When, if ever, can healthcare provider's lay claim to knowing what is best for their patients? In this paper, I offer a taxonomy of clinical disagreements. The taxonomy, I argue, reveals that healthcare providers often can lay claim to knowing what is best for their patients, but that oftentimes, they cannot do so *as* healthcare providers.

We sometimes seek expert guidance when we don’t know what to think or do about a problem. In challenging cases concerning medical ethics, we may seek a clinical ethics consultation for guidance. The assumption is that the bioethicist, as an expert on ethical issues, has knowledge and skills that can help us better think about the problem and improve our understanding of what to do regarding the issue. The widespread practice of ethics consultations raises these questions and more: -/- (...) • What would it take to be a moral expert? • Is anyone a moral expert, and if so, how could a non-expert identify one? • Is it in any way problematic to accept and follow the advice of a moral expert as opposed to coming to moral conclusions on your own? • What should we think and do when moral experts disagree about a practical ethical issue? -/- In what follows, we address these theoretical and practical questions about moral expertise. (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)

This thesis discusses how societies should allocate clinical care resources. The first aim of the thesis is to defend the idea that clinical care resource allocation is a matter for deliberative democratic procedures. I argue that deliberative democracy is justified because of its ability to implement equal respect and autonomy. Furthermore, I address several in-principle objections to the project of applying deliberative democracy to clinical care resource allocation. Most notably, I respond to the narrow view of the (...) scope of deliberative democracy and the critiques of explicit rationing. -/- The second aim of the thesis is to determine what is required by deliberative democracy in clinical care resource allocation. I identify the general requirements that resource allocation agencies should meet, namely public reason, public involvement, transparency, accuracy and revisability. I then examine what is required by deliberative democracy with regard to two particularly salient specific topics, namely the substantive values that should govern resource allocation and the involvement of scientific experts in decision-making. -/- I demonstrate that public reason imposes severe constraints on the substantive values that should be employed. Most of these constraints are rooted in the idea that, under a regime of scarcity, public reason requires that resources be allocated so as to minimise the strongest complaint anyone may have. Out of the variety of values that are commonly proposed as relevant, only priority to the worst-off, ability to benefit, specialness of clinical care and cost are consistent with public reason. Turning to expert involvement, I argue that deliberative democracy can overcome several formidable threats, such as the opacity of expert opinions to laypersons and the tendency to hide uncertainty and disagreement from the public. I also discuss how my proposals on substantive values and expert involvement could be implemented, in order to add to the plausibility of my theory. (shrink)

Proposals for allocating scarce lifesaving resources in the face of the Covid-19 pandemic have aligned in some ways and conflicted in others. This paper attempts a kind of priority setting in addressing these conflicts. In the first part, we identify points on which we do not believe that reasonable people should differ—even if they do. These are (i) the inadequacy of traditional clinical ethics to address priority-setting in a pandemic; (ii) the relevance of saving lives; (iii) the flaws of (...) first-come, first-served allocation; (iv) the relevance of post-episode survival; (v) the difference between age and other factors that affect life-expectancy; and (vi) the need to avoid quality-of-life judgments. In the second part, we lay out some positions on which reasonable people can and do differ. These include (i) conflicts between maximizing benefits and priority to the worst off; (ii) role-based priority; and (iii) whether patients’ existing lifesaving resources should be subject to redistribution. (shrink)

The International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) COVID-19 dataset is one of the largest international databases of prospectively collected clinical data on people hospitalized with COVID-19. This dataset was compiled during the COVID-19 pandemic by a network of hospitals that collect data using the ISARIC-World Health Organization Clinical Characterization Protocol and data tools. The database includes data from more than 705,000 patients, collected in more than 60 countries and 1,500 centres worldwide. Patient data are available (...) from acute hospital admissions with COVID-19 and outpatient follow-ups. The data include signs and symptoms, pre-existing comorbidities, vital signs, chronic and acute treatments, complications, dates of hospitalization and discharge, mortality, viral strains, vaccination status, and other data. Here, we present the dataset characteristics, explain its architecture and how to gain access, and provide tools to facilitate its use. (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)

