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)

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)

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)

"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)

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)

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.

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.

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)

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)

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)

While several tests and strategies are recommended for colorectal cancer (CRC) screening, studies suggest that primary care providers often recommend colonoscopy without providing information about its risks or alternatives. These observations raise concerns about the quality of informed consent for screening colonoscopy.

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)

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)

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 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)

What is posthumanism and why does it matter? This book offers an introduction to the ways in which humanism's belief in the natural supremacy of the Family of Man has been called into question at different moments and from different theoretical positions. What is the relationship between posthumanism and technology? Can posthumanism have a politics—postcolonial or feminist? Are postmodernism and poststructuralism posthumanist? What happens when critical theory meets Hollywood cinema? What links posthumanism to science fiction. Posthumanism addresses these and other (...) questions in an attempt to come to terms with one of the most pressing issues facing contemporary society. (shrink)

We can infer moral conclusions from nonmoral evidence using a three-step procedure. First, we distinguish the processes generating belief so that their reliability in generating true belief is statistically predictable. Second, we assess the processes’ reliability, perhaps by observing how frequently they generate true nonmoral belief or logically inconsistent beliefs. Third, we adjust our credence in moral propositions in light of the truth ratios of the processes generating beliefs in them. This inferential route involves empirically discovering truths of the form (...) “Process P, which generates belief in moral proposition M, has truth ratio T", and using them to discover probabilities for moral propositions. The inferential route is noncircular, and progress along it is driven fundamentally by induction. (shrink)

Nietzsche takes moral judgments to be false beliefs, and encourages us to pursue subjective nonmoral value arising from our passions. His view that strong and unified passions make one virtuous is mathematically derivable from this subjectivism and a conceptual analysis of virtue, explaining his evaluations of character and the nature of the Overman.

Parents play a critical role in their child’s personal development and day-to-day experiences. However, as digital technologies are increasingly embedded in most New Zealand children’s everyday life activities parents face the task of ensuring their child’s online safety. To do so, they need to understand the way their child engages with and through these tools and make sense of the rapidly changing, and more technically complex, nature of digital devices. This presents a digital parenting dilemma: maximising children’s online opportunities while (...) minimising online risks and potential harm. This factsheet presents evidence about digital parenting in New Zealand based on nationally representative data collected from parents, caregivers and whānau and their children aged 9-17. It uses measures from the Global Kids Online project to explore the prevalence of different practices used by New Zealand parents to influence or mediate children’s internet use. (shrink)

Disputes over territory are a major contributing factor to the disruption of international relations. We believe that a cumulative, integrated, and continuously updated resource providing information about such disputes in an easily accessible form would be of benefit to intelligence analysts, military strategists, political scientists, and also to historians and others concerned with international disputes. We propose an ontology-based strategy for creating such a resource. The resource will contain information about territorial disputes, arguments for and against claims pertaining to sovereignty, (...) proffered evidence for such claims, political and military motives (overt or hidden), and associated conflicts. Our approach is designed to address several issues surrounding the representation of geopolitical conflict, including the tracking and individuation of disputes and the validation of disseminated information. (shrink)

Multiverse Views in set theory advocate the claim that there are many universes of sets, no-one of which is canonical, and have risen to prominence over the last few years. One motivating factor is that such positions are often argued to account very elegantly for technical practice. While there is much discussion of the technical aspects of these views, in this paper I analyse a radical form of Multiversism on largely philosophical grounds. Of particular importance will be an account of (...) reference on the Multiversist conception, and the relativism that it implies. I argue that analysis of this central issue in the Philosophy of Mathematics indicates that Radical Multiversism must be algebraic, and cannot be viewed as an attempt to provide an account of reference without a softening of the position. (shrink)

A central area of current philosophical debate in the foundations of mathematics concerns whether or not there is a single, maximal, universe of set theory. Universists maintain that there is such a universe, while Multiversists argue that there are many universes, no one of which is ontologically privileged. Often forcing constructions that add subsets to models are cited as evidence in favour of the latter. This paper informs this debate by analysing ways the Universist might interpret this discourse that seems (...) to necessitate the addition of subsets to V. We argue that despite the prima facie incoherence of such talk for the Universist, she nonetheless has reason to try and provide interpretation of this discourse. We analyse extant interpretations of such talk, and analyse various tradeoffs in naturality that might be made. We conclude that the Universist has promising options for interpreting different forcing constructions. (shrink)

