Objective: There are benefits and risks of giving patients more granular control of their personal health information in electronic health record (EHR) systems. When designing EHR systems and policies, informaticists and system developers must balance these benefits and risks. Ethical considerations should be an explicit part of this balancing. Our objective was to develop a structured ethics framework to accomplish this. -/- Methods: We reviewed existing literature on the ethical and policy issues, developed an ethics framework called a “Points to (...) Consider” (P2C) document, and convened a national expert panel to review and critique the P2C. -/- Results: We developed the P2C to aid informaticists designing an advanced query tool for an electronic health record (EHR) system in Indianapolis. The P2C consists of six questions (“Points”) that frame important ethical issues, apply accepted principles of bioethics and Fair Information Practices, comment on how questions might be answered, and address implications for patient care. -/- Discussion: The P2C is intended to clarify whatis at stake when designers try to accommodate potentially competing ethical commitments and logistical realities. The P2C was developed to guide informaticists who were designing a query tool in an existing EHR that would permit patient granular control. While consideration of ethical issues is coming to the forefront of medical informatics design and development practices, more reflection is needed to facilitate optimal collaboration between designers and ethicists. This report contributes to that discussion. (shrink)

The Gathas, a corpus of seventeen poems in Old Avestan composed by the ancient Iranian poet-priest Zarathushtra (Zoroaster) ca. 1200 B.C.E., is the foundation document of Zoroastrian religion. Even though the dualistic axiology of the Gathas has been widely noted, it has proved very difficult to understand the meaning and genre of the corpus or the position of Zarathushtra’s ideas with regard to other religious philosophies. Relying on recent advances in translation and decryptions of Gathic poetry, I shall here develop (...) a philosophical interpretation of the Gathas, including, as shall be discussed here in detail, explication of the revelation he reports in the poem known as Yasna 30. I argue that, similarly to Marx, Henry, and Schutz, Zarathushtra connects social criticism with an original philosophy of (inter)subjectivity and existential reflection, placing his account in the context of a fully developed metaphysics which includes the human-divine sharing of mental properties. I show that in order to accommodate this complicated problematic, Zarathushtra uses the vehicle of multiple realities. Reflecting the spontaneity of life, the dynamics of various ontological modes in the text create a reference to subjectivity. A description of the dream in Yasna 30 is sufficiently within the limits of possibility for a dream experience, and thereby delivers three original phenomenological reductions. The reductions initiate a genetic account of the phenomenalization of invisible impulses which give rise to moral choices, and define the human-divine relationship. The opposing moral choices open into a reverse axiological intentionality in the sphere of intersubjectivity, and are said to plot life for the rightful and lifelessness for the wrongful. It can be concluded that Zarathushtra’s theism and views of the social world are “the first philosophy”, with a unique and original phenomenological ontology of intersubjectivity at its core. (shrink)

THIS PAPER IS THE CO-WINNER OF THE FRED BERGER PRIZE IN PHILOSOPHY OF LAW FOR THE 1999 AMERICAN PHILOSOPHICAL ASSOCIATION FOR THE BEST PUBLISHED PAPER IN THE PREVIOUS TWO YEARS. -/- The conflict between liberal legal theory and critical legal studies (CLS) is often framed as a matter of whether there is a theory of justice that the law should embody which all rational people could or must accept. In a divided society, the CLS critique of this view is overwhelming: (...) there is no such justice that can command universal assent. But the liberal critique of CLS, that it degenerates into an unpalatable moral relativism on which there is no non-arbitrary basis between a justice that underwrites forms of domination such as slavery and a justice that condemns such forms of domination is equally powerful and compelling. I show that there is a way to harmonize both views that is subject to empirical test. -/- First I show that the most widely accepted and influential formulation of liberal justice, John Rawls' Justice as Fairness, in. e.g, A Theory of Justice, cannot avoid the relativistic challenge because it would not be accepted, as a matter of sociological fact, by real people in a divided society once the "veil of Ignorance" is removed and real people step out from the Original Position. To put it differently, different reflective equilibria are inevitable in a divided society. Given the weight that Rawls properly puts on the realizability of a conception of justice and its stability in practice, this is a fatal objection. There can be no divided society that is "well ordered" in Rawls' sense, governed by a shared conception of justice and known to be so governed. -/- I then turn to the most powerful statement of the CLS view, Milton's Fisk's relativistic account in The State and Justice. For Fisk, justice is a compromise between what the dominant groups can compel and what the the subordinate groups will acquiesce to., There is no one such compromise in any given situation, so the account is in that sense relativistic, but more deeply, it is relativistic in that it offers no non-arbitrary, non-question begging way to choose between the official justice of, e.g., a slaveholding society and and the radical justice of the slaves, which has no place for slaveholders as a group or slavery as an institution.All that Fisk can offer is an arbitrary existential choice: I'm with the slaves. (Or the slaveowners.) Most of us would find this disconcerting or even unacceptable. -/- I show that Fisk's general sort of account can be modified to allow for an non-arbitrary choice. Given general facts about human nature, societies based on domination will produce resistance that over the long run will diminish or eliminate various forms of domination. Through a sort of ratchet effect, rights won will be hard if not impossible to reverse. Societies embodying forms of domination can therefore be compared on dimensions of stability: the more domination, the more resistance, and the less stability. Such societies are inferior on the dimension of justice to more emancipatory society on the terms of both kinds of justice, official and radical. -/- This is not question begging because regimes of domination incorporate stability no less than more emancipatory social orders. The choice between official justice embodying domination and radical justice that does not is not arbitrary because it is based on a shared commitment to long term stability. This offers an empirical test of which social orders are more justice, and a prediction that over time, domination will tend to decrease. (shrink)