In a series of recent publications, orofacial researchers have debated the question of how ‘bruxism’ should be defined for the purposes of accurate diagnosis and reliable clinical research. Following the principles of realism-based ontology, we performed an analysis of the arguments involved. This revealed that the disagreements rested primarily on inconsistent use of terms, so that issues of ontology were thus obfuscated by shortfalls in terminology. In this paper, we demonstrate how bruxism terminology can be improved by paying (...) attention to the relationships between (1) particulars and types, and (2) continuants and occurrents. (shrink)

By definition, pain is a sensory and emotional experience that is felt in a particular part of the body. The precise relationship between somatic events at the site where pain is experienced, and central processing giving rise to the mental experience of pain remains the subject of debate, but there is little disagreement in scholarly circles that both aspects of pain are critical to its experience. Recent experimental work, however, suggests a public view that is at odds with this conceptualisation. (...) By demonstrating that the public does not necessarily endorse central tenets of the “mental” view of pain (subjectivity, privacy, and incorrigibility), experimental philosophers have argued that the public holds a more “body-centric” view than most clinicians and scholars. Such a discrepancy would have important implications for how the public interacts with pain science and clinical care. In response, we tested the hypothesis that the public is capable of a more “mind-centric” view of pain. Using a series of vignettes, we demonstrate that in situations which highlight mental aspects of pain the public can, and does, recognize pain as a mental phenomenon. We also demonstrate that the public view is subject to context effects, by showing that the public’s view is modified when situations emphasizing mental and somatic aspects of pain are presented together. (shrink)

The idea that the brain is a representational organ has roots in the nineteenth century, when neurologists began drawing conclusions about what the brain represents from clinical and experimental studies. One of the earliest controversies surrounding representation in the brain was the “muscles versus movements” debate, which concerned whether the motor cortex represents complex movements or rather fractional components of movement. Prominent thinkers weighed in on each side: neurologists John Hughlings Jackson and F.M.R. Walshe in favor of complex movements, (...) neurophysiologist Charles Sherrington and neurosurgeon Wilder Penfield in favor of movement components. This essay examines these and other brain scientists’ evolving notions of representation during the first eighty years of the muscles versus movements debate (c. 1873–1954). Although participants agreed about many of the superficial features of representation, their inferences reveal deep-seated disagreements about its inferential role. Divergent epistemological commitments stoked conflicting conceptions of what representational attributions imply and what evidence supports them. (shrink)

Medical scientists employ ‘quality assessment tools’ (QATs) to measure the quality of evidence from clinical studies, especially randomized controlled trials (RCTs). These tools are designed to take into account various methodological details of clinical studies, including randomization, blinding, and other features of studies deemed relevant to minimizing bias and error. There are now dozens available. The various QATs on offer differ widely from each other, and second-order empirical studies show that QATs have low inter-rater reliability and low inter-tool (...) reliability. This is an instance of a more general problem I call the underdetermination of evidential significance. Disagreements about the strength of a particular piece of evidence can be due to different—but in principle equally good—weightings of the fine-grained methodological features which constitute QATs. (shrink)

Given some of the various possible impacts of clinical germline editing, we can expect robust disagreement about how best to regulate it. One can point to examples of the promise of editing: “rough...

Background: Current practice frequently fails to provide care consistent with the preferences of decisionally-incapacitated patients. It also imposes significant emotional burden on their surrogates. Algorithmic-based patient preference predictors (PPPs) have been proposed as a possible way to address these two concerns. While previous research found that patients strongly support the use of PPPs, the views of surrogates are unknown. The present study thus assessed the views of experienced surrogates regarding the possible use of PPPs as a means to help make (...) treatment decisions for decisionally-incapacitated patients. -/- Methods: This qualitative study used semi-structured interviews to determine the views of experienced surrogates [n=26] who were identified from two academic medical centers and two community hospitals. The primary outcomes were respondents’ overall level of support for the idea of using PPPs and the themes related to their views on how a PPP should be used, if at all, in practice. -/- Results: Overall, 21 participants supported the idea of using PPPs. The remaining five indicated that they would not use a PPP because they made decisions based on the patient’s best interests, not based on substituted judgment. Major themes which emerged were that surrogates, not the patient’s preferences, should determine how treatment decisions are made, and concern that PPPs might be used to deny expensive care or be biased against minority groups. -/- Conclusions: Surrogates, like patients, strongly support the idea of using PPPs to help make treatment decisions for decisionally-incapacitated patients. These findings provide support for developing a PPP and assessing it in practice. At the same time, patients and surrogates disagree over whose preferences should determine how treatment decisions are made, including whether to use a PPP. These findings reveal a fundamental disagreement regarding the guiding principles for surrogate decision-making. Future research is needed to assess this disagreement and consider ways to address it. (shrink)

