A lively topic of debate in decision theory over recent years concerns our understanding of the different risk attitudes exhibited by decision makers. There is ample evidence that risk-averse and risk-seeking behaviours are widespread, and a growing consensus that such behaviour is rationally permissible. In the context of clinical medicine, this matter is complicated by the fact that healthcare professionals must often make choices for the benefit of their patients, but the norms of rational choice are conventionally grounded in (...) a decision maker’s own desires, beliefs and actions. The presence of both doctor and patient raises the question of whose risk attitude matters for the choice at hand and what to do when these diverge. Must doctors make risky choices when treating risk-seeking patients? Ought they to be risk averse in general when choosing on behalf of others? In this paper, I will argue that healthcare professionals ought to adopt a deferential approach, whereby it is the risk attitude of the patient that matters in medical decision making. I will show how familiar arguments for widely held anti-paternalistic views about medicine can be straightforwardly extended to include not only patients’ evaluations of possible health states, but also their attitudes to risk. However, I will also show that this deferential view needs further refinement: patients’ higher-order attitudes towards their risk attitudes must be considered in order to avoid some counterexamples and to accommodate different views about what sort of attitudes risk attitudes actually are. (shrink)

Background: Patient participation in clinical ethics support services has been marked as an important issue. There seems to be a wide variety of practices globally, but extensive theoretical or empirical studies on the matter are missing. Scarce publications indicate that, in Europe, patient participation in CESS varies from region to region, and per type of support. Practices vary from being non-existent, to patients being a full conversation partner. This contrasts with North America, where PP seems more or less (...) standard. While PP seems to be on the rise in Europe, there is no data to confirm this. This study sought a deep understanding of both habits and the attitudes towards PP in the Netherlands, including respondents’ practical and normative perspectives on the matter. Methods and Results: We developed a national survey on PP for Dutch CESS staff. Our survey comprised a total of 25 open and close-ended questions, focused on four topics related to PP goals of CESS, status quo of PP, ideas and ideals concerning PP, and obstacles for PP. Discussion: The four most important findings were that: Patient participation in Dutch CESS is far from standard. Views on patient participation are very much intertwined with the goals of ethics support. Hesitations, fears and perceived obstacles for PP were not on principle and Most respondents see PP as a positive opportunity, yet requiring additional training, practical guidance and experience. Conclusions: Various normative reasons require PP. However, PP seems far from standard and somewhat rare in Dutch CESS settings. Our respondents did not raise many principled objections to PP. Instead, reasons for the lack of PP are intertwined with viewpoints on the goals of CESS, which seemingly focus on supporting health care professionals. Training and practical guidance was thought to be helpful for gaining experience for both CESS staff and HCPs. (shrink)

Background: Use of patients’ medical data for secondary purposes such as health research, audit, and service planning is well established in the UK. However, the governance environment, as well as public understanding about this work, have lagged behind. We aimed to systematically review the literature on UK and Irish public views of patient data used in research, critically analysing such views though an established biomedical ethics framework, to draw out potential strategies for future good practice guidance and inform ethical (...) and privacy debates. Methods: We searched three databases using terms such as patient, public, opinion, and electronic health records. Empirical studies were eligible for inclusion if they surveyed healthcare users, patients or the public in UK and Ireland and examined attitudes, opinions or beliefs about the use of patient data for medical research. Results were synthesised into broad themes using a framework analysis. Results: Out of 13,492 papers and reports screened, 20 papers or reports were eligible. While there was a widespread willingness to share patient data for research for the common good, this very rarely led to unqualified support. The public expressed two generalised concerns about the potential risks to their privacy. The first of these concerns related to a party’s competence in keeping data secure, while the second was associated with the motivation a party might have to use the data. Conclusions: The public evaluates trustworthiness of research organisations by assessing their competence in data-handling and motivation for accessing the data. Public attitudes around data-sharing exemplified several principles which are also widely accepted in biomedical ethics. This provides a framework for understanding public attitudes, which should be considered in the development in any guidance for regulators and data custodians. We propose four salient questions which decision makers should address when evaluating proposals for the secondary use of data. (shrink)

The diabetic foot is a global threat to public health because it can result in infection and amputation, as well as cause the patient to experience considerable pain and incur financial costs. The condition of patients with diabetic foot in North China is distinguished by more severe local ulcers, a worse prognosis, and a longer duration of disease than that of patients with diabetic foot in the south. Through appropriate preventive measures, the diabetic foot can be effectively avoided. This (...) study assesses the existing knowledge, attitudes and practices associated with diabetic foot prevention among adults with diabetes living in rural areas of North China. (shrink)

The use of tobacco is a major cause of preventable mortality. The estimated number of smokers is 1.1 billion. Of these, 700 million men and 100 million women are in developing countries. The objective of this study was to find out attitude towards tobacco consumption among residents of Dhankuta Municipality. The cross sectional study was conducted among the residents of Dhankuta Municipality where 205 households were taken as subjects. Pretested semi structured questionnaire was administered to the study subjects and face (...) to face interview was conducted. The collected data was entered in MS Excel 2000. The quantitative data was analyzed using Statistical Package for the Social Sciences SPSS software package. The study subjects consist of 50.2 of male and 49.8 of female. Regarding respondent's education, study population showed high level of SLC and above 40.5 followed by below SLC 36.1 and very less was illiterate 14.1 . Majority of the respondents think that there should be ban of the advertising of tobacco products 87.3 and smoking in public places 79 . Almost 67 of respondents think that patient's chances of quitting smoking will be increased if health professionals will give advice to patients. Almost 72.6 of the study population feel cut down tobacco use and 80.3 feel guilty about this habit. Almost 65.8 have tried to discontinue tobacco consumption. We conclude that the residents of Dhankuta reflect good attitude towards cessation of tobacco but poor practice to prevent of tobacco consumption. Dr. Ram Bilakshan Sah | Jha N "Attitude towards tobacco consumption among residents of Dhankuta Municipality of Nepal" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-1 | Issue-4 , June 2017. (shrink)

Health service consumers' satisfaction with the services they receive has been a challenge over the past decade, and this has been attributed to many factors that diverse scholars have investigated using different variables. In this study, the attitude and ethical behaviours of healthcare providers as antidotes to health service consumers' satisfaction in the Primary Health Centre at Mgbuoshimini, Port Harcourt, Nigeria, were investigated. A cross-sectional descriptive research design was used to select participants from pregnant women, nursing mothers, couples for family (...) planning, and sick patients. The data were analysed using descriptive statistical tools. The results of the grand total response values were 400 (100%) and strongly agree had 190 (47.5%), agree had 160 (40%), 390 (100%) and strongly agree had 260 (66.7%), agree had 100 (25.6%), and strongly disagree had 13 (3.3%). The overall results were strongly agreed (66.7%) and agreed (25.6%); these connote that the attitudes and ethical behaviours of the healthcare providers towards healthcare service consumers in the primary healthcare facility were poor and that healthcare providers do not execute good ethical behaviour towards health service consumers in the facility, leading to low levels of health resource consumption, low patronage image promotion, and consumers' loss of confidence in the service provider. Therefore, the government should put mechanisms in place to ensure a positive attitude and favourable ethical behaviour among healthcare providers, and individual healthcare providers should also acquire soft skills to improve their attitude and ethical behaviour. (shrink)

