Arguably, there is no substantial, general answer to the question of what makes for the approximate truth of theories. But in one class of cases, the issue seems simply resolved. A wide class of applied dynamical theories can be treated as two-component theories—one component specifying a certain kind of abstract geometrical structure, the other giving empirical application to this structure by claiming that it replicates, subject to arbitrary scaling for units etc., the geometric structure to be found in some real-world (...) dynamical phenomenon. In such a case, a theory is approximately true just if the one geometric structure approximately replicates the other (and if problems remain here, they are problems in geometry, of specifying suitable metric approximation relations, not conceptual problems). This article amplifies and defends this simple approach to approximate truth for dynamical theories. (shrink)

Mainstream epistemology is a highly theoretical and abstract enterprise. Traditional epistemologists rarely present their deliberations as critical to the practical problems of life, unless one supposes—as Hume, for example, did not—that skeptical worries should trouble us in our everyday affairs. But some issues in epistemology are both theoretically interesting and practically quite pressing. That holds of the problem to be discussed here: how laypersons should evaluate the testimony of experts and decide which of two or more rival experts is most (...) credible. It is of practical importance because in a complex, highly specialized world people are constantly confronted with situations in which, as comparative novices, they must turn to putative experts for intellectual guidance or assistance. It is of theoretical interest because the appropriate epistemic considerations are far from transparent; and it is not clear how far the problems lead to insurmountable skeptical quandaries. This paper does not argue for flat-out skepticism in this domain; nor, on the other hand, does it purport to resolve all pressures in the direction of skepticism. It is an exploratory paper, which tries to identify problems and examine some possible solutions, not to establish those solutions definitively. (shrink)

Truth is standardly considered a requirement on epistemic acceptability. But science and philosophy deploy models, idealizations and thought experiments that prescind from truth to achieve other cognitive ends. I argue that such felicitous falsehoods function as cognitively useful fictions. They are cognitively useful because they exemplify and afford epistemic access to features they share with the relevant facts. They are falsehoods in that they diverge from the facts. Nonetheless, they are true enough to serve their epistemic purposes. Theories that contain (...) them have testable consequences, hence are factually defeasible. (shrink)

The initial successes in recent years in harnessing machine learning technologies to improve medical practice and benefit patients have attracted attention in a wide range of healthcare fields. Particularly, it should be achieved by providing automated decision recommendations to the treating clinician. Some hopes placed in such ML-based systems for healthcare, however, seem to be unwarranted, at least partially because of their inherent lack of transparency, although their results seem convincing in accuracy and reliability. Skepticism arises when the physician as (...) the agent responsible for the implementation of diagnosis, therapy, and care is unable to access the generation of findings and recommendations. There is widespread agreement that, generally, a complete traceability is preferable to opaque recommendations; however, there are differences about addressing ML-based systems whose functioning seems to remain opaque to some degree—even if so-called explicable or interpretable systems gain increasing amounts of interest. This essay approaches the epistemic foundations of ML-generated information specifically and medical knowledge generally to advocate differentiations of decision-making situations in clinical contexts regarding their necessary depth of insight into the process of information generation. Empirically accurate or reliable outcomes are sufficient for some decision situations in healthcare, whereas other clinical decisions require extensive insight into ML-generated outcomes because of their inherently normative implications. (shrink)

The aim of this literature review was to compose a narrative review supported by a systematic approach to critically identify and examine concerns about accountability and the allocation of responsibility and legal liability as applied to the clinician and the technologist as applied the use of opaque AI-powered systems in clinical decision making. This review questions if it is permissible for a clinician to use an opaque AI system in clinical decision making and if a patient was harmed as a (...) result of using a clinician using an AIS’s suggestion, how would responsibility and legal liability be allocated? Literature was systematically searched, retrieved, and reviewed from nine databases, which also included items from three clinical professional regulators, as well as relevant grey literature from governmental and non-governmental organisations. This literature was subjected to inclusion/exclusion criteria; those items found relevant to this review underwent data extraction. This review found that there are multiple concerns about opacity, accountability, responsibility and liability when considering the stakeholders of technologists and clinicians in the creation and use of AIS in clinical decision making. Accountability is challenged when the AIS used is opaque, and allocation of responsibility is somewhat unclear. Legal analysis would help stakeholders to understand their obligations and prepare should an undesirable scenario of patient harm eventuate when AIS were used. (shrink)

We discuss the social-epistemic aspects of Catherine Elgin’s theory of reflective equilibrium and understanding and argue that it yields an argument for the view that a crucial social-epistemic function of epistemic authorities is to foster understanding in their communities. We explore the competences that enable epistemic authorities to fulfil this role and argue that among them is an epistemic virtue we call “epistemic empathy”.

