This chapter provides an account of what dogmatism is, why the term matters, and how it applies to withholding judgment. Roughly, a person is dogmatic about P when a certain problematic personal investment—a superiority complex, broadly construed—biases their judgment concerning whether P. The term dogmatism and its cognates matter because of their social function. To accuse you of dogmatism is to signal how you are to be treated: your judgment or behavior needs to be “brought down to earth,” so (...) that you have a more accurate view of yourself or so you stop treating others as less important or less than. Withholding judgment can be dogmatic in the same way that belief is dogmatic. Belief (withholding) is dogmatic just when the relevant problematic personal investment results in biases that keep a person stuck in that belief (withholding). (shrink)

It may seem that epistemic and practical rationality weigh reasons differently, because ties in practical rationality tend to generate permissions and ties in epistemic rationality tend to generate a requirement to withhold judgment. I argue that epistemic and practical rationality weigh reasons in the same way, but they have different "default biases". Practical rationality is biased toward every option being permissible whereas epistemic rationality is biased toward withholding judgment's being required.

This paper presents a puzzle about justification and withholding. The puzzle arises in a special case where experts advise us to not withhold judgment. My main thesis is simply that the puzzle is genuinely a puzzle, and so leads us to rethink some common assumptions in epistemology, specifically assumptions about the nature of justification and doxastic attitudes. Section 1 introduces the common assumptions. Section 2 presents the puzzle case. Section 3 assesses the puzzle case. Section 4 explains the choice (...) we're faced with. Sections 5 and 6 consider and reject some proposed solutions, and in the process refine and clarify the choice we're faced with. Section 7 considers and rejects a miscellany of different proposed solutions. (shrink)

Several authors have recently endorsed the thesis that there is what has been called pragmatic encroachment on knowledge—in other words, that two people who are in the same situation with respect to truth-related factors may differ in whether they know something, due to a difference in their practical circumstances. This paper aims not to defend this thesis, but to explore how it could be true. What I aim to do, is to show how practical factors could play a role in (...) defeating knowledge by defeating epistemic rationality—the very kind of rationality that is entailed by knowledge, and in which Pascalian considerations do not play any role—even though epistemic rationality consists in having adequate evidence. (shrink)

I discuss Turri's puzzle about withholding. I argue that attention to the way in which evidence can justify withholding dissolves the puzzle.

Recent work has argued that there may be cases where no attitude – including withholding – is rationally permissible. In this paper, I consider two such epistemic dilemmas, John Turri’s Dilemma from Testimony and David Alexander’s Dilemma from Doubt. Turri presents a case where one’s only evidence rules out withholding (without warranting belief or disbelief). Alexander presents a case where higher order doubt means one must withhold judgment over whether withholding judgment is rational. In both cases, the (...) authors conclude that no doxastic attitude is warranted. In this paper, I argue against the possibility of these epistemic dilemmas. I argue that withholding cannot be irrational in either case. But meditating on the dilemmas gives us an important – and overlooked – insight into the nature of rational withholding. First, rational withholding is a function of evidence failing to sufficiently support belief or disbelief. As a result, withholding is not symmetrical to belief and disbelief. Second, there can be two distinct grounds for rational withholding. First, propositional withholding, which arises when our evidence does not support belief or disbelief in p. And second, doxastic withholding, which arises when we cannot determine whether our evidence supports belief or disbelief in p. Accepting two grounds of rational withholding licenses a kind of Weak Permissivism. But this Weak Permissivism should not be troubling to anyone. (shrink)

Disclosure in clinical practice is aimed at promoting patient autonomy, usually culminating in patient choice (e.g., to consent to an operation or not, or between different medications). In medical ethics, there is an implicit background assumption that knowing more about (X) automatically translates to greater, or more genuine, autonomy with respect to one's choices involving (X). I challenge this assumption by arguing that in rare cases, withholding information can promote a patient's autonomy (understood as the capacity for rational choice (...) in alignment with one's values and goals). (shrink)

A dilemma exists when a doctor is faced with a child or young person who refuses medically indicated treatment. The Gillick case has been interpreted by many to mean that a child of sufficient age and intelligence could validly consent or refuse consent to treatment. Recent decisions of the Court of Appeal on a child's refusal of medical treatment have clouded the issue and undermined the spirit of the Gillick decision and the Children Act 1989. It is now the case (...) that a child patient whose competence is in doubt will be found rational if he or she accepts the proposal to treat but may be found incompetent if he or she disagrees. Practitioners are alerted to the anomalies now exhibited by the law on the issue of children's consent and refusal. The impact of the decisions from the perspectives of medicine, ethics, and the law are examined. Practitioners should review each case of child care carefully and in cases of doubt seek legal advice. (shrink)

