Summary Background Self-binding directives instruct clinicians to overrule treatment refusal during future severe episodes of illness. These directives are promoted as having potential to increase autonomy for individuals with severe episodic mental illness. Although lived experience is central to their creation, service users’ views on self-binding directives have not been investigated substantially. This study aimed to explore whether reasons for endorsement, ambivalence, or rejection given by service users with bipolar disorder can address concerns regarding self-binding directives, decision-making capacity, and human (...) rights. Methods This study used qualitative data from an internet-based survey distributed to the mailing list of the UK charity Bipolar UK, which contained multiple closed and open questions on advance decision-making in bipolar disorder. Quantitative analysis of a closed question about self-binding directives had already demonstrated endorsement amongst a very high proportion of participants with bipolar disorder who completed the survey. We conducted thematic analysis of responses from those participants who answered a subsequent open question about reasons for their view. Research was co-produced within a multi-disciplinary team, with clinical, legal, and ethical expertise, and lived experience of bipolar disorder. Ideas and methodologies associated with all these areas of expertise were used in the analysis of these reasons and to gain insight into the thoughts of individuals with bipolar disorder about self-binding directives and associated issues. Findings Between Oct 23 and Dec 5, 2017, 932 individuals with a self-reported clinical diagnosis of bipolar disorder completed the internet survey, with 565 (154 men; 400 women; 11 transgender or other) providing free text answers to the open question. A large majority of respondents endorsed self-binding directives, nearly all describing a determinate shift to types of distorted thinking and decision-making when unwell as their key justification. Responses indicating ambivalence were dominated by logistical concerns about the drafting and implementation of self-binding directives, while those who rejected self-binding directives also cited logistical concerns, validity of their thinking when unwell, and potential contravention of human rights. Interpretation This study is, to our knowledge, the first large study of reasons why mental health service users might endorse or reject the use of self-binding directives. The findings provide empirical support for introducing self-binding directives into mental health advance decision-making practice and policy and may help to address enduring ethical concerns surrounding possible implementation of the directive while a person retains decision-making capacity. The opinions expressed here in responses given by multiple service users with bipolar disorder challenge a prominent view within international disability rights debates that involuntary treatment and recognition of impaired mental capacity constitute inherent human rights violations. Funding The Wellcome Trust . (shrink)

This article, prompted by an extended essay published in the Journal of Medical Ethics by Charles Foster, and the current controversy surrounding the case of Vincent Lambert, analyses the legal and ethical arguments in relation to the withdrawal of life-sustaining treatment from patients with prolonged disorders of consciousness. The article analyses the legal framework through the prism of domestic law, case-law of the European Court of Human Rights and the Convention on the Rights of Persons with Disabilities, and examines the (...) challenge to the ethical consensus made by Foster. It concludes that the right approach remains a version of the approach that has prevailed for the last 25 years since the decision in Airedale NHS Trust v Bland[1993] AC 789, refined to reflect that that there is now, and rightly, a much more limited place for judgments made about the ‘burden’ of treatment or the quality of life enjoyed by the person made on the basis of assumptions about that person as a category as opposed to investigation of that person as an individual human being. (shrink)

Here we present the personal perspectives of two authors on the important and unfortunately frequent scenario of ambulance clinicians facing a deceased individual and family members who do not wish them to attempt cardiopulmonary resuscitation. We examine the professional guidance and the protection provided to clinicians, which is not matched by guidance to protect family members. We look at the legal framework in which these scenarios are taking place, and the ethical issues which are presented. We consider the interaction between (...) ethics, clinical practice and the law, and offer suggested changes to policy and guidance which we believe will protect ambulance clinicians, relatives and the patient. (shrink)

The modern legal and ethical movement against traditional welfare paternalism in medical decision-making extends to how decisions are made for patients lacking decisional capacity, prioritising surrogates’ judgment about what patients would have decided over even their best interests. In England and Wales, the Mental Capacity Act 2005 follows this trend of prioritising the patient’s prior wishes, values and beliefs but the dominant interpretation in life-sustaining treatment cases does so by in effect calling those values the ‘best interests’ of the patient (...) and focusing nearly exclusively on the ‘subjective’ viewpoint of the patient. In this article, we examine the recent Court of Protection judgment inBarnsley Hospitals NHS Foundation Trust v MSP[2020] EWCOP 26, which adhered closely to this approach, to suggest that it could have unexpected negative consequences. These include insufficient information gathering about and attention to patients’ objective medical interests, inadequacy of the evidentiary standard used for the substituted decision-making and, in some cases, even prioritising a surrogate’s current substituted judgment over the potential for an actual judgment by the patient. (shrink)

