Research has consistently shown that people consider harmful side effects of an action more intentional than helpful side effects. This phenomenon is known as the side- effect effect (SEE), which refers to the influence of moral considerations in judgments of intentionality and other non-moral concepts. There is an ongoing debate about how to explain this asymmetric pattern of judgment and the psychological factors involved in it. It has been posited that affective reactions to agents that (...) bring about harmful side- effects could bias intentionality attributions in these cases, explaining the asymmetric pattern of intentionality judgments that we observe in the SEE. We call this the affective bias hypothesis (ABH). Evidence for the ABH is mixed, with some findings suggesting a role for affective processes, while others suggesting that affective processes play no role in the SEE. A possible explanation for these apparently contradictory results points to affective processes involved in the SEE being confined to anger. In a series of empirical studies, we systematically measured and manipulated participants’ anger in order to test this possibility. Our findings suggest that anger play no role in intentionality judgments in SEE cases, while providing support for a non-emotional motivation to blame as a factor underlying the SEE. (shrink)

Beebe and Buckwalter made the surprising discovery that people are more inclined to attribute knowledge when norms are violated than when they are conformed to. The epistemic side-effect effect is the analogue of the Knobe effect. ESEE was replicated in a number of experiments. It was also studied under various conditions. We have carried out a meta-analysis of research on ESEE. The results suggest that ESEE is a robust finding but its magnitude is highly variable. Two (...) study-level covariates influence its size: the subject of the knowledge attribution and the type of norm that is violated or complied with. The effect size is not influenced, however, by the manipulation of chances, by whether the story is about a side effect or not, by language or by question phrasing. The impact of the Gettierization of the story is marginally significant. (shrink)

Studying the folk concept of intentional action, Knobe (2003a) discovered a puzzling asymmetry: most people consider some bad side effects as intentional while they consider some good side effects as unintentional. In this study, we extend these findings with new experiments. The first experiment shows that the very same effect can be found in ascriptions of intentionality in the case of means for action. The second and third experiments show that means are nevertheless generally judged more intentional (...) than side effects, and that people do take into account the structure of the action when ascribing intentionality. We then discuss a number of hypotheses that can account for these data, using reactions times from our first experiment. (shrink)

Adults’ intentionality judgments regarding an action are influenced by their moral evaluation of this action. This is clearly indicated in the so-called side-effect effect: when told about an action (e.g. implementing a business plan) with an intended primary effect (e.g. raise profits) and a foreseen side effect (e.g. harming/helping the environment), subjects tend to interpret the bringing about of the side effect more often as intentional when it is negative (harming the environment) (...) than when it is positive (helping the environment). From a cognitive point of view, it is unclear whether the side-effect effect is driven by the moral status of the side effects specifically, or rather more generally by its normative status. And from a developmental point of view, little is known about the ontogenetic origins of the effect. The present study therefore explored the cognitive foundations and the ontogenetic origins of the side-effect effect by testing 4-to 5-year-old children with scenarios in which a side effect was in accordance with/violated a norm. Crucially, the status of the norm was varied to be conventional or moral. Children rated the bringing about of side-effects as more intentional when it broke a norm than when it accorded with a norm irrespective of the type of norm. The side-effect effect is thus an early-developing, more general and pervasive phenomenon, not restricted to morally relevant side effects. (shrink)

In the last decade, experimental philosophers have documented systematic asymmetries in the attributions of mental attitudes to agents who produce different types of side effects. We argue that this effect is driven not simply by the violation of a norm, but by salient-norm violation. As evidence for this hypothesis, we present two new studies in which two conflicting norms are present, and one or both of them is raised to salience. Expanding one’s view to these additional cases presents, (...) we argue, a fuller conception of the side-effect effect, which can be reversed by reversing which norm is salient. (shrink)

Knobe (2003a, 2003b, 2004b) and others have demonstrated the surprising fact that the valence of a side-effect action can affect intuitions about whether that action was performed intentionally. Here we report the results of an experiment that extends these findings by testing for an analogous effect regarding knowledge attributions. Our results suggest that subjects are less likely to find that an agent knows an action will bring about a side-effect when the effect is good (...) than when it is bad. It is further argued that these findings, while preliminary, have important implications for recent debates within epistemology about the relationship between knowledge and action. (shrink)