While agreeing with the main conclusion of Dominic Wilkinson and colleagues (Wilkinson, Butcherine, and Savulescu 2019), namely, that there is no moral difference between treatment withholding and withdrawal as such, we wish to criticize their approach on the basis that it treats the widespread acceptance of withdrawal aversion (WA) as a cognitive bias. Wilkinson and colleagues understand WA as “a nonrational preference for withholding (WH) treatment over withdrawal (WD) of treatment” (22). They treat WA as a manifestation of (...) loss aversion and refer to Kahneman and colleagues (1991), which defined this effect as follows: “the disutility of giving up an object is greater that the utility associated with acquiring it” (194). In a previous work, Wilkinson and Savulescu understood nonequivalence between treatment withholding and withdrawal as a reflection of slightly different, although related, phenomena: status quo bias or omission bias (Wilkinson and Savulescu 2012, 130–131). In neither of these two papers do they describe precisely the relation between these well-known psychological effects and WA, nor do they explain why they treat these effects as examples of nonrational preferences, despite the fact that these issues have been the subject of wide-ranging discussions on the intersection of psychology, economy, and philosophy. (shrink)

I develop an egalitarian account of what's objectionable about coercion. The account is rooted in the idea that certain relationships, like those of master to slave or lord to peasant, are relationships of subordination or domination. These relationships are morally objectionable. Such relationships are in part constituted by asymmetries of power. A master subordinates a slave because the master has more power over the slave than vice versa. Coercion is objectionable, I argue, because it creates such asymmetries of power and (...) so creates relationships of subordination. This account, moreover, illuminates what's wrong with blackmail, exploitation, withholding aid, and compulsion. (shrink)

Objectives—To assess whether UK and US health care professionals share the views of medical ethicists about medical futility, withdrawing/withholding treatment, ordinary/extraordinary interventions, and the doctrine of double effectDesign, subjects and setting–A 138-item attitudinal questionnaire completed by 469 UK nurses studying the Open University course on “Death and Dying” was compared with a similar questionnaire administered to 759 US nurses and 687 US doctors taking the Hastings Center course on “Decisions near the End of Life”.Results–Practitioners accept the relevance of concepts (...) widely disparaged by bioethicists: double effect, medical futility, and the distinctions between heroic/ordinary interventions and withholding/ withdrawing treatment. Within the UK nurses' group a “rationalist” axis of respondents who describe themselves as having “no religion” are closer to the bioethics consensus on withholding and withdrawing treatment.Conclusions—Professionals' beliefs differ substantially from the recommendations of their professional bodies and from majority opinion in bioethics. Bioethicists should be cautious about assuming that their opinions will be readily accepted by practitioners. (shrink)

This paper argues that higher-order doubt generates an epistemic dilemma. One has a higher-order doubt with regards to P insofar as one justifiably withholds belief as to what attitude towards P is justified. That is, one justifiably withholds belief as to whether one is justified in believing, disbelieving, or withholding belief in P. Using the resources provided by Richard Feldman’s recent discussion of how to respect one’s evidence, I argue that if one has a higher-order doubt with regards to (...) P, then one is not justified in having any attitude towards P. Otherwise put: No attitude towards the doubted proposition respects one’s higher-order doubt. I argue that the most promising response to this problem is to hold that when one has a higher-order doubt about P, the best one can do to respect such a doubt is to simply have no attitude towards P. Higher-order doubt is thus much more rationally corrosive than non-higher-order doubt, as it undermines the possibility of justifiably having any attitude towards the doubted proposition. (shrink)

In “Stakes, Withholding, and Pragmatic Encroachment on Knowledge,” I used a variety of cases, including cases of forced choice, to illustrate my explanation of how and why some pragmatic factors, but not others, can affect whether an agent knows. In his recent contribution, Andy Mueller argues that cases of forced choice actually pose a dilemma for my account. In this paper I reply.

The concept of epistemic defeat or defeasibility has come to occupy an important place in contemporary epistemology, especially in relation to the closely allied concepts of justified belief, warrant, and knowledge. These allied concepts signify positive epistemic appraisal or positive epistemic status. As a first approximation, defeasibility refers to a belief’s liability to lose some positive epistemic status, or to having this status downgraded in some particular way. For example, a person may be epistemically justified in believing some proposition p (...) at one time, but then the belief might become less justified or even unjustified at some later time. Moreover, beliefs may also be prevented from having or acquiring some positive epistemic status in the first place. So more generally, defeasibility refers to a kind of epistemic liability or vulnerability, the potential of loss, reduction, or prevention of some positive epistemic status. A defeater is, broadly speaking, a condition that actualizes this potential. This article begins by outlining two general types of defeaters: propositional defeaters and mental state defeaters. Propositional defeaters are conditions external to the perspective of the cognizer that prevent an overall justified true belief from counting as knowledge. Mental state defeaters are conditions internal to the perspective of the cognizer (such as experiences, beliefs, withholdings) that cancel, reduce, or even prevent justification. (shrink)

In his Principles of Philosophy, Descartes says, Finally, it is so manifest that we possess a free will, capable of giving or withholding its assent, that this truth must be reckoned among the first and most common notions which are born with us.