The COVID-19 pandemic put a large burden on many healthcare systems, causing fears about resource scarcity and triage. Several COVID-19 guidelines included age as an explicit factor and practices of both triage and ‘anticipatory triage’ likely limited access to hospital care for elderly patients, especially those in care homes. To ensure the legitimacy of triage guidelines, which affect the public, it is important to engage the public’s moral intuitions. Our study aimed to explore general public views in the UK on (...) the role of age, and related factors like frailty and quality of life, in triage during the COVID-19 pandemic. We held online deliberative workshops with members of the general public. Participants were guided through a deliberative process to maximise eliciting informed and considered preferences. Participants generally accepted the need for triage but strongly rejected ‘fair innings’ and ‘life projects’ principles as justifications for age-based allocation. They were also wary of the ‘maximise life-years’ principle, preferring to maximise the number of lives rather than life years saved. Although they did not arrive at a unified recommendation of one principle, a concern for three core principles and values eventually emerged: equality, efficiency and vulnerability. While these remain difficult to fully respect at once, they captured a considered, multifaceted consensus: utilitarian considerations of efficiency should be tempered with a concern for equality and vulnerability. This ‘triad’ of ethical principles may be a useful structure to guide ethical deliberation as societies negotiate the conflicting ethical demands of triage. (shrink)

The overwhelming weight of legal authority in the USA and Canada holds that consent is not required for brain death testing. The situation in England and Wales is similar but different. While clinicians in England and Wales may have a prima facie duty to obtain consent, lack of consent has not barred testing. In three recent cases where consent for brain death testing was formally presented to the court, lack of consent was not determinative, and in one case the court (...) questioned whether the clinicians were even required to seek consent from the parents of a child at all. (shrink)

All contemporary frameworks of mental capacity stipulate that we must begin from the presumption that an adult has capacity. This presumption is crucial, as it manifests respect for autonomy and guards against prejudice and paternalism on the part of the evaluator.Given its ubiquity, we might presume that we all understand the presumption’s meaning and application in the same way. Evidence demonstrates that this is not the case and that this has led to harm in vulnerable persons. There is thus strong (...) reason to question our presumptions about the presumption of capacity.We distinguish between two main ways of understanding and applying the presumption of capacity, and advocate for the one that we argue mitigates risk of harm. Our proposed interpretation offers many advantages in that it is consonant with actual practice of capacity evaluations, precludes confused and abusive avoidance of needed evaluations, and preserves the respect for autonomy motivating the presumption in the first place. (shrink)

In February 2022, the Court of Protection was faced with the question of whether a kidney transplant was in the best interests of William Verden. The case highlighted the legal, ethical and clinical complexities of treating potential kidney transplant patients with impaired decision-making. Above all, it exposed the potential risk of discrimination on the basis of disability when treatment decisions in relation to potential kidney recipients with impaired capacity are being made. In this paper, we draw on the Verden case (...) to (1) examine the role of the Court of Protection in cases relating to patients with impaired decision-making capacity who require a transplant, (2) to highlight the lack of empirical data on patients who have faced inequitable access to transplant and (3) highlight the shortcomings of the existing legal and regulatory framework in England and Wales guiding clinical decision making for patients in William’s position. We consequently argue that there is a clear need for action to ensure equitable access to transplant for those in William’s position. Furthermore, we suggest that there is a responsibility incumbent on policy makers and clinicians alike to develop a meaningful, and meaningfully operational, framework centred on preventing discrimination against potential organ recipients based on their decision-making capacity. (shrink)

This paper is an exploration of the state of ‘clinical unease’ experienced by clinicians in contexts where professional judgement—grounded in clinical knowledge, critical reflection and a sound grasp of the law—indicates that there is more than one ethically defensible way to proceed. The question posed is whether the courts can be viewed as an appropriate vehicle to settle clinical unease by providing a ruling that clarifies the legal and ethical issues arising in the case, even in situations where there is (...) no dispute between the patient (or her proxies) and the healthcare team.The concept of ‘clinical unease’ is framed with reference to the broader experience of clinical decision-making, and distinguished from other widely discussed phenomena in the healthcare literature like moral distress and conscientious objection. A number of reported cases are briefly examined where the courts were invited to rule in circumstances of apparent ‘unease’. The respective responsibilities of clinicians and courts are discussed: in particular, their capability and readiness to respond to matters of ethical concern.Four imagined clinical scenarios are outlined where a clinical team might welcome a court adjudication, under current rules. Consideration is given to the likelihood of such cases being heard, and to whether there may be better remedies than the courts. There are final reflections on what clinicians may actually wish for in seeking court involvement, and on whether a willingness to engage with the experience of clinical unease may lead to greater sensitivity towards the value perspectives of others. (shrink)

