In this article, we explicate evidence-based nursing (EBN), critically appraise its framework and respond to nurses’ concern that EBN sidelines the caring elements of nursing practice. We use resources from care ethics, especially Vrinda Dalmiya’s work that considers care as crucial for both epistemology and ethics, to show how EBN is compatible with, and indeed can be enhanced by, the caring aspects of nursing practice. We demonstrate that caring can act as a bridge between ‘external’ evidence and the other pillars (...) of the EBN framework: clinical expertise; patient preferences and values. Drawing on an influential EBN handbook, section 1 presents the aims and features of EBN, including the normative principle that EBN should take place within a ‘context of caring’. We aim to understand this context and whether it can be neatly detached from the EBN framework, as the handbook seems to suggest. In section 2, we highlight the grounds for resistance to EBN from the nursing community, before mounting the argument that nursing practices can be understood fruitfully through feminist care ethics and/or virtue ethics lenses. In section 3, we deepen that analysis using Dalmiya’s concepts of care-knowing and care as a hybrid ethico-epistemic virtue, which are ideally suited to the complex practices of nursing. In section 4, we bring this rich understanding of care into conversation with EBN, showing that its framework cannot be adequately theorised without paying proper attention to care. Caring can be neither an innocuous background assumption of nor an afterthought to the EBN framework. (shrink)

List of Illustrations Introduction 1 The Didactic and the Elegant: Some Thoughts on Scientific and Technological Illustrations in the Middle Ages and Renaissance 3 2 Temples of the Body and Temples of the Cosmos: Vision and Visualization in the Vesalian and Copernican Revolutions 40 3 Descartes’s Scientific Illustrations and ’la grande mecanique de la nature’ 86 4 Illustrating Chemistry 135 5 Representations of the Natural System in the Nineteenth Century 164 6 Visual Representation in Archaeology: Depicting the Missing-Link in Human (...) Origins 184 7 Towards an Epistemology of Scientific Illustration 215 8 Illustration and Inference 250 9 Visual Models and Scientific Judgment 269 10 Are Pictures Really Necessary? The Case of Sewall Wright’s ’Adaptive Landscapes’ 303 Bibliography 339 Notes on Contributors 373 Index 377. (shrink)

This chapter contains section titled: Kepler's New Astronomy Kepler's New Science of Vision Galileo and the Telescope Galileo and the Creation of Mathematical Physics Mersenne and the New Science.

The new inter-disciplinary eclecticism championed by many philosophers of science has generated a heterogeneous family of science studies projects. Philosophers who favor an inter-disciplinary approach face many problems if they are to successfully forge a hybrid science studies that does not violate their integrity as philosophers in particular, they must isolate an intellectual space in which traditional agendas, such as the concern for the clarification of concepts, can hold court. In this paper, I outline what I regard as a new (...) brand of HPS, one that is deeply rooted in the history of the exact science. The virtue of this New HPS, I will submit, is that it furnishes philosophers of science with a fresh perspective from which to carry on philosophy's classic normative mission. (shrink)

Rationale, Aims, and Objectives: Confidence (or belief) that a therapy is effective is essential to practicing clinical medicine. GRADE, a popular framework for developing clinical recommendations, provides a means for assigning how much confidence one should have in a therapy's effect estimate. One's level of confidence (or “degree of belief”) can also be modelled using Bayes theorem. In this paper, we look through both a GRADE and Bayesian lens to examine how one determines confidence in the effect estimate. Methods: Philosophical (...) examination. Results: The GRADE framework uses a criteria‐based method to assign a quality of evidence level. The criteria pertain mostly to considerations of methodological rigour, derived from a modified evidence‐based medicine evidence hierarchy. The four levels of quality relate to the level of confidence one should have in the effect estimate. The Bayesian framework is not bound by a predetermined set of criteria. Bayes theorem shows how a rational agent adjusts confidence (ie, degree of belief) in the effect estimate on the basis of the available evidence. Such adjustments relate to the principles of incremental confirmation and evidence proportionism. Use of the Bayesian framework reveals some potential pitfalls in GRADE's criteria‐based thinking on confidence that are out of step with our intuitions on evidence. Conclusions: A rational thinker uses all available evidence to formulate beliefs. The GRADE criteria seem to suggest that we discard some of that information when other, more favoured information (eg, derived from clinical trials) is available. The GRADE framework should strive to ensure that the whole evidence base is considered when determining confidence in the effect estimate. The incremental value of such evidence on determining confidence in the effect estimate should be assigned in a manner that is theoretically or empirically justified, such that confidence is proportional to the evidence, both for and against it. (shrink)

