It is sometimes thought that randomized study group allocation is uniquely proficient at producing comparison groups that are evenly balanced for all confounding causes. Philosophers have argued that in real randomized controlled trials this balance assumption typically fails. But is the balance assumption an important ideal? I run a thought experiment, the CONFOUND study, to answer this question. I then suggest a new account of causal inference in ideal and real comparative group studies that helps clarify the roles of confounding (...) variables and randomization. 1Confounders and Causes2The Balance Assumption3The CONFOUND Study 3.1CONFOUND 13.2CONFOUND 24Disjunction C and the Ideal Study 4.1The ultimate ‘other cause’: C4.2The ideal comparative group study4.3Required conditions for causal inference5Confounders as Causes, Confounders as Correlates6Summary. (shrink)

Many epidemics consist in individuals spreading infection to others. From the population perspective, they also have population characteristics important in modeling, explaining, and intervening in epidemics. I analyze epidemiology’s contemporary population perspective through the example of epidemics by examining two central principles attributed to Geoffrey Rose: a distinction between the causes of cases and the causes of incidence, and between “high-risk” and “population” strategies of prevention. Both principles require revision or clarification to capture the sense in which they describe distinct (...) perspectives on the same phenomenon, each perspective capturing a different level of contrastive analysis. (shrink)

Introduction: Clinical practice guidelines (CPGs) are an important source of justification for clinical decisions in modern evidence-based practice. Yet, we have given little attention to how they argue their evidence. In particular, how do CPGs argue for treatment with long-term medications that are increasingly prescribed to older patients? Approach and rationale: I selected six disease-specific guidelines recommending treatment with five of the medication classes most commonly prescribed for seniors in Ontario, Canada. I considered the stated aims of these CPGs and (...) the techniques employed towards those aims. Finally, I reconstructed and logically analysed the arguments supporting recommendations for pharmacotherapy. Analysis: The primary function of CPGs is rhetorical, or persuasive, and their means of persuasion include both a display of their credibility and their argumentation. Arguments supporting pharmacotherapy recommendations for the target population follow a common inductive pattern: statistical generalization from randomized controlled trial (RCT) and meta-analysis evidence. Two of the CPGs also argue their treatment recommendations for older patients in this style, while three fail to justify pharmacotherapy specifically for the older population. Discussion: The arguments analysed lack the auxiliary assumptions that would warrant making a generalization about the clinical effectiveness of medications for the older population. Guidelines reason using simple induction, while ignoring important inferential gaps. Future guidelines should aspire to be well-reasoned rather than simply evidence-based; argue from a plurality of evidence; be wary of hasty inductions; appropriately limit the scope of their recommendations; and avoid making law-like, prescriptive generalizations. (shrink)

Over the past several decades, we devoted much energy to generating, reviewing and summarizing evidence. We have given far less attention to the issue of how to thoughtfully apply the evidence once we have it. That’s fine if all we care about is that our clinical decisions are evidence-based, but not so good if we also want them to be well-reasoned. Let us not forget that evidence based medicine (EBM) grew out of an interest in making medicine ‘rational’, with the (...) idea that rational clinical evaluations should be evidence-based. I agree with the uncontroversial statement that the best decision is supported, at least in part, by the best available evidence. Rationality, however, is constituted by reasoning, not evidence. Complete arguments are necessary for rational evaluations, arguments that begin with general evidence and end in a conclusion about a particular patient. In order to traverse these inferential gaps, medicine must address the issue of how to establish, as an intermediate premise, what the evidence has to say about the efficacy of an intervention for particular patients in a particular practice setting. (shrink)

The new field of meta-research investigates industry bias, publication bias, contradictions between studies, and other trends in medical research. I argue that its findings should be used as meta-evidence for evaluating therapies. ‘Meta-evidence’ is evidence about the support that direct ‘first-order evidence’ provides the hypothesis. I consider three objections to my proposal: the irrelevance objection, the screening-off objection, and the underdetermination objection. I argue that meta-research evidence works by rationally revising our confidence in first-order evidence and, consequently, in the hypothesis—typically, (...) downward. (shrink)