Taken together, Sections 145 and 63 of the Mental Health Act 1983 provide for treatment without consent of physical illness ancillary to the mental disorder with which a patient presents. On a daily basis, clinicians make both the decision that the Act’s authority can be applied to their patient’s case, and that it should be applied. But in the unusual circumstances where there is uncertainty as to the applicability of the MHA to the ancillary treatment of physical illness, the assistance (...) of a court may be sought. In so doing, the law may justify compulsion but never prescribes it; the clinician is presented with authority that he or she could use but is left to decide whether it should be employed. This paper explores how the clinical question is set before the court, and whether the distinction between symptom, manifestation and consequence is sufficiently understood. This has important consequences in the context of self-neglect and its close cousin self-harm: the question whether the relevant ailment was attributable to or exacerbated by neglect or self- inflicted harm will determine whether compulsion under the MHA is applicable; and furthermore, whether or not compulsion is clinically acceptable. No data are available. Not applicable. (shrink)

Most jurisdictions require that a mental capacity assessment be conducted using a functional model whose definition includes several abilities. In England and Wales and in increasing number of countries, the law requires a person be able to understand, to retain, to use or weigh relevant information and to communicate one’s decision. But interpreting and applying broad and vague criteria, such as the ability ‘to use or weigh’ to a diverse range of presentations is challenging. By examining actual court judgements of (...) capacity, we previously developed a descriptive typology of justifications used in the application of the Mental Capacity Act criteria. We here critically optimise this typology by showing how clear definitions—and thus boundaries—between the criteria can be achieved if the ‘understanding’ criterion is used narrowly and the multiple rationales that fall under the ability to ‘use or weigh’ are specifically enumerated in practice. Such a typology-aided practice, in theory, could make functional capacity assessments more transparent, accountable, reliable and valid. It may also help to create targeted supports for decision making by the vulnerable. We also discuss how the typology could evolve legally and scientifically, and how it lays the groundwork for clinical research on the abilities enumerated by the MCA. No data are available. This paper does not report any original data. (shrink)

When a novel scientific theory conflicts with otherwise plausible moral assumptions, we do not treat that as evidence against the theory. We may scrutinize the empirical data more keenly and take extra care over its interpretation, but science is in some core sense immune to moral refutation. Can the same be said of philosophical theories (or the non-ethical, ‘metaphysical’ ones at least)? If a position in the philosophy of mind, for example, is discovered to have eye-widening moral import, does that (...) count against it at all? Actual responses by philosophers to the question of whether unanticipated moral consequences of metaphysical theories have evidential force are scattered, implicit, divergent, under-argued, and sometimes even self-undermining. The present discussion is, most immediately, an attempt to sort out the confusion. Beyond that, it exploits the new perspective this question gives us on a familiar topic: the relation of philosophy to science. (shrink)

We investigate the impact of informal arguments on judgments about thought experiment cases in light of Deutsch and Cappelen’s mischaracterization view, which claims that philosophers’ case judgments are primarily based on arguments and not intuitions. If arguments had no influence on case judgments, this would seriously challenge whether they are, or should be, based on arguments at all—and not on other cognitive sources instead, such as intuition. In Experiment 1, we replicated Wysocki’s (Rev Philos Psychol 8(2):477–499, 2017) pioneering study on (...) a Gettier-style case, and we confirmed that the informal arguments used by him had no significant effect. However, we also included an improved argument for ascribing knowledge, which did have a significant effect even in Wysocki’s original design. We therefore followed up with Experiment 2 on three Gettier-style cases, where we used a more natural dialogical format for presenting both case descriptions and informal arguments. Overall, we found a clear impact of prima facie good pro and con arguments on case judgments. The issue of argument impact is thus no obstacle to arguing about thought experiments. (shrink)