The evidence based medicine movement has championed the need for objective and transparent methods of clinical guideline development. The Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) framework was developed for that purpose. Central to this framework is criteria for assessing the quality of evidence from clinical studies and the impact that body of evidence should have on our confidence in the clinical effectiveness of a therapy under examination. Grades of Recommendation, Assessment, Development, and Evaluation has been adopted by a (...) number of professional medical societies and organizations as a means for orienting the development of clinical guidelines. As a result, the method of GRADE has implications on how health care is delivered and patient outcomes. In this paper, we reveal several issues with the underlying logic of GRADE that warrant further discussion. First, the definitions of the “grades of evidence” provided by GRADE, while explicit, are functionally vague. Second, the “criteria for assigning grade of evidence” is seemingly arbitrary and arguably logically incoherent. Finally, the GRADE method is unclear on how to integrate evidence grades with other important factors, such as patient preferences, and trade‐offs between costs, benefits, and harms when proposing a clinical practice recommendation. Much of the GRADE method requires judgement on the part of the user, making it unclear as to how the framework reduces bias in recommendations or makes them more transparent—both goals of the programme. It is our view that the issues presented in this paper undermine GRADE's justificatory scheme, thereby limiting the usefulness of GRADE as a tool for developing clinical recommendations. (shrink)

Translating risk estimates derived from epidemiologic study into evidence of causality for a particular patient is problematic. The difficulty of this process is not unique to the medical context; rather, courts are also challenged with the task of using risk estimates to infer evidence of cause in particular cases. Thus, an examination of how this is done in a legal context might provide insight into when and how it is appropriate to use risk information as evidence of cause in a (...) medical context. A careful study of the case of Goodman v. Viljoen, a medical malpractice suit litigated in the Ontario Superior Court of Justice in 2011, reveals different approaches to how risk information is used as or might be considered a substitute for evidence of causation, and the pitfalls associated with these approaches. Achieving statistical thresholds, specifically minimizing the probability of falsely rejecting the null hypothesis, and exceeding a relative risk of 2, plays a significant role in establishing causality of the particular in the legal setting. However, providing a reasonable explanation or establishing “biological plausibility” of the causal association also seems important, and (to some) may even take precedent over statistical thresholds for a given context. (shrink)

Rationale, aims, and objectives: One of the sectors challenged by the COVID-19 pandemic is medical research. COVID-19 originates from a novel coronavirus (SARSCoV- 2) and the scientific community is faced with the daunting task of creating a novel model for this pandemic or, in other words, creating novel science. This paper is the first part of a series of two papers that explore the intricate relationship between the different challenges that have hindered biomedical research and the generation of scientific knowledge (...) during the COVID-19 pandemic. Methods: During the early stages of the pandemic, research conducted on hydroxychloroquine (HCQ) was chaotic and sparked several heated debates with respect to the scientific methods used and the quality of knowledge generated. Research on HCQ is used as a case study in both papers. The authors explored biomedical databases, peer-reviewed journals, pre-print servers, and media articles to identify relevant literature on HCQ and COVID-19, and examined philosophical perspectives on medical research in the context of this pandemic and previous global health challenges. Results: This paper demonstrates that a lack of prioritization among research questions and therapeutics was responsible for the duplication of clinical trials and the dispersion of precious resources. Study designs, aimed at minimising biases and increasing objectivity, were, instead, the subject of fruitless oppositions. The duplication of research works, combined with poor-quality research, has greatly contributed to slowing down the creation of novel scientific knowledge. Conclusions: The COVID-19 pandemic presented challenges in terms of (1) finding and prioritising relevant research questions and (2) choosing study designs that are appropriate for a time of emergency. (shrink)

