Loneliness in medicine is a serious problem not just for patients, for whom illness is intrinsically isolating, but also for physicians in the contemporary condition of medicine. We explore this problem by investigating the ideal physician-patient relationship, whose analogy with friendship has held enduring normative appeal. Drawing from Talbot Brewer and Nir Ben-Moshe, we argue that this appeal lies in a dynamic form of companionship incompatible with static models of friendship-like physician-patient relationships: a mutual refinement of embodied virtue (...) that draws both persons together. The ideal physician-patient relationship has a dialectical character that fosters each member's improvement of phenomenologically recognizing and embodying moral virtues. A key component of this dynamic is a commitment to the common goal of the patient's health, realized through joint interactivities and conversations over time. The physician's presence to the patient's suffering—understood best as an alienating phenomenological condition for the patient—orients and discloses possibilities for virtuous caregiving by structuring the meanings of the goals, conversations, and joint narrative constitutive of their relationship. Presence to suffering, paradoxically, is perhaps an important prerequisite for this dynamic partnership. These activities dialectically build an interpretive horizon of understanding through which moral goods and character refinement—in and for the other—may become revealed for both persons in their shared being-in-the-world. This analysis of suffering, mood, and revealing of (possible) moral goods has implications for addressing the modern problem of loneliness for patients and physicians, who are increasingly inhibited from building flourishing relationships with each other. (shrink)

Following the Introduction, the second section of this essay lays out Tom Cavanaugh’s helpful and convincing account of the enduring significance of the Hippocratic Oath in terms of how it responds to the problem of iatrogenic harm. The third section discusses something underemphasized in Cavanaugh’s account, namely, the key role of the virtue of piety within the Oath and the profession it establishes, and argues that this virtue should be regarded as integral to an authentic Hippocratic ethic. The fourth and (...) final section briefly examines the connection between medicine and philosophy, focusing on how both should be seen as wisdom-seeking ways of life, and shows the relevance of this for regarding the virtue of piety as the key virtue of medical practice. (shrink)

Racial disparities in health outcomes have recently become a flashpoint in the debate about the value of race as a biological concept. What role, if any, race has in the etiology of disease is a philosophically and scientifically contested topic. In this article, I expand on the insights of the new mechanistic philosophy of science to defend a mechanism discovery approach to investigating epidemiological racial disparities. The mechanism discovery approach has explanatory virtues lacking in the populational approach typically employed (...) in the study of race and biomedicine. The explanatory constraints that form an integral part of the new mechanistic approach enable mechanism discovery to avoid the epistemic and normative shortcomings of the populational approach. The methodology of mechanism discovery can fruitfully be extended to the treatment and reversal of epidemiological racial disparities. (shrink)

Background: Community-based education (CBE) involves educating the head (cognitive), heart (affective), and the hand (practical) by utilizing tools that enable us to broaden and interrogate our value systems. This article reports on the use of virtue ethics (VE) theory for understanding the principles that create, maintain and sustain a socially accountable community placement programme for undergraduate medical students. Our research questions driving this secondary analysis were; what are the goods which are internal to the successful practice of CBE in (...) class='Hi'>medicine, and what are the virtues that are likely to promote and sustain them? -/- Methods: We conducted a secondary theoretically informed thematic analysis of the primary data based on MacIntyre’s virtue ethics theory as the conceptual framework. -/- Results: Virtue ethics is an ethical approach that emphasizes the role of character and virtue in shaping moral behavior; when individuals engage in practices (such as CBE), goods internal to those practices (such as a collaborative attitude) strengthen the practices themselves, but also augment those individuals’ virtues, and that of their community (such as empathy). We identified several goods that are internal to the practice of CBE and accompanying virtues as important for the development, implementation and sustainability of a socially accountable community placement programme. A service-oriented mind-set, a deep understanding of community needs, a transformed mind, and a collaborative approach emerged as goods internal to the practice of a socially accountable CBE. The virtues needed to sustain the identified internal goods included empathy and compassion, connectedness, accountability, engagement [sustained relationship], cooperation, perseverance, and willingness to be an agent of change. -/- Conclusion: This study found that MacIntyre’s virtue ethics theory provided a useful theoretical lens for understanding the principles that create, maintain and sustain CBE practice. (shrink)

In Molière’s comedy The Imaginary Invalid a doctor “explains” that opium reliably induces sleep because it has a “dormitive virtue.” Molière intended this to be a satirical play on the use of opaque scholastic concepts in medicine, and since then the phrase “dormitive virtue” has become a byword for explanatory failure. However, contemporary work on the metaphysics of grounding and dispositions appears to permit explanations with a strikingly similar structure. In this paper I explore competing verdicts on dormitive virtue (...) explanation, using a model of explanation I call Contextualist Pluralist Non-Realist Backing, or CPN Backing. I show that CPN Backing illuminates the puzzle about dormitive virtue explanation, shows what is required for a resolution, and makes sense of conflicting responses to this case. (shrink)