To say that evidence is normative is to say that what evidence one possesses, and how this evidence relates to any proposition, determines which attitude among believing, disbelieving and withholding one ought to take toward this proposition if one deliberates about whether to believe it. It has been suggested by McHugh that this view can be vindicated by resting on the premise that truth is epistemically valuable. In this paper, I modify the strategy sketched by McHugh so as to (...) overcome the initial difficulty that it is unable to vindicate the claim that on counterbalanced evidence with respect to P one ought to conclude deliberation by withholding on P. However, I describe the more serious difficulty that this strategy rests on principles whose acceptance commits one to acknowledging non-evidential reasons for believing. A way to overcome this second difficulty, against the evidentialists who deny this, is to show that we sometimes manage to believe on the basis of non-epistemic considerations. If this is so, one fundamental motivation behind the evidentialist idea that non-epistemic considerations could not enter as reason in deliberation would lose its force. In the second part of this paper I address several strategies proposed in the attempt to show that we sometimes manage to believe on the basis of non-epistemic considerations and show that they all fail. So, I conclude that the strategy inspired by McHugh to ground the normativity of evidence on the value of truth ultimately fails. (shrink)

Many caregivers feel that they need to lie or withhold the truth from people living with dementia, but worry that, in doing so, they are violating a duty to tell the truth. In this article, I argue that withholding the truth from and, in limited circumstances, lying to people living with dementia is not only morally permissible, but morally required by a more general requirement that we treat each other as persons worthy of respect. I do so through an (...) analysis of the groundings of the duty to tell the truth, and a critical reflection on its cognitively ableist construction. (shrink)

Self-deception is typically considered epistemically irrational, for it involves holding certain doxastic attitudes against strong counter-evidence. Pragmatic encroachment about epistemic rationality says that whether it is epistemically rational to believe, withhold belief or disbelieve something can depend on perceived practical factors of one’s situation. In this paper I argue that some cases of self-deception satisfy what pragmatic encroachment considers sufficient conditions for epistemic rationality. As a result, we face the following dilemma: either we revise the received view about self-deception or (...) we deny pragmatic encroachment on epistemic rationality. I suggest that the dilemma can be solved if we pay close attention to the distinction between ideal and bounded rationality. I argue that the problematic cases fail to meet standards of ideal rationality but exemplify bounded rationality. The solution preserves pragmatic encroachment on bounded rationality, but denies it on ideal rationality. (shrink)

Epistemologists often claim that in addition to belief and disbelief there is a third, neutral, doxastic attitude. Various terms are used: ‘suspending judgment’, ‘withholding’, ‘agnosticism’. It is also common to claim that the factors relevant to the justification of these attitudes are epistemic in the narrow sense of being factors that bear on the strength or weakness of one’s epistemic position with respect to the target proposition. This paper addresses two challenges to such traditionalism about doxastic attitudes. The first (...) concerns the relevance of non-epistemic factors we might call "future-comparative" – e.g., that you’ll have more decisive evidence on whether p tomorrow – to the justification of suspending judgment. The second, from Jane Friedman, is to explain the point of the neutral attitude without appealing to inquiry and thus taking goal-related factors, which are not epistemic, such as the value of the goal or the prospects for finding means to achieve it, to bear on the justification of the neutral attitude. My defense of traditionalism relies on distinguishing three ways of being neutral on a question: agnosticism, inquiry and suspension of judgment. Traditionalism is saved because, of these, agnosticism alone is a genuine doxastic attitude. (shrink)

Sometimes epistemologists theorize about belief, a tripartite attitude on which one can believe, withhold belief, or disbelieve a proposition. In other cases, epistemologists theorize about credence, a fine-grained attitude that represents one’s subjective probability or confidence level toward a proposition. How do these two attitudes relate to each other? This article explores the relationship between belief and credence in two categories: descriptive and normative. It then explains the broader significance of the belief-credence connection and concludes with general lessons from the (...) debate thus far. (shrink)

The use of placebo controls in clinical trials remains controversial. Ethical analysis and international ethical guidance permit the use of placebo controls in randomized trials when scientifically indicated in four cases: (1) when there is no proven effective treatment for the condition under study; (2) when withholding treatment poses negligible risks to participants; (3) when there are compelling methodological reasons for using placebo, and withholding treatment does not pose a risk of serious harm to participants; and, more controversially, (...) (4) when there are compelling methodological reasons for using placebo, and the research is intended to develop interventions that can be implemented in the population from which trial participants are drawn, and the trial does not require participants to forgo treatment they would otherwise receive. The concept of methodological reasons is essential to assessing the ethics of placebo controls in these controversial last two cases. This article sets out key considerations relevant to considering whether methodological reasons for a placebo control are compelling. (shrink)

What I call medically enabled suicides have four distinctive features: 1. They are instigated by actions of a suicidal individual, actions she intends to result in a physiological condition that, absent lifesaving medical interventions, would be otherwise fatal to that individual. 2. These suicides are ‘completed’ due to medical personnel acting in accordance with recognized legal or ethical protocols requiring the withholding or withdrawal of care from patients (e.g., following an approved advance directive). 3. The suicidal individual acts purposefully (...) to ensure that medical personnel will act on these protocols. 4. These suicides do not involve medical personnel providing aid in dying in the standard sense, either through (a) active voluntary euthanasia, or (b) assistance by means of prescriptions, etc. -/- Regardless of how common medically enabled suicides are, they raise compelling questions at the interface of medicine and individual choice. After first clarifying the concept of medically enabled suicide and exploring some of the reasons why it might be attractive to suicidal individuals, I then investigate two apparent dilemmas that medically enabled suicides raise for medical care providers. The first alleges that medical care providers may not contribute to harming their patients, and so they may not contribute to their patients’ suicides. The second alleges that if care providers, as a matter of personal conscience, believe that suicide is wrong, then they may not be compelled to contribute to their patient’s acting wrongly by assenting to the wishes of a patient pursuing medically enabled suicide. Both dilemmas arise from the fact that while medical personnel are bound by widely accepted precepts of medical ethics to honor the competent wishes of their patients, medically enabled suicides entangle them in their patients’ suicidal plans in ways that result in their contributing to those suicides. I conclude that neither dilemma should be resolved in the direction of medical personnel having the right to refrain from involvement in medically enabled suicides. Thus, while we may find medically enabled suicide distasteful or exploitative, a strong case cannot be made that medical personnel refusing to involve themselves in such suicides is ethically permissible. (shrink)