Health care providers (HCPs) are routinely placed into morally challenging situations that have the potential to cause moral distress. This is especially true for HCPs working in the military, whether they are on deployment outside their typical contexts of practice such as in disaster relief (e.g., Haiti and the Ebola missions in West Africa), or in more typically military settings such as peace keeping or armed conflicts (e.g., Afghanistan, Syria). Moral distress refers to “painful feelings and/or psychological disequilibrium” (Nilsson, Sjöberg, (...) Kallenberg, & Larsson, 2011, p. 50) that occur when an individual is aware of a morally appropriate action in a moral dilemma but obstruction prevents them from carrying it out, or when in a situation where they must choose between upholding equally treasured but conflicting moral values. Similarly, moral distress can occur when faced with a ‘tragic choice’ where all available courses of action require something of moral significance to be given up, such as surgical triage in a mass casualty event (Hunt, Sinding, & Schwartz, 2012). In the literature, moral distress has been connected to negative psychological effects and even stress related mental health issues including compassion fatigue, burnout, and post-traumatic stress disorder (Owen & Wanzer, 2014; Gustafsson, Eriksson, Strandberg, & Norberg, 2010; Litz, et al., 2009). (shrink)

An action-oriented perspective changes the role of an individual from a passive observer to an actively engaged agent interacting in a closed loop with the world as well as with others. Cognition exists to serve action within a landscape that contains both. This chapter surveys this landscape and addresses the status of the pragmatic turn. Its potential influence on science and the study of cognition are considered (including perception, social cognition, social interaction, sensorimotor entrainment, and language acquisition) and its impact (...) on how neuroscience is studied is also investigated (with the notion that brains do not passively build models, but instead support the guidance of action). A review of its implications in robotics and engineering includes a discussion of the application of enactive control principles to couple action and perception in robotics as well as the conceptualization of system design in a more holistic, less modular manner. Practical applications that can impact the human condition are reviewed (e.g., educational applications, treatment possibilities for developmental and psychopathological disorders, the development of neural prostheses). All of this foreshadows the potential societal implications of the pragmatic turn. The chapter concludes that an action-oriented approach emphasizes a continuum of interaction between technical aspects of cognitive systems and robotics, biology, psychology, the social sciences, and the humanities, where the individual is part of a grounded cultural system. (shrink)

Some ‘naturalist’ accounts of disease employ a biostatistical account of dysfunction, whilst others use a ‘selected effect’ account. Several recent authors have argued that the biostatistical account offers the best hope for a naturalist account of disease. We show that the selected effect account survives the criticisms levelled by these authors relatively unscathed, and has significant advantages over the BST. Moreover, unlike the BST, it has a strong theoretical rationale and can provide substantive reasons to decide difficult cases. This is (...) illustrated by showing how life-history theory clarifies the status of so-called diseases of old age. The selected effect account of function deserves a more prominent place in the philosophy of medicine than it currently occupies. _1_ Introduction _2_ Biostatistical and Selected Effect Accounts of Function _3_ Objections to the Selected Effect Account _3.1_ Boorse _3.2_ Kingma _3.3_ Hausman _3.4_ Murphy and Woolfolk _4_ Problems for the Biostatistical Account _4.1_ Schwartz _5_ Analysis versus Explication _6_ Explicating Dysfunction: Life History Theory and Senescence _7_ Conclusion. (shrink)

Similarly to other accounts of disease, Christopher Boorse’s Biostatistical Theory (BST) is generally presented and considered as conceptual analysis, that is, as making claims about the meaning of currently used concepts. But conceptual analysis has been convincingly critiqued as relying on problematic assumptions about the existence, meaning, and use of concepts. Because of these problems, accounts of disease and health should be evaluated not as claims about current meaning, I argue, but instead as proposals about how to define and use (...) these terms in the future, a methodology suggested by Quine and Carnap. I begin this article by describing problems with conceptual analysis and advantages of “philosophical explication,” my favored approach. I then describe two attacks on the BST that also question the entire project of defining “disease.” Finally, I defend the BST as a philosophical explication by showing how it could define useful terms for medical science and ethics. (shrink)

This volume presents discussions on a wide range of topics focused on eco-phenomenology and the interdisciplinary investigation of contemporary environmental thought. Starting out with a Tymieniecka Memorial chapter, the book continues with papers on the foundations, theories, readings and philosophical sources of eco-phenomenology. In addition, it examines issues of phenomenological anthropology, ecological perspectives of the human relationship to nature, and phenomenology of the living body and the virtual body. Furthermore, the volume engages in a dialogue with contemporary behavioral sciences on (...) topics such as eco-alienation, sustainability, and the human relationship to the earth in the context of the cosmos. (shrink)

In Book I of his Nicomachean Ethics (NE), Aristotle defines happiness, or eudaimonia, in accordance with an argument he makes regarding the distinctive function of human beings. In this paper, I argue that, despite this argument, there are moments in the NE where Aristotle appeals to elements of happiness that don’t follow from the function argument itself. The place of these elements in Aristotle’s account of happiness should, therefore, be a matter of perplexity. For, how can Aristotle appeal to elements (...) of happiness not entailed by his argument for what happiness involves? I will examine two instances that exemplify the sort of appeal to outside elements that I have in mind. The first deals with Aristotle’s reference, in NE, I, 8, to certain goods—ancestry, children, beauty—goods unrelated to man’s function or his fulfillment of it, but nevertheless required for his happiness. The second instance involves pleasure. Aristotle makes various arguments, both in Books I and X of the NE, that tie pleasure to the activity of the soul, and the function argument in turn. However, none of these arguments succeeds in demonstrating that pleasure would necessarily follow from this activity. Taken together then, these two examples demonstrate the extent to which Aristotle’s definition of happiness is more inclusive than his function argument permits. (shrink)