Artificial intelligence (AI) systems have demonstrated impressive performance across a variety of clinical tasks. However, notoriously, sometimes these systems are 'black boxes'. The initial response in the literature was a demand for 'explainable AI'. However, recently, several authors have suggested that making AI more explainable or 'interpretable' is likely to be at the cost of the accuracy of these systems and that prioritising interpretability in medical AI may constitute a 'lethal prejudice'. In this paper, we defend the value of interpretability (...) in the context of the use of AI in medicine. Clinicians may prefer interpretable systems over more accurate black boxes, which in turn is sufficient to give designers of AI reason to prefer more interpretable systems in order to ensure that AI is adopted and its benefits realised. Moreover, clinicians may be justified in this preference. Achieving the downstream benefits from AI is critically dependent on how the outputs of these systems are interpreted by physicians and patients. A preference for the use of highly accurate black box AI systems, over less accurate but more interpretable systems , may itself constitute a form of lethal prejudice that may diminish the benefits of AI to - and perhaps even harm - patients. (shrink)

In this paper, findings from research in neuroscience of morality will be reviewed to consider the purposes of moral education. Particularly, I will focus on two main themes in neuroscience, novel neuroimaging and experimental investigations, and Bayesian learning mechanism. First, I will examine how neuroimaging and experimental studies contributed to our understanding of psychological mechanisms associated with moral functioning while addressing methodological concerns. Second, Bayesian learning mechanism will be introduced to acquire insights about how moral learning occurs in human brains. (...) Based on the reviewed neuroscientific research on morality, I will examine how evidence can support the model of moral education proposed by virtue ethics, Neo-Aristotelian moral philosophy in particular. Particularly, two main aims of virtue ethics-based moral education, the habituation of virtues and the cultivation of phronesis, will be discussed as the important purposes of moral education based on neuroscientific evidence. (shrink)

There is disagreement among physicians and medical ethicists on the precise goals of Hospice and Palliative Medicine (HPM). Some think that HPM's goals should differ from those of other branches of medicine and aim primarily at lessening pain, discomfort, and confusion; while others think that HPM's practices should, like all other branches of medicine, aim at promoting health. I take the latter position: using the ars moriendi to set a standard for what it means to die well, (...) I argue that if HPM's practices were to aim at mitigating suffering with little regard to promoting health, some patients would die worse deaths than if HPM's practices were to aim at health. According to the ars moriendi, flourishing at the end of one's life requires that one exercise her agency and pursue the goods most important to her. On this view, HPM's practices should promote patients’ health to enable them to pursue these goods. (shrink)

Recently, a friend of one of these writers told her story of using one of a healthcare product to activate her stem cells as part of regenerative medicine. Regenerative medicine is a field of medicine that seeks to repair or replace damaged or diseased tissues and organs. This can be done through a variety of methods, including stem cell therapy, tissue engineering, and gene therapy. This is a short review article on this rapid field called regenerative (...) class='Hi'>medicine, in particular via a new method called photobiomodulation, especially by virtue of low-intensity laser pen treatment. Hopefully it will attract more research in this interesting direction, both for laser/photobiomodulation to boost plant growth as well as in healthcare (see also: Christianto & Smarandache, 2022; Christianto, 2023). (shrink)

Many philosophers working on virtue theory have resisted the idea that the virtues are practical skills, apparently following Aristotle’s resistance to that idea. Bucking the trend, Matt Stichter defends a strong version of this idea in The Skillfulness of Virtue by marshaling a wide range of conceptual and empirical arguments to argue that the moral virtues are robust skills involving the cognitive-conative unification of Aristotelian phronêsis (‘practical intelligence’). Here I argue that Aristotle overlooks a more delimited kind of (...) practical intelligence, strongly analogous to his own account of phronêsis, that unifies complex forms of expertise such as medicine or even high-level sports. Insofar as the skill model of virtue is compelling, it must draw on a robust conception of practical expertise (technê) like the one developed here rather than the ordinary, anemic conception of practical skills. (shrink)

According to Aristotle, the medical art aims at health, which is a virtue of the body, and does so in an unlimited way. Consequently, medicine does not determine the extent to which health should be pursued, and “mental health” falls under medicine only via pros hen predication. Because medicine is inherently oriented to its end, it produces health in accordance with its nature and disease contrary to its nature—even when disease is good for the patient. Aristotle’s politician (...) understands that this inherent orientation can be systematically distorted, and so would see the need for something like the Hippocratic Oath. (shrink)