Doxastic voluntarism is the thesis that our beliefs are subject to voluntary control. While there’s some controversy as to what “voluntary control” amounts to (see 1.2), it’s often understood as direct control: the ability to bring about a state of affairs “just like that,” without having to do anything else. Most of us have direct control over, for instance, bringing to mind an image of a pine tree. Can one, in like fashion, voluntarily bring it about that one believes a (...) specific proposition? Doxastic voluntarists hold that, at least in some circumstances—such as when the evidence is ambiguous—we can. Doxastic involuntarists, in contrast, maintain that we cannot. Some involuntarists hold that the concept of belief itself precludes the possibility of believing voluntarily. Others hold that the impossibility of voluntary belief is a contingent psychological fact. Historically, the issue of doxastic voluntarism has been connected to how many think about religious commitment: a prominent view of faith is that it is a voluntary decision to believe. Furthermore, the issue of voluntarism has also been viewed as having bearing on fundamental questions in epistemology. For example, are epistemic norms duties to believe in certain ways? Are there practical or moral reasons to believe? If the answer to either question is “yes,” it seems some measure of voluntary doxastic control is required. -/- In section 1, we expand on the definition of doxastic voluntarism, and survey various kinds of control (e.g. direct, indirect, long-range) and the doxastic attitudes we might control (e.g. outright belief, withholding, credences). In section 2, we discuss a number of historical views on doxastic voluntarism. In section 3, we survey motivations for rejecting doxastic voluntarism. There are two general strategies: arguments that appeal to psychological considerations, and conceptual arguments regarding the nature of belief. In section 4, we survey five approaches to defending voluntarism: those that appeal to epistemic permissivism, doxastic compatibilism, skepticism, one-off considerations, and non-standard views of belief. In section 5, we cover empirical work on doxastic voluntarism. The last two sections discuss two implications of voluntarism. In section 6, we discuss voluntarism’s implications for the ethics of belief, and in section 7, we discuss issues at the intersection of voluntarism and religious faith. (shrink)

Despite the notable lack of Chaplinesque romantic flourishes, Buster Keaton has a sophisticated approach to romantic love in his films. Love in Keaton’s films is a mutual recognition and admiration for the physical and mental competence necessary to deal with an absurd, cruel, or indifferent social and physical environment and an agreement to face the world together. There are two ways in which this claim might seem surprising to someone familiar with Keaton’s films. Keaton’s famously stoic persona seems to be (...) at odds with the very idea that there is an expression of romantic love in the films. How could someone so un-expressive express romantic love? There is simply not enough there to be interpreted. Additionally, the topic of love seems to be the wrong approach to take toward Keaton, the master of the gag. His films are original and interesting and funny because of their visual wit, not because of their thematic value. Watching his films for themes is to miss what is valuable about them. In answering these objections, I will set the stage for my argument that Keaton’s narratives assume the viewer recognizes the Buster character is in love while withholding many of the traditional emotional signifiers of that love. The narrative cannot proceed without this assumption and many of the gags don’t work without recognizing Buster’s motivation. Through careful attention to the resolution of the stories within the films, we can begin to recognize the surprising, sophisticated approach to romantic love that the films contain. (shrink)

In deciding whether to forgive, we often focus on the wrongdoer, looking for an apology or a change of ways. However, to fully consider whether to forgive, we need to expand our focus from the wrongdoer and their wrongdoing, and we need to consider who we are, what we care about, and what we want to care about. The difference between blame and forgiveness is, at bottom, a difference in priorities. When we blame, we prioritize the wrong, and when we (...) forgive, we shift our priorities away from the wrong. Recognizing this essential role for priorities in forgiveness allows us to address a thorny puzzle in thinking about forgiveness: how is it that forgiveness can be both principled and elective? If there is sufficient reason to forgive, as will sometimes be the case because forgiveness is principled, how can it be reasonable to withhold forgiveness? Recognizing that forgiveness is a shift in our priorities dissolves this apparent tension between forgiveness being principled and forgiveness being elective. (shrink)

Controversial view agnosticism is the thesis that we are rationally obligated to withhold judgment about a large portion of our beliefs in controversial subject areas, such as philosophy, religion, morality and politics. Given that one’s social identity is in no small part a function of one’s positive commitments in controversial areas, CVA has unsurprisingly been regarded as objectionably ‘spineless.’ That said, CVA seems like an unavoidable consequence of a prominent view in the epistemology of disagreement—conformism—according to which the rational response (...) to discovering that someone you identify as an epistemic peer or expert about p disagrees with you vis-à-vis p is to withhold judgment. This paper proposes a novel way to maintain the core conciliatory insight without devolving into an agnosticism that is objectionably spineless. The approach offered takes as a starting point the observation that–for reasons that will be made clear—the contemporary debate has bypassed the issue of the reasonableness of maintaining, rather than giving up, representational states weaker than belief in controversial areas. The new position developed and defended here explores this overlooked space; what results is a kind of controversial view. (shrink)

