This paper considers the view that medicine is both “science” and “art.” It is argued that on this view certain clinical knowledge – of patients’ histories, values, and preferences, and how to integrate them in decision-making – cannot be scientific knowledge. However, by drawing on recent work in philosophy of science it is argued that progress in gaining such knowledge has been achieved by the accumulation of what should be understood as “scientific” knowledge. I claim there are varying degrees (...) of objectivity pertaining to various aspects of clinical medicine. Hence, what is often understood as constituting the “art” of medicine is amenable to objective methods of inquiry, and so, may be understood as “science”. As a result, I conclude that rather than endorse the popular philosophical distinction between the art and science of medicine, in the future a unified, multifaceted epistemology of medicine should be developed to replace it. (shrink)

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

If one had to identify the biggest change within the philosophical tradition in the twenty-first century, it would certainly be the rapid rise of experimental philosophy to address differences in intuitions about concepts. It is, therefore, surprising that the philosophy of medicine has so far not drawn on the tools of experimental philosophy in the context of a particular conceptual debate that has overshadowed all others in the field: the long-standing dispute between so-called naturalists and normativists about the concepts (...) of health and disease. In this paper, I defend and advocate the use of empirical methods to inform and advance this and other debates within the philosophy of medicine. (shrink)

Many extant theories of placebo focus on their causal structure wherein placebo effects are those that originate from select features of the therapy (e.g., client expectations or “incidental” features like size and shape). Although such accounts can distinguish placebos from standard medical treatments, they cannot distinguish placebos from everyday occurrences, for example, when positive feedback improves our performance on a task. Providing a social-epistemological account of a treatment context can rule out such occurrences, and furthermore reveal a new way to (...) distinguish clinical placebos from standard medical treatments. (shrink)

A common epistemological assumption in contemporary bioethics held b y both proponents and critics of non-traditional forms of cognitive enhancement is that cognitive enhancement aims at the facilitation of the accumulation of human knowledge. This paper does three central things. First, drawing from recent work in epistemology, a rival account of cognitive enhancement, framed in terms of the notion of cognitive achievement rather than knowledge, is proposed. Second, we outline and respond to an axiological objection to our proposal that (...) draws from recent work by Leon Kass (2004), Michael Sandel (2009), and John Harris (2011) to the effect that ‘enhanced’ cognitive achievements are (by effectively removing obstacles to success) not worthy of pursuit, or are otherwise ‘trivial’. Third, we show how the cognitive achievement account of cognitive enhancement proposed here fits snugly with recent active externalist approaches (e.g., extended cognition) in the philosophy of mind and cognitive science. (shrink)

The purpose of this chapter is to describe what we see as several important new directions for philosophy of medicine. This recent work (i) takes existing discussions in important and promising new directions, (ii) identifies areas that have not received sufficient and deserved attention to date, and/or (iii) brings together philosophy of medicine with other areas of philosophy (including bioethics, philosophy of psychiatry, and social epistemology). To this end, the next part focuses on what we call the (...) “epistemological turn” in recent work in the philosophy of medicine; the third part addresses new developments in medical research that raise interesting questions for philosophy of medicine; the fourth part is a discussion of philosophical issues within the practice of diagnosis; the fifth part focuses on the recent developments in psychiatric classification and scientific and ethical issues therein, and the final part focuses on the objectivity of medical research. (shrink)

The first part of a symposium devoted to Alex Broadbent's essay titled ‘Prediction, Understanding and Medicine’, this article notes the under-development of a variety of issues in the philosophy of medicine that transcend bioethics and the long-standing debates about the nature of health/illness and of evidence-based medicine. It also indicates the importance of drawing on non-Western, and particularly African, traditions in addressing these largely metaphysical and epistemological matters.

About the analogy between the epistemological and methodological aspects of the activity of intelligence agencies and some scientific disciplines, advocating for a more scientific approach to the process of collecting and analyzing information within the intelligence cycle. I assert that the theoretical, ontological and epistemological aspects of the activity of many intelligence agencies are underestimated, leading to incomplete understanding of current phenomena and confusion in inter-institutional collaboration. After a brief Introduction, which includes a history of the evolution of the intelligence (...) concept after World War II, Intelligence Activity defines the objectives and organization of intelligence agencies, the core model of these organizations (the intelligence cycle), and the relevant aspects of the intelligence gathering and intelligence analysis. In the Ontology section, I highlight the ontological aspects and the entities that threaten and are threatened. The Epistemology section includes aspects specific to intelligence activity, with the analysis of the traditional (Singer) model, and a possible epistemological approach through the concept of tacit knowledge developed by scientist Michael Polanyi. In the Methodology section there are various methodological theories with an emphasis on structural analytical techniques, and some analogies with science, archeology, business and medicine. In Conclusions I argue on the possibility of a more scientific approach to methods of intelligence gathering and analysis of intelligence agencies. -/- ISBN 978-606-033-219-0, DOI: 10.58679/MM58823. (shrink)