There are at least two different aspects of our rational evaluation of agents’ doxastic attitudes. First, we evaluate these attitudes according to whether they are supported by one’s evidence (substantive rationality). Second, we evaluate these attitudes according to how well they cohere with one another (structural rationality). In previous work, I’ve argued that substantive and structural rationality really are distinct, sui generis, kinds of rationality – call this view ‘dualism’, as opposed to ‘monism’, about rationality – by arguing that the (...) requirements of substantive and structural rationality can come into conflict. In this paper, I push the dialectic on this issue forward in two main ways. First, I argue that the most promising ways of resisting the diagnosis of my cases as conflicts still end up undermining monism in different ways. Second, supposing for the sake of argument that we should understand the cases as conflicts, I address the question of what we should do when such conflicts arise. I argue that, at least in a prominent kind of conflict case, the coherence requirements take precedence over the evidential requirements. (shrink)

Some combinations of attitudes--of beliefs, credences, intentions, preferences, hopes, fears, and so on--do not fit together right: they are incoherent. A natural idea is that there are requirements of "structural rationality" that forbid us from being in these incoherent states. Yet a number of surprisingly difficult challenges arise for this idea. These challenges have recently led many philosophers to attempt to minimize or eliminate structural rationality, arguing that it is just a "shadow" of "substantive rationality"--that is, correctly responding to one's (...) reasons. -/- In *Fitting Things Together*, Alex Worsnip pushes back against this trend--defending the view that structural rationality is a genuine kind of rationality, distinct from and irreducible to substantive rationality, and tackling the most important challenges for this view. In so doing, he gives an original positive theory of the nature of coherence and structural rationality that explains how the diverse range of instances of incoherence can be unified under a general account, and how facts about coherence are normatively significant. He also shows how a failure to focus on coherence requirements as a distinctive phenomenon and distinguish them adequately from requirements of substantive rationality has led to confusion and mistakes in several substantive debates in epistemology and ethics. -/- Taken as a whole, Fitting Things Together provides the first sustained defense of the view that structural rationality is a genuine, autonomous, unified, and normatively significant phenomenon. (shrink)

Does immorality necessarily involve irrationality? The question is often taken to be among the deepest in moral philosophy. But apparently deep questions sometimes admit of deflationary answers. In this case we can make way for a deflationary answer by appealing to dualism about rationality, according to which there are two fundamentally distinct notions of rationality: structural rationality and substantive rationality. I have defended dualism elsewhere. Here, I’ll argue that it allows us to embrace a sensible – I will not say (...) boring – moderate view about the relationship between immorality and irrationality: roughly, that immorality involves substantive irrationality, but not structural irrationality. I defend this moderate view, and argue that many of the arguments for less moderate views turn either on missing the distinction between substantive and structural rationality, or on misconstruing it. (shrink)

Lying is an everyday moral phenomenon about which philosophers have written a lot. Not only the moral status of lying has been intensively discussed but also what it means to lie in the first place. Perhaps the most important criterion for an adequate definition of lying is that it fits with people’s understanding and use of this concept. In this light, it comes as a surprise that researchers only recently started to empirically investigate the folk concept of lying. In this (...) paper, we describe three experimental studies which address the following questions: Does a statement need to be objectively false in order to constitute lying? Does lying necessarily include the intention to deceive? Can one lie by omitting relevant facts? (shrink)

Especially but not exclusively in the United States, there is a significant gulf between expert opinion and public opinion on a range of important political, social, and scientific issues. Large numbers of lay people hold views contrary to the expert consensus on topics such as climate change, vaccines, and economics. Much political commentary assumes that ordinary people should defer to experts more than they do, and this view is certainly lent force by the literally deadly effects of many denials of (...) established science. But there are complex philosophical issues here, concerning, among other things, (i) what an expert is; (ii) what kind of deference is called for; (iii) and when deference is called for. This entry gives an overview of these three issues and recent work on them. It then examines some potential collective and pragmatic disadvantages of deference, before concluding with reflections on what we can say to those who distrust experts. (shrink)

Outside the philosophy classroom, global skeptics – skeptics about all (purported) knowledge of the external world – are rare. But there are people who describe themselves as “skeptics” about various more specific domains, including self-professed “skeptics” about the reality of anthropogenic climate change. There is little to no philosophical literature that juxtaposes the climate change skeptic with the external world skeptic. While many “traditional” epistemologists assume that the external world skeptic poses a serious philosophical challenge in a way that the (...) climate change skeptic doesn’t, many “applied” or “social” epistemologists assume that there isn’t much to be learned from debates about the external world skeptic, finding her challenge to be distant from both common sense and real-world concerns. I try to show that both of these views are mistaken. The external world skeptic raises deep questions that are important for our everyday deliberation about what to believe, and there are significant structural parallels between the arguments for external world skepticism and those for at least a form of climate change skepticism that is idealized – but not too idealized! – from the views of flesh-and-blood climate change skeptics. As such, we have strong reasons to think in parallel about how to reply to both skeptics’ challenges. I thus finish by (briefly) considering how different widespread responses to the external world skeptic might or might not generalize happily to the climate change skeptic’s challenge. (shrink)

This is volume One of texts (from sanskrit and Tibetan sources) of the two planned volumes on Buddhist Ligic (the second volume to be on topics and opponents).

