the performance of modern medicine. (shrink)

In his influential theory of health Nordenfelt bases the concepts of health and illness on the notions of ability and disability. A premise for this is that ability and disability provide a more promising, adequate, and useful basis than well-being and suffering. Nordenfelt uses coma and manic episodes as paradigm cases to show that this is so. Do these paradigm cases (and thus the premise) hold? What consequences does it have for the theory of health and illness if it they (...) do not? These are the key questions in this article, which first presents the relationship between pain and disability in Nordenfelt’s theory and the paradigm cases he uses to argue for the primacy of disability over pain. Then, Nordenfelt’s concepts of illness are outlined, highlighting its presumptions and arguments. The main point is that if you do not have an action-theoretical perspective, it is not obvious that disability is the core concept for illness. The compelling effect of the paradigm cases presupposes that you see ability as the primary issue. To those who do not share this presumption, people in coma may not be ill. There are alternative well founded arguments for the primacy of first person experiences for the concept of illness. Hence, we need better arguments for the primacy of disability over first person experiences in illness, or first-person experience should be more primarily included in the concept of illness. (shrink)

Written in a jargon-free way, Body Matters provides a clear and accessible phenomenological critique of core assumptions in mainstream biomedicine and explores ways in which health and illness are experienced and interpreted differently in various socio-historical situations. By drawing on the disciplines of literature, cultural anthropology, sociology, medical history, and philosophy, the authors attempt to dismantle common presuppositions we have about human afflictions and examine how the methods of phenomenology open up new ways to interpret the body and to (...) re-envision therapy. (shrink)

Background Equal access to healthcare is a core principle in Norway’s public healthcare system. The COVID-19 pandemic challenged healthcare systems in the early phase – in particular, related to testing and hospital capacity. There is little knowledge on how older people experienced being infected with an unfamiliar and severe disease, and how they experienced the need for healthcare early in the pandemic Aim To explore the experiences of older people infected by COVID-19 and their need for testing and hospitalisation. (...) Research design An explorative and descriptive approach, with qualitative interviews conducted in October 2020. Participants and research context Seventeen participants above 60 years of age hospitalised due to COVID-19 during spring 2020 were recruited 6 months after discharge. Ethical considerations Ethical approval was granted by the Regional Committee for Medical and Health Research Ethics in South-Eastern Norway (155425). Findings The main finding was that the informants experienced vulnerability and arbitrariness. This finding was supported by three sub-themes: experiences with a severe and unfamiliar disease, the strict criteria and the importance of someone advocating needs. Discussion Participants described varying access to healthcare. Those who did not meet the national criteria to be tested or hospitalised struggled against the system. Findings reveal arbitrary access to healthcare, in contrast to Norway’s ethical principle of fair and just access to health services. Moreover, to access and receive necessary healthcare, informants were dependent on their next-of-kin’s advocacy. Conclusion Even when dealing with an unfamiliar disease, health professionals’ assessments of symptoms must be performed with an ethical obligation to applicate competent appraisal and the exercise of discernment; this is in line with care ethics and ethical standards for nurses. These perspectives are a significant part of caring and the intension of doing good. (shrink)

For individuals whose mental illness impair their ability to accept appropriate care—the depressed, acutely suicidal mother, or the psychotic lawyer too paranoid to eat any food—statutes exist to permit involuntary hospitalization, a temporary override of paternalistic benefice over personal autonomy. This exception to the primacy of personal autonomy at the core of bioethics has the aim of restoring the mental health of the temporarily incapacitated individual, and with it, their autonomy.

It is a matter of some irony that psychiatry's most trenchant critic for over four decades is himself a psychiatrist. I refer to Thomas S. Szasz. Szasz's core thesis may be succinctly rendered: mental illness is a “myth”, a “metaphor” which serves only to obscure the social and ethical “problems in living” we face as human beings. This paper reconsiders the conceptual bases of Szasz's assault on psychiatry and assesses recent counter-arguments of his critical interlocutors. It presents a defence (...) of the Szaszian conception and emphasises the continuing relevance of his earliest work. Additionally, the paper discusses Szasz's thesis in light of the work of the influential French philosopher of medicine, Georges Canguilhem. (shrink)

Circadian rhythm abnormalities in bipolar disorder have led to a search for genetic abnormalities in circadian "clock genes" associated with BD. However, no significant clock gene findings have emerged from genome-wide association studies. At least three factors could account for this discrepancy: complex traits are polygenic, the organization of the clock is more complex than previously recognized, and/or genetic risk for BD may be shared across multiple illnesses. To investigate these issues, we considered the clock gene network at three levels: (...) essential "core" clock genes, upstream circadian clock modulators, and downstream clock controlled genes. Using relaxed thresholds for GWAS statistical significance, we determined the rates of clock vs. control genetic associations with BD, and four additional illnesses that share clinical features and/or genetic risk with BD. Then we compared the results to a set of lithium-responsive genes. Associations with BD-spectrum illnesses and lithium-responsiveness were both enriched among core clock genes but not among upstream clock modulators. Associations with BD-spectrum illnesses and lithium-responsiveness were also enriched among pervasively rhythmic clock-controlled genes but not among genes that were less pervasively rhythmic or non-rhythmic. Our analysis reveals previously unrecognized associations between clock genes and BD-spectrum illnesses, partly reconciling previously discordant results from past GWAS and candidate gene studies. (shrink)