The concept of acting intentionally is an important nexus where ‘theory of mind’ and moral judgment meet. Preschool children’s judgments of intentional action show a valence-driven asymmetry. Children say that a foreseen but disavowed side-effect is brought about 'on purpose' when the side-effect itself is morally bad but not when it is morally good. This is the first demonstration in preschoolers that moral judgment influences judgments of ‘on-purpose’ (as opposed to purpose influencing moral judgment). Judgments of (...) intentional action are usually assumed to be purely factual. That these judgments are sometimes partly normative — even in preschoolers — challenges current understanding. Young children’s judgments regarding foreseen side-effects depend upon whether the children process the idea that the character does not care about the side-effect. As soon as preschoolers effectively process the ‘theory of mind’ concept, NOT CARE THAT P, children show the side-effect effect.idea.. (shrink)

People asymmetrically attribute various agential features such as intentionality, knowledge, or causal impact to other agents when something of normative significance is at stake. I will argue that three questions are of primary interest in the debate about this effect. A methodological question about how to explain it at all; a substantive question about how to explain it correctly: and a normative question about whether to explain it in terms of an error or a legitimate judgmental pattern. The problem, (...) I argue, is that these three questions are difficult to disentangle. I propose a solution to this problem, and show how it accounts for the most recent data regarding the effect. (shrink)

A large body of research has found that people judge bad foreseen side effects to be more intentional than good ones. While the standard interpretation of this Side-Effect Effect takes it to show that the ordinary concept of intentionality is influenced by normative considerations, a competing account holds that it is the result of pragmatic pressure to express moral censure and, thus, that the SEE is an experimental artifact. Attempts to confirm this account have previously been (...) unsuccessful, but Lindauer and Southwood :181–186, 2021) present a study that appears to provide support for it, by cancelling the SEE. We are not convinced. Here, we detail three studies testing their interpretation. The results indicate that it is the purported cancellation, rather than the SEE, that is an experimental artifact. (shrink)

The side-effect effect, in which an agent who does not speci␣cally intend an outcome is seen as having brought it about intentionally, is thought to show that moral factors inappropriately bias judgments of intentionality, and to challenge standard mental state models of intentionality judgments. This study used matched vignettes to dissociate a number of moral factors and mental states. Results support the view that mental states, and not moral factors, explain the side-effect effect. However, (...) the critical mental states appear not to be desires as proposed in standard models, but rather ‘deeper’ evaluative states including values and core evaluative attitudes. (shrink)

In this paper, we investigate the effect described in the literature as the Group Knobe Effect, which is an asymmetry in ascription of intentionality of negative and positive side-effects of an action performed by a group agent. We successfully replicate two studies originally conducted by Michael and Szigeti, who observed this effect and provide empirical evidence of the existence of two related effects—Group Epistemic and Doxastic Knobe Effects—which show analogous asymmetry with respect to knowledge and belief (...) ascriptions. We explain how the existence of the Group Knobe Effect and its epistemic and doxastic counterparts affects the philosophical debate on collective agency and intentionality and supports the intuitiveness of realism about collective agency among laypeople. We also critically assess the reasoning presented by Michael and Szigeti in favor of the realist-collectivist interpretation of their results. We argue that a thorough analysis of both their data and our new findings shows a rather wide range of differing intuitions among laypeople regarding the status of groups as agents. These results show that while some laypeople may have realist-collectivist intuitions, the contrary realist-distrubutivist intuitions are also widespread and the claim that the majority of laypeople hold collectivist intuitions regarding group agency is unjustified. (shrink)

A number of researchers have begun to demonstrate that the widely discussed ?Knobe effect? (wherein participants are more likely to think that actions with bad side-effects are brought about intentionally than actions with good or neutral side-effects) can be found in theory of mind judgments that do not involve the concept of intentional action. In this article we report experimental results that show that attributions of knowledge can be influenced by the kinds of (non-epistemic) concerns that drive (...) the Knobe effect. Our findings suggest there is good reason to think that the epistemic version of the Knobe effect is a theoretically significant and robust effect, and that the goodness or badness of side-effects can often have greater influence on participant knowledge attributions than explicit information about objective probabilities. Thus, our work sheds light on important ways in which participant assessments of actions can affect the epistemic assessments participants make of agents? beliefs. (shrink)

Theory of mind, the capacity to understand and ascribe mental states, has traditionally been conceptualized as analogous to a scientific theory. However, recent work in philosophy and psychology has documented a "side-effect effect" suggesting that moral evaluations influence mental state ascriptions, and in particular whether a behavior is described as having been performed 'intentionally.' This evidence challenges the idea that theory of mind is analogous to scientific psychology in serving the function of predicting and explaining, rather than (...) evaluating, behavior. In three experiments, we demonstrate that moral evaluations do inform ascriptions of intentional action, but that this relationship arises because behavior that conforms to norms (moral or otherwise) is less informative about underlying mental states than is behavior that violates norms. This analysis preserves the traditional understanding of theory of mind as a tool for predicting and explaining behavior, but also suggests the importance of normative considerations in social cognition. (shrink)