For both Jung and Patañjali our human desire to understand “God” is as real as any other instinct. Jung’s and Patañjali’s models further align in their emphasis on the teleological directedness of the psyche, and their aim at reconciling science and religious experience. As an atheist, Freud was in disagreement, but all three scholars align in their emphasis on the study of affect as an empirical means of entering into the psyche. For Patañjali, the nadir of affect lays in transcending (...) sorrow and stabilizing the mind. Mental stability in turn produces the capacity to fully differentiate between the binding states of mind, which lead to human suffering, and the experience of pure consciousness resting in authentic nature. Contemporary brain research indicates that conscious states are inherently affective—further, the upper brainstem is intrinsically conscious whereas the cortex is not; it derives its consciousness from the brainstem. Understanding consciousness, then, may have less to do with reflective cognition than with instinct. This research spotlights the phenomena of affect, as it appears to not only draw us back to the highly significant rupture of the Freud Jung dialogue, but also forward into formulating a contemporary clinical picture of the drive towards (or away from) religious experience. (shrink)

In biomedical measurement, biomarkers are used to achieve reliable prediction of, and useful causal information about patient outcomes while minimizing complexity of measurement, resources, and invasiveness. A biomarker is an assayable metric that discloses the status of a biological process of interest, be it normative, pathophysiological, or in response to intervention. The greatest utility from biomarkers comes from their ability to help clinicians (and researchers) make and evaluate clinical decisions. In this paper we discuss a specific methodological use of (...) clinical biomarkers in pharmacological measurement: Some biomarkers, called ‘surrogate markers’, are used to substitute for a clinically meaningful endpoint corresponding to events and their penultimate risk factors. We confront the reliability of clinical biomarkers that are used to gather information about clinically meaningful endpoints. Our aim is to present a systematic methodology for assessing the reliability of multiple surrogate markers (and biomarkers in general). To do this we draw upon the robustness analysis literature in the philosophy of science and the empirical use of clinical biomarkers. After introducing robustness analysis we present two problems with biomarkers in relation to reliability. Next, we propose an intervention-based robustness methodology for organizing the reliability of biomarkers in general. We propose three relevant conditions for a robust methodology for biomarkers: (R1) Intervention-based demonstration of partial independence of modes: In biomarkers partial independence can be demonstrated through exogenous interventions that modify a process some number of “steps” removed from each of the markers. (R2) Comparison of diverging and converging results across biomarkers: By systematically comparing partially-independent biomarkers we can track under what conditions markers fail to converge in results, and under which conditions they successfully converge. (R3) Information within the context of theory: Through a systematic cross-comparison of the markers we can make causal conclusions as well as eliminate competing theories. We apply our robust methodology to currently developing Alzheimer’s research to show its usefulness for making causal conclusions. (shrink)

Disagreements that resist rational resolution, often termed “deep disagreements”, have been the focus of much work in epistemology and informal logic. In this paper, I argue that they also deserve the attention of philosophers of mathematics. I link the question of whether there can be deep disagreements in mathematics to a more familiar debate over whether there can be revolutions in mathematics. I propose an affirmative answer to both questions, using the controversy over Shinichi Mochizuki’s work on (...) the abc conjecture as a potential example of both phenomena. I conclude by investigating the prospects for the resolution of mathematical deep disagreements in virtue-theoretic approaches to informal logic and mathematical practice. (shrink)

Conciliatory theories of disagreement require that one lower one’s confidence in a belief in the face of disagreement from an epistemic peer. One question about which people might disagree is who should qualify as an epistemic peer and who should not. But when putative epistemic peers disagree about epistemic peerhood itself, then Conciliationism makes contradictory demands and paradoxes arise.