Evidence-based medicine is a clinical decision-making framework which makes claims about what physicians ought to do. Though heralded as the cutting edge of medical science, evidence-based medicine is a value-laden normative theory which implicitly depends on substantive views regarding what is morally good or right. In this paper, I provide an ethical analysis of evidence-based medicine. I consider its normative underpinnings in three ethical theories: utilitarianism, Kantian deontology, and virtue ethics. In the face of uncertainty, evidence-based (...) class='Hi'>medicine endorses expected utility theory using the best available evidence in order to avoid doing more harm than good. In accordance with the Kantian respect for individuals as ends in themselves, evidence-based medicine calls for integrating the values and preferences of the patient. De-emphasizing intuition, clinical expertise, and pathophysiologic rationale emphasizes the need for the intellectual virtues of curiosity, critical thinking, and courage. Evidence-based medicine is a successful clinical practice that can be morally justified by all three major ethical theories. Although its focus on maximizing good health outcomes and integrating respect for individual patients has been emphasized, the role of the intellectual virtues in evidence-based medicine remains highly under-explored. (shrink)

Evidence-based medicine is a clinical decision making framework which makes claims about what physicians ought to do. Though heralded as the cutting edge of medical science evidence-based medicine is a value laden normative theory which implicitly depends on substantive views regarding what is morally good or right. In this paper, I provide an ethical analysis of evidence-based medicine. I consider its normative underpinnings in three ethical theories: utilitarianism, Kantian deontology, and virtue ethics. In the face of uncertainty, (...) evidence-based medicine endorses expected utility theory using the best available evidence in order to avoid doing more harm than good. In accordance with the Kantian respect for individuals as ends in themselves, evidence-based medicine calls for integrating the values and preferences of the patient. De-emphasizing intuition, clinical expertise, and pathophysiologic rationale emphasizes the need for the intellectual virtues of curiosity, critical thinking, and courage. Evidence-based medicine is a successful clinical practice that can be morally justified by all three major ethical theories. Although its focus on maximizing good health outcomes and integrating respect for individual patients has been emphasized, the role of the intellectual virtues in evidence- based medicine remains highly under-explored. (shrink)

A large swathe of the indigenous African ethical tradition is frequently encapsulated in the maxim, “A person is a person through other persons.” This phrasing is an overly literal translation of some sayings that are prominent in the southern and central regions of Africa, but that resonate with most indigenous sub-Saharan cultures. This chapter articulates and motivates a philosophical interpretation of the maxim for an international readership interested in virtue. According to the initial formulation, one should strive to become a (...) real person, which one can do insofar as one prizes other persons’ capacity to relate harmoniously, where harmony consists of identifying with and exhibiting solidarity toward them. The chapter also explores ways of revising this theory to respond to some powerful criticisms, such as that virtue is not purely relational, but also includes some self-regarding dispositions, and that virtue can be manifested by relating to parts of the natural world, particularly to some non-human animals. (shrink)

One of the many debates in the philosophy of race is whether we should eliminate or conserve discourse, thought, and practices reliant on racial terms and categories (i.e., race-talk). In this paper, I consider this debate in the context of medicine. The recent resurgence in anti-racist activism and the COVID-19 pandemic have prompted philosophers, medical professionals, and the public to (re)consider race, its role in long-standing health disparities, and the utility of race-based medicine. In what follows, I argue (...) that while utility is insufficient for adjudicating permissible uses of race in medicine, eliminativism is neither necessary nor sufficient for dealing with the sort of ills associated with race-based medicine. I, then, use a virtue-based framework to adjudicate morally permissible uses of race in medicine. In doing so, I demonstrate the limitations of eliminativism, offer a decision procedure for determining morally permissible uses of race, and demonstrate that the debate regarding eliminating or preserving race-talk need not depend on conclusive answers to metaphysical questions regarding race. (shrink)

In this paper, I offer one example of conceptual change. Specifically, I contend that the discovery that viruses could cause cancer represents an excellent example of branch jumping, one of Thagard’s nine forms of conceptual change. Prior to about 1960, cancer was generally regarded as a degenerative, chronic, non-infectious disease. Cancer causation was therefore usually held to be a gradual process of accumulating cellular damage, caused by relatively non-specific component causes, acting over long periods of time. Viral infections, on the (...) other hand, were generally understood to be acute processes, whereby single, specific and necessary causal agents acted alone to produce disease. However, during the 1960s and 1970s, a number of cancers were discovered to have an infectious aetiology. Of particular note were two—Burkitt’s lymphoma and cervical cancer—which I will discuss in detail later in this piece. Together, these discoveries led, in the short term, to a tentative aetiological reclassification of some types of cancer as infectious diseases and, in the longer term, to a full-blown reclassification of cancer as an aetiological disease branch in its own right. This process of reclassification forms the empirical basis for my concluding remarks on the influence of classification upon causation in medicine. Through this, I aim to demonstrate that conceptual change, far from being a purely abstract concern of the philosopher of science, is of substantial import to scientific practitioners. (shrink)