Several studies reveal that positive attitudes towards individuals with a mental illness are correlated with knowledge about mental illness. The aim of this study was to explore and describe psychiatric nurses’ experiences of living next to people with mental health problems. In addition, it sought to identify and describe how they handle situations arising in a neighbourhood where people with a mental illness live. Two men and seven women participated in the study. The constant comparative method of grounded theory was (...) used for data collection and analysis. The process of ‘behaving as a nurse or not’ was identified as a core category. Four subcategories were identified: ‘receiving involuntary information’, ‘to take action or not’, ‘behaving as a mediator in the neighbourhood’ and ‘the freedom of choice’. The findings show that psychiatric nurses with professional knowledge about mental illness have moral concerns about their role as nurses during their leisure time. In conclusion, it is not obvious that psychiatric nurses want to live in the same neighbourhood as persons with a mental illness. However, this study shows that their knowledge about mental illness creates for them a moral dilemma consisting of a conflict between whether to care for these mentally ill persons or to preserve their own leisure time. (shrink)

The study investigated the influence of resilience and dispositional optimism on, first, emotional distress and, second, the intention to self-isolate, experienced by people with a lower and higher illness risk, during the lockdown imposed in Spain during the first COVID-19 wave. These effects were investigated against the background of the Health Belief Model. A convenience sample of N = 325 participants completed an online survey including an ad-hoc questionnaire measuring the HBM core factors: Perceived health threat, and perceived quarantine (...) benefits and costs. Self-efficacy and perceived social pressure were also measured. Based on reviews regarding pandemic outbreaks, quarantine benefits were conceptualized as the perceived effectiveness and solidary contribution of self-isolating in line with the quarantine protocols. Quarantine “psychosocial” costs were conceptualized as a composite of perceived boredom, loneliness, and economic concerns. Findings revealed an asymmetrical pattern of results so that people at higher risk were more distressed by the perceived severity of getting infected whereas people at lower risk were more distressed by the psychosocial costs. Moreover, resilience and optimism were more “protective” against distress within the lower and higher risk groups, respectively. In addition, quarantine benefits and self-efficacy promoted the intention to self-isolate within both groups. However, optimism hindered such intention. This finding is discussed in the light of links between dispositional optimism and optimistic bias; the underestimation of experiencing negative events, which can relax the perceived health risk. Based on these findings, communication campaigns should prioritize information about the effectiveness of the implemented preventive behaviors rather than the costs of not implementing them, and be cautionary in encouraging excessive optimism. (shrink)

Background Regionalised models of health care delivery have important implications for people with disabilities and chronic illnesses yet the ethical issues surrounding disability and regionalisation have not yet been explored. Although there is ethics-related research into disability and chronic illness, studies of regionalisation experiences, and research directed at improving health systems for these patient populations, to our knowledge these streams of research have not been brought together. Using the Canadian province of Ontario as a case study, we address this gap (...) by examining the ethics of regionalisation and the implications for people with disabilities and chronic illnesses. The critical success factors we provide have broad applicability for guiding and/or evaluating new and existing regionalised health care strategies. Discussion Ontario is in the process of implementing fourteen Local Health Integration Networks (LHINs). The implementation of the LHINs provides a rare opportunity to address systematically the unmet diverse care needs of people with disabilities and chronic illnesses. The core of this paper provides a series of composite case vignettes illustrating integration opportunities relevant to these populations, namely: (i) rehabilitation and services for people with disabilities; (ii) chronic illness and cancer care; (iii) senior's health; (iv) community support services; (v) children's health; (vi) health promotion; and (vii) mental health and addiction services. For each vignette, we interpret the governing principles developed by the LHINs – equitable access based on patient need, preserving patient choice, responsiveness to local population health needs, shared accountability and patient-centred care – and describe how they apply. We then offer critical success factors to guide the LHINs in upholding these principles in response to the needs of people with disabilities and chronic illnesses. Summary This paper aims to bridge an important gap in the literature by examining the ethics of a new regionalisation strategy with a focus on the implications for people with disabilities and chronic illnesses across multiple sites of care. While Ontario is used as a case study to contextualize our discussion, the issues we identify, the ethical principles we apply, and the critical success factors we provide have broader applicability for guiding and evaluating the development of – or revisions to – a regionalised health care strategy. (shrink)

In recent years limitations in the biomedical conceptualisation of health and illness have been well documented and a variety of alternative explanations produced to replace or supplement it. One such is Fredrik Svenaeus’s philosophy of medical practice, which is a development of Hans-Georg Gadamer and Martin Heideggers’ phenomenological and hermeneutical writings. This paper explores two texts, a short story by H. G. Wells, The Country of the Blind, and a poem by William Carlos Williams, Danse Russe to add further insight (...) into the ideas proposed by Svenaeus. Both texts were written before either Gadamer or Heidegger published their work. Analysis of the texts reveal examples of Heidegger’s understanding of ‘da-sein’, human-being, as the fundamental of human existence—how we relate to our ‘life-world’—together with its conditions including the tools we use to engage with and the moods that interpret the world. Emerging from this core relationship of being are the phenomena of health and illness, which are conceptualised as home-like (Heimischkeit) and un-home-like (Unheimlichkeit) being-in-the-world. In the texts the sense of home-like (and un-home-like) being is an ontological ‘web of significance’, to use Heidegger’s phrase, that creates, rather than results from a person’s psychological state. One factor that is not fully explicated in the philosophical accounts is the role that behaviour (as the physical-relating of a person) plays as a pre-requisite for agency, the ability to act in taken-for-granted ways. A person’s sense of authenticity, the extent to which someone makes their own choices rather than being led by what ‘others’ say, is linked with their ability to physically engage with and relate to their ‘life-world’. Finally, similarities between the ontological wholeness of poetry—the meaning structure of poetry—and of Dasein are noted. (shrink)