In this paper I will use sex by deception as a case study for highlighting some of the most tricky concepts around sexuality and moral psychology, including rape, consensual sex, sexual rights, sexual autonomy, sexual individuality, and disrespectful sex. I begin with a discussion of morally wrong sex as rooted in the breach of five sexual liberty rights that are derived from our fundamental human liberty rights: sexual self-possession, sexual autonomy, sexual individuality, sexual dignity and sexual privacy. I then argue (...) (against the standard interpretation) that experimental findings in moral psychology show that the principle of respect for persons—a principle that grounds our human liberty rights—drives our intuitive moral judgments. In light of this discussion, I examine a puzzle about sex by deception—a puzzle which at first may seem to compel us to define 'rape' strictly in terms of force rather than sexual autonomy. I proceed by presenting an argument against the view that, as a rule, sex by deception undermines consent—a position held by prominent thinkers such as Philippe Patry (2001), Onora O’Neill (2003), Rubenfeld (2012), Tom Dougherty (2013a, 2013b), Joyce M. Short (2013), and Danielle Bromwich and Joseph Millum (2013, 2018). As we will see, sex following deception to increase your chances does not always constitute rape. Lying about your age, education, job, family background, marital status, or interest in a relationship, for example, does not make your sex partner incapable of consenting, which is to say that sex by deception need not be rape. I even go so far as to say that sex with another person that is facilitated by withholding information about having a venereal disease shouldn't be classified as rape. Although sex by deception doesn't compromise consent, it nonetheless violates the principle of respect for persons, not by vitiating sexual autonomy and compromising consent, but by failing to respect other sexual rights, such as our rights to sexual dignity, individuality, and privacy. (shrink)

This discussion treats a set of familiar social derelictions as consequences of the perversion of a universalistic moral theory in the service of an ill-considered or insufficiently examined personal agenda.The set includes racism, sexism, anti-Semitism, homophobia, and class elitism, among other similar pathologies, under the general heading of discrimination. The perversion of moral theory from which these derelictions arise, I argue, involves restricting its scope of application to some preferred subgroup of the moral community of human beings. -/- The following (...) analysis of higher-order discrimination suggests that we often select the individuals who constitute such subgroups for reasons that we ourselves would reject on moral grounds were we to examine them carefully, but that we choose instead to put our rational resources in the service of avoiding any such examination at all costs. The implication is that arguments that truncate the scope of moral theory in fact justify bestowing the gift of moral treatment on a select few who deserve it no more than the many from whom we withhold it. Therefore, it would be precipitous to conclude that universalistic moral theory can be legitimately restricted in its practical scope of application in any way at all. (shrink)

Plakias has recently argued that there is nothing wrong with publishing defences of philosophical claims which we don't believe and also nothing wrong with concealing our lack of belief, because an author's lack of belief is irrelevant to the merit of a published work. Fleisher has refined this account by limiting the permissibility of publishing without belief to what he calls ‘advocacy role cases’. I argue that such lack of belief is irrelevant only if it is the result of an (...) inexplicable incredulity or the result of a metaphilosophical or epistemic stance that is unrelated to the specific claim. However, in many real-life cases, including Fleisher's advocacy role cases, our doubts regarding the claims we defend arise from reasons that have something to do with the insufficiency of the philosophical evidence supporting the claim, and publishing an unconditional defence of a claim without revealing our doubts is impermissible as it involves withholding philosophically relevant reasons. Plakias has also argued that discouraging philosophers from publishing claims they don't believe would be unfair to junior philosophers with unsettled views. I propose that we should change our academic practices that pressure philosophers to publish articles that pretend to be defences of settled views. (shrink)

During the recent Ebola epidemic, some commentators and stakeholders argued that it would be unethical to carry out a study that withheld a potential treatment from affected individuals with such a serious, untreatable disease. As a result, the initial trials of experimental treatments did not have control arms, despite important scientific reasons for their inclusion. In this paper, we consider whether the duty to rescue entails that it would be unethical to withhold an experimental treatment from patient-participants with serious diseases (...) for which there are no effective treatments, even when doing so is scientifically necessary to test the effectiveness of the treatment. We argue that the duty to rescue will rarely apply. The context of medical research also throws new light on the content of the duty to rescue, since the interests of future patients—who stand to benefit from the fruits of medical research—are relevant to whether the duty applies. (shrink)