Two brief Late Antique religious texts, respectively by the monk Theophanis and by Monoimus the Arab, present an interesting problem of whether they embody the authors’ experience, or whether they are merely literary constructs. Rather than approaching this issue through the lens of theory, the article shows how phenomenological analysis and studies of living subjectivity can be engaged with the text in order to clarify the contents of introspective experience and the genesis of its religious connotations. The analysis uncovers a (...) previously unnoticed form of embodied introspective religious experience which is structured as a ladder with a distinct internal structure with the high degree of synchronic and diachronic stability. This approach also helps one identify the specific introspective techniques in the canonical and non-canonical literature of early Christian tradition, as related to the concepts of “ theosis ” and “ kenosys ”, as well as to suggest some neurological correspondents of religious cognition. (shrink)

This article presents phenomenological meta-analysis of Tymieniecka's phenomenology of life with regard to its strategies of knowledge. The novelty of phenomenology of life consists in special orientation of direct intuition of Tymieniecka's insight. The analysis suggests that the positioning of the direct intuition differes from philosopher to philosopher. Even though this perspective pays attention to individual differences in philosophical thinking, this view has to be distinguished froll1 psychologism as criticized by Husser!. and rather, seen as a development of Husserl 's (...) lheory of direct intuition. A framework for such analysis can be also found in Islamic philosophies of Suhrawardi and Ibn 'Arabi, who introduced the concepts of individual predisposition, modes of knowledge, and self-knowledge mediated by knowledge by presence. These concepts can be applied to understanding of the origins of philosophical insight. The paper examines in depth the workings of direct, or presentive, intuition in Tymieniecka's descriptions of the phenomenal field of life, and of life per se as a dynamic object. It demonstrates the dialogical nature of interrogation, and the sentience of logos as a horizon of philosophical inquiry. Finally, the paper introduces the concept of process phenomenology, and suggests directions of future research with regard to phenomenology of imagination. (shrink)

Applying Michel Henry’s philosophical framework to the phenomenological analysis of religious experience, the author introduces a concept of material introspection and a new theory of the constitution of religious experience in phenomenologically material interiority. As opposed to ordinary mental self-scrutiny, material introspection happens when the usual outgoing attention is reverted onto embodied self-awareness in search of mystical self-knowledge or union with God. Such reversal posits the internal field of consciousness with the self-disclosure of phenomenological materiality. As shown by the example (...) of Vedantic self-inquiry, material introspection is conditioned on the attitude ‘I “see” myself’ and employs reductions which relieve phenomenological materiality from the structuring influence of intentionality; the telos of material introspection is expressed by the inward self-transcendence of intentional consciousness into purified phenomenological materiality. Experience in material introspection is constituted by the self-affection and self-luminosity of phenomenological materiality; experience is recognized as religious due to such essential properties as the capacity of being selffulfilled, and specific qualitative “what it’s like”(s). Drawing on more than 5000 live accounts of internal religious experience, it is shown that introspective attention can have different trajectories, producing, within a temporal extension of material introspection, different spatial modifications of embodied selfawareness and a variety of corresponding religious experiences. (shrink)

In this Article, I propose a novel law and economics explanation of a deeply puzzling aspect of business organization in market economies. Why are virtually all firms organized as capital-managed and -owned (capitalist) enterprises rather than as labor-managed and -owned cooperatives? Over 150 years ago, J.S. Mill predicted that efficiency and other advantages would eventually make worker cooperatives predominant over capitalist firms. Mill was right about the advantages but wrong about the results. The standard explanation is that capitalist enterprise is (...) more efficient. Empirical research, however, overwhelmingly contradicts this. But employees almost never even attempt to organize worker cooperatives. I critique the explanations of the three leading analysts of the subject (N. Scott Arnold, Henry Hansmann, and Gregory Dow), all of whom offer are different transactions cost accounts, as logically defective and empirically inadequate. I then propose an explanation that has been oddly neglected in the literature, that the rarity of cooperatives is explained by the collective action problem identified by writers such as Mancur Olson. Labor management is a public good that generates the n-person prisoner’s dilemma which gives rational actors the incentive to create it in suboptimal (or no) amounts. I support this by reference to the empirical facts about the origin of existing cooperatives and show that this explanation requires no strong version of a questionable rational choice theory. This explanation is supplemented by the mere exposure or familiarity effect derived from social and cognitive psychology, which turns on the fact that labor managed firms are rare, in part because of the public goods problem, thus unfamiliar, which makes them less attractive and thus more likely to be rare. My account points advocates of labor management towards solutions such as institutional changes in incentives, which, however, themselves involve public goods issues. (shrink)

This paper argues that the Islamic metaphysical vision finds its Western philosophical counterpart in Anna-Teresa Tymienecka's Phenomenology of Life. Comparative analysis of the main categories and strategies of knowledge in Islamic metaphysics and the Phenomenology of Life demonstrates obvious similarities, but also significant distinctions whereby the systems can be viewed as complementary. Tymieniecka’s philosophy begins with epoché on preceding philosophical knowledge, while Islamic philosophy begins with revelation. Tymieniecka uses presuppositionless phenomenological direct intuition combined with reflective analysis, while Sufi metaphysics combines (...) logic, intuitio,n and reliance on the experience attained in states of mystical perception. Unification of Reality and realization of truth in the Phenomenology of Life is attained via phenomenological intuition of life in all forms of experience, and in Islam, via certainty attained in religious experiences of unveiling. Due to its refocusing on the dynamic moments of the ontopoiesis of life, Tymieniecka’s ontology serves as a possible solution to the problems incurred by the more static metaphysical vision of Reality in Sufism. (shrink)

