In this article, we explicate evidence-based nursing (EBN), critically appraise its framework and respond to nurses’ concern that EBN sidelines the caring elements of nursing practice. We use resources from care ethics, especially Vrinda Dalmiya’s work that considers care as crucial for both epistemology and ethics, to show how EBN is compatible with, and indeed can be enhanced by, the caring aspects of nursing practice. We demonstrate that caring can act as a bridge between ‘external’ evidence and the other pillars (...) of the EBN framework: clinical expertise; patient preferences and values. Drawing on an influential EBN handbook, section 1 presents the aims and features of EBN, including the normative principle that EBN should take place within a ‘context of caring’. We aim to understand this context and whether it can be neatly detached from the EBN framework, as the handbook seems to suggest. In section 2, we highlight the grounds for resistance to EBN from the nursing community, before mounting the argument that nursing practices can be understood fruitfully through feminist care ethics and/or virtue ethics lenses. In section 3, we deepen that analysis using Dalmiya’s concepts of care-knowing and care as a hybrid ethico-epistemic virtue, which are ideally suited to the complex practices of nursing. In section 4, we bring this rich understanding of care into conversation with EBN, showing that its framework cannot be adequately theorised without paying proper attention to care. Caring can be neither an innocuous background assumption of nor an afterthought to the EBN framework. (shrink)

Dismissing criticisms that Leonard Peikoff's book, The DIM Hypothesis, is unscientific, deterministic, or rationalistic, this essay focuses on problems with the logical framework of Peikoff's study of Western culture. In particular, Peikoff has conflated two different kinds of rationalists and empiricists and has completely overlooked combinations of the Platonist and so-called “Kantian” modes. As a result, his three pure integration “modes” actually produce not just two “mixtures” but a total of six. Furthermore, without absolving Kant of very serious philosophical errors, (...) the author marshals evidence that the real culprit responsible for the culturally disastrous “Disintegration” mode was one of Kant's predecessors. (shrink)

The author reiterates his thesis that the motivation for power lust in liberals, conservatives, and totalitarians cannot be explained by “metaphysical importance” of economic or noneconomic activity per se, but only by the metaphysical fear that voluntary action in one or both of these realms evokes in statists of whatever stripe. Rand actually made both of these arguments, but only the latter has psychological explanatory power and plausibility in terms of Rand's discussion of the benevolent and malevolent universe premises, and (...) thus is to be preferred over the former. (shrink)

THE CONCEPT OF CONSCIOUSNESS CHAPTER I THE RENAISSANCE OF LOGIC WITHIN the last two decades the scholarly world has witnessed a revival of interest in logic ...

This paper is divided into two parts. In Section 1, I explore and defend a “regulative view” of folk-psychology as against the “standard view”. On the regulative view, folk-psychology is conceptualized in fundamentally interpersonal terms as a “mind-making” practice through which we come to form and regulate our minds in accordance with a rich array of socially shared and socially maintained sense-making norms. It is not, as the standard view maintains, simply an epistemic capacity for coming to know about the (...) mental states and dispositions already there. Importantly, the regulative view can meet and beat the standard at its own epistemic game. But it also does more. In Section 2, I show how the regulative view makes progress on two other problems that remain puzzling on the standard view: the problem of “first-person authority” – accounting for the special features of self-knowledge; and the problem of “reactive.. (shrink)

The medicalisation of pregnancy and childbirth has been encouraged by the continuing growth of technology that can be applied to the reproductive journey. Technology now has the potential to fully separate reproduction from the human body with the prospect of ectogenesis—the gestation of a fetus outside of the human body. This paper considers the issues that have been caused by the general medicalisation of pregnancy and childbirth and the impact that ectogenesis may have on these existing issues. The medicalisation of (...) pregnancy and childbirth is criticised for its impact on the relationship between doctors and pregnant women and the way in which doctors treat fetuses. It is argued that ectogenesis may cause more imbalance in the doctor and intended parent relationship and may result in an increased lack of clarity regarding a doctor’s duty to the fetus. This paper finds that extensive guidance and revised legislation will be necessary to minimise the impact of ectogenesis on the existing issues caused by the medicalisation of reproduction. (shrink)

We call systematic disputes that are particularly hard to resolve deep disagreements. We can divide most theories of deep disagreements in analytic epistemology into two camps: the Wittgensteinian view and the fundamental epistemic principles view. This essay analyzes how both views deal with two of the most pressing issues a theory of deep disagreement must address: their source and their resolution. After concluding that the paradigmatic theory of each camp struggles on both fronts, the essay proceeds to show that, despite (...) their differences, these theories share some core assumptions and think of deep disagreements similarly: as grounded in fundamental epistemic differences between the parties. This underlying conception of deep disagreements the author calls “the fundamental model.” The essay provides reasons to be wary of this conception, and hence, mainstream epistemologists’ treatment of the issue. (shrink)