Decision-making capacity (DMC) plays an important role in clinical practice—determining, on the basis of a patient’s decisional abilities, whether they are entitled to make their own medical decisions or whether a surrogate must be secured to participate in decisions on their behalf. As a result, it’s critical that we get things right—that our conceptual framework be well-suited to the task of helping practitioners systematically sort through the relevant ethical considerations in a way that reliably and transparently delivers correct verdicts about (...) who should and should not have the authority to make their own medical decisions. Unfortunately, however, the standard approach to DMC does not get things right. It is of virtually no help in identifying and clarifying the relevant ethical considerations. And, embedded in the prevailing anti-paternalist paradigm, DMC assessments obfuscate and distort the underlying ethical justification for granting or withholding decisional authority. Here, we describe the core commitments of the standard approach to DMC and then highlight three problems with it. We then argue that these problems are significant enough that they call for more than merely tinkering and fine tuning—variations of the standard approach cannot adequately address them. Instead, we should ditch DMC. (shrink)

People cannot contemplate a proposition without believing that proposition. A model of belief fixation is sketched and used to explain hitherto disparate, recalcitrant, and somewhat mysterious psychological phenomena and philosophical paradoxes. Toward this end I also contend that our intuitive understanding of the workings of introspection is mistaken. In particular, I argue that propositional attitudes are beyond the grasp of our introspective capacities. We learn about our beliefs from observing our behavior, not from introspecting our stock beliefs. -/- The model (...) of belief fixation offered in the dissertation poses a novel dilemma for theories of rationality. One might have thought that the ability to contemplate ideas while withholding assent is a necessary condition on rationality. In short, it seems that rational creatures shouldn‘t just form their beliefs based on whatever they happen to think. However, it seems that we are creatures that automatically and reflexively form our beliefs based on whatever propositions we happen to consider. Thus, either the rational requirement that states that we must have evidence for our beliefs must be jettisoned or we must accept the conclusion that we are necessarily irrational. (shrink)

Domestic violence and abuse (DVA) are at last coming to be recognised as serious global public health problems. Nevertheless, many women with personal histories of DVA decline to disclose them to healthcare practitioners. In the health sciences, recent empirical work has identified many factors that impede DVA disclosure, known as barriers to disclosure. Drawing on recent work in social epistemology on testimonial silencing, we might wonder why so many people withhold their testimony and whether there is some kind of epistemic (...) injustice afoot here. In this paper, I offer some philosophical reflections on DVA disclosure in clinical contexts and the associated barriers to disclosure. I argue that women with personal histories of DVA are vulnerable to a certain form of testimonial injustice in clinical contexts, namely, testimonial smothering, and that this may help to explain why they withhold that testimony. It is my contention that this can help explain the low rates of DVA disclosure by patients to healthcare practitioners. (shrink)

I examine the epistemological debate on scientific realism in the context of quantum physics, focusing on the empirical underdetermin- ation of different formulations and interpretations of QM. I will argue that much of the interpretational, metaphysical work on QM tran- scends the kinds of realist commitments that are well-motivated in the light of the history of science. I sketch a way of demarcating empirically well-confirmed aspects of QM from speculative quantum metaphysics in a way that coheres with anti-realist evidence from (...) the history of science. The minimal realist attitude sketched withholds realist com- mitment to what quantum state |Ψ⟩ represents. I argue that such commitment is not required for fulfilling the ultimate realist motiva- tion: accounting for the empirical success of quantum mechanics in a way that is in tune with a broader understanding of how theoretical science progresses and latches onto reality. (shrink)

Philosophers have often noted a contrast between practical and theoretical reasons when it comes to cases involving equally balanced reasons. When there are strong practical reasons for A-ing, and equally strong practical reasons for some incompatible option, B-ing, the agent is permitted to make an arbitrary choice between them, having sufficient reason to A and sufficient reason to B. But when there is strong evidence for P and equally strong evidence for ~ P, one isn’t permitted to simply believe one (...) or the other. Instead, one must withhold belief, neither believing that P nor believing that ~ P. This paper examines what explains this contrast, focusing in particular on a proposal recently developed by Mark Schroeder across several papers. Schroeder aims to explain the contrast by an appeal to non-evidential, epistemic reasons against belief. But, I argue, it’s not clear exactly what those reasons are, nor how those reasons are to be weighed against evidential reasons. Despite these challenges, I argue that there are grounds for optimism that the contrast can be explained within the broad framework Schroeder provides, and I aim to provide resources to meet the aforementioned challenges. (shrink)

Ephecticism is the tendency towards suspension of belief. Epistemology often focuses on the error of believing when one ought to doubt. The converse error—doubting when one ought to believe—is relatively underexplored. This essay examines the errors of undue doubt. I draw on the relevant alternatives framework to diagnose and remedy undue doubts about rape accusations. Doubters tend to invoke standards for belief that are too demanding, for example, and underestimate how farfetched uneliminated error possibilities are. They mistake seeing how incriminating (...) evidence is compatible with innocence for a reason to withhold judgement. Rape accusations help illuminate the causes and normativity of doubt. I propose a novel kind of epistemic injustice, for example, wherein patterns of unwarranted attention to farfetched error possibilities can cause those error possibilities to become relevant. Widespread unreasonable doubt thus renders doubt reasonable and makes it harder to know rape accusations. Finally, I emphasise that doubt is typically a conservative force and I argue that the relevant alternatives framework helps defend against pernicious doubt-mongers. (shrink)

