While every health care system stakeholder would seem to be concerned with obtaining the greatest value from a given technology, there is often a disconnect in the perception of value between a technology’s promoters and those responsible for the ultimate decision as to whether or not to pay for it. Adopting an empirical ethics approach, this paper examines how five Canadian medical device manufacturers, via their websites, frame the corporate “value proposition” of their innovation and seek to respond to what (...) they consider the key expectations of their customers. Our analysis shows that the manufacturers’ framing strategies combine claims that relate to valuable socio-technical goals and features such as prevention, efficiency, sense of security, real-time feedback, ease of use and flexibility, all elements that likely resonate with a large spectrum of health care system stakeholders. The websites do not describe, however, how the innovations may impact health care delivery and tend to obfuscate the decisional trade-offs these innovations represent from a health care system perspective. Such framing strategies, we argue, tend to bolster physicians’ and patients’ expectations and provide a large set of stakeholders with powerful rhetorical tools that may influence the health policy arena. Because these strategies are difficult to counter given the paucity of evidence and its limited use in policymaking, establishing sound collective health care priorities will require solid critiques of how certain kinds of medical devices may provide a better (i.e., more valuable) response to health care needs when compared to others. (shrink)

Volume 19, Issue 9, September 2019, Page 64-66.

The paper is written in response to those who fail to recognize the relation between a patient's mental competency and her state of pain. Some clinicians claim that a proper diagnosis can only be made in the absent of analgesia. Rather, the patient's state of pain directly affects her mental competency and thus her ability to give valid consent. Clinicians should rethink their approach to diagnosis when the patient is in pain.

Here we present what we believe is a novel account of what languages are, along with an axiomatically rich representation of languages and language-related data that is based on this account. We propose an account of languages as aggregates of dispositions distributed across aggregates of persons, and in doing so we address linguistic competences and the processes that realize them. This paves the way for representing additional types of language-related entities. Like demographic data of other sorts, data about languages may (...) be of use to researchers in a number of areas, including biomedical research. Data on the languages used in clinical encounters are typically included in medical records, and capture an important factor in patient-provider interactions. Like many types of patient and demographic data, data on a person’s preferred and primary languages are organized in different ways by different systems. This can be a barrier to data integration. We believe that a robust framework for representing language in general and preferred and primary language in particular – which has been lacking in ontologies thus far – can promote more successful integration of language-related data from disparate data sources. (shrink)

We introduce the Vital Sign Ontology (VSO), an extension of the Ontology for General Medical Science (OGMS) that covers the consensus human vital signs: blood pressure, body temperature, respiratory rate, and pulse rate. VSO provides a controlled structured vocabulary for describing vital sign measurement data, the processes of measuring vital signs, and the anatomical entities participating in such measurements. VSO is implemented in OWL-DL and follows OBO Foundry guidelines and best practices. If properly developed and extended, we believe the VSO (...) will find applications for the EMR, clinical informatics, and medical device communities. (shrink)

The translational research community, in general, and the Clinical and Translational Science Awards (CTSA) community, in particular, share the vision of repurposing EHRs for research that will improve the quality of clinical practice. Many members of these communities are also aware that electronic health records (EHRs) suffer limitations of data becoming poorly structured, biased, and unusable out of original context. This creates obstacles to the continuity of care, utility, quality improvement, and translational research. Analogous limitations to sharing objective data in (...) other areas of the natural sciences have been successfully overcome by developing and using common ontologies. This White Paper presents the authors’ rationale for the use of ontologies with computable semantics for the improvement of clinical data quality and EHR usability formulated for researchers with a stake in clinical and translational science and who are advocates for the use of information technology in medicine but at the same time are concerned by current major shortfalls. This White Paper outlines pitfalls, opportunities, and solutions and recommends increased investment in research and development of ontologies with computable semantics for a new generation of EHRs. (shrink)