“Excited Delirium Syndrome” (ExDS) is a controversial diagnosis. The supposed syndrome is sometimes considered to be a potential cause of death. However, it has been argued that its sole purpose is to cover up excessive police violence because it is mainly used to explain deaths of individuals in custody. In this paper, we examine the epistemic conditions giving rise to the controversial diagnosis by discussing the relation between causal hypotheses, evidence, and data in forensic medicine. We argue that the (...) practitioners’ social context affects causal inquiry through background assumptions that enter inquiry at multiple stages. This analysis serves to better understand the wide usage of the controversial diagnosis of ExDS. (shrink)

In this article, we discuss epistemological limitations relating to the use of ethnoracial categories in biomedical research as devised by the Office of Management and Budget’s institutional guidelines. We argue that the obligation to use ethnoracial categories in genomics research should be abandoned. First, we outline how conceptual imprecision in the definition of ethnoracial categories can generate epistemic uncertainty in medical research and practice. Second, we focus on the use of ethnoracial categories in medical genetics, particularly genomics-based precision medicine, (...) where ethnoracial identity is understood as a proxy for medically relevant differences among individuals. Notably, extensive criticisms have been made already against the genetic interpretation of races, but, nonetheless, the concept of race remains a key element of contemporary genomics. This motivates us to explore possible reasons why such criticisms may have been ineffective in redirecting attention to other (non-race-based) ways of controlling for human variability. We contend that popular arguments against the idea that human races have a genetic basis, though convincing in many respects, are not sufficient to exclude the pragmatic use of race and ethnicity as proxies for genetic variability related to complex phenotypes. Finally, we provide two further arguments to support the idea that ethnoracial categories are unlikely to provide meaningful insights into medical genetics, which implies that even the interpretation of race as a useful tool to stratify disease risk is unwarranted. (shrink)

In this paper, I identify two major philosophical crises confronting medicine as a global phenomenon. The first crisis is the epistemological crisis of adopting an epistemic attitude, adequate for improving medical knowledge and practice. The second is the ethical crisis, also known as the “quality-of-care crisis,” arising from the traditional patient-physician dyad. I acknowledge the different proposals put forward in the quest for solutions to these crises. However, I observe that most of these proposals remain inadequate given their over-reliance (...) on the Western biomedical tradition and the medical hegemony that underpins the proposals themselves. Contrary to the approach employed in these proposals, I propose medical pluralism as a viable platform for resolving the philosophic crises in medicine, by critically engaging non-Western medical traditions and thought systems. Ultimately, I make a push for the deliberate inauguration of an African philosophy of medicine and bioethics and other context-specific or indigenous philosophies of medicine and bioethics that will ensure continuous investigations into NMTs and their contribution to global medical issues. (shrink)

Diagnoses are central to the practice of medicine, where they serve a variety of functions for clinicians, patients, and society. They aid communication, explain symptoms, inform predictions, guide therapeutic interventions, legitimize sickness, and authorize access to resources. Insofar as psychiatry is a discipline whose practice is shaped by medical conventions, its diagnoses are sometimes presented as if they serve the same sorts of function as diagnoses in bodily medicine. However, there are philosophical problems that cast doubt on whether (...) the functions of psychiatric diagnoses can legitimately be considered to be equivalent to those of medical diagnoses. The aim of this chapter is to explicate some of these problems, particularly conceptual and epistemological problems pertaining to the roles of diagnoses as explanations. I begin with an overview of the various functions that medical diagnoses normally serve and suggest that many of these functions receive justificatory support from the explanatory roles of the diagnoses. I then present issues regarding the epistemic functions of psychiatric diagnoses and how these issues have featured in the arguments of prominent critics of psychiatry. (shrink)