I argue that ductal carcinoma in situ (DCIS), the tumor most commonly diagnosed by breast mammography, cannot be confidently classified as cancer, that is, as pathological. This is because there may not be dysfunction present in DCIS—as I argue based on its high prevalence and the small amount of risk it conveys—and thus DCIS may not count as a disease by dysfunction-requiring approaches, such as Boorse’s biostatistical theory and Wakefield’s harmful dysfunction account. Patients should decide about treatment for DCIS based (...) on the risks it poses and the risks and benefits of treatment, not on its disease status. (shrink)

Debate about legal and policy reform has been haunted by a pernicious confusion about human nature, the idea that it is a set of rigid dispositions, today generally conceived as genetic, that is manifested the same way in all circumstances. Opponents of egalitarian alternatives argue that we cannot depart far from the status quo because human nature stands in the way. Advocates of such reforms too often deny the existence of human nature because, sharing this conception, they think it would (...) prevent changes they deem desirable. Both views rest on deep errors about what it is to have a nature and how genetics works. Human nature, like the nature of anything else, is a set of potentials to behave certain ways in given environments, not a nonsocial genetic something that inevitably produces the same result in any environment. To say that existing inequalities, are due to our genes, inalterable because heritable, ignores that genetic propensities may be differently manifested in different environments. Heritability has meaning only relative to an environment and a population and implies nothing about inevitability. A better sort of inegalitarian argument is that a proposed reform, given our nature, would be too costly even if possible. However, this sort of argument is too rarely supported by evidence and generally ignores the costs of existing inequalities. But egalitarians err in supposing that, if behavior is unconstrained by biology, the status quo is easily alterable. The environment may be extremely hard to change. Legal and policy debate should adopt a correct understanding of human nature as a set of propensities and ask of any proposed reform agreed to be otherwise desirable what and how alterable are its causes, genetic, environmental, or more accurately both. (shrink)

Accounts of the concepts of function and dysfunction have not adequately explained what factors determine the line between low‐normal function and dysfunction. I call the challenge of doing so the line‐drawing problem. Previous approaches emphasize facts involving the action of natural selection (Wakefield 1992a, 1999a, 1999b) or the statistical distribution of levels of functioning in the current population (Boorse 1977, 1997). I point out limitations of these two approaches and present a solution to the line‐drawing problem that builds on the (...) second one. (shrink)

Terraforming is a process of planetary engineering by which the extant environment of a planetary body is transformed into an environment capable of supporting human inhabitants. The question I would like to consider in this paper is whether there is any reason to believe that the terraforming of another planet—for instance, the terraforming of Mars—is morally problematic. Topics related to the human exploration of space are not often discussed in philosophical circles. Nevertheless, there exists a growing body of philosophical literature (...) dedicated to sorting out the moral implications of the use of resources from (and in) space. Most of this literature is produced as environmental philosophy. Questions of .. (shrink)

Obsessive-compulsive disorder is a commonly occurring neuropsychiatric condition characterized by bothersome intrusive thoughts and urges that frequently lead to repetitive dysfunctional behaviours such as excessive handwashing. There are well-documented alterations in cerebral function which appear to be closely related to the manifestation of these symptoms. Controlled studies of cognitive-behavioural therapy techniques utilizing the active refocusing of attention away from the intrusive phenomena of OCD and onto adaptive alternative activities have demonstrated both significant improvements in clinical symptoms and systematic changes in (...) the pathological brain circuitry associated with them. Careful investigation of the relationships between the experiential and putative neurophysiological processes involved in these changes can offer useful insights into volitional aspects of cerebral function. (shrink)

This paper examines the practice of using predictive systems to lengthen the prison sentences of convicted persons when the systems forecast a higher likelihood of re-offense or re-arrest. There has been much critical discussion of technologies used for sentencing, including questions of bias and opacity. However, there hasn’t been a discussion of whether this use of predictive systems makes sense in the first place. We argue that it does not by showing that there is no plausible theory of punishment that (...) supports it. (shrink)

According to simulationism, the function of episodic memory is not to remember the past, but to help construct representations of possible future episodes, by drawing together features from different experiential sources. This article suggests that the relationship between the traditional storehouse view, on which the function of memory is remembering, and the simulationist approach is more complicated than has been typically acknowledged. This is attributed, in part, to incorrect interpretations of what remembering on the storehouse view requires. Further, by appeal (...) to function pluralism, the article questions both the assumption that the traditional view and simulationism are inconsistent, and the simulationist’s inference to the best explanation strategy that is based upon this assumption. The article then provides an evaluation of the simulationist argument against the traditional view, and finds it in need of further support. (shrink)

Given the technological constraints of long-duration space travel and planetary settlement, off-Earth humans will likely need to employ food systems very different from their terrestrial counterparts, and newly emerging food technologies are being developed that will shape novel food systems in these off-Earth contexts. Projected off-Earth food systems may therefore potentially “alienate” their users in new ways compared to Earth-based food systems. They will be susceptible to alienation in ways that are similar to such potential on Earth, where there are (...) points of overlap between off-Earth food systems and any of the multitudes of ways in which food systems on Earth are structured. They will also be susceptible to new forms of alienation, as we encounter scenarios that are genuinely structurally novel to humanity. These are especially important to consider since there are comparatively fewer analyses of these food systems where they differ from existing ones. We propose five non-exhaustive sources of value beyond nutrition our individual relationships with a food may possess: gustatory, social, cultural, epistemic, and authorial value. Using these, we offer examples of ways in which an off-Earth food system may exacerbate or alleviate alienation for humans in long-term off-Earth food systems. (shrink)