Since its publication, the Psychopathic Personality Inventory and its revision (Lilien- feld & Andrews, 1996; Lilienfeld & Widows, 2005) have become increasingly popular such that it is now among the most frequently used self-report inventories for the assessment of psychopathy. The current meta-analysis examined the relations between the two PPI factors (factor 1: Fearless Dominance; factor 2: Self-Centered Impulsivity), as well as their relations with other validated measures of psychopathy, internalizing and externalizing forms of psychopathology, general personality traits, and antisocial (...) personality disorder symptoms. Across 61 samples reported in 49 publications, we found support for the convergent and criterion validity of both PPI factor 2 and the PPI total score. Much weaker validation was found for PPI factor 1, which manifested limited convergent validity and a pattern of correlations with central criterion variables that was inconsistent with many conceptualizations of psychopathy. (shrink)

Information can be public among a group. Whether or not information is public matters, for example, for accounts of interdependent rational choice, of communication, and of joint intention. A standard analysis of public information identifies it with (some variant of) common belief. The latter notion is stipulatively defined as an infinite conjunction: for p to be commonly believed is for it to believed by all members of a group, for all members to believe that all members believe it, and so (...) forth. This analysis is often presupposed without much argument in philosophy. Theoretical entrenchment or intuitions about cases might give some traction on the question, but give little insight about why the identification holds, if it does. The strategy of this paper is to characterize a practical-normative role for information being public, and show that the only things that play that role are (variants of) common belief as stipulatively characterized. In more detail: a functional role for “taking a proposition for granted” in non-isolated decision making is characterized. I then present some minimal conditions under which such an attitude is correctly held. The key assumption links this attitude to beliefs about what is public. From minimal a priori principles, we can argue that a proposition being public among a group entails common commitment to believe among that group. Later sections explore partial converses to this result, the factivity of publicity and publicity from the perspective of outsiders to the group, and objections to the aprioricity of the result deriving from a posteriori existential presuppositions. (shrink)

This paper examines two puzzles of indeterminacy. The first puzzle concerns the hypothesis that there is a unified phenomenon of indeterminacy. How are we to reconcile this with the apparent diversity of reactions that indeterminacy prompts? The second puzzle focuses narrowly on borderline cases of vague predicates. How are we to account for the lack of theoretical consensus about what the proper reaction to borderline cases is? I suggest (building on work by Maudlin) that the characteristic feature of indeterminacy is (...) alethic normative silence, and use this to explain both plurality and lack of consensus. (shrink)

In the literature on supervaluationism, a central source of concern has been the acceptability, or otherwise, of its alleged logical revisionism. I attack the presupposition of this debate: arguing that when properly construed, there is no sense in which supervaluational consequence is revisionary. I provide new considerations supporting the claim that the supervaluational consequence should be characterized in a ‘global’ way. But pace Williamson (1994) and Keefe (2000), I argue that supervaluationism does not give rise to counterexamples to familiar inference-patterns (...) such as reductio and conditional proof. (shrink)

This article investigates the claim that some truths are fundamentally or really true — and that other truths are not. Such a distinction can help us reconcile radically minimal metaphysical views with the verities of common sense. I develop an understanding of the distinction whereby Fundamentality is not itself a metaphysical distinction, but rather a device that must be presupposed to express metaphysical distinctions. Drawing on recent work by Rayo on anti-Quinean theories of ontological commitments, I formulate a rigourous theory (...) of the notion. In the final sections, I show how this package dovetails with ' interpretationist' theories of meaning to give sober content to thought that some things — perhaps sets, or gerrymandered mereological sums — can be 'postulated into existence'. (shrink)

This paper outlines Lewis’s favoured foundational account of linguistic representation, and outlines and briefly evaluates variations and modifications. Section 1 gives an opinionated exegesis of Lewis’ work on the foundations of reference—his interpretationism. I look at the way that the metaphysical distinction between natural and non-natural properties came to play a central role in his thinking about language. Lewis’s own deployment of this notion has implausible commitments, so in section 2 I consider variations and alternatives. Section 3 briefly considers a (...) buck-passing strategy involving fine-grained linguistic conventions. (shrink)

