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.

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)

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)

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)

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)

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)

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)

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)

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)

According to robust virtue epistemology , knowledge is type-identical with a particular species of cognitive achievement. The identification itself is subject to some criticism on the grounds that it fails to account for the anti-luck features of knowledge. Although critics have largely focused on environmental luck, the fundamental philosophical problem facing RVE is that it is not clear why it should be a distinctive feature of cognitive abilities that they ordinarily produce beliefs in a way that is safe. We propose (...) a novel way to resolve this problem. Key to our proposal will be an appreciation of different representational states beholden to truth. We suggest these different representational states are distinguished by how, in the proper governance of these states, the twin goods of attaining truth and avoiding error are weighted. Moreover, we explain how varieties of representational states line up with varieties of cognitive achievement such that knowledge, cum cognitive achievement, must be safe because of the kind of attempt at success that belief is—namely, an attempt that places the premium it does on avoiding error. (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.

One of the deepest ideological divides in contemporary epistemology concerns the relative importance of belief versus credence. A prominent consideration in favor of credence-based epistemology is the ease with which it appears to account for rational action. In contrast, cases with risky payoff structures threaten to break the link between rational belief and rational action. This threat poses a challenge to traditional epistemology, which maintains the theoretical prominence of belief. The core problem, we suggest, is that belief may not be (...) enough to register all aspects of a subject’s epistemic position with respect to any given proposition. We claim this problem can be solved by introducing other doxastic attitudes—genuine representations—that differ in strength from belief. The resulting alternative picture, a kind of doxastic states pluralism, retains the central features of traditional epistemology—most saliently, an emphasis on truth as a kind of objective accuracy—while adequately accounting for rational action. (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)

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.

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)

Common Sense and Science from Aristotle to Reid reveals that thinkers have pondered the nature of common sense and its relationship to science and scientific thinking for a very long time. It demonstrates how a diverse array of neglected early modern thinkers turn out to have been on the right track for understanding how the mind makes sense of the world and how basic features of the human mind and cognition are related to scientific theory and practice. Drawing on a (...) wealth of primary sources and scholarship from the history of ideas, cognitive science, and the history and philosophy of science, this book helps readers understand the fundamental historical and philosophical relationship between common sense and science. (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)

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)

In lieu of an abstract, here is a brief excerpt of the content:Thomas Abbt and the Formation of an Enlightened German “Public”Benjamin W. RedekopScholarly interest in the emergence of a “public sphere” and “public opinion” in eighteenth-century Europe remains strong, and with good reason. The ideological construct of a modern public in Europe “was a characteristic product of the Enlightenment, and it marked one of the critical zones of intersection between Enlightenment discourse and a broad range of socio-economic and (...) institutional changes.” 1 Analysis of the emerging figure of “the public” helps illuminate the relationship between intellectual and material culture, between “Enlightenment” and society. The recognition of the constitutive nature of language and its role in the interplay between “meaning” and “experience” 2 lead one to take seriously terms like “the public” and “public opinion” as important links between linguistic and social domains. Text and context merge into one as social entities like “the public” become rhetorical ones, and vice-versa.Keith Baker, for example, resolves the contextual dimension of “public opinion” in France into the textual one, whereby it emerges as a “rhetorical figure” or “political invention” in the latter decades of the eighteenth century. 3 Others stay closer to the social domain, including the salons of Paris, to look for the emergence of the notion of rational public opinion. 4 Taken together, these are two sides of the same coin—an emerging sphere of “public” discourse carried on by “private” individuals, and a more private sphere in which public discursivity was nurtured. 5 [End Page 81]In this article I explore these themes in a German context, focusing on the writings of Thomas Abbt (1738–66) as an attempt to grapple with the exigencies of German social and intellectual life in a novel fashion. Making use of a variety of European sourc es, Abbt—an academic with broad interests—strove in On Dying for the Fatherland (1761), On Merit (1765), and in his contributions to the seminal journal Letters Concerning the Newest Literature to conceptualize and to create a sense of citizenship and the “common good” which cut across the various divisions of German society, uniting all orders into a greater and harmonious whole or Publikum (public). The written word was the primary vehicle available for this simultaneous mo vement of enlightenment and socio-political formation, and Abbt’s works represent an early attempt to inscribe a public sphere—to create a space in which it became possible for individuals to think, talk, and act in reference to a larger socio-political whole. While Prussian patriotism was behind his initial foray into the topic of the public sphere in On Dying for the Fatherland, Abbt’s On Merit reveals an expansion in perspective, and with it the emergence of “the public” as a moral and s ocio-political point of reference. There is a good degree of continuity, however, between the two works, concerned as they are with overcoming the basic German problem of a fragmented public sphere with enlightened arguments designed to lead readers to lo cate themselves and their well-being in an enlarged societal frame.While at least one commentator has argued that Abbt was seeking to write for the common German Volk, 6 his primary audience was clearly that of the middling and higher orders. 7 The general problem Abbt addressed, however, was that of reconciling Enlightenment and reform with the entire spectrum of German society. This entailed the exploration of new, informal, and inclusive terms and modes of address: an available term was “the public,” and the mode of address a writing style which transformed ancient forms of public oratory into text—the public speaker became, under modern circumstances, the public writer.It is in this sense that Abbt was original and influential. Johann Gottfried Herder, Friedrich Nicolai, Moses Mendelssohn, J. G. Zimmerman, Friedrich Schiller, and others were moved in one way or another by Abbt’s writings. 8 [End Page 82] Herder in particular was stimulated by Abbt’s works, and Herder’s project was informed by the same kinds of socio-political concerns outlined here in relation to Abbt. 9 G. E. Lessing’s work also reflected a concern with the formation of a broader Publikum, as he mediated... (shrink)