Advanced AI systems are rapidly making their way into medical research and practice, and, arguably, it is only a matter of time before they will surpass human practitioners in terms of accuracy, reliability, and knowledge. If this is true, practitioners will have a prima facie epistemic and professional obligation to align their medical verdicts with those of advanced AI systems. However, in light of their complexity, these AI systems will often function as black boxes: the details of their contents, calculations, (...) and procedures cannot be meaningfully understood by human practitioners. When AI systems reach this level of complexity, we can also speak of black-box medicine. In this paper, we want to argue that black-box medicine conflicts with core ideals of patient-centered medicine. In particular, we claim, black-box medicine is not conducive for supporting informed decision-making based on shared information, shared deliberation, and shared mind between practitioner and patient. (shrink)

Many of the computing systems programmed using Machine Learning are opaque: it is difficult to know why they do what they do or how they work. Explainable Artificial Intelligence aims to develop analytic techniques that render opaque computing systems transparent, but lacks a normative framework with which to evaluate these techniques’ explanatory successes. The aim of the present discussion is to develop such a framework, paying particular attention to different stakeholders’ distinct explanatory requirements. Building on an analysis of “opacity” from (...) philosophy of science, this framework is modeled after accounts of explanation in cognitive science. The framework distinguishes between the explanation-seeking questions that are likely to be asked by different stakeholders, and specifies the general ways in which these questions should be answered so as to allow these stakeholders to perform their roles in the Machine Learning ecosystem. By applying the normative framework to recently developed techniques such as input heatmapping, feature-detector visualization, and diagnostic classification, it is possible to determine whether and to what extent techniques from Explainable Artificial Intelligence can be used to render opaque computing systems transparent and, thus, whether they can be used to solve the Black Box Problem. (shrink)

The usefulness of machine learning algorithms has led to their widespread adoption prior to the development of a conceptual framework for making sense of them. One common response to this situation is to say that machine learning suffers from a “black box problem.” That is, machine learning algorithms are “opaque” to human users, failing to be “interpretable” or “explicable” in terms that would render categorization procedures “understandable.” The purpose of this paper is to challenge the widespread agreement about the existence (...) and importance of a black box problem. The first section argues that “interpretability” and cognates lack precise meanings when applied to algorithms. This makes the concepts difficult to use when trying to solve the problems that have motivated the call for interpretability. Furthermore, since there is no adequate account of the concepts themselves, it is not possible to assess whether particular technical features supply formal definitions of those concepts. The second section argues that there are ways of being a responsible user of these algorithms that do not require interpretability. In many cases in which a black box problem is cited, interpretability is a means to a further end such as justification or non-discrimination. Since addressing these problems need not involve something that looks like an “interpretation” of an algorithm, the focus on interpretability artificially constrains the solution space by characterizing one possible solution as the problem itself. Where possible, discussion should be reformulated in terms of the ends of interpretability. (shrink)

The claims of RCTs to be the gold standard rest on the fact that the ideal RCT is a deductive method: if the assumptions of the test are met, a positive result implies the appropriate causal conclusion. This is a feature that RCTs share with a variety of other methods, which thus have equal claim to being a gold standard. This paper describes some of these other deductive methods and also some useful non-deductive methods, including the hypothetico-deductive method. It argues (...) that with all deductive methods, the benefit that the conclusions follow deductively in the ideal case comes with a great cost: narrowness of scope. This is an instance of the familiar trade-off between internal and external validity. RCTs have high internal validity but the formal methodology puts severe constraints on the assumptions a target population must meet to justify exporting a conclusion from the test population to the target. The paper reviews one such set of assumptions to show the kind of knowledge required. The overall conclusion is that to draw causal inferences about a target population, which method is best depends case-by-case on what background knowledge we have or can come to obtain. There is no gold standard. (shrink)