Deceptive implicatures are a subtle communicative device for leading someone into a false belief. However, it is widely accepted that deceiving by means of deceptive implicature does not amount to lying. In this paper, we put this claim to the empirical test and present evidence that the traditional definition of lying might be too narrow to capture the folk concept of lying. Four hundred participants were presented with fourteen vignettes containing utterances that communicate conversational implicatures which the speaker believes to (...) be false. We further collected several potential proxy measures of lying, to get a better understanding of when a deceptive implicature is considered a case of lying. The results indicate that most implicatures (ten out of fourteen) were evaluated as lies and that lie ratings were closely tracked by the degree to which speakers were considered to have committed themselves to the truth of the content conveyed by their deceptive implicatures. (shrink)

This essay examines a recent line of thought in aesthetics that challenges realist-leaning aesthetic theories. According to this line of thought, aesthetic diversity and disagreement are good, and our aesthetic judgments, responses, and attachments are deeply personal and even identity-constituting. These facts are further used to support anti-realist theories of aesthetic normativity. I aim to achieve two goals: (1) to disentangle arguments concerning diversity, disagreement, and personality; and (2) to offer realist-friendly replies to all three.

A cryptonormative judgment, roughly speaking, is a judgment that is presented by the agent who makes it as non-normative, but that is in fact normative. The idea of cryptonormativity is familiar from debates in social theory, social psychology, and continental political philosophy, but has to my knowledge never been treated in analytic metaethics, moral psychology or epistemology except in passing. In this paper, I argue, first, that cryptonormative judgments are pervasive: familiar cases from everyday life are most naturally diagnosed as (...) cryptonormative judgments. Secondly, they reveal that normative judgment is a state that can be quite deeply non-transparent to its bearer, in a way that is not, for example, assimilable to the phenomenon of self-deception. Thirdly, they shed light on debates over amoralism and lend some support to a picture of normative psychology that links normative judgment constitutively to motivation. In the conclusion, I make some remarks about the social and political insidiousness of cryptonormativity, looking forward to future work. (shrink)

In this paper, we consider how certain longstanding philosophical questions about mental representation may be answered on the assumption that cognitive and perceptual systems implement hierarchical generative models, such as those discussed within the prediction error minimization framework. We build on existing treatments of representation via structural resemblance, such as those in Gładziejewski :559–582, 2016) and Gładziejewski and Miłkowski, to argue for a representationalist interpretation of the PEM framework. We further motivate the proposed approach to content by arguing that it (...) is consistent with approaches implicit in theories of unsupervised learning in neural networks. In the course of this discussion, we argue that the structural representation proposal, properly understood, has more in common with functional-role than with causal/informational or teleosemantic theories. In the remainder of the paper, we describe the PEM framework for approximate Bayesian inference in some detail, and discuss how structural representations might arise within the proposed Bayesian hierarchies. After explicating the notion of variational inference, we define a subjectively accessible measure of misrepresentation for hierarchical Bayesian networks by appeal to the Kullbach–Leibler divergence between posterior generative and approximate recognition densities, and discuss a related measure of objective misrepresentation in terms of correspondence with the facts. (shrink)

The term ‘coherence’ (and its antonym ‘incoherence’) is used in a bewildering variety of ways in epistemology (and in philosophy more broadly). This entry attempts to bring some discipline to uses of the term by offering a taxonomy of notions of coherence (and incoherence), and then surveying which of the resulting notions is (or should be) at work in the various different contexts in which it is deployed.