This paper addresses the recent rise of the use of alternative medicine in Western countries. It offers a novel explanation of that phenomenon in terms of cognitive and economic factors related to the free-market and patient-centric approach to medicine that is currently in place in those countries, in contrast to some alternative explanations of this phenomenon. Moreover, the paper addresses this troubling trend in terms of the serious harms associated with the use of alternative medical modalities. The explanatory (...) theory defended here is then predicated on the idea that an extreme patient-centric model of medical practice that treats largely ignorant patients as consumers of medical products and services endowed with an essentially unrestricted power of freedom to choose treatments predictably leads serious and avoidable harms. Some important moral and epistemological consequences of this model are then articulated and corrective measures are suggested. (shrink)

Positivist medical historians, guided by the savoir of modern western biomedicine, have long depicted medieval medicine as an aberration along the continuum of scientific and medical progress. Historical epistemology, founded in the ideas of Cavailles, Foucault, Davidson, and Hacking, however, allows the historian to disrupt this false continuum and to unchain medieval medicine from modern medicine. Postmodernist approaches, such as those sourced in Lyotard, Barthes, and Derrida, allow the historian to further deconstruct medieval and modern medical (...) discourse, revealing a multitude of narrative lenses spinning around biomedical and biocultural strands. In liberating these two medical systems and setting them within the distinct historical and epistemological contexts that both shaped and were shaped by them, the historian can revision the theories, practices, and culture of medieval medicine without having to anachronistically justify them according to modern medical discourse. (shrink)

In this paper, I open an inquiry that provides a catalyst for the inauguration of African Philosophy of Medicine and Bioethics (APMB) as a full-fledged academic pursuit. I situate this inquiry within the quest of early professional African philosophers for a stirring of the course of contemporary African philosophy along the path of critically retrieving, clarifying, and articulating aspects of traditional African culture and practices in the light of social pluralism and modernization. The case I make for the establishment (...) of this discipline and my effort to delineate its nature, scope, and method hinge on three important realities: (i) The existence of African Traditional Medicine (ATM); (ii) the existence of philosophical puzzles in ATM that require conceptual, metaphysical, epistemological, ethical, and socio-political analyses; and (iii) the need to carry out this analysis in the context of the twenty-first-century reality of medical pluralism and globalization. Solidifying my effort to map out the landscape of this new enterprise, in the concluding part of this paper, I make recommendations on the direction the discipline is to take if it must fulfil its goal of providing a framework for the improvement of medical knowledge and practice in contemporary Africa. (shrink)

The success of precision medicine depends on obtaining large amounts of information about at-risk populations. However, getting consent is often difficult. Why? In this commentary I point to the differentials in social status involved. These differentials are inevitable once personal information is surrendered, but are particularly intense when the studied populations are socioeconomically or socioculturally disadvantaged and/or ethnically stigmatized groups. I suggest how the deep distrust of the latter groups can be partially justified as a lack of confidence that (...) their core values or interests will sufficiently be taken into account. Hence, the ethical challenge here lies not in avoiding status differentials, but in dealing with them appropriately. Scientists should not assume trust from others but adopt a norm of “demonstrating trustworthiness”. (shrink)

This paper aims to clarify the nature of understanding in medicine. The first part describes in more detail what it means to understand something and links a type of understanding (i.e., objectual understanding) to explanations. The second part proceeds to investigate what objectual understanding of a disease (i.e., biomedical understanding) requires by considering the case of scurvy from the history of medicine. The main hypothesis is that grasping a mechanistic explanation of a condition is necessary for a biomedical (...) understanding of that condition. The third part of the paper argues that biomedical understanding is necessary, but not sufficient for understanding in a clinical context (i.e., clinical understanding). The hypothesis is that clinical understanding combines biomedical understanding of a _disease_ or pathological condition with understanding _illness,_ which involves some degree of personal understanding of the patient. It is argued that, in many cases, clinical understanding necessitates adopting a particular second-personal stance and using cognitive resources _in addition_ to those involved in biomedical understanding. (shrink)