Psychiatry has witnessed a new wave of approaches to clinical phenotyping and the study of psychopathology, including the National Institute of Mental Health’s Research Domain Criteria, clinical staging, network approaches, the Hierarchical Taxonomy of Psychopathology, and the general psychopathology factor, as well as a revival of interest in phenomenological psychopathology. The question naturally emerges as to what the relationship between these new approaches is – are they mutually exclusive, competing approaches, or can they be integrated in some way (...) and used to enrich each other? In this opinion piece, we propose a possible integration between clinical staging and phenomenological psychopathology. Domains identified in phenomenological psychopathology, such as selfhood, embodiment, affectivity, etc., can be overlaid on clinical stages in order to enrich and deepen the phenotypes captured in clinical staging (‘high resolution’ clinical phenotypes). This approach may be useful both ideographically and nomothetically, in that it could complement diagnosis, enrich clinical formulation, and inform treatment of individual patients, as well as help guide aetiological, prediction, and treatment research. The overlaying of phenomenological domains on clinical stages may require that these domains are reformulated in dimensional rather than categorial terms. This integrative project requires assessment tools, some of which are already available, that are sensitive and thorough enough to pick up on the range of relevant psychopathology. The proposed approach offers opportunities for mutual enrichment: clinical staging may be enriched by introducing greater depth to phenotypes; phenomenological psychopathology may be enriched by introducing stages of severity and disorder progression to phenomenological analysis. (shrink)

Is democracy a requirement of justice or an instrument for realizing it? The correct answer to this question, I argue, depends on the background circumstances against which democracy is defended. In the presence of thin reasonable disagreement about justice, we should value democracy only instrumentally (if at all); in the presence of thick reasonable disagreement about justice, we should value it also intrinsically, as a necessary demand of justice. Since the latter type of disagreement is pervasive in real-world politics, I (...) conclude that theories of justice designed for our world should be centrally concerned with democracy. (shrink)

In recent years, several philosophers have argued that their discipline makes no progress (or not enough in comparison to the “hard sciences”). A key argument for this pessimistic position appeals to the purported fact that philosophers widely and systematically disagree on most major philosophical issues. In this paper, we take a step back from the debate about progress in philosophy specifically and consider the general question: How (if at all) would disagreement within a discipline undermine that discipline’s progress? We reject (...) two arguments from disagreement to a lack of progress, and spell out two accounts of progress on which progress is compatible with disagreements that persist or increase over time. However, we also argue that disagreement can undermine our ability to tell which developments are progressive (and to what degree). So, while disagreement can indeed be a threat to progress, the precise nature of the threat has not been appreciated. (shrink)

Metaethical absolutism is the view that moral concepts have non-relative satisfaction conditions that are constant across judges and their particular beliefs, attitudes, and cultural embedding. If it is correct, there is an important sense in which parties of moral disputes are concerned to get the same things right, such that their disputes can be settled by the facts. If it is not correct, as various forms of relativism and non-cognitivism imply, such coordination of concerns will be limited. The most influential (...) support for absolutism comes from an argument with two related premises. According to the first premise, moral thinking and moral discourse display a number of features that are characteristically found in paradigmatically absolutist domains, and only partly in uncontroversially non-absolutist domains. According to the second, the best way of making sense of these features is to assume that absolutism is correct. This paper defends the prospect of a non-ad hoc, non-absolutist, explanation of these "absolutist" features, thus calling into question the second premise. But instead of attempting to directly explain why the moral domain displays these features, it attends to how they are partially displayed by paradigmatically non-absolutists judgments about taste and likelihood. Based on this, it proposes independently motivated general accounts of attributions of agreement, disagreement, correctness and incorrectness that can explain both why absolutist domains display all "absolutist" features and why these non-absolutist domains display some. Based on these accounts, it provides preliminary reasons to think that these features of moral discourse can be given a non-absolutist explanation. (shrink)

One of Mill’s main arguments for free speech springs from taking disagreement as an epistemically valuable resource for fallible thinkers. Contemporary conciliationist treatments of disagreement spring from the same motivation, but end up seeing the epistemic implications of disagreement quite differently. Conciliationism also encounters complexities when transposed from the 2-person toy examples featured in the literature to the public disagreements among groups that give the issue much of its urgency. Group disagreements turn out to be in some ways (...) more powerful defeaters of rational belief, even when opposing groups are comparable in size and epistemic credentials. And conciliationism also shows us why determining the rational response to these disagreements can in certain cases (e.g. politics) be a particularly difficult and nuanced matter. (shrink)