In this article we argue that our present-day mode of looking at bodies expresses a cosmetic gaze, that is, a gaze already informed by the techniques, expectations and strategies of bodily modification and a way of looking at bodies as awaiting an improvement. The cosmetic gaze, as we see it epitomized in contemporary media phenomena like reality makeover shows on television, is also a physiognomic gaze in that it creates a short-circuit between inside and outside beauty. Our article traces some (...) of the history of the present short-circuit between an inside and an outside and analyzes how different visual media have informed and shaped the gaze in historically specific ways, but also how aspects of that history inhere in media practices today. More specifically, we will analyze John Caspar Lavater’s hand-drawn portraits, Francis Galton’s photographical composites, the anthropometrically defined but still intuitively discovered ideals of the ‘Aryan body’ in Nazi Germany, and today’s reality television makeover shows in order to understand some of the continuities and discontinuities of the cosmetic gaze. (shrink)

Much of our ordinary thought and talk about responsibility exhibits what I call the ‘pie fallacy’—the fallacy of thinking that there is a fixed amount of responsibility for every outcome, to be distributed among all those, if any, who are responsible for it. The pie fallacy is a fallacy, I argue, because how responsible an agent is for some outcome is fully grounded in facts about the agent, the outcome and the relationships between them; it does not depend, in particular, (...) on how responsible anyone else is for that same outcome. In this paper, I explore how the pie fallacy can arise by considering several different kinds of case in which two or more agents are responsible for the same outcome. I’ll end with some brief remarks on the potential consequences of my arguments for how to think about responsibility in war. (shrink)

Philosophy of Medicine provides a fresh and comprehensive treatment of the topic. It offers a novel theory of the nature of medicine, and proposes a new attitude to medicine, aimed at improving the quality of debates between medical traditions and facilitating medicine's decolonization.

It is often natural to compare two events by describing one as ‘more of a cause’ of some effect than the other. But what do such comparisons amount to, exactly? This paper aims to provide a guided tour of the recent literature on ‘degrees of causation’. Section 2 looks at what I call ‘dependence measures’, which arise from thinking of causes as difference‐makers. Section 3 looks at what I call ‘production measures’, which arise from thinking of causes as jointly sufficient (...) for their effects. Finally, section 4 examines the important question of whether there is any sense in which an agent is more responsible for an outcome in virtue of her action being more of a cause of it. I describe a puzzle that emerges from this question, and explore various strategies for resolving it. (shrink)

The difference between the unity of the individual and the separateness of persons requires that there be a shift in the moral weight that we accord to changes in utility when we move from making intrapersonal tradeoffs to making interpersonal tradeoffs. We examine which forms of egalitarianism can, and which cannot, account for this shift. We argue that a form of egalitarianism which is concerned only with the extent of outcome inequality cannot account for this shift. We also argue that (...) a view which is concerned with both outcome inequality and with the unfairness of inequality in individuals‘ expected utilities can account for this shift. Finally, we limn an alternative view, on.. (shrink)

Mark Johnston has recently argued that four-dimensionalist theories of persistence are incompatible with some of our most basic ethical and prudential principles. I argue that although Johnston’s arguments succeed on a worm-theoretic account of persistence, they fail on a stage-theoretic account. So much the worse, I conclude, for the worm theory.

Many philosophers and psychologists have attempted to elucidate the nature of mental representation by appealing to notions like isomorphism or abstract structural resemblance. The ‘structural representations’ that these theorists champion are said to count as representations by virtue of functioning as internal models of distal systems. In his 2007 book, Representation Reconsidered, William Ramsey endorses the structural conception of mental representation, but uses it to develop a novel argument against representationalism, the widespread view that cognition essentially involves the manipulation of (...) mental representations. Ramsey argues that although theories within the ‘classical’ tradition of cognitive science once posited structural representations, these theories are being superseded by newer theories, within the tradition of connectionism and cognitive neuroscience, which rarely if ever appeal to structural representations. Instead, these theories seem to be explaining cognition by invoking so-called ‘receptor representations’, which, Ramsey claims, aren’t genuine representations at all—despite being called representations, these mechanisms function more as triggers or causal relays than as genuine stand-ins for distal systems. I argue that when the notions of structural and receptor representation are properly explicated, there turns out to be no distinction between them. There only appears to be a distinction between receptor and structural representations because the latter are tacitly conflated with the ‘mental models’ ostensibly involved in offline cognitive processes such as episodic memory and mental imagery. While structural representations might count as genuine representations, they aren’t distinctively mental representations, for they can be found in all sorts of non-intentional systems such as plants. Thus to explain the kinds of offline cognitive capacities that have motivated talk of mental models, we must develop richer conceptions of mental representation than those provided by the notions of structural and receptor representation. (shrink)

