Current methods of obtaining an informed consent leave much to be desired. Patients rarely read consent forms or understand all of the risks, benefits, or alternatives associated with their treatment. Evaluating the advantages and disadvantages of treatment options often presents a more significant challenge for patients with lower levels of health literacy. This article reviews the evidence of shortcomings in our informed consent system and then explores the potential for a new approach to engage patients at all levels of health (...) literacy in their treatment decisions. Specifically, the article will examine the potential of shared decision-making to bridge gaps in knowledge, increase patient adherence to treatment, and improve health outcomes in low health literacy patient populations. Leveling barriers to treatment information for disadvantaged populations should be a public health imperative, especially if it can be shown to improve health outcomes and reduce health disparities. (shrink)

Current methods of obtaining an informed consent leave much to be desired. Patients rarely read consent forms or understand all of the risks, benefits, or alternatives associated with their treatment. Evaluating the advantages and disadvantages of treatment options often presents a more significant challenge for patients with lower levels of health literacy. This article reviews the evidence of shortcomings in our informed consent system and then explores the potential for a new approach to engage patients at all levels of health (...) literacy in their treatment decisions. Specifically, the article will examine the potential of shared decision-making to bridge gaps in knowledge, increase patient adherence to treatment, and improve health outcomes in low health literacy patient populations. Leveling barriers to treatment information for disadvantaged populations should be a public health imperative, especially if it can be shown to improve health outcomes and reduce health disparities. (shrink)

We conducted focus groups with 47 potential jurors who were presented with diferent scenarios in a hypothetical malpractice case involving failure to order a PSA test. Better documentation that a patient made an informed decision to decline a PSA test appeared to provide more medical-legal protection for physicians, especially with the use of a decision aid.

Screening for prostate cancer with the prostate-specific antigen blood test is controversial, as evidence to date has not demonstrated such screening does more good than harm. While the potential benefit of PSA screening on reducing prostate cancer mortality has not been documented in randomized trials, many risks of PSA screening have been well documented. These risks include a substantially higher risk of a prostate cancer diagnosis over a screenee’s lifetime, false-positive and false-negative test results, possible complications from biopsies done in (...) response to suspicious test results, and substantial risks of side effects from subsequent prostate cancer treatments. Nevertheless, PSA screening is widespread in the United States, and many physicians in a national survey reported supporting routine PSA screening as well as getting PSA tests themselves, despite the lack of evidence. (shrink)

The objective of this study is to evaluate if use of a patient decision aid, when choosing between a repeat cesarean or a trial of labor after a cesarean, reduces medical liability exposure. The authors conclude that use of a PDA conferred liability protection when potential jurors were presented with a hypothetical malpractice claim against an obstetrician following a TOLAC.

I have taken an experimental approach to this question. Freely voluntary acts are preceded by a specific electrical change in the brain that begins 550 ms before the act. Human subjects became aware of intention to act 350-400 ms after RP starts, but 200 ms. before the motor act. The volitional process is therefore initiated unconsciously. But the conscious function could still control the outcome; it can veto the act. Free will is therefore not excluded. These findings put constraints on (...) views of how free will may operate; it would not initiate a voluntary act but it could control performance of the act. The findings also affect views of guilt and responsibility. But the deeper question still remains: Are freely voluntary acts subject to macro-deterministic laws or can they appear without such constraints, non-determined by natural laws and ‘truly free'? I shall present an experimentalist view about these fundamental philosophical opposites. (shrink)

I have taken an experimental approach to this question. Freely voluntary acts are preceded by a specific electrical change in the brain that begins 550 ms before the act. Human subjects became aware of intention to act 350-400 ms after RP starts, but 200 ms. before the motor act. The volitional process is therefore initiated unconsciously. But the conscious function could still control the outcome; it can veto the act. Free will is therefore not excluded. These findings put constraints on (...) views of how free will may operate; it would not initiate a voluntary act but it could control performance of the act. The findings also affect views of guilt and responsibility. But the deeper question still remains: Are freely voluntary acts subject to macro-deterministic laws or can they appear without such constraints, non-determined by natural laws and ‘truly free'? I shall present an experimentalist view about these fundamental philosophical opposites. (shrink)