Initial responses to questionnaires used to assess participants' understanding of informed consent for malaria vaccine trials conducted in the United States and Mali were tallied. Total scores were analyzed by age, sex, literacy (if known), and location. Ninety-two percent (92%) of answers by United States participants and 85% of answers by Malian participants were correct. Questions more likely to be answered incorrectly in Mali related to risk, and to the type of vaccine. For adult participants, independent predictors of higher scores (...) were younger age and female sex in the United States, and male sex in Mali. Scores in the United States were higher than in Mali (P = 0.005). Despite this difference participants at both sites were well informed overall. Although interpretation must be qualified because questionnaires were not intended as research tools and were not standardized among sites, these results do not support concerns about systematic low understanding among research participants in developing versus developed countries. (shrink)

*This work has turned into a bigger project, and some of it is published in "Lewis on reference".* Some things, argues Lewis, are just better candidates to be referents than others. Even at the cost of attributing false beliefs, we interpret people as referring to the most interesting kinds in their vicinity. How should this be accounted for? In section 1, I look at Lewis’s interpretationism, and the reference magnetism it builds in (not just for ‘perfectly natural’ properties, but for (...) certain kinds of auxiliary apparatus). In section 2, I draw on (Field, 1975) to argue that what properties are reference magnetic may be an ultimately conventional matter—though in the Lewisian setting, there may be an objectively best conventional choice to make. But Lewis’s own account has implausible commitments, so in section 3 I consider variations and alternatives, all of which have problems. In section 4, I look in more detail at eligibility-based interpretationism that do not appeal to naturalness, arguing that there are credible metasemantic theories of this form. (shrink)

*This work is no longer under development* Two major themes in the literature on indicative conditionals are that the content of indicative conditionals typically depends on what is known;1 that conditionals are intimately related to conditional probabilities.2 In possible world semantics for counterfactual conditionals, a standard assumption is that conditionals whose antecedents are metaphysically impossible are vacuously true.3 This aspect has recently been brought to the fore, and defended by Tim Williamson, who uses it in to characterize alethic necessity by (...) exploiting such equivalences as: A⇔¬A A. One might wish to postulate an analogous connection for indicative conditionals, with indicatives whose antecedents are epistemically impossible being vacuously true: and indeed, the modal account of indicative conditionals of Brian Weatherson has exactly this feature.4 This allows one to characterize an epistemic modal by the equivalence A⇔¬A→A. For simplicity, in what follows we write A as KA and think of it as expressing that subject S knows that A.5 The connection to probability has received much attention. Stalnaker suggested, as a way of articulating the ‘Ramsey Test’, the following very general schema for indicative conditionals relative to some probability function P: P = P 1For example, Nolan ; Weatherson ; Gillies. 2For example Stalnaker ; McGee ; Adams. 3Lewis. See Nolan for criticism. 4‘epistemically possible’ here means incompatible with what is known. 5This idea was suggested to me in conversation by John Hawthorne. I do not know of it being explored in print. The plausibility of this characterization will depend on the exact sense of ‘epistemically possible’ in play—if it is compatibility with what a single subject knows, then can be read ‘the relevant subject knows that p’. If it is more delicately formulated, we might be able to read as the epistemic modal ‘must’. (shrink)

We discuss potential biorisks from large language models (LLMs). AI assistants based on LLMs such as ChatGPT have been shown to significantly reduce barriers to entry for actors wishing to synthesize dangerous, potentially novel pathogens and chemical weapons. The harms from deploying such bioagents could be further magnified by AI-assisted misinformation. We endorse several policy responses to these dangers, including prerelease evaluations of biomedical AIs by subject-matter experts, enhanced surveillance and lab screening procedures, restrictions on AI training data, and access (...) controls on biomedical AI. We conclude with a suggestion about future research directions in bioethics. (shrink)

According to proponents of the extended mind, bio-external resources, such as a notebook or a smartphone, are candidate parts of the cognitive and mental machinery that realises cognitive states and processes. The present chapter discusses three areas of ethical concern associated with the extended mind, namely mental privacy, mental manipulation, and agency. We also examine the ethics of the extended mind from the standpoint of three general normative frameworks, namely, consequentialism, deontology, and virtue ethics.