Intellectualism is the claim that practical knowledge or ‘know-how’ is a kind of propositional knowledge. The debate over Intellectualism has appealed to two different kinds of evidence, semantic and scientific. This paper concerns the relationship between Intellectualist arguments based on truth-conditional semantics of practical knowledge ascriptions, and anti-Intellectualist arguments based on cognitive science and propositional representation. The first half of the paper argues that the anti-Intellectualist argument from cognitive science rests on a naturalistic approach to metaphysics: its proponents assume that (...) findings from cognitive science provide evidence about the nature of mental states. We demonstrate that this fact has been overlooked in the ensuing debate, resulting in inconsistency and confusion. Defenders of the semantic approach to Intellectualism engage with the argument from cognitive science in a way that implicitly endorses this naturalistic metaphysics, and even rely on it to claim that cognitive science support Intellectualism. In the course of their arguments, however, they also reject that scientific findings can have metaphysical import. We argue that this situation is preventing productive debate about Intellectualism, which would benefit from both sides being more transparent about their metaphilosophical assumptions. (shrink)

Ethics should guide the design of electronic health records (EHR), and recognized principles of bioethics can play an important role. This approach was adopted recently by a team of informaticists designing and testing a system where patients exert granular control over who views their personal health information. While this method of building ethics in from the start of the design process has significant benefits, questions remain about how useful the application of bioethics principles can be in this process, especially when (...) principles conflict. For instance, while the ethical principle of respect for autonomy supports a robust system of granular control, the principles of beneficence and non-maleficence counsel restraint due to the danger of patients being harmed by restrictions on provider access to data. Conflict between principles has long been recognized by ethicists and has even motivated attacks on approaches that state and apply principles. In this paper we show how using ethical principles can help in the design of EHRs by first, explaining how ethical principles can and should be used generally, and then by, discuss how attention to details in specific cases can show that the tension between principles is not as bad as it initially appeared. We conclude by suggesting further ways in which the application of these (and other) principles can add value to the ongoing discussion of patient involvement in their health care. This is a new approach to linking principles to informatics design that we expect will stimulate further interest. (shrink)

The Negation Problem states that expressivism has insufficient structure to account for the various ways in which a moral sentence can be negated. We argue that the Negation Problem does not arise for expressivist accounts of all normative language but arises only for the specific examples on which expressivists usually focus. In support of this claim, we argue for the following three theses: 1) a problem that is structurally identical to the Negation Problem arises in non-normative cases, and this problem (...) is solved once the hidden quantificational structure involved in such cases is uncovered; 2) the terms ‘required’, ‘permissible’, and ‘forbidden’ can also be analyzed in terms of hidden quantificational structure, and the Negation Problem disappears once this hidden structure is uncovered; 3) the Negation Problem does not arise for normative language that has no hidden quantificational structure. We conclude that the Negation Problem is not really a problem about expressivism at all but is rather a feature of the quantificational structure of the required, permitted, and forbidden. (shrink)

"Modern History" versions of the etiological theory claim that in order for a trait X to have the proper function F, individuals with X must have been recently favored by natural selection for doing F (Godfrey-Smith 1994; Griffiths 1992, 1993). For many traits with prototypical proper functions, however, such recent selection may not have occurred: traits may have been maintained due to lack of variation or due to selection for other effects. I examine this flaw in Modern History accounts and (...) offer an alternative etiological theory, the Continuing Usefulness account, which appears to avoid such problems. (shrink)

With the growing focus on prevention in medicine, studies of how to describe risk have become increasing important. Recently, some researchers have argued against giving patients “comparative risk information,” such as data about whether their baseline risk of developing a particular disease is above or below average. The concern is that giving patients this information will interfere with their consideration of more relevant data, such as the specific chance of getting the disease (the “personal risk”), the risk reduction the treatment (...) provides, and any possible side effects. I explore this view and the theories of rationality that ground it, and I argue instead that comparative risk information can play a positive role in decision-making. The criticism of disclosing this sort of information to patients, I conclude, rests on a mistakenly narrow account of the goals of prevention and the nature of rational choice in medicine. (shrink)

G. A. Cohen defends and Jon Elster criticizes Marxist use of functional explanation. But Elster's mechanical conception of explanation is, contrary to Elster's claims, a better basis for vindication of functional explanation than Cohen's nomological conception, which cannot provide an adequate account of functional explanation. Elster also objects that functional explanation commits us to metaphysically bizarre collective subjects, but his argument requires an implausible reading of methodological individualism which involves an unattractive eliminativism about social phenomena.

Although there is a growing recognition that older adults and those with extensive comorbid conditions undergo cancer screening too frequently, there is little information about patients’ perceptions regarding cessation of cancer screening. Information on older adults’ views of screening cessation would be helpful both for clinicians and for those designing interventions to reduce overscreening.

Most people do not know there are different kinds of medical studies; some are conducted on people who already have a disease or medical condition, and others are performed on healthy volunteers who want to help science find answers. No matter what sort of research you are invited to participate in, or whether you are a patient when you are asked, it’s entirely up to you whether or not to do it. This decision is important and may have many implications (...) for your health and well-being, as well as those of other patients now and in the future. Making a good decision – the right one for you – requires you to become educated about topics you may not have thought about before, some of which may be quite complicated. This chapter explains the key issues to help you make a good decision. (shrink)