What is the relation between acting intentionally and acting for a reason? While this question has generated a considerable amount of debate in the philosophy of action, on one point there has been a virtual consensus: actions performed for a reason are necessarily intentional. Recently, this consensus has been challenged by Joshua Knobe and Sean Kelly, who argue against it on the basis of empirical evidence concerning the ways in which ordinary speakers of the English language describe and explain certain (...) side-effect actions. Knobe and Kelly's argument is of interest not only because it challenges a widely accepted philosophical thesis on the basis of experimental evidence, but also because it indirectly raises an important and largely neglected question, the question of whether or in what sense an agent can perform a side-effect action for a reason. In this article, I address this question and provide a positive answer to it. Specifically, I argue that agents act for a reason whenever they perform side-effect actions as trade-offs. Thus, I claim that there are three distinct types of rational action: actions performed as ends in themselves, actions performed as means to further ends, and side-effect actions performed as trade-offs. Given this multiplicity of types of rational action, the question of whether or not actions performed for a reason are necessarily intentional is in need of refinement. The more specific question that lies at the heart of this article is whether or not side-effect actions performed as trade-offs are necessarily intentional. I conclude that, contrary to what Knobe and Kelly suggest, the question remains open. (shrink)

One aim of this article is to explore the connection between the Knobe effect and the epistemic side-effect effect (ESEE). Additionally, we report evidence about a further generalization regarding probability judgments. We demonstrate that all effects can be found within German material, using ‘absichtlich’ [intentionally], ‘wissen’ [know] and ‘wahrscheinlich’ [likely]. As the explanations discussed with regard to the Knobe effect do not suffice to explicate the ESEE, we survey whether the characteristic asymmetry in knowledge judgments (...) is caused by a differing perception of probabilities concerning the occurrence of the side-effects. Our findings show that a negative side-effect is judged more probable, even if the objective probabilities would suggest otherwise. We argue that the best explanation for these results is that the Knobe effect applies to the perception of probabilities as well: a probabilistic side-effect effect. (shrink)

This paper focuses on Joshua Knobe's experiments which show that people attribute blame and intentionality to the chairman of a company that knowingly causes harmful side effects, but do not attribute praise and intentionality to the chairman of a company that knowingly causes helpful side effects. Knobe's explanation of this data is that people determine intentionality based on the moral consideration of whether the side effect is good or bad. This observation and explanation has come to (...) be known as the "Knobe Effect." One implication from the Knobe Effect is that it seems profit-driven businesses can only intentionally cause harmful and never good side effects. This paper examines the Knobe Effect, and argues for a way that business persons can understand it and avoid its implications. The argument has three parts. The first point is that business persons who care only about profits are blameworthy and rightly should not get credit for good side effects. Second, when a morally praiseworthy person who cares about values other than profits causes side effects, her actions are intentional and praiseworthy. Therefore, profit-driven business persons can be praised for intentionally producing good side effects if they consider other moral values as moral agents should. Finally, morally praiseworthy business persons need only to be Minimally Good Samaritans and not totally altruistic. When a business person strives for profits, adheres to other morally important values, and produces morally good side effects, then we should say that she intentionally caused those effects and is praiseworthy. (shrink)

Our goal in this paper is to experimentally investigate whether folk conceptions of explanation are psychologistic. In particular, are people more likely to classify speech acts as explanations when they cause understanding in their recipient? The empirical evidence that we present suggests this is so. Using the side-effect effect as a marker of mental state ascriptions, we argue that lay judgments of explanatory status are mediated by judgments of a speaker’s and/or audience’s mental states. First, we show (...) that attributions of both understanding and explanation exhibit a side-effect effect. Next, we show that when the speaker’s and audience’s level of understanding is stipulated, the explanation side-effect effect goes away entirely. These results not only extend the side-effect effect to attributions of understanding, they also suggest that attributions of explanation exhibit a side-effect effect because they depend upon attributions of understanding, supporting the idea that folk conceptions of explanation are psychologistic. (shrink)