The inherently subjective nature of consciousness severely limits our ability to make progress on the problem of consciousness. The inability to acquire objective, publicly available data on the phenomenal aspect of consciousness makes evaluating alternative theories very difficult, if not impossible. However, the anomalous nature of subjective states with respect to our conventional theories of the physical world suggests the possibility of considering other anomalous data around consciousness that happen to be objective. For such purposes, I propose that we examine (...) the psi data gathered under laboratory conditions, which generally receive little attention. I wish to consider whether we have theories or frameworks of consciousness that attempt to account for subjective qualia but also fit the psi data. I argue that Russellian monism can be combined with an argument regarding quantum holism to arrive at a version of cosmopsychism that fits very well with the psi data. While I do not argue that such a framework exhausts the theoretical possibilities, I do suggest we can move forward with a framework that has attractive theoretical features and is also consistent with objective data currently on the table. (shrink)

Understanding the relationship between wilderness outings and the resulting experience has been a central theme in resource-based, outdoor recreation research for nearly 50 years. The authors provide a review and synthesis of literature that examines how people, over time, build relationships with wilderness places and express their identities as consequences of multiple, ongoing wilderness engagements (i.e., continued participation). The paper reviews studies of everyday places and those specifically protected for wilderness and backcountry qualities. Beginning with early origins and working through (...) contemporary research the authors synthesize what diverse social scientists have learned about the long-term and continual nature of wilderness participation and its impact on the formation of identity. The thrust of the paper points researchers, planners, and managers in non-traditional directions and reframes goals and objectives for visitor planning and management in wilderness and other protected areas. (shrink)

"Nothing Better Than Death" is a comprehensive analysis of the near-death experiences profiled on my website at www.near-death.com. This book provides complete NDE testimonials, summaries of various NDEs, NDE research conclusions, a question and answer section, an analysis of NDEs and Christian doctrines, famous quotations about life and death, a NDE bibliography, book notes, a list of NDE resources on the Internet, and a list of NDE support groups associated with IANDS.org - the International Association for Near-Death Studies. -/- The (...) unusual title of this book, "Nothing Better Than Death," was inspired by NDE experiencer Dr. Dianne Morrissey who once said, "If I lived a billion years more, in my body or yours, there's not a single experience on Earth that could ever be as good as being dead. Nothing." -/- Having read every NDE book I could get my hands on, I didn't want to create just another NDE book. My motivation was to give readers a large variety of information about NDEs challenging both the seasoned NDE enthusiast as well as the novice. This book gives readers the means to understand the NDE phenomenon from the perspective of a large number of some of the most profound NDEs ever documented. My hope is that you will enjoy this book, my labor of love, and that you will be truly blessed by the heavenly insights within it. (shrink)

This paper presents a preliminary analysis of the first participatory budgeting experiment in the United States, in Chicago's 49th Ward. There are two avenues of inquiry: First, does participatory budgeting result in different budgetary priorities than standard practices? Second, do projects meet normative social justice outcomes? It is clear that allowing citizens to determine municipal budget projects results in very different outcomes than standard procedures. Importantly, citizens in the 49th Ward consistently choose projects that the research literature classifies as low (...) priority. The results are mixed, however, when it comes to social justice outcomes. While there is no clear pattern in which projects are located only in affluent sections of the ward, there is evidence of geographic clustering. Select areas are awarded projects like community gardens, dog parks, and playgrounds, while others are limited to street resurfacing, sidewalk repairs, bike racks, and bike lanes. Based on our findings, we offer suggestions for future programmatic changes. (shrink)

We discuss arguments against the thesis that the world itself can be vague. The first section of the paper distinguishes dialectically effective from ineffective arguments against metaphysical vagueness. The second section constructs an argument against metaphysical vagueness that promises to be of the dialectically effective sort: an argument against objects with vague parts. Firstly, cases of vague parthood commit one to cases of vague identity. But we argue that Evans' famous argument against will not on its own enable one to (...) complete the reductio in the present context. We provide a metaphysical premise that would complete the reductio, but note that it seems deniable. We conclude by drawing general morals from our case study. (shrink)