This paper offers an analysis of the nature of epistemic trust. With increased philosophical attention to social epistemology in general and testimony in particular, the role for an epistemic or intellectual version of trust has loomed large in recent debates. But, too often, epistemologists talk about trust without really providing a sustained examination of the concept. After some introductory comments, I begin by addressing various components key to trust simpliciter. In particular, I examine what we might think of when we (...) consider what it means to place trust in someone. Once we have examined trust in general, we can modify this discussion to derive an epistemic version of trust—placing trust in someone for an epistemic reason. I argue that ET includes four components: belief, communication, reliance, and confidence. The first two sets are distinctively epistemic and the second set of conditions form the core of any kind of trust. Put together,.. (shrink)

The chief goal of Velmans' article is to find a way to solve the problem of how conscious experience could have bodily effects. I shall discuss his treatment of this below. First, I would like to deal with Velmans' treatment of my own studies of volition and free will in relation to brain processes. Unconscious Initiation and Conscious Veto of Freely Voluntary Acts Velmans appropriately refers to our experimental study that found that onset of an electrically observable cerebral process preceded (...) the appearance of the subject's awareness of the conscious wish to act, by at least 350 msec. That indicated that the volitional process is initiated unconsciously. Velmans uses the term preconscious instead of unconscious. But, in fact, subjects have no reportable awareness or intuitive feeling that the brain has started a process before their conscious wish/urge to act appears. Unconscious initiation of the voluntary process appeared to mean that conscious free will could not actually 'tell' the brain to begin its preparation to carry out a voluntary act. (shrink)

More than ever, it is in vogue to argue that no norms either play a role in or directly follow from the theory of mental content. In this paper, I present an intuitive theory of intentionality (including a theory of mental content) on which norms are constitutive of the intentional properties of attitude and content in order to show that this trend is misguided. Although this theory of intentionality—the teleological theory of intentional representation—does involve a commitment to representational norms, these (...) norms are not problematic in the way critics have suggested they would be. In particular, these norms do not guide thinking by motivating intentional agents to (intentionally) accord with them; as a result, no obvious vicious regress threatens the theory. In the final section of this paper, I argue that accepting this teleological theory of intentionality need not commit one to thinking that intentionality is the product of natural selection. (shrink)

The paper begins by contrasting the unitary nature of conscious experience with the demonstrable localization of neural events. Philosophers and neuroscientists have developed models to account for this paradox, but they have yet to be tested empirically. The author proposes a `Conscious Mental Field', which is produced by, but is phenomenologically distinct from, brain activity. The hypothesis is, in principle, open to experimental verification. The paper suggests appropriate surgical procedures and some of the difficulties that would need to be overcome (...) in such an experiment. (shrink)

Behav. and Brain Sci., 8, 558-566. Libet, B. (1987). 'Consciousness: Conscious, Subjective Experience.' In Encyclopedia of Neuroscience , ed. G. Adelman. ...

This paper begins with the oft-repeated claim that having faith involves trust in God. Taking this platitude seriously requires at least two philosophical tasks. First, one must address the relevant notion of “trust” guiding the platitude. I offer a sketch of epistemic trust: arguing that epistemic trust involves several components: acceptance, communication, dependence, and confidence. The first duo concerns the epistemic element of epistemic trust and the second part delimit the fiducial aspect to epistemic trust. Second, one must also examine (...) what differentiates faith qua trust. I argue that we should not distinguish faith from trust merely by believing religious propositions but by the attitudes they express. In particular, the attitude of faith is more deeply entrenched and central to one’s noetic structure than trust simpliciter. The paper ends by arguing that the account proposed insofar as it accommodates and explains certain “faith desiderata”. We can thus give content to the “faith is a kind of trust” platitude with a model of trust on hand while showing how that model confirms and explains important features of faith. (shrink)