This paper presents a new theory of modal reasoning, i.e. reasoning about what may or may not be the case, and what must or must not be the case. It postulates that individuals construct models of the premises in which they make explicit only what is true. A conclusion is possible if it holds in at least one model, whereas it is necessary if it holds in all the models. The theory makes three predictions, which are corroborated experimentally. First, conclusions (...) correspond to the true, but not the false, components of possibilities. Second, there is a key interaction: it is easier to infer that a situation is possible as opposed to impossible, whereas it is easier to infer that a situation is not necessary as opposed to necessary. Third, individuals make systematic errors of omission and of commission. We contrast the theory with theories based on formal rules. (shrink)

In Building Better Beings, Vargas develops and defends a naturalistic account of responsibility, whereby responsible agents must possess a feasibly situated capacity to detect and respond to moral considerations. As a preliminary step, he also offers a substantive account of how we might justify our practices of holding responsible—viz., by appeal to their efficacy in fostering a ‘valuable form of agency’ across the community at large, a form of agency that precisely encompasses sensitivity to moral considerations. But how do these (...) accounts relate to one another? Though I find much that is appealing in Vargas’s general approach, I challenge his insistence that these accounts should be treated as ‘conceptually independent’, arguing that this generates an objectionable “justification gap”: on his analysis, someone could remain an appropriate target of our responsibility practices and yet fail to be a morally responsible agent. In closing, I offer a potential solution to this problem, though it means re-visioning how the account of moral responsibility is conceptually tied to the justification of our responsibility practices. (shrink)

A psychological study of thought and language which takes an exposition of scientific linquistics as a point of departure.

In his 2014 article “Motivations for Relativism as a Solution to Disagreements”, Steven Hales argues that relativism is a plausible disagreement resolution strategy for epistemically irresolvable disagreements. I argue that his relativistic strategy is not adequate for disagreements of this kind, because it demands an impossible doxastic state for disputants to resolve the disagreement. Contrarily, Fogelin’s :1–8, 1985) theory of deep disagreement does not run into the same problems. Deep disagreements, according to Fogelin, cannot be resolved through argumentation because the (...) conditions for argumentation are lacking in such contexts. I advance the view that deep disagreements arise due to differences in disputants’ mutually supporting interrelated beliefs. This view avoids the hurdles caused by the tiered structure of support found at the heart of Hales’s view on disagreement: the assumption that belief and perspective can be separated, and that disagreement is located. (shrink)

Empirical ethics research is increasingly valued in bioethics and healthcare more generally, but there remain as yet under-researched areas such as pharmacy, despite the increasingly visible attempts by the profession to embrace additional roles beyond the supply of medicines. A descriptive and critical review of the extant empirical pharmacy ethics literature is provided here. A chronological change from quantitative to qualitative approaches is highlighted in this review, as well as differing theoretical approaches such as cognitive moral development and the four (...) principles of biomedical ethics. Research with pharmacy student cohorts is common, as is representation from American pharmacists. Many examples of ethical problems are identified, as well as commercial and legal influences on ethical understanding and decision making. In this paper, it is argued that as pharmacy seeks to develop additional roles with concomitant ethical responsibilities, a new prescription is needed for empirical ethics research in pharmacy—one that embraces an agenda of systematic research using a plurality of methodological and theoretical approaches to better explore this under-researched discipline. (shrink)

The class forcing theorem, which asserts that every class forcing notion ${\mathbb {P}}$ admits a forcing relation $\Vdash _{\mathbb {P}}$, that is, a relation satisfying the forcing relation recursion—it follows that statements true in the corresponding forcing extensions are forced and forced statements are true—is equivalent over Gödel–Bernays set theory $\text {GBC}$ to the principle of elementary transfinite recursion $\text {ETR}_{\text {Ord}}$ for class recursions of length $\text {Ord}$. It is also equivalent to the existence of truth predicates for the (...) infinitary languages $\mathcal {L}_{\text {Ord},\omega }$, allowing any class parameter A; to the existence of truth predicates for the language $\mathcal {L}_{\text {Ord},\text {Ord}}$ ; to the existence of $\text {Ord}$ -iterated truth predicates for first-order set theory $\mathcal {L}_{\omega,\omega }$ ; to the assertion that every separative class partial order ${\mathbb {P}}$ has a set-complete class Boolean completion; to a class-join separation principle; and to the principle of determinacy for clopen class games of rank at most $\text {Ord}+1$. Unlike set forcing, if every class forcing notion ${\mathbb {P}}$ has a forcing relation merely for atomic formulas, then every such ${\mathbb {P}}$ has a uniform forcing relation applicable simultaneously to all formulas. Our results situate the class forcing theorem in the rich hierarchy of theories between $\text {GBC}$ and Kelley–Morse set theory $\text {KM}$. (shrink)