This article reports the findings of AI4People, an Atomium—EISMD initiative designed to lay the foundations for a “Good AI Society”. We introduce the core opportunities and risks of AI for society; present a synthesis of five ethical principles that should undergird its development and adoption; and offer 20 concrete recommendations—to assess, to develop, to incentivise, and to support good AI—which in some cases may be undertaken directly by national or supranational policy makers, while in others may be led by other (...) stakeholders. If adopted, these recommendations would serve as a firm foundation for the establishment of a Good AI Society. (shrink)

Science relies on models and idealizations that are known not to be true. Even so, science is epistemically reputable. To accommodate science, epistemology should focus on understanding rather than knowledge and should recognize that the understanding of a topic need not be factive. This requires reconfiguring the norms of epistemic acceptability. If epistemology has the resources to accommodate science, it will also have the resources to show that art too advances understanding.

This paper offers a sizeable menu of approaches to what it means to be an expert. Is it a matter of reputation within a community, or a matter of what one knows independently of reputation? An initial proposal characterizes expertise in dispositional terms—an ability to help other people get answers to difficult questions or execute difficult tasks. What cognitive states, however, ground these abilities? Do the grounds consist in “veritistic” states or in terms of evidence or justifiedness? To what extent (...) is expertise a matter of superior knowledge or other factors? Some authors seek to debunk the notion of expertise entirely. The present approach resists this stance, but doesn’t dispute the variability and fluidness of the concept. Even more challenging is the problem of how laypersons can determine who is the superior expert, especially when experts disagree. (shrink)

How is medical knowledge made? There have been radical changes in recent decades, through new methods such as consensus conferences, evidence-based medicine, translational medicine, and narrative medicine. Miriam Solomon explores their origins, aims, and epistemic strengths and weaknesses; and she offers a pluralistic approach for the future.

Fredrik Svenaeus' book is a delight to read. Not only does he exhibit keen understanding of a wide range of topics and figures in both medicine and philosophy, but he manages to bring them together in an innovative manner that convincingly demonstrates how deeply these two significant fields can be and, in the end, must be mutually enlightening. Medicine, Svenaeus suggests, reveals deep but rarely explicit themes whose proper comprehension invites a careful phenomenological and hermeneutical explication. Certain philosophical approaches, on (...) the other hand - specifically, Heidegger's phenomenology and Gadamer's hermeneutics - are shown to have a hitherto unrealized potential for making sense of those themes long buried within Western medicine. Richard M. Zaner, Ann Geddes Stahlman Professor of Medical Ethics, Vanderbilt University. (shrink)

It is surely obvious that medicine, like any other rational activity, must be based on evidence. The interest is in the details: how exactly are the general principles of the logic of evidence to be applied in medicine? Focussing on the development, and current claims of the ‘Evidence-Based Medicine’ movement, this article raises a number of difficulties with the rationales that have been supplied in particular for the ‘evidence hierarchy’ and for the very special role within that hierarchy of randomized (...) controlled trials (and meta-analyses of the results of randomized controlled trials). The point is not at all to question the application of a scientific approach to evidence in medicine, but, on the contrary, to indicate a number of areas where philosophers of science can contribute to a proper implementation of exactly that scientific-evidential approach. (shrink)

Many realists have maintained that the success of scientific theories can be explained only if they may be regarded as approximately true. Laurens Laudan has in turn contended that a necessary condition for a theory's being approximately true is that its central terms refer, and since many successful theories of the past have employed central terms which we now understand to be non-referential, realism cannot explain their success. The present paper argues that a realist can adopt a view of reference (...) according to which a theory might plausibly be said to be approximately true even though its central terms do not refer, or alternatively, he may construe reference in such a way as to assign reference to a range of successful older theories which includes Laudan's purported counterexamples. (shrink)

This book brings phenomenology, the main player in the continental tradition of philosophy, to bioethics. Medical science and emerging technologies are examined as endeavours that bring enormous possibilities in relieving human suffering but also great risks in transforming our fundamental life views.