Henry Richardson has recently published the first book ever devoted to ancillary care obligations, which roughly concern what medical researchers are morally required to provide to participants beyond what safety requires. In it Richardson notes that he has presented the ‘only fully elaborated view out there’ on this topic, which he calls the ‘partial-entrustment model’. In this article, I provide a new theory of ancillary care obligations, one that is grounded on ideals of communion salient in the African philosophical tradition (...) and is intended to rival and surpass Richardson’s model, which is a function of Western considerations of autonomy. I argue that the relational approach of the former has several virtues in comparison to the basic individualism of the latter. (shrink)

Virtue theories have become influential in ethics and epistemology. This paper argues for a similar approach to argumentation. Several potential obstacles to virtue theories in general, and to this new application in particular, are considered and rejected. A first attempt is made at a survey of argumentational virtues, and finally it is argued that the dialectical nature of argumentation makes it particularly suited for virtue theoretic analysis.

In this chapter, we consider ethical and philosophical aspects of trust in the practice of medicine. We focus on trust within the patient-physician relationship, trust and professionalism, and trust in Western (allopathic) institutions of medicine and medical research. Philosophical approaches to trust contain important insights into medicine as an ethical and social practice. In what follows we explain several philosophical approaches and discuss their strengths and weaknesses in this context. We also highlight some relevant empirical work in (...) the section on trust in the institutions of medicine. It is hoped that the approaches discussed here can be extended to nursing and other topics in the philosophy of medicine. (shrink)

We first survey the Catholic social justice tradition, the foundation on which Caritas in Veritate builds. Then we discuss Benedict’s addition of love to the philosophical virtues (as applied to economics), and how radical a change that makes to an ethical perspective on economics. We emphasise the reality of the interpersonal aspects of present-day economic exchanges, using insights from two disciplines that have recognized that reality, human resources and marketing. Personal encounter really is a major factor in economic exchanges (...) in professional services, such as law and medicine. Finally, we examine the prospects for an economics of gratuitousness at a level higher than the individual, that is, for businesses devoted to social ends more than profit. -/- . (shrink)

We expand on Della Croce’s ambition to interpret “epistemic injustice” as a specification of non-maleficence in the use of the influential four-principle framework. This is an alluring line of thought for conceptual, moral, and heuristic reasons. Although it is commendable, Della Croce’s attempt remains tentative. So does our critique of it. Yet, we take on the challenge to critically address two interrelated points. First, we broaden the analysis to include deliberations about hermeneutical injustice. We argue that, if due consideration of (...) epistemic injustice is to require more than negative ethical obligations in medicine, dimensions of hermeneutical injustice should be explored as an avenue to arrive at such positive duties. Second, and relatedly, we argue that this may encompass moral responsibilities beyond the individual level, that is: positive obligations to take action on a structural level. Building on Dotson’s concept of “contributory injustice” and Scheman’s concept of “perceptual autonomy,” we suggest that the virtues of testimonial and hermeneutical justice may provide additional content not only to negative prohibitions of action (i.e. non-maleficence) but also to positive requirements of action, like respecting patient autonomy. (shrink)

It is a common view among philosophers of science that theoretical virtues (also known as epistemic or cognitive values), such as simplicity and consistency, play an important role in scientific practice. In this article, I set out to study the role that theoretical virtues play in scientific practice empirically. I apply the methods of data science, such as text mining and corpus analysis, to study large corpora of scientific texts in order to uncover patterns of usage. These patterns (...) of usage, in turn, might shed some light on the role that theoretical virtues play in scientific practice. Overall, the results of this empirical study suggest that scientists invoke theoretical virtues explicitly, albeit rather infrequently, when they talk about models (less than 30%), theories (less than 20%), and hypotheses (less than 15%) in their published works. To the extent that they are mentioned in scientific publications, the results of this study suggest that accuracy, consistency, and simplicity are the theoretical virtues that scientists invoke more frequently than the other theoretical virtues tested in this study. Interestingly, however, depending on whether they talk about hypotheses, theories, or models, scientists may invoke one of those theoretical virtues more than the others. (shrink)