There is a puzzle about the very possibility of foreseen but unintended side effects, and solving this puzzle requires us to revise our basic picture of the structure of practical deliberation. The puzzle is that, while it seems that we can rationally foresee, but not intend, bringing about foreseen side effects, it also seems that we rationally must decide to bring about foreseen side effects and that we intend to do whatever we decide to do. I propose (...) solving this puzzle by rejecting the idea that we intend to do whatever we decide to do. My solution involves taking account of the underappreciated role that qualified intentions play in deliberation. I also argue that this solution fares better than those that instead reject the idea that we rationally must decide to bring about foreseen side effects, for these solutions are committed to rejecting the even more compelling idea that decisions rationally serve as the conclusions of practical deliberation. (shrink)

Certain recent experiments are often taken to show that people are far more likely to classify a foreseen side-effect of an action as intentional when that side-effect has some negative normative valence. While there is some disagreement over the details, there is broad consensus among experimental philosophers that this is the finding. We challenge this consensus by presenting an alternative interpretation of the experiments, according to which they show that a side-effect is classified as (...) intentional only if the agent considered its relative importance when deciding on the action. We present two new experiments whose results can be explained by our hypothesis but not by any version of the consensus view. In the course of doing so, we develop a methodological critique of the previous literature on this topic and draw from it lessons for future experimental philosophy research. (shrink)

The side-effect effect is the seemingly irrational tendency for people to say harmful side effects were more intentional than helpful side effects of the same action. But the tendency may not be irrational. According to the Tradeoffs Justification Model, judgments of a person's intentions to cause harm depend on how that person decided to act, and on whether the reasons for acting justified causing the harmful consequences. Across three experiments (N = 660), unjustified harms were (...) viewed as more intentional than justified harms. If the person had a choice of what to do and knowingly caused harm for no good reason, people judged that the person must have actually desired and intended to cause the harm. However, if the person had a strong, compelling reason (e.g., to ransom his daughter from kidnappers) that the observer deemed to have justified causing the harm, then observers thought the harm was weakly intended at most. Taboo harms that violated sacred moral values were especially likely to be seen as intentional because most reasons do not adequately justify violating a sacred value. (shrink)

The Knobe effect :190–194, 2003a) consists in our tendency to attribute intentionality to bringing about a side effect when it is morally bad but not when it is morally good. Beebe and Buckwalter have demonstrated that there is an epistemic side-effect effect : people are more inclined to attribute knowledge when the side effect is bad in Knobe-type cases. ESEE is quite robust. In this paper, I present a new explanation of ESEE. (...) I argue that when people attribute knowledge in morally negative cases, they express a consequence-knowledge claim rather than a predictive claim. I use the omissions account :550–571, 2015) to explain why the consequence-knowledge claim is particularly salient in morally negative cases. Unlike the doxastic heuristic account :264–289, 2012), the omissions account can explain the persistence of ESEE in the so-called slight-chance of harm conditions. I present the results of empirical studies that test the predictions of the account. I show that ESEE occurs in Butler-type scenarios. Some of the studies involve close replications of Nadelhoffer’s :277–284, 2004) study. (shrink)

Philosophical discussions have critically analysed the methodological pitfalls and epistemological implications of evidence assessment in medicine, however they have mainly focused on evidence of treatment efficacy. Most of this work is devoted to statistical methods of causal inference with a special attention to the privileged role assigned to randomized controlled trials (RCTs) in evidence based medicine. Regardless of whether the RCT’s privilege holds for efficacy assessment, it is nevertheless important to make a distinction between causal inference of intended and unintended (...) effects, in that the unknowns at stake are heterogonous in the two contexts. However, although “lower level” evidence is increasingly acknowledged to be a valid source of information contributory to assessing the risk profile of medications on theoretical or empirical grounds, current practices have difficulty in assigning a precise epistemic status to this kind of evidence because they are more or less implicitly parasitic on the (statistical) methods developed to test drug efficacy. My thesis is that (1) “lower level” evidence is justified on distinct grounds and at different conditions depending on the different epistemologies which one wishes to endorse, in that each impose different constraints on the methods we adopt to collect and evaluate evidence; (2) such constraints ought to be understood to be different in the case of evidence for risk versus benefit assessment for a series of reasons which I will illustrate on the basis of the recent debate on the causal association between acetaminophen (a.k.a. paracetamol) and asthma. (shrink)

We explore and provide an account for a recently identified judgment anomaly, i.e., an order effect that changes the strength of intentionality ascriptions for some side effects (e.g., when a chairman's pursuit of profits has the foreseen but unintended consequence of harming the environment). Experiment 1 replicated the previously unanticipated order effect anomaly controlling for general individual differences. Experiment 2 revealed that the order effect was multiply determined and influenced by factors such as beliefs (i.e., that (...) the same actor was involved in bringing about both good and bad side effects) and philosophical training (i.e., more training was associated with smaller differences in judgment when harm followed help). Results provide more evidence that the folk's philosophically relevant intuitions are predictably fragmented and depend on the dynamic interplay between persons, process, and environments. Methodological and theoretical implications are discussed. (shrink)

Mind &Language, Volume 34, Issue 3, Page 357-375, June 2019.