This paper examines the methodological claim made famous by P.F. Strawson: that we understand what features are required for responsible agency by exploring our attitudes and practices of holding responsible. What is the presumed metaphysical connection between holding responsible and being fit to be held responsible that makes this claim credible? I propose a non-standard answer to this question, arguing for a view of responsible agency that is neither anti-realist (i.e. purely 'conventionalist') nor straightforwardly realist. It is instead ‘constructivist’. On (...) the ‘Scaffolding View’ I defend, reactive attitudes play an essential role in developing, supporting, and thereby maintaining the capacities that make for responsible agency. While this view has relatively novel implications for a metaphysical understanding of capacities, its chief virtue, in contrast with more standard views, is providing a plausibly defensible account of how so-called responsible agents genuinely deserve to be treated as such. (shrink)

In “The Logic of Deep Disagreements,” Robert Fogelin claims that parties to a deep disagreement lack the common ground needed for arguments to work, making the disagreement impervious to rational resolution. Although Fogelin’s article received numerous responses, there has been no attempt to elucidate the epistemological theory behind Fogelin’s theses. In this article, I examine Fogelin’s theory of deep disagreements in light of his broader philosophy. The picture that emerges is that of relativism of distance, à la Bernard Williams. By (...) interpreting Fogelin’s theory as relativism of distance, it avoids some of the critiques that have been raised against it. (shrink)

We show that the theory, consisting of the usual axioms of but with the power set axiom removed—specifically axiomatized by extensionality, foundation, pairing, union, infinity, separation, replacement and the assertion that every set can be well‐ordered—is weaker than commonly supposed and is inadequate to establish several basic facts often desired in its context. For example, there are models of in which ω1 is singular, in which every set of reals is countable, yet ω1 exists, in which there are sets of (...) reals of every size, but none of size, and therefore, in which the collection axiom fails; there are models of for which the Łoś theorem fails, even when the ultrapower is well‐founded and the measure exists inside the model; there are models of for which the Gaifman theorem fails, in that there is an embedding of models that is Σ1‐elementary and cofinal, but not elementary; there are elementary embeddings of models whose cofinal restriction is not elementary. Moreover, the collection of formulas that are provably equivalent in to a Σ1‐formula or a Π1‐formula is not closed under bounded quantification. Nevertheless, these deficits of are completely repaired by strengthening it to the theory, obtained by using collection rather than replacement in the axiomatization above. These results extend prior work of Zarach. (shrink)

Philosophers and social scientists have focussed a great deal of attention on our human capacity to trust, but relatively little on the capacity to hope. This is a significant oversight, as hope and trust are importantly interconnected. This paper argues that, even though trust can and does feed our hopes, it is our empowering capacity to hope that significantly underwrites—and makes rational—our capacity to trust.

Scientific articles have been traditionally written from single points of view. In contrast, new knowledge is derived strictly from a dialectical process, through interbreeding of partially disparate perspectives. Dialogues, therefore, present a more veritable form for representing the process behind knowledge creation. They are also less prone to dogmatically disseminate ideas than monologues, alongside raising awareness of the necessity for discussion and challenging of differing points of view, through which knowledge evolves. Here we celebrate 250 years since the discovery of (...) the chemical identity of the inorganic component of bone in 1769 by Johan Gottlieb Gahn through one such imaginary dialogue between two seasoned researchers and aficionados of this material. We provide the statistics on ups and downs in the popularity of this material throughout the history and also discuss important achievements and challenges associated with it. The shadow of Samuel Beckett’s Waiting for Godot is cast over the dialogue, acting as its frequent reference point and the guide. With this dialogue presented in the format of a play, we provide hope that conversational or dramaturgical compositions of scientific articles—albeit virtually prohibited from the scientific literature of the day—may become more pervasive in the future. (shrink)