Rationale, aims and objectives: The COVID-19 pandemic has impacted every facet of society, including medical research. This paper is the second part of a series of articles that explore the intricate relationship between the different challenges that have hindered biomedical research and the generation of novel scientific knowledge during the COVID-19 pandemic. In the first part of this series, we demonstrated that, in the context of COVID-19, the scientific community has been faced with numerous challenges with respect to (1) finding (...) and prioritizing relevant research questions and (2) choosing study designs that are appropriate for a time of emergency. Methods: During the early stages of the pandemic, research conducted on hydroxychloroquine (HCQ) sparked several heated debates with respect to the scientific methods used and the quality of knowledge generated. Research on HCQ is used as a case study in both papers. The authors explored biomedical databases, peerreviewed journals, pre-print servers and media articles to identify relevant literature on HCQ and COVID-19, and examined philosophical perspectives on medical research in the context of this pandemic and previous global health challenges. Results: This second paper demonstrates that a lack of research prioritization and methodological rigour resulted in the generation of fleeting and inconsistent evidence that complicated the development of public health guidelines. The reporting of scientific findings to the scientific community and general public highlighted the difficulty of finding a balance between accuracy and speed. Conclusions: The COVID-19 pandemic presented challenges in terms of (3) evaluating evidence for the purpose of making evidence-based decisions and (4) sharing scientific findings with the rest of the scientific community. This second paper demonstrates that the four challenges outlined in the first and second papers have often compounded each other and have contributed to slowing down the creation of novel scientific knowledge during the COVID-19 pandemic. (shrink)

Brief response to Brian Baigrie's "The Justification of Kepler’s Ellipse" (1990).

We provide a new interpretation of Zeno’s Paradox of Measure that begins by giving a substantive account, drawn from Aristotle’s text, of the fact that points lack magnitude. The main elements of this account are (1) the Axiom of Archimedes which states that there are no infinitesimal magnitudes, and (2) the principle that all assignments of magnitude, or lack thereof, must be grounded in the magnitude of line segments, the primary objects to which the notion of linear magnitude applies. Armed (...) with this account, we are ineluctably driven to introduce a highly constructive notion of (outer) measure based exclusively on the total magnitude of potentially infinite collections of line segments. The Paradox of Measure then consists in the proof that every finite or potentially infinite collection of points lacks magnitude with respect to this notion of measure. We observe that the Paradox of Measure, thus understood, troubled analysts into the 1880’s, despite their knowledge that the linear continuum is uncountable. The Paradox was ultimately resolved by Borel in his thesis of 1893, as a corollary to his celebrated result that every countable open cover of a closed line segment has a finite sub-cover, a result he later called the “First Fundamental Theorem of Measure Theory.” This achievement of Borel has not been sufficiently appreciated. We conclude with a metamathematical analysis of the resolution of the paradox made possible by recent results in reverse mathematics. (shrink)

Intuitively, Gettier cases are instances of justified true beliefs that are not cases of knowledge. Should we therefore conclude that knowledge is not justified true belief? Only if we have reason to trust intuition here. But intuitions are unreliable in a wide range of cases. And it can be argued that the Gettier intuitions have a greater resemblance to unreliable intuitions than to reliable intuitions. Whats distinctive about the faulty intuitions, I argue, is that respecting them would mean abandoning a (...) simple, systematic and largely successful theory in favour of a complicated, disjunctive and idiosyncratic theory. So maybe respecting the Gettier intuitions was the wrong reaction, we should instead have been explaining why we are all so easily misled by these kinds of cases. (shrink)

I defend normative externalism from the objection that it cannot account for the wrongfulness of moral recklessness. The defence is fairly simple—there is no wrong of moral recklessness. There is an intuitive argument by analogy that there should be a wrong of moral recklessness, and the bulk of the paper consists of a response to this analogy. A central part of my response is that if people were motivated to avoid moral recklessness, they would have to have an unpleasant sort (...) of motivation, what Michael Smith calls “moral fetishism”. (shrink)

I consider the problem of how to derive what an agent believes from their credence function and utility function. I argue the best solution of this problem is pragmatic, i.e. it is sensitive to the kinds of choices actually facing the agent. I further argue that this explains why our notion of justified belief appears to be pragmatic, as is argued e.g. by Fantl and McGrath. The notion of epistemic justification is not really a pragmatic notion, but it is being (...) applied to a pragmatically defined concept, i.e. belief. (shrink)

In his Principles of Philosophy, Descartes says, Finally, it is so manifest that we possess a free will, capable of giving or withholding its assent, that this truth must be reckoned among the first and most common notions which are born with us.