In this chapter it is demonstrated that the way in which leaders implement a decision largely depends on the nature of it, that is, whether it is strategic or not. Leaders must be as open as possible and not withhold information from the persons involved in the process. Therefore, they should distribute as much relevant information as possible to meeting participants before a meeting. At the same time, they must be able to steer the process. It is not unusual for (...) there to be a separation between the formulation and implementation of a strategic decision. Often, it is the top leadership that formulates the decision problem and the middle managers that implement its solution. For this reason, it is relatively common that the top leadership signals that the implementation has been successful as soon as the middle managers begin to report positive results. This can sometimes happen even though most of the implementation is incomplete. However, there are also cases where the top leaders rule out certain implementation processes as failures when in fact they prove later on to be successful. A common problem in organizations is that leaders often inherit the task of implementing decisions that past leaders have made. In order to succeed with an implementation, leaders must understand the importance of the process. They must communicate their vision clearly, evaluate and monitor continuously, and allow interested parties to participate actively in the process. They should also understand that what at first may look like a failure, at a later stage may prove to be a success -/- . (shrink)

Receiving information about threats to one’s health can contribute to anxiety and depression. In contemporary medical ethics there is considerable consensus that patient autonomy, or the patient’s right to know, in most cases outweighs these negative effects of information. Worry about the detrimental effects of information has, however, been voiced in relation to public health more generally. In particular, information about uncertain threats to public health, from—for example, chemicals—are said to entail social costs that have not been given due consideration. (...) This criticism implies a consequentialist argument for withholding such information from the public in their own best interest. In evaluating the argument for this kind of epistemic paternalism, the consequences of making information available must be compared to the consequences of withholding it. Consequences that should be considered include epistemic effects, psychological effects, effects on private decisions, and effects on political decisions. After giving due consideration to the possible uses of uncertain information and rebutting the claims that uncertainties imply small risks and that they are especially prone to entail misunderstandings and anxiety, it is concluded that there is a strong case against withholding of information about uncertain threats to public health. (shrink)

In Frege’s Puzzle (1986), Salmon analyzed ‘a withholds believing p’ in terms of a ternary relation BEL of x believing a proposition p under a guise g. The proposed analysis is the following: There is a proposition guise g such that a grasps p by means of g but a does not stand in BEL to p and g. Sean Crawford has made a proposal for Millians to evade propositional guises through second-order belief. Specifically, in effect, Crawford’s proposes to analyze (...) the crucial notion of withheld belief instead as believing that one does not believe: a believes that a does not believe p. Crawford’s clever proposal thus avoids explicit quantification over guises. However, it is shown that the proposal is inadequate to avoid guises. The resulting notion is too weak to capture the relevant notion of withheld belief. (shrink)

I propose to explain Kant’s novel claim, in the Critique of Pure Reason, that all judgments have a formal modality. I begin by distinguishing the modality of a judgment’s form from the modality of its content, and I suggest that the former is peculiar in merely affecting the subject’s understanding of his own act of judging. I then contrast the modal account of such an understanding (in terms of the possibility and actuality of a judgment) with the traditional, non-modal understanding (...) of it (in terms of the giving and withholding of assent). I conclude by suggesting that Kant prefers the former because he conceives of knowledge on Aristotle’s model: as a progress in the mind from capacity to act. (shrink)

An epistemic duty would be a duty to believe, disbelieve, or withhold judgment from a proposition, and it would be grounded in purely evidential or epistemic considerations. If I promise to believe it is raining, my duty to believe is not epistemic. If my evidence is so good that, in light of it alone, I ought to believe it is raining, then my duty to believe supposedly is epistemic. I offer a new argument for the claim that there are no (...) epistemic duties. Though people do sometimes have duties to believe, disbelieve, or withhold judgment from propositions, those duties are never grounded in purely epistemic considerations. (shrink)

The author reviews the planned withdrawal of healthcare from the primary public hospital, Grady Memorial Hospital, of Atlanta, Georgia. Prior to passage of the Affordable Care Act of 2010, at least half of the patients had no public or private health insurance and their care was financially supported by State and County funding as well as supplementation from Emory University. New administration in the elected positions of the State and County and at the University reached agreement to decrease care. The (...) University President stated that the Hippocratic Oath was no longer valid for salaried physicians who must follow the direction of their business manager. The author, a tenured Professor, was forcibly transferred to the Veterans Hospital, which also was withholding standard medical care, including life-saving medications. Organizing multiple concerned organizations including members of the King Center, the Carter Center, the Open Door Community Center, Gay Rights, etc., (Grady Coalition) multiple public protests were successful in raising the necessary funds to continue adequate care at Grady and begin an investigation of the Veterans Affairs Hospital. (shrink)

Across care settings, the practice of lying to or withholding the truth from people living with dementia is common, yet it is objected to by many. Contrary to this common discomfort, I have argued in previous work that respecting members of this group as moral equals sometimes requires deceiving them. In this paper, I test my proposed practice against complex, controversial cases, demonstrating both its theoretical strength and its practical value for those working in social care.

Children and young people under 18 years old should no longer be regarded as incompetent to give or withhold consent in decisions involving their health care, Recent research suggests a functional test of cognitive and emotional maturity, rather than a strict age cut-off point. However, it is often difficult to implement these recommendations in practice, not least because the law is, if anything, increasingly 'hard-line' about children's autonomy.