Consumer-operated services organizations (COSOs) are independent, non-profit organizations that provide peer support and other non-clinical services to seriously mentally ill people. Mental health consumers provide many of these services and make up at least a majority of the organization’s leadership. Although the dominant conception of the COSO is as an adjunct to clinical care in the public mental health system, this paper reconceives the organization as a civic association and thereby a locus of citizenship. Drawing on empirical research on COSOs (...) in one state and the citizenship and civic democracy literatures, COSOs are analyzed here as membership organizations with democratic norms and strong ties to local communities. The suggestion is made that by embracing and enhancing their status as civic associations, COSOs may advance the goals of the social movement that spawned them and avoid predictable obstacles to further growth and development. (shrink)

The first part of this essay argues that the specification of rationality operating in Manifest Rationality does not allow for the inclusion of the dialectical tier as a necessary component of a rational product. It next considers Perelman's conception of "reasonableness" as an alternative to Johnson's structural sense of rationality. Adopting a contextually rich conception of rationality, like that of Perelman, allows Johnson to insist that a rational product must consist of both an illative core and a dialectical (...) tier. (shrink)

Cogency is the central normative concept of informal logic. But it is a loose evaluative concept and I argue that a generic notion covering all of the qualities of a well-reasoned argument is the most plausible conception. It is best captured by the standard RSA criterion: in a good argument acceptable (A) and relevant (R) premises provide sufficient (S) grounds for the conclusion. Logical qualities in a broad sense are affected by the epistemic qualities of the premises and “consequence” in (...) a broad sense exhibits an interplay of form and content. There are four proposals for the premise—conclusion relation: (i) no strictly logical connection (“non-logical” consequence); (ii) one type of connection only (deductivism); (iii) a few types of connection (deduction, induction, perhaps conduction and analogical reasoning); (iv) many types of connection (argumentation schemes). Deductivism is a serious option but in its strong version, as the discussion about petitio shows, it fails to establish that arguments which are not cogent are thereby invalid. And weak deductivism, very attractive from the pedagogical point of view, has some deficiencies (implausible hidden premises; preservation of truth, not probability). I argue that the idea of a counterexample, when we regard certain components of the argument as fixed and others as variable, is the best approach to the analysis of the illative core of every-day arguments (the approach of David Hitchcock on material consequence). (shrink)

Ralph Johnson argues that mathematical proofs lack a dialectical tier, and thereby do not qualify as arguments. This paper argues that, despite this disavowal, Johnson’s account provides a compelling model of mathematical proof. The illative core of mathematical arguments is held to strict standards of rigour. However, compliance with these standards is itself a matter of argument, and susceptible to challenge. Hence much actual mathematical practice takes place in the dialectical tier.

Ralph Johnson has proposed a “two tiered” conception of argument, comprising of the illative core and the dialectical tier. This paper's two-part thesis is that (i) the dialectical tier is best understood as an epistemic requirement for argument, and (ii) once understood epistemically, the dialectical tier requirement can be defended against the leading objections.

How should we deal with mental disorder - as an "illness" like diabetes or bronchitis, as a "problem in living", or what? This book seeks to answer such questions by going to their roots, in philosophical questions about the nature of the human mind, the ways in which it can be understood, and about the nature and aims of scientific medicine. The controversy over the nature of mental disorder and the appropriateness of the "medical model" is not just an abstract (...) theoretical debate: it has a bearing on very practical issues of appropriate treatment, as well as on psychiatric ethics and law. A major contention of this book is that these questions are ultimately philosophical in character: they can be resolved only if we abandon some widespread philosophical assumptions about the "mind" and the "body", and about what it means for medicine to be "scientific". The "phenomenological" approach of the twentieth-century French philosopher, Maurice Merleau-Ponty is used to question these assumptions. His conception of human beings as "body-subjects" is argued to provide a more illuminating way of thinking about mental disorder and the ways in which it can be understood and treated. The conditions we conventionally call "mental disorders" are, it is argued, not a homogeneous group: the standard interpretation of the medical model fits some more readily than others. The core mental disorders, however, are best regarded as disturbed ways of being in the world, which cause unhappiness because of deviation from "human" rather than straightforwardly "biological" norms. That is, they are problems in how we experience the world and especially other people, rather than in physiological functioning - even though the nature of our experience cannot ultimately be separated from the ways in which our bodies function. This analysis is applied within the book both to issues in clinical treatment and to the special ethical and legal questions of psychiatry. Written by a well known philosopher in an accessible and clear style, this book should be of interest to a wide range of readers, from psychiatrists to social workers, lawyers, ethicists, philosophers and anyone with an interest in mental health. (shrink)

The core aims of the Global Health Impact Project include incentivizing pharmaceutical companies for socially conscious production and promoting socially conscious consumption among consumers. Its backbone is a metric that computes the amount of illness burden alleviated by a pharmaceutical drug. This essay aims to assess the connection between values and numbers in the Global Health Impact Project. Specifically, I concentrate on two issues, the anonymity of illness burden and the distribution of health benefits. The former issue asks whether (...) we should treat the illness burden of every person the same. The latter issue asks among whom health benefits should be fairly distributed. Examination of these issues begs for clarification of some of the key concepts of the Global Health Impact Project, such as the definition of essential medicines and the significance of national borders. Although this essay focuses on the two particular metric issues in the Global Health Impact Project, its core argument is applicable to other metrics for ethically motivated initiatives—to construct a metric for an ethically motivated initiative, it is not only important to articulate underlying concepts and values, but it is also important to operationalize them, so they are consistently reflected in the metric. (shrink)

This essay attempts to give definitions and identity conditions for the two predominant senses of ‘Argument’ currently in use, the one involving reasons for a conclusion and the other denoting an expressed disagreement with ensuing verbal behaviour by two parties. I see Johnson's new concept of ‘Argument’, as developed in his book Manifest Rationality, as a hybrid of the two common senses of ‘Argument’, and, accordingly, I try to define and give the identity conditions of Johnson-arguments. Finally, I disagree with (...) Johnson on the nature of the definition he thinks he has proposed, and I conclude with observations suggesting that his logical perspective has dialectical and rhetorical components. (shrink)