This dissertation explores the influence of time constraints on different research practices. The first two parts present case studies, which serve as a basis for discussing the epistemological and ethical implications of temporal limitations in scientific research. Part I is a case study on gravitational wave research, conducted by the LIGO Scientific Collaboration. This exemplifies fundamental research – without immediate societal applications, open-ended in terms of timeline and in terms of research goals. It is based, in part, on qualitative interviews (...) conducted with gravitational wave physicists. I show that considerations about time and speed play a role in every stage of research: goal setting, method design, and the evaluation and communication of results. Part II provides a case study on translational medicine, an approach explicitly dedicated to accelerating research in order to develop and implement new therapies. This epitomizes applied research with high social stakes, motivated by non-epistemic goals. Here, epistemic trade-offs between speed and reliability intersect with ethical trade-offs between different types of harms. In Part III, the insights from both of these case studies are used as the basis for a more general discussion concerning the pragmatic aspects of epistemic practices, especially in relation to current debates centered on the role of values in science. A particular focus is on the value of speed and the ability to generate reliable results, either via choice of methods, or via decisions about which goals to set, as well as decisions about when to stop further testing. The primary thesis of the dissertation is that pragmatic considerations stemming from limitations of resources are a necessary feature of the pursuit of epistemic aims, and that the epistemic is thus inherently pragmatic. (shrink)

Philosophy of immunology is a subfield of philosophy of biology dealing with ontological and epistemological issues related to the studies of the immune system. While speculative investigations and abstract analyses have always been part of immune theorizing, until recently philosophers have largely ignored immunology. Yet the implications for understanding the philosophical basis of organismal functions framed by immunity offer new perspectives on fundamental questions of biology and medicine. Developed in the context of history of medicine, theoretical biology, and (...) medical anthropology, philosophy of immunology differs from these related branches of study in its focus on traditional philosophical questions concerning identity, individuality, ecology, cognition, scientific methodology and theory construction. This broad agenda derives from immunology’s multifaceted research program that has developed from its initial clinical challenges of host defense, transplantation, autoimmunity, tumor immunology, and allergy. In addition to these well-established research areas, immunity is now understood to play a central role in other physiological functions, development, ecology, and evolutionary mechanics. Holding together these diverse domains of inquiry lie philosophical commitments oriented by organismal identity. In this regard, pertinent issues are raised concerning cognition (organization of immune perception and information processing), the character of individuality (framed by the ecological context of immune-mediated assimilation and rejection), and the dynamics of complex systems (understood as holistic systems biology). Indeed, immunology, in the context of cognitive science, evolutionary biology, environmental sciences, and development provides multi-focal perspectives for philosophy of science. (shrink)

Evidence-based medicine (EBM) calls for medical practitioners to “integrate” our best available evidence into clinical practice. A significant amount of the literature on EBM takes this integration to be unproblematic, focusing on questions like how to interpret evidence and engage with patient values, rather than critically looking at how these features of EBM can be implemented together. Other authors have also commented on this gap in the literature, for example, identifying the lack of clarity about how patient preferences and (...) evidence from trials is supposed to be integrated in practice. In this paper, I look at this issue from an epistemological perspective, (looking at how different types of knowledge in EBM can be used to make sounds judgements). In particular, I introduce an epistemological issue for this integration problem, which I call the epistemic integration problem. This is essentially the problem of how we can use information that is both general (eg, about a population sample) and descriptive (eg, about what expected outcomes are) to reach clinical judgements that are individualized (applying to a particular patient) and normative (about what is best for their health). (shrink)

What position on dualism does medicine require? Our understanding of that ques- tion has been dictated by holism, as defined by the biopsychosocial model, since the late twentieth century. Unfortunately, holism was characterized at the start with con- fused definitions of ‘dualism’ and ‘reductionism’, and that problem has led to a deep, unrecognized conceptual split in the medical professions. Some insist that holism is a nonreductionist approach that aligns with some form of dualism, while others insist it’s a reductionist (...) view that sets out to eradicate dualism. It’s important to consider each version. Nonreductive holism is philosophically consistent and clinically unprob- lematic. Reductive holism, however, is conceptually incoherent—yet it is the basis for the common idea that the boundary between medical and mental health disorders must be vague. When we trace that idea through to its implementation in medical practice, we find evidence that it compromises the safety of patient care in the large portion of cases where clinicians grapple with diagnosis at the boundary between psychiatry and medicine. Having established that medicine must embrace some form of nonreduc- tionism, I argue that Chalmers’ naturalistic dualism is a stronger prima facie candidate than the nonreductive alternatives. Regardless of which form of nonreductionism we prefer, some philosophical corrections are needed to give medicine a safe and coherent foundation. (shrink)

There have recently been novel applications of medical systematic review guidelines to economic policy interventions which contain controversial methodological assumptions that require further scrutiny. A landmark 2017 Cochrane review of unconditional cash transfer (UCT) studies, based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE), exemplifies both the possibilities and limitations of applying medical systematic review guidelines to UCT and universal basic income (UBI) studies. Recognizing the need to upgrade GRADE to incorporate the differences between medical and policy interventions, (...) the GRADE Public Health Project Group (PHPG) was convened to enumerate and address these methodological challenges. However, in light of our analysis of additional methodological challenges that arise for UCT and UBI studies, we argue that the adaptation of medical systematic review guidelines to economic methodology is far from straightforward and is in fact more challenging than claimed by the PHPG. (shrink)

This article surveys recent developments in the epistemology of modality.

