First-person reports of Major Depressive Disorder reveal that when an individual becomes depressed a profound change or ‘shift’ to one’s conscious experience occurs. The depressed person reports that something fundamental to their experience has been disturbed or shifted; a change associated with the common but elusive claim that when depressed one finds oneself in a ‘different world’ detached from reality and other people. Existing attempts to utilise these phenomenological observations in a psychiatric context are challenged by the fact that this (...) experiential ‘shift’ characteristic of depression appears mysterious and resists analysis in scientific terms. This paper offers a way out of this predicament. The hypothesis proposed is that when an individual becomes depressed, the individual departs from a state of ordinary wakeful consciousness and enters a distinctive global state of consciousness akin to dreaming and the psychedelic state. After unpacking and motivating this hypothesis in the context of research in consciousness science, I outline two of its important implications for the neurobiology of depression and psychedelic psychiatry. The upshot is a promising and conceptually well-motivated hypothesis about depression which is apt for empirical uptake and development. (shrink)

In recent years there has been an explosion of interest in Artificial Intelligence (AI) both in health care and academic philosophy. This has been due mainly to the rise of effective machine learning and deep learning algorithms, together with increases in data collection and processing power, which have made rapid progress in many areas. However, use of this technology has brought with it philosophical issues and practical problems, in particular, epistemic and ethical. In this paper the authors, with backgrounds in (...) philosophy, maternity care practice and clinical research, draw upon and extend a recent framework for shared decision-making (SDM) that identified a duty of care to the client's knowledge as a necessary condition for SDM. This duty entails the responsibility to acknowledge and overcome epistemic defeaters. This framework is applied to the use of AI in maternity care, in particular, the use of machine learning and deep learning technology to attempt to enhance electronic fetal monitoring (EFM). In doing so, various sub-kinds of epistemic defeater, namely, transparent, opaque, underdetermined, and inherited defeaters are taxonomized and discussed. The authors argue that, although effective current or future AI-enhanced EFM may impose an epistemic obligation on the part of clinicians to rely on such systems' predictions or diagnoses as input to SDM, such obligations may be overridden by inherited defeaters, caused by a form of algorithmic bias. The existence of inherited defeaters implies that the duty of care to the client's knowledge extends to any situation in which a clinician (or anyone else) is involved in producing training data for a system that will be used in SDM. Any future AI must be capable of assessing women individually, taking into account a wide range of factors including women's preferences, to provide a holistic range of evidence for clinical decision-making. (shrink)

Consider a terrible situation that too many women find themselves in: 85,000 women are raped in England and Wales alone every year. Many of these women do not bring their cases to trial. There are multiple reasons that they might not want to testify in the courts. The incredibly low conviction rate is one. Another reason, however, might be that these women do not want the fact that they were raped to become the most salient thing about them. More specifically, (...) they do not want it to be the thing that others attend to the most—that others find most noticeable and memorable. In this paper, I introduce the notion of ‘harmful salience perspectives’ to help to explain this and related phenomena. This refers either to attention on things that should not be salient, or not enough attention on things that deserve to be made salient. Following ideas within the feminist literature on objectification, I argue that we can be harmed when aspects of our identity that do not reflect our personhood—our agency, rationality, personality, and so on—are more prominent in the minds of others than aspects that do reflect our personhood. Crucially, these ways of attending do not need to implicate false beliefs and harmful ideologies to be harmful, but can be harmful in their own right. (shrink)

Whenever we communicate, we inevitably have to say one thing before another. This means introducing particularly subtle patterns of salience into our language. In this paper, I introduce ‘order-based salience patterns’, referring to the ordering of syntactic contents where that ordering, pretheoretically, does not appear to be of consequence. For instance, if one is to describe a colourful scarf, it wouldn’t seem to matter if one were to say it is ‘orange and blue’ or ‘blue and orange’. Despite their apparent (...) triviality, I argue that order-based salience patterns tend to make the content positioned first more salient – in the sense of attention-grabbing – in a way that can have surprising normative implications. Giving relative salience to gender differences over similarities, for instance, can result in the activation of cognitively accessible beliefs about gender differences. Where those beliefs are epistemically and/or ethically flawed, we can critique the salience pattern that led to them, providing an instrumental way of evaluating those patterns. I suggest that order-based salience patterns can also be evaluated on constitutive grounds; talking about gender differences before similarities might constitute a subtle form of bias. Finally, I reflect on how the apparent triviality of order-based salience patterns in language gives them an insidious strength. (shrink)

Shared decision-making involves health professionals and patients/clients working together to achieve true person-centred health care. However, this goal is infrequently realized, and most barriers are unknown. Discussion between philosophers, clinicians, and researchers can assist in confronting the epistemic and moral basis of health care, with benefits to all. The aim of this paper is to describe what shared decision-making is, discuss its necessary conditions, and develop a definition that can be used in practice to support excellence in maternity care. Discussion (...) between the authors, with backgrounds in philosophy, clinical maternity care, health care management, and maternity care research, assisted the team to confront established norms in maternity care and challenge the epistemic and moral basis of decision-making for caesarean section. The team concluded that shared decision-making must start in pregnancy and continue throughout labour and birth, with equality in discourse facilitated by the clinician. Clinicians have a duty of care for the adequacy of women's knowledge, which can only be fulfilled when relevant knowledge is offered freely and when personal beliefs and biases that may impinge on decision-making (defeaters) are disclosed. Informed consent is not shared decision-making. Key barriers include existing cultural norms of “the doctor knows best” and “patient acquiescence” that prevent defeaters being acknowledged and discussed and can lead to legal challenges, overuse of medical intervention and, in some areas, obstetric violence. Shared decision-making in maternity care can thus be defined as an enquiry by clinician and expectant woman aimed at deciding upon a course of care or none, which takes the form of a dialogue within which the clinician fulfils their duty of care to the client's knowledge by making available their complete knowledge (based on all types of evidence) and expertise, including an exposition of any relevant and recognized potential defeaters. Research to develop measurement tools is required. (shrink)