The aim of this study is to describe how hermeneutic photography and one application of hermeneutic photography in particular, namely the photo-instrument, can be used as a health care intervention that fosters meaning (re-)construction of mental illness experiences. Studies into the ways how patients construct meaning in illness narratives indicate that aesthetic expressions of experiences may play an important role in meaning making and sharing. The study is part of a larger research project devoted to understanding the photostories that result (...) from groups of psychiatric patients using the photo-instrument. Within a focused ethnography approach we employed a qualitative design of a single case study. Text analysis of photostories was combined with observational data. Data were analyzed using hermeneutic theory. Participant observations were used for triangulation and complementarity. The interaction and collaboration between health care professionals and patients in the context of a photo group emerged as core concept that underlies the photo-instrument. The interaction triggered a reframing of meaning in the patient’s illness narrative that offered new perspectives on positive identity growth. The role of visualizing meaning in images was found to lend a dynamic power to the process and triggered a dialectic between real life circumstances and imagination played out in the context of situated action. The findings suggest that a positive reframing of meaning in illness narratives is facilitated by the photo-instrument. (shrink)

The core of this special issue of Arts and Humanities in Higher Education emerged from the Broken Narratives and the Lived Body conference held in 2016. The ‘Broken Narrative’ essays included in this issue open up a critical space for understanding and theorising illness narratives that defy a conventional cognitive ordering of the self as a bounded spatial and temporal entity. Here, we discuss how narratives might be ‘broken’ by discourse, trauma, ‘ill’ lived bodies and experiences that exceed linguistic (...) representation. We trouble distinctions between coherent and incoherent narratives, attending to what gaps, silences and ‘nonsenses’ can convey about embodied illness experiences. Ultimately, we suggest that ‘breaks’ are in fact a continuation of embodied narration. This is shown in the ‘Art and Trauma’ forum of essays, which reveal how narrative silences can ‘infect’ other embodied subjects and be transformed, achieving musical or visual representation that allow us to apprehend the ‘constitutive outside’ of narratives of illness or trauma. (shrink)

This article considers the proposals of the final report of the Commission on Religious Education (CoRE 2018) and its controversial conclusion that the law should require religious education to include teaching about non-religious worldviews alongside religions, presumably in equal measure. Attention is given both to Trevor Cooling’s recent defence of CoRE’s proposals against already expressed criticisms and to additional criticisms, that of the abstract nature of a worldview as a highly ramified, philosophical concept, which is educationally ill-suited to (...) the interests and intellectual capabilities of many pupils, and that of the failure of the proposals to indicate in what ways they overcome current systemic weaknesses. It is concluded that religious education should not be reconceptualised as the study of religious and non-religious worldviews nor should it adopt a framework that construes religions primarily as worldviews. (shrink)

In this paper, I respond to papers on my Manifest Rationality (2000) by Leo Groarke, Hans Hansen, David Hitchcock, and Christopher Tindale presented at the meetings of the Ontario Philosophical Society, October 2000. From the many useful challenges they have directed at my position, I have chosen to focus on two. The dominant issue raised by their papers concerns my definition of argument, and particularly problems with the idea of a dialectical tier. I have selected that as the first strand. (...) Second, several have raised questions that deal with the relationship between logic, rhetoric and dialectic. That is the second strand. (shrink)

According to Bayertz the core meaning of solidarity is the perception of mutual obligations between the members of a community. This definition leaves open the various ways solidarity is perceived by individuals in different communities and how it manifests itself in a particular community. This paper explores solidarity as manifested in the context of families in respect of caregiving for a family member who has become dependent because of disease or illness. Though family caregiving is based on the same (...) perception of mutual obligation as the solidarity that supports welfare arrangements in society, the manifestation of solidarity in families is different. Solidarity that underpins welfare arrangements is based on a perception of mutual obligation towards an anonymous dependent other and is enforced by the government. Solidarity in families is directed towards a concrete other and is based on free choice, albeit often accompanied by a strong sense of personal duty. In this paper we try to distinguish between solidarity as a sociological concept and as a moral concept. An important moral element of solidarity, as expressed in families, is the need for recognition of family caregivers, not only of their concrete practical efforts, but also of their own identity as caregivers and as individuals. We illustrate this argument by referring to examples in the Nuffield Council on Bioethics report Dementia : ethical issues, about the experiences of family caregivers in dementia care and the importance for them of recognition of their role. (shrink)

Dans ce texte, nous proposons un cadre, qui vise à intégrer les contributions des approches constructionnistes et biologiques dans un domaine précis, celui des maladies mentales. Pour ce faire, nous utiliserons quelques propositions récentes faites par des philosophes de la biologie — plus spécifiquement les idées avancées par les tenants de la « théorie des systèmes développementaux » ainsi que la notion d’« enracinement génératif » .In this paper, we are proposing a framework to integrate the core insights of (...) the constructivist and biological approaches of mental illness. In order to do so, we will use some recent propositions by philosophers of biology, specifically ideas put forth by «developmental system theory» and the notion of «generative entrenchment». (shrink)

High levels of somatic symptom distress represent a core component of both mental and physical illness. The exact aetiology and pathogenesis of this transdiagnostic phenomenon remain largely unknown. The Affective Picture Paradigm (APP) represents an innovative experimental paradigm to study somatic symptom distress. Based on the HiTOP framework and a population-based sampling approach, associations between facets of somatic symptom distress and symptoms induced by the APP were explored in two studies (N1 = 201; N2 = 254) using structural equation (...) bi-factor models. Results showed that the APP effect was significantly positively correlated with general somatic symptom distress (PHQ-15, HiTOP), cardio-respiratory symptoms (PHQ-15), as well as difficulties identifying feelings. In conclusion, negative affective cues in the APP can elicit somatic symptoms, particularly in people with higher levels of somatic symptom distress. Difficulties identifying feelings might contribute to this phenomenon. Results are compatible with a predictive processing account of somatic symptom perception. (shrink)