Often philosophers, logicians, and mathematicians employ a notion of intended structure when talking about a branch of mathematics. In addition, we know that there are foundational mathematical theories that can find representatives for the objects of informal mathematics. In this paper, we examine how faithfully foundational theories can represent intended structures, and show that this question is closely linked to the decidability of the theory of the intended structure. We argue that this sheds light on the trade-off between expressive power (...) and meta-theoretic properties when comparing first-order and second-order logic. (shrink)

We explain and explore class-theoretic potentialism—the view that one can always individuate more classes over a set-theoretic universe. We examine some motivations for class-theoretic potentialism, before proving some results concerning the relevant potentialist systems (in particular exhibiting failures of the $\mathsf {.2}$ and $\mathsf {.3}$ axioms). We then discuss the significance of these results for the different kinds of class-theoretic potentialists.

In the contemporary philosophy of set theory, discussion of new axioms that purport to resolve independence necessitates an explanation of how they come to be justified. Ordinarily, justification is divided into two broad kinds: intrinsic justification relates to how `intuitively plausible' an axiom is, whereas extrinsic justification supports an axiom by identifying certain `desirable' consequences. This paper puts pressure on how this distinction is formulated and construed. In particular, we argue that the distinction as often presented is neither well-demarcated nor (...) sufficiently precise. Instead, we suggest that the process of justification in set theory should not be thought of as neatly divisible in this way, but should rather be understood as a conceptually indivisible notion linked to the goal of explanation. (shrink)

This factsheet presents findings from a quantitative study looking at adults’ experiences of sending and sharing potentially harmful digital communications in New Zealand. Typically research into harmful digital communications focuses on the experiences of those on the receiving end – the victims. However, to better address the distress and harm caused, information is needed about the people sending and sharing potentially harmful messages and posts. In this study we asked adult New Zealanders whether they had sent potentially harmful digital communications (...) in the previous year and if so, how often they had done this, who they were sent to, the channel(s) they used, and the reason for doing this. (shrink)

Zero provides a challenge for philosophers of mathematics with realist inclinations. On the one hand it is a bona fide cardinal number, yet on the other it is linked to ideas of nothingness and non-being. This paper provides an analysis of the epistemology and metaphysics of zero. We develop several constraints and then argue that a satisfactory account of zero can be obtained by integrating an account of numbers as properties of collections, work on the philosophy of absences, and recent (...) work in numerical cognition and ontogenetic studies. (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)

John McDowell claims that virtuous people recognize moral reasons using a perceptual capacity that doesn't include desire. I show that the phenomena he cites are better explained if desire makes us see considerations favoring its satisfaction as reasons. The salience of moral considerations to the virtuous, like the salience of food to the hungry, exemplifies the emotional and attentional effects of desire. I offer a desire-based account of how we can follow uncodifiable rules of common-sense morality and how some reasons (...) can be silenced in deliberation. I conclude by arguing that animals can be virtuous by having the right desires. (shrink)

Informal rigour is the process by which we come to understand particular mathematical structures and then manifest this rigour through axiomatisations. Structural relativity is the idea that the kinds of structures we isolate are dependent upon the logic we employ. We bring together these ideas by considering the level of informal rigour exhibited by our set-theoretic discourse, and argue that different foundational programmes should countenance different underlying logics (intermediate between first- and second-order) for formulating set theory. By bringing considerations of (...) perturbations in modal space to bear on the debate, we will suggest that a promising option for representing current set-theoretic thought is given by formulating set theory using quasi-weak second-order logic. These observations indicate that the usual division of structures into \particular (e.g. the natural number structure) and general (e.g. the group structure) is perhaps too coarse grained; we should also make a distinction between intentionally and unintentionally general structures. (shrink)

Let's suppose you think that there are no uncountable sets. Have you adopted a restrictive position? It is certainly tempting to say yes---you've prohibited the existence of certain kinds of large set. This paper argues that this intuition can be challenged. Instead, I argue that there are some considerations based on a formal notion of restrictiveness which suggest that it is restrictive to hold that there are uncountable sets.