The use of black box algorithms in medicine has raised scholarly concerns due to their opaqueness and lack of trustworthiness. Concerns about potential bias, accountability and responsibility, patient autonomy and compromised trust transpire with black box algorithms. These worries connect epistemic concerns with normative issues. In this paper, we outline that black box algorithms are less problematic for epistemic reasons than many scholars seem to believe. By outlining that more transparency in algorithms is not always necessary, and by explaining that (...) computational processes are indeed methodologically opaque to humans, we argue that the reliability of algorithms provides reasons for trusting the outcomes of medical artificial intelligence. To this end, we explain how computational reliabilism, which does not require transparency and supports the reliability of algorithms, justifies the belief that results of medical AI are to be trusted. We also argue that several ethical concerns remain with black box algorithms, even when the results are trustworthy. Having justified knowledge from reliable indicators is, therefore, necessary but not sufficient for normatively justifying physicians to act. This means that deliberation about the results of reliable algorithms is required to find out what is a desirable action. Thus understood, we argue that such challenges should not dismiss the use of black box algorithms altogether but should inform the way in which these algorithms are designed and implemented. When physicians are trained to acquire the necessary skills and expertise, and collaborate with medical informatics and data scientists, black box algorithms can contribute to improving medical care. (shrink)

This paper focuses on the use of ‘black box’ AI in medicine and asks whether the physician needs to disclose to patients that even the best AI comes with the risks of cyberattacks, systematic bias, and a particular type of mismatch between AI’s implicit assumptions and an individual patient’s background situation.Pacecurrent clinical practice, I argue that, under certain circumstances, these risks do need to be disclosed. Otherwise, the physician either vitiates a patient’s informed consent or violates a more general obligation (...) to warn him about potentially harmful consequences. To support this view, I argue, first, that the already widely accepted conditions in the evaluation of risks, i.e. the ‘nature’ and ‘likelihood’ of risks, speak in favour of disclosure and, second, that principled objections against the disclosure of these risks do not withstand scrutiny. Moreover, I also explain that these risks are exacerbated by pandemics like the COVID-19 crisis, which further emphasises their significance. (shrink)

In recent years, a plethora of high-profile scientific publications has been reporting about machine learning algorithms outperforming clinicians in medical diagnosis or treatment recommendations. This has spiked interest in deploying relevant algorithms with the aim of enhancing decision-making in healthcare. In this paper, we argue that instead of straightforwardly enhancing the decision-making capabilities of clinicians and healthcare institutions, deploying machines learning algorithms entails trade-offs at the epistemic and the normative level. Whereas involving machine learning might improve the accuracy of medical (...) diagnosis, it comes at the expense of opacity when trying to assess the reliability of given diagnosis. Drawing on literature in social epistemology and moral responsibility, we argue that the uncertainty in question potentially undermines the epistemic authority of clinicians. Furthermore, we elucidate potential pitfalls of involving machine learning in healthcare with respect to paternalism, moral responsibility and fairness. At last, we discuss how the deployment of machine learning algorithms might shift the evidentiary norms of medical diagnosis. In this regard, we hope to lay the grounds for further ethical reflection of the opportunities and pitfalls of machine learning for enhancing decision-making in healthcare. (shrink)

This paper discusses the problem of responsibility attribution raised by the use of artificial intelligence technologies. It is assumed that only humans can be responsible agents; yet this alone already raises many issues, which are discussed starting from two Aristotelian conditions for responsibility. Next to the well-known problem of many hands, the issue of “many things” is identified and the temporal dimension is emphasized when it comes to the control condition. Special attention is given to the epistemic condition, which draws (...) attention to the issues of transparency and explainability. In contrast to standard discussions, however, it is then argued that this knowledge problem regarding agents of responsibility is linked to the other side of the responsibility relation: the addressees or “patients” of responsibility, who may demand reasons for actions and decisions made by using AI. Inspired by a relational approach, responsibility as answerability thus offers an important additional, if not primary, justification for explainability based, not on agency, but on patiency. (shrink)