Aim: To elicit preferences for prognostic information, attitudes towards withdrawal of life-sustaining treatment (WLST) and perspectives on acceptable quality of life after post-anoxic coma within the adult general population of Germany, Italy, the Netherlands and the United States of America. Methods: A web-based survey, consisting of questions on respondent characteristics, perspectives on quality of life, communication of prognostic information, and withdrawal of life-sustaining treatment, was taken by adult respondents recruited from four countries. Statistical analysis included descriptive analysis and chi2-tests (...) for dierences between countries. Results: In total, 2012 respondents completed the survey. In each country, at least 84% indicated they would prefer to receive early prognostic information. If a poor outcome was predicted with some uncertainty, 37-54% of the respondents indicated that WLST was not to be allowed. A conscious state with severe physical and cognitive impairments was perceived as acceptable quality of life by 17–44% of the respondents. Clear differences between countries exist, including respondents from the U.S. being more likely to allow WLST than respondents from Germany (OR = 1.99, p < 0.001) or the Netherlands (OR = 1.74, p < 0.001) and preferring to stay alive in a conscious state with severe physical and cognitive impairments more than respondents from Italy (OR = 3.76, p < 0.001), Germany (OR = 2.21, p < 0.001), or the Netherlands (OR = 2.39, p < 0.001). Conclusions: Over one-third of the respondents considered WLST unacceptable when there is any remaining prognostic uncertainty. Respondents had a more positive perspective on acceptable quality of life after coma than what is currently considered acceptable in medical literature. This indicates a need for a closer look at the practice of WLST based on prognostic information, to ensure responsible use of novel prognostic tests. (shrink)

Hippocrate a contribué à l’évolution de la médecine grecque de son temps par ses observations détaillées sur les maladies et leurs effets, en insistant sur l’importance du régime et de l’environnement en ce qui concerne la santé des patients. Il s’est interrogé sur la moralité du praticien, son comportement et son attitude avec son patient afin de produire des normes éthiques solides pour départager sa médecine des conceptions magico-religieuses, des pratiques qu’il estimait douteuses, trompeuses. Certains aspects des textes du (...) Corpus Hippocratique ont été largement considérés pertinents par la médecine moderne, tout particulièrement en ce qui concerne les rapports médecin-patient. Dans l’article qui suit, nous nous intéressons au rôle de la confiance dans la relation médecin-patient au sein du Corpus Hippocratique : comment le corps des médecins hippocratiques joue-t-il un rôle dans la construction de la confiance avec le patient ? Nous soutenons que le corps du médecin agit comme élément essentiel dans l’établissement de la confiance et comme support de sa réputation. Or, si la relation de confiance médecin-patient est une condition fondamentale pour la pratique de l’art médical, la confiance est un facteur important et s’inscrit dans une approche où le malade est l’allié du médecin afin de combattre la maladie. Plus le patient a confiance en son médecin, plus le médecin hippocratique est apte à pratiquer son art médical et prêt à aider le patient dans son combat contre la maladie. Ainsi, pour répondre à la question posée, nous présenterons, en premier lieu, le contexte dans lequel le médecin hippocratique pratique son art. Cette présentation nous aidera à comprendre l’importance de la confiance, notamment en ce qui concerne son impact dans la relation médecin-patient, ainsi que de la quantité de données indispensables transmises par le patient au médecin. Nous serons alors en mesure, en deuxième lieu, de démontrer que le corps du médecin et le corps du patient sont des éléments fondamentaux dans l’élaboration de la confiance : corps comme vecteur de l’image du médecin et corps comme instrument. (shrink)

Background: Tuberculosis is among the major causes of illness and death worldwide especially in Asia. Smoking is associated with recurrent tuberculosis and its related mortality. Also, it could affect clinical manifestations, bacteriological conversion and outcome of treatment. This study aimed to evaluate the pattern of tobacco smoking, history of previous quit attempts and attitude towards quitting in tuberculosis patients. Materials and Methods: It was a cross-sectional study done amongst tuberculosis patients presented to DOTS corner of Rajshahi Medical College Hospital. 315 (...) patients entered the study as "First Come First Serve". Selfreported questionnaires were designed according to the standard questionnaires of smoking pattern. Results: Sixty one percent (61%) patients (n=192) were smoker before the diagnosis of tuberculosis. 51.1% were current smokers at the time of interview and were continuing smoking after the diagnosis of tuberculosis. Only 10.2% discontinued smoking after diagnosis. 68.2% smokes less than 10 cigarettes per day. 53.1% was between 31-50 age group. 21-30 is the commonest age group (62%) to start smoking is and 66.1% smoked less than 10 years before diagnosis. To reduce stress was the most common cause to continue smoking (48.9%). 71.9% smokers showed keen interest to stop smoking. Conclusion: Considering the prevalence of smoking in tuberculosis patients, evaluation of tobacco smoking status in such patients and motivating them to quit smoking could be considered as important steps in their treatment process. (shrink)

It is fair to say that in contemporary society there is a growing demand amongst consumers for instant gratification and for products and services that can be accessed 24-hours a day. This appears to be the case across numerous sectors of society including (but not limited to) business, education, retail, tourism, health, and recreation. Some examples that come to mind are the: (i) investor looking for a quick-win return on their outlay, (ii) patient demanding a same-day diagnosis and medicine (...) for their latest ailment, (iii) fast-food restaurant goer, (iv) all-inclusive package holiday-maker that can have food, drink, and entertainment any time of day and without having to leave the confines of their hotel, (v) student or professional undertaking an accelerated program of studies or training in order to be awarded the qualification/certificate in the shortest time possible, and (vi) individual using an online dating agency in order to be instantly matched with the “perfect partner”. In addition to the sectors and examples mentioned above, this trend towards wanting immediate reward also appears to be occurring in the spirituality and religion marketplace. For example, one only has to conduct a search on the internet or look at the spiritualty section of a bookshop and it is easy to be overwhelmed by the number of individuals purporting to be spiritual teachers and promising a quick-fix for alleviating suffering. In this post, we examine the benefits and risks of the ‘I want it all, I want it now’ mentality as they relate to the spiritual (and high-street) consumer, and discuss whether it is possible to embody the essence of the Buddha’s teachings whilst living in a “fast-food” society. (shrink)