Let mathematical justification be the kind of justification obtained when a mathematician provides a proof of a theorem. Are Gettier cases possible for this kind of justification? At first sight we might think not: The standard for mathematical justification is proof and, since proof is bound at the hip with truth, there is no possibility of having an epistemically lucky justification of a true mathematical proposition. In this paper, I argue that Gettier cases are possible (and indeed actual) in mathematical (...) reasoning. By analysing these cases, I suggest that the Gettier phenomenon indicates some upshots for actual mathematical practice. (shrink)

This article addresses two areas of continuing controversy about consent in clinical research: the question of when consent to low risk research is necessary, and the question of when consent to research is valid. The article identifies a number of considerations relevant to determining whether consent is necessary, chief of which is whether the study would involve subjects in ways that would (otherwise) infringe their rights. When consent is necessary, there is a further question of under what conditions consent is (...) valid or successful in waiving a right. The most influential account of validity conditions is non-moralized, in the sense that the conditions make no essential reference to whether the researcher soliciting consent has obtained it in a way that wrongs the subject. The article examines the implications of this account, and compares it with recent accounts that moralize some of the validity conditions. -/- . (shrink)

This essay presents an ideal for modern Western romantic love.The basic ideas are the following: people want to form a distinctive sort of plural subject with another, what Nozick has called a "We", they want to be loved for properties of certain kinds, and they want this love to establish and sustain a special sort of commitment to them over time.

A pervasive thought in contemporary philosophy of mathematics is that in order to justify reflection principles, one must hold universism: the view that there is a single universe of pure sets. I challenge this kind of reasoning by contrasting universism with a Zermelian form of multiversism. I argue that if extant justifications of reflection principles using notions of richness are acceptable for the universist, then the Zermelian can use similar justifications. However, I note that for some forms of richness argument, (...) the status of reflection principles as axioms is left open for the Zermelian. (shrink)

Epistemic akrasia can be rational. I consider a lonely pragmatist who believes that her imaginary friend doesn’t exist, and also believes on pragmatic grounds that she should believe in him. She rationally believes that her imaginary friend doesn’t exist, rationally follows various sources of evidence to the view that she should believe in him to end her loneliness, and rationally holds these attitudes simultaneously. Evidentialism suggests that her ambivalent epistemic state is rational, as considerations grounded in the value of truth (...) justify her beliefs. (shrink)

This article articulates and assesses an imperatival approach to the foundations of mathematics. The core idea for the program is that mathematical domains of interest can fruitfully be viewed as the outputs of construction procedures. We apply this idea to provide a novel formalisation of arithmetic and set theory in terms of such procedures, and discuss the significance of this perspective for the philosophy of mathematics.

APPENDIX: The data emerging from the clinical and brain studies described above suggest that, in the case of OCD, there are two pertinent brain mechanisms that are distinguishable both in terms of neuro-dynamics and in terms of the conscious experiences that accompany them. These mechanisms can be characterized, on anatomical and perhaps evolutionary grounds, as a lower-level and a higher-level mechanism. The clinical treatment has, when successful, an activating effect on the higher-level mechanism, and a suppressive effect on the lower-level (...) one. (shrink)

Philosophers from Hart to Lewis, Johnston and Bennett have expressed various degrees of reservation concerning the doctrine of double effect. A common concern is that, with regard to many activities that double effect is traditionally thought to prohibit, what might at first look to be a directly intended bad effect is really, on closer examination, a directly intended neutral effect that is closely connected to a foreseen bad effect. This essay examines the extent to which the commonsense concept of intention (...) supports a reasonably consistent and coherent application of double effect. Two important conclusions are these: (1) a number of traditionally proscribed activities involve a kind of “targeting” of innocents that can be taken to exhibit a direct intention to harm them; (2) a direct intention to harm need not involve a desire to harm in any ordinary sense of the latter expression. (shrink)

In Thus Spoke Zarathustra, Nietzsche presents passion as constituting human agency. He encountered this Humean view in Schopenhauer, and recognized its explanatory advantages over Platonic and Kantian rationalism. Zarathustra's poetic speeches anticipate and address contemporary objections to the view that passion constitutes agency. "On the Despisers of the Body" explains why understanding the self as constituted by passion provides better explanations of reasoning, value judgment, and the unity of the self than Christine Korsgaard's neo-Kantian view. "On Enjoying and Suffering the (...) Passions" explains why understanding virtues as constituted by passions provides a better explanation of moral phenomenology than John McDowell's rationalism. (shrink)

In this article, I survey some philosophical attitudes to talk concerning `the' universe of sets. I separate out four different strands of the debate, namely: (i) Universism, (ii) Multiversism, (iii) Potentialism, and (iv) Pluralism. I discuss standard arguments and counterarguments concerning the positions and some of the natural mathematical programmes that are suggested by the various views.