Within eighteenth-century debates on animal cognition we can distinguish at least three main theoretical positions: (i) Buffon’s mechanism, (ii) Reimarus’ theory of instincts, and (iii) the sensationalism of Condillac and Leroy. In this paper, I adopt a philosophical perspective on this debate and argue that in order to fully understand the justification Buffon, Reimarus, Condillac, and Leroy gave for their respective theories, we must pay special attention to the theoretical virtues these naturalists alluded to while justifying their position. These (...) theoretical virtues have received little to no attention in the literature on eighteenth-century animal cognition, but figure prominently in the justification of the mechanist, instinctive, and sensationalist theories of animal behavior. Through my philosophical study of the role of theoretical virtues in eighteenth-century debates on animal cognition, we obtain a deeper understanding of how theoretical virtues were conceptualized in eighteenth-century science and how they influenced the justification of theories of animal cognition. (shrink)

Plato seems to have been pessimistic about how most people stand with regard to virtue. However, unlike the Stoics, he did not conclude that most people are vicious. Rather, as we know from discussions across several dialogues, he countenanced decent ethical conditions that fall short of genuine virtue, which he limited to the philosopher. Despite Plato's obvious interest in this issue, commentators rarely follow his lead by investigating in detail such conditions in the dialogues. When scholars do investigate what kind (...) of virtue, if any, Plato thinks is open to non-philosophers, they typically look to the Republic. But in the Republic Plato sets out an ideal city; therefore, the virtue available to non-philosophers there is likely different from what he thinks is available to them in the real world. If we want to determine Plato's thoughts about the virtue of actual non-philosophers, we must look elsewhere. In this paper, I set my sights on the Phaedo. (shrink)

In this thesis, I give a metascientific account of causality in medicine. I begin with two historical cases of causal discovery. These are the discovery of the causation of Burkitt’s lymphoma by the Epstein-Barr virus, and of the various viral causes suggested for cervical cancer. These historical cases then support a philosophical discussion of causality in medicine. This begins with an introduction to the Russo- Williamson thesis (RWT), and discussion of a range of counter-arguments against it. Despite these, (...) I argue that the RWT is historically workable, given a small number of modifications. I then expand Russo and Williamson’s account. I first develop their suggestion that causal relationships in medicine require some kind of evidence of mechanism. I begin with a number of accounts of mechanisms and produce a range of consensus features of them. I then develop this consensus position by reference to the two historical case studies with an eye to their operational competence. In particular, I suggest that it is mechanistic models and their representations which we are concerned with in medicine, rather than the mechanism as it exists in the world. -/- I then employ these mechanistic models to give an account of the sorts of evidence used in formulating and evaluating causal claims. Again, I use the two human viral oncogenesis cases to give this account. I characterise and distinguish evidence of mechanism from evidence of difference-making, and relate this to mechanistic models. I then suggest the relationship between types of evidence presents us with a means of tackling the reference-class problem. This sets the scene for the final chapter. Here, I suggest the manner in which these two different classes of evidence become integrated is also reflected in the way that developing research programmes change as their associated causal claims develop. (shrink)

In this MA-thesis in applied ethics a conceptual basis or framework is examined for teaching programs in medicine to be able to enhance strengths of character, skills and virtues – clinical maturity of future healthcare professionals. Concepts of virtue ethics and human understanding are sought from Aristotle‘s rich theory of ethics and applied theories from philosophy, psychology, education and medicine over the last 50 years to construct a conceptual framework of virtue and character education. As input to (...) that construction, a multifactorial quantitative study was done in the form of a questionnaire about strengths of character among medical students and medical doctors. This research revealed those virtues and skills that participants consider most important in the character of the ideal physician and the results were compared to a similar British study of the Jubilee Centre for Character and Virtues. The comparison indicated the existence of common human ethical traits which are reflected in the strong correlation of the professionals’ choice of the most important strengths of character and their consequent ranked order, between the two countries. Other parts of this study indicate that virtues and skills merge in functional clusters during the process of decision-making and work of medical professionals aiming for good ends. However, the high frequency of perceived stress at work among Icelandic physicians is reported to partially subdue their moral character at work. In summary, from the structured concepts in the above-mentioned theories and learned outcomes from these two studies, a suggested conceptual framework for virtue and character education in medicine is presented. The major challenges to its implementation are lack of formal education in its conceptual basis among teachers and lack of reliable ways to evaluate results among students. The evidence points to the importance of virtue and character education and that nurturing teaching environment is needed in medical universities and clinical setting of healthcare facilities, for it to flourish. (shrink)

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

In four experiments, we offer evidence that virtues are often judged as uniquely important for some business practices (e.g., hospital management and medical error investigation). Overall, actions done only from virtue (either by organizations or individuals) were judged to feel better, to be more praiseworthy, to be more morally right, and to be associated with more trustworthy leadership and greater personal life satisfaction compared to actions done only to produce the best consequences or to follow the correct moral rule. (...) These results accord with claims made by some virtue ethicists. The current data contribute to a small but growing body of literature emphasizing both empirical soundness and philosophical rigor in the scientific study of virtue. Results also offer some guidance concerning how businesses, employees, and executives are evaluated and perceived. Implications for theory and practice are discussed. (shrink)