Following Strawson, many philosophers have claimed that holding someone responsible necessitates its being appropriate to feel or express the negative reactive attitudes (e.g., resentment) toward her. This view, while compelling, is unable to capture the full range of cases in which we hold others responsible in ordinary life. Consider the parent who holds her five-year-old responsible for not teasing his sister, or the therapist who holds her patient responsible for avoiding self-injurious behavior. Holding responsible in such cases requires (...) enforcing normative expectations, but these norms can (and typically should) be enforced without involving the negative reactive attitudes. To demonstrate this, I consider how responsibility attributions function in psychotherapy, as well as in other contexts where the negative reactive attitudes do not have a natural home. (shrink)

I discuss the trilemma that consists of the following three principles being inconsistent: 1. The Common Principle: if one distribution, A, necessarily brings a higher total sum of personal value that is distributed in a more egalitarian way than another distribution, B, A is more valuable than B. 2. (Weak) ex-ante Pareto: if one uncertain distribution, A, is more valuable than another uncertain distribution, B, for each patient, A is more valuable than B. 3. Pluralism about attitudes to (...) risk (Pluralism): the personal value of a prospect is a weighted sum of the values of the prospect’s outcomes, but the weight each outcome gets might be different from the probability the prospect assigns to the outcome. (shrink)

By the early 2000s, it was already being mentioned that one of the issues affecting bioethics was a lack of wonder or amazement. Today, we see the patient, the weak and the helpless have become clients or objects placed at the disposal of personal, community and entrepreneurial whims based on functionality or utility that can take on a life of its own. Accordingly, the authors of this article propose wonder or amazement as an attitude that not only makes it (...) possible to place the human being at the center and starting point of bioethical reflection, but it is those who suffer the most, the weak and the defenseless, who are predominantly at that center or starting point. -/- A comienzos de la década del 2000 ya se mencionaba que una de las cuestiones que aquejaba la Bioética era la falta de asombro. En la actualidad vemos que el paciente, el débil y el indefenso han pasado a ser clientes u objetos puestos a disposición de caprichos personales, comunitarios o empresariales basados en la funcionalidad o utilidad que pueda tener una vida en particular. Es por eso que en este trabajo proponemos el asombro como una actitud que permite no solo situar a la persona humana como centro y punto de partida de la reflexión bioética, sino que en dicho centro esté de manera preponderante el que más sufre, el débil y el indefenso. (shrink)

At the height of the Covid-19 pandemic, frontline medical professionals at intensive care units around the world faced gruesome decisions about how to ration life-saving medical resources. These events provided a unique lens through which to understand how the public reasons about real-world dilemmas involving trade-offs between human lives. In three studies (total N = 2298), we examined people’s moral attitudes toward the triage of acute coronavirus patients, and found elevated support for utilitarian triage policies. These utilitarian tendencies did (...) not stem from period change in moral attitudes relative to pre-pandemic levels–but rather, from the heightened realism of triage dilemmas. Participants favoured utilitarian resolutions of critical care dilemmas when compared to structurally analogous, non-medical dilemmas–and such support was rooted in prosocial dispositions, including empathy and impartial beneficence. Finally, despite abundant evidence of political polarisation surrounding Covid-19, moral views about critical care triage differed modestly, if at all, between liberals and conservatives. Taken together, our findings highlight people’s robust support for utilitarian measures in the face of a global public health threat, and illustrate how the dominant methods in moral psychology (e.g. trolley cases) may deliver insights that do not generalise to real-world moral dilemmas. (shrink)

Female Genital Cosmetic Surgery (FGCS) is an umbrella term referring to different procedures including labiaplasty (reducing the length of the labia minora), clitoral hood reduction (reducing excess folds of the clitoral hood), hymenoplasty (building the hymen), labia majora augmentation (reducing the labia majora), vaginoplasty (tightening the vagina), and G-spot amplification (increasing the size and sensitivity of the G-spot). This paper is concerned with “all-or-nothing” approaches to FGCS procedures in women’s healthcare, i.e., those that overemphasize either women’s autonomy so as to (...) defend total accessibility to the procedures, or the oppressive social context affecting women as to defend the total banning of the procedures. What is missing in the literature, however, is an articulation of how both approaches ignore that the practice of autonomy can coexist and coincide with facing up to oppression. This paper first provides an articulation of how these attitudes – seemingly in disagreement – have underlying normative assumptions in common. This articulation further helps frame the so-called tension between oppression and autonomy in a way that highlights unique aspects of FGCS procedures. By contrast, I argue in favor of an “in-between” approach, which takes both phenomena into consideration. I argue that merely emphasizing psychophysical harm is not sufficient to justify the total banning of an FGCS procedure. Instead, identifying patterns of false consciousness, as a form of epistemic injustice and weighing those against other forms of potential harm done to a patient provides a moral basis for a doctor to possibly deny a patient’s consent at face value. This also requires a substantial shift in the doctor patient relationship such that it centers around moral deliberations between the two parties. This deliberative model of the doctor patient relationship is intended as a first step toward a feminist model for women’s healthcare; by grounding an “in-between” approach to FGCS where the denial or acceptance of the patient’s consent to an FGCS procedure relies on their epistemic situatedness, and whether the doctor considers that situatedness to justify their motivation to undergo the surgery. (shrink)

Sterilisation requests made by young, childfree adults are frequently denied by doctors, despite sterilisation being legally available to individuals over the age of 18. A commonly given reason for denied requests is that the patient will later regret their decision. In this paper I examine whether the possibility of future regret is a good reason for denying a sterilisation request. I argue that it is not and hence that decision-competent adults who have no desire to have children should have (...) their requests approved. It is a condition of being recognised as autonomous that a person ought to be permitted to make decisions that they might later regret, provided that their decision is justified at the time that it is made. There is also evidence to suggest that sterilisation requests made by men are more likely to be approved than requests made by women, even when age and number of children are factored in. This may indicate that attitudes toward sterilisation are influenced by gender discourses that define women in terms of reproduction and mothering. If this is the case, then it is unjustified and should be addressed. There is no good reason to judge people’s sterilisation requests differently in virtue of their gender. (shrink)

Several quantitative surveys have been conducted internationally to gather empirical information about physicians’ general attitudes towards health care rationing. Are physicians ready to accept and implement rationing, or are they rather reluctant? Do they prefer implicit bedside rationing that allows the physician–patient relationship broad leeway in individual decisions? Or do physicians prefer strategies that apply explicit criteria and rules?

