The nature and role of the patient in biomedicine comprise issues central to bioethical inquiry. Given its developmental history grounded firmly in a backlash against 20th-century cases of egregious human subjects abuse, contemporary medical bioethics has come to rely on a fundamental assumption: the unit of care is the autonomous self-directing patient. In this article we examine first the structure of the feminist social critique of autonomy. Then we show that a parallel argument can be made against relational autonomy as (...) well, demonstrating how this second concept of autonomy fails to take sufficiently into account an array of biological determinants, particularly those from microbial biology. Finally, in light of this biological critique, we question whether or to what extent any relevant and meaningful view of autonomy can be recovered in the contemporary landscape of bioethics. (shrink)

We argue that the interaction of biased media coverage and widespread employment of the recognition heuristic can produce epistemic injustices. First, we explain the recognition heuristic as studied by Gerd Gigerenzer and colleagues, highlighting how some of its components are largely external to, and outside the control of, the cognitive agent. We then connect the recognition heuristic with recent work on the hypotheses of embedded, extended, and scaffolded cognition, arguing that the recognition heuristic is best understood as an instance of (...) scaffolded cognition. In section three, we consider the double-edged sword of cognitive scaffolding. On the one hand, scaffolds can reduce the internal processing demands on cognitive agents while increasing their access to information. On the other hand, the use of scaffolding leaves cognitive agents increasingly vulnerable to forming false beliefs or failing to form beliefs at all about particular topics. With respect to the recognition heuristic, agents rely on third parties (such as the media) to report not just what’s true but also what’s important or valuable. This makes cognitive agents relying on these third parties vulnerable to two erroneous influences: 1) because they don’t recognize something, it isn’t important or valuable, and 2) because they do recognize something, it is important or valuable. Call the latter the Kardashian Inference and the former the Darfur Inference. In section four, we use Fricker’s (2007) concept of epistemic injustice to characterize the nature and harm of these false inferences, with special emphasis on the Darfur Inference. In section five, we use data-mining and an empirical study to show how Gigerenzer’s population estimation task is liable to produce Darfur Inferences. We conclude with some speculative remarks on more important Darfur Inferences, and how to avoid them by scaffolding better. One primary way to accomplish this it to shift the burden of embodying the virtue of epistemic justice from the hearer or consumer of media to the media themselves. (shrink)

Human beings have the unique ability to view the world in a detached way: We can think about the world in terms that transcend our own experience or interest, and consider the world from a vantage point that is, in Nagel's words, "nowhere in particular". At the same time, each of us is a particular person in a particular place, each with his own "personal" view of the world, a view that we can recognize as just one aspect of the (...) whole. How do we reconcile these two standpoints--intellectually, morally, and practically? To what extent are they irreconcilable and to what extent can they be integrated? Thomas Nagel's ambitious and lively book tackles this fundamental issue, arguing that our divided nature is the root of a whole range of philosophical problems, touching, as it does, every aspect of human life. He deals with its manifestations in such fields of philosophy as: the mind-body problem, personal identity, knowledge and skepticism, thought and reality, free will, ethics, the relation between moral and other values, the meaning of life, and death. Excessive objectification has been a malady of recent analytic philosophy, claims Nagel, it has led to implausible forms of reductionism in the philosophy of mind and elsewhere. The solution is not to inhibit the objectifying impulse, but to insist that it learn to live alongside the internal perspectives that cannot be either discarded or objectified. Reconciliation between the two standpoints, in the end, is not always possible. (shrink)

This article takes the following two assumptions for granted: first, that gifts influence physicians and, second, that the influences gifts have on physicians may be harmful for patients. These assumptions are common in the applied ethics literature, and they prompt an obvious practical question, namely, what is the best way to mitigate the negative effects? We examine the negative effects of gift giving in depth, considering how the influence occurs, and we assert that the ethical debate surrounding gift-giving practices must (...) be reoriented. Our main claim is that the failure of recent policies addressing gift giving can be traced to a misunderstanding of what psychological mechanisms are most likely to underpin physicians’ biased behavior as a result of interaction with the medical industry. The problem with gift giving is largely not a matter of malicious or consciously self-interested behavior, but of well-intentioned actions on the part of physicians that are nonetheless perniciously infected by the presence of the medical industry. Substantiating this claim will involve elaboration on two points. First, we will retrace the history of policies regarding gift giving between the medical profession and the medical industry and highlight how most policies assume a rationalistic view of moral agency. Reliance on this view of agency is best illustrated by past attempts to address gift giving in terms of conflicts of interest. Second, we will introduce and motivate an alternate view of moral agency emerging from recent literature in social psychology on implicit social cognition. We will show that proper consideration of implicit social cognition paints a picture of human psychology at odds with the rationalistic model assumed in discussions of COIs. With these two pieces on the table we will be able to show that, without fully appreciating the social-psychological mechanisms of implicit cognition, policy-makers are likely to overlook significant aspects of how gifts influence doctors. (shrink)