Joshua Knobe's work has marshaled considerable support for the hypothesis that everyday judgments of whether an action is intentional are systematically influenced by evaluations of the action or agent. The main source of evidence for this hypothesis is a series of surveys that involve an agent either helping or harming something as a side effect. Respondents are much more likely to judge the side effect intentional if harm is involved. It is a remarkable feature of the (...) discussion so far that it assumes without scrutiny that the substitution of one act-type for another could not, taken alone, explain the difference in responses that the two scenarios yield. This paper presents evidence, both experimental and conceptual, that it is precisely this difference that explains the asymmetry in responses. Briefly, agents who token the act-type help must fulfill certain psychological conditions that they don't have to fulfill if they are to token the act-type harm. Harming, unlike helping, does not require the ful.. (shrink)

The Doctrine of Double Effect (DDE) provides that, all else equal, intentional deaths are harder to justify than merely foreseen deaths. The principle is meant to ground the distinction within humanitarian law between terror bombing and strategic bombing. However, according to the “closeness problem,” terror bombers are not necessarily intentional killers. Terror bombing strictly requires only that the civilians appear dead, goes the argument, such that—for a “sophisticated” terror bomber—the civilians’ deaths could be unintended side-effects of making them (...) appear dead. But if intentions could be calibrated so finely and strategically, the argument continues, then the DDE would very doubtfully be true. This essay replies to the closeness problem in three steps. First, agents often intend _causal processes_, with specific causal “ingredients,” as the proximate means of bringing about their specifically intended means or ends. Second, when an agent foresees a byproduct as resulting directly from their intended causal process, it is morally equivalent to a specifically intended outcome. The process’s causal relationship to the byproduct is constitutive of the process from the agent’s perspective. Third, a “sophisticated” terror bomber’s intended causal process involves blowing up the civilians, while a strategic bomber’s involves blowing up, say, a munitions factory. Thus, because the “sophisticated” terror bomber foresees their intended causal process as resulting directly in the civilians’ deaths, while the strategic bomber foresees their deaths as side-effects of their intended causal process occurring within an environment that happens to contain civilians, the DDE can distinguish between the bombers. (shrink)

Side effects are a concern in medical decision making and a robust area of biomedical research. However, there is relatively little philosophical investigation into side effects as such, especially given that side effects are appealed to for various applications in philosophy of medicine. In addition, health authorities like the FDA, CDC, and WHO have contrary definitions of ‘side effect.’ Moreover, these definitions have clear counterexamples. This dissertation aims to provide a complete account of what (...) class='Hi'>side effects are. I posit that an account of side effects ought to draw clean conceptual lines between side effects and related treatment outcomes. I contend that an account of side effects must address two components: the reasons behind an intervention that produced the side effect, and the causal powers of the intervention that brought about that effect. With this account in mind, I address contemporary philosophical models that distinguish placebo effects from side effects. These arguments, respectively in chapters 2 and 3, yield a more complete, less problematic account of side effects than previous accounts. The dissertation then turns to the process of discovering side effects, specifically in the post-market context. Given the paucity of external validity in pre-market drug trials, chapter 4 argues that post-market ‘phase IV’ trials blur the received distinction of ‘confirmatory’ versus ‘exploratory’ experimentation in philosophy of science. The other component of post-market drug research is spontaneous reporting, or the voluntary reporting of a suspected side effect to a regulatory body. Chapter 5 uses the framework of risks and values in science to examine why clinicians underreport, which hinders our ability to prevent drug-related harms. Chapter 6 looks at how patients could mitigate underreporting and develops a social-epistemic, pragmatic, and ethical framework which can evaluate proposals to engage patients to spontaneously report their suspected side effects. In short, this dissertation aims to firstly address the conceptual problems in how we define ‘side effect’ and relate it to other treatment outcomes, and secondly it addresses issues that hinder the scientific investigation of side effects. (shrink)