We live in a world of crowds and corporations, artworks and artifacts, legislatures and languages, money and markets. These are all social objects — they are made, at least in part, by people and by communities. But what exactly are these things? How are they made, and what is the role of people in making them? In The Ant Trap, Brian Epstein rewrites our understanding of the nature of the social world and the foundations of the social sciences. Epstein (...) explains and challenges the three prevailing traditions about how the social world is made. One tradition takes the social world to be built out of people, much as traffic is built out of cars. A second tradition also takes people to be the building blocks of the social world, but focuses on thoughts and attitudes we have toward one another. And a third tradition takes the social world to be a collective projection onto the physical world. Epstein shows that these share critical flaws. Most fundamentally, all three traditions overestimate the role of people in building the social world: they are overly anthropocentric. Epstein starts from scratch, bringing the resources of contemporary metaphysics to bear. In the place of traditional theories, he introduces a model based on a new distinction between the grounds and the anchors of social facts. Epstein illustrates the model with a study of the nature of law, and shows how to interpret the prevailing traditions about the social world. Then he turns to social groups, and to what it means for a group to take an action or have an intention. Contrary to the overwhelming consensus, these often depend on more than the actions and intentions of group members. (shrink)

Certain puzzling cases have been discussed in the literature recently which appear to support the thought that knowledge can be obtained by way of deduction from a falsehood; moreover, these cases put pressure, prima facie, on the thesis of counter closure for knowledge. We argue that the cases do not involve knowledge from falsehood; despite appearances, the false beliefs in the cases in question are causally, and therefore epistemologically, incidental, and knowledge is achieved despite falsehood. We also show that the (...) principle of counter closure, and the concomitant denial of knowledge from falsehood, is well motivated by considerations in epistemological theory--in particular, by the view that knowledge is first in the epistemological order of things. (shrink)

Dogmatism is sometimes thought to be incompatible with Bayesian models of rational learning. I show that the best model for updating imprecise credences is compatible with dogmatism.

Intelligent activity requires the use of various intellectual skills. While these skills are connected to knowledge, they should not be identified with knowledge. There are realistic examples where the skills in question come apart from knowledge. That is, there are realistic cases of knowledge without skill, and of skill without knowledge. Whether a person is intelligent depends, in part, on whether they have these skills. Whether a particular action is intelligent depends, in part, on whether it was produced by an (...) exercise of skill. These claims promote a picture of intelligence that is in tension with a strongly intellectualist picture, though they are not in tension with a number of prominent claims recently made by intellectualists. (shrink)

I set out and defend a view on indicative conditionals that I call “indexical relativism ”. The core of the view is that which proposition is expressed by an utterance of a conditional is a function of the speaker’s context and the assessor’s context. This implies a kind of relativism, namely that a single utterance may be correctly assessed as true by one assessor and false by another.

Conciliatory theories of disagreement face a revenge problem; they cannot be coherently believed by one who thinks they have peers who are not conciliationists. I argue that this is a deep problem for conciliationism.