The significance of critical phenomenology for psychiatric praxis has yet to be expounded. In this paper, I argue that the adoption of a critical phenomenological stance can remedy localised instances of hermeneutical injustice, which may arise in the encounter between clinicians and patients with psychosis. In this context, what is communicated is often deemed to lack meaning or to be difficult to understand. While a degree of un-shareability is inherent to subjective life, I argue that issues of unintelligibility can be (...) addressed by shifting from individualistic conceptions of understanding to an interactionist view. This takes into account the contextual, historical and relational background within which meaning is co-constituted. I conclude by providing a corrective for hermeneutical injustice, which entails a specific attentiveness towards the person’s subjectivity, a careful sensitivity to contingent meaning-generating structures, and a degree of hermeneutical flexibility as an attitude of openness towards alternative horizons of possibility. (shrink)

Chronic fatigue syndrome or myalgic encephalomyelitis remains a controversial illness category. This paper surveys the state of knowledge and attitudes about this illness and proposes that epistemic concerns about the testimonial credibility of patients can be articulated using Miranda Fricker’s concept of epistemic injustice. While there is consensus within mainstream medical guidelines that there is no known cause of CFS/ME, there is continued debate about how best to conceive of CFS/ME, including disagreement about how to interpret clinical studies of (...) treatments. Against this background, robust qualitative and quantitative research from a range of countries has found that many doctors display uncertainty about whether CFS/ME is real, which may result in delays in diagnosis and treatment for patients. Strikingly, qualitative research evinces that patients with CFS/ME often experience suspicion by health professionals, and many patients vocally oppose the effectiveness, and the conceptualization, of their illness as psychologically treatable. We address the intersection of these issues and healthcare ethics, and claim that this state of affairs can be explained as a case of epistemic injustice. We find evidence that healthcare consultations are fora where patients with CFS/ME may be particularly vulnerable to epistemic injustice. We argue that the marginalization of many patients is a professional failure that may lead to further ethical and practical consequences both for progressive research into CFS/ME, and for ethical care and delivery of current treatments among individuals suffering from this debilitating illness. (shrink)

Descartes was certain that he was thinking and he was accordingly certain that he existed. Like Descartes, we seem to be more certain of our thoughts and our existence than of anything else. What is less clear is the reason why we are thus certain. Philosophers throughout history have provided different interpretations of the cogito, disagreeing both on the kind of thoughts it characterizes and on the reasons for its cogency. According to what we may call the empiricist interpretation of (...) the cogito, I can only claim to be certain of having experiences, and this certainty, as well as that of my own existence, stems from their phenomenal and subjective character. According to rationalist interpretations, on the other hand, I am certain of having some self-reflexive propositional attitudes, and this certainty derives from their rational features. Psychiatric patients suffering from acute forms of depersonalization or of the Cotard syndrome often doubt that they think and exist, and might even believe that they don't. I argue that their study allows us to favor the empiricist interpretation of the cogito. (shrink)

Neo-Kantianism is common conceived as a philosophy ‘from above’, excelling in speculative constructions – as opposed to the attitude of patient description which is exemplified by the phenomenological turn ‘to the things themselves’. When we study the work of Emil Lask in its relation to that of Husserl and the phenomenologists, however, and when we examine the influences moving in both directions, then we discover that this idea of a radical opposition is misconceived. Lask himself was influenced especially by (...) Husserl’s Logical Investigations, and Husserl, especially in his later writings, was in some respects closer to Kant than were the Neo-Kantians. The contrast between the two philosophers can be illustrated by looking at their view of the objects of judgment; for Lask, as for Kant, judgment can relate to the thing as such only in an indirect way. The world of judgment is a collection of ‘imitations holding a secondary position’. It is cut apart from the plain world of real things by what Lask calls a ‘chasm of artificiality and imagery’. For Husserl, in contrast, the object of judgment is a ‘Sachverhalt’ or state of affairs, something ontologically ‘positive’ in the sense that it is an entity in its own right and does not point beyond itself in the manner of a mere sign or proxy for something else. (shrink)

At the height of the Covid-19 pandemic, frontline medical professionals at intensive care units around the world faced gruesome decisions about how to ration life-saving medical resources. These events provided a unique lens through which to understand how the public reasons about real-world dilemmas involving trade-offs between human lives. In three studies (total N = 2298), we examined people’s moral attitudes toward triage of acute coronavirus patients, and found elevated support for utilitarian triage policies. These utilitarian tendencies did not (...) stem from period change in moral attitudes relative to pre-pandemic levels--but rather, from the heightened realism of triage dilemmas. Participants favored utilitarian resolutions of critical care dilemmas when compared to structurally analogous, non-medical dilemmas—and such support was rooted in prosocial dispositions, including empathy and impartial beneficence. Finally, despite abundant evidence of political polarization surrounding Covid-19, moral views about critical care triage differed modestly, if at all, between liberals and conservatives. Taken together, our findings highlight people’s robust support for utilitarian measures in the face of a global public health threat, and illustrate how hypothetical scenarios in moral psychology (e.g. trolley cases) should strive for more experiential and psychological realism, otherwise their results might not generalize to real-world moral dilemmas. (shrink)

This chapter connects the phenomenon of double bookkeeping to two critical debates in the philosophy of delusion: one from the analytic tradition and one from the phenomenological tradition. First, I will show how the failure of action guidance on the part of some delusions suggests an argument to the standard view that delusions are beliefs (doxasticism about delusion) and how its proponents have countered it by ascribing behavioral inertia to avolition, emotional disturbances, or a failure of the surrounding environment in (...) supporting the agent’s motivation to act. Second, I will show how the mismatch between the experience of double bookkeeping and that of having the usual propositional attitudes of folk psychology suggests another, more recalcitrant argument not only against doxasticism but against the very attempt to fit delusion into folk psychology. Third, I will show how phenomenologically inspired theories of delusion, such as the multiple realities hypothesis, bypass the debates above and focus on describing and understanding the disturbances in the structure of experience undergone by patients. I conclude that the philosophical discussions ensuing from an appreciation of double bookkeeping show some of the limitations of the analytic philosophical approach to delusion. (shrink)

Regarding the appropriateness of deception in clinical practice, two (apparently conflicting) claims are often emphasised. First, that ‘clinicians should not deceive their patients.’ Second, that deception is sometimes ‘in a patient’s best interest.’ Recently, Hardman has worked towards resolving this conflict by exploring ways in which deceptive and non-deceptive practices extend beyond consideration of patients’ beliefs. In short, some practices only seem deceptive because of the (common) assumption that non-deceptive care is solely aimed at fostering true beliefs. Non-deceptive care, (...) however, relates to patients’ non-doxastic attitudes in important ways as well. As such, Hardman suggests that by focusing on belief alone, we sometimes misidentify non-deceptive care as ‘deceptive’. Further, once we consider patients’ beliefs and non-doxastic attitudes, identifying cases of deception becomes more difficult than it may seem. In this essay, I argue that Hardman’s reasoning contains at least three serious flaws. First, his account of deception is underdeveloped, as it does not state whether deception must be intentional. The problem is that if intention is not required, absurd results follow. Alternatively, if intention is required, then identifying cases of deception will be much easier (in principle) than Hardman suggests. Second, Hardman mischaracterises the ‘inverse’ of deceptive care. Doing so leads to the mistaken conclusion that common conceptions of non-deceptive care are unjustifiably narrow. Third, Hardman fails to adequately separate questions about deception from questions about normativity. By addressing these issues, however, we can preserve some of Hardman’s most important insights, although in a much simpler, more principled way. (shrink)