This paper is ambitious: it begins with mixing externalism in philosophy of mind with internalism in epistemology, and it ends with instructive insights from social and feminist thought. In the first stage, I argue that one can consistently combine two theses that appear, at first glance, incompatible: cognitive externalism—the thesis that one’s mental states/processing can extend past one’s biological boundaries—and mentalism in epistemology—i.e., that epistemic justification supervenes on one’s mental states. This yields the perhaps startling or strange view that the (...) loci of epistemic justification are both mental states and located externally to one’s skull and skin. This motivates the second stage: I aim to ease that strangeness by suggesting that most discussions of cognitive externalism and epistemology too often focus exclusively on extending epistemically reliable abilities, faculties, dispositions, etc. to artifacts in one’s environment. Instead, we should think of this combination as informed by feminist epistemologists’ insistence of our thinking’s irreducible and radical sociality. Epistemic communities shape and are shaped by our cognition—echoing the dynamic, interactive integration at the heart of cognitive externalism. Thus, just as I am part of an epistemic community, it is also a part of me. Thus, I think with others: not merely as an artifact but as constituent elements of my cognition itself; resulting in a robust socially extended internalism. (shrink)

Here, I explore a modernist aesthetics of death metal. First, I briefly describe a few themes that characterize some modern art, without any claim that they are necessary, sufficient, or exhaustive. The goal is to obtain a set of themes that might be set against similar themes characteristic of death metal. This is the task in the second half of the paper. In particular, I argue that (some) modernist art and death metal share themes centered on transgressively breaking with the (...) past, pursue their conception of the truth, eliminate elements in their art form to purity them, and attack the art/non-art or music/non-music distinction. I contend that centering on death metal vocals reflects these themes. Death metal growls, like some modernist art, transgresses on past vocal traditions, tells us important truths, eliminates traditional concepts/techniques of signing, and undermines the singing/noise distinction. (shrink)

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

Commentary on John Searle's Article John Searle presents a philosopher's view of how conscious experience and free action relate to brain function. That view demands an examination by a neuroscientist who has experimentally investigated this issue.

Recent approaches to the social epistemology of belief formation have appealed to an epidemiological model, on which the mechanisms explaining how we form beliefs from our society or community along the lines of infectious disease. More specifically, Alvin Goldman (2001) proposes an etiology of (social) belief along the lines of an epistemological epidemiology. On this “contagion model,” beliefs are construed as diseases that infect people via some socio-epistemic community. This paper reconsiders Goldman’s epidemiological approach in terms of epistemic trust. By (...) focusing on beliefs as diseases, Goldman misconstrues and underestimates the central role that epistemic trust plays in their formation (maintenance, revision, etc.). I suggest that we put trust, accordingly, as the center of an epidemiological model of social doxology—epistemic trust, rather than beliefs, is the disease with which one is infected. So, contra Goldman, beliefs themselves aren’t the disease—they are symptoms. Trust, on this approach, can be viewed as a pathology. This point connects Annette Baier’s (1994) work on moral trust—taking a cue from her “pathologies of trust.” The real pathology centered in social doxology is the epistemic trust manifested by those beliefs. Accordingly, I shall explore (and tentatively defend) an epidemiological model for such “pathological” epistemic trust inspired by Baier’s work on moral trust, one which can more adequately account for the infectious epistemic trust at work in social belief formation. (shrink)

This collection brings together new papers addressing the philosophical challenges that the concept of a Devil presents, bringing philosophical rigor to treatments of the Devil. Contributors approach the idea of the Devil from a variety of philosophical traditions, methodologies, and styles, providing a comprehensive philosophical overview that contemplates the existence, nature, and purpose of the Devil. While some papers take a classical approach to the Devil, drawing on biblical exegesis, other contributors approach the topic of the Devil from epistemological, metaphysical, (...) phenomenological, and ethical perspectives. This volume will be relevant to researchers and scholars interested in philosophical conceptions of the Devil and related areas, such as philosophers of religion, theologians, and scholars working in philosophical theology and demonology. (shrink)