Marx thinks that capitalism is exploitative, and that is a major basis for his objections to it. But what's wrong with exploitation, as Marx sees it? (The paper is exegetical in character: my object is to understand what Marx believed,) The received view, held by Norman Geras, G.A. Cohen, and others, is that Marx thought that capitalism was unjust, because in the crudest sense, capitalists robbed labor of property that was rightfully the workers' because the workers and not the capitalists (...) produced it. This view depends on a Labor Theory of Property (LTP), that property rights are based ultimately on having produced something. (A view oddly enough shared with the libertarian right, though the LTP is better support for egalitarian or socialist views; see my From Libertarianism to Egalitarianism, 18 Social Theory & Prac. 259-288 (1992).) -/- I show that the idea that Marx's objection to exploitation is based on injustice or LTP-grounded theft is mistaken. Marx's real objection to exploitation is based on unfreedom, that capitalist relations of production, he thinks, unnecessarily limit human freedom. In the first place Marx is quite clear that he vehemently rejects the concepts of justice, fairness, or rights as bourgeois ideology. It is true that he uses the language of "theft" on occasion, but either a literal interpretation of that language must be abandoned, or his consistent, life-long objection to rights- and justice talk must be given up. Second, the structure, indeed the point, of his analysis of the laws of motion of capitalism, is that capitalists make profits through exploitation of labor -- without cheating -- by the normal "legitimate" operation of the system. Other arguments make the same point. -/- The unfreedom or force-based view, though not necessarily my specific arguments advocated so far is shared by a minority of other writers, such as Nancy Holmstrom and Richard Arneson. What my paper offers that is novel, part from arguments for the foregoing that are different and better than those found elsewhere (although Holmstrom and Arneson are excellent), is an account of in detail of what Marx regards as the real problem with exploitation. -/- I analyze Marx's objection that capitalist exploitation causes unnecessary unfreedom by distinguishing and spelling out three different kinds of freedom that he invokes: classic negative freedom, or noninterference; positive freedom, understood as control over or access to the resources enabling one to exercise one's negative freedom; and "real" freedom, as he puts it, the ability to "give the law to oneself," to regulate one's own activities under rules chosen by oneself, to develop one's capacities by autonomous choice. This puts Marx in the tradition going back through Hegel and Kant to Rousseau, the first express advocate of this idea. The opposite of real freedom, the unfreedom due to lack of autonomy, is alienation. -/- I conclude by stating that I think that justice-based objections to exploitation that avoid Marx's objections to the concept are possible. I do not attempt to spell these out here. I take up that task in my subsequently published paper Relativism, Reflective Equilibrium, and Justice, 17 Legal Stud.,128-168 (1997). -/- The present paper is related to and partly overlaps with my paper In Defense of Exploitation, 11 Econ. & Phil. 49-81 (1995), a critique of John Roemer's equality based account of the nature of exploitation and its wrongness. The research and writing of this paper was financially supported by the philosophy department of The Ohio State University. -/- Keywords: Exploitation, Justice, Unjustice, Theft, Labor Theory of Property, Marx, Freedom, Unfreedom, Rights, Fairness, Critique of Justice, Negative Freedom, Positive Freedom, Real Freedom, Alienation, G.A. Cohen, Norman Geras. (shrink)

Is the family subject to principles of justice? In "A Theory of Justice", John Rawls includes the (monogamous) family along with the market and the government as among the, "basic institutions of society", to which principles of justice apply. Justice, he famously insists, is primary in politics as truth is in science: the only excuse for tolerating injustice is that no lesser injustice is possible. The point of the present paper is that Rawls doesn't actually mean this. When it comes (...) to the family, and in particular its impact on fair equal opportunity, (the first part of the Difference Principle, Rawls' second principle of justice), he abandons the priority of justice. I also argue that he is right to do so. -/- The central argument is simple. As Rawls admits, what family one is raised by profoundly affects one's life chances: a child raised by a family has far greater life chances on every dimension than one raised in a poorer family that may lack books, education, and time to give the child attention. But the prevailing family arrangements in the industrialized West, assigning children to be raised by their biological parents, is guaranteed to perpetuate this injustice. While Rawls says an unjust institution in the basic structure of society, in which he includes the family, must be, "reformed or abolished," he refrains from calling for the reform or abolition of the family. We must simply work around it to compensate for the injustices he admits it involves. And this despite the fact that alternative arrangements involving communal child-rearing (Plato) or assigning children to those best qualified to raise them (Rousseau) are common in the philosophical literature. Moreover, the practice of having children raised by their biological parents is a relatively recent one, at least in the West, where, before the late 18th century, fostering-out or apprenticeship arrangements were normal and expected for both rich and poor for centuries. -/- Much of the paper is devoted to fine-grained textual analysis of Rawls' attempts to avoid the devastating implications of this argument for his theory of justice -- much of which are stated only in the original edition of "A Theory of Justice" and simply deleted, without substitution by anything better, in the second edition. In the end, Rawls has no way out. He cannot keep the priority of justice, fair equality of opportunity, and the monogamous family in which children are raised by their biological parents. As he admits, these are mutually inconsistent. -/- In the final part of the paper, I argue that Rawls should give up on the priority of justice. While child-rearing by the biological parents is a historical anomaly, in the real modern world it would be politically unfeasible to institute Platonic, Rousseauean, or similar legislation that purportedly assigned children to those best able to raise them, regardless of biological relationship. Since Rawls is committed to principles of political stability and feasibility, as he should be, and since ought implies can, such proposals are off the table. I concur with Rawls that we must work around this injustice, even those there are more just arrangements available in principle. But the cost of this -- less high than Rawls suggests -- is abandoning the principle of the priority of justice. Justice is one of a number of considerations that we must or may balance in deciding on the best attainable social relations. It is not a trump. However, this comes a great cost for Rawls: he must also abandon the lexical ordering of principles of justice or, in general, right or good principles of social order, in favor of the messy intuitionist balancing that his theory is designed to avoid. -/- One feature of the paper that is worth independent attention is a discussion of Marx's rejection of justice in the Critique of the Gotha Program, which I explicate, and urge, without adopting it, that it has a great deal more force than is widely understood. (shrink)

Patients should not always receive hard data about the risks and benefits of a medical intervention. That information should always be available to patients who expressly ask for it, but it should be part of standard disclosure only sometimes, and only for some patients. And even then, we need to think about how to offer it.