Regarding the appropriateness of deception in clinical practice, two (apparently conflicting) claims are often emphasised. First, that ‘clinicians should not deceive their patients.’ Second, that deception is sometimes ‘in a patient’s best interest.’ Recently, Hardman has worked towards resolving this conflict by exploring ways in which deceptive and non-deceptive practices extend beyond consideration of patients’ beliefs. In short, some practices only seem deceptive because of the (common) assumption that non-deceptive care is solely aimed at fostering true beliefs. Non-deceptive care, (...) however, relates to patients’ non-doxastic attitudes in important ways as well. As such, Hardman suggests that by focusing on belief alone, we sometimes misidentify non-deceptive care as ‘deceptive’. Further, once we consider patients’ beliefs and non-doxastic attitudes, identifying cases of deception becomes more difficult than it may seem. In this essay, I argue that Hardman’s reasoning contains at least three serious flaws. First, his account of deception is underdeveloped, as it does not state whether deception must be intentional. The problem is that if intention is not required, absurd results follow. Alternatively, if intention is required, then identifying cases of deception will be much easier (in principle) than Hardman suggests. Second, Hardman mischaracterises the ‘inverse’ of deceptive care. Doing so leads to the mistaken conclusion that common conceptions of non-deceptive care are unjustifiably narrow. Third, Hardman fails to adequately separate questions about deception from questions about normativity. By addressing these issues, however, we can preserve some of Hardman’s most important insights, although in a much simpler, more principled way. (shrink)

In this paper I examine the ways in which our language and terminology predetermine how we approach, investigate and conceptualise mental illness. I address this issue from the standpoint of hermeneutic phenomenology, and my primary object of investigation is the phenomenon referred to as “mania”. Drawing on resources from classical phenomenology, I show how phenomenologists attempt to overcome their latent presuppositions and prejudices in order to approach “the matters themselves”. In other words, phenomenologists are committed to the idea that in (...) our everyday, natural attitude, we take for granted a number of prejudices and presuppositions that predetermine how we conceive of and understand what we experience. In order to properly approach the phenomena themselves, we need to find ways of neutralising our presuppositions and prejudices in order to develop new (and hopefully more accurate) accounts of the phenomena under investigation. One of the most popular examples of such an attempt at neutralisation is what Edmund Husserl calls the epoché, which is the practice of bracketing out or suspending presuppositions. However, later phenomenologists developed alternative approaches. Martin Heidegger, for instance, engaged in etymological analyses to discover latent meanings in our language and terminology. Hans-Georg Gadamer also engaged in historical analyses of how our traditions sediment into latent prejudices. After discussing the various ways in which phenomenologists have attempted to neutralise presuppositions and prejudices prior to engaging in their investigations, I apply some of these principles and methods to the domain of psychopathology, and discuss some of the prejudices inherent in contemporary discussions of the phenomenon of mania. I examine recent attempts to link the phenomenon that we today refer to as “mania” with the ancient Greek concept of “μανία” (mania), and argue that the practice of linking contemporary and historical concepts can be detrimental to attempts at reclassifying disorders. In addition, I consider the implications of the shift in terminology from “manic depressive illness” to “bipolar disorder” – especially how conceiving of mania as one of two “poles” predetermines its description by both clinicians and patients. Finally, I address the implications of the headings under which mania and bipolar disorder are discussed within diagnostic manuals. For example, I discuss the removal of the headings of affective and mood disorders in the DSM-5, and the explicit decision by the authors to place bipolar disorder between depressive disorders and schizophrenia. What I aim to accomplish in this paper is not so much a phenomenological investigation of mania as it is a pre-phenomenological investigation. In other words, I offer a preparatory investigation of the phenomenon (or phenomena) referred to as “mania” in contemporary discourse, with the intention of laying the groundwork for further phenomenological and psychological research. (shrink)

This article focuses on justified responses to “immoral” behavior and crimes committed by patients undergoing neuromodulation therapies. Such patients could be held morally responsible in the basic desert sense—the one that serves as a justification of severe practices such as backward‐looking moral outrage, condemnation, and legal punishment—as long as they possess certain compatibilist capabilities that have traditionally served as the quintessence of free will, that is, reasons‐responsiveness; attributability; answerability; the abilities to act in accordance with moral reasons, second‐order volitions, or (...) Deep Self. Recently leading compatibilist neuroethicists added the condition of not feeling alienated from desires motivating a person's action. This article argues against such attempts to determine conditions under which patients undergoing neuromodulation should be subject to negative reactive attitudes and legal punishment. Compatibilism should not be used to justify basic desert moral responsibility and legal punishment. Instead, a new way of thinking about the function of moral responsibility attribution is proposed for patients with neuromodulation. Their compatibilist capabilities should serve as important indicators for determining appropriate, forward‐looking courses of action, such as quarantining and restorative treatment, to ensure the public safety and well‐being of the patients. (shrink)

This chapter provides an outline of consent in the history of medical ethics. In doing so, it ranges over attitudes towards consent in medicine in ancient Greece, medieval Europe and the Middle East, as well as the history of Western law and medical ethics from the early modern period onwards. It considers the relationship between consent and both the disclosure of information to patients and the need to indemnify physicians, while attempting to avoid an anachronistic projection of concern with (...) patient autonomy too far back into the historical record. The chapter also includes a survey of the development of the social and intellectual infrastructure that underpins modern medical consent. It concludes with a brief discussion of possible future directions for ethical approaches to medical consent and competence that would depart from the models that arose in the twentieth-century. (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)