The commentaries in response to our feature paper1 are indicative of the varied perspectives that can be taken towards artificial amnion and placenta technology (AAPT) and more specifically its relationship with pregnancy (loss). Kennedy rightly argues that empirical research is essential for understanding the experiences of pregnancy loss and AAPT2 and our own advocacy of empirical research is evident in previous work.3–5 Kennedy also acknowledges the current impossibility of researching AAPT experiences since it has not yet been applied in clinical (...) settings. It is precisely for this reason that we draw on the reported experiences of neonatal intensive care (NICU) parents since they present the closest analogy which can be drawn with the technology.1 What we reject in Kennedy’s response, however, is the claim that the experiences of NICU parents have been ‘exploited’ by us.2 Studies documenting the experiences of NICU parents were drawn on to indicate that our considerations are more than mere speculation. As stated, the experiences of NICU parents, particularly the pregnant individual who experiences pregnancy loss, are the closest indication we have of how AAPT and what it entails may be experienced. To claim that this data is being exploited by us is to undermine the very purpose that such research is undertaken—to indicate how future care may be improved. It would be much more harmful to not use this information. While we believe that experiences of …. (shrink)

The author discusses how Rand’s largely underdeveloped concept of the “dual-aspect objective,” first introduced in the 1960s, is vital for understanding how knowledge is grounded in reality. He defines it, then applies it to perception and introspection, and to concepts, propositions, and syllogisms. The author also defines content of awareness, carefully distinguishing it from both object and form of awareness, and applies those distinctions throughout. In addition, he discusses how truth is both dual-aspect and contextual, and he extends his discussion (...) in Part 1 of Rand’s “unit-perspective,” showing how units, too, have a dual-aspect, even on the level of syllogisms. (shrink)

In this third installment of his series on key, underappreciated ideas in Ayn Rand's epistemology, the author discusses the nature of differentiation and integration as the functional essence of consciousness and applies that insight to various cognitive and noncognitive processes of awareness, with a special emphasis on logic and illogic. He offers an extended analysis of the fallacies of “Frozen Abstraction” and “False Alternative,” as well as critiques of a long-standing Objectivist conflation of falsity and contradiction and a relatively more (...) recent Objectivist error, the fallacy of “genuine awareness.”. (shrink)

Over the last decade there has been a noticeable increase in attention, on the part of public health scholars and professionals, to the important ethical challenges that arise in the context of public health policy, practice and research. This has arguably been a driver for the development of public health ethics as both a specialized field of study in bioethics and a subject for professional education. But how is PHE taught in public health programs and schools? Are current educational approaches (...) sufficient to provide future professionals with the necessary tools to address the diverse ethical challenges they will encounter? In this article, we examine the international public health and bioethics literatures regarding PHE education in public health programs and schools. Specifically, we 1) summarize the results from studies that describe PHE education in the United States, Europe, Canada and in some developing countries, 2) explore current attitudes and educational approaches toward ethics curricula in public health, and 3) identify and discuss reported barriers to PHE education. We conclude with some general recommendations and a research agenda to guide future work on implementing PHE into different public health programs. (shrink)

En este capítulo, analizo a qué se refiere Kuhn cuando habla de metáfora en las Conferencias Notre Dame, pero sobre todo a explorar a qué no se refiere. En la primera sección, analizo por qué Kuhn usa el término “metáfora” para referirse al proceso de aprendizaje de lenguaje científico, en particular, los paralelismos que encuentra entre ambos fenómenos. En la segunda sección, se presentan algunos aspectos centrales de dos teorías influyentes sobre la metáfora: la teoría del mapeo estructural y la (...) teoría de las metáforas conceptuales. Luego, en la sección III, vuelvo a Kuhn para ver las diferencias cruciales que encontramos entre los procesos metafóricos y el proceso de ostensión del que habla el autor. Finalmente, presento una noción del segundo Wittgenstein, la idea de figura, para ofrecer una nueva forma de interpretar la idea de que el cambio revolucionario involucra un cambio en la metáfora central. (shrink)

The author examines the canonical Objectivist model of free will and finds it wanting, amounting to a form of Agency—Indeterminism. Employing an Aristotelian Four Cause analysis, he explores the complementary roles of determinism and free will, as well as the conditional nature of necessity and contingency, in understanding how causality operates in the human realm. He proposes an integration of what he calls “value-determinism” and “conditional free will,” arguing that it amounts to a basic axiom of human choice and action, (...) and urges its acceptance in place of the Orthodox Objectivist view of free will. (shrink)

Prenatal screening, consisting of maternal serum screening and nuchal translucency screening, is on the verge of expansion, both by being offered to more pregnant women and by screening for more conditions. The Society of Obstetricians and Gynaecologists of Canada and the American College of Obstetricians and Gynecologists have each recently recommended that screening be extended to all pregnant women regardless of age, disease history, or risk status. This screening is commonly justified by appeal to the value of autonomy, or women's (...) choice. In this paper, I critically examine the value of autonomy in the context of prenatal screening to determine whether it justifies the routine offer of screening and the expansion of screening services. I argue that in the vast majority of cases the option of prenatal screening does not promote or protect women's autonomy. Both a narrow conception of choice as informed consent and a broad conception of choice as relational reveal difficulties in achieving adequate standards of free informed choice. While there are reasons to worry that women's autonomy is not being protected or promoted within the limited scope of current practice, we should hesitate before normalizing it as part of standard prenatal care for all. (shrink)