[Correction Notice: An erratum for this article was reported in Vol 109 of Psychological Review. Due to circumstances that were beyond the control of the authors, the studies reported in "Models of Ecological Rationality: The Recognition Heuristic," by Daniel G. Goldstein and Gerd Gigerenzer overlap with studies reported in "The Recognition Heuristic: How Ignorance Makes Us Smart," by the same authors and with studies reported in "Inference From Ignorance: The Recognition Heuristic". In addition, Figure 3 in the Psychological Review article (...) was originally published in the book chapter and should have carried a note saying that it was used by permission of Oxford University Press.] One view of heuristics is that they are imperfect versions of optimal statistical procedures considered too complicated for ordinary minds to carry out. In contrast, the authors consider heuristics to be adaptive strategies that evolved in tandem with fundamental psychological mechanisms. The recognition heuristic, arguably the most frugal of all heuristics, makes inferences from patterns of missing knowledge. This heuristic exploits a fundamental adaptation of many organisms: the vast, sensitive, and reliable capacity for recognition. The authors specify the conditions under which the recognition heuristic is successful and when it leads to the counter-intuitive less-is-more effect in which less knowledge is better than more for making accurate inferences. (shrink)

Simple Heuristics That Make Us Smart invites readers to embark on a new journey into a land of rationality that differs from the familiar territory of cognitive science and economics. Traditional views of rationality tend to see decision makers as possessing superhuman powers of reason, limitless knowledge, and all of eternity in which to ponder choices. To understand decisions in the real world, we need a different, more psychologically plausible notion of rationality, and this book provides it. It is about (...) fast and frugal heuristics--simple rules for making decisions when time is pressing and deep thought an unaffordable luxury. These heuristics can enable both living organisms and artificial systems to make smart choices, classifications, and predictions by employing bounded rationality. But when and how can such fast and frugal heuristics work? Can judgments based simply on one good reason be as accurate as those based on many reasons? Could less knowledge even lead to systematically better predictions than more knowledge? Simple Heuristics explores these questions, developing computational models of heuristics and testing them through experiments and analyses. It shows how fast and frugal heuristics can produce adaptive decisions in situations as varied as choosing a mate, dividing resources among offspring, predicting high school drop out rates, and playing the stock market. As an interdisciplinary work that is both useful and engaging, this book will appeal to a wide audience. It is ideal for researchers in cognitive psychology, evolutionary psychology, and cognitive science, as well as in economics and artificial intelligence. It will also inspire anyone interested in simply making good decisions. (shrink)

Advanced biological brains are by nature open-ended opportunistic controllers. Such controllers compute, pretty much on a moment-to-moment basis, what problem-solving resources are readily available and recruit them into temporary problem-solving wholes. Neural plasticity, exaggerated in our own species, makes it possible for such resources to become factored deep into both our cognitive and physical problem-solving routines. One way to think about this is to depict the biological brain as a master of what I shall dub ‘ecological control’. Ecological control is (...) the kind of top-level control that does not micro-manage every detail, but rather encourages substantial devolvement of power and responsibility. This kind of control allows much of our skill at walking to reside in the linkages and elastic properties of muscles and tendons. And it allows much of our prowess at thought and reason to depend upon the robust and reliable operation, often in dense brain-involving loops, of a variety of non-biological problem-solving resources spread throughout our social and technological surround. Are the complex distributed systems that result in some sense ‘out of control’, beyond the reach of useful governance? I shall argue that they are not, although understanding them requires us to re-think some key ideas about control and the nature of the self. To make this case, I shall first examine some strategies for efficient, external opportunity exploiting control in simple systems. I shall then argue that many of the same lessons apply to the case of higher-level human problem-solving. (shrink)

Advanced biological brains are by nature open-ended opportunistic controllers. Such controllers compute, pretty much on a moment-to-moment basis, what problem-solving resources are readily available and recruit them into temporary problem-solving wholes. Neural plasticity, exaggerated in our own species, makes it possible for such resources to become factored deep into both our cognitive and physical problem-solving routines. One way to think about this is to depict the biological brain as a master of what I shall dub ‘ecological control’. Ecological control is (...) the kind of top-level control that does not micro-manage every detail, but rather encourages substantial devolvement of power and responsibility. This kind of control allows much of our skill at walking to reside in the linkages and elastic properties of muscles and tendons. And it allows much of our prowess at thought and reason to depend upon the robust and reliable operation, often in dense brain-involving loops, of a variety of non-biological problem-solving resources spread throughout our social and technological surround. Are the complex distributed systems that result in some sense ‘out of control’, beyond the reach of useful governance? I shall argue that they are not, although understanding them requires us to re-think some key ideas about control and the nature of the self. To make this case, I shall first examine some strategies for efficient, external opportunity exploiting control in simple systems. I shall then argue that many of the same lessons apply to the case of higher-level human problem-solving. (shrink)