In the TACITUS project for using commonsense knowledge in the understanding of texts about mechanical devices and their failures, we have been developing various commonsense theories that are needed to mediate between the way we talk about the behavior of such devices and causal models of their operation. Of central importance in this effort is the axiomatization of what might be called commonsense metaphysics. This includes a number of areas that figure in virtually every domain of discourse, such as granularity, (...) scales, time, space, material, physical objects, shape, causality, functionality, and force. Our effort has been to construct core theories of each of these areas, and then to define, or at least characterize, a large number of lexical items in terms provided by the core theories. In this paper we discuss our methodological principles and describe the key ideas in the various domains we are investigating. (shrink)

The author takes a look at sixty-two near-death experiences and shares them with the reader. They range in topics from God, Heaven, Hell, Reincarnation and Suicide, to name a few. Did these people truly see into the next world? Did they reveal hat awaits each one of us as we walk through that portal? Does it really matter what faith we are or how good or bad we are in this life? This book delivers to the reader compelling testimonies from (...) credible people who are absolutely convinced theire's was an experience of life after death. (shrink)

This study aimed to understand the preserved elements of self-identity in persons with moderate to severe dementia attributable to Alzheimer’s disease. A semi-structured interview was developed to explore the narrative self among residents with dementia in a residential care facility and residents without dementia in an independent living setting. The interviews were transcribed verbatim from audio recordings and analyzed for common themes, while being sensitive to possible differences between the groups. The participants with dementia showed evidence of self-reference even though (...) losses in explicit memory were evident. The most noticeable difference between the two groups was time frame reference. Nonetheless, all participants showed understanding of their role in relationships and exhibited concrete preferences. Our findings suggest that memory loss and other cognitive deficits associated with moderate to severe dementia do not necessarily lead to a loss of “self.”. (shrink)

Vaccination complacency occurs when perceived risks of vaccine-preventable diseases are sufficiently low so that vaccination is no longer perceived as a necessary precaution. Disease outbreaks can once again increase perceptions of risk, thereby decrease vaccine complacency, and in turn decrease vaccine hesitancy. It is not well understood, however, how change in perceived risk translates into change in vaccine hesitancy. -/- We advance the concept of vaccine propensity, which relates a change in willingness to vaccinate with a change in perceived risk (...) of infection—holding fixed other considerations such as vaccine confidence and convenience. (shrink)

Purpose Prescription stimulant use as “cognitive enhancers” has been described among undergraduate college students. However, the use of prescription stimulants among future health care professionals is not well characterized. This study was designed to determine the prevalence of prescription stimulant misuse among students at an academic health sciences center. -/- Method Electronic surveys were e-mailed to 621 medical, pharmacy, and respiratory therapy students at East Tennessee State University for four consecutive weeks in fall 2011. Completing the survey was voluntary and (...) anonymous. Surveys asked about reasons for, frequency of, and side effects of nonprescription misuse of prescription stimulants. Given the sensitive material, an opportunity to win one of ten $50 gift cards was used as an incentive. -/- Results Three hundred seventy-two (59.9%) students completed the survey from three disciplines (47.6% medical, 70.5% pharmacy, and 57.6% respiratory therapy). Overall, 11.3% of responders admitted to misusing prescription stimulants. There was more misuse by respiratory therapy students, although this was not statistically significant (10.9% medicine, 9.7% pharmacy, 26.3% respiratory therapy; P = .087). Reasons for prescription stimulant misuse included to enhance alertness/ energy (65.9%), to improve academic performance (56.7%), to experiment (18.2%), and to use recreationally/get high (4.5%). -/- Conclusions Prescription stimulant misuse was prevalent among participating students, but further research is needed to describe prevalence among future health care workers more generally. The implications and consequences of such misuse require further study across professions with emphasis on investigating issues of academic dishonesty (e.g., “cognitive enhancement”), educational quality, and patient safety or health care quality. (shrink)

Very roughly, the epistemic objection to the growing block theory (GBT) says that according to that theory there are many past times at which persons falsely believe they are present. Since there is nothing subjectively distinguishable about a situation in which one truly believes one is present, from a situation in which one falsely believes one is present, the GBT is a theory on which we cannot know that we are present. In their articulation and defence of the GBT, Correia (...) and Rosenkranz (C&R) argue that the epistemic objection fails miserably. In what follows I try to unpack their response to the objection, and locate it amongst others. Along the way I flag some confusions I have about how we are to think about the GBT as articulated by C&R. (shrink)