What meaning does epidemiological evidence have for the individual? In evidence-based medicine, epidemiological evidence measures the patient’s risk of the outcome or the change in risk due to an intervention. The patient’s risk is commonly understood as an individual probability. The problem of understanding epidemiological evidence and risk thus becomes the challenge of interpreting individual patient probabilities. I argue that the patient’s risk is interpreted ontically, as a propensity. After exploring formidable problems with this interpretation in the medical context, I (...) propose an epistemic reinterpretation of individual patient probabilities as credences. On this view, epidemiological evidence informs medical uncertainty. (shrink)

Over the past 25 years, several new “medicines” have come screeching onto health care’s various platforms, including narrative medicine, personalized medicine, precision medicine and person-centred medicine. Philosopher Miriam Solomon calls the first three of these movements different “ways of knowing” or “methods,” and argues that they are each a response to shortcomings of methods that came before them. They should also be understood as reactions to the current dominant model of medicine. In this article, I will describe our dominant model, (...) which I call “the new medical model.” I will argue that several towering problems in modern medicine can be traced to its philosophical foundations, which calls for philosophical analysis. (shrink)

Last year saw the 20th anniversary edition of JECP, and in the introduction to the philosophy section of that landmark edition, we posed the question: apart from ethics, what is the role of philosophy ‘at the bedside’? The purpose of this question was not to downplay the significance of ethics to clinical practice. Rather, we raised it as part of a broader argument to the effect that ethical questions – about what we should do in any given situation – are (...) embedded within whole understandings of the situation, inseparable from our beliefs about what is the case, what it is that we feel we can claim to know, as well as the meaning we ascribe to different aspects of the situation or to our perception of it. Philosophy concerns fundamental questions: it is a discipline requiring us to examine the underlying assumptions we bring with us to our thinking about practical problems. Traditional academic philosophers divide their discipline into distinct areas that typically include logic: questions about meaning, truth and validity; ontology: questions about the nature of reality, what exists; epistemology: concerning knowledge; and ethics: how we should live and practice, the nature of value. Any credible attempt to analyse clinical reasoning will require us to think carefully about these types of question and the relationships between them, as they influence our thinking about specific situations and problems. So, the answers to the question we posed, about the role of philosophy at the bedside, are numerous and diverse, and that diversity is illustrated in the contributions to this thematic edition. (shrink)

This chapter begins with an empirical analysis of attitudes towards the law, which, in turn, inspires a philosophical re-examination of the moral status of the rule of law. In Section 2, we empirically analyse relevant survey data from the US. Although the survey, and the completion of our study, preceded the recent anti-police brutality protests sparked by the killing of George Floyd, the relevance of our observations extends to this recent development and its likely reverberations. Consistently with prior studies, we (...) find that people’s ascriptions of legitimacy to the legal system are predicted strongly by their perceptions of the procedural justice and lawfulness of police and court officials’ action. Two factors emerge as significant predictors of people’s compliance with the law: (i) their belief that they have a (content-independent, moral) duty to obey the law (which is one element of legitimacy, as defined here); and (ii) their moral assessment of the content of specific legal requirements (‘perceived moral content of laws’). We also observe an interactive relationship between these two factors. At higher levels of perceived moral content of laws, felt duty to obey is a better predictor of compliance. And, similarly, perceived moral content of laws is a better predictor of compliance at higher levels of felt duty to obey. This suggests that the moral content incorporated in specific laws interacts with the normative force people ascribe to legal authorities by virtue of other qualities, specifically here procedural justice and lawfulness. In Section 3, the focus shifts to a philosophical analysis, whereby we identify a parallel (similarly interactive) modality in the way that form and content mutually affect the value of the rule of law. We advocate a distinctive alternative to two rival approaches in jurisprudential discourse, the first of which claims that Lon Fuller’s eight precepts of legality embody moral qualities not contingent on the law’s content, while the second denies any independent moral value in these eight precepts, viewing them as entirely subservient to the law’s substantive goals. In contrast, on the view put forward here, Fuller’s principles possess (inter alia) an expressive moral quality, but their expressive effect does not materialise in isolation from other, contextual factors. In particular, the extent to which it materialises is partly sensitive to the moral quality of the law’s content. (shrink)

This article gives an overview of some recent debates about the relationship between reasons and rational requirements of coherence - e.g. the requirements to be consistent in our beliefs and intentions, and to intend what we take to be the necessary means to our ends.