Alison Bailey’s The Weight of Whiteness: A Feminist Engagement with Privilege, Race, and Ignorance examines how whiteness misshapes our humanity, measuring the weight of whiteness in terms of its costs and losses to collective humanity. People of color feel the weight of whiteness daily. The resistant habits of whiteness and its attendant privileges, however, make it difficult for white people to feel the damage. White people are more comfortable thinking about white supremacy in terms of what privilege does for them, (...) rather than feeling what it does to them. The first half of the book focuses on the overexposed side of white privilege, the side that works to make the invisible and intangible structures of power more visible and tangible. Bailey discusses the importance of understanding privileges intersectionally, the ignorance-preserving habits of “white talk,” and how privilege and ignorance circulate in educational settings. The second part invites white readers to explore the underexposed side of white dominance, the weightless side that they would rather not feel. The final chapters are powerfully autobiographical. Bailey engages readers with a deeply personal account of what it means to hold space with the painful weight of whiteness in her own life. She also offers a moving account of medicinal genealogies, which helps to engage the weight she inherits from her settler colonial ancestors. The book illustrates how the gravitational pull of white ignorance and comfort are stronger than the clean pain required for collective liberation. The stakes are high: Failure to hold the weight of whiteness ensures that white people will continue to blow the weight of historical trauma through communities of color. -/- All rights reserved. No portion of this publication may be reproduced, stored in a retrieval system, or transmitted in any form by any means, electronic, mechanical, photocopying, recording or otherwise without the prior written permission of the publisher. -/- -/- . (shrink)

While most of healthcare research and practice fully endorses evidence-based healthcare, a minority view borrows popular themes from philosophy of science like underdetermination and value-ladenness to question the legitimacy of the evidence-based movement’s philosophical underpinnings. While the feminist origins go unacknowledged, those critics adopt a feminist reading of the “gap argument” to challenge the perceived objectivism of evidence-based practice. From there, the critics seem to despair over the “subjective elements” that values introduce to clinical reasoning, demonstrating that they do not (...) subscribe to feminist science studies’ normative program——where contextual values can enable good science and justified decisions. In this paper, I investigate why it is that the critics of evidence-based medicine adopt feminist science’s characterization of the problem but resist the productive solutions offered by those same theorists. I suggest that the common feminist empiricist appeal to idealized epistemic communities is impractical for those working within the current biomedical context and instead offer an alternate stream of feminist research into the empirical content of values (found in the work of Elizabeth Anderson and Sharyn Clough) as a more helpful recourse for facilitating the important task of legitimate and justified clinical decision-making. I use a case study on clinical decision-making to illustrate the fruitfulness of the latter feminist empiricist framework. -/- See response by Sharyn Clough: http://wp.me/p1Bfg0-1aN See reply by Maya Goldenberg: http://wp.me/p1Bfg0-1oY. (shrink)

This article explores Galen's analysis of and response to the Rationalist and Empiricist medical sects. It argues that his interest in their debate concerning the epistemology of medicine and anatomy was key to his advancement of an experimental methodology.

There is a lot of conceptual engineering going on in medical research. I substantiate this claim with two examples, the medical debate about cancer classification and about obesity as a disease I also argue that the proper target of conceptual engineering in medical research are experts’ conceptions. These are explicitly written down in documents and guidelines, and they bear on research and policies. In the second part of the chapter, I propose an externalist framework in which conceptions have both the (...) explanatory power of psychological concepts and that of semantic concepts. It is likely, however, that human activities and practices distinct from medical research, and regulated by different practices and epistemic rules, call for different targets for conceptual engineering. I conclude with indicating an open agenda of problems for philosophers of medicine interested in conceptual engineering. (shrink)