"Nothing Better Than Death" is a comprehensive analysis of the near-death experiences profiled on the www.near-death.com website. This book provides complete NDE testimonials, summaries of various NDEs, NDE research conclusions, a Question and Answer section, an analysis of NDEs and Christian doctrines, famous quotations about life and death, a NDE bibliography, book notes, a list of NDE resources on the Internet, and a list of NDE support groups associated with IANDS.org - the International Association for Near-Death Studies. The unusual title (...) of this book, "Nothing Better Than Death," was inspired by NDE experiencer Dr. Dianne Morrissey who once said, "If I lived a billion years more, in my body or yours, there's not a single experience on Earth that could ever be as good as being dead. Nothing.". (shrink)

This article identifies and compares meanings of wildfire risk mitigation for stakeholders in the Front Range of Colorado, USA. We examine the case of a collaborative partnership sponsored by government agencies and directed to decrease hazardous fuels in interface areas. Data were collected by way of key informant interviews and focus groups. The analysis is guided by the Circuit of Culture model in communication research. We found both shared and differing meanings between members of this partnership (the ‘‘producers’’) and other (...) stakeholders not formally in the partnership (the ‘‘consumers’’). We conclude that those promoting the partnership’s project to mitigate risk are primarily aligned with a discourse of scientific management. Stakeholders outside the partnership follow a discourse of community. We argue that failure to recognize and account for differences in the way risk mitigation is framed and related power dynamics could hamper the communicational efforts of the collaborative partnership and impact goals for fuels reduction. We recommend ways that both groups can capitalize on shared meanings and how agency managers and decision makers can build better working relationships with interface communities and other external stakeholders. (shrink)

In ‘from times to worlds and back again: a transcendentist theory of persistence’ (henceforth TTP) Alessandro Giordani outlines five competitor views regarding the manner in which objects occupy regions along a dimension. These are: (1) classical uni-location (2) bare uni-location (3) multi-location (4) counterpart presence and (5) transcendent presence. Each view comes in both a temporal and modal version and Giordani argues that one ought to prefer transcendentism (i.e. 5) along both dimensions. According to temporal transcendentism, necessarily, no object is (...) exactly located at any region along the temporal dimension. Instead, any object, O, is derivatively present at some region, R, along the temporal dimension in virtue of bearing certain relations to something (according to TTP an event) that occupies R along that dimension. According to modal transcendentism, no object is exactly located at any region along the modal dimension. Instead, any object, O, is derivatively present at some region, R, along the modal dimension in virtue of bearing certain relations to something (according to TTP an event) that occupies R along that dimension. I argue that such a view is under motivated, and, at any rate, may not in fact offer a distinct view. (shrink)

At 435c-d and 504b ff., Socrates indicates that there is a "longer and fuller way" that one must take in order to get "the best possible view" of the soul and its virtues. But Plato does not have him take this "longer way." Instead Socrates restricts himself to an indirect indication of its goals by his images of sun, line, and cave and to a programmatic outline of its first phase, the five mathematical studies. Doesn't this pointed restraint function as (...) a provocation, moving us to want to begin the "longer way" and to make use of its conceptual resources to rethink Socrates' images? I begin by finding a double movement in the complex trajectory of the five studies: they both guide the soul in the "turn away from what is coming to be ... [to] what is" (518c) and, at the same time, lead the soul back, albeit in the medium of pure intelligibility, to the sensible world; for the pure figures and ratios that they disclose constitute the core structures of sensible things. I then draw on what Socrates says about geometry and harmonics to address three fundamental questions that he leaves open: the nature of the Good in its responsibility for truth and for the being of the forms; the relations of forms, mathematicals, and sensibles as these are disclosed by dialectic; and the bearing of the philosopher's discovery of the Good on his disposition towards his community and the task of ruling. I close by marking six sets of further questions that these reflections bequeath for dialogues to come. (shrink)