A crucial tenet of virtue-based or expertise-based theorizing about politics is that there are ways to identify and select morally and epistemically excellent people to hold office. This paper considers historical challenges to this task that come from within Greek and Confucian thought and political practice. Because of how difficult it is to assess character in ordinary settings, we argue that it is even more difficult to design institutions that select for virtue at the much wider political scale. Specifically, we (...) argue that the vast majority of proposals that purport to select for virtue are either (a) unlikely to be effective, (b) not implementable at the scale of most current nations, or (c) have already been incorporated into most democratic states. Thus defenders of meritocratic institutions should take more seriously the practical barriers that will almost certainly arise when trying to implement these proposals at scale. Historical proponents of meritocratic values were well aware of concerns about the feasibility of their political ideals, and we should be too. (shrink)

I argue that Aristotle believes that virtue comes in degrees. After dispatching with initial concerns for the view, I argue that we should accept it because Aristotle conceives of heroic virtue as the highest degree of virtue. I support this interpretation of heroic virtue by considering and rejecting alternative readings, then showing that heroic virtue characterized as the highest degree of virtue is consistent with the doctrine of the mean.

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)

The literature on conscientious objection in medicine presents two key problems that remain unresolved: Which conscientious objections in medicine are justified, if it is not feasible for individual medical practitioners to conclusively demonstrate the genuineness or reasonableness of their objections? How does one respect both medical practitioners’ claims of conscience and patients’ interests, without leaving practitioners complicit in perceived or actual wrongdoing? My aim in this paper is to offer a new framework for conscientious objections in medicine, (...) which, by bringing medical professionals’ conscientious objection into the public realm, solves the justification and complicity problems. In particular, I will argue that: an “Uber Conscientious Objection in Medicine Committee” —which includes representatives from the medical community and from other professions, as well as from various religions and from the patient population—should assess various well-known conscientious objections in medicine in terms of public reason and decide which conscientious objections should be permitted, without hearing out individual conscientious objectors; medical practitioners should advertise their conscientious objections, ahead of time, in an online database that would be easily accessible to the public, without being required, in most cases, to refer patients to non-objecting practitioners. (shrink)

One of the fundamental problems in the philosophy of psychology is to determine the relation between personal and subpersonal explanations of human behavior. The problem of determining the relation between the personal and subpersonal levels is called the “interface problem”. This paper has two goals. The first is to introduce the domestic reader to the interface problem from the perspective of the philosophy of psychology. The second goal is to show that insufficient focus on the interface problem and its potential (...) solutions can lead to uncritical and fallacious reasoning that can have significant consequences for particular debates in philosophy of medicine and philosophy of law. (shrink)

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

In recent work, Stephen John (2018, 2019) has deepened the social epistemological perspective on expert testimony by arguing that science communication often operates at the institutional level, and that at that level sincerity, transparency, and honesty are not necessarily epistemic virtues. In this paper I consider his arguments in the context of science journalism, a key constituent of the science communication ecosystem. I argue that this context reveals both the weakness of his arguments and a need for further analysis (...) of how non-experts learn from experts. (shrink)

We generally accept that medicine’s conceptual and ethical foundations are grounded in recognition of personhood. With patients in vegetative state, however, we’ve understood that the ethical implications of phenomenal consciousness are distinct from those of personhood. This suggests a need to reconsider medicine’s foundations. What is the role for recognition of consciousness (rather than personhood) in grounding the moral value of medicine and the specific demands of clinical ethics? I suggest that, according to holism, the moral value (...) of medicine is secured when conscious states are recognized in everyday medical science. Moreover, consciousness fully motivates traditional principles of clinical ethics if we understand respect for autonomy as respect for the dominion of an experiencer in the private, inescapable realm of bodily experience. When medicine’s foundations are grounded in recognition of consciousness, we understand how patients fully command respect even when they lack capacity to exercise their bodily dominion through decision-making. (shrink)

The problem that I am primarily concerned with in this paper is the nature of moral capacity as it relates to virtue in Hume’s ethical system.1 In particular, I am concerned with the relationship between virtue and moral sense. Hume’s remarks about this matter are both brief and scattered. I will argue, nevertheless, that when we piece together his various claims and observations on this subject we discover some important insights that add to the overall coherence and credibility of his (...) system. The most important of these is the suggestion that our ability to acquire and sustain the virtues depends in large measure on our capacity for moral sense. Throughout this paper I will explore this theme and show how it relates to other key components in Hume’s scheme. (shrink)