Debate rages in virtue epistemology between virtue reliabilists and responsibilists. Here, I develop and argue for a new kind of responsibilism that is more conciliar to reliabilism. First, I argue that competence-based virtue reliabilism cannot adequately ground epistemic credit. Then, with this problem in hand, I show how Aristotle’s virtue theory is motivated by analogous worries. Yet, incorporating too many details of Aristotelian moral theory leads to problems, notably the problem of unmotivated belief. As a result, I suggest a re-turn (...) to Aristotle to develop a distinctively epistemological virtue theory that does not require any motive or affect for epistemic virtue. Nevertheless, my theory affirms that virtues are acquired, agent-expressive traits. The result is a conciliar responsibilism that leans closer to reliabilism. I end by arguing that my virtue responsibilism can solve worries facing both reliabilism and responsibilism. (shrink)

In this paper, I respond to an objection raised by Duncan Pritchard and Jesper Kallestrup against virtue epistemology. In particular, they argue that the virtue epistemologist must either deny that S knows that p only if S believes that p because of S’s virtuous operation or deny that intuitive cases of testimonial knowledge. Their dilemma has roots in the apparent ease by which we obtain testimonial knowledge and, thus, how the virtue epistemologist can explain such knowledge in a way that (...) both preserves testimonial knowledge and grounds it in one’s virtues. I argue that the virtue epistemologist has a way to accomplish both tasks if we take epistemic trust to be an intellectual virtue. I briefly discuss what such trust must look like and then apply it to the dilemma at hand: showing that a key intellectual virtue plausibly operates in cases of testimonial knowledge and/or belief. (shrink)

Sensation elicited by a skin stimulus was subjectively reported to feel stronger when followed by a stimulus to somatosensory cerebral cortex , even when C was delayed by up to 400 ms or more. This expands the potentiality for retroactive effects beyond that previously known as backward masking. It also demonstrates that the content of a sensory experience can be altered by another cerebral input introduced after the sensory signal arrives at the cortex. The long effective S-C intervals support the (...) thesis that a duration of cortical activity of up to 0.5 s is required before awareness of a sensory stimulus is developed. (shrink)

By the middle of the eighteenth century the new science had challenged the intellectual primacy of common experience in favor of recondite, expert and even counter-intuitive knowledge increasingly mediated by specialized instruments. Meanwhile modern philosophy had also problematized the perceptions of common experience — in the case of David Hume this included our perception of causal relations in nature, a fundamental precondition of scientific endeavor.In this article I argue that, in responding to the ‘problem of induction’ as advanced by Hume, (...) Reid reformulated Aristotelian foundationalism in distinctly modern terms. An educator and mathematician self-consciously working within the framework of the new science, Reid articulated a philosophical foundation for natural knowledge anchored in the human constitution and in processes of adjudication in an emerging modern public sphere of enlightened discourse. Reid thereby transformed one of the bases of Aristotelian science — common experience — into a philosophically and socially justified notion of ‘common sense’. Reid's intellectual concerns had as much to do with the philosophy of science as they did with moral philosophy or epistemology proper, and were bound up with wider social and scientific changes taking place in the early modern period. (shrink)

Patrick Grim and Einar Duenger Bohn have recently argued that there can be no perfectly knowing Being. In particular, they urge that the object of omniscience is logically absurd (Grim) or requires an impossible maximal point of all knowledge (Bohn). I argue that, given a more classical notion of omniscience found in Aquinas and Augustine, we can shift the focus of perfect knowledge from what that being must know to the mode of that being’s understanding. Since Grim and Bohn focus (...) on the object rather than mode of God’s knowledge, this classical approach to omniscience undermines their objections. (shrink)