Caring is at the core of what nurses and other health professionals do. But caring encompasses more than simply looking after people's physical health needs. People requiring any health service will have psychological needs that affect their feelings, thoughts, and behaviour. Good psychological care can even help improve physical health outcomes. An Introduction to Psychological Care in Nursing and the Health Professions explains and promotes the importance of psychological care for people when they become physically ill, giving a sound (...) theoretical basis to ensure care is evidence-based. It encourages the reader to think about the effects of illness and disability on patients, and to understand what can be done to identify and minimise any difficulties they might be experiencing in these areas. The chapters cover: the meaning and elements of care and holistic care; a model of psychological care in practice; the personal qualities and skills of carers that best underpin psychological care delivery, and how these might be enhanced; the knowledge needed for effective psychological caregiving; psychological care as it might be practised in a range of health care settings. This text contains key learning points, practical activities, reflective exercises and case illustrations. It is ideal for student and practising nurses, and health professionals who would like to improve their care for patients in this essential area. (shrink)

Abstractα/β barrels have an ill‐defined origin. Evidence exists which favours their divergent evolution from a common ancestral barrel and convergent evolution to a stable fold. However, recent sequence and structural information for the flavin oxidase/dehydrogenase family of barrel enzymes indicate that sub‐families of α/β barrels have evolved divergently. The modular fusion of barrel domains with core structures from other gene families has also contributed to the evolution of related but catalytically distinct enzyme molecules within each sub‐family of the flavin (...) oxidases/dehydrogenases. An analysis of the structures and sequences of the flavin oxidases/dehydrogenases has now enabled studies focusing on the evolutionary origins and modular assembly of this important family of proteins to be initiated. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Hegel’s Idea of a “Phenomenology of Spirit” by Michael N. ForsterGünter ZöllerMichael N. Forster. Hegel’s Idea of a “Phenomenology of Spirit.” Chicago: University of Chicago Press, 1998. Pp. xi + 661. Paper, $30.00.Hegel’s Phenomenology of Spirit (1807) has remained an enigmatic and controversial work. Typically it has been studied and appropriated selectively, by focusing on a few topics or sections of this immense opus. There are also several (...) commentaries on all or part of the work that immerse the reader in plenty of detail, but often with insufficient attention paid to the work’s overall design. Forster’s book is thematically focused but has sufficient scope to provide the reader with an overall orientation about the Phenomenology. Moreover, it is written in a clear, accessible language, with plenty of genuinely philosophical material to balance the more narrowly exegetical aspects of the study. Forster’s work stands in the tradition of a number of German and French studies that seek to unravel the “genesis and structure” (Hyppolite) of the Phenomenology as a key to understanding and assessing the import of Hegel’s singular work. Forster discusses those earlier readings, subjects them to a thorough critique, and develops original positions on a number of key issues in scholarship on the Phenomenology.The entire first half of the book (Parts One and Two) is concerned with the “official project of the Phenomenology,” which Forster reconstructs as three sets of philosophical tasks. First are the pedagogical tasks designed to introduce the reader to the superior viewpoint of Hegel’s system and its ability to overcome the ills specific to modern culture. In particular, Hegel is shown to further advance Herder’s and Schiller’s philosophical project of replacing the multiple, unreconciled dualisms of the modern intellectual and moral outlook with a unified, monistic account of natural and social reality. In a strong interpretive move, Forster attributes a naturalism of sorts to Hegel’s integrationist account of mind and body or self and world.Second are the epistemological tasks designed to justify the cognitive claims of Hegel’s [End Page 541] system (“science”) against those of all other philosophical and popular viewpoints. In particular, Forster shows Hegel’s indebtedness to the ancient (Pyrronic) skeptical strategy of equipollence, i.e., the method of setting into opposition equally strong arguments on both sides of any issue and thereby producing an equal balance of justification on all sides of the issue. Of all possible viewpoints only Hegel’s own, which is not subject to any external opposition, eludes the scope of the method of equipollence.The third, specifically metaphysical set of tasks of the Phenomenology centers around the work’s social and (on Forster’s reading) naturalist conceptions of God, meaning and truth, in which transcendent warrants are replaced by communal consensus. Forster concludes the first half of his study with a detailed consideration of the relation between the Phenomenology and Hegel’s system proper. He stresses that the work is only the “appearance” (Erscheinung) of the philosophical science itself and that it remains systematically independent of the latter.Part Three examines the role of history and historicism in the Phenomenology. Forster distinguishes between teleological or normative historicism and intellectual or descriptive historicism, and limits his investigation to the latter as the philosophically defensible of the two enterprises. He argues extensively for a one-to-one correlation between the various “shapes of consciousness” to be found in the core of the Phenomenology (from the chapter on Consciousness through the chapter on Reason) and specific periods in human history. This chronological history of consciousness is shown to be supplemented by two further accounts of the history of consciousness (in the chapter on Spirit and in the chapters on Religion and Absolute Knowledge, respectively), in which the first history’s focus on individual consciousness is enlarged to include supra-individual mind (“spirit”).In Part Four Forster explains the tripling of the history of consciousness with a shift in the plan of the Phenomenology, away from the more limited project of the original or “Ur-Phenomenology”—to lead individual consciousness to the viewpoint of (Hegelian) science—to the more ambitious goal... (shrink)