Imagine you fly home from vacation with your one-and-a-half-year-old son who is traveling for free as a “lap child.” In the airport parking lot, you put him into his forward-facing car seat, where he sits much more contentedly than he did in the rear-facing one that was mandatory until his first birthday. After he falls asleep on the way home, you transfer him to his crib without waking him, lowering the side rail so you can lift him in more easily. (...) -/- Many parts of this idyllic parenting picture are deemed unacceptably risky according to recent child safety proposals. While these proposals all aim to improve child safety, their possible impact is unclear because there has been little discussion of the absolute risk and risk reduction involved in each. And while precise figures are lacking, rough estimates indicate that the magnitudes are quite small. I will argue that this risk and benefit data raises important questions about the proposals, including whether parents might reasonably believe that the small absolute risk reduction offered by the proposed changes does not justify the attendant burdens. This possibility—termed the “prevention paradox” in other contexts—highlights ethical and theoretical challenges in this area of public health. (shrink)

Some experts have argued that patients should routinely be told the specific magnitude and absolute probability of potential risks and benefits of screening tests. This position is motivated by the idea that framing risk information in ways that are less precise violates the ethical principle of respect for autonomy and its application in informed consent or shared decisionmaking. In this Perspective, we consider a number of problems with this view that have not been adequately addressed. The most important challenges stem (...) from the danger that patients will misunderstand the information or have irrational responses to it. Any initiative in this area should take such factors into account and should consider carefully how to apply the ethical principles of respect for autonomy and beneficence. (shrink)

A standard natural rights argument for libertarianism is based on the labor theory of property: the idea that I own my self and my labor, and so if I "mix" my own labor with something previously unowned or to which I have a have a right, I come to own the thing with which I have mixed by labor. This initially intuitively attractive idea is at the basis of the theories of property and the role of government of John Locke (...) and Robert Nozick. Locke saw and Nozick agreed that fairness to others requires a proviso: that I leave "enough and as good" for others. The same considerations apply to legitimate acquisition by voluntary exchange, gift, or bequeathal. -/- This sort of argument has been critiqued for the purely hypothetical and counterfactual nature of its premises, for the coherence of the idea of self-ownership, for the notion that mixing what I own with what I do not gives me a right in what I do not rather than wasting what I own, and for the unacceptably cruel and heartless consequences of adopting it, among other reasons. -/- However, I accept the premises and waive (though note) these objections, and formulate a new objection, showing that to give me a right in what I do not own, the labor theory of property requires a commitment to a right to what I need. I distinguish several senses of need and show that the sense of need the argument requires is "use need," the need I have to to use something to exercise my labor on it. This turns out to have a startling counter-intuitive result: the libertarian principle, so understood, turns out to be "to each according to his needs," which Marx identified as the principle of the highest phase of communism as he understood it. If communism is understood as in some sense egalitarian, this argument for libertarianism turns itself inside out into an argument for egalitarian communism. Libertarians therefore cannot use the Labor Theory of Property to defend the positions they typically wish to hold. (shrink)

A standard problem with the objectivity of social scientific theory in particular is that it is either self-referential, in which case it seems to undermine itself as ideology, or self-excepting, which seem pragmatically self-refuting. Using the example of Marx and his theory of ideology, I show how self-referential theories that include themselves in their scope of explanation can be objective. Ideology may be roughly defined as belief distorted by class interest. I show how Marx thought that natural science was informed (...) by class interest but not therefore necessarily ideology. Capitalists have an interest in understanding the natural world (to a point) so that they can manipulate it for profit. Their survival in the marketplace often depends on their competitive success in doing so. The fact that their interventions into nature, driven by class interest, often succeed, is evidence of the reliability and truth of their natural scientific theories. -/- With social science, capitalists have a partial interest in understanding the world, so that they may maintain their class power, ideological hegemony, and a reasonably stable and self-reproducing economy. Some bourgeois social science, Marx thinks, is therefore vindicated the same way that natural science is, because of, not despite, its success in promoting the class interests that cause it. But the capitalist class, Marx thinks, also has an interest in obfuscating the truth about the social world. It would undermine the stability of capitalism, for example, for the bourgeoisie to adopt what Marx thinks to be the correct social theory, Marxism, and proclaim to the world that capitalism is exploitative and unstable. Capitalism creates a a need for ideological social theories that, driven by class interest, represent capitalism as just, natural, inevitable, and unalterable. If Marxism is correct, while these theories may further capitalist interests, they will not withstand the test of time as capitalist exploitation and instability engenders countersystemic political action. -/- How, then can we know, according to Marx, that Marxism is correct, as applied to itself? In part it is whether it succeeds in further the class interests that cause it. If workers adopt bourgeois theories and Marxism is right, they will find themselves frustrated in pursuit of goals that they have, such as improving their well-being, and if Marxism is wrong, then those theories will help them further their own goals. Similarly with Marxism: if it is right, then workers who adopt it should in the long run have more success in furthering their own goals, and if not, then not. But it is question begging to say that our confidence in the reliability of Marxism is enhanced by its successful promotion of goals that capitalists do not have but (according to Marxism) workers do. To avoid this problem it is necessary to compare the relative success of each sort of theory in promoting the interests and needs that the respective classes have independently of the theory, as well as by the usual criteria of scientific theory choice. -/- Thus the Soviet variant of Marxism was fairly decisively refuted by its failure to generate the support of its own designated constituency necessary to grow and survive. Whether the same is true of other varieties of Marxism or of capitalist social theory, it is, as Zhou En Lai said when asked whether the French Revolution had succeeded, too soon to tell, at least in any definitive way. However, and this is the point of the paper, an objective test of Marxism is possible even though Marxism says that all theory is informed by class interest. The question is whether the interests are in discovering or obfuscating the truth. The point is not limited to Marx, but applies to any self-referential social scientific theory that includes itself in its scope. -/- Keywords: ideology, self-referential theory, self-reference, reliabilism, objectivity, Marx, Marxism, sociology of science, class interest, classes, capitalism, bourgeoisie, workers, working class, social theory of knowledge, confirmation of scientific theory. (shrink)