Thirty years after the rise of the evidence-based medicine (EBM) movement, formal training in philosophy remains poorly represented among medical students and their educators. In this paper, I argue that EBM’s reception in this context has resulted in a privileging of empiricism over rationalism in clinical reasoning with unintended consequences for medical practice. After a limited review of the history of medical epistemology, I argue that a solution to this problem can be found in the method of the (...) 2nd-century Roman physician Galen, who brought empiricism and rationalism together in a synthesis anticipating the scientific method. Next, I review several of the problems that have been identified as resulting from a staunch commitment to empiricism in medical practice. Finally, I conclude that greater epistemological awareness in the medical community would precipitate a Galenic shift toward a more epistemically balanced, scientific approach to clinical research. (shrink)

The epistemology of essence is a topic that has received relatively little attention, although there are signs that this is changing. The lack of literature engaging directly with the topic is probably partly due to the mystery surrounding the notion of essence itself, and partly due to the sheer difficulty of developing a plausible epistemology. The need for such an account is clear especially for those, like E.J. Lowe, who are committed to a broadly Aristotelian conception of essence, (...) whereby essence plays an important theoretical role. In this chapter, our epistemic access to essence is examined in terms of the a posteriori vs. a priori distinction. The two main accounts to be contrasted are those of David S. Oderberg and E.J. Lowe. (shrink)

In spite of a considerable progress in comorbidity research and huge literature on it, this phenomenon is one of the greatest epistemological, research and clinical challenges to contemporary psychiatry and medicine. Mental disorders are very often comorbidly expressed, both among themselves and with various sorts of somatic diseases and illnesses. Therefore, comorbidity studies have been expected to be an impetus to research on the validity of current diagnostic systems as well as on establishing more effective and effi cient treatment (...) within the frame of person centered transdisciplinary psychiatry and integrative medicine. This review focuses fi rst on conceptual chaos and different connotations, then on transdisciplinary perspectives of comorbidity and multimorbidity. The authors compiled an extensive set of various views and perspectives, dilemmas and controversies, in order to evaluate what we know and what we don’t about comorbidity, what comorbidity is and what comorbidity is not, what are facts and what are non-facts on comorbidity and multimorbidity. (shrink)

Root, branch, and blossom, attention is intertwined with epistemology. It is essential to our capacity to learn and decisive of the evidence we obtain, it influences the intellectual connections we forge and those we remember, and it is the cognitive tool whereby we enact decisions about inquiry. Moreover, because it is both an epistemic practice and a site of agency, attention is a natural locus for questions about epistemic morality. This article surveys the emerging epistemology of attention, reviewing (...) the existing literature and sketching avenues for future investigation. It also argues for a reorientation of epistemology itself. This argument is the focus of Section 1. Section 2 briefly reviews philosophical accounts of attention, Section 3 focuses on issues in traditional, individualistic epistemology, and Section 4 turns to social epistemology. (shrink)

Philosophers of science and medicine now aspire to provide useful, socially relevant accounts of mechanism. Existing accounts have forged the path by attending to mechanisms in historical context, scientific practice, the special sciences, and policy. Yet, their primary focus has been on more proximate issues related to therapeutic effectiveness. To take the next step toward social relevance, we must investigate the challenges facing researchers, clinicians, and policy makers involving values and social context. Accordingly, we learn valuable lessons about the (...) connections between mechanistic processes and more fundamental reasons for medical interventions, particularly moral, ethical, religious, and political concerns about health, agency, and power. This paper uses debates over the controversial morning-after pill to gain insight into the deeper reasons for the production and use of mechanistic knowledge throughout biomedical research, clinical practice, and governmental regulation. To practice socially relevant philosophy of science, I argue that we need to account for mechanistic knowledge beyond immediate effectiveness, such as how it can also provide moral guidance, aid ethical categorization in the clinic, and function as a political instrument. Such insights have implications for medical epistemology, including the value-laden dimensions of mechanistic reasoning and the “epistemic friction” of values. Furthermore, there are broader impacts for teaching research ethics and understanding the role of science advisors as political advocates. (shrink)

Because “evidence” is at issue in evidence-based medicine (EBM), the critical responses to the movement have taken up themes from post-positivist philosophy of science to demonstrate the untenability of the objectivist account of evidence. While these post-positivist critiques seem largely correct, I propose that when they focus their analyses on what counts as evidence, the critics miss important and desirable pragmatic features of the evidence-based approach. This article redirects critical attention toward EBM’s rigid hierarchy of evidence as the culprit (...) of its objectionable epistemic practices. It reframes the EBM discourse in light of a distinction between objectivist and pragmatic epistemology, which allows for a more nuanced analysis of EBM than previously offered: one that is not either/or in its evaluation of the decision-making technology as either iconoclastic or creedal. -/- . (shrink)