We discuss two philosophical explanations of the epistemic side-effect effect: the doxastic heuristic account (Alfano et al. The Monist 95 (2): 264–289, 2012) and the consequence account (Paprzycka-Hausman Synthese 197: 5457–5490, 2020). We argue that the doxastic heuristic account has problems with explaining knowledge attributions in cases where the probability that the side effect will occur is low and where the side effect does not ultimately occur. It can explain why there is a (...) difference between the harm and the help cases but it cannot explain why people are willing to attribute knowledge in the harm cases. Such attributions can be explained on the consequence account, which takes knowledge attributions in norm-violation cases to be due to the increased salience of a consequence-awareness claim (knowledge that a possible consequence of the chairman’s action is that the environment would be harmed). We report the results of a new study that tests the predictions of both accounts. In some conditions, people attribute knowledge of the side effect even in cases where the chairman does not have the relevant belief. This result directly contradicts the central tenet of the doxastic heuristic account. Linear regression models of knowledge attribution that correspond to the two accounts were compared. The addition of different justification options significantly contributes to the predictive power of the statistical model. The consequence account can explain the pattern of justifications better than the doxastic heuristic account. Our findings support the consequence account and pose a challenge to the proponents of the doxastic heuristic account. (shrink)

Side effects are ubiquitous in medicine and they often play a role in treatment decisions for patients and clinicians alike. Philosophers and health researchers often use side effects to illustrate issues with contemporary medical research and practice. However, technical definitions of ‘side effect’ differ among health authorities. Thus, determining the side effects of an intervention can differ depending on whose definition we assume. Here I review some of the common definitions of side effect (...) and highlight their issues. In response, I offer an account of side effects as jointly (i) unintended and (ii) effects due to the causal capacities or invariances of an intervention. I discuss (i) by examining the intentions or reasons behind therapeutic interventions, and I discuss (ii) by appealing to a manipulationist model of causation. The analysis here highlights that side effects are conceptually distinct from related outcomes like adverse events, adverse drug reactions, and placebo effects. The analysis also allows for reflection on the utility of ‘side effect’ as a technical term in medical research and practice. (shrink)

In everyday discourse, we often draw a distinction between actions that are performed intentionally (e.g. opening your car door) and those that are performed unintentionally (e.g. shutting a car door on your finger). This distinction has interested philosophers working in a number of different areas. Indeed, intentional actions are not only the primary focus of those concerned with understanding and explaining human behavior, but they often occupy center stage in philosophical discussions of free will and moral and legal responsibility as (...) well. And while most philosophers agree that the distinction between intentional and unintentional action plays an important role in our folk psychology, there is still wide-scale disagreement about the precise nature of this role. Until recently, there has been a lack of empirical data about the folk concept of intentional action and as a result the debate among philosophers has been mostly. (shrink)

In this Current Controversy article, I describe and analyse the imminent move to a system of deemed consent for deceased organ donation in England and similar planned changes in Scotland, in light of evidence from Wales, where the system changed in 2015. Although the media has tended to focus on the potential benefits and ethical issues relating to the main change from an opt-in default to an opt-out one, other defaults will also change, while some will remain the same. Interaction (...) of these other defaults with the principal one raise several ethical issues that may complicate efforts to use deemed consent to increase donation rates. Most significantly, changing the main default will have the effect of changing the default for patients' families, who play a vital role in the consent process. (shrink)

ObjectiveHormone positive breast cancer patients bear side effects of endocrine therapy and that may be related to depression and anxiety. We sought to find an association between mental health and side effects of endocrine therapy.MethodsA total of 398 patients participated. Sociodemographic, disease profile, and side effects questionnaires were administered. We screened for depressive and anxiety disorders by using the SDS and SAS.ResultsThe prevalence of depression and anxiety in our study were 33.4% and 13.3%, respectively. Depression was linked (...) to education level, night sweats, vaginal dryness, and fatigue ; anxiety was associated with education level, time to diagnosis, osteopenia, loss of hair, and fatigue. A stratified analysis according to age was performed as an exploratory. None of factor-age interactions was statistically significant.ConclusionSide effects of endocrine therapy were significantly associated with anxiety and depression. Side effects deserve greater emphasis and clinical interventions are needed to reduce anxiety and depression in breast cancer patients accepting ET. (shrink)

Experimental research suggests that people draw a moral distinction between bad outcomes brought about as a means versus a side effect (or byproduct). Such findings have informed multiple psychological and philosophical debates about moral cognition, including its computational structure, its sensitivity to the famous Doctrine of Double Effect, its reliability, and its status as a universal and innate mental module akin to universal grammar. But some studies have failed to replicate the means/byproduct effect especially in the (...) absence of other factors, such as personal contact. So we aimed to determine how robust the means/byproduct effect is by conducting a meta-analysis of both published and unpublished studies (k = 101; 24,058 participants). We found that while there is an overall small difference between moral judgments of means and byproducts (standardized mean difference = 0.87, 95% CI 0.67 – 1.06; standardized mean change = 0.57, 95% CI 0.44 – 0.69; log odds ratio = 1.59, 95% CI 1.15 – 2.02), the mean effect size is primarily moderated by whether the outcome is brought about by personal contact, which typically involves the use of personal force. (shrink)