Widespread deflationistic readings of Quine misrepresent his view of disquotation’s significance and the truth predicate’s utility. I demonstrate this by answering a question that philosophers have not directly addressed: how does Quine understand the philosophical problem of truth? A primary thesis of this paper is that we can answer this question only by working from within Quine’s naturalistic framework. Drawing on neglected texts from Quine's corpus, I defend the view that, for Quine, the problem of truth emerges from the development (...) of science, in particular, from logical theorizing. I show that disquotation itself, from this Quinean point of view, is the problematic phenomenon calling for philosophical reflection. I conclude by arguing that Quine does not envisage the kind of explanatory role for disquotation taken up by contemporary deflationists, and he shows no interest in the task that animates deflationism, namely, to show that concerns with truth’s nature are fundamentally confused. (shrink)

Some experts have argued that patients facing certain types of choices should not be told whether their risk is above or below average, because this information may trigger a bias (Fagerlin et al. 2007). But careful consideration shows that the comparative risk heuristic can usefully guide decisions and improve their quality or rationality. Building on an earlier paper of mine (Schwartz 2009), I will argue here that doctors and decision aids should provide comparative risk information to patients, even while (...) further research is conducted. (shrink)

In the remainder of this article, we will disarm an important motivation for epistemic contextualism and interest-relative invariantism. We will accomplish this by presenting a stringent test of whether there is a stakes effect on ordinary knowledge ascription. Having shown that, even on a stringent way of testing, stakes fail to impact ordinary knowledge ascription, we will conclude that we should take another look at classical invariantism. Here is how we will proceed. Section 1 lays out some limitations of previous (...) research on stakes. Section 2 presents our study and concludes that there is little evidence for a substantial stakes effect. Section 3 responds to objections. The conclusion clears the way for classical invariantism. (shrink)

This paper argues in favor of two related theses. First, due to a fundamental, biologically grounded world-openness, human culture is a biological imperative. As both biology and culture evolve historically, cultures rise and fall and the diversity of the human species develops. Second, in this historical process of rise and fall, abnormality plays a crucial role. From the perspective of a broader context traditionally addressed by speculative philosophies of history, the so-called mental disorders may be seen as entailing particular functional (...) advantages, and thus have a great impact on the course of human history. Nowadays, however, we live under a threat of cultural uniformity. While the diversity of the human species is cherished at the political level, it is being slowly eradicated through medical means. This paradox is a dangerous feature of contemporary globalized society that can lead to highly problematic consequences. (shrink)

Dretske has provided very influential arguments that there is a difference between our sensory awareness of objects and our awareness of facts about these objects—that there is a difference, for example, between seeing x and seeing that x is F. This distinction between simple and epistemic seeing is a staple of the philosophy of perception. Memory is often usefully compared to perception, and in this spirit I argue for the conditional claim that if Dretske’s arguments succeed in motivating the posit (...) of simple seeing, then parallel arguments should equally motivate a posit I call simple remembering. Simple remembering would be a conscious form of memory about an object or event which is prior to and independent of any beliefs the subject may or may not form about the object or event simply remembered. (shrink)

Roemer's attempt to undermine the normative reasons that Marxists have thought exploitation important (domination, alienation, and inequality) is vitiated by several crucial errors. First, Roemer ignores the dimension of freedom which is Marx's main concern and replaces it with an interest in justice, which Marx rejected. This leads him to misconstrue the nature of exploitation as Marx understands it. Second, his procedure for disconnecting these evils from exploitation, or denying their importance, involves the methodological assumption that exploitation must strictly imply (...) these evils. He thus fails to see that exploitation may 'cause' domination, alienation, and inequality; this assumption and the focus on justice also lead him to overlook the sort of alienation that is most important to Marx and the way exploitation, as Marx understands it, does imply coercion. Roemer's alternative conception of exploitation thus fails to capture basic Marxist normative and explanatory concerns. But Roemer's insistence on the importance of justice and the need for an articulated alternative to capitalism are a necessary supplement to a Marxist account. (shrink)

This paper critiques the view, widely held by philosophers of mind and cognitive scientists, that psychological explanation is a matter of ascribing propositional attitudes (such as beliefs and desires) towards language-like propositions in the mind, and that cognitive mental states consist in intentional attitudes towards propositions of a linguistic quasi-linguistic nature. On this view, thought is structured very much like a language. Denial that propositional attitude psychology is an adequate account of mind is therefore, on this view, is tantamount to (...) eliminative materialism, the denial that human beings are thinking beings. -/- I dispute this on the basis of recent work in cognitive psychology and artificial intelligence. Mental models theory, on which thought is better understood as nonpropositional intentional psychology, accords better with the evidence and offers an alternative view to propositional attitude psychology -- one that means that the denial that that is propositional is not eliminative. However, I argue that propositional attitude psychology is a useful idealization, as classical mechanics is of relativity theory, strictly but not radically false, and useful for prediction and indeed, as long as its idealized character is born in mind, for explanation of behavior. (shrink)