Antimicrobial resistance (AMR) is a global public health disaster driven largely by antibiotic use in human health care. Doctors considering whether to prescribe antibiotics face an ethical conflict between upholding individual patient health and advancing public health aims. Existing literature mainly examines whether patients awaiting consultations desire or expect to receive antibiotic prescriptions, but does not report views of the wider public regarding conditions under which doctors should prescribe antibiotics. It also does not explore the ethical significance of public (...) views or their sensitivity to awareness of AMR risks or the standpoint (self-interested or impartial) taken by participants. Methods: An online survey was conducted with a sample of the U.S. public (n = 158). Participants were asked to indicate what relative priority should be given to individual patients and society-at-large from various standpoints and in various contexts, including antibiotic prescription. Results: Of the participants, 50.3% thought that doctors should generally prioritize individual patients over society, whereas 32.0% prioritized society over individual patients. When asked in the context of AMR, 39.2% prioritized individuals whereas 45.5% prioritized society. Participants were significantly less willing to prioritize society over individuals when they themselves were the patient, both in general (p = .001) and in relation to AMR specifically (p = .006). Conclusions: Participants’ attitudes were more oriented to society and sensitive to collective responsibility when informed about the social costs of antibiotic use and when considered from a third-person rather than first-person perspective. That is, as participants came closer to taking the perspective of an informed and impartial “ideal observer,” their support for prioritizing society increased. Our findings suggest that, insofar as antibiotic policies and practices should be informed by attitudes that are impartial and well-informed, there is significant support for prioritizing society. (shrink)

Neo-Kantianism is common conceived as a philosophy ‘from above’, excelling in speculative constructions – as opposed to the attitude of patient description which is exemplified by the phenomenological turn ‘to the things themselves’. When we study the work of Emil Lask in its relation to that of Husserl and the phenomenologists, however, and when we examine the influences moving in both directions, then we discover that this idea of a radical opposition is misconceived. Lask himself was influenced especially by (...) Husserl’s Logical Investigations, and Husserl, especially in his later writings, was in some respects closer to Kant than were the Neo-Kantians. The contrast between the two philosophers can be illustrated by looking at their view of the objects of judgment; for Lask, as for Kant, judgment can relate to the thing as such only in an indirect way. The world of judgment is a collection of ‘imitations holding a secondary position’. It is cut apart from the plain world of real things by what Lask calls a ‘chasm of artificiality and imagery’. For Husserl, in contrast, the object of judgment is a ‘Sachverhalt’ or state of affairs, something ontologically ‘positive’ in the sense that it is an entity in its own right and does not point beyond itself in the manner of a mere sign or proxy for something else. (shrink)

Browne 1 (this issue ) argues that what may appear to be a benevolent practice-disclosing the sex of a fetus to expecting parents who wish to know-is in fact an epistemically problematic and, as a result, ethically questionable medical practice. Browne worries that not only will the disclosure of fetal sex encourage sex-selective abortions (an issue we will not take up here), but also that it will convey a misleading and pernicious message about the relationship between sex and gender. More (...) specifically, she contends that the practice of disclosure is problematic because (1) it purports to establish the gender of the developing baby based on information about the baby's sex, whereas this is not a warranted inference because while sex is determined by biological factors, gender is determined by social factors and (2) it conflates (biological) sex with (social) gender or encourages such conflation or reduction and thereby promotes 'essentialistic' thinking about gender that is closely linked to sexism and social injustice. If (1) is true, then disclosing fetal sex amounts to misinforming or misleading prospective parents-and since misinforming patients is wrong, the act of disclosing is also wrong. However, beyond the wrongs of misinforming patients, the practice also perpetuates the harms associated with a rigidly gendered society through endorsing the message in (2), thus lending the authority of the medical profession to the gender-essentialist ideas that have underpinned, and continue to drive, sexism and social injustice. This analysis leads Browne to recommend that clinicians be prohibited from informing parents about the sex of their developing fetus. -/- We agree with Browne that gender essentialism-the notion that 'femaleness' and 'maleness' carve out distinct natural classes with innate, immutable properties-is not only a false metaphysical thesis, but also a pernicious idea insofar as the sexist attitudes it fosters motivate policies that systematically violate the human rights of women, as well as those of the LGBTQ community. However, we do not think that the disclosure of fetal sex misinforms prospective parents about the gender of their baby, nor do we believe that such disclosure presupposes or promotes gender essentialism properly understood. (shrink)

Advance directives are intended to extend patient autonomy by enabling patients to prospectively direct the care of their future incapacitated selves. There has been much discussion about issues such as whether the future incompetent self is identical to the agent who issues the advance directives or whether advance directives can legitimately secure patient autonomy. However, there is another important question to ask: to what extent and in what conditions is it ethically appropriate for one to limit the liberty (...) or agency of one’s future incompetent self by issuing an advance directive? -/- In this paper, I use a virtue-ethical approach to explore this question, focusing on the case of an advance directive for the future self with moderate dementia. First, I examine virtuous attitudes with regard to autonomy and argue that one can manifest vices or ethically undesirable character traits in trying to intervene in the future self’s life. In particular, I argue that this case can manifest vices such as disdainfulness, intellectual arrogance, and self-dictatorship, which is the vice of trying to control one’s life to an excessive degree, and that a self-dictator fails to give due moral consideration to the future self’s liberty or agency. I then introduce the Daoist idea of wu-wei, which recommends embracement of what happens in one’s life, as one of the possible remedies for the overemphasis on the value of autonomy and control. (shrink)

The article analyzes methodological and practical approaches of psychological counseling for adult clients. General psychological problems of this age group are generalized; the concept of restoration of balance between the image of the world and the image of the “I” of clients as the main internal mechanism of mental equilibrium is substantiated; the aspects of professional training of a psychologist to advisory practice with adults are considered. -/- The urgent problem of psychological counseling for adult clients is to help them (...) to solve such problems as negative behaviors, disadaptation, loss of the meaning of life, addictive behavior, depression, etc. Psychological help should be carried out in the direction of qualitative transformations of the image of the world and the image of “I”, which envisage the expansion of knowledge about the world, its positive emotional experience, the realism of ideological beliefs. The general trend in the development of the worldview is the lack of realism in the image of the world, which affects the formation of a false system of values, the development of distorted moral ideas, and as a consequence, problems of health, self-realization, professional adaptation, and behavior deviations. -/- The purpose of the article is to substantiate the methodology and methods of psychological counseling for clients of the adult age group. Specialization of practical activity of a psychologist with this age category requires special knowledge, skills, and skills from a specialist that qualitatively differ from the provision of psychological services to other age groups (children, adolescents, etc.). The success of solving the psychological problems of clients entirely depends on the introduction of the correct, in other words, “more objective”, realistic methodology of counseling. The task of the article is to describe specific aspects of advisory psychological counseling for adults. -/- Summarizing the issue of adult counseling, we note that this type of activity requires from a psychologist to continuously improve the theoretical knowledge and practical skills, as well as to rethink the life experience. The presence of only one of the components of this activity provokes unprofessionality – it often manifests as the behavior in the style of a teacher, a teacher of higher education, in which there is a somewhat superficial, authoritarian attitude to students. Consequently, effective counseling for adult clients is stimulated by professional introspection and qualification in order to avoid professional deviation. Therefore, it is advisable for a psychologist to gain experience with clients (patients) of the adult age group to practice in a counseling center under the guidance of a specialist, and if this is a medical institution – a doctor or therapist. (shrink)