The generic Vopěnka principle, we prove, is relatively consistent with the ordinals being non-Mahlo. Similarly, the generic Vopěnka scheme is relatively consistent with the ordinals being definably non-Mahlo. Indeed, the generic Vopěnka scheme is relatively consistent with the existence of a \-definable class containing no regular cardinals. In such a model, there can be no \-reflecting cardinals and hence also no remarkable cardinals. This latter fact answers negatively a question of Bagaria, Gitman and Schindler.

The author contends that the Objectivist epistemology has lacked a viable model of propositional knowledge for nearly fifty years, due to neglect of Rand's unit-perspective view of concepts. This pioneering insight, he says, not only is an essential building block of her concept theory, but also welds together the three levels of logical theory and provides the clearest X-ray picture of our multilayered conceptual knowledge. Using the unit-perspective to expand Rand's theory of concepts, the author then devises a theory of (...) the proposition, giving considerable attention to axioms and statements about nonexistent subjects. (shrink)

The National Institute for Health and Care Excellence, the UK’s main healthcare priority-setting body, recently reaffirmed a longstanding claim that in recommending technologies to the National Health Service it cannot apply the ‘rule of rescue’. This paper explores this claim by identifying key characteristics of the rule and establishing to what extent these are also features of NICE’s approach to evaluating ultra-orphan drugs through its highly specialised technologies programme. It argues that although NICE in all likelihood does not act because (...) of the rule in prioritising these drugs, its actions in relation to HSTs are nevertheless in accordance with the rule and are not explained by the full articulation of any alternative set of rationales. That is, though NICE implies that its approach to HSTs is not motivated by the rule of rescue, it is not explicit about what else might justify this approach given NICE’s general concern with overall population need and value for money. As such, given NICE’s reliance on notions of procedural justice and its commitment to making the reasons for its priority-setting decisions public, the paper concludes that NICE’s claim to reject the rule is unhelpful and that NICE does not currently meet its own definition of a fair and transparent decision-maker. (shrink)

Do UK community pharmacists encounter the high drama dilemmas of the medical ethics literature or is a 'morality of the mundane' more appropriate? This paper presents the findings of a qualitative study that asked a sample of UK pharmacists to describe their ethical issues and to establish whether these were ethical dilemmas as understood philosophically or ethical problems of a more legal or emotional nature. It emerged that although many pharmacists referred to 'dilemmas', these were often problems involving a conflict (...) between an ethical value and a legal or procedural issue and often arose in the routine minutiae of dispensing prescriptions and selling medicines. Such ethical problems remained of concern for pharmacists and the commercial environment, corporate pharmacy ownership and pharmacists' subordination to doctors, all precipitated ethical problems. Law and ethics appeared to be understood synonymously but this may reflect a modernity that increasingly brackets out ethical experiences by encouraging reliance upon law and procedure. (shrink)

One of the numerous characterizations of a Ramsey cardinal κ involves the existence of certain types of elementary embeddings for transitive sets of size κ satisfying a large fragment of ZFC. We introduce new large cardinal axioms generalizing the Ramsey elementary embeddings characterization and show that they form a natural hierarchy between weakly compact cardinals and measurable cardinals. These new axioms serve to further our knowledge about the elementary embedding properties of smaller large cardinals, in particular those still consistent with (...) V = L. (shrink)

The team has become a popular model to organize joint human–robot behavior. Robot teammates are designed with high-levels of autonomy and well-developed coordination skills to aid humans in unpredictable environments. In this paper, we challenge the assumption that robots will succeed as teammates alongside humans. Drawing from the literature on human teams, we evaluate robots’ potential to meet the requirements of successful teammates. We argue that lacking humanlike mental models and a sense of self, robots may prove untrustworthy and will (...) be rejected from human teams. Benchmarks for evaluating human–robot teams are included, as are guidelines for defining alternative structures for human–robot groups. (shrink)

The author provides another metaphysical argument to bolster his thesis of the logical harmony of determinism and volition. He shows how the typical mainstream and Objectivist doctrine of “libertarian” free will commits the same logical error as the Sophist attacks on the Law of Non-Contradiction—namely, an out-of-context interpretation of, respectively, the Law of Causality and the Law of Identity as being unconditional absolutes, which they are not and cannot be.