Epistemic Courage is a timely and thought-provoking exploration of the ethics of belief, which shows why epistemology is no mere academic abstraction - the question of what to believe couldn't be more urgent. Jonathan Ichikawa argues that a skeptical, negative bias about belief is connected to a conservative bias that reinforces the status quo.

This chapter examines the ways in which the debates about the epistemic significance of disagreement are debates about the nature and impact of higher-order evidence.

Causal claims are context sensitive. According to the old orthodoxy (Mackie 1974, Lewis 1986, inter alia), the context sensitivity of causal claims is all due to conversational pragmatics. According to the new contextualists (Hitchcock 1996, Woodward 2003, Maslen 2004, Menzies 2004, Schaffer 2005, and Hall ms), at least some of the context sensitivity of causal claims is semantic in nature. I want to discuss the prospects for causal contextualism, by asking why causal claims are context sensitive, what they are sensitive (...) to, and where they are sensitive to it. (shrink)

D. M. Armstrong famously claims that deterministic laws of nature are contingent relations between universals and that his account can also be straightforwardly extended to irreducibly probabilistic laws of nature. For the most part, philosophers have neglected to scrutinize Armstrong’s account of probabilistic laws. This is surprising precisely because his own claims about probabilistic laws make it unclear just what he takes them to be. We offer three interpretations of what Armstrong-style probabilistic laws are, and argue that all three interpretations (...) are incompatible either with some feature of Armstrong’s broader metaphysics or with essential features of his account of laws (or both). (shrink)

Political polarization is one of the most discussed challenges facing contemporary democracies and is often associated with a broader epistemic crisis. While inspiring a large literature in political science, polarization’s epistemic problems also have significance for normative democratic theory, and this study develops a new approach aimed at understanding them. In contrast to prominent accounts from political psychology—group polarization theory and cultural cognition theory—which argue that polarization leads individuals to form unreliable political beliefs, this study focuses on system-level diversity. It (...) argues that polarization’s epistemic harms are best located in its tendency to reduce the diversity of perspectives utilized in a democratic system and in how this weakens the system’s ability to identify and address problems of public concern. Understanding such harms is also argued to require a greater consideration of the political dynamics of polarization and issues of elite discourse, alongside political psychology. (shrink)

This chapter has four central aims. First, in §1, I distinguish two ideas within epistemology that sometimes travel under the name ‘contextualism’ — the ‘situational contextualist’ idea that an individual’s context, especially their social context, can make for a difference in what they know, and the ‘linguistic contextualist’ idea that discourse using the word ‘knows’ and its cognates is context-sensitive, expressing dif- ferent contents in different conversational contexts. -/- Second, in §2, I situate contextualism with respect to several influential ideas (...) in feminist epistemology. These ideas are thoroughgoingly contextualist in the situational sense; I’ll explore the prospects for linguistic contextualist analogues or implementations of them. Simple connections between these feminist ideas and linguistic contextualism will prove elusive, but more subtle ones are possible, and sometimes attractive. -/- §3 considers the degree to which contextual epistemic parameters are determined interpersonally, as opposed to individualistically. Should contextualists hold that speakers can individually determine the contextual parameters that influence the truth- conditions of their utterances? Or are they fixed at a broader social level? I’ll rehearse some influential reasons to opt for the latter, more social, form of contextualism. -/- In §4 I discuss the practical and moral significance of speakers’ choices of epistemic parameters, given contextualism. For example, I’ll consider how standards-raising can be used to discredit evidential sources, with an eye towards the social and moral consequences of such moves. (shrink)

Ross Cameron proposes to reconcile presentism and truth-maker theory by invoking temporal distributional properties, instantiated by present entities, as the truth-makers for truths about the past. This chapter argues that Cameron's proposal fails because objects can change which temporal distributional properties they instantiate and this entails that the truth-values of truths about the past can change in an objectionable way.

Humans often attribute the things that happen to one or another actual cause. In this chapter, we survey some recent philosophical and psychological research on causal attribution. We pay special attention to the relation between graphical causal modeling and theories of causal attribution. We think that the study of causal attribution is one place where formal and experimental techniques nicely complement one another.