Physicians try hard to alleviate mental and physical ailments of their patients. Thus, they are heavily burdened by observing ethics and staying well-informed while improving health of their patients. A major ethical concern or dilemma in medication is that some physicians know their behavior is unethical, yet act against their moral compass. This study develops models of theory–practice gap, offering optimal solutions for the gap. These solutions would enhance self-motivation or remove external obstacles to stimulate ethical practices in medicine. The (...) Constructivist Grounded Theory Methodology is applied here where the participants and the main researcher mutually interacted with each other. Data collection was performed through qualitative methods including observation and semi-structured interviews with 21 physicians and medical students. Initial and focused coding was done, from which principal concepts were later extracted. MAXQDA software was used for analyzing data. Analysis of twelve major concepts in the study resulted in two factors and solution groups, from which four general notions influencing the ethical theory and practice gap in medicine were extracted: providing effective education to change attitude and behavior; considering motivational and emotional factors; reconstructing regulations and processes to facilitate ethical practice; conducting comprehensive and systematic studies. The existing medical educational system needs to be reconsidered to add to individual internal motivation, including optimizing persuasion strategies, maximizing participation of students, adhering to virtuous ethical theories, and fostering emotions. Additionally, regulations and processes can be reconstructed to remove practical obstacles and promote ethical practice with insignificant damages to individual self-motivation. (shrink)

Les professionnels ont par définition un public bénéficiaire de leurs services : le patient pour le médecin, le psychologue ou l’infirmière ; le client pour l’avocat ; le consommateur pour le gestionnaire d’une entreprise commerciale ; etc. L’usager ou l’habitant du cadre bâti constitue un des destinataires des services professionnels du designer d’intérieur. De quelle manière peut-on apprendre aux étudiants/futurs professionnels du design d’intérieur à se mettre à la place de l’usager/habitant des espaces qu’ils conçoivent ? Le concept de (...) l’empathie, communément décrit comme la capacité de se mettre à la place de l’autre, de le comprendre et de ressentir ses sentiments et ses émotions, est bien adapté pour explorer cette attitude. Cet article est composé de deux parties. La première présente une expérience pédagogique en design d’intérieur où des étudiants apprennent à se représenter les usagers de leur projet d’aménagement en utilisant un outil méthodologique appelé « boussole éthique ». Cette boussole est constituée essentiellement de trois pôles qui renvoient aux trois rapports fondamentaux de l’être humain tels qu’étudiés dans la tradition stoïcienne : rapport à soi-même, à autrui et à la nature. Dans la seconde par- tie, l’article met en relief plusieurs éléments théoriques qui permettent de comprendre, de consolider et, éventuellement, de faire évoluer les bases conceptuelles qui sous-tendent cette démarche. Il s’agira notamment des théories éthiques et de certaines approches spécifiques au concept de l’empathie. (shrink)

It is easier to talk frankly to a person whom one trusts. It is also easier to agree with a scientist whom one trusts. Even though in both cases the psychological state that underlies the behavior is called ‘trust’, it is controversial whether it is a token of the same psychological type. Trust can serve an affective, epistemic, or other social function, and comes to interact with other psychological states in a variety of ways. The way that the functional role (...) of trust changes across contexts and objects is further complicated when communities and individuals mediate it through technologies, and even more so when that mediation involves artificial intelligence (AI) and machine learning (ML). In this chapter I look at the ways in which trust in institutions, and specifically the medical profession, is affected by the use of AI and ML. There are two key elements of this analysis. The first is a disanalogy between institutional trust in medicine and institutional trust in science (Irzik and Kurtulmus 2021, 2019; Kitcher 2001). I note that as AI and ML become a more prominent part of medicine, trust in a medical institution becomes more like trust in a scientific institution. This is problematic for institutional trust in medicine and the practice of medicine, since institutional trust in science has been undermined by, among other things, the spread of misinformation online and the replication crisis (Romero 2019). There is also a strong analogy between the psychological state of the person who trusts a scientific report or testimony and the psychological state of a patient who trusts individual recommendations made by a medical professional in a clinical setting. In both cases, institutional trust makes it less likely that a mistake or malfeasance will result in reactive attitudes, such as blame or anger, directed at other individual members of that institution. However, it also renders people vulnerable enough to blame the institution itself. This, with time, can erode trust in the institution and naturally leads to policy recommendations that aim to preserve institutional trust. I survey two ways in which that can be done with institutional trust in medicine in the age of AI and ML. (shrink)

The paper reports results of the very first survey-based study on the prevalence, frequency and nature of ethical or other non-medical difficulties faced by Polish physicians in their everyday clinical practice. The study involved 521 physicians of various medical specialties, practicing mainly in inpatient healthcare. The study showed that the majority of Polish physicians encounter ethical and other non-medical difficulties in making clinical decisions. However, they confront such difficulties less frequently than their foreign peers. Moreover, Polish doctors indicate different circumstances (...) as a source of the experienced problems. The difficulties most often reported relate to (i) patients (or their proxies) requests for medically non-indicated interventions; (ii) problems with communication with patients (or their proxies) due to the patients’ negative attitude, unwillingness to cooperate, or aggression; and (iii) various difficulties with obtaining informed consent. Polish physicians report difficulties associated with disagreements among care givers or scarcity of resources less frequently than doctors from other countries. The study’s findings provide support for the thesis that a significant portion of Polish physicians still follow a traditional, paternalistic, and hierarchical model of healthcare practice. Instead of promoting patient’s empowerment, engagement, and rights, they often consider these ideas as a threat to physicians’ professional authority and autonomy. The study leads to the conclusion that due to insufficient training in medical ethics, communication skills, and medical law, many Polish physicians lack the knowledge and competence necessary to adequately respond to challenges posed by modern healthcare practice. (shrink)

Many of our attitudes are non-culpable: there was nothing that we should have done to avoid holding them. I argue that we can still be blameworthy for non-culpable attitudes: they can impair our relationships in ways that make our full practice of apology and forgiveness intelligible. My argument poses a new challenge to indirect voluntarists, who attempt to reduce all responsibility for attitudes to responsibility for prior actions and omissions. Rationalists, who instead explain attitudinal responsibility by appeal (...) to reasons-responsiveness, can make sense of blameworthiness for non-culpable attitudes. In response, voluntarists could propose a revision of our actual practices. This would lead us into a quite different debate. (shrink)

A fascinating recent turn in epistemology focuses on inquiring attitudes like wondering and being curious. Many have argued that these attitudes are governed by norms similar to those that govern our doxastic attitudes. Yet, to date, this work has only considered norms that might *prohibit* having certain inquiring attitudes (``norms of restriction''), while ignoring those that might *require* having them (``norms of expansion''). We aim to address that omission by offering a framework that generates norms of (...) expansion for inquiring attitudes. The framework draws on inferential erotetic logic, which we explain and augment with some theorems. We explore several of the norms that it yields - some sympathetically, others unsympathetically. (shrink)