This book examines the moral luck paradox, relating it to Kantian, consequentialist and virtue-based approaches to ethics. It also applies the paradox to areas in medical ethics, including allocation of scarce medical resources, informed consent to treatment, withholding life-sustaining treatment, psychiatry, reproductive ethics, genetic testing and medical research. If risk and luck are taken seriously, it might seem to follow that we cannot develop any definite moral standards, that we are doomed to moral relativism. However, Dickenson offers strong counter-arguments (...) to this view that enable us to think in terms of universal standards. (shrink)

In this article, I argue that mass incarceration belongs to a category of social status interventions by which the modern state either withholds the ordinary protections and benefits of the law from outlawed groups or subjects them to private punishment based on their mere membership in those groups. In the US these groups include immigrants and resident Latinos, the homeless, the poor and poor blacks, sex workers, and ex-convicts. Outlawry is a fundamentally anti-democratic practice that cannot be justified in terms (...) of deterrence and is incompatible with public safety. (shrink)

The phenomenal view of thought holds that thinking is an experience with phenomenal character that determines what the thought is about. This paper develops and responds to the objection that the phenomenal view is chauvinistic: it withholds thoughts from creatures that in fact have them. I develop four chauvinism objections to the phenomenal view—one from introspection, one from interpersonal differences, one from thought experiments, and one from the unconscious thought paradigm in psychology—and show that the phenomenal view can resist all (...) four. (shrink)

Philosophers and scientists have across the ages been amazed about the fact that development and learning often lead to not just a merely incremental and gradual change in the learner but sometimes to a result that is strikingly different from the learner’s original situation: amazed, but at times also worried. Both philosophical and cognitive neuroscientific insights suggest that experts appear to perform ‘different’ tasks compared to beginners who behave in a similar way. These philosophical and empirical perspectives give some insight (...) into what happens when a novice is transitioning to a stage of expertise. Generally, this implies that increased skill and expertise support better results and a more flexible performance, in part because these allow an agent to withdraw part of her attention and other cognitive resources from the tasks involved, enabling her to devote those resources to supporting, or completely different, tasks. As positive as these developments appear, these changes have also raised concerns. The main concern is whether gaining expertise is like raising a ‘cognitive monster’ which escapes the individual’s conscious control and influences her actions with undesirable automatisms. If so, we should ask ourselves whether experts are capable of taming this monster. The answer appears initially not to be positive. Indeed, it has been noted that since it is difficult for experts to withhold automatic responses this can lead to inflexibility or performance that is only optimal under certain conditions, because it is limited to a specific domain, often context-dependent, biased and inflexible. In what follows, I will consider this challenge of protecting expertise and harnessing this brittleness from philosophical and cognitive neuroscientific perspectives. Taking into account that action is in general determined by a multitude of factors, with learning and development affecting how these factors exert their influence, a philosophical question is how this complex and dynamic process can be explained and subsequently, how controlling it might be understood. First, though, I will present the issue at hand more closely: should we appreciate expertise if it is similar to growing a ‘cognitive monster’? Second, I will introduce the framework of a “Sculpted Space of Actions” (Keestra, 2014), which I developed in order to explain how the challenge of selecting an adequate option for action is facilitated by expertise as it helps to constrain the space of potential action options. Subsequently, the question is raised of how such a Sculpted Space of Actions influences an expert’s engagement with specific situations, like teaching students in a classroom setting. It will be argued that a well prepared expert—teacher or otherwise— is not only able to rely upon her routines but will at the same time be more perceptive and attentive to unforeseen events and actions, according to the recent cognitive neuroscientific theory of Predictive Processing. Integrating the theory of Predictive Processing with the Sculpted Space of Actions framework, I conclude that expertise contributes to adaptive and flexible responses to specific contexts, yet only if it is associated with explicit planning and articulation of situation specific intentions—the latter effectively putting the cognitive monster at rest for a while. (shrink)

This article examines when deceptive withholding of information is ethically acceptable in research. The first half analyses the concept of deception. We argue that there are two types of accounts of deception: normative and non-normative, and argue that non-normative accounts are preferable. The second half of the article argues that the relevant ethical question which ethics committees should focus on is not whether the person from whom the information is withheld will be deceived, but rather on the reasonableness of (...) withholding the information from the person who is deceived. We further argue that the reasonableness of withholding information is dependent on the context. The last section examines how the context of research should shape our judgements about the circumstances in which withholding information from research participants is ethically acceptable. We argue that some important features of research make it more difficult to justify withholding information in the context of research than elsewhere. (shrink)

In 1993, for the first time, John L. Schellenberg, the contemporary philosopher of religion, proposed the “Hiddenness Argument’’. According to this argument, as God doesn’t provide for many people sufficient evidence for His existence, He is Hidden. In the other words, that many people inculpably fail to find sufficient evidence for the existence of God constitutes evidence for atheism. Schellenberg argues that since a loving God would not withhold the benefits of belief, the lack of evidence for God’s existence is (...) incompatible with divine love. This paper argues that his defense of two controversial premises of his argument is unsuccessful: one is that God’s love is incompatible with His allowing some to remain in doubt in His existence, and the other is: the nonbelief of some agnostics is inculpable. Theistic Religions have plausible reasons, which Schellenberg has not succeeded in refuting, for thinking that all nonbelief is culpable. (shrink)