This paper introduces and motivates a solution to a dilemma from peer disagreement. Following Buchak (2021), I argue that peer disagreement puts us in an epistemic dilemma: there is reason to think that our opinions should both change and not change when we encounter disagreement with our epistemic peers. I argue that we can solve this dilemma by changing our credences, but not our beliefs in response to disagreement. I explain how my view solves the dilemma in question, and then (...) offer two additional arguments for it: one related to contents and attitudes, and another related to epistemic peerhood. (shrink)

In the contemporary epistemological literature, peer disagreement is often taken to be an instance of a more general phenomenon of “higher-order evidence.” Correspondingly, its epistemic significance is often thought to turn on the epistemic significance of higher-order evidence in general. This chapter attempts to evaluate this claim, and in doing so to clarify some points of unclarity in the current literature – both about what it is for evidence to be “higher-order,” and about the relationship between disagreement and higher-order evidence. (...) We will begin by considering some candidate definitions of “higher-order evidence,” and offering our own definition that attempts to capture the phenomenon of interest. We will then consider, in light of this definition, whether disagreement and its epistemic significance are best-understood as a kind of higher-order evidence. We’ll argue that although peer disagreement can be epistemically significant qua higher-order evidence, this role doesn’t exhaust its significance, and that it can also serve as straightforward first-order evidence. Finally, we’ll suggest that inattention to this latter point has made broadly conciliatory views about peer disagreement seem somewhat easier to resist than they in fact are. (shrink)

Responding rationally to the information that others disagree with one’s beliefs requires assessing the epistemic credentials of the opposing beliefs. Conciliatory accounts of disagreement flow in part from holding that these assessments must be independent from one’s own initial reasoning on the disputed matter. I argue that this claim, properly understood, does not have the untoward consequences some have worried about. Moreover, some of the difficulties it does engender must be faced by many less conciliatory accounts of disagreement.

This chapter covers contemporary work on disagreement, detailing both the conceptual and normative issues in play in the debates in mainstream analytic epistemology, and how these relate to religious diversity and disagreement. §1 examines several sorts of disagreement, and considers several epistemological issues: in particular, what range of attitudes a body of evidence can support, how to understand higher-order evidence, and who counts as an epistemic “peer”. §2 considers how these questions surface when considering disagreements over religion, including debates (...) over the nature of evidence and truth in religion, epistemic humility, concerns about irrelevant influences and about divine hiddenness, and arguments over exclusivism, inclusivism, and pluralism. Finally, §3 summarizes the contributors’ essays in this volume. (shrink)

Disagreement is common: even informed, intelligent, and generally reasonable people often come to different conclusions when confronted with what seems to be the same evidence. Can the competing conclusions be reasonable? If not, what can we reasonably think about the situation? This volume examines the epistemology of disagreement. Philosophical questions about disagreement arise in various areas, notably politics, ethics, aesthetics, and the philosophy of religion: but this will be the first book focusing on the general epistemic issues arising from informed (...) disagreement. Ten leading philosophers offer specially written essays which together will offer a starting-point for future work on this topic. (shrink)

Consensus and disagreement play important roles in the practice, development, and dissemination of science. This raises a host of important philosophical questions. Some of these issues are conceptual: When, exactly, does a scientific agreement count as a consensus? And in what sense, if any, is disagreement the opposite of consensus? Other questions concern the role of consensus and disagreement in the development of science: For example, is consensus on central methodological issues and assumptions necessary for scientific work to proceed normally? (...) Yet other questions are epistemological: From a layperson’s perspective, does the presence of a scientific consensus ever indicate that the relevant theory is probably correct? If so, what are the conditions under which it does so? Relatedly, should scientists themselves also defer to the consensus position among their peers whenever such a consensus exists? Or should they instead evaluate consensus theories for themselves, or even actively aim to dissent against such theories? (shrink)