Whether or not capitalism is compatible with ethics is a long standing dispute. We take up an approach to virtue ethics inspired by Adam Smith and consider how market competition influences the virtues most associated with modern commercial society. Up to a point, competition nurtures and supports such virtues as prudence, temperance, civility, industriousness and honesty. But there are also various mechanisms by which competition can have deleterious effects on the institutions and incentives necessary for sustaining even these (...) most commercially friendly of virtues. It is often supposed that if competitive markets are good, more competition must always be better. However, in the long run competition enhancing policies that neglect the nurturing and support of the bourgeois virtues may undermine the continued flourishing of modern commercial society. (shrink)

In recent years, there has been increasing interest in analytic philosophy that engages with non-Western philosophical traditions, including South Asian religions such as Hinduism, Buddhism, and Jainism. However, thus far, there has been no engagement with Sikhism, despite its status as a major world religion with a rich philosophical tradition. This paper is an attempt to get a start at analytic philosophical engagement with Sikh philosophy. My focus is on Sikh ethics, and in particular on the theory of vice and (...) virtue that can be gleaned from Sikh scripture. According to this theory, the five major vices have a unified source in the vice of haumai. Haumai is a kind of false conception of oneself as singularly important, and correspondingly, a false conception of the world as revolving around oneself, as a world of objects there for one’s use. Vice, then, comes down to the failure to recognize the importance of others. The corresponding picture of virtue is that virtue consists in a recognition of the importance of others, through the recognition of an ultimate reality on which all are One. After reconstructing the Sikh theory of vice and virtue, I conclude with some comparative remarks on Sikh and Western ethics. (shrink)

Diagnoses in medicine are often taken to serve as explanations of patients’ symptoms and signs. This article examines how they do so. I begin by arguing that although some instances of diagnostic explanation can be formulated as covering law arguments, they are explanatory neither in virtue of their argumentative structures nor in virtue of general regularities between diagnoses and clinical presentations. I then consider the theory that medical diagnoses explain symptoms and signs by identifying their actual causes in particular (...) cases. While I take this to be largely correct, I argue that for a diagnosis to function as a satisfactory causal explanation of a patient’s symptoms and signs, it also needs to be supplemented by understanding the mechanisms by which the identified cause produces the symptoms and signs. This mechanistic understanding comes not from the diagnosis itself, but rather from the theoretical framework within which the physician operates. (shrink)

One question pursued in Buddhist studies concerns the classification of Buddhist ethics. Damien Keown has argued that Aristotelian virtue ethics provides a useful framework for understanding Buddhist ethics, but recently other scholars have argued that character consequentialism is more suitable for this task. Although there are similarities between the two accounts, there are also important differences. In this paper, I follow Keown in defending the aretaic interpretative model, although I do not press the analogy with Aristotelian ethics. Rather, I argue (...) that Buddhist ethics corresponds to a more generic, act-centered virtue ethics. Buddhist moral reasoning is often strikingly consequentialist, but I argue that this does not support the consequentialist interpretation. Analyzing the concept of right action must be distinguished from providing a justification for living a moral life and from formulating a procedure for making moral decisions. (shrink)

The classification of preserved hypothalamic activity in brain death and brainstem death as functional or non-functional has become a subject of debate. While proponents of the neurological criterion claim that these activities lack functional significance (Shemie et al. 2014), Nair-Collins and Joffe (2023) argue for their functional physiological role. However, the interpretation of the term "function" within the medico-legal framework, where death is characterized by the irreversible cessation of all brain functions, remains unclear. -/- My intention here is not to (...) engage in a debate over the validity of different viewpoints regarding the functional significance of preserved activities in the hypothalamus or the heart. Rather, I aim to highlight the critical importance of exploring and defining the concept of function in medicine, which currently lacks clarity. My point is that, whatever our position in the brain death debate, reaching a consensus on this conceptual matter would minimize misunderstandings and establish a robust foundation for further insightful analysis. (shrink)

There is considerable enthusiasm about the prospect that artificial intelligence (AI) will help to improve the safety and efficacy of health services and the efficiency of health systems. To realize this potential, however, AI systems will have to overcome structural problems in the culture and practice of medicine and the organization of health systems that impact the data from which AI models are built, the environments into which they will be deployed, and the practices and incentives that structure their (...) development. This perspective elaborates on some of these structural challenges and provides recommendations to address potential shortcomings. (shrink)