In this paper, I explore what gives collective testimony its epistemic credentials, through a critical discussion of three competing accounts of the epistemology of collective testimony. According to the first view, collective testimony inherits its epistemic credentials from the beliefs the testimony expresses— where this can be seen either as the beliefs of all or some of the group’s members, or as the beliefs of group itself. The second view denies any necessary connection to belief, claiming instead that the (...) epistemic credentials of collective testimony derive from the reliability or truth-conduciveness of the statement that expresses the testimony. Finally, the third view claims that the epistemic credentials of collective testimony derive from the fact that it involves undertaking a collective commitment to trustworthiness, which makes the group susceptible to rebuke and blame if its testimony is not trustworthy. I argue that this last account holds the most promise for preserving what is distinctive about testimonial knowledge while still underwriting a robust epistemology of collective testimony. (shrink)

Fears of black-box algorithms are multiplying. Black-box algorithms are said to prevent accountability, make it harder to detect bias and so on. Some fears concern the epistemology of black-box algorithms in medicine and the ethical implications of that epistemology. In ‘Who is afraid of black box algorithms? On the epistemological and ethical basis of trust in medical AI,' Durán and Jongsma seek to allay such fears. While some of their arguments are compelling, we still see reasons for (...) fear. (shrink)

What is W. V. O. Quine’s relationship to classical pragmatism? Although he resists the comparison to William James in particular, commentators have seen an affinity between his “web of belief” model of theory confirmation and James’s claim that our beliefs form a “stock” that faces new experience as a corporate body. I argue that the similarity is only superficial. James thinks our web of beliefs should be responsive not just to perceptual but also to emotional experiences in some cases; Quine (...) denies this. I motivate James’s controversial view by appealing to an episode in the history of medicine when a researcher self-experimented by swallowing a vial of bacteria that at the time had not been studied in much detail. The researcher’s commitment to his own as-yet untested hypothesis was based in part on emotional considerations. Finally, I argue that Quine’s insistence that emotions can never be relevant to adjusting our web of belief reflects a tacit holdover of one of logical positivism’s crucially anti-pragmatist commitments—that philosophy of science should focus exclusively on the context of justification, not the context of discovery. James’s emphasis on discovery as a (perhaps the) crucial locus for epistemological inquiry is characteristic of pragmatism in general. Since Quinean epistemology is always an epistemology of justification, he is not happily viewed as a member of the pragmatist tradition. (shrink)

The goal of this programmatic paper is to highlight a close connection between the core problem in the philosophy of medicine, i.e. the concept of health, and the core problem of the philosophy of mind, i.e. the concept of consciousness. I show when we look at these phenomena together, taking the evolutionary perspective of modern state-based behavioural and life-history theory used as the teleonomic tool to Darwinize the agent- and subject-side of organisms, we will be in a better position (...) to make sense of them both as natural phenomena. (shrink)

This is an introduction to the volume The Epistemology of Group Disagreement (Routledge, forthcoming), (eds.) F. Broncano-Berrocal and J.A. Carter.

Disagreement among experts is a central topic in social epistemology. What should an expert do when confronted with the different opinion of an epistemic peer? Possible answers include the steadfast view, the abstemious view, and moderate conciliatory views, which specify criteria for belief change when a peer’s different opinion is encountered. The practice of Delphi techniques in healthcare, medicine, and social sciences provides a real-life case study of expert disagreement, where disagreement is gradually transformed into consensus. An analysis (...) of Delphi shows that moderate conciliatory views are descriptively more adequate than rival views. However, it also casts doubt on whether the debate in social epistemology is explanatory relevant vis-à-vis real life cases of expert disagreement, where consensus replaces truth, and acceptance is more explanatorily relevant than belief. (shrink)

How should one react when one has a belief, but knows that other people—who have roughly the same evidence as one has, and seem roughly as likely to react to it correctly—disagree? This paper argues that the disagreement of other competent inquirers often requires one to be much less confident in one’s opinions than one would otherwise be.