Many writers have held that in his later work, David Lewis adopted a theory of predicate meaning such that the meaning of a predicate is the most natural property that is (mostly) consistent with the way the predicate is used. That orthodox interpretation is shared by both supporters and critics of Lewis's theory of meaning, but it has recently been strongly criticised by Wolfgang Schwarz. In this paper, I accept many of Schwarze's criticisms of the orthodox interpretation, and add some (...) more. But I also argue that the orthodox interpretation has a grain of truth in it, and seeing that helps us appreciate the strength of Lewis's late theory of meaning. (shrink)

In previous work I’ve defended an interest-relative theory of belief. This paper continues the defence. It has four aims. -/- 1. To offer a new kind of reason for being unsatis ed with the simple Lockean reduction of belief to credence. 2. To defend the legitimacy of appealing to credences in a theory of belief. 3. To illustrate the importance of theoretical, as well as practical, interests in an interest-relative account of belief. 4. To revise my account to cover propositions (...) that are practically and theoretically irrelevant to the agent. (shrink)

Recently four different papers have suggested that the supervaluational solution to the Problem of the Many is flawed. Stephen Schiffer (1998, 2000a, 2000b) has argued that the theory cannot account for reports of speech involving vague singular terms. Vann McGee and Brian McLaughlin (2000) say that theory cannot, yet, account for vague singular beliefs. Neil McKinnon (2002) has argued that we cannot provide a plausible theory of when precisifications are acceptable, which the supervaluational theory needs. And Roy Sorensen (2000) (...) argues that supervaluationism is inconsistent with a directly referential theory of names. McGee and McLaughlin see the problem they raise as a cause for further research, but the other authors all take the problems they raise to provide sufficient reasons to jettison supervaluationism. I will argue that none of these problems provide such a reason, though the arguments are valuable critiques. In many cases, we must make some adjustments to the supervaluational theory to meet the posed challenges. The goal of this paper is to make those adjustments, and meet the challenges. (shrink)

Suppose a rational agent S has some evidence E that bears on p, and on that basis makes a judgment about p. For simplicity, we’ll normally assume that she judges that p, though we’re also interested in cases where the agent makes other judgments, such as that p is probable, or that p is well-supported by the evidence. We’ll also assume, again for simplicity, that the agent knows that E is the basis for her judgment. Finally, we’ll assume that the (...) judgment is a rational one to make, though we won’t assume the agent knows this. Indeed, whether the agent can always know that she’s making a rational judgment when in fact she is will be of central importance in some of the debates that follow. (shrink)

I defend interest-relative invariantism from a number of recent attacks. One common thread to my response is that interest-relative invariantism is a muchweaker thesis than is often acknowledged, and a number of the attacks only challenge very specific, and I think implausible, versions of it. Another is that a number of the attacks fail to acknowledge how many things we have independent reason to believe knowledge is sensitive to. Whether there is a defeater for someone's knowledge can be sensitive to (...) all manner of features of their environment, as the host of examples from the post-Gettier literature shows. Adding in interest-sensitive defeaters is a much less radical move than most critics claim it is. (shrink)

Three objections have recently been levelled at the analysis of intrinsicness offered by Rae Langton and David Lewis. While these objections do seem telling against the particular theory Langton and Lewis offer, they do not threaten the broader strategy Langton and Lewis adopt: defining intrinsicness in terms of combinatorial features of properties. I show how to amend their theory to overcome the objections without abandoning the strategy.

Timothy Williamson has recently argued that few mental states are luminous , meaning that to be in that state is to be in a position to know that you are in the state. His argument rests on the plausible principle that beliefs only count as knowledge if they are safely true. That is, any belief that could easily have been false is not a piece of knowledge. I argue that the form of the safety rule Williamson uses is inappropriate, and (...) the correct safety rule might not conflict with luminosity. (shrink)

A contribution to a symposium on Herman Cappelen's Philosophy without Intuitions.

This paper explores an emerging sub-field of both empirical bioethics and experimental philosophy, which has been called “experimental philosophical bioethics” (bioxphi). As an empirical discipline, bioxphi adopts the methods of experimental moral psychology and cognitive science; it does so to make sense of the eliciting factors and underlying cognitive processes that shape people’s moral judgments, particularly about real-world matters of bioethical concern. Yet, as a normative discipline situated within the broader field of bioethics, it also aims to contribute to substantive (...) ethical questions about what should be done in a given context. What are some of the ways in which this aim has been pursued? In this paper, we employ a case study approach to examine and critically evaluate four strategies from the recent literature by which scholars in bioxphi have leveraged empirical data in the service of normative arguments. (shrink)