There is widespread agreement that there should be a principle requiring that artificial intelligence be ‘explicable’. Microsoft, Google, the World Economic Forum, the draft AI ethics guidelines for the EU commission, etc. all include a principle for AI that falls under the umbrella of ‘explicability’. Roughly, the principle states that “for AI to promote and not constrain human autonomy, our ‘decision about who should decide’ must be informed by knowledge of how AI would act instead of us” :689–707, 2018). There (...) is a strong intuition that if an algorithm decides, for example, whether to give someone a loan, then that algorithm should be explicable. I argue here, however, that such a principle is misdirected. The property of requiring explicability should attach to a particular action or decision rather than the entity making that decision. It is the context and the potential harm resulting from decisions that drive the moral need for explicability—not the process by which decisions are reached. Related to this is the fact that AI is used for many low-risk purposes for which it would be unnecessary to require that it be explicable. A principle requiring explicability would prevent us from reaping the benefits of AI used in these situations. Finally, the explanations given by explicable AI are only fruitful if we already know which considerations are acceptable for the decision at hand. If we already have these considerations, then there is no need to use contemporary AI algorithms because standard automation would be available. In other words, a principle of explicability for AI makes the use of AI redundant. (shrink)

This paper critically analyses the concept of evidence in evidence-based-policy arguing that there is key problem: that there is no existing practicable theory of evidence, one which is philosophically grounded and yet applicable for evidencebased policy. The paper critically considers both philosophical accounts of evidence and practical treatments of evidence in evidence-based-policy. It argues that both fail in different ways to provide a theory of evidence that is adequate for evidence-basedpolicy. The paper is a valuable contribution to the part of (...) the research project that explores how evidence can and should be used to reduce contingency in science, and policy based on science. (shrink)

Although decision‐making algorithms are not new to medicine, the availability of vast stores of medical data, gains in computing power, and breakthroughs in machine learning are accelerating the pace of their development, expanding the range of questions they can address, and increasing their predictive power. In many cases, however, the most powerful machine learning techniques purchase diagnostic or predictive accuracy at the expense of our ability to access “the knowledge within the machine.” Without an explanation in terms of reasons or (...) a rationale for particular decisions in individual cases, some commentators regard ceding medical decision‐making to black box systems as contravening the profound moral responsibilities of clinicians. I argue, however, that opaque decisions are more common in medicine than critics realize. Moreover, as Aristotle noted over two millennia ago, when our knowledge of causal systems is incomplete and precarious—as it often is in medicine—the ability to explain how results are produced can be less important than the ability to produce such results and empirically verify their accuracy. (shrink)

This article critically analyses the concept of evidence in evidence‐based policy, arguing that there is a key problem: there is no existing practicable theory of evidence, one which is philosophically‐grounded and yet applicable for evidence‐based policy. The article critically considers both philosophical accounts of evidence and practical treatments of evidence in evidence‐based policy. It argues that both fail in different ways to provide a theory of evidence that is adequate for evidence‐based policy. The article contributes to the debate about how (...) evidence can and should be used to reduce contingency in science and in policy based on science. (shrink)

The claims of randomized controlled trials to be the gold standard rest on the fact that the ideal RCT is a deductive method: if the assumptions of the test are met, a positive result implies the appropriate causal conclusion. This is a feature that RCTs share with a variety of other methods, which thus have equal claim to being a gold standard. This article describes some of these other deductive methods and also some useful non-deductive methods, including the hypothetico-deductive method. (...) It argues that with all deductive methods, the benefit that the conclusions follow deductively in the ideal case comes with a great cost: narrowness of scope. This is an instance of the familiar trade-off between internal and external validity. RCTs have high internal validity but the formal methodology puts severe constraints on the assumptions a target population must meet to justify exporting a conclusion from the test population to the target. The article reviews one such set of assumptions to show the kind of knowledge required. The overall conclusion is that to draw causal inferences about a target population, which method is best depends case-by-case on what background knowledge we have or can come to obtain. There is no gold standard. (shrink)

I present an account of what it is to trust a speaker, and argue that the account can explain the common intuitions which structure the debate about the transmission view of testimony. According to the suggested account, to trust a speaker is to grant her epistemic authority on the asserted proposition, and hence to see her opinion as issuing a second order, preemptive reason for believing the proposition. The account explains the intuitive appeal of the basic principle associated with the (...) transmission view of testimony: the principle according to which, a listener can normally obtain testimonial knowledge that p by believing a speaker who testifies that p only if the speaker knows that p. It also explains a common response to counterexamples to this principle: that these counterexamples do not involve normal cases of testimonial knowledge. (shrink)