This book investigates context-sensitivity in natural language by examining the meaning and use of a target class of theoretically recalcitrant expressions. These expressions-including epistemic vocabulary, normative and evaluative vocabulary, and vague language -exhibit systematic differences from paradigm context-sensitive expressions in their discourse dynamics and embedding properties. Many researchers have responded by rethinking the nature of linguistic meaning and communication. Drawing on general insights about the role of context in interpretation and collaborative action, Silk develops an improved contextualist theory of CR-expressions (...) within the classical truth-conditional paradigm: Discourse Contextualism. The aim of Discourse Contextualism is to derive the distinctive linguistic behavior of a CR-expression from a particular contextualist interpretation of an independently motivated formal semantics, along with general principles of interpretation and conversation. It is shown how in using CR-expressions, speakers can exploit their mutual grammatical and world knowledge, and general pragmatic reasoning skills, to coordinate their attitudes and negotiate about how the context should evolve. The book focuses primarily on developing a Discourse Contextualist semantics and pragmatics for epistemic modals. The Discourse Contextualist framework is also applied to other categories of epistemic vocabulary, normative and evaluative vocabulary, and vague adjectives. The similarities/differences among these expressions, and among context-sensitive expressions more generally, have been underexplored. The development of Discourse Contextualism in this book sheds light on general features of meaning and communication, and the variety of ways in which context affects and is affected by uses of language. Discourse Contextualism provides a fruitful framework for theorizing about various broader issues in philosophy, linguistics, and cognitive science. (shrink)

Are there ‘degrees of causation’? Yes and no: causation is not a scalar relation, but different causes can contribute to a causing of an effect to different extents. In this paper, I motivate a probabilistic analysis of an event’s degree of contribution to a causing of an effect and explore some of its consequences.

Priority monism is the view that the cosmos is the only independent concrete object. The paper argues that, pace its proponents, Priority monism is in conflict with the dependence of any whole on any of its parts: if the cosmos does not depend on its parts, neither does any smaller composite.

Perceptual experiences justify beliefs—that much seems obvious. As Brewer puts it, “sense experiential states provide reasons for empirical beliefs” (this volume, xx). In Mind and World McDowell argues that we can get from this apparent platitude to the controversial claim that perceptual experiences have conceptual content: [W]e can coherently credit experiences with rational relations to judgement and belief, but only if we take it that spontaneity is already implicated in receptivity; that is, only if we take it that experiences have (...) conceptual content. (1994, 162) Brewer agrees. Their view is sometimes called conceptualism; nonconceptualism is the rival position, that experiences have nonconceptual content. One initial obstacle is understanding what the issue is. What is conceptual content, and how is it different from nonconceptual content? Section 1 of this paper explains two versions of each of the rival positions: state (non)conceptualism and content (non)conceptualism; the latter pair is the locus of the relevant dispute. Two prominent arguments for content nonconceptualism—the richness argument and the continuity argument—both fail (section 2). McDowell’s and Brewer’s epistemological defenses of content conceptualism are also faulty (section 3). Section 4 gives a more simple-minded case for conceptualism; finally, some reasons are given for rejecting the claim—on one natural interpretation—that experiences justify beliefs. (shrink)

Targeted modifications of the human epigenome, epigenome editing (EE), are around the corner. For EE, techniques similar to genome editing (GE) techniques are used. While in GE the genetic information is changed by directly modifying DNA, intervening in the epigenome requires modifying the configuration of DNA, for example, how it is folded. This does not come with alterations in the base sequence (‘genetic code’). To date, there is almost no ethical debate about EE, whereas the discussions about GE are voluminous. (...) Our article introduces EE into bioethics by translating knowledge from science to ethics and by comparing the risks of EE with those of GE. We, first (I), make the case that a broader ethical debate on EE is due, provide scientific background on EE, compile potential use-cases and recap previous debates. We then (II) compare EE and GE and suggest that the severity of risks of novel gene technologies depends on three factors: (i) the choice of an ex vivo versus an in vivo editing approach, (ii) the time of intervention and intervention windows and (iii) the targeted diseases. Moreover, we show why germline EE is not effective and reject the position of strong epigenetic determinism. We conclude that EE is not always ethically preferable to GE in terms of risks, and end with suggestions for next steps in the current ethical debate on EE by briefly introducing ethical challenges of new areas of preventive applications of EE (III). (shrink)