In this paper I take up the question of the nature of the doxastic attitudes we entertain while inquiring into some matter. Relying on a distinction between two stages of open inquiry, I urge to acknowledge the existence of a distinctive attitude of cognitive inclination towards a proposition qua answer to the question one is inquiring into. I call this attitude “hypothesis”. Hypothesis, I argue, is a sui generis doxastic attitude which differs, both functionally and normatively, from suspended judgement, (...) full belief, credences, and acceptance. In closing, I point to the epistemological significance of hypothesis. More specifically, I contend that holding an attitude of hypothesis enables us to respond rationally to peer disagreement, and I suggest that such an attitude offers a suitable articulation of the view, originally put forward by Philip Kitcher, that cognitive diversity in inquiry has epistemic benefits. (shrink)

According to the fitting attitude (FA) analysis of value concepts, to conceive of an object as having a given value is to conceive of it as being such that a certain evaluative attitude taken towards it would be fitting. Among the challenges that this analysis has to face, two are especially pressing. The first is a psychological challenge: the FA analysis must call upon attitudes that shed light on our value concepts while not presupposing the mastery of these concepts. (...) The second challenge is normative: the FA analysis must account for the fittingness of the relevant attitudes in terms of a kind of normativity intimately related to these attitudes, but again without presupposing the mastery of the relevant value concepts. In this paper, we show that real progress is possible if we pay close attention to the nature of the attitudes recruited by the analysis. More specifically, we claim that an FA analysis that appeals to emotions conceived as evaluative attitudes — as opposed to, for instance, evaluative judgements or evaluative perceptions — has the best prospects of meeting the two challenges and of putting the FA analysis on a strong footing. (shrink)

I offer here a new hypothesis about the nature of implicit attitudes. Psy- chologists and philosophers alike often distinguish implicit from explicit attitudes by maintaining that we are aware of the latter, but not aware of the former. Recent experimental evidence, however, seems to challenge this account. It would seem, for example, that participants are frequently quite adept at predicting their own perfor- mances on measures of implicit attitudes. I propose here that most theorists in this area (...) have nonetheless overlooked a commonsense distinction regarding how we can be aware of attitudes, a difference that fundamentally distinguishes implicit and explicit attitudes. Along the way, I discuss the implications that this distinction may hold for future debates about and experimental investigations into the nature of implicit attitudes. (shrink)

Vigorous debate over the moral propriety of cognitive enhancement exists, but the views of the public have been largely absent from the discussion. To address this gap in our knowledge, four experiments were carried out with contrastive vignettes in order to obtain quantitative data on public attitudes towards cognitive enhancement. The data collected suggest that the public is sensitive to and capable of understanding the four cardinal concerns identified by neuroethicists, and tend to cautiously accept cognitive enhancement even as (...) they recognize its potential perils. The public is biopolitically moderate, endorses both meritocratic principles and the intrinsic value of hard work, and appears to be sensitive to the salient moral issues raised in the debate. Taken together, these data suggest that public attitudes toward enhancement are sufficiently sophisticated to merit inclusion in policy deliberations, especially if we seek to align public sentiment and policy. (shrink)

Counterfactual attitudes like imagining, dreaming, and wishing create a problem for the standard formal semantic theory of de re attitude ascriptions. I show how the problem can be avoided if we represent an agent's attitudinal possibilities using "multi-centered worlds", possible worlds with multiple distinguished individuals, each of which represents an individual with whom the agent is acquainted. I then present a compositional semantics for de re ascriptions according to which singular terms are "assignment-sensitive" expressions and attitude verbs are "assignment (...) shifters". (shrink)

This paper offers a positive account of an important but under-explored class of mental states, non-propositional attitudes such as loving one’s department, liking lattice structures, fearing Freddy Krueger, and hating Sherlock Holmes. In broadest terms, the view reached is a representationalist account guided by two puzzles. The proposal allows one to say in an elegant way what differentiates a propositional attitude from an attitude merely about a proposition. The proposal also allows one to offer a unified account of the (...) non-propositional attitudes that captures both empty and non-empty cases by properly locating the posited representations in the metaphysical structure of the attitudes. (shrink)

It seems that we can be directly accountable for our reasons-responsive attitudes—e.g., our beliefs, desires, and intentions. Yet, we rarely, if ever, have volitional control over such attitudes, volitional control being the sort of control that we exert over our intentional actions. This presents a trilemma: (Horn 1) deny that we can be directly accountable for our reasons-responsive attitudes, (Horn 2) deny that φ’s being under our control is necessary for our being directly accountable for φ-ing, or (...) (Horn 3) deny that the relevant sort of control is volitional control. This paper argues that we should take Horn 3. (shrink)

The attitudes P. F. Strawson dubs reactive are felt toward another (or oneself). They are thus at least in part affective reactions to what Strawson describes as qualities of will that people manifest toward others and themselves. The reactive attitudes are also interpersonal, relating persons to persons. But how do they relate persons? On the deontic, imperative view, they relate persons in second-personal authority and accountability relations. After addressing how best to understand the reactive attitudes as sentiments, (...) I evaluate the deontic imperative view. I argue that the modality of reactive attitudes is not invariably deontic nor is their mood invariably imperative. Certain reactive attitudes are aretaic, appellative sentiments that prescribe non-jural ideals of conduct or character. Although expansive, my resulting conception of the reactive attitudes escapes the charge of failing to distinguish reactive sentiments from “disengaged aesthetic reactions” to the beautiful and ugly in human action and character. (shrink)

I hope to show that, although belief is subject to two quite robust forms of agency, "believing at will" is impossible; one cannot believe in the way one ordinarily acts. Further, the same is true of intention: although intention is subject to two quite robust forms of agency, the features of belief that render believing less than voluntary are present for intention, as well. It turns out, perhaps surprisingly, that you can no more intend at will than believe at will.

Drawing inspiration from the notion of evocation employed in inferential erotetic logic, we defend an ‘evoked questions norm’ on inquiring attitudes. According to this norm, it is rational to have an inquiring attitude concerning a question only if that question is evoked by your background information. We offer two arguments for this norm. First, we develop an argument from convergence. Insights from several independent literatures (20th-century ordinary-language philosophy, inferential erotetic logic, inquisitive epistemic logic, and contemporary zetetic epistemology) all converge (...) on the evoked questions norm. Second, we show that suitably interpreted, the evoked questions norm correctly predicts several underappreciated kinds of bad questions. It does this, in part, by recovering versions of previously defended ignorance and knowledge norms. Some of those bad questions cannot be predicted by either norm singly, but only when corporately taken to reflect a common normative category. We identify this category as evocation. (shrink)