The U.S. health care system is ostensibly market based and therefore at least partially reliant on competition and consumer demand to regulate costs. Yet information about an essential feature of market transactions—costs—is typically obscure to patients until long after treatment. When discussing what must be disclosed for informed consent, the same list of required information is often mentioned regardless of the health care system in question, and information about costs rarely merits a place within this list. However, our assumptions about (...) what a moral principle requires need to be responsive to the realities of the health care system in which the principle is applied.This paper explores the moral foundations of disclosure and informed consent to argue that, in a market‐based system of the sort found in the United States, these same considerations support a requirement to disclose out‐of‐pocket costs before patients receive care. Next, I consider two objections to this view: first, that health care practitioners should focus solely on medical considerations in their encounters with patients and, second, that disclosing out‐of‐pocket costs would be too difficult to be mandated. I argue that medical and financial interests are inseparable within the U.S. health care system. If the difficulties in disclosing costs are deemed insurmountable, then the current system may prove unsustainable, both morally and financially, since we face the same practical impediments to implementing any meaningful consumer‐driven, market‐based health care reform. Finally, I explore some of the consequences of failing to disclose costs. The requirements of disclosing costs can be supported by the principle of respect for autonomy, regardless of the consequences, but in light of the consequences of the decision of whether to disclose, a concern about justice provides further support. (shrink)

There has been a long-standing dispute in the philosophical literature about the conditions under which a behavior counts as 'intentional.' Much of the debate turns on questions about the use of certain words and phrases in ordinary language. The present paper investigates these questions empirically, using experimental techniques to investigate people's use of the relevant words and phrases. g.

Can an event’s blameworthiness distort whether people see it as intentional? In controversial recent studies, people judged a behavior’s negative side effect intentional even though the agent allegedly had no desire for it to occur. Such a judgment contradicts the standard assumption that desire is a necessary condition of intentionality, and it raises concerns about assessments of intentionality in legal settings. Six studies examined whether blameworthy events distort intentionality judgments. Studies 1 through 4 show that, counter to recent (...) claims, intentionality judgments are systematically guided by variations in the agent’s desire, for moral and nonmoral actions alike. Studies 5 and 6 show that a behavior’s negative side effects are rarely seen as intentional once people are allowed to choose from multiple descriptions of the behavior. Specifically, people distinguish between “knowingly” and “intentionally” bringing about a side effect, even for immoral actions. These studies suggest that intentionality judgments are unaffected by a behavior’s blameworthiness. (shrink)

A recent study published in the American Journal of Organ Transplantation proposes that an organ donor application in Facebook can increase the rates at which individuals donate organs. While I offer support for the use of social media mechanisms in the service of the promotion of organ donation public health initiatives, there are several ethical concerns surrounding informed consent.While Facebook has made a noble effort to aid public health initiatives focused on organ donation, the current application does not promote decisions (...) that are based on individuals’ personal values and goals. Without an intervention that promotes an understanding and appreciation of a decision for or against donation, the application does not obtain informed consent. Without first ensuring that a Facebook member has registered with her or his own state donor registry, this social media mechanism may create more confusion than clarity about an individual’s organ donor status.If Facebook desires to have a positive impact on the rates of organ donation, it must do so in a manner that obtains proper consent and promotes ethically informed decisions. (shrink)

In relation to semantics, “grounding” has two relevant meanings. “Symbol grounding” is the process of connecting symbols to perception and the world. “Communicative grounding” is the process of interactively adding to common ground in dialog. Strategies for grounding in human communication include, crucially, strategies for resolving troubles caused by various kinds of miscommunication. As it happens, these two processes of grounding are closely related. As a side-effect of grounding an utterance, dialog participants may adjust the meanings they assign (...) to linguistic expressions, in a process of semantic coordination. Meanings of at least some expressions include perceptual aspects which enable DPs to classify entities as falling under the expression or not based on their perception of those entities. We show how perceptual grounding of symbols can be achieved in a process of interactively adding to common ground. This requires that perceptual aspects of meaning can be updated as a result of participating in linguistic interaction, thereby enabling fine-grained semantic coordination of perceptually grounded linguistic meanings. A formal semantics for low-level perceptual aspects of meaning is presented, tying these together with the logical-inferential aspects of meaning traditionally studied in formal semantics. The key idea is to model perceptual meanings as classifiers of perceptual input. This requires a framework where intensions are represented independently of extensions, and structured objects which can be modified as a result of learning. We use Type Theory with Records, a formal semantics framework which starts from the idea that information and meaning are founded on our ability to perceive and classify the world, that is, to perceive objects and situations as being of types. As an example of our approach, we show how a simple classifier of spatial information based on the Perceptron can be cast in TTR. (shrink)