In Davidson's philosophy, one finds a wide variety of rich, provocative, and influential arguments concerning the nature of the mind—that mental states emerge only in the context of interpretation, that belief is "in its nature" veridical, that mental events are physical events, and so on. Most, if not all, of Davidson's conclusions about the mind have their source in discussions about the project of "radical interpretation." They rely upon arguments concerning the conditions on the successful interpretation of a speaker by (...) an interpreter who knows nothing initially about the speaker's language or mental states. But what is the relevance of this activity of radical interpretation? Why should the conditions on succeeding at it illuminate anything about the nature of the mind in general? In this paper, I explore these issues. In particular, I will argue that Davidson's confidence in the relevance of radical interpretation for understanding the mind ultimately depends upon a prior and quite substantive view of the mind. Moreover, it is a view of the mind for which Davidson provides little support. Indeed, the little support Davidson does provide appears to depend itself on the very relevance of radical interpretation. (shrink)

According to Paul Boghossian and others, inference is subject to the taking condition: it necessarily involves the thinker taking his premises to support his conclusion, and drawing the conclusion because of that fact. Boghossian argues that this condition vindicates the idea that inference is an expression of agency, and that it has several other important implications too. However, we argue in this paper that the taking condition should be rejected. The condition gives rise to several serious prima facie problems and (...) the reasons which have been offered in favour of it fail to convince. (shrink)

Members of oppressed groups are often silenced. One form of silencing is what Kristie Dotson calls “testimonial smothering”. Testimonial smothering occurs when a speaker limits her testimony in virtue of the reasonable risk of it being misunderstood or misapplied by the audience. Testimonial smothering is thus a form of epistemic paternalism since the speaker is interfering with the audience’s inquiry for their benefit without first consulting them. In this paper, we explore the connections between epistemic injustice and epistemic paternalism through (...) the phenomenon of silencing. We argue that when you silence your testimony as a result of epistemic injustice it is an act of epistemic paternalism and that it is epistemically permissible. In fact, self-silencing resulting from epistemic injustice is a particularly clear example of permissible epistemic paternalism. (shrink)

Research on the capacity to understand others' minds has tended to focus on representations ofbeliefs,which are widely taken to be among the most central and basic theory of mind representations. Representations ofknowledge, by contrast, have received comparatively little attention and have often been understood as depending on prior representations of belief. After all, how could one represent someone as knowing something if one does not even represent them as believing it? Drawing on a wide range of methods across cognitive science, (...) we ask whether belief or knowledge is the more basic kind of representation. The evidence indicates that nonhuman primates attribute knowledge but not belief, that knowledge representations arise earlier in human development than belief representations, that the capacity to represent knowledge may remain intact in patient populations even when belief representation is disrupted, that knowledge (but not belief) attributions are likely automatic, and that explicit knowledge attributions are made more quickly than equivalent belief attributions. Critically, the theory of mind representations uncovered by these various methods exhibits a set of signature features clearly indicative of knowledge: they are not modality-specific, they are factive, they are not just true belief, and they allow for representations of egocentric ignorance. We argue that these signature features elucidate the primary function of knowledge representation: facilitating learning from others about the external world. This suggests a new way of understanding theory of mind – one that is focused on understanding others' minds in relation to the actual world, rather than independent from it. (shrink)

A number of writers have drawn on Hayek’s epistemic defence of market institutions to argue that free-markets and tort law are best placed to overcome the knowledge problems associated with the environmental sphere. This paper argues to the contrary, that this Austrian School approach itself suffers from significant knowledge problems. The first of these relates to the ability of Austrian economics to assign victim compensation and the second to the difficulty of establishing causation in complex environmental problems. The paper will (...) also show how alternative approaches may not suffer from these epistemic challenges and are better placed to overcome them. (shrink)