This is the text of a paper (along with appendixes) delivered at the 2019 annual meeting of the Minnesota Philosophical Society on Oct 26 in Cambridge, MN. -/- Beauchamp and Childress’s “Four Principles” (or “Principlism”) approach to bioethics has become something of a standard not only in bioethics classrooms and journals, but also within medicine itself. In this teaching-focused workshop, I’ll be doing the following: (1) Introducing the basics of the “Four Principles” approach, with a special focus on its (...) relation to the common morality and the importance to weighing and balancing of competing norms. (2) Comparing and contrasting this to other potential approaches, such as those provided by virtue ethics, act utilitarianism, casuistry, and competing versions of principles-based ethics. (3) Considering the ways in which the principles-based approach can best be implemented for lower-level, introductory bioethics classes, where the average student may have little background knowledge in either philosophy or medicine. I’ll be presenting sample activities, case studies, and lesson plans. There will be considerable time reserved for discussion at the end, so that participants can exchange ideas relating to the teaching of both bioethics and other varieties of applied ethics. (shrink)

Since its inception in the early 1990s, evidence-based medicine (EBM) has become the dominant epistemic framework for Western medical practice. However, in light of powerful criticisms against EBM, alternatives such as casuistic medicine have been gaining support in both the medical and philosophical community. In the absence of empirical evidence in support of the claim that EBM improves patient outcomes, and in light of considerations that it is unlikely that such evidence will be forthcoming, another standard is needed (...) to assess EBM against its alternatives. In this paper, I propose a set of criteria for this purpose based on Helen Longino's criteria for assessing the objectivity of a knowledge productive community. I then apply these criteria to assess EBM against a casuistic framework for medical knowledge. I argue that EBM's strict adherence to a hierarchical organization of knowledge can reasonably be expected to block it from fulfilling a high level of objectivity. A casuistic framework, on the other hand, because it emphasizes critical evaluation in conjunction with the flexibility of a case-based approach, could be expected to better facilitate a more optimal epistemic community. (shrink)

In Nicomachean Ethics 1.8, Aristotle seems to argue that certain external goods are needed for happiness because, in the first place, they are needed for virtuous activity. This has puzzled scholars. After all, it seems possible for a virtuous agent to exercise her virtuous character even under conditions of extreme hardship or deprivation. Indeed, it is natural to think these are precisely the conditions under which one's virtue shines through most clearly. Why then does Aristotle think that a wide range (...) of external goods is required for virtuous activity, and therefore, for happiness? -/- I argue that there is good sense to be made of Aristotle's stance on external goods. Specifically, I explain how, on this view, a range of external goods is required for the full exercise of virtue, and I show that it is only this full exercise that is constitutive of eudaimonia. Drawing on passages in Politics 7.13 and Nicomachean Ethics 3.1, I develop and defend a distinction between the "mere" exercise of virtue, and the full or complete exercise of virtue. I argue that, for Aristotle, the distinguishing feature of this distinction is the value of the virtuous action's ends. An action that fully expresses virtue aims at an end that is unqualifiedly good, while an action that merely exercises virtue does not. I argue that the external goods Aristotle mentions in NE 1.8 are necessary for performing actions with unqualifiedly good ends, and so necessary for the complete exercise of virtue. In addition to providing a more satisfactory account than existing proposals of the role of external goods in Aristotelian happiness, my interpretation has two additional upshots. First, it brings to light an under-appreciated and independently compelling feature of Aristotle's ethical thought: the value of virtuous actions depends in part on the value of the ends they aim to realize. Second, it finds in Aristotle a distinct and powerful way of thinking about the badness of certain kinds of misfortune and deprivation: they are bad in part because they prevent us from fully realizing our capacity for moral agency, from fully engaging with value in the world. (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)

I examine Zhu Xi's investigation thesis, the claim that a necessary condition (in ordinary cases) for one’s acting fully virtuously is one’s investigating the all-pervasive pattern in things (gewu格物). I identify four key objections that the thesis faces, which I label the rationalism, elitism, demandingness, and irrelevance worries. Zhu Xi, I argue, has resources for responding to each of these worries, and for defending a broadly intellectualist conception of fully virtuous agency.

Answers to the questions of what justifies conscientious objection in medicine in general and which specific objections should be respected have proven to be elusive. In this paper, I develop a new framework for conscientious objection in medicine that is based on the idea that conscience can express true moral claims. I draw on one of the historical roots, found in Adam Smith’s impartial spectator account, of the idea that an agent’s conscience can determine the correct moral norms, (...) even if the agent’s society has endorsed different norms. In particular, I argue that when a medical professional is reasoning from the standpoint of an impartial spectator, his or her claims of conscience are true, or at least approximate moral truth to the greatest degree possible for creatures like us, and should thus be respected. In addition to providing a justification for conscientious objection in medicine by appealing to the potential truth of the objection, the account advances the debate regarding the integrity and toleration justifications for conscientious objection, since the standard of the impartial spectator specifies the boundaries of legitimate appeals to moral integrity and toleration. The impartial spectator also provides a standpoint of shared deliberation and public reasons, from which a conscientious objector can make their case in terms that other people who adopt this standpoint can and should accept, thus offering a standard fitting to liberal democracies. (shrink)