Response-dependence theories have historically been very popular in aesthetics, and aesthetic response-dependence has motivated response-dependence in ethics. This chapter closely examines the prospects for such theories. It breaks this category down into dispositional and fittingness strands of response-dependence, corresponding to descriptive and normative ideal observer theories. It argues that the latter have advantages over the former but are not themselves without issue. Special attention is paid to the relationship between hedonism and response-dependence. The chapter also introduces two aesthetic properties that (...) lead to wrong kinds of reasons problems for aesthetic response-dependence: insightfulness and the capacity to change one’s perspective. These properties do not have obvious parallels in the ethical domain, and so present an obstacle for response-dependence even in aesthetics. The chapter ends by examining replies on behalf of the response-dependence theorist, ultimately suggesting that a restricted form of response-dependence is the most promising way forward for fans of such theories. (shrink)

Philosophy and Phenomenological Research, Volume 103, Issue 3, Page 687-709, November 2021.

The lack of access to gender-affirming surgery represents a significant unmet health care need within the transgender community, frequently resulting in depression and self-destructive behavior. While some transgender people may have access to gender reassignment surgery, an overwhelming majority cannot afford facial feminization surgery. The former may be covered as a “medical necessity,” but FFS is considered “cosmetic” and excluded from insurance coverage. This demarcation between “necessity” and “cosmetic” in transgender health care based on specific body parts is in direct (...) opposition to the scientific community’s understanding of gender dysphoria and professional guidelines for transgender health. GRS affects one’s ability to function in an intimate relationship, while FFS has the same impact on social interactions an, therefore may have a far greater implication for one’s quality of life. FFS is a cost-effective intervention that needs to be covered by insurance policies. The benefits of such coverage far exceed the insignificant costs. (shrink)

In the nineteenth century a group of “labor republicans” argued that the system of wage-labor should be replaced by a system of cooperative production. This system of cooperative production would realize republican liberty in economic, not just political, life. Today, neo-republicans argue that the republican theory of liberty only requires a universal basic income. A non-dominated ability to exit is sufficient to guarantee free labor. This essay reconstructs the more radical, labor republican view and defends it against the prevailing the (...) neo-republican one. It argues that neorepublicanism lacks an adequate conception of structural domination, which leaves it without theoretical resources to address certain forms of economic domination. The concept of structural domination allows us to comprehend the coherence of the nineteenth century, labor republican view and identify its relevance to modern labor markets. Labor republicanism takes us beyond a universal basic income to a concern with control over productive assets and workplace organization. As such, it shows us how the republican theory of liberty can support an argument for the transformation of work, not just the escape from it. (shrink)

This paper sets out a novel response to the ‘screening off problem’ for naïve realism. The aim is to resist the claim (which many naïve realists accept) that the kind of experience involved in hallucinating also occurs during perception, by arguing that there are causal constraints that must be met if an hallucinatory experience is to occur that are never met in perceptual cases. Notably, given this response, it turns out that, contra current orthodoxy, naïve realists need not adopt any (...) particular view about the psychological nature of hallucinatory experience to handle the screening off problem. Consequently, room opens up for naïve realists to endorse whatever theory of hallucinatory experience seems to best capture the distinctive nature of such episodes. (shrink)

In contemporary Cognitive Science and Philosophy of Mind, "attention" is a burgeoning field, with ever-increasing amounts of empirical research and philosophical analysis being directed toward it.1 In this essay I make a first attempt to contrast how Nyāya-Vaiśeṣikas2 and Buddhists would address some aspects of attention that are discussed in that literature. The sources of what I attribute to "Nyāya-Vaiśeṣikas" are the sections dealing with the manas in the Nyāyabhāṣya, Nyāyamañjarī, and Praśastapādabhāṣya. The words "Buddhist" and "Buddhism" in this essay (...) refer specifically to the Sautrāntika Buddhism of Vasubandhu's Abhidharmako-śabhāṣya.3 A comparison... (shrink)

When A utters a declarative sentence in a context to B, typically A can mean a proposition by the sentence, the sentence in context literally expresses a proposition, there are propositions A and B can agree the sentence literally expressed, and B can acquire knowledge from this testimonial exchange. In recent work on linguistic communication, each of these four platitudes has been challenged, and on the same basis: viz. on the ground that exactly which proposition the sentence expressed in context (...) is not discernible given the information provided by the context. I argue that, even if this is true, there will be propositional parts of the proposition expressed by the sentence in context which can be identified and that, consequently, the partial understanding afforded by the existence of such identifiable parts undermines the soundness of the arguments against the platitudes. (shrink)