The collaboration of Language and Computing nv (L&C) and the Institute for Formal Ontology and Medical Information Science (IFOMIS) is guided by the hypothesis that quality constraints on ontologies for software ap-plication purposes closely parallel the constraints salient to the design of sound philosophical theories. The extent of this parallel has been poorly appreciated in the informatics community, and it turns out that importing the benefits of phi-losophical insight and methodology into application domains yields a variety of improvements. L&C’s LinKBase® (...) is one of the world’s largest medical domain ontologies. Its current primary use pertains to natural language processing ap-plications, but it also supports intelligent navigation through a range of struc-tured medical and bioinformatics information resources, such as SNOMED-CT, Swiss-Prot, and the Gene Ontology (GO). In this report we discuss how and why philosophical methods improve both the internal coherence of LinKBase®, and its capacity to serve as a translation hub, improving the interoperability of the ontologies through which it navigates. (shrink)

Non-Relational Realism is a popular solution to the Bradleyan regress of facts or truths. It denies that there is a relational universal of exemplification; for an object a to exemplify a universal F-ness, on this view, is not for a relation to subsist between a and F-ness. An influential objection to Non-Relational Realism is that it is unacceptably obscure. The author argues that Non-Relational Realism can be understood as a selective application of satisfaction semantics to predicates like ‘exemplify’, and that (...) so understood, it is not obscure. This kind of selective use of satisfaction semantics may be feasible in other contexts as a means of making theories more parsimonious. (shrink)

Epistemic questions have become an important area of debate within democratic theory. Epistemic democrats have revived epistemic justification of democracy, while social scientific research has speared a significant debate on voter knowledge. An area which has received less attention, however, is the epistemic case for markets. Market advocates have developed a number of epistemic critiques of democracy which suggest that most goods are better provided by markets than democratic institutions. Despite representing important challenges to democracy, these critiques have gone without (...) reply as democratic theorists have tended to exclude markets from consideration. This article responds to these critiques and argues that there are good epistemic grounds for granting a much greater role to democracy than its market critics have claimed. It argues that there is a broad range of goods, including important ethical goods, which are better provided by democracy than markets due to the particular epistemic burdens they create. (shrink)

This paper pursues the philosophical significance of a relatively unexplored point of Platonic aesthetics: the social dimension of beauty. The social dimension of beauty resides in its conceptual connection to shame and honour. This dimension of beauty is fundamental to the aesthetic education of the Republic, as becoming virtuous for Plato presupposes a desire to appear and to be admired as beautiful. The ethical significance of beauty, shame, and honour redound to an ethically rich notion of appearing before others which (...) corresponds to a public conception of virtue. I suggest how this dimension of beauty in Plato – particularly the emphasis on beautification – proves fruitful for reconsidering the scope and the nature of aesthetic experience. (shrink)

There is no agreement on whether any invertebrates are conscious and no agreement on a methodology that could settle the issue. How can the debate move forward? I distinguish three broad types of approach: theory-heavy, theory-neutral and theory-light. Theory-heavy and theory-neutral approaches face serious problems, motivating a middle path: the theory-light approach. At the core of the theory-light approach is a minimal commitment about the relation between phenomenal consciousness and cognition that is compatible with many specific theories of consciousness: the (...) hypothesis that phenomenally conscious perception of a stimulus facilitates, relative to unconscious perception, a cluster of cognitive abilities in relation to that stimulus. This “facilitation hypothesis” can productively guide inquiry into invertebrate consciousness. What is needed? At this stage, not more theory, and not more undirected data gathering. What is needed is a systematic search for consciousness-linked cognitive abilities, their relationships to each other, and their sensitivity to masking. (shrink)

How does consciousness vary across the animal kingdom? Are some animals ‘more conscious’ than others? This article presents a multidimensional framework for understanding interspecies variation in states of consciousness. The framework distinguishes five key dimensions of variation: perceptual richness, evaluative richness, integration at a time, integration across time, and self-consciousness. For each dimension, existing experiments that bear on it are reviewed and future experiments are suggested. By assessing a given species against each dimension, we can construct a consciousness profile for (...) that species. On this framework, there is no single scale along which species can be ranked as more or less conscious. Rather, each species has its own distinctive consciousness profile. (shrink)

From mitochondria to meerkats, the natural world is full of spectacular examples of social behaviour. In the early 1960s W. D. Hamilton changed the way we think about how such behaviour evolves. He introduced three key innovations - now known as Hamilton's rule, kin selection, and inclusive fitness - and his pioneering work kick-started a research program now known as social evolution theory. This is a book about the philosophical foundations and future prospects of that program. [Note: only the Introduction (...) is available to download.]. (shrink)