It is widely agreed that hypocrisy can undermine one’s moral standing to blame. According to the Nonhypocrisy Condition on standing, R has the standing to blame some other agent S for a violation of some norm N only if R is not hypocritical with respect to blame for violations of N. Yet this condition is seldom argued for. Macalester Bell points out that the fact that hypocrisy is a moral fault does not yet explain why hypocritical blame is standingless blame. (...) She raises a challenge: one must explain what is distinct about hypocritical blame such that the hypocritical blamer lacks the standing to blame, even if the arrogant or petty blamer does not. Of those writing on hypocrisy, only we offer a direct response to Bell’s challenge. Recently, however, our account has come under criticism. We argue here that (1) our account can handle these criticisms and that (2) no other rival account adequately addresses Bell’s challenge of explaining what is uniquely objectionable about hypocritical blame. Because answering Bell’s challenge is a necessary component of any plausible account of the relationship between hypocrisy and standing, our account remains the best on offer. (shrink)

Medicine, like law, is a pragmatic, probabilistic activity. Both require that decisions be made on the basis of available evidence, within a limited time. In contrast to law, medicine, particularly evidence-based medicine as it is currently practiced, aspires to a scientific standard of proof, one that is more certain than the standards of proof courts apply in civil and criminal proceedings. But medicine, as Dr. William Osler put it, is an "art of probabilities," or at best, a "science of (...) uncertainty." One can better practice medicine by using other evidentiary standards in addition to the "scientific." To employ only the scientific standard of proof is inappropriate, if not impossible; furthermore, as this review will show, its application in medicine is fraught with bias. Evidence is information. It supports or undermines a proposition, whether a hypothesis in science, a diagnosis in medicine, or a fact or point in question in a legal investigation. In medicine, physicians marshal evidence to make decisions on how to best prevent, diagnose, and treat disease, and improve health. In law, courts decide the facts and render justice. Judges and juries assess evidence to establish liability, to settle custody and medical issues, and to determine a defendant's guilt or innocence. (shrink)

The revival of analytic metaphysics in the latter half of the twentieth century is typically understood as a consequence of the critiques of logical positivism, Quine’s naturalization of ontology, Kripke’s Naming and Necessity, clarifications of modal notions in logic, and the theoretical exploitation of possible worlds. However, this explanation overlooks the work of metaphysicians at the height of positivism and linguisticism that affected metaphysics of the late twentieth century. Donald C. Williams is one such philosopher. In this paper I explain (...) how Williams’s fundamental ontology and philosophy of time influenced in part the early formation of David Lewis’s metaphysics. Thus, Williams played an important role in the revival of analytic metaphysics. (shrink)

W.K. Clifford’s famous 1876 essay The Ethics of Belief contains one of the most memorable lines in the history of philosophy: "it is wrong always, everywhere, and for anyone, to believe anything upon insufficient evidence." The challenge to religious belief stemming from this moralized version of evidentialism is still widely discussed today.

In 1596, in the Mysterium Cosmographicum, a twenty-five-year-old Johannes Kepler rashly banished lines from the universe. They “scarcely admit of order,” he wrote, and God himself could have no use for them in this “well-ordered universe.” Twenty-five years later, though, Kepler had come to repent the temerity of his youth. “O male factum!” he lamented in a 1621 second edition of the Mysterium – “O what a mistake” it was to dismiss lines, for linearity is revealed in those most perfect (...) and divine motions – the revolutions of the heavenly orbs. Why did Kepler come to lament the rashness of his youth? The answer lies deep in the details of Kepler’s discovery of elliptical orbits in 1605. Kepler struggled to find an empirically adequate description and physically plausible explanation of Mars’s path through the heavens. He realized, though, that his originally spherical notion of location and direction were insufficient to reconcile descriptions and explanations of the planet’s motion. Crucially inspired by the “magnetic philosophy” of William Gilbert, Kepler adopted an oriented conception of space, which finally allowed a plausible mechanism to be constructed for elliptical motion – the true path of the planet. Yet, this oriented space required the stipulation of straight lines. Without straight lines, even God could not construct the planets’ elliptical orbits. (shrink)