Hinge epistemology has to dispel the worry that disagreeing over hinges is rationally inert. Building on a companion piece (Coliva and Palmira 2020), this paper offers a constitutivist solution to the problem of rational inertia by maintaining that a Humean sceptic and a hinge epistemologist disagree over the correct explication of the concept of epistemic rationality. The paper explores the implications of such a solution. First, it clarifies in what sense a disagreement over hinges would be a conceptual disagreement. Secondly, (...) it uses considerations about the (alleged) rational inertia of hinge disagreement to offer a test whereby to demarcate genuine hinges from merely entrenched beliefs. Thirdly, it offers a response to the challenge of explaining why we have reason to engage in the epistemic practices that hinges are constitutive of in the first place. Fourthly, it argues that the constitutivist approach to hinge disagreement does not result in a relativist view. (shrink)

The fact of moral disagreement when conjoined with Conciliationism, an independently attractive view about the epistemic significance disagreement, seems to entail moral skepticism. This worries those who like Conciliationism, the independently attractive view, but dislike moral skepticism. Others, equally inclined against moral skepticism, think this is a reductio of Conciliationism. I argue that they are both wrong. There is no reductio and nothing to worry about.

The desideratum of semantic interoperability has been intensively discussed in medical informatics circles in recent years. Originally, experts assumed that this issue could be sufficiently addressed by insisting simply on the application of shared clinical terminologies or clinical information models. However, the use of the term ‘ontology’ has been steadily increasing more recently. We discuss criteria for distinguishing clinical ontologies from clinical terminologies and information models. Then, we briefly present the role clinical ontologies play in (...) two multicentric research projects. Finally, we discuss the interactions between these different kinds of knowledge representation artifacts and the stakeholders involved in developing interoperational real-world clinical applications. We provide ontology engineering examples from two EU-funded projects. (shrink)

I investigate the implication of the truth-relativist’s alleged ‘ faultless disagreements’ for issues in the epistemology of disagreement. A conclusion I draw is that the type of disagreement the truth-relativist claims to preserve fails in principle to be epistemically significant in the way we should expect disagreements to be in social-epistemic practice. In particular, the fact of faultless disagreement fails to ever play the epistemically significant role of making doxastic revision rationally required for either party in a disagreement. (...) That the truth-relativists’ disagreements over centred content fail to play this epistemically significant role that disagreements characteristically play in social epistemology should leave us sceptical that disagreement is what the truth-relativist has actually preserved. (shrink)

Outcomes research in healthcare has been a topic much addressed in recent years. Efforts in this direction have been supplemented by work in the areas of guidelines for clinical practice and computer-interpretable workflow and careflow models.In what follows we present the outlines of a framework for understanding the relations between organizations, guidelines, individual patients and patient-related functions. The derived framework provides a means to extract the knowledge contained in the guideline text at different granularities, in ways that can help (...) us to assign tasks within the healthcare organization and to assess clinical performance in realizing the guideline. It does this in a way that preserves the flexibility of the organization in the adoption of the guidelines. (shrink)

How much should your confidence in your beliefs be shaken when you learn that others – perhaps 'epistemic peers' who seem as well-qualified as you are – hold beliefs contrary to yours? This article describes motivations that push different philosophers towards opposite answers to this question. It identifies a key theoretical principle that divides current writers on the epistemology of disagreement. It then examines arguments bearing on that principle, and on the wider issue. It ends by describing some outstanding questions (...) that thinking about this issue raises. (shrink)

In discussions of religious disagreement, some epistemologists have suggested that religious disagreement is distinctive. More specifically, they have argued that religious disagreement has certain features which make it possible for theists to resist conciliatory arguments that they must adjust their religious beliefs in response to finding that peers disagree with them. I consider what I take to be the two most prominent features which are claimed to make religious disagreement distinct: religious evidence and evaluative standards in religious contexts. I argue (...) that these two features fail to distinguish religious disagreement in the ways they have been taken to. However, I show that the view that religious disagreement is not a unique form of disagreement makes religious disagreement less, rather than more, worrisome to the theist who would prefer to rationally remain steadfast in her religious beliefs. (shrink)

This Element examines what we can learn from religious disagreement, focusing on disagreement with possible selves and former selves, the epistemic significance of religious agreement, the problem of disagreements between religious experts, and the significance of philosophy of religion. Helen De Cruz shows how religious beliefs of others constitute significant higher-order evidence. At the same time, she advises that we should not necessarily become agnostic about all religious matters, because our cognitive background colors the way we evaluate evidence. This (...) allows us to maintain religious beliefs in many cases, while nevertheless taking the religious beliefs of others seriously. (shrink)