Consciousness has an important role in ethics: when a being consciously experiences the frustration or satisfaction of its interests, those interests deserve higher moral priority than those of a behaviourally similar but non-conscious being. I consider the relationship between this ethical role and an a posteriori (or “type-B”) materialist solution to the mind-body problem. It is hard to avoid the conclusion that, if type-B materialism is correct, then the reference of the concept of phenomenal consciousness is radically indeterminate between a (...) neuronal-level property that is distinctive to mammals and a high-level functional property that is much more widely shared. This would leave many non-mammalian animals (such as birds, fish, insects and octopuses) with indeterminate moral status. There are ways to manage this radical moral indeterminacy, but all of these ways lead to profoundly troubling consequences. (shrink)

In debates about animal sentience, the precautionary principle is often invoked. The idea is that when the evidence of sentience is inconclusive, we should “give the animal the benefit of the doubt” or “err on the side of caution” in formulating animal protection legislation. Yet there remains confusion as to whether it is appropriate to apply the precautionary principle in this context, and, if so, what “applying the precautionary principle” means in practice regarding the burden of proof for animal sentience. (...) Here I construct a version of the precautionary principle tailored to the question of animal sentience together with a practical framework for implementing it. I explain and defend the key features of this framework, argue that it is well-aligned with current practice in animal welfare science, and consider and reject a number of influential counterarguments to the use of precautionary reasoning in this area. (shrink)

We are all guided by thousands of norms, but how did our capacity for normative cognition evolve? I propose there is a deep but neglected link between normative cognition and practical skill. In modern humans, complex motor skills and craft skills, such as toolmaking, are guided by internally represented norms of correct performance. Moreover, it is plausible that core components of human normative cognition evolved as a solution to the distinctive problems of transmitting complex motor skills and craft skills, especially (...) skills related to toolmaking, through social learning. If this is correct, the expansion of the normative domain beyond technique to encompass more abstract norms of fairness, reciprocity, ritual and kinship involved the elaboration of a basic platform for the guidance of skilled action by technical norms. This article motivates and defends this “skill hypothesis” for the origin of normative cognition and sets out various ways in which it could be empirically tested. (shrink)

Norm-attitude accounts of value say that for something to be valuable is for there to be norms that support valuing that thing. For example, according to fitting-attitude accounts, something is of value if it is fitting to value, and according to buck-passing accounts, something is of value if the reasons support valuing it. Norm-attitude accounts face the partiality problem: in cases of partiality, what it is fitting to value, and what the reasons support valuing, may not line up with what’s (...) valuable. Buck-passers have a solution to this problem and may claim that this gives them an advantage over fitting-attitude accounts. In this paper, we show how fitting-attitudes accounts can offer a broadly analogous, and equally attractive, solution to the problem. (shrink)

Human neural organoid research is advancing rapidly. As Greely notes in the target article, this progress presents an “onrushing ethical dilemma.” We can’t rule out the possibility that suff...

When agents violate norms, they are typically judged to be more of a cause of resulting outcomes. In this paper, we suggest that norm violations also affect the causality attributed to other agents, a phenomenon we refer to as "causal superseding." We propose and test a counterfactual reasoning model of this phenomenon in four experiments. Experiments 1 and 2 provide an initial demonstration of the causal superseding effect and distinguish it from previously studied effects. Experiment 3 shows that this causal (...) superseding effect is dependent on a particular event structure, following a prediction of our counterfactual model. Experiment 4 demonstrates that causal superseding can occur with violations of non-moral norms. We propose a model of the superseding effect based on the idea of counterfactual sufficiency. (shrink)

Sentience is the capacity to have feelings, such as feelings of pain, pleasure, hunger, thirst, warmth, joy, comfort and excitement. It is not simply the capacity to feel pain, but feelings of pain, distress or harm, broadly understood, have a special significance for animal welfare law. Drawing on over 300 scientific studies, we evaluate the evidence of sentience in two groups of invertebrate animals: the cephalopod molluscs or, for short, cephalopods (including octopods, squid and cuttlefish) and the decapod crustaceans or, (...) for short, decapods (including crabs, lobsters and crayfish). We also evaluate the potential welfare implications of current commercial practices involving these animals. (shrink)