Alston argues that there is no such thing as a single concept of epistemic justification. Instead, there is an irreducible plurality of epistemically valuable features of beliefs: ‘epistemic desiderata.’ I argue that this approach is problematic for meta-epistemological reasons. How, for instance, do we characterize epistemic evaluation and do we do we go about it if there’s no theoretical unity to epistemology? Alston’s response is to ground all epistemic desiderata, thereby unifying epistemology, in truth and truth-conduciveness. I argue that this (...) move over-unifies epistemology, in effect, giving us a single criterion for epistemology on par with the epistemology-by-justification approach he rejects. Perhaps surprisingly, we find a similar theoretical worry in Aristotle’s argument about the science of metaphysics. Aristotle’s resolution in this problem by the ‘analogy of being’ provides a parallel framework to resolve the worries with Alston’s approach. In particular, I argue that we can focus epistemic evaluation on the person of epistemic virtue: this category will be focal, unifying the disparate desiderata, without reducing to one thing all epistemic values or relations that desiderate must bear to the central value. A virtue-centric account of epistemic normativity follows: one that can remain genuinely pluralistic and yet unified as well. (shrink)

Solutions to the ‘hard problem’ of consciousness must accept conscious experience as a fundamental non-reducible phenomenon in nature, as Chalmers suggests. Chalmers proposes candidates for an acceptable theory, but I find basic flaws in these. Our own experimental investigations of brain processes causally involved in the development of conscious experience appear to meet Chalmers’ requirement. Even more directly, I had previously proposed a hypothetical ‘conscious mental field’ as an emergent property of appropriate neural activities, with the attributes of integrated subjective (...) experience and a causal ability to modulate some neural processes. This theory meets all the requirements imposed by the ‘hard problem’ and, significantly, it is experimentally testable. (shrink)

In an age when it has become fashionable to dismiss the Enlightenment as a sinister movement based on instrumental rationality, Benjamin Redekop delves deeper to understand the movement on its own terms. In Enlightenment and Community he shows that the E.

In this paper, I assess Duncan Pritchard’s defense of the “orthodox” view on epistemic normativity. On this view, termed “epistemic value T-monism” (EVTM), only true belief has final value. Pritchard discusses three influential objections to EVTM: the swamping problem, the goal of inquiry problem, and the trivial truths problem. I primarily focus on Pritchard’s defense of the trivial truths problem: truth cannot be the only final epistemic value because we value “trivial” truths less than “significant” truths. In response, Pritchard appeals (...) to epistemic virtue: the virtuous agent desires “substantial” truths, where “substantiality” is a matter of the non-luckiness of the true belief. Thus, what has substantial value, for Pritchard, is well-grounded true belief. Yet, I argue, this moves away from “orthodox” EVTM: this view fails to attribute final epistemic value to non-grounded, accidentally true belief. Aside from giving up EVTM altogether, I suggest this leads to either a revision or revolution. On the revision interpretation, EVTM was always imprecise: what orthodoxy always really cared about was epistemically grounded truth rather than truth simpliciter. On the revolutionary reading, what we really care about, contra orthodoxy, formation of belief in line with virtues rather than truth simpliciter. (shrink)

In contradistinction to the many monographs and edited volumes devoted to historical, cultural, or theological treatments of demonology, this collection features newly written papers by philosophers and other scholars engaged specifically in philosophical argument, debate, and dialogue involving ideas and topics in demonology. The contributors to the volume approach the subject from the perspective of the broadest areas of Western philosophy, namely metaphysics, epistemology, logic, and moral philosophy. The collection also features a plurality of religious, cultural, and theological views on (...) the nature of demons from both Eastern and Western thought, in addition to views that may diverge from these traditional roots. _Philosophical Approaches to Demonology_ will be of interest to philosophers of religion, theologians, and scholars working in philosophical theology and demonology, as well as historians, cultural anthropologists, and sociologists interested more broadly in the concept of demons. (shrink)