Religious disagreement is an emerging topic of interest in social epistemology. Little is known about how philosophers react to religious disagreements in a professional context, or how they think one should respond to disagreement. This paper presents results of an empirical study on religious disagreement among philosophers. Results indicate that personal religious beliefs, philosophical training, and recent changes in religious outlook have a significant impact on philosophers' assessments of religious disagreement. They regard peer disagreement about religion as common, and (...) most surveyed participants assume one should accord weight to the other's opinion. Theists and agnostics are less likely to assume they are in a better epistemic position than their interlocutors about religious questions compared with atheists, but this pattern only holds for participants who are not philosophers of religion. Continental philosophers think religious beliefs are more like preferences than analytic philosophers, who regard religious beliefs as fact-like. (shrink)

In the recent debate about the semantics of perspectival expressions, disagreement has played a crucial role. In a nutshell, what I call “the challenge from disagreement” is the objection that certain views on the market cannot account for the intuition of disagreement present in ordinary exchanges involving perspectival expressions like “Licorice is tasty./no, it’s not.” Various contextualist answers to this challenge have been proposed, and this has led to a proliferation of notions of disagreement. It is now accepted in the (...) debate that there are many notions of disagreement and that the search for a common, basic notion is misguided. In this paper I attempt to find such a basic notion underneath this diversity. The main aim of the paper is to motivate, forge and defend a notion of “minimal disagreement” that has beneficial effects for the debate over the semantics of perspectival expressions. (shrink)

When speakers utter conflicting moral sentences, it seems clear that they disagree. It has often been suggested that the fact that the speakers disagree gives us evidence for a claim about the semantics of the sentences they are uttering. Specifically, it has been suggested that the existence of the disagreement gives us reason to infer that there must be an incompatibility between the contents of these sentences. This inference then plays a key role in a now-standard argument against certain theories (...) in moral semantics. In this paper, we introduce new evidence that bears on this debate. We show that there are moral conflict cases in which people are inclined to say both that the two speakers disagree and that it is not the case at least one of them must be saying something incorrect. We then explore how we might understand such disagreements. As a proof of concept, we sketch an account of the concept of disagreement and an independently motivated theory of moral semantics which, together, explain the possibility of such cases. (shrink)

Religious communities often discourage disagreement with religious authorities, on the grounds that allowing it would be epistemically detrimental. I argue that this attitude is mistaken, because any social position in a community—including religious authority—comes with epistemic advantages as well as epistemic limitations. I argue that religious communities stand to benefit epistemically by engaging in disagreement with people occupying other social positions. I focus on those at the community’s margins and argue that religious marginalization is apt to yield religiously important insights; (...) so their disagreement with religious authorities should be encouraged. (shrink)

I will consider disagreement from a communal perspective. Thus, my focus will not primarily be on disagreement between different groups although this case will figure as well. My main focus is on the epistemic pros and cons of disagreement for a community and on how the social structure of the community bears on these pros and cons. A central lesson will be that disagreement has more epistemic costs at the communal level than is often recognized, and that these epistemic costs (...) often yield epistemic injustice. (shrink)

Introduction to the Synthese Special Issue on Disagreement in Science.

My aim in this paper is to develop and defend a novel answer to a question that has recently generated a considerable amount of controversy. The question concerns the normative significance of peer disagreement. Suppose that you and I have been exposed to the same evidence and arguments that bear on some proposition: there is no relevant consideration which is available to you but not to me, or vice versa. For the sake of concreteness, we might picture.