The problem of collecting, analyzing and evaluating evidence on adverse drug reactions (ADRs) is an example of the more general class of epistemological problems related to scientific inference and prediction, as well as a central problem of the health-care practice. Philosophical discussions have critically analysed the methodological pitfalls and epistemological implications of evidence assessment in medicine, however they have mainly focused on evidence of treatment efficacy. Most of this work is devoted to statistical methods of causal inference with a special (...) attention to the privileged role assigned to randomized controlled trials in Evidence Based Medicine. Regardless of whether the RCT’s privilege holds for efficacy assessment, it is nevertheless important to make a distinction between causal inference of intended and unintended effects, in that the unknowns at stake are heterogonous in the two contexts. This point has been emphasized by epidemiologists in the last decade. Their main focus is methodological, and regards the fact that bias and confounding do not affect studies on intended and unintended effects in the same way. However, deeper concerns ground the intuition for such a distinction; these are related to the constraints which we impose on evidence and their epistemological justification. My thesis is that such constraints ought to be understood to be different in the case of evidence for risk vs. benefit assessment. I present the recent debate on the causal association between acetaminophen and asthma in order to illustrate the point at issue. (shrink)

Genetic interventions, which include transgenic engineering, gene editing, and other forms of genome modification aimed at altering the information “in” the genetic code, are rapidly increasing in power and scale. Biosemiotics offers unique tools for understanding the nature, risks, scope, and prospects of such technologies, though few in the community have turned their attention specifically in this direction. Bruni is an important exception. In this paper, I examine how we frame the concept of “side effects” that result from genetic (...) interventions and how the concept stands up to current perspectives of the role of organism activity in development. I propose that once the role of living systems in constructing and modifying the informational value of their various developmental resources is taken into account, the concept of a “side effect” will need to be significantly revised. Far from merely a disturbance brought about in a senseless albeit complex system, a biosemiotic view would take “side effects” as at least sometimes the organism’s active re-organization in order to accommodate or make use of novelty. This insight is nascent in the work of developmental plasticity and niche construction theory, but it is brought into sharper focus by the explicitly interpretive perspective offered by biosemiotics. Understanding the “side effects” of genetic interventions depends in part on being able to articulate when and where unexpected consequences are a result of semiotic activity at various levels within the system. While a semiotic interpretation of “side effects” puts into question the naive attitude that would see all unintended side effects as indications of disturbance in system functionality, it certainly does not imply that such side effects are of no concern for the viability of the organisms in the system. As we shall see, the fact that such interventions do not respect the translation of information that occurs in multi-level biological systems ensures that disruption is still likely. But it does unprivilege the human agent as the sole generator of meaning and information in the products of biotechnology, with important consequences on how we understand our relationship with other species. (shrink)

On Anscombe's view, intentional actions are characterized by a specific type of knowledge (practical knowledge) possessed by the agents that perform them. Recently, interest in Anscombean action theory has been renewed. Sarah Paul argues that Anscombean action theory faces a serious problem: It fails to discriminate between an action’s intended aim or purpose and its foreseen side effects. Since Anscombeans conceive practical knowledge as the formal cause of intentional actions, Paul dubs this a problem of “deviant formal causation.” In (...) this paper I will show that Anscombean action theory can escape Paul’s critique by employing a sufficiently developed conception of practical knowledge. It will turn out that Anscombeans can precisely capture the difference between intended aim and foreseen side effect in terms of differences in the agent’s knowledge. (shrink)

In a previous paper, I suggested that if an agent is a morally praiseworthy person and one of the consequences of the action she knowingly brings about is morally positive, then this consequence isn’t really a side effect for the agent. Adam Feltz has recently developed a case that purportedly puts pressure on my account of side effects. In the present paper, I am going to argue that Feltz’s purported counter-example fails to undermine my view even if (...) it happens to shed new light on the difference between negative side effects and positive fringe benefits. After responding to Feltz’s criticisms, I will conclude by presenting the results of a pilot study that provide prima facie support for my view. (shrink)