This is a collective study of the epistemic significance of disagreement: twelve contributors explore rival responses to the problems that it raises for philosophy. They develop our understanding of epistemic phenomena that are central to any thoughtful engagement with others' beliefs.

How should one react when one has a belief, but knows that other people—who have roughly the same evidence as one has, and seem roughly as likely to react to it correctly—disagree? This paper argues that the disagreement of other competent inquirers often requires one to be much less confident in one’s opinions than one would otherwise be.

In this chapter I give an account of the epistemology underlying the concept of “extension” in the Mengzi, an early Confucian text written in the fourth century BCE. Mengzi suggests in a conversation with King Xuan of Qi that a solution to the King’s problem of how one comes to act in a kingly manner is that one engages in “extension”. I argue that a long-standing scholarly debate on the exact nature of Mengzian “extension” can be resolved by closely (...) investigating the epistemological assumptions that must be in place for “extension” to be a viable solution to King Xuan’s problem. More specifically, my argument is that knowledge of a certain kind, namely knowing-to, is both necessary and sufficient for extension to take place. In other words, for a person S to extend X, where X is a capacity for action, S at least needs to have knowing-to. (shrink)

I provide a critical review of Moti Mizrahi's The Relativity of Theory, expounding on the book's strengths and then providing an extended argument that Mizrahi mischaracterizes the epistemic attitude of concern to antirealism about science as well as the practical stakes involved in adopting the antirealist position.

Recent advancements in artificial intelligence have fueled widespread academic discourse on the ethics of AI within and across a diverse set of disciplines. One notable subfield of AI ethics is machine ethics, which seeks to implement ethical considerations into AI systems. However, since different research efforts within machine ethics have discipline-specific concepts, practices, and goals, the resulting body of work is pestered with conflict and confusion as opposed to fruitful synergies. The aim of this paper is to explore ways to (...) alleviate these issues, both on a practical and theoretical level of analysis. First, we describe two approaches to machine ethics: the philosophical approach and the engineering approach and show how tensions between the two arise due to discipline specific practices and aims. Using the concept of disciplinary capture, we then discuss potential promises and pitfalls to cross-disciplinary collaboration. Drawing on recent work in philosophy of science, we finally describe how metacognitive scaffolds can be used to avoid epistemological obstacles and foster innovative collaboration in AI ethics in general and machine ethics in particular. (shrink)

In disagreements about trivial matters, it often seems appropriate for disputing parties to adopt a ‘middle ground’ view about the disputed matter. But in disputes about more substantial controversies (e.g. in ethics, religion, or politics) this sort of doxastic conduct can seem viciously acquiescent. How should we distinguish between the two kinds of cases, and thereby account for our divergent intuitions about how we ought to respond to them? One possibility is to say that ceding ground in a trivial dispute (...) is appropriate because the disputing parties are usually epistemic peers within the relevant domain, whereas in a more substantial disagreement the disputing parties rarely, if ever, qualify as epistemic peers, and so ‘sticking to one’s guns’ is usually the appropriate doxastic response. My aim in this paper is to explain why this way of drawing the desired distinction is ultimately problematic, even if it seems promising at first blush. (shrink)

Disagreement among experts is a central topic in social epistemology. What should an expert do when confronted with the different opinion of an epistemic peer? Possible answers include the steadfast view (holding to one’s belief), the abstemious view (suspending one’s judgment), and moderate conciliatory views, which specify criteria for belief change when a peer’s different opinion is encountered. The practice of Delphi techniques in healthcare, medicine, and social sciences provides a real-life case study of expert disagreement, where disagreement (...) is gradually transformed into consensus. An analysis of Delphi shows that moderate conciliatory views are descriptively more adequate than rival views. However, it also casts doubt on whether the debate in social epistemology is explanatory relevant vis-à-vis real life cases of expert disagreement, where consensus replaces truth, and acceptance is more explanatorily relevant than belief. (shrink)

What is it to know someone? Epistemologists rarely take up this question, though recent developments make such inquiry possible and desirable. This paper advances an account of how such interpersonal knowledge goes beyond mere propositional and qualitative knowledge about someone, giving a central place to second-personal treatment. It examines what such knowledge requires, and what makes it distinctive within epistemology as well as socially. It assesses its theoretic value for several issues in moral psychology, epistemic injustice, and philosophy of (...) mind. And it offers an account of the complex content in play if interpersonal knowledge is to be understood in terms of its mental states and their functions. (shrink)