Disagreement is a hot topic in epistemology. A fast-growing literature centers around a dispute between the ‘steadfast’ view, on which one may maintain one’s beliefs even in the light of disagreement with epistemic peers who have all the same evidence, and the ‘conciliationist’ view, on which such disagreement requires a revision of attitudes. In this paper, however, I argue that there is less separating the main rivals in the debate about peer disagreement than is commonly thought. The extreme versions of (...) both views are clearly indefensible, while more moderate versions of the views converge on the idea that how much revision of belief is called for by an instance of peer disagreement varies from case to case. Those tempted by this diagnosis are sometimes pessimistic about the prospects for giving a unified account which clearly predicts when more or less extensive revisions will be called for. By contrast, in this paper I give an account that aspires to such unity and predictive power, centering on the notion of the net resilience of your estimate of your own reliability against your estimate of your interlocutor’s reliability. The view I present thus amounts to a new, moderate theory of how one should respond to disagreement. I argue that ultimately, when we weaken conciliationism and the steadfast view to account for exception cases and to make them adequately plausible, they end up converging on the moderate view I present. Much of the seeming disagreement about disagreement is, then, illusory. (shrink)

This paper addresses a largely neglected question in ongoing debates over disagreement: what is the relation, if any, between disagreements involving credences and disagreements involving outright beliefs? The first part of the paper offers some desiderata for an adequate account of credal and full disagreement. The second part of the paper argues that both phenomena can be subsumed under a schematic definition which goes as follows: A and B disagree if and only if the accuracy conditions of A's (...) doxastic attitude are such that, if they were fulfilled, this would ipso facto make B's doxastic attitude inaccurate, or vice-versa. (shrink)

Conciliatory theories of disagreement face a revenge problem; they cannot be coherently believed by one who thinks they have peers who are not conciliationists. I argue that this is a deep problem for conciliationism.

There has been a recent explosion of interest in the epistemology of disagreement. Much of the recent literature is concerned with a particular range of puzzle cases (discussed in the Cases section of my paper). Almost all of the papers that contribute to that recent literature make mention of questions about religious disagreement in ways that suggest that there are interesting connections between those puzzle cases and real life cases of religious disagreement. One important aim of my paper is to (...) cast doubt on that suggestion. More generally, the aim of my paper is to give a reasonably full account of the recent literature on the epistemology of disagreement, and then to give a serious discussion of some of the epistemological issues that are raised by real world religious disagreements. (shrink)

We often get evidence concerning the reliability of our own thinking about some particular matter. This “higher-order evidence” can come from the disagreement of others, or from information about our being subject to the effects of drugs, fatigue, emotional ties, implicit biases, etc. This paper examines some pros and cons of two fairly general models for accommodating higher-order evidence. The one that currently seems most promising also turns out to have the consequence that epistemic akrasia should occur more frequently than (...) is sometimes supposed. But it also helps us see why this might not be a bad thing. (shrink)

The discussion about deep disagreement has gained significant momentum in the last several years. This discussion often relies on the intuition that deep disagreement is, in some sense, rationally irresolvable. In this paper, I will provide a theory of rationally irresolvable disagreement. Such a theory is interesting in its own right, since it conflicts with the view that rational attitudes and procedures are paradigmatic tools for resolving disagreement. Moreover, I will suggest replacing discussions about deep disagreement with an analysis of (...) rationally irresolvable disagreement, since this notion can be more clearly defined than deep disagreement and captures the basic intuitions underlying deep disagreement. I will first motivate this project by critically assessing the current debate about deep disagreement. I then detail the notions of rationality and resolvable disagreement which are crucial for a suitable theory of rationally irresolvable disagreement before sketching various instances of rationally irresolvable disagreement. Finally, I argue for replacing theories of deep disagreement with theories of rationally irresolvable disagreement, an approach that has significant advantages over existing theories of deep disagreement which focus on hinge propositions or fundamental epistemic principles. (shrink)

This chapter addresses an ambiguity in some of the literature on rational peer disagreement about the use of the term 'rational'. In the literature 'rational' is used to describe a variety of normative statuses related to reasons, justification, and reasoning. This chapter focuses most closely on the upshot of peer disagreement for what is rationally required of parties to a peer disagreement. This follows recent work in theoretical reason which treats rationality as a system of requirements among an agent's mental (...) states. It is argued that peer disagreement has either no, or a very limited, affect on what rationality requires of an agent in a given circumstance. This is in part because of difficulties generated by a novel example of evidence of evidence of p being evidence against p. This example calls into question the mechanisms whereby peer disagreement might affect what is rationally required of an agent. The chapter also reevaluates the importance of actual peer disagreement against the backdrop of prior expectations about whether disagreement is believed to be likely, arguing that peer disagreement is most likely to change what is rationally required of an agent when it is believed to be unlikely. (shrink)