This book draws on core concepts coined by Adorno, such as identity thinking, the culture industry, and his critique of the autonomous and rational subject, to address the ills that plague neoliberal capitalist societies today. These ills range from the risk of a return to totalitarian tendencies, to the global rise of the far-right, and anti-feminist conceptions of motherhood. Subsequent chapters outline the ways in which Adorno's thought can also be seen to redress the challenges of modern societies, such (...) as the critical function of artworks, and the subversive potential of slow-food and popular music. The important underlying concern of the book is to highlight the continuing relevance of Adorno, both in dealing with the failures of neo-liberal capitalist societies, and in his applicability to a wide range of disciplines. (shrink)

Background:Moral distress occurs when constraints prevent healthcare providers from acting in accordance with their core moral values to provide good patient care. The experience of moral distress in nurses might be magnified during the current Covid-19 pandemic.Objective:To explore causes of moral distress in nurses caring for Covid-19 patients and identify strategies to enhance their moral resiliency.Research design:A qualitative study using a qualitative content analysis of focus group discussions and in-depth interviews. We purposively sampled 31 nurses caring for Covid-19 patients (...) in the acute care units within large academic medical systems in Maryland and New York City during April to June 2020.Ethical considerations:We obtained approval from the Institutional Review Board at the University of Maryland, Baltimore.Results:We identified themes and sub-themes representative of major causes of moral distress in nurses caring Covid-19 patients. These included (a) lack of knowledge and uncertainty regarding how to treat a new illness; (b) being overwhelmed by the depth and breadth of the Covid-19 illness; (c) fear of exposure to the virus leading to suboptimal care; (d) adopting a team model of nursing care that caused intra-professional tensions and miscommunications; (e) policies to reduce viral transmission (visitation policy and PPE policy) that prevented nurses to assume their caring role; (f) practicing within crisis standards of care; and (g) dealing with medical resource scarcity. Participants discussed their coping mechanisms and suggested future strategies.Discussion/Conclusion:Our study affirms new causes of moral distress related to the Covid-19 pandemic. Institutions need to develop a supportive ethical climate that can restore nurses’ moral resiliency. Such a climate should include non-hierarchical interdisciplinary spaces where all providers can meet together as moral peers to discuss their experiences. (shrink)

Politics in America are polarized and trivialized, perhaps as never before. In Congress, the media, and academic debate, opponents from right and left, the Red and the Blue, struggle against one another as if politics were contact sports played to the shouts of cheerleaders. The result, Ronald Dworkin writes, is a deeply depressing political culture, as ill equipped for the perennial challenge of achieving social justice as for the emerging threats of terrorism. Can the hope for change be realized? Dworkin, (...) one the world's leading legal and political philosophers, identifies and defends core principles of personal and political morality that all citizens can share. He shows that recognizing such shared principles can make substantial political argument possible and help replace contempt with mutual respect. Only then can the full promise of democracy be realized in America and elsewhere. Dworkin lays out two core principles that citizens should share: first, that each human life is intrinsically and equally valuable and, second, that each person has an inalienable personal responsibility for identifying and realizing value in his or her own life. He then shows what fidelity to these principles would mean for human rights, the place of religion in public life, economic justice, and the character and value of democracy. Dworkin argues that liberal conclusions flow most naturally from these principles. Properly understood, they collide with the ambitions of religious conservatives, contemporary American tax and social policy, and much of the War on Terror. But his more basic aim is to convince Americans of all political stripes--as well as citizens of other nations with similar cultures--that they can and must defend their own convictions through their own interpretations of these shared values. (shrink)

Prioritarianism pertains to the generic idea that it matters more to benefit people, the worse off they are, and while prioritarianism is not uncontroversial, it is considered a generally plausible and widely shared distributive principle often applied to healthcare prioritisation. In this paper, I identify social justice prioritarianism, severity prioritarianism and age-weighted prioritarianism as three different interpretations of the general prioritarian idea and discuss them in light of the effect of pandemic consequences on healthcare priority setting. On this analysis, the (...) paper arrives at the following three conclusions: that we have strong prioritarian reasons for special concern about the vulnerable and socially disadvantaged in reference to pandemic effects, that severity of illness is an important factor in identifying the worse off in priority setting but that this must not over-ride the special priority to the socially disadvantaged and that the maximisation rationale of the age-weighted view runs against the core prioritarian idea, and the age-weighted prioritarianism is thus unfitting as a prioritarian response to the COVID-19 case. (shrink)

Patient support tools have drawn on a variety of disciplines, including psychotherapy, social psychology, and social care. One discipline that has not so far been used to support patients is philosophy. This paper proposes that a particular philosophical approach, phenomenology, could prove useful for patients, giving them tools to reflect on and expand their understanding of their illness. I present a framework for a resource that could help patients to philosophically examine their illness, its impact on their life, and its (...) meaning. I explain the need for such a resource, provide philosophical grounding for it, and outline the epistemic and existential gains philosophy offers. Illness often begins as an intrusion on one’s life but with time becomes a way of being. I argue that this transition impacts on core human features such as the experience of space and time, human abilities, and adaptability. It therefore requires philosophical analysis and response. The paper uses ideas from Husserl and Merleau-Ponty to present such a response in the form of a phenomenological toolkit for patients. The toolkit includes viewing illness as a form of phenomenological reduction, thematizing illness, and examining illness as altering the ill person’s being in the world. I suggest that this toolkit could be offered to patients as a workshop, using phenomenological concepts, texts, and film clips to reflect on illness. I conclude by arguing that examining illness as a limit case of embodied existence deepens our understanding of phenomenology. (shrink)

Heidegger's connection with Nazism is well known and has been exhaustively debated. But we need to understand better why Heidegger believed National Socialism to be the best cure for the ills of modern society. In this book Christopher Rickey examines the internal logic of Heidegger's ideas to explain how they led him to become a powerful critic of liberalism and a Nazi supporter. Key to Rickey's interpretation is the radically antinomian conception of religiosity he finds at the core of (...) Heidegger's challenge to modernity. Heidegger responds to the crisis of modernity with a philosophy attuned to the fundamental need for humans to live with the proper stance toward the divine. Inspired by Lutheran and mystical theology, Heidegger outlines an essentially religious conception of authentic human being. Like his radical Lutheran forerunners, Heidegger politicizes the radical strains of Luther's theology to create a potent revolutionary brew: the revolution of the saints. Rickey traces out the ways in which these currents fundamentally shape Heidegger's thought: the Lutheran background to his critique of modern science and the technological rationality it spawns; his transformation of Aristotle's prudential conception of practical wisdom into the total revelation of being that lays the basis for revolutionary political action; and his mystical and sectarian understanding of authentic community. Rickey shows how this political-theological vision forms the basis of Heidegger's concrete political action, and concludes with an analysis of the fundamental problems this vision poses to our political thinking today. (shrink)

In this essay I explore the relationship of sport to art. I do not intend to argue that sport is one of the arts. I will rather argue that sport and art have a commonality, in that both are alienated philosophy. This is to propose – in an argument that has its roots in Hegel's aesthetics – that sport and art may both be interpreted as a way of reflecting upon metaphysical and normative issues, albeit in media that are alien (...) to philosophy's conceptual language. The medium of art is the manipulation of sensuous materials, such as stone, paint, or sound. The medium of sport is the pursuit of a physical challenge, at which the athlete may fail. I will develop this argument by borrowing from the philosophy of art of Arthur C. Danto. In particular, I will suggest that a parallel to his concept of ‘artworld’ can be seen in a ‘sportworld’. As the artworld is an ‘atmosphere of theory’ and a ‘knowledge of history’ through which an event is interpreted and thereby constituted as art, so a sportworld is the atmosphere of theory through which an event is constituted as sport. I will argue that much of the existing discussion of the relationship between sport and art is grounded in an ill-conceived aesthetics. In order to be appreciated and appropriately interpreted, sport must be understood within a modernist aesthetics and hermeneutics. As such, the core issue of an aesthetics of sport is not that of beauty, but rather of the meaning of the sport, and what I shall call the capacity of sport to ‘speak as a world’ – to bring to consciousness through play the taken-for-granted cultural conditions through which our social lives are constituted, and within which metaphysical and normative problems are articulated. I will propose that the hermeneutics of music provides a useful model for the interpretation of sport. (shrink)

On March 11, 2020 the World Health Organization classified COVID‐19, caused by Sars‐CoV‐2, as a pandemic. Although not much was known about the new virus, the first outbreaks in China and Italy showed that potentially a large number of people worldwide could fall critically ill in a short period of time. A shortage of ventilators and intensive care resources was expected in many countries, leading to concerns about restrictions of medical care and preventable deaths. In order to be prepared for (...) this challenging situation, national triage guidance has been developed or adapted from former influenza pandemic guidelines in an increasing number of countries over the past few months. In this article, we provide a comparative analysis of triage recommendations from selected national and international professional societies, including Australia/New Zealand, Belgium, Canada, Germany, Great Britain, Italy, Pakistan, South Africa, Switzerland, the United States, and the International Society of Critical Care Medicine. We describe areas of consensus, including the importance of prognosis, patient will, transparency of the decision‐making process, and psychosocial support for staff, as well as the role of justice and benefit maximization as core principles. We then probe areas of disagreement, such as the role of survival versus outcome, long‐term versus short‐term prognosis, the use of age and comorbidities as triage criteria, priority groups and potential tiebreakers such as ‘lottery’ or ‘first come, first served’. Having explored a number of tensions in current guidance, we conclude with a suggestion for framework conditions that are clear, consistent and implementable. This analysis is intended to advance the ongoing debate regarding the fair allocation of limited resources and may be relevant for future policy‐making. (shrink)

In my Steinberger 2009 I argued that Neil Tennant’s Harmony requirement is untenable because of its failure to account for the standard quantifier rules.1 Instead of justifying the customary rules for the existential and universal quantifiers, Tennant’s account appears to sanction only wholly unrestricted – and so patently disharmonious – quantifier rules. In his characteristically thoughtful response Tennant 2010, Tennant offers a sequent calculus version of his Harmony requirement that rules out such pathological would-be quantifiers. While I agree with Tennant (...) that recasting his Harmony requirement in the sequent format as he proposes blocks the said disharmonious quantifier rules, I submit that Tennant’s revamped Harmony requirement nevertheless misses the mark. I present two objections to substantiate my claim. First, I show that the crucial additional assumption underlying Tennant’s sequent calculus-based account – what I call the admissibility assumption – is excessively strong: so strong, in fact, that it renders otiose the core of Tennant’s original account. Second, I argue that the admissibility assumption, as a global requirement on deductive systems, is ill-suited for the purposes of codifying the intuitive notion of harmony. Fortunately, though, as I will demonstrate, we can dispense with the admissibility assumption altogether. (shrink)

The paper deals primarily with the standard question in what exactly, according to Husserl, consists the crisis of the European sciences. In the literature so far, there have been two tendencies on this question, one focusing on the loss of the sciences’ meaningfulness for life, the other emphasizing the inadequacy of their scientificity. Instead of arguing for one of these two options or for some sort of combination of both, another interpretation of this topic will be suggested. The focus will (...) be on Husserl’s notion of historicity and its connection with the concept of life-world. It will be argued that it is the historical detachment of sciences from ideas and consequently the sphere of meaning altogether which lies at the core of their ill state. On this basis, it will show that Husserl’s approach to science in Crisis is actually double. For one, it is an attempt to supplement science with a philosophical justification. The other is a historical de-construction of scientific objectivism as a misleading metaphysical claim concerning the lived world. This second, historical approach is developed exclusively in the Crisis. However, it does bring out questions leading to rethinking the meaning and goals of transcendental phenomenology itself. (shrink)

In recent times, daily, ordinary medical practices have incontrovertibly been developing under the condition of complexity. Complexity jeopardizes the moral core of practicing medicine: helping people, with their illnesses and suffering, in a medically competent way. Practical wisdom has been proposed as part of the solution to navigate complexity, aiming at the provision of morally good care. Practical wisdom should help practitioners to maneuver in complexity, where the presupposed linear ways of operating prove to be insufficient. However, this solution (...) is unsatisfactory, because the proposed versions of practical wisdom are too individualistic of nature, while physicians are continuously operating in varying teams, and dealing with complicated technologies and pressing structures. A second point of critique is, that these versions are theory based, and thus insufficiently attuned to the actual context of everyday medical practices. Now, our proposal is to use an approach of practical wisdom that enables medical practices to counter the complexity issue and to re-invent the moral core of medical practicing as well. This implies a practice oriented approach, as thematized by practice theory, qualitative empirical research from the inside, and abduction from actual performed practical wisdom towards an apt understanding of phronèsis. (shrink)

In the first chapter, we discuss Dummett’s idea that the notion of truth arises from the one of the correctness of an assertion. We argue that, in a first-order language, the need of defining truth in terms of the notion of satisfaction, which is yielded by the presence of quantifiers, is structurally analogous to the need of a notion of truth as distinct from the one of correctness of an assertion. In the light of the analogy between predicates in Frege (...) and open formulas in Tarksi, we concentrate on the semantic status of predicates. We register a dual attitude of Dummett towards Frege’s ascription of reference to predicates. On the one it is needed to endow quantifiers with their appropriate meaning. On the other hand, the introduction of concepts, as semantic correlate of predicates, smuggles a realist flavor in the overall semantic picture. In concluding the excursus (and with it the chapter), we stress Dummett’s will of developing a semantic picture free from this realist trait. In the second chapter, we present the idea of a proof-theoretic semantics. As for Frege true sentences denotes the truth-value True, so here closed' (i.e. categorical) valid argumentations denotes proofs. If a language contains implication-like operators, in order to characterize the condition of validity of a closed argumentation one has to introduce a notion of validity applying to ‘open’ (i.e. hypothetical) argumentations. We argue that this problem is analogous to the one posed by quantifiers in Frege-Tarksi’s style semantics. That is, implication forces one to introduce notion of validity for argumentations, which is more substantial than the correctness of the assertion of their conclusions. As we saw, the corresponding claim in the truth-based approach—that quantifiers require one to introduce a notion of truth, which is more substantial than the one of an assertion being correct—was the source of realism. Hence, Dummett proposes to reduce the semantic contribution of open argumentations to the one of their ‘closed instances’. In the truth-based perspective, this would correspond to the denial of the need of introducing concepts as the semantic correlates of predicates. We argue that Dummett’s fear, that an irreducible notion of function (represented by the need of ascribing validity to open argumentations) would lead to realism, turns out to be ill-founded. In the third chapter, we discuss the role played by the notion of truth in the anti-realist account. The notion of truth is what the anti-realist needs to cope with the so-called paradox of deduction. The analysis of the paradox yields to distinguishing between the truth of a sentence and the truth of a sentence being recognized. In terms of these conceptual couple, we reconsider the relationship between truth and assertion in an anti-realist perspective. Grounds are provided for a thesis (which was already advanced in chapter two), according to which the notion of the assertion of a sentence being correct is primarily connected only with the canonical means of establishing a sentence. The possibility of establishing a sentence by indirect means is conceptually dependent on the practice of establishing logical relationship of dependence among sentences. That is, the notion of a closed valid non-canonical argumentation is of any theoretical relevance only in presence of a notion of validity applying to open argumentations. In the fourth chapter, we discuss the possibility of characterizing in the proof-theoretic-semantics a notion of refutation. We develop an original characterization of refutations starting from an informal inductive specification of the condition of refutations of logically complex sentences. A sub-structural logic, called dual-intuitionistic logic, stands to this notion in the same relationship in which intuitionistic logic stands to the notion of proof so far consdered. All notions developed in chapter 2 have their corresponding (dual) ones in the framework developed. In particular, the distinctions canonical/non-canonical and closed/open argumentations. In the refutation based perspective, elimination rules have priority over introductions and the (only) assumption over the (many) conclusions. In the conclusions, we indicate the ingredients that an anti-realist approach to meaning should incorporate, in order to avoid the difficulties we registered. The core of an alternative view is a different conception of the relationship between categorical and hypothetical notions, in which the validity of open argumentations is not reduced to that of their instances, but rather it is directly defined. As a limit case, one would get a notion of validity applying to closed argumentations. (shrink)

Williamson argues for the contention that substructural logics are ‘ill-suited to acting as background logics for science’. That contention, if true, would be very important, but it is refutable, given what is already known about certain substructural logics. Classical Core Logic is a substructural logic, for it eschews the structural rules of Thinning and Cut and has Reflexivity as its only structural rule. Yet it suffices for classical mathematics, and it furnishes all the proofs and disproofs one needs for (...) the hypothetico-deductive method in science. We explain exactly what Classical Core Logic is, why it is a substructural logic par excellence, and what the basic requirements would be for a logic to be ‘suited to acting as [a] background logic for science’. We also explain how Classical Core Logic meets all these requirements. We end by examining Williamson’s